10 principles of breastfeeding according to the World Health Organization

Breastfeeding Principles: A Complete Guide

During World Breastfeeding Week from 1 to 7 August 2010, the focus was on the Ten Principles for Successful Breastfeeding. The World Health Organization (WHO) has renewed its call for health facilities and health workers to adhere to ten principles to promote successful breastfeeding and improve child health and survival. The Ten Principles for Successful Breastfeeding were developed by WHO and UNICEF to give every infant the right start in life and the support mothers need to breastfeed. This checklist is currently used by hospitals in more than 150 countries.

10 principles for successful breastfeeding

10 The principles of successful breastfeeding were developed by a group of global experts and consist of evidence-based practices that have been shown to increase the initiation and duration of breastfeeding. Baby-friendly hospitals and birthing facilities must adhere to the Ten Steps to obtain and maintain baby-friendly appointments.

Ten steps to successful breastfeeding:

1. Create a written breastfeeding policy that is regularly communicated to all health care personnel.

2. Train all health care personnel in the skills needed to implement this policy.

3. Educate all pregnant women about the benefits and management of breastfeeding.

4. Help mothers start breastfeeding within one hour of birth.

5. Show mothers how to breastfeed and how to maintain lactation even if they are separated from their babies.

6. Do not give infants any food or drink other than breast milk unless medically directed.

7. Allow mothers and babies to stay together 24 hours a day.

8. Encourage breastfeeding on demand.

9. Do not give pacifiers or artificial nipples to infants.

10. Promote the creation of breastfeeding support groups and refer mothers to them upon discharge from the hospital or birth center.

The Ten Steps are endorsed and promoted by major maternal and child health authorities in the United States, including:

• American Academy of Family Physicians
• American Academy of Nursing
• American Academy of Pediatrics
• American College of Nurse-Midwives
• American College of Obstetricians and Gynecologists
• Academy of Breastfeeding Medicine
• Academy of Nutrition and Dietetics
• Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)
• Centers for Disease Control and Prevention(CDC)
• National WIC Association
• US Breastfeeding Committee (USBC)
• US Preventive Services Task Force
• US Surgeon General

It has long been established that breast milk is the ideal food for newborns and infants. It is safe and contains nutrients essential for healthy development in children and antibodies to help protect infants from common childhood diseases.

The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have for years emphasized the importance of preserving breastfeeding—and reviving the practice when it is in decline—as a way to improve the health and nutrition of infants and young children. Efforts to promote breastfeeding and address issues that may impede it are part of the overall nutrition and maternal and child health programs of both organizations.

Member States of the World Health Organization:

1. Affirm the right of every child and every pregnant and lactating woman to adequate food as a means of achieving and maintaining health;
2. Recognize that child malnutrition is part of broader problems such as lack of education, poverty and social injustice;
3. Recognize that the health of infants and young children cannot be isolated from the health and nutrition of women, their socioeconomic status and their role as mothers;
4. Recognize that breastfeeding is an unrivaled way of providing the ideal nutrition for the healthy growth and development of infants; that it forms a unique biological and emotional basis for the health of both mother and child; that the anti-infective properties of breast milk help protect babies from disease; and that there is an important relationship between breastfeeding and child spacing;
5. Recognize that the promotion and protection of breastfeeding is an important part of the health, nutrition and other social interventions necessary to promote the healthy growth and development of infants and young children; and that breastfeeding is an important aspect of primary health care;
6. Consider that when mothers are not breastfeeding or only partially breastfeeding, there is a legitimate market for infant formula and suitable ingredients for its preparation; that all these products should be available to those who need them through commercial or non-commercial distribution systems; and that they should not be sold or distributed in a manner that might interfere with the protection and promotion of breastfeeding;
7. Recognize that inappropriate feeding practices contribute to malnutrition, morbidity and mortality among newborns in all countries and that inappropriate marketing practices of breast-milk substitutes and related products may contribute to these major public health problems;
8. Believe that it is important for infants to receive appropriate complementary foods, usually when they reach four to six months of age, and that every effort should be made to use local products; and are nevertheless convinced that such complementary products should not be used as breast milk substitutes;
9. Recognize that there are a number of social and economic factors that influence breastfeeding and, accordingly, governments should establish social support systems to protect, facilitate and encourage, and that they create an environment conducive to breastfeeding, family and community support and protect mothers from factors that interfere with breastfeeding;
10. Reaffirm that health systems, and the health care and other health professionals working within them, have an important role to play in guiding infant feeding practices, 7 promoting and facilitating breastfeeding, and providing objective and consistent advice to mothers and families about the excellent value of breastfeeding or, if necessary, the proper use of infant formula, whether produced industrially or at home;
11. Further affirm that education systems and other social services should be involved in the protection and promotion of breastfeeding and the appropriate use of complementary products;
12. Recognize that families, communities, women's organizations and other non-governmental organizations have a special role to play in protecting and promoting breastfeeding and in providing the support that pregnant women and mothers of infants and young children need, whether breastfeeding or not;
13. Reaffirming the need for governments, United Nations organizations, non-governmental organizations, experts from various related disciplines, consumer groups and industry to collaborate in activities aimed at improving the health and nutrition of mothers, infants and young children;
14. Recognize that governments should implement a variety of health, nutrition and other social policies to promote the healthy growth and development of infants and young children and that this Code addresses only one aspect of these policies;
15. Consider that manufacturers and distributors of breast-milk substitutes play an important and constructive role in relation to breastfeeding and in promoting the purpose of this Code and its proper implementation;
16. Confirm that Governments are invited to take measures consistent with their social and legislative frameworks and their overall development objectives to give effect to the principles and purpose of this Code, including the adoption of legislation, regulations or other appropriate measures;
17. It is believed that in light of the above considerations and in view of the vulnerability of infants in the first months of life and the risks associated with poor feeding practices, including the unnecessary and incorrect use of breast-milk substitutes, such marketing practices are considered unsuitable as a food product;

