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Since 1993, WHO efforts to improve infants and young child nutrition have focused on
promoting breastfeeding. It has been calculated that breastfeeding could prevent the death of
at least one million children in a year. A new baby friendly hospital initiative created and
promoted by WHO and UNICEF has proved highly successful in encouraging proper infant

Baby friendly hospital is a scheme is envisaged which advocates immediate breast
feeding of the children born in hospital. Mothers are initiative breastfeeding within an hour.


Step 1 : Have a written breastfeeding policy that is routinely communicated to all staffs.
The policy guidelines in co-operating ten steps for successful breastfeeding should be
prominently displayed in the antenatal clinic, delivery room, special care baby unit and
maternity ward, so that mother and health care staff are constantly reminded of its importance
and implementation. The hospital authority should clearly state their commitment of not
accepting any free of low cost samples of infant formula. The policy statement should written
in English and local languages.

Step 2 : Train health care staff in skill necessary to implement this policy
The health care staff should be trained the art and science of breastfeeding. The
practical training to implement steps for successful breastfeeding should be taught as a part of
ongoing inservice training programme. They should be provided with practical information and
skills to assist the nursing methods for manual and mechanical expression of breast milk correct
positioning and attachment of the baby during breastfeeding etc.

Step 3 : Inform all pregnant woman about the benefits and management of breastfeeding
During antenatal period the mother should be educated regarding the advantages of
breastfeeding not only their babies but also nursing mothers as well. They should be motivated
and assisted for promotion of exclusive lactation should explained, aware them about dangers
of bottle feeding.

Step 4 : Help mothers to initiate breastfeeding within half hour of birth

Establish mother-baby bonding soon after delivery and encourage all mothers to put the
baby on the breast within half-hour of birth. They should be advised not to administer any pre-
lacteal feeds. Babies born by caesarean section should be put to the breast as soon as the
mother has recovered from the effect of anaesthesia.

Step 5 : Show mothers how to breastfeed, how to maintain lactation, even they are
separated from their infants
The mother should be taught the art of breastfeeding when their baby is small or sick,
they should be taught the correct technique of expressing the breast milk manually or with the
help of breast pump to maintain adequate lactation.

Step 6 : Give new born infant no food or drink other than breast milk unless medically
Ensure as far as possible feeding of all new born babies with human milk. The staff
should know the indication when supplementation is required.

Step 7 : Practice rooming in allow mothers and infants to remain together round the
The policy of keeping healthy normal babies or babies born by caesarean section in a
nursery is strongly condemned because it is detrimental for the success of breastfeeding.

Step 8 : Encourage breastfeeding on demand

Mother should be encouraged to breastfeed their babies whenever they are hungry and as
often as long as the baby wants.

Step 9 : Give no artificial feeds or pacifier (also called dummies and so other) to
breastfeeding babies
No pacifiers should be promoted in the hospital due to their potential risk of causing
infection and compromising nutrition. Expressed breast milk or any other medically indicated
fluids should be administered either through an oro-gastric tube or spoon/palady (depending
upon the vigor and maturity of the infant and the use of feeding bottles should be banned.
Step 10 : Foster the establishment of breastfeeding support groups and refer mothers to
them on discharge from the hospital or clinic
The breastfeeding women’s support group should be established in the community for the
promotion of breastfeeding. There should be an effective system of follow-up support for all
breastfeeding mother after they are discharge from the hospital. The key family members
should be sensitized and motivated to support the breastfeeding mother. The mother should be
encouraged to take a nutritious diet to sustain her health and to ensure good quality of milk


1. Education and advice must be given to every mother in the antenatal clinic. Retracted
and cracked nipples must be managed before delivery.
2. The first feed should be breast milk (no water, honey, etc.)
3. Breastfeeding should preferable be started in the first hour of life.
4. The baby should be held in the correct position to ensure proper attachment to the
breast by grasping both nipple as well as areola.
5. Mother can feed in any position that is comfortable both for herself and her baby.
6. Rooming in is must for successful location.
7. Baby should be fed on demand and not by clock.
8. Bottle feeds should never being introduced.
9. A breast fed baby does not require supplementation with water.
10. Frequent sucking, complete emptying of the breast, correct positioning and supportive
care are the corner stone of successful lactation.

The commonest excuse for starting bottle feeding is inadequacy of lactation. This
problem of lactation failure exists but rare. The condition appears to be genetically
determined but is aggravated by poor motivated on the part of mother and lack of social
support and proper guidance to her.

The parameter for evaluating satisfactory lactation are

 There is no anatomical problem in the breast or nipple and the baby is mature and healthy
and without any oral abnormalities (cleft lip/pullate).

