Breastfeeding Practices and Infant Development Outcomes

Abstract

The biochemistry of human milk contains a vast amount of knowledge and information that was previously un-recognised and unknown. The neonate and infant receive both nutritive and non-nutritive signals from milk, according to evidence. There is strong evidence that early, continuous breast feeding for 23 months significantly lowers neonatal and child mortality on a global scale. Breast feeding is the gold standard for an infant’s survival, health, and development, according to scientific research. Due to its nutritional, immunological, and psychological advantages, it is thought to be the best start for infant life. To achieve the best possible growth, development, and health, the World Health Organisation advises mothers to exclusively breastfeed their infants for the first six months of their lives, then continue to do so while supplementing with the right foods until they are two years old or older. Infant developmental milestones and outcomes like cognitive development, socio- emotional development, psychomotor development, and language development have been linked to both the components of breast milk and the act of breast feeding.

1. Introduction

Infant health studies conducted around the world have primarily centered on and focused to understand the complex factors, both positive and negative affecting the infant’s health. Given that childhood under nutrition is one of the most significant public health issues, breastfeeding is one of the most important issues for research on infant mortality and morbidity. It is estimated that 35% of deaths in children under the age of five in the world can be attributed to malnutrition. Early breastfeeding initiation, exclusive breastfeeding for the first six months of life, adequate, timely, and appropriate complementary feeding from six to 24 months of age, continued breastfeeding following the introduction of complementary foods, adequate dietary diversity in complementary foods, and adequate frequency of meals are all aspects of infant and young child feeding (IYCF) that are crucial in the first two years of life.

Breastfeeding is considered as the gold standard for an infant’s survival, health, and development due to its nutritional, immunological, and psychological advantages, it is thought to be the best start for infant life. To achieve the best possible growth, development, and health, the World Health Organisation advises mothers to exclusively breastfeed their infants for the first six months of their lives, then continue to do so while supplementing with the right foods until they are two years old or older. According to WHO fact files from 2015, the first 28 days of life account for 44% of deaths in children under five [1]. Globally, the rates of exclusive breastfeeding up to 6 months of age is slightly better in South Asia (44%) as compared to dismal figures of 20% for Central and European nations [https://www.unicef.org/ info by country/India statistics.html].

Breastfeeding (BF) is the act of transferring human milk from a mother to her infant, in which case the baby takes the milk directly from the mother’s breast. Additionally, Exclusive Breastfeeding (EBF) means that the infant receives no other type of milk or liquid including water, infant formula and other pre-lacteal feeds for the first six months except vitamins and medicines. Breastfeeding is the best way to give babies the ideal nutrition they need for healthy growth and development. It is also an essential part of the reproductive process with significant health benefits for mothers. As long as they have access to accurate information and have the support of their family, the healthcare system, and society at large, almost all mothers can successfully breastfeed. The WHO advises using colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, as the ideal food for the newborn, and that feeding should begin within the first hour of delivery. For the baby, human milk is regarded as being “hand crafted” or “well-suited” because of its benefits to the infant’s nutritional needs, immune system, and psychological development; hence it is thought to be the best start to life [2, 3, 4].

Improvements in breastfeeding rates are critical to the attainment of the Millennium Development Goals and Post-2015 Sustainable Development Goals, especially to reduce the child mortality and improving maternal health. Adequate breastfeeding counselling and support are essential for mothers and families to initiate and maintain optimal breastfeeding practices. Because of its nutritional, anti-infective, and biological qualities, human milk has been referred to as the best food for human growth and development. It is also known to provide a lot of advantages to the growing infant. Infant developmental milestones and outcomes have been linked to both the components of breast milk and nursing as a primary factor. The achievement of the Millennium Development Goals and Post-2015 Sustainable Development Goals, particularly to reduce child mortality and improve maternal health, depends on improving successful breastfeeding practice rates. For mothers and families to start and continue optimal breastfeeding practices, adequate breastfeeding counselling and support are crucial. Because of its nutritional, anti-infective, and biological qualities, human milk has been referred to as the best food for human growth and development. It is also known to provide a number of advantages to the growing child. Breastfeeding practices and its components have both been linked to significant influences on the developmental milestones and outcomes of infants [5, 6, 7].

