NEAR EAST UNIVERSITY

2023-2024 SPRING TERM

FACULTY OF NURSING

THR RESEARCH PROCESS IN NURSING

NUR306

PROJECT GROUP NO.....8

PROJECT TITLE......... BREASTFEEDING

SUB- TOPIC: THE IMPORTANCE OF EXCLUSIVE BREASTFEEDING IN CHILDREN

PROJECT GROUP MEMEBERS

OBIAMAKA FRANCISCA ACHIKEH 20206762

SAIDAT ABU 20207365

EDITH PETER 20213013

OLUWATOMISIN V OLORUNETO 20213817

BAMIDELE O FAITH MARY 20226788

Background: Exclusive breastfeeding is a highly essential practice for both the mother and the

child, especially in the early stages of life. It entails giving newborns and babies just breastmilk and no

other meals or drinks. Breastfeeding exclusively provides newborns babies, and children under two

years old with an unparalleled supply of vitamins, minerals, and enzymes that are essential for immune

system development, growth, and overall well-being. It significantly reduces the risk of diseases such as

diarrhea, respiratory infections, and otitis media, especially in settings with inadequate resources. Baby

death rates are lowered as a result. Given the importance of exclusive breastfeeding, there is a need for

broad support networks, including online forums for nursing mothers, changes to workplace policies,

and guidance from medical professionals, in order for society to save and encourage healthier

generations, healthcare expenses may be reduced, and sustainable development goals can be

supported. Exclusive breastfeeding is giving newborns babies just breastmilk and nothing else.

AIMS: the aim of this topic is to enlighten people, especially non- medical students, patients,

clients and researchers about how breastfeeding can have a positive impact in the lives of children.

KEYWORDS: Exclusive breastfeeding, Children, World Health Organization.

Optimal breastfeeding is linked to higher IQs and enhanced cognitive development, according to several

studies. When home stimulation and socioeconomic level factors were taken into consideration in a

precise survey and investigation of ponders, for the most part from high-income nations, breastfed

children scored 3.4 points higher than non-breastfed children [1]. There are benefits to breastfeeding for

both mother and child. Benefits of breastfeeding include a decreased risk of endometrial, ovarian, and

breast cancer as well as a shorter postpartum involution. Additionally, it lowers the chance of obesity in

kids in middle school as well as the risk of allergies and infectious disorders in newborns [2].

The United Nations Children’s Fund (UNICEF), The World Health Organization (WHO), and The American

Academy of pediatrics (AAP) suggests exclusive breastfeeding (EBF) for six months after birth. During

EBF, the infant must only consume breast milk with no additional food or drink including water [3]. The

World Health Organization states that colostrum, the yellowish, sticky breast milk produced at the end of

pregnancy, is beneficial as a perfect diet for infants and that breastfeeding should begin within the first

hour of the baby's birth. It is advised to breastfeed exclusively for the first six months of life and to

continue breastfeeding for at least two years beyond that, along with the appropriate complementary

foods [4]. Some nursing challenges that lead to early weaning are associated with maternal traits, such

as being a young mother, having a low household income, or working outside the home. Inadequate

education, being a single mother, lack of prior breastfeeding experience, not knowing the advantages of

breastfeeding, lack of breastfeeding awareness instructions in the maternity ward, and nipple fissure

because of using improper breastfeeding technique [5].

This topic is important because it highlights the maximum benefits that are gotten from exclusive

breastfeeding in newborn and infants, and it talks about the positive impact it has on mothers during

postpartum recovery.
 LITERATURE REVIEW

According to Dukuzumuremyi and Acheampong, Exclusive breastfeeding is one of the key

strategies that goes into the most well-known and effective intervention for preventing early childhood

mortality. Over 1.4 million deaths of children under five can be prevented globally each year by using

good nursing practices. Furthermore, breastfeeding supports healthy brain development and has been

associated with superior cognitive test results in kids and teens. It has been shown that breastfeeding

mothers reduce their risk of hemorrhaging, postpartum depression, breast cancer, ovarian cancer, and

endometrial cancer in addition to encouraging weight loss. One of the most important choices for

postpartum family planning is the breastfeeding amenorrhea approach [6].