 During feeding, the milk drips from the contra lacteral breast.
 The mother actively interacts with the baby during breastfeeding to ensure effective feeding
for at least 10 – 15 minute.
 The baby is satisfied happy and play full and sleeps for at least 2 hours before crying for the
next feed.
 The baby voids urine at least 6 times or more during day time.
 The weight gain is satisfactory.


The criteria are;
a. A hospital that conducts a minimum of 250 deliveries per year can seek the recognition
after implementation of ten global steps for promotion of breastfeeding a duly completed
self assessment form and registration forms are sent to BFHI secretarial.
b. The hospital meeting all ten criteria is visited by an assessor for on the spot checks and to
interview the mothers and health care staff. The assessor send his report to the BFHI
secretarial which is reviewed by review committee for final recommendation.
c. The hospitals fulfilling the national BFHI requirements are recognized as baby friendly.
The national task force organizes a public ceremony for presentation of BFHI recognition
certificate and a logoplaque. The hospitals who are unable to fulfill the required criteria
for certification are informed regarding their short coming, they can reapply in later date
after eliminating all the short comings.

For the first few months of life breastfeeding is the best food which is made available by
nature for healthy growth and development. It has many advantages such as;
i. It is nutritious appropriate to the requirement of the child upto 4 to 6 months old age.
ii. It is fully digested and absorbed.
iii. It does not require any preparations, avoidable in the right consistency and temperature.
iv. It provides immunity for the various infection for the first few months.
v. It is simplest ways of feeding the baby.
vi. It is safe because it is clean and hygienic.
vii. It helps to restoring woman’s figure as the fat accumulated during the pregnancy is used
up in breastfeeding.
viii. Breastfeeding helps in involution of uterus in normal size.

ix. Breastfeeding delays menstruation inhabit ovulation and thus protect against pregnancy
but the duration of contraceptive effect is unknown.
x. It promote bonding between mother and baby.
xi. Sucking in breast helps development of jaws and teeth.
xii. It helps in preventing malnutrition and promote child survival.
xiii. It reduce the risk of post partum haemorrhage.
xiv. It lowers the risk of breast and ovarian cancer.
It is a rare expectation when a woman cannot breastfeed her baby for physical or
medical reasons. Yet a woman’s ability to feel self confidential and secure with her decision to
breastfeed is challenged by her family and friends. The media and health care provider.
Although the hospital is not and should not be the only place a mother received support for
breastfeeding hospitals provide a unique and critical link between the breast feeding support
provided prior and after delivery.


In uterus infant is exposed to sound level about 40 – 60 decibels. It has been shown that
when sound level exceeds 7.7 bb it causes discomfort to the baby. The main sources of noise in
NICU include telephone rings, equipment alarms, paging bleeps, air compressor, curting of
equipment, loud talking during rounds, etc. It is amazing to realize the babies in the NICU can
handly sleep not more then 4 – 10 min at a time.

For prevention, the doors and drawers should be padded and ceiling and the walls can be
provided with noise-absorbing materials. The health personal should learn the art of speaking
softly and walking gracefully in the nursery.
 The incubator can covered with blanket.
 The doors and port holes of incubator should opened gently.
 The incubator top should never used for writing surface.

Most NICU maintain high intensity of day and night illumination ranging. Bright light may
adversely affect the development if central visual system and may lead to development of
squint. Deam light has been shown to improve duration of sleep, decrease motor activities,
reduce heart rate, improve tolerance of feeds and increase weight gain of stable preterm

Gentle handling

All efforts should be made to handle babies gently kept them in a comfortable position.
Preterm baby maintain better oxygenation, temperature control and sleep pattern when they
are nursed in prone or leteral position.

Bad handling
When a baby is handle roughly he is squirming, crying and recoiling his arms and legs,
which some times may lead to hypoxymia and sudden elevation of BP and intraventricular

Feeding with human milk

By expression or nasal tube only human mothers milk should provide.

Rhythmic gentle stimulation

It is desirable to assign one or two babies o nurse and they should follow individualized
and flexible approach in their care. Stimulation should be provide when the baby is
physiologically and alert or receptive.

Tactile – Kinesthetic stimulation

The tactile stimulation should be provided by gently touching the head or back of the
baby while speaking softly in a soothing voice. The baby should be positioned in such a way so
that he is able to suck his finger or touch his face etc. Encourage to grasp the fingers of care

Body massage
Body massage is culturally accepted in our society and has scientifically proven benefits.
Massage should done with non irritating and non scented oil (Eg. Olive oil, coconut oil). The
baby enjoy comfort to touch and oil massage it promotes handing wit the mother.
After all the NICU should have womb like ambience and ecology. The lighting should be
kept dimmed with a day night pattern. The sound level should be low and light kept dimmed to
have quiet periods during each shift. The baby should be provided with a comfortable next and
kept on the side or prone with flemon of the limbs. The nurse should be trained to provide an
individualized and developmentally supportive care.