Lactation and infant nutrition.

Abstract

Lactation is of great importance to infant nutritional needs. It is difficult to generalize about infant growth expectations since there are variations among communities and since there may be some modification of infant feeding practices. The choice of an appropriate standard is even more difficult to estimate since they are interdependent on energy intakes. However, the balance between energy and protein content in breastmilk appears to be fairly constant through lactation and among communities. It is likely that for normally growing children exclusive breastfeeding is not likely to result in a serious mineral or nutrient deficiency. Discussion is included about measurement of breastmilk output and the various means to do so in order to calculate energy and nutrient requirements. Currently, controversy surrounds the timing of milk supplements for those infants being breastfed. A general guideline seems to be that weaning should be avoided before age 4 months in industrialized countries. The various problems which are reiterated are: growth targets, nutritional requirements, optimization of lactation, and the weanling dilemma. A rational public health target should be normal growth and the maintenance of a normal nutritional status. Nutritional requirements must be sensibly set because if the target is too high it will be dismissed as impractical; if it is too low, it will fail to meet the needs of a substantial portion of the population. It seems wise to concentrate on achieving an optimal start to lactation in the early weeks when it appears likely that the breastfeeding potential is being determined. Since normal growth in infancy is an appropriate health goal, breastfeeding should perhaps be utilized to the maximum and be backed by systematic supplementation at a time when growth would likely falter. More attention must be directed toward prevalent weaning strategies.