2. Human milk composition and the empirical evidence

A consistent and substantial evidence extensively indicates that early, exclusive, and continuous breastfeeding for 23 months significantly lowers neonatal and child mortality. According to an estimate, initiating breastfeeding within the first hour of birth could prevent 20% of neonatal deaths, according to a technical brief on the effect of early breastfeeding initiation on newborn deaths. Additionally, it was discovered that starting breastfeeding within 24 hours of birth is linked to a 44–45% lower relative risk (RR) of neonatal mortality from all causes and infection-related mortality. Suboptimal breastfeeding is linked to increased incidence of pneumonia, diarrhoea, morbidity and mortality among infants in the age range of 0–5 months and never breastfed children in 6–23 months of age. Every year about 800,000 child deaths occurs due to inadequate breastfeeding practices [8].

There is a vast body of knowledge and research on the biochemistry of human milk. The analysis of milk composition is now more sensitive, fast, and resolving thanks to improvements in analytical techniques. Compounds that had not previously been discovered or recognised have been found. We now know that milk gives a newborn both nutritionally important and non-nutritional signals. The milk is more nutrient-dense when the offspring develops quickly, and more nutrient-deficient when it does so slowly. All milks contain minerals, vitamins, proteins, and other nutrients in addition to fat, carbohydrates, and proteins. Lipids are organised in milk composition as emulsified globules coated with a membrane, proteins are dispersed colloidally as micelles, and the remaining components are a true solution. A single meal is insufficient at all other times in life.

Human milk is a mammary gland secretion which changes the composition and is not a uniform body fluid. Hind milk and foremilk are completely distinct with each other and compared to them, colostrum is different. Milk varies by the time of day. Physical properties like osmolarity and pH change as protein, fat, carbohydrate, mineral, and cell concentrations vary. It is becoming clearer how compositional changes affect the infant gut’s physiology. Many constituents serve multiple purposes, including nutrition and immunity or a variety of other effects.

2.1 Stages of human milk

Colostrum, transitional milk, and mature milk are the three stages in the continuum of human milk according to traditional nomenclature, and their respective contents are important for newborns physiologic adjustment to extra-uterine life (Table 1).

Milk elements	Colostrum	Transitional	Mature	Cow milk
Lactose (g)	—	—	72.0 ± 2.5 (7%)	4.8%
Protein (g)	—	—	10.5 ± 2 (0.9%)	3.5%
Fat (g)	—	—	39.0 ± 4.0 (3.8%)	3.7%
Vitamin A (μg)	151.0	88.0	75.0	41.0
Vitamin B1 (μg)	1.9	5.9	14.0	43.0
Vitamin B2 (μg)	30.0	37.0	40.0	145.0
Nicotinic acid (μg)	75.0	175.0	160.0	82.0
Vitamin B6 (μg)	—	—	12.0–15.0	64.0
Pantothenic acid (μg)	183.0	288.0	246.0	340.0
Biotin (μg)	0.06	0.35	0.6	2.8
Folic acid (μg)	0.05	0.02	0.14	0.13
Vitamin B12 (μg)	0.05	0.04	0.1	0.6
Vitamin C (mg)	5.9	7.1	5.0	1.1
Vitamin D (μg)	—	—	0.04	0.02
Vitamin E (mg)	1.5	0.9	0.25	0.07
Vitamin K (μg)	—	—	1.5	6.0
Ash (g)	0.3	0.3	0.2	0.7
Calories (kcal)	57.0	63.0	65.0	65.0
Specific gravity	1050.0	1035.0	1031.0	1032.0
Milk (pH)	—	—	7.0	6.8

Table 1.

Vitamin and other constituents of human milk and cow milk (per Deciliter).

Source: Food and Nutrition Board, National Research Council, National Academy of Sciences: Recommended Dietary Allowances, ed 10 [9].