International Code of Marketing of Breast-milk Substitutes

One of the principles of the Breastfeeding Hospital Initiative is that the marketing of breast milk substitutes, including infant formula, discourages mothers from initiating and/or exclusively breastfeeding their infants. The WHO International Code of Marketing of Breast-milk Substitutes, adopted in 1981, recommends restrictions on the marketing of breast-milk substitutes, nursing bottles and pacifiers. Hospitals and birth centers wishing to achieve baby-friendly practices must comply with the International Code of Marketing of Breast-milk Substitutes. Significant provisions of this code prevent hospitals and birth centers from accepting free or low-cost infant formula, providing free samples of infant formula to families, or advertising breast milk substitutes. The International Code of Marketing of Breast-milk Substitutes requires: 1. No advertising of breast-milk substitutes to families. 2. No free samples or supplies in the healthcare system. 3. No promotion of products through medical institutions, including without free or low-cost formula. 4. Lack of contact between marketing staff and mothers. 5. No gifts or personal samples to healthcare professionals. 6. No words or images that idealize formula feeding, including images of babies on labels or products. 7. Information for health professionals should be scientific and factual. 8. All information about formula feeding, including labels, should explain the benefits of breastfeeding and the costs and dangers associated with formula feeding. 9. Poor quality products should not be advertised to infants. 10. All products must be of high quality and take into account the climate and storage conditions in the country where they are used. Source: www.who.int/nutrition/publications/code_english.pdf

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Specifics of modern breastfeeding

There are now studies that show that babies fed breast milk have lower morbidity and mortality. They also have much fewer malocclusion pathologies and higher intelligence development compared to those who are bottle-fed or mixed-fed. This difference persists throughout life.

There are certain principles of breastfeeding to ensure optimal breastfeeding for your baby.

The first application should be carried out as quickly as possible - within the first 30 minutes of life. Early contact forms the rapid development of milk production in sufficient volume. It also enhances maternal feelings and calms after childbirth. On the part of the child, the mental relationship with the mother increases. In the first days after birth, the baby receives nutritious colostrum rich in beneficial microelements.

The frequency of attachments depends on the child’s needs and is carried out at his first request. More than 10 feedings per day is considered normal. They ensure the correct psycho-emotional connection between the baby and the mother and the preservation of lactation.

Night feedings, especially early morning feedings, are recommended to be maintained until the baby is at least six months old. In the early morning hours, the hormone prolactin, which is responsible for high-quality lactation, is produced to its maximum.

The duration of feeding is not limited. It is desirable that during one feeding the baby receives both fore and hind milk, that is, it fully satisfies its need for nutrients and microelements.

It is necessary to avoid supplementation between feedings with milk formulas and water if the volume of milk is sufficient. Thanks to this, the child’s addiction to poor nutrition is avoided. The break between feedings is on average 1-2 hours during the day, 3-4 hours at night. Over time, the baby will establish his own routine, making life easier for the mother.

According to the World Health Organization, breastfeeding is recommended to be maintained until two years of age, and later at the mutual desire of mother and child.