Журнал «Здоровье ребенка» 2 (45) 2013

Breastfeeding is the main form of human nutrition, which was formed during biological evolution. It is physiologically the most appropriate method of feeding newborns and infants. Breastfeeding should be considered as a phenomenon of the greatest wisdom of the life evolution, general biological impact on the imminent and late health of the child and the adult, including basics of its spirituality [7, 11, 14, 38, 39, 44]. Breastfeeding performs a wide range of vital functions not only as food and protective nature, but also fine-regulation of management development and differentiation [9, 17, 23, 39].

The world's leading pediatricians and World Health Organization have been conducted explorations on the epidemiology of breastfeeding, both in developed and developing countries. It became possible to represent a real image of the prevalence and duration of breastfeeding on the different continents [32, 42]. In different countries breastfeeding is affected by economic level, socio-economic conditions of the mother's life, traditions on duration of the breastfeeding, which are certainly related to the level of supply of suitable infant food and mothers awareness of their use. According to the exploration, it was found that in poor urban and especially rural population lactation lasts at least 1.5-2.0 years. Most children, who were born in Africa, receive breast milk for a long period of time (sometimes up to 3-4 years) [27, 42, 46, 48]. In East Asia countries, the duration of breastfeeding is highest in rural areas [45].

The explorations in Australia have shown such factors with negative effect on the duration of breastfeeding as poor education, lack of knowledge about the benefits of breastfeeding, incorrect baby latching to the breast [42]. An important factor that affects on the duration of breastfeeding is support by other family members. In the group of women, whose husbands did not see the difference between breastfeeding and formula feeding, 56,5% of mothers hadn’t been breastfeeding their children or had been feeding for one month only. Factors such as increasing employment of women in manufacturing, urbanization, emancipation led to the abandonment of breastfeeding.

After a general admiration with breast milk substitutes, came general "sobering" which was based on the negative results of the early spread of formula feeding. So there is a need to return to breastfeeding. Since the early 80-ies of the last century on the initiative of the WHO / UNICEF have been conducted active work to support breastfeeding in all countries. Research over the past decade on the dynamics of the duration of breastfeeding, indicate trend towards its recovery [3]. According to U.S. scientists, average annual rate of increase of the duration of lactation is 9,4% [34, 49].

In 1989, WHO and UNICEF issued a joint report, called “Promoting, Protecting and Supporting Breastfeeding - the special role of the maternity services”. It describes how Health Service can support breastfeeding. “Ten steps to successful breastfeeding” is a summary of the main recommendations of this report, which is based on physiological principles of forming and maintaining lactation. These steps are put in the foundation of the initiative "Baby-friendly hospitals" In order to lying-in hospital has obtained the status of "Baby-friendly hospitals", it’s necessary to implement in life “ten steps” to successful breastfeeding. These "steps" are related to early feeding period, which takes place in maternity services [22, 30, 31, 35].

Effect of breastfeeding on the child is multileveled and can be represented as four directions - food security, biological support, psycho-emotional relationships and optimization of the digestive system [19].

Breast milk has optimal quantity and quality of basic nutrients, microcomponents which have a great importance for proper growth and development of infant. It also contains components (enzymes) that promote the absorption of key nutrients. The composition of breast milk nutrients is dynamically changing, adapting to the needs of the infant in the process of growth and forming an optimal ways for preparing child to products that it’ll receive after breast milk, providing protection against damaging effect of excess revenues nutrients. Even with excess food associated with intense sucking and a high concentration of nutrients in mother's milk, children react only on increased accumulation of adipose tissue. It is not accompanied by degenerative changes in tissues and heterochrony of development that have a place when excess nutrients entering at artificial feeding [6, 37].

Also, contemporary researches have shown, that the risk of future obesity, atherosclerosis, diabetes, chronic digestive diseases, dental disorders is significantly lower than in children who were fed by formula or cow milk. Some interest has the hypothesis that formula feeding occurs early lesions of the vascular wall at the level of the microvasculature immune complexes, which are formed under the influence of food antigens. In the literature there are data that show the relationship of early artificial feeding of various diseases in the pathogenesis dominated immune responses. The artificial feeding is a risk factor for Crohn’s disease and ulcerative-necrotic enterocolitis in adulthood, promotes celiac disease, insulin-dependent diabetes [7, 13, 29, 44].

Breast milk promotes protection against allergic reactions and immunological tolerance to antigens products that mother takes. With breast milk baby gets a limited number of non-infectious antigens and allergens. In recent years, increasing allergic diseases among children was marked with association of artificial feeding. The breastfeeding is not a panacea for allergic diseases protection but their incidence is much lower in those children who were breastfed. In some studies confirmed the value of long enough (more than 6 months) breastfeeding in reducing the frequency of food allergy in infant. It was shown that artificial feeding increases the risk of allergic diseases in infants who have family history of atopic diseases. Particularly sharply increases incidence of asthma and allergic bronchitis [7, 44].