2.1.1 Colostrum

During the first few days, colostrums, a thick, yellowish fluid, makes up the mammary secretion. Colostrums are formed when the residual mixture of substances in the mammary glands and ducts at delivery and immediately after gradually combines with freshly secreted milk. It is well known that the nature and relative proportions of the components of human colostrum differ from those of mature milk. Colostrum’s yellow colour is due to –carotene; and it high ash content as well higher concentrations of sodium, potassium, and chloride than in mature milk. Compared to transitional or mature milk, more protein, fat-soluble vitamins, and minerals are present. The concentrations of Lactoferrin and secretary immunoglobulin A (SIgA) rise. At this point, the oligosaccharides, which are complex sugars, also increase and contribute to the infection protection properties in infants.

The development of Lactobacillus bifidus flora in the digestive tract and meconium passage are both made easier by colostrum. Antibodies found in human colostrum may offer defence against bacteria and viruses found in the birth canal and those brought on by other human contact. The newborn’s requirements and reserves at birth are met by the colostrum’s high protein and low-fat content. The development of Lactobacillus bifidus flora in the digestive tract and meconium passage are both made easier by colostrum. The abundance of antibodies in human colostrum may offer defence against the germs and viruses found in the birth canal and those brought on by contact with other people. The newborn’s needs and reserves at birth are met by the high protein and low-fat content of colostrum. Uric acid and an antioxidant that resembles ascorbate are both present in colostrum and these anti-oxidants may act in the colostrum as filters for reactive oxygen metabolites produced by neutrophils. The enzymatic processes of polymorphonuclear leukocytes and oxygen metabolism are interfered with by the aqueous human colostrum providing evidence to the theory that human milk is anti-inflammatory.

2.1.2 Transitional milk

Transitional milk is the milk produced between the colostrum and mature milk stages; its composition gradually changes and the period lasts roughly from 7 to 10 days after delivery to 2 weeks after delivery. While lactose, fat, and total calorie content rise, immunoglobulin concentration and total protein content fall. The levels of fat-soluble vitamins fall to those of mature milk while the water-soluble vitamin levels rise.

2.1.3 Mature milk

With the exception of some arctic and aquatic species that produce milks with high fat content (for example, the northern fur seal produces milk with 54% fat and 65% total solids), water makes up the majority of almost all mammalian milks. Water dissolves, disperses, or suspends all other components and due to the evaporation of water from the lungs and skin it accounts for 25% of heat loss and thus helps the newborn’s body to regulate its temperature.

2.2 Benefits of human milk to infants growth and development

It provides optimum fluidity and warmth; and is very economical and convenient. Physiologically it has high lactose content and is the sweetest milk. The protein is simple to digest. Long chain polyunsaturated fats (LCP), phospholipids, and precursors to prostaglandins are all abundant and provides enzymes like amylase, lipoprotein lipase, bile salt stimulated lipases (BSSL), oxidases, lactoperoxidases, leucocyte myeloperoxidases, etc. These enzymes aid in digestion and serve as a barrier against microbes. Additionally, it contains growth modulators, growth promoters, and growth regulators. LCPs, docosahexaenoic acid (DHA) and aracidonic acid (ARA)) reduce hyperactivity and promote brain growth.

Breast milk is biochemically superior. Whey protein makes up the majority of the protein (80%), and casein makes up 20%. Whey protein is high in lactoferrin and lactalbumin. Tryptophan, the building block of serotonin, a crucial neurotransmitter, is abundant in lactalbumin. Lactoferrin is bacteriostatic and ensures iron and zinc absorption and binds iron and prevents the bacteria from accessing it. Human milk does not contain the allergens Alph-casein and Lactoglobulin. Despite the lower protein content, non-protein nitrogens are more abundant in breast milk. The infant’s growth and development are significantly influenced by the non-protein nitrogen in breast milk. It also contains a lot of proteins that bind substances like vitamin D, B12, and thyroxin. Calcium absorption is guaranteed because the calcium-phosphorous ratio is greater than two; and absorption of calcium and magnesium is aided by lactose. The lack of certain minerals in whey protein lowers solute load guarantees a mild load on an infant’s developing kidney. The best vitamins and minerals, including calcium, iron, and zinc, are also provided at the same time in order to meet the needs of infant growth [10, 11, 12, 13, 14].

