OPINION | Standing together to support breastfeeding for strong immunity

• Breastmilk is the optimal food for babies
• However, less than a third of babies in South Africa are exclusively breastfed until the age of six months
• In many communities, substituting breastfeeding with formula milk results in poor nutritional status

It’s National Nutrition and Obesity Week, and the theme this year is “Good Nutrition for Good Immunity”. And where better to start with good nutrition and good immunity than at birth?

Promoting optimal breastfeeding and complementary feeding is about creating awareness of practices that can contribute to health and economic prosperity for all, and for rallying more social, economic and environmental support. This means more women can have the information to make informed decisions, and the support and resources they need.

The guidelines

Breastmilk is the recommended ideal, most healthful, natural and economic food for optimal growth and development of infants and young children. Therefore, the World Health Organization recommends that mothers exclusively breastfeed their babies (breastmilk only) from birth to six months. From six months, solid foods can be included in the diet with sustained breastfeeding for up to two years or longer.

Together with complementary foods, breastmilk supplies half of a baby’s nutritional needs from six to 12 months and a third of the baby's nutritional needs between 12 and 18 months. Thereafter, breastmilk contributes to the toddler's dietary needs along with a balanced diet consisting of a variety of foods.

The challenge

Research has shown that although breastfeeding has many advantages for babies and mothers, fathers, families, communities and ultimately countries, optimal breastfeeding practices remain low. Though breastmilk has many protective factors that decrease baby’s risk for disease and morbidity significantly, less than a third of babies in South Africa are exclusively breastfed until the recommended age of six months. This is a troubling fact as breastfeeding provides complete nutrition security for infants up until the age of six months.

In lower socioeconomic environments, poor nutritional status of infants results from substituting breastfeeding with formula milk, as formula milk is often not prepared under hygienic conditions, leading to illness. It is also  too expensive to sustain, leading to diluted milk given to babies.

In low-and-middle-income countries, optimal breastfeeding practices could prevent more than 54% of diarrhoea episodes and more than 32% of respiratory infections. It is estimated that globally, 820 000 lives of children under the age of five could be saved per year as a result of optimal breastfeeding practices. 

Other consequences of suboptimal breastfeeding practices may include an infant’s inability to thrive mentally and physically. This, in turn, can lead to immune-compromised adults, adults with a higher risk for developing  diseases such as diabetes and hypertension, and adults who struggle to be economically active.

So, in support of optimal breastfeeding and optimal complementary feeding practices to combat malnourishment and disease, here are a few facts to consider:

Breastmilk and immunity

• The first milk that a mother’s breasts produces, just after birth and within the first two to three days, is called colostrum. It is a yellowish, sticky liquid that is produced in small quantities. It contains mainly white blood cells with antibodies. The antibodies strengthen the baby's resistance (immunity) and protect them from infections. It also contains a large amount of protein, minerals and fat-soluble vitamins (especially vitamins A, E, and K) that protect the baby in those early days. Colostrum is considered to be the baby's first immunisation or vaccination as it is so high in antibodies and vitamin A.
• Many people believe that breastmilk from birth to six months of age is the only time when breastfeeding provides active immunological components to the baby. However, this is not true. As long as breastfeeding continues, the mother actively transmits immunity to the baby. For the mother, continued breastfeeding has the benefit of post-pregnancy weight loss. Since so many women of childbearing age in SA are overweight, this is a great bonus. The mother's risk of developing certain cancers (breast and ovary) is also reduced. Furthermore, it remains economical to breastfeed and it encourages a very special bond between mother and baby.

Complementary feeding and immunity

• From six months, your baby’s energy and nutrient needs starts to exceed what is provided by breastmilk. So, this is the time to start giving extra foods that contain a bigger variety of nutrients. 
• The young baby’s capacity to digest proteins, lipids, and complex carbohydrates is incomplete at birth and remains so for much of the first year of life. Continued breastfeeding during the complementary feeding period supports their immature immune system.

Complementary feeding guidelines

• Between six and eight months: Offer complementary foods two to three times a day, after your child's breastmilk feed. These first foods should be high in nutrients, e.g. scrambled egg, chicken livers, green and yellow vegetables (spinach, carrots, butternut)
• Between nine and 24 months: Feed complementary foods three to four times a day before your child’s breastmilk feed. This is to make sure they start relying more on the food for their nutrients and energy.
• Also offer a nutritious snacks (e.g. fruit pieces, carrot or cucumber slices, hummus, avocado or peanut butter on wholewheat bread or crackers, full-cream unsweetened yoghurt, homemade fish fingers)  one to two  times a day.
• By one year, your child should be eating about one tablespoon each of vegetables, meat and starch at every meal, in addition to the snacks.
• Remember that this is only a guideline. Gradually increase the amount of food and number of feeds as your baby gets older

Supporting immunity through complementary foods

It is important to include a variety of foods in your baby’s diet to ensure they get adequate amounts of micronutrients. Here are some examples:

• Include foods rich in iron, vitamins and minerals, e.g. egg and chicken livers.
• Vitamin C is a powerful anti-oxidant and needed for fighting infection and wound healing. Good sources are peppers, tomato, green vegetables like broccoli, mango and citrus, like oranges.
• Vitamin A is another antioxidant and needed for good eyesight, growth and development, and healthy intestines. Good sources are egg yolks and beef liver and most orange, yellow and green vegetables like carrots and butternut and spinach.
• Iron is essential for oxygen delivery by the red blood cells to the rest of the body. Good plant sources are dark green vegetables, whole grains, legumes and animal sources, e.g. liver, meat and chicken.
• Zinc is essential for wound healing, normal growth and fighting infections. Good sources include whole grains, beans, peas, nuts, liver and dairy. 

Tips for complementary feeding

• Avoid foods and drinks with little or no nutrient value, fizzy drinks, chips, sweets and tea. Drinks can fill up your child’s stomach, making them less likely to want to eat other nutritious foods. This can lead to slower growth rates because of a nutrient shortage
• Adding extra salt and sugar to food will make your child used to these tastes. This might lead to them not wanting to try new or more complex flavours, or eat food that is not salty or sweet. You can, however, add herbs and spices, which have more complex flavours.
• The earlier children are exposed to foods with stronger flavours (like broccoli, spinach or beets), the more likely they are to accept them.
• Only giving your child neutral or sweet food, like fruit or sweet vegetables, can lead to an unwillingness to accept stronger-flavoured foods.
• Continue offering your child the new foods. It can take up to 10 different exposures before they accept these foods.

Visit www.nutritionweek.co.za for more tips and information. 

Lisanne du Plessis is an associate professor at the Division of Human Nutrition, Department Global Health, at Stellenbosch University. Liezel Engelbrecht is a registered dietitian. They are both spokespeople for the Association of Dietetics in South Africa (ADSA).

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