Saha et.al however argues that Breastfeeding is essential for the proper growth, development,

and health of infants. Sociocultural factors can influence some breastfeeding techniques and overall

health. The media, education, partners, and spouses are important sources of information on selective

breastfeeding. The factors that influence a child's growth and development include genetic potential,

family dynamics, lifestyle choices, socioeconomic surroundings, environmental contaminants, food, and

the availability of medical treatment. But food stands out as the most significant factor that can directly

or indirectly affect children's future development. For example, children who are malnourished and

manage to live do not value a high quality of life, which hinders their long-term progress. Concern over

childhood obesity and overweight is growing. Therefore, proper nutrition and support during the early

years of life are essential for a newborn to achieve optimal health and wellbeing. Therefore,

breastfeeding is the most priceless benefit in the early stages. "Breastfeeding is an unparalleled method

of providing optimal nutrition for the healthy growth and development of infants; additionally, it is an

essential component of the restorative process with crucial recommendations for the mother's well-

being. The WHO and UNICEF's current breastfeeding recommendations are as follows:

1. Breastfeeding started during the first hour following delivery.

3.Nursing for two months or longer, and starting in the sixth month, providing suitable and sufficient

robust sustenance that is safe and secure.

Exclusive Nursing According to the World health organization (WHO) and United nations

children fund (UNICEF), exclusive breastfeeding is the only way for a baby to get breast milk from their

mother, also known as moist nurturing or transmitted breast milk. According to recommendations from

UNICEF and WHO, mothers should exclusively breastfeed their child for the first six months of life,

continue nursing for a further two years, or stop breastfeeding altogether as early as four to six months.

While there are several advantages of nursing an infant during the first six months of life, many

questions are focused on the "weanling's dilemma," which involves deciding between the (speculative)

inadequate breastfeeding to fulfill the infants' vitality and micronutrient demands past four months of

age and the defensive impacts of EBF against irresistible diseases. However, the author asserted that no

data exists that provides an estimate of the proportion of newborns who are exclusively breastfed who

may have certain nutritional deficits. Breast milk expressed Breastfeeding has benefits for the mother as

well as the infant. In any event, women who are unable to breastfeed their children due to certain

situations would want to express their drain because this is the newborn child's first opportunity to

experience human drain. In essence, communicating is a means of taking milk from the breast without

the infant nursing; this can be done with an electric pump or a hand pump [7].

The scientific basis of breast milk's preventative measures benefits against respiratory and

gastrointestinal disorders are provided by a variety of its constituents. In addition to antibodies like

immunoglobulin A (IgA), lactoferrin, prebiotic oligosaccharides, nonspecific anti-infective agents,

lymphocytes, leucocytes, probiotics, and other immune cells and beneficial microbes, it contains several

bioactive components that enhance its overall immune activity. Formula milk lacks a number of these

advantageous ingredients, including immune cells, oligosaccharides, hormones, stem cells, and
secretory antibodies. Human milk, like formula milk, is dynamic and changes in composition over time to

meet the evolving demands of the growing baby. These components provide a means of preventing

infections, particularly in the early months of infancy and throughout the period of nursing. According to

research, IgA prevents bacteria and viruses from adhering to mucosal epithelial cells, which might result

in infections. IgA antibodies provide defense against bacteria such Giardia, ETEC, and campylobacter

that can lead to gastrointestinal illnesses. Lactoferrin acts as a pathogen-killing antimicrobial agent [8].

Breastfeeding is regarded as exclusive when a child is fed solely breast milk and not any other food,

except for vitamins, supplements, and prescriptions. In addition to offering infants the vital nutrients

they need for normal growth and development, breastmilk protects them from diseases including

allergies, gastrointestinal and respiratory tract infections, obesity, and endocrine abnormalities.

Additionally, it promotes psychomotor and brain growth. In addition, it protects women from unwanted

pregnancies and reduces the mother's risk of breast cancer. It decreases adult-onset diabetes mellitus

risk, blood pressure, and cholesterol. Because it is high in water, protein, fat, carbohydrates, cholesterol,

saturated, unsaturated, and polyunsaturated fatty acids, as well as vitamins and minerals including

calcium, phosphorus, magnesium, iron, and zinc, breastmilk is the ideal meal [9].