3. Breastfeeding and cognitive development

Cognitive development is the intellectual equivalent of a person’s biological adaptation to their environment. It describes the progressive and ongoing growth of perception, memory, imagination, conception, judgement, and reason. Additionally, cognition includes the mental processes involved in understanding information as well as the process of acquiring, organising, retaining, and applying knowledge. Following that, this knowledge is applied to problem-solving and generalisation to new situations.

From conception to age five, a variety of processes are included in early child development. It occurs concurrently with growth and describes the maturation of the function of picking up skills, behaviours, and values, as well as environmental adaptation. The complex process of a child’s cognitive development is influenced by both genetic and environmental factors. The child’s capacity for cognitive development is genetically determined. The child’s cognitive development, however, may also be positively impacted by environmental factors, such as adequate nutrition and the parents’ capacity to create a pleasant and stimulating home environment [15, 16]. Numerous studies have found a link between breastfeeding and children’s cognitive development. Science has been studying the impact of breastfeeding on infant health and development for many years. Extensive research has looked at how breastfeeding affects the development of the brain, particularly two aspects of brain development: cognitive development and the development of visual acuity. There is a significant correlation between the length of exclusive breastfeeding and test results in the vocabulary and similarity tests as well as cognitive IQ [8, 17]. Among the benefits attributed to feeding children with human milk in comparison with substitutes such as infant formula, breastfeeding is also associated with advanced language development, high scores on vocabulary tests and very sensitive to speech stimuli [17, 18, 19, 20]. Evidence is emerging that DHA is important in neural and visual development of preterm as well as term infants, especially for retinal and brain development [21, 22].

3.1 Essential fatty acids and brain development

The final trimester of pregnancy and the first six months of life are when the human brain grows more rapidly. The major building blocks of neural tissues are adequate long chain polyunsaturated fatty acids (LCPUFAs), such as docosahexaenoic acid (DHA; 22:6n-3) and arachidonic acid (AA; 20:4n-6). DHA is crucial for the development of the central nervous system during this growth spurt because it makes up up to 50% of the phospholipids in the retina and cerebral cortex. The main source of DHA and AA is breast milk. Because LCPUFA precursors have a low capacity for elongation and de-saturation, infants can only synthesise a small amount of LCPUFAs. There is mounting evidence that DHA plays a critical role in the neural and visual development of both term and preterm infants [23]. There is evidence that breastfeeding promotes increased white matter development in the later maturing frontal and association brain regions of children. In several brain regions, there are also positive relationships between breastfeeding duration and white matter microstructure that are anatomically in line with the observed enhancements in cognitive and behavioural performance measures [21, 22, 24].

3.2 Lactose as a source of galactose

As a readily available source of galactose, lactose is necessary for the synthesis of galactolipids, including cerebroside, which is crucial for the growth of the CNS (Central Nervous System). The relationship between amount of lactose content in a species’ milk and its brain’s relative size varies; with human milk having the highest levels of both and this is found to influence early language expression and comprehension measures in term infants and toddlers. When compared to breastfed infants, formula-fed infants with DHA supplements are found to score lower on receptive and expressive vocabulary tests at 14 months of age [25].

3.3 Immunoglobulins, hormone and growth factor content

Additionally, breast milk contains immunoglobulins, growth factors, and hormones like neurotensin, nerve growth factor, sialylated oligosaccharides, and thyroid stimulating hormone that are not present in formula milk but are essential for the functional development of the brain during the foetal and neonatal periods. T4 is the main form of hormonal iodine found in breast milk, whereas iodide is the only maternally derived component found in infant formulae (the inorganic form of iodine). Iodine deficiency has long-lasting effects on development because it prevents the production of thyroid hormone.

Hormonal iodine in breast milk is found as T₄, while infant formulae are devoid of such maternally-derived factors but contain iodide which is the inorganic form of iodine. Iodine deficiency has long-lasting effects on development because it prevents the production of thyroid hormone [12].

3.4 Cholesterol

The plasma membrane and myelin, a fatty sheath that surrounds the axons of neurons in both the central and peripheral nervous systems have cholesterol as an integral component. Breast milk contains significant amount of cholesterol (90–150 mg/L) whereas formula lacks cholesterol. It permits effective transmission of nerve impulses and synaptogenesis, which is crucial for neurodevelopment [26].