An epidemiological exploration, which included a survey of 930 children showed that allergic reactions to medications and foods is a common condition among surveyed children. For example, among children who started formula feeding in the first months of life, allergic reactions were observed in 21,7% - two times more often than among children who received breast milk for more than 6 months (10,9%). From this study the prevalence of allergic reactions to medications and products appeared that this pathology is more common in children who were fed with cow's milk. In addition, these allergic conditions occur more frequently in infant with cow's milk feeding entering them in the first months of life [10, 38].

According to foreign and domestic researches, children who are breastfed rarely have anemia, while in 30% of children who are formula fed anemia with varying severity is common [23, 33]. Based on many years studying the epidemiology of acute leukemia formulated the concept of communication occurrence of leukemia with growth and development. It’s found that among children, early transferred to artificial feeding incidence of acute leukemia is higher. The relative risk of malignancy, due to irregularities in the immune system in babies who are formula fed was higher, especially at weaning in the first 6 months of life [18].

Development of mental and emotional communication between mother and child is a long process and has the closest physical and emotional contact with feeding. Gradually this relation translates into constant and independent from feeding response on the mother, as the source and symbol of peace and protection. Interaction in a pair (dyad) "mother-child" is mutual, but with the active role of the mother [43].

The researches over the past decades, passed in many countries have shown that breastfeeding is the main condition that determines the health of present and future generations, physical and mental health. Breastfeeding has a positive effect on the health of mother too. Breastfeeding is one of the stages of fertile functions for women and gives birth process certain physiological completeness. The first cycle of birth and breastfeeding provides complete morphological and functional maturation of the mothers’ body. This applies to both the breast and of neuroendocrine regulation of lactation, hormonal status of women [37, 47].

Breastfeeding promotes normal course of postpartum (reduces risk of bleeding, anemia, septic diseases). Equally important is the psychological impact of feeding. There is strong evidence that the formation and consolidation of maternal behavior with the dominance of the complex emotions of love, caring is not formed during pregnancy and childbirth, namely in apposition newborn baby to the breast [31, 40, 49].

Completeness physiological period of development and reproductive cycle of breastfeeding is important for future life and health of women in the later periods. A number of studies have shown a significant reduction in the frequency of mastopathy, malignant tumors, breast and ovarian cancer in women who were breastfeeding a long time [31].

Nervous and mental development of breastfed children, by contrast, may be outstripping. It was shown that even in the first days of life, children who received breast milk were more active physically and emotionally. An important component of early socialization is an audible mutual alarm adaptation: Certain types of sounds from the child - signals of hunger, satiety, comfort, discomfort and mother's words, tone of reassurance, support, help. This further contributes to a child's personality.

The explorations dedicated for the effect of breastfeeding on child development indicate that the physical development of breastfed infants is going by other rules than in formula fed children. Thus in the first 2-3 months of life exclusive breastfeeding provides more intensive weight gain, there is a dominant growth and balanced adipose tissue formation comparing with predominant formation of fat-free lean components during artificial feeding. Starting from 4-5 months of life in breastfed infants begin to dominate the processes of growth and maturation and doubling the weight faster. The artificial feeding reduced rate of body weight gain is slower than with breastfeeding [9, 10, 36].

Despite the compelling advantages the frequency of breastfeeding, both in Ukraine and in the world still remains relatively low for several reasons. Almost a third of infant populations of the urban and rural areas during the first three months receive breast milk. According to the literature in this period in lactating woman appears so-called "lactational crisis" the cause of which is explained mainly by psychogenic factors [4, 15, 34]. In the presence of milk in the mother’s breast almost 4% of women during the first month of life start feeding their children with artificial milk substitutes or cow's milk. Urban women of significantly more likely than women in rural areas introduced adapted and used semi adapted formula supplementation for their infants in the first months of life [20]. In the absence of breast milk mothers feed their infant with the help of less adapted substitutes 5 times more than with modern formulas. At the same time, women in rural areas, if they have no milk, more likely than women of the city used for the feeding cow's milk and 3 times less adapted formulas [18].

All reasons for reducing the duration and prevalence of breastfeeding can be divided into four groups: social, medical, biological and environmental factors. According to the literature it is known that the duration of breastfeeding may affect a group of social factors which include the level of education of the mother, socioeconomic an marital status, type of nutrition and bad habits of parents. Women with secondary education significantly more often stopped to feed their children human milk in the first month of life than women with higher education [2, 31, 40]. The analysis of the duration of lactation in women depending on the type of work, showed that in the group of women who engaged in physical labor, ceased to breastfeed their children in the first months of life 18,0% of women, and in the group of unemployed women – 8,6%. Among women who live in satisfactory conditions termination of lactation up to three months were reported in 34,1% of cases versus 51,2% of those who thought their living conditions are poor. In analyzing the relationship of duration of lactation and marital status found that single-parent families have stopped breastfeeding in the first months of twice as many women than in complete families (16,0% vs. 9,1% respectively). The same marked difference in the duration of breastfeeding longer than 6 months between complete and incomplete families [1, 16].

