a way of providing ideal nourishment for adequate growth and development of children
and the advantages range from physiological to psychological for both mothers
It is well known that breastfeeding influences a child’s health positively and
improves nutritional status2 3.Breast
milk is the best gift a mother can give her child.
The WHO recommends that
for the first six months of life, infants should be exclusively breastfed to
achieve optimal growth and development. The infants should thereafter, receive
nutritionally adequate and safe complementary foods, while continuing to
breastfeed for up to two years. 4
Feeding (EBF) is defined as infant feeding with human milk without the addition
of any other liquids or solids.5The prevalence of breastfeeding differs from one country to
another and from one society to another, this is due to cultural and religious
For all new-borns,
irrespective of mode of delivery, especially those delivered by caesarean
section, skin to skin contact should be initiated in about 5 minutes of birth.
This early contact should be continued till the first breastfeed is complete,
this is called Breast Crawl. This practice was initiated by IYCF& HMB
guidelines (Infant and Young Child Feeding & Human Milk Banking Guidelines)
in 2015. 7 Since the reflexes in the new-born are
highly active in the first few minutes of delivery, especially those reflexes
for feeding, it is important that the bond between the mother and child for
feeding is built in this crucial time.
Colostrum is the first milk produced by
the mammary glands of mammals in late pregnancy just prior to giving birth and
continuing through the early days of breastfeeding. 8The
colostrum feeding has significant effects for immediate and future health of new-born
infants especially in developing countries that have high rates of
malnutrition, infectious diseases and mortality for children under the age of 5
years. 9 10 Colostrum
is very rich in proteins, carbohydrates, vitamin A, and sodium chloride and
contains lower amounts of lipids and potassium than normal milk. It has
essential immunoglobulins which build the child’s immunity, hence can be called
as the 1st natural vaccine. 11 12 13
Breast crawl helps in receiving this essential colostrum.
The prevalence of early
breastfeeding has remained low even though there has been adequate information
to promote and support early breast feeding. 14
In India, breastfeeding
appears to be influenced by social, cultural, and economic factors. In 1991,
Breastfeeding Promotion Network of India (BPNI) was introduced to protect,
promote and support the practice breastfeeding.15 Furthermore, the Government of India has undertaken the
National Rural Health Mission, which is to implement Integrated Management of
Neonatal and Childhood Illnesses (IMNCI) through the already existing
healthcare delivery system.16 The promotion and acceptance of these practices, such
as early breastfeeding and breast crawl, are specifically important in
While, a significant number
of studies have been made to assess the knowledge, attitude and practice of
breastfeeding in different parts of the world; such studies are low in number
among Indian mothers. There are not many reported studies of breast crawl
knowledge and attitudes of mothers using the IIFAS (Iowa Infant Feeding
Attitudes Scale) and IYCF & HMB guidelines from India. Moreover, maternal
attitude is also a concept of interest to those who support breastfeeding. 717 18 19 20
In this regard, we are
proposing a study to examine the knowledge, attitude and practices towards
breast crawl among Indian postnatal mothers’ using the IIFAS and IYCF & HMB
access the knowledge, attitude and practices of mothers, of rural parts of
central Karnataka, regarding and breast crawl.
document why the mothers are unable to practice breast crawl.
is a cross-sectional study. The study population comprises of post-natal mothers, who delivered and are admitted in
Adichunchanagiri Hospital and Research centre, B.G. Nagar, Mandya district,
Study participants will be selected through a random sampling
method of post-natal mothers admitted in the hospital. Those who meet the
inclusion criteria will be interviewed.
The study criteria;
a) Mothers of newly
delivered healthy infants,
b) Born between 37weeks
and 42weeks of gestation period,
c) Without major birth
defects such as congenital heart disease, cleft lip/cleft palate, Down syndrome,
d) Those who volunteer to participate.
Mothers of preterm
infants, and/or multiple gestations will be excluded.
200 postnatal mothers will be interviewed.
obtaining the permission from the hospital authorities, all mothers
participating will be briefed about the purpose of the study. Informed oral consent
will be obtained from each of the participants. A predesigned questionnaire
will be administered to the mothers. Data will be collected through a face-face
interview. Patient confidentiality will be maintained. Neither the mother nor
the child will be harmed in this study.
study will help us access the knowledge, attitude and practicing of breast
crawl among mothers of rural (central) Karnataka. With the above expected
results we can plan on strengthening the IYCF & HBM guidelines and educate
more mothers about the practice of breast crawl.
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Van Rossum CT, Büchner FL, Hoekstra J. Quantification
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