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1.0 Introduction

Breastfeeding is the nourishing of ababy or young child with milk from her mother’s breasts. Breast milk is the healthiest form of milk babies could have. The World Health Organization has endorsed breastfeeding as the best way of feeding infants. Years of research have shown that there are not just benefits for the infants, but for the mothers as well (Kakuma 2002). For the infants, breast milk protects against acute and chronic diseases and supports optimal development. It also promotes a psychological attachment with the mother, which is very important for them as they grow. For the mothers, breastfeeding helps them not only recover from the pregnancy and childbirth experience, but also has some lifelong health advantages (Aarts 2001).

2.0 Literature Review

Infants have a sucking impulse that allows them to suck and swallow milk. Along with some exclusion, (e.g. presence of HIV in mother) human breast milk is the greatest source of nutrition for human babies. Some scientists, however, differ on the optimal breastfeed period in order to reap the greatest value. Another fundamental question is how much more risk is involved in utilizing artificial formulas rather than breast milk. Despite there being conflicting arguments about the relative value of formula feeding, Riordan (2004) asserts that formula feeding is mediocre to breastfeeding for both premature and full-term infants. International organizations, such as the World Health Organization (WHO), endorse breastfeeding as the best way of feeding babies in their first year and beyond. There are abundant examples of studies promoting exclusive breastfeeding i.e. when a newborn receives no other food or drink, as well as water, besides breast milk, and the use of human breast milk. Regulatory establishments are aware of the superiority of breastfeeding, but are also working to make artificial feeding benign. The American Academy of Pediatrics (AAP) also encourages exclusive breastfeeding and the use of colostrum as the best technique of feeding babies.

International guidelines indorse that all newborns be breastfed wholly for the initial six months of life. The American Association of Pediatricsendorses this so that the baby receives the perfect amount of nutrients essential for ideal growth and development. Breastfeeding may carry on with the addition of suitable foods for two years or more. The WHO suggests that in those few health circumstances where babies cannot or should not be breastfed, the following substitutes should be taken: breast milk from a healthy milk bank, expressed milk from the baby’s own mother, or a breast milk auxiliary fed to the baby with a cup. The selection of any of these options is reliant on on individual conditions. Newborns, who are not breastfed, should be accorded special consideration from the social welfare and health system as they are part of a risk group. This means that, babies who are not breastfed are likely to be predisposed to to infections.

Breastfeeding assists both mother and child psychologically, physically and emotionally. The preferment of breastfeeding and the use of colostrums for baby feeding leads to a number of profits, including; nutritional, health, psychological, developmental, economic, social and environmental benefits.  Timely breast feeding of the kid helps to fight the attack of certain maladies and improves the physical well-being and sound brain growth of the kid. Exclusive breastfeeding has vividly reduced newborn deaths in developing countries by decreasing cases of infectious diseases and diarrhea. Breastfed children also have a reduced risk of sudden infant death syndrome (SIDS). During the course of breastfeeding, the antibodies, nutrients and beneficial hormones in the mother’s body are distributed to her baby. Breast milk comprises the amino acids taurine and cystine that are crucial for the growth of an infant’s nervous system and brain. Breast milk also has numerous anti-infective factors, such as the anti-malarial factor para-amino benzoic acid. Sucking boosts the proper growth of the infant’s teeth and speech organs and helps avert impediments.

In addition, breastfeeding strengthens the tie between mother and baby, since breastfeeding releases the hormones prolactin andoxytocin, which eases the mother and causes her to feel a sense of comfort and compassion for the baby during breastfeeding. Since fat amassed during pregnancy is utilized to create milk, breastfeeding may aid mothers drop weight. Exclusive breastfeeding can also defer the reoccurrence of ovulation. Even though some mothers may experience pain after breastfeeding due to staphylococcal infection of the nipple, this problem can be easily treated with continued breastfeeding. Mothers who breastfeed their infants face a lower risk of endometrial and breast cancer.