3.5 Psychological and psychobiological effect

In addition to the obvious nutritional advantages of breastfeeding for brain development, the nurturing and interaction with the mother that occurs during breastfeeding also has a positive impact on cognitive growth [3]. Maternal–infant touch and contact in the neonatal period, such as skin-to-skin contact are found to promote interactive behaviour in terms of increased maternal touch, adaptation and higher infant visual alertness; and this further predicts better cognitive outcomes among the infants [27].

4. Breast feeding and psycho-motor development

Between birth and age 3, young children experience rapid growth, development, and achievement of significant milestones, laying the groundwork for future development. Physical development is one aspect of newborn and toddler development. It relates to the growth, change, and development of the body, including the expansion of the muscles and the senses. The psychomotor domain pertains to physical bodily changes and involves motor skill use, coordination, and movement. It happens in a comparatively steady, predicable order. Changes in bone thickness, vision, hearing and muscle are all included [28]. The development of the body’s size and weight is also a part of physical growth. Appropriate nutrition, which includes a balance of the right foods and enough water to drink, is essential for both growth and development. The developing brain and nervous system, growing bones and muscles, exercise, and physical activity help to increase control and coordination. Motor development refers to changes in children’s ability to control their body’s movements, from infants’ first spontaneous waving and kicking movements to the adaptive control of reaching, locomotion and complex sport skills [29]. All bodily movements, including eye movements (as in the gaze) and an infant’s developing control over their head, are referred to as motor behaviour. Large limbs or the entire body can be moved in gross motor actions, such as when walking. The use of fingers to grasp and manipulate objects is a fine motor behaviour. Exploratory behaviour includes motor actions like reaching, touching, and grasping [30].

The intrinsic qualities of the child and the mother’s skill in child care form a complex interaction that affects the child’s growth and nutritional outcomes. The most recent estimates of the global burden of malnutrition in children under five are that 178 million (one-third of all children) are stunted, 112 million are underweight, 55 million are wasted (19 million having severe acute malnutrition) and 13 million children are born each year with intrauterine growth retardation. Together they account for 21% of all under-5 deaths [11].

Studies have consistently shown a positive relationship between breastfeeding and motor development. Vestergaard et al. observed a positive relationship between breastfeeding duration and an earlier ability to crawl and perform the “pincer grip” and babies who were exclusively breastfed for six months were significantly more likely to be walking by one year compared with those who were exclusively breastfed for four months (60 vs. 39%) [31]. children breastfed for only 3 months show lower psychometric scores compared to the ones with 6 or more months of breastfeeding. A significant association between early initiation of breastfeeding, EBF and long duration of breast feeding is found to reduce the risk of underweight and have progressively more odds to high levels of psychomotor development when compared to those not breast fed successfully. The most affected psychometric domains by shortness of breastfeeding are communication and gross motor skills [2, 32, 33, 34].

There is consensus about the benefits of breastfeeding for infant growth and health, particularly in developing countries where it may be the only means to avoid malnutrition and a high risk of morbidity and mortality in the first year of life.

5. Breastfeeding and obesity/overweight

Adiposity refers to state of being fat or excessive accumulation of fat (Merriam-Webster, 2006). The Latin term adiposity means severe or morbid overweight an increase in overweight is linked to an increase in the risk of diseases that are linked to obesity. The body-mass-index is a general indicator of obesity (BMI). Adiposity and obesity rates have recently increased among children and adults, signalling a serious public health crisis in both developed and developing countries [24]. Children who are overweight run a high risk of continuing to be overweight as adults, putting them at risk for the related health issues like hypertension and coronary heart disease. According to a meta-analysis, breastfeeding is linked to a lower risk of being overweight than formula feeding [35].

