Indian Pediatrics 1999;36:700-703

Relaction-Manipal  Experience

Relactation means restarting breastfeeding after a period of cessation or significant decrease. in breast feeds. Though it is proved beyond doubt that "breast milk is the best milk", we come across a large number of mothers who stop breastfeeding for trivial reasons. Hence, relactation should become an integral part of Baby Friendly Hospital Ini- tiative (BFHI) programme. Herewith we report 20 mothers who stopped breastfeeding due to different reasons but could be successfully relactated.

Subjects and Methods

This prospective study included 20 mothers with babies aged between 1 month to 1 year, who had stopped giving breast milk to their children from periods varying between 2 weeks to 4 months. Eight children were hospitalized for different illnesses and rest of the mothers came for routine immunization. Their socio-economic status varied from very low to upper income group mothers. Eleven were housewives. Employment status of working mothers included garden workers, hospital attendants, teachers and two were doctors. Age of baby, duration of lactation gap, reason for stopping breast milk and types of feeding were noted. A complete examination of the baby and mother's breast was done. Mothers were asked to take good diet, no supplementation was given till they started lactating. If needed by mother's attitude, metaclopropamide was given for 2 weeks. Mothers were advised to suckle the baby every 2 hours followed by top feed given by paladai or cup and spoon. If infant did not suck due to lack of milk, milk was poured on breast while suck- ling or an infant feeding tube was attached to breast with one end at nipple and other end in a cup of milk(1 ,2).

Initiation of relactation was said to occur when milk could be expressed from breast manually which was tried every day. Establishment of relactation was considered when at least. two feeds were replaced by breast milk.

When approximately half of total top feed were replaced by breast milk, it was designated as partial breastfeeding except for children who were above 6 months when it was defined as successful relactation. When all the top feeds were replaced by breast feeds it was considered as exclusive breastfeeding.

Mothers were managed on an Out Patient basis and followed up weekly for 4 weeks and 2 weekly for 3 months. After that monthly follow up was done to note weight gain of baby or any problems.

Results

All the babies were term with mean birth weight of 2.8 kg (SD :t 0.8 Kg). Age ranged from I month to 1 year. Eight babies were on bottle feeds and the rest were fed by cup and spoon. The mean age of mothers was 22.8:t 2.71 yr). Causes of lactation failure were, no milk in 40%, nipple problem in 30%, Working mother in 25%, mothers' education in 5%. Duration of lactation gap ranged from 2 weeks to 4 months. Twelve were primiparas. The time for initiation of lactation and duration for established lactation in relation to lactatioon gap is given in Table I. Table II shows relation between duration of lactation gap and success of relactation. All the mothers were biological mothers. Weight gain of babies was within normal range and followed their channel in growth curve. Initiation of lactation ranged from 2 days to 16 days. Time taken for established lactation ranged from 18 days to 3 months. Younger the age of baby, early was the initiation and better was lactation performance. Metaclopropamide was given in only 4 mothers and no difference in lactation performance was noticed with addition of this drug. Drip-Drop technique was used in 10 mothers and breast milk supplementer was used in 5 mothers. The mean duration needed for proper attachment to breast was 4 days (:t 3.1 days). Bottle fed babies and babies with long lactation gap took more time for proper attachment.

Table 1

Relation Between Lactation Gap and Performance of Relactation

Lactation gap (week)	No. of mothers	Initiation of lactation		Establishment of relactation
		<1week	>1 week	< 1 mo	> 1 mo
<4	10	7	3	8	2
4-8	5	3	2	4	1
8-12	3	2	1	-	3
>12	2	-	2	-	2

 

TABLE II

Relation Between lactation Gap and Success of Relactation

Lactation gap (Weeks)	No. of Mothers	Full breastfeeding	Partial breastfeeding
< 4	10	6	4
4-8	5	3	2
8-12	3	1	2
> 12	2	-	2

Main problems encountered in relactation was poor motivation of mothers. especially if lactation gap was more. Breast and nipple problems and nipple confusion delayed the motivation of mother.

Discussion

All the twenty mothers started breastfeeding their babies within 24 hours of birth except one who did not want to breastfeed as she was studying. This shows that basic concept that breast milk is "the food for babies" was already there in mother's mind. In all of above mothers breastfeeding could be established irrespective of cause, which shows that they are not the real causes of lactation failure. Similar results have been documented earlier(3,4).

In 60% of mothers, milk appeared within first of week of suckling irrespective of duration of lactation gap. In 36% mothers inititiation of lactation took more than one week though lactation gap was less than 12 weeks. Here, the reasons appeared to be age of baby (>6 months), irregularity in suckling, nipple confusion due to bottle feeding and delay in getting mothers motivated. These findings are in consonance with an earlier report(3). Sixty per cent of mothers in whom lactation could be established within a month had a lactation gap less than eight weeks; thus more the duration of lactation gap more is the time needed for relactation. Similarly, if the lactation gap was shorter than 8 weeks mothers could revert back to full breast feeds.

Regular demonstration to mothers how her baby is gaining proper weight during the process of relactation helps to build her confidence. Counselling for initiation of relactation should includehusbarid as well as grand mother/mothers also, which helps to reduce negative reinforcement of mothers. Drip drop technique (1) and breast milk supplement (2) both help in reducing the baby's frustration in initial days but a motivated attendant to drop the milk and proper sterilization of breast milk supplementer are also needed.

It is concluded that with motivation, relactation can be successfully achieved and should be tried in all mothers who have stopped breastfeeding due to trivial reasons.

 References

1. Kesaree N. Drip and drop method. Indian Pediatr 1993; 30: 277-278.

2. Oiscoll JW. Breast feeding. In: Manual of Neonatal Care, 3rd edn. Ed. Cloherty JP, Stark AR.

Philadelphia, W.B. Saunders Co, 1993; pp 559-563.

3. Banapurmath CR, Banapurmat SC, Kesaree N. Initiation of relactation. Indian Pediatr 1993; 30: 1329-1332.

4. Seema, Patwari AK, Satyanarayana L. Relactation: An effective intervention to pro- mote exclusive breast feeding. J Trop Pediatr 1997;43:213-216.