Breastfeeding is the preferred method to feed infants until they are six months old. It remains

the most cost-effective way to reduce mortality and the chance of developing diseases including

eczema, type obesity, type 2 diabetes, and hypertension in later life. Breast engorgement, sore nipples,

and inadequate milk are the main factors affecting the length, exclusivity, and beginning of

breastfeeding. On the other hand, between the ages of 4 and 6 months, supplemental diets high in

nutrients are frequently given. An infant's refusal to feed, which is often followed by vomiting, colic,

allergic reactions, and diarrhea, is a common obstacle throughout the weaning process. Given the

interconnected problems with nursing, it is extremely likely that research on nutrigenomics, or

nutrigenetics, will provide [10].

growth of the brain, particularly the white matter(subcortical). Additionally, research indicates a

negative relationship between breastfeeding and the likelihood of obesity later, as well as a possible

lower risk of type 2 diabetes mellitus. Breastfed babies are often able to control how much food they

eat. This may positively impact subsequent eating patterns and the likelihood of gaining weight. Given

the advantages of breastfeeding for health, it is advised that babies be breastfed only for the first few

months of their lives, with the introduction of complementary feedings starting as early as the beginning

of the fifth month and no later than the beginning of the seventh. supplementary food must be provided

in an appropriate way while taking the child's indications into account. All things considered;

breastfeeding can significantly save the cost of healthcare by improving the overall health of the

population. in a suitable manner while taking the needs of the child into consideration. All things

considered; breastfeeding can significantly save healthcare expenditures by improving population health

[11].

RESEARCH METHODOLOGY

All German hospitals offering maternity services—henceforth referred to as "hospitals"—were mailed an

invitation to take part in September 2017. They were also contacted via phone, fax, and video invitation

from the research head in case any feedback was missing. The hospitals were requested to help the

study team recruit mothers for the follow-up survey and to complete a web-based questionnaire on

their breastfeeding circumstances. Every participating institution was given a predetermined 14-day

window from January to March 2018 to enroll moms. The hospital ward staff was asked to record

certain basic data for every birth. If the following requirements for inclusion were satisfied, an

information letter was given out: a full-term, healthy baby (birthweight >2500 g (about 5.51 lb),

gestational age ≥ 37 weeks (about 8 and a half months), and no admission to a neonatal intensive care

unit), adequate fluency in German as determined by research personnel, telephone access, and e-mail
address availability.

The hospital questionnaire, which assessed the promotion of breastfeeding in hospitals, was based on

the WHO/UNICEF (2018) 10-step program and the guidelines that were modified for Germany

(Bundesinstitut für Risikobewertung, 2007; WHO & UNICEF, 2018).

A more sophisticated version of the prior analysis of the SUSE I research, known as tpromotion index

(BPI), was created using ten questions that addressed various topics (Dulon et al., 2003). According to

Dulon et al. (2003), each item received a score of 1 for practice and 0 for not practicing the specific step.

A BPI score in the range of 0 to 10 might be attained. The index's levels of variability were classified into

low (≤5), medium (6-7), and high (≥9) using the percentiles P25, P50, and P75 as cut points.

An online questionnaire was sent to the participating moms at two, four, six, and twelve months after

giving delivery (pp). The initial survey evaluated the nutritional status of the newborn at two weeks, as

well as retrospectively during the hospital stay and at discharge. In addition, this questionnaire

evaluated sociodemographic and nutritional data related to mothers and infants. Up to the age of 12

months, the follow-up surveys on current nutrition stayed the same.

The minimum recommended for the length of the EBF is four months, and this assessment includes the

following five time points: during a hospital stay, after discharge, and after 0.5, 2, and 4 months.

Mothers were given four weeks to complete the survey. Two groups were formed: moms who were EBF

and mothers who were not EBF at these times to evaluate the success of breastfeeding. According to

WHO/UNICEF criteria, breastmilk is the only liquid or semi-solid that a newborn should ingest; vitamins,

minerals, or medications may be given in the form of drops or syrups.

A summary of the hospital and mother involvement, recruitment, and inclusion is provided. Out of the

692 German hospitals invited, 109 participated, and 103 recruited a total of 962 mother-infant pairs

who took part in the initial evaluation, which took place two weeks ago. 46 mother-infant pairs were

initially disqualified from the study, either for failing to attempt breastfeeding (n = 33) or for failing to
submit information about all the factors that were to be considered throughout the analyses.