In addition, impairs emotional background of lactating women and reduce of the lactation was seen in family with smoking fathers, with abuse of alcohol in both parents and lack of family help for woman in child care. Thus, in families in which mothers breastfed their infants up to 3 months the 92,5% of fathers and 11,7% of mothers had alcohol abuse. However, in families where the mothers breastfed their infants longer than 6 months the number of fathers who smoke was 6,3% and with alcohol abuse only 3,3%. Similar results were obtained when analyzing the impact of fathers help for woman in child care. Despite the fact that the media paid a lot of attention to the harmful effects of nicotine on the child, more than 20% of women continue to smoke during this important period. For example, among women who smoked cessation of lactation in the first three months seen twice as often as those who do not smoke [28, 30].

Unfortunately, studies have shown that even most of physicians had not enough information about the benefits of breastfeeding for both mother and child. It just for them that knowledge is extremely important professionally. Results of the survey of young mothers and physicians indicate that their level of skills of breastfeeding is not very different from the knowledge of students and non-medical students profile which do not yet have children. This indicates insufficient or inept medical staff work with pregnant and lactating women. Data on our survey showed that the need to change public attitudes and outlook of today's youth for support breastfeeding. It is known that from conscious, awareness and attitudes towards parenthood largely depends on the success of breastfeeding and, consequently, the health of future generations. These surveys show that young people have the lack of knowledge of family planning and the benefits of breastfeeding in school, higher education and non-clinical profile of the media. Given this, the problem of breastfeeding and family planning becomes very relevant [8, 25, 30, 31].

As sources of information about the factors, that influence the formation of maternal and child health, almost half of young mothers notes the role of their parents. The second most important source of information young men and women was named communication with their peers, but the information from friends is not always accurate and complete. The third place was obtained by the media, few respondents noted the role of teachers and teachers in shaping the worldview of healthy lifestyles [26]. In addition, when young mothers want to feed children by breast milk and who have some difficulties feeding or decrease the amount of milk, they do not have knowledge about tactics to overcome the difficulties to maintain milk production. This can cause a real loss of breastfeeding in the future [12].

According to the recommendations of WHO and UNICEF, the basic principles that should be followed in conducting breastfeeding after maternity home which mothers should know reflect a number of provisions. [4] Breastfeeding is not only a means of feeding infants, but also an essential element of social ecology of childhood. It defines the properties development and health as during infancy and subsequent periods of life [41]. The optimal form of breastfeeding for children during the first months of life should be considered exclusive breastfeeding, which is carried out through the application of the child to the mother's breast. Possible, but less adequate alternatives breastfeeding is feeding pumping breast milk, milk lactating women, pasteurized donor milk (using donor milk should be mindful of the possibility of infection by different pathogens) [5, 22, 24, 26].

Delayed-type recovery of body weight newborn is not a basis to supplement food glucose solution, sweet tea, milk formula. Stool to 6-8 times per day with a satisfactory general condition of the child when exclusively breastfed may not be cause for termination of attachment to the breast, milk pasteurization and holding bacteriology of milk and emptying. Breast inflammation with indications of surgical treatment is not an indication to stop infant breastfeeding or the pasteurization of milk. The question of the adequacy or inadequacy of breastfeeding could not be solved easily by energy calculation oriented to the RDA needs chemicals and energy [4, 26, 30].

A woman breastfeeding should be given advice about her diet and, if necessary, to insist on a change of diet. The main "control objects" should be a source of vitamins and salts.

It is extremely important not to introduce food concern child supplement between feedings, glucose solution and artificial mixtures. An exploration in many countries has shown that additional energy intake of glucose solution affects the appetite of the child, reduces the activity of sucking and thus shortens lactation in the mother. The use of breast milk substitutes not only reduces the appetite of the child to the mother's milk, but also increases the risk of infections and allergies [13, 21].

In implementing the regime co-host mother and child, especially in the first days after birth, mothers should receive attention and professional assistance from medical personnel. This is one of the leading terms of the feasibility of using the regime co-host mother and child as the main, central link of all modern systems support breastfeeding [13].

Conclusions. Medical and organizational factors may be significant part in the causes that lead to a decrease in the duration of breastfeeding, but at the same time can be easily removed by local health services. However, according to the literature, the best results in preserving the duration of breastfeeding occur where there are groups support breastfeeding in "Baby friendly hospital". In control feeding did not need to seek additional food rations in order to obtain higher growth and weight increases. Tactics of supplementary food introduction and a selection of foods should be driven by the needs of the child.