Leptin, a hormone that is thought to regulate adult obesity, has a similar effect on infant obesity. First, individuals who were breastfed have a leptin profile that may support effective appetite control and less fat deposition. With regards to appetite regulation, According to Pérez-Escamilla et al. [36], Honduran infants changed the volume of milk they consumed in inverse relation to the energy density of their mother’s breast milk. It has also been suggested that the milk fat content (hind milk), which is higher than the milk at the beginning of the feeding episode (fore-milk), indicates to the baby that the feeding episode is about to end. Babies who are fed formula are obviously not subject to such “physiological signalling,” as the amount of fat in the formula does not change during the feeding episode. This implies that in babies who are fed formula, it is the carer, not the child, who sets the child’s calorie intake. Second, during the first year of life, breastfed infants gain less weight than infants who are fed formula. Third, because infant formula contains more protein than breast milk, formula-fed babies have bloodstream insulin levels that are higher. This may encourage the body to store more fat. Fourth, it’s possible that breast milk influences how a person’s taste receptors develop, which may lead to a preference for lower-energy diets in later life [36, 37].

The higher human milk oligosaccharides (HMOs) diversity and evenness are associated with lower total and percentage fat mass in infants; breastfeeding reduced the risk of obesity in childhood significantly [6, 35]. The risk of obesity is found higher among children who are not exclusively breast fed, breast fed for short duration and formula fed infants [8, 38, 39].

6. Breastfeeding and socio-emotional development

Social-emotional development includes the child’s experience, expression and management of emotions and the ability to establish positive and rewarding relationships with others. It encompasses both intra- and interpersonal processes [40].

The behavioural research indicates that in the first few minutes after birth, infants and mothers appear ready to interact. These discoveries include the newborn infant’s capacity to crawl toward the breast in order to begin sucking as well as mother-infant thermoregulation. Encouragement of attachment through early contact, suckling, and rooming-in has been shown to reduce abandonment. Oxytocin plays a role in the biological regulation of the attachment felt between a mother and her infant [41]. Even though it’s well agreed that EBF encourages greater cognitive growth, nothing is known about how it might affect socio-emotional development [42]. Yet, research indicates that longer breastfeeding periods are connected to a happy bias, whereas shorter breastfeeding periods were linked to a fear bias, indicating that breastfeeding experience can influence how newborns respond to emotional cues. Additionally, they perform better in the areas of adaptability and communication. Breastfeeding has also been linked to improved maternal-infant bonding and empathy during the early postpartum period, as well as a greater sensitivity to infant cues [42, 43, 44].

7. Breastfeeding and infant morbidity/mortality

There is strong evidence that early, continuous breastfeeding for 23 months significantly lowers neonatal and child mortality on a global scale. According to a technical brief on the effect of early breastfeeding on newborn deaths, starting breastfeeding within the first hour of birth could prevent 20% of neonatal deaths and lower the risk of infection-related neonatal mortality by 45%. According to epidemiological data, breast feeding would save about 800,000 lives annually, if they were breastfed within an hour of birth, exclusively fed breast milk for the first six months of life, and then continued breastfeeding until age two [45]. It was also reaffirmed in The Lancet Nutrition Series, 2016 on how important optimal IYCF (Infant and Young Child Feeding) is to a child’s survival. According to estimates, optimal IYCF, particularly exclusive breastfeeding, could avert 1.4 million under-five deaths annually (out of the approximately 10 million annual deaths) [46, 47].

It is sterile and has the least chance of being contaminated microbiologically. Bacteriostatic lactoferrin prevents the growth of Escherichia coli and binds iron and prevents E. coli from accessing it. Lipases and peroxidases eliminate bacteria. Amoeba and giardia are destroyed by bile salt stimulated lipase (BSSL). PABA is crucial for malaria prevention and relatively low levels of PABA in human milk suppresses parasites to subclinical levels and provides an adequate antigenic stimulus for an immune response.

