A small study was conducted in our tertiary care hospital. The prevalence of top fed babies attending the hospital outpatient department was 12% (36 out of 300 mothers with babies 4 months or less), despite antenatal and post-natal advice regarding breast-feeding. We interviewed these 36 mothers of lactational failure to assess the common factor associated with failure of breastfeeding. A pretested questionnaire in regional language was used to assess the reasons why mothers started top feeding their babies. More than half of them were aware that breast milk was more nutritious and 75% had some form of education. Of these, 89% of mothers and 92% babies had no breast problems, chronic illness or congenital anomalies in baby that would interfere with breast-feeding. The majority (89%) said that they were giving top feed because they felt that their feeds were inadequate. On inquiring on why they felt it was inadequate, 59% felt that it was inadequate on expressing milk by squeezing the breast, 33% felt so because baby cried even after nursing and 8% were told of their inadequacy by family members. All mothers practiced squeezing the breast and checking milk expression.

The commonest reason for starting top feeds was "inadequate milk expressed when breasts were squeezed". All mothers expressed milk before nursing to check if they are having adequate secretions. They are unaware that the mechanism for sucking and extraction of milk by the baby is far more efficient than the ability of an inexperienced mother to express her milk. They are also unaware that milk secretion is unrelated to the amount they express and anxiety on observing no or "less" milk on expressing makes them doubt their ability to feed leading to lactational failure(1). However, this practice and attitude of mothers has never been recognized or addressed in any recommendations or manuals of training for breastfeeding, by pediatric academies, UNICEF or WHO(2,3,4)

Therefore, this attitude can be further studied. The mothers can be taught and reassured that they have sufficient milk so they must not squeeze their breasts to reassure themselves when the baby cries.

Archana B. Patel,
Samiuddin Shaikh,
Department of Pediatrics and
Clinical Epidemiology Unit,
Indira Gandhi Medical College,
Nagpur, India.

1. Overby KJ. Nutrition and Feeding Issues. In: Rudolph CD, Rudolph AM, Hostetter MK, Lister G, Siegel N, eds. Rudolph’s Pediatrics 21st edn. New York: McGraw-Hill; 2003. p 27-31.

2. American Academy of Pediatrics. Policy statement: Breastfeeding and use of human milk. Pediatrics 2005; 115: 496-506.

3. Indian Academy of Pediatrics. IAP Policy on Infant Feeding. Available from: URL: http:// www.iapindia.orq/policyinfant1.cfm. Accessed September 16, 2005.

4. WHO and UNICEF. Protecting, promoting and supporting breastfeeding: The special role of maternity services. Geneva, Switzerland: WHO; 1989: 13-18.