Furthermore, eight mothers were not included for the hospital stays or discharges since they were

unaware of the nursing status at those times. Seven moms who gave birth as an outpatient and

disclosed EBF both at the hospital (retrospectively) and at the first evaluation (2 weeks pp) were

categorized as EBF also at discharge. Thus, 916 moms were still alive two weeks after the data on

maternal characteristics and breastfeeding practices for newborns in the hospital and at release was

gathered. Ultimately, 909 mother-child pairs—915 at discharge, 916 at two weeks, 830 at two months,

and 804 at four months—were included in the study of EBF in the hospital [12].

In this sense, a father's knowledge and attitude are essential as he is the one who assists women in

parenting and feeding their children the most. Additionally, due to the importance of the father's

position in a family, a partner's or wife's subjective standard about exclusive breastfeeding (EBF) may

change based on how the father is seen to be acting. To determine how best to support new moms,

future programs should focus on new mothers and their partners. Targeting newlywed couples should

be the primary goal. The power hierarchy in homes might be the cause of the father's lack of

engagement. This hierarchical feature means that dads or partners can have a big impact on a mother's

decision on how to properly feed their kid. childcare and household duties, ensuring the health of their

partner, cooking, identifying a baby's hunger signals, burping, and changing the baby's diaper after

feeding—all these tasks help a mother begin and continue nursing the newborn [13].

Studies have shown that women with only a primary education exclusively breastfeed for a longer

period than women with a secondary or higher education. These results were found in nations in

northern Africa. This might be because of the greater employment opportunities that educated moms

benefit over their uneducated peers. Because of time restrictions and other circumstances connected to

their jobs, many find it difficult to continue the EBF practice for up to six months. Certain writers claim

that a mother's degree of education positively affects when she starts exclusive breastfeeding, how long
it lasts, and whether she avoids prelacteal feeding. Moreover, some recent research provides credence

to the idea that moms with higher levels of education have better access to and utilization of knowledge

than mothers with lower levels of education [14].

Breastfeeding protects infants from acute gastroenteritis caused by rotavirus; however, in low- and

middle-income countries, breastfeeding can reduce an infant's immune response to rotavirus vaccines.

Infant genetics and lactadherin, a milk glycoprotein, may also play a role in this lower response rate.

Additionally, breastfeeding may reduce the amount of virus that the vaccinated infant sheds in their

stool [15]. In terms of growth and development, the breastfeeding phase is the most significant, and an

infant's nutrition is crucial at this time. The secretory IgA found in breast milk also reduces the severity

of infections including bacterial meningitis, diarrhea, respiratory tract infections, otitis media, and

urinary tract infections while also protecting the ears, nose, throat, and digestive tract. Compared to

infants fed milk powder, breast-fed babies had greater amounts of carnitine. To use fatty acids as an

energy source, you need carnitine. During the first six months of life, breastfeeding is the only way to

lower an infant's risk of gastrointestinal tract infections, asthma attacks, and childhood obesity [16]. A

wide range of problems might make EBF challenging. Early breastfeeding cessation has been associated

with a variety of mother sociodemographic characteristics, such as low maternal education, pre-

pregnancy overweight or obesity, cesarean delivery, and maternal health problems. Earlier research

indicates that there are variations in the early introduction of supplementary meals based on the

socioeconomic and cultural context. Nevertheless, more research is needed to completely comprehend

the factors influencing women's intentions to breastfeed, especially those pertaining to setting (such as

family, peers, the hospital, and the workplace) and societal impacts [17]. Breastfeeding has a

tremendously advantageous effect on children's health from birth and significantly reduces the risk of

sudden infant death syndrome (SIDS). On the other hand, 50-year-old moms who breastfed their

children had a decreased chance of getting cardiovascular disease and were less likely to experience
hypertension. They also had a decreased likelihood of postpartum migraine recurrence and a lower

chance of developing breast cancer [18]. Breastfeeding also supports the mother's postpartum

involution and contributes to the medium- and long-term prevention of certain diseases; it also aids in

the development of the infant's immune system, locomotor system, emotions, and psychological state

[19]. To enable working moms to practice exclusive breastfeeding, family support and a high degree of

paternal education are essential. Involving the spouse and other family members in breastfeeding-

related health care programs should be the main goal of interventions that support exclusive

breastfeeding [20]. painful latching to the nipple deserves special care as it could possibly lead to

diminished supply of milk, low transfer of milk, and cessation of breastfeeding [21]. Another importance

of breastfeeding is that it enhances the bond between the mother and child through kangaroo care [22].

To reduce the related morbidity and regulate the rise of secondary respiratory syndrome\virulence,

exclusive breastfeeding is essential. Numerous components of breastmilk have antibacterial qualities

that shield the infant, lower the risk of illness, and/or relieve symptoms [23]. When a baby is taken from

its mother at birth, even for a brief period, for procedures like examination and vitamin K injections, or

to repair an episiotomy or perineal injury, the baby may experience adverse physiological effects, such

as increased crying and stress. Because of this, the neonate is less likely to initiate nutritional behaviors

while using stored energy, which has an impact on the stimuli and essential reactions for the

development of sucking skills, successful breastfeeding, and the length of nursing [24]. Breastfeeding-

related inflammation must be treated right away. Inflammation has the potential to lead to an early

discontinuation of breastfeeding, which is the accepted norm for baby feeding and nutrition if left

untreated [25]. The oxytocin release that promotes the let-down reflex of breastfeeding may be

prevented by high cortisol levels during a traumatic birth, which could interfere with breastfeeding [26].

It's important nurses and medical personnel to educate women on postpartum breastfeeding,

particularly since they started the practice and may have experienced difficulties. Education could
enhance women's exclusive breastfeeding practices, attitudes, and understanding throughout the

community. Now, once a woman leaves the hospital, the nurses visit her at home to check on her after

giving birth [27]. Because breastfeeding increases energy needs (by around 500 kcal per day) and may

cause fat to be stimulated, it is possible that breastfeeding will aid in postpartum weight loss. On the

other hand, it is frequently seen that during nursing, women retain or even gain weight following

childbirth. This is largely explained by the fact that many women are skeptical about limiting their calorie

intake during nursing because they think it would result in less milk being produced [28]. A recent meta-

analysis study shows that BF is associated with a lower risk of the onset of rheumatoid arthritis among

nursing mothers, whether the duration of BF is longer than 12 months [29].During breastfeeding,

children with Down Syndrome receive stimulation of their facial muscles, which is essential because

children with this syndrome, generally have muscular hypotonia(low muscle tone).[30].Lastly, breastmilk

is used topically for skin disorders in babies like diaper rash, atopic eczema, and infant conjunctivitis[31].
 Conclusion

In a child's diet during the first two years of life, breast milk is the ideal substitute. The World

Health Organization's current recommendation encourages breastfeeding to begin in the first six months

of life and to continue breastfeeding for the full two years of life. Premature weaning raises the risk of

illness and has detrimental short- and long-term effects on both the mother and the child, according to

strong data. The effects are connected in that the risk of illness decreases with increased breast milk

consumption. These guidelines are supported by strong empirical data that demonstrates a number of

advantages, such as decreased rates of diarrhea (as this study demonstrates), decreased mortality from

all causes, enhanced cognitive function in children, and maybe decreased chances of developing

diabetes mellitus and obesity in the future. Across all worldwide areas with Low and Middle Income

countries (LMICs), the uptake of this simple, low-cost intervention is still not at its best. In order to

guarantee that WHO standards are implemented effectively, assessments of interventions aimed at

promoting the adoption of exclusive and early breastfeeding in various sociocultural circumstances are

desperately needed. High-potential strategies include innovative use of social media and mobile phone

technology to further improve early and exclusive breastfeeding, communication through radio and TV,

and integrated behavior change interventions involving health care workers educating mothers both

pre- and post-partum. A longer-term approach would be to raise the average level of maternal

education, given data from secondary analyses of South Asian Demographic health surveys (DHS )

datasets that revealed a strong correlation between early breastfeeding initiation, exclusive

breastfeeding, and multiple aspects of appropriate complementary feeding practices, and maternal

completion of secondary or higher education. The safest, least allergenic, and most effective way to feed

a baby is to breastfeed. In many countries, states, and local governments, the prevalence and length of

breastfeeding remain lower than the worldwide recommendation of exclusive breastfeeding for the first
six months of life, despite the nutritional, immunological, behavioral, and economic benefits of

breastfeeding.

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