Child feedings in less developed countries: induced breast feeding in a transitional society

Abstract

Breast feeding is the best promoter of growth and health of infants in traditional and transitional societies. Supplementation with semisolid and solid foods is generally required after 3-6 months in most developing countries. Supplements given to infants and young children in developing countries have been presumed to have a low nutrient value. Although this is true in many instances, continued breast feeding provides an excellent way to assure that the dietary deficiency of supplements is corrected. Intakes of older infants and young children are nutritionally poor, but they could be sufficient if children stay at the breast for at least 18-24 months. This statement is supported by studies in Costa Rica which showed that nutrient intakes usually are 70-80% of the World Health Organization recommendation. Children with such intakes, however, grow well during infancy and early childhood, provided that they are relatively protected from infection. If infection is endemic, as is the situation of poor traditional and crowded societies, similar levels of food consumption will not prevent chronic malnutrition, due to the wasting and debilitating effect of infectious diseases. Malnutrition and high mortality are prevalent in deprived societies in transition, especially in large urban centers, among infants weaned prematurely. It is then important to reverse the trend in declining breast feeding, for which several measures have been proposed. The hypothesis that mother-infant separation after delivery is one important cause of early weaning was tested by means of an intervention in a leading hospital of Costa Rica. Rooming-in resulted in almost universal nursing during the first month of life, and in a sustained high incidence of breast feeding up to 9 months of age. The result was related to the rooming-in implemented in the hospital and to an added postpartum stimulation by health personnel contacting the mothers at monthly intervals. In addition to the increase in breast feeding, there were lower rates of diarrhea, child abandonment, and neonatal mortality. This investigation shows the importance of changing hospital norms to generalize rooming-in. Other measures should address other hospital practices and the negative effects of commercial promotion of milk formulas and weaning foods.