Infants are born with immature immune systems and organs that may take some time to develop into their ideal functioning states and breast milk is extremely safe and non-allergenic immunologically. Prebiotics, free fatty acids (FFA), mono glycerides, oligosaccharides, antimicrobial peptides, human milk glycans, lysozyme, lacto peroxidase, lacto ferrin, lipoprotein lipase, and epidermal growth factors, which stimulate the gastrointestinal epithelium as a barrier, are all present in breast milk which contributes to the development and enhancement of an infant’s innate immune system. When compared to milk from other species, human milk is exceptional due to its high concentration of complex oligosaccharides. Oligosaccharides also have an impact on the development of the intestinal flora because they feed the beneficial Lactobacillus bifidus bacteria while inhibiting the growth of potentially pathogenic bacteria. It includes secretory elements, secretary IgA, and immunoglobulin (SIgA) which plays a crucial role in preventing microbial pathogen adhesion to the surface of the intestinal epithelium and binding their toxins thus providing the GI and respiratory tracts with surface protection. T and B lymphocytes, as well as anti-inflammatory nutrients like vitamins A, C, and E, enzymes, E prostaglandins, enzyme inhibitors, protease inhibitors, and growth factors, are also provided by breast milk. These work against rotavirus, the most common cause of diarrhoea in infants. Now, researchers in the United States and Mexico have discovered that complex carbohydrate in breast milk affords babies even more protection than the antibody specifically made to fight against fatal diseases like diarrhoea, viral infections and other diseases [48, 49]. Thus, we can say infant’s first immunisation is mother’s milk as these antimicrobial, anti-inflammatory, and immunologic-stimulating substances guard the infant against diarrhoea and other infectious diseases like food allergies, respiratory (asthma), urinary, otitis media, botulism, necrotizing enterocolitis, bacterial meningitis, and bacteremia. Additionally, there is proof that breastfeeding guards against less common diseases like Urinary tract infection, sudden infant death syndrome, celiac disease, Crohn’s disease, ulcerative colitis, Type I diabetes, and childhood lymphoma [50, 51, 52]. Due to the low pH of the bowels, breastfed babies experience fewer diaper rashes. As babies who are breastfed for longer periods of time accept different tastes more readily than those who are not, it may also prevent picky eating syndrome, which may develop later in life [11, 53, 54].

8. Conclusion

Breastfeeding is considered as best start for an infant’s survival, health, and development due to its nutritional, immunological, and psychological advantages. To achieve the best possible growth, development, and health, the World Health Organisation advocates mothers to initiate breast feeding within one hour of birth, feed colostrum, exclusively breastfeed their infants for the first six months of their lives, then continue to do so while supplementing with the right foods until they are two years old or older. Improvements in breastfeeding rates are critical to the attainment of the sustainable development goals, especially to reduce the child morbidity, mortality and improving maternal health. Both the constituents of breast milk and the act of breastfeeding have been implicated in the process playing a major role on infant developmental milestones/outcomes. It provides optimum fluidity and warmth; and is very economical and convenient. Breast milk has high lactose content and is the sweetest milk. The protein is simple to digest. Long chain polyunsaturated fats (LCP), phospholipids, and precursors to prostaglandins are all abundant and provides enzymes like amylase, lipoprotein lipase, bile salt stimulated lipases (BSSL), oxidases, lactoperoxidases, leucocyte myeloperoxidases, etc. A significant association was found between exclusive breastfeeding and long duration of breast on infant developmental outcomes viz. cognition, language, psycho motor and socio-emotional development. The mechanism/s underlying these effects are likely to be linked to the high nutritional sensitivity of physical, motor and brain development in the critical early period of life. The higher human milk oligosaccharides (HMOs) diversity in breast milk are associated with lower percentage fat mass in infants and reduces the risk of obesity in childhood significantly. Prebiotics, free fatty acids (FFA), mono glycerides, oligosaccharides, antimicrobial peptides, human milk lysozyme, lacto peroxidase, lacto ferrin, lipoprotein lipase, and epidermal growth in breast milk enhances infant’s innate immune system thus reduces the risk of infant mortality and morbidity due to malnutrition.

Hence, adequate breastfeeding counselling and support are essential for mothers and families to initiate and maintain optimal breastfeeding practices. Training of health workers and volunteers should focus on counselling rather than just giving messages. Also, there is a need to regulate commercial brands of prelacteal feeds like herbal syrups, gripe water, etc., that display the advice that they can be given from birth. It is vital to establish breast milk bank to feed the babies whose mothers are ill or in distress and who have lost mothers.