Babies who are breastfed solely feed anywhere from seven to fifteen times per day, with infants consuming between 40 mL and 100 mL of milk every day. After the age of five weeks, children ingest around 11 mL per feed. Every baby is different, but as he or she develops the volume of milk ingested normally increases. It is significant to identify the baby’s hunger indicators since it is presumed that the infant knows how much milk they require and it is thus advised to let the baby direct the incidence and length of each feed. The quantity of colostrums from the breast is decided by the length and number of these feeds or the volume of milk conveyed, among other factors. An infant’s birth weight might also have impact on their feeding habits and mothers may be prejudiced by what they observe the baby’s requirements to be. For instance, a babywho weighs less than their recommended weight for their gestational age, might lead a mother to think that her kid needs to feed more than if her child was larger; nevertheless, mothers should survey the needs of the baby instead of what they assume to be necessary. Even though it can be challenging to measure how much food a breastfed child ingests, babies typically feed to meet their own needs. Toddlers should also be weighed before and after breastfeeding in order to regulate the result of their feeding habits on their development.

Exclusive breastfeeding is providing an infant with the mother’s breast milk directly from the breast instead of a baby bottle (Ehiri 2009). Infants have no problem doing this because they are born with a natural suckling reflex. Mothers are advised to do exclusive breastfeeding for the first 6 months without feeding the infant any supplements. This paper aims at answering the following question; is exclusive breastfeeding important for infants? The paper achieves this goal by investigating the wide ranging benefits of exclusive breastfeeding for infants below the age of seven months.

Breastfeeding is vital because of the health, nutritional, developmental, immunological, and psychological benefits that breast milk offers infants and children. The American Academy of Pediatrics recommends breastfeeding as the preeminent type of nutrition for babies. Studies show that newborns who are breastfed are not likely to suffer from urinary tract infectionsear infections, lower respiratory infections, diarrhea, andbacterial meningitis. Breast milk could also help shield against allergies, digestive disorders and Sudden Infant Death Syndrome. Breastfed toddlers are highly unlikely to need visits to doctor’s offices and hospitals and are less likely to need pharmaceuticals. Science has also discovered the long-term merits of breastfeeding, proposing that breastfeeding may increase long-term immunological reaction. Furthermore, breastfeeding may have health benefits for the mother, with one research discovering that moms who breastfeed for a longer period were not likely to develop type 2 diabetes, even when controlling for other risk factors. In consideration of cognitive and developmental benefits, studies have shown a positive link between longer breastfeeding and enhanced school performance in offspring and adolescents and higher IQ in adults. Finally, the act of breastfeeding has emotional merits for both the mother and infant. Breastfeeding is a time of bodily contact and intimacy, nurturing the bond amid mother and child.

The effect of breastfeeding on the superior cognitive and emotional development of the child and later Intelligent Quotient (IQ) has been documented by several studies. Breast fed infants versus artificially fed have been shown to have higher IQs and more advanced social and cognitive development relative to their hereditary makeup, the social, nutritional and environmental background. The benefits of breastfeeding to the nursing mother in the first few months after delivery have also been shown, attributed to mother infant bonding. Early mother-infant bonding induces a series of changes in the brain cells with the release of chemical neurotransmitters activating of the hormones of lactation. The ensuing increase in prolactin hormone creates a state of tranquility in the mother and allows her to withstand the strain of childcare and the additional burden of transition to parental role. The psychological status of mothers impacts the health and well-being of their children in so many ways. Of particular importance is the psychological status of mothers who are breastfeeding, since their infants are passing through a critical stage of their growth and development. Earlier studies have shown the impact of maternal deprivation on the development of inorganic failure to thrive, autism and other forms of cognitive dysfunction. Moreover, mothers who have been exposed to abuse in their early childhood tend to have high rates of affective disorders as parents. However during the second year of life it not known whether the psychological benefits of breastfeeding are still present. It is well documented that extended breastfeeding of infants into the second year of life have immunological advantages to the baby whereby shielding the newborn from the recurrentinfective incidents in this stage of life. Breast milk is a good source of calories, protein and micronutrients for children living in deprived conditions. However the effects of continued breastfeeding into the second year on child development and behavior are not clear. Moreover it is not clear whether the psychological status of mothers benefit from the extended breastfeeding. The interaction of factors influencing continuity of breastfeeding into the second year of life makes it challenging for us to define clear cut behaviors that affect stability. Use of optimal development as a criterion for optimal feeding practices in that period is not possible since so many factors influence child's development in this period as nutritional status, iron deficiency, exposure to lead, prematurity and breastfeeding practices in the first year, also environmental and socio-cultural factors. Whereas the psychological status of the mother is influenced by many factors such as working status, social support, medication, chronic illness and hereditary tendency to development of affective disorder.

The research was guided by Erik Erikson’s Psychosocial Theory of Development. He believed development occurs throughout the lifespan, and his theory provides new light into the formulation of a healthy personality (Ding and Littleton 2005). His theory includes eight stages and at each stage, conflict or crisis occurs. This study focuses on the first stage, Trust vs. Mistrust, which occurs during the first eighteen months of life. At this stage, children learn to trust or mistrust the environment where they are in and to trust it, they need to have warm, consistent, predictable and attentive care (Ding and Littleton 2005). They need living physical contact and nourishment. Mistrust occurs when the infant is handled harshly and experiences an unpredictable world. The psychosocial theory will guide me in finding out if exclusive breastfeeding plays any role in the wholesome personal development of infants.

3.0Methods

Stage I: Qualitative research:

Preceding to the research we piloted three focus group discussions with mother-infant pairs in the second year postpartum. The aim of the FG was to design appropriate questionnaire forms for assessing breastfeeding practices, mother-infant interactions and other factors that may be relevant to this community that could be worth considering during the quantitative analysis stage of the study.

Stage II: Quantitative research

Sampling: Selection was done from the pediatric outpatient clinic XXX hospital that is located in XXX urban regional community. The sample consisted of eight mother-infant pairs whose infants were aged zero to six months and were free of any major clinical illness, developmental delay or chronic disability. Stage III: Evaluation:

3.01 Interviews:

1. All mothers were interviewed to assess their socio-demographic background, breastfeeding practices in the first year, mother infant interaction, infant's development and behavior.

2. Assessment for Affective trait in themothers: The mothers were assessed for melancholy using the Beck Depression Inventory (BDI) and for anxiety scores using the STAI for anxiety state and trait.

3. Assessment of Infants: The infants were assessed for growth, nutritional status, behavior and development. Growth wasassessed by measurement and charting of weight and supine length measurement to the nearest gram for weight and cm for length according to WHO standard methods for anthropometry. The charts used were the NCHS/WHO/CDC reference child growth charts for developing countries. The growthindicators were evaluated using the Denver developmental screening test (DDST-R), in which the screener identifies and administers the three items immediately to the left of the age line for a total of 12 items. If any of the items failed or refused this indicates delay or potential delay respectively. Behavior disorders were diagnosed based on history taking, mother's description of the disorder, and by observation. The child was observed during the visit to assess speech, vision and hearing using the classic tests described for this age, also for mother-infant interactions, behavior, socialization and play.

Stage IV: Statistical Analysis: This was conducted using chi-square, computer software, one-way ANOVA testandT-test.

3.02 Ethical guidelines.

Handling data can be quite tricky and the various data protection principles that are stipulated in the data protection act must be observed. Various guidelines were followed in order to ensure that the research was conducted in an ethical manner. The first guideline followed was the anonymity guideline. The survey forms were designed in a way that, the respondents were anonymous (Linden, 2005).

The survey forms did not have an option, whereby the respondents were going to identify themselves by their names. This was in a bid to ensure respondent anonymity. This is important in the sense that, knowing the respondents identification might, leads to victimization.

Also, another ethical guideline that was followed is the informed consent guideline. The informed consent basically states that respondents should voluntary participate in a survey, and they must be informed of the research objectives.

The respondents should not be forced into participating in a research. Their participation in the survey should be voluntary and at their own discretion. Students were informed of the objectives of the study, and the goals of the research. This was explicitly explained in the cover letter of the survey forms. Also, on the cover page of the survey forms, students were informed that the participation in the surveys is voluntary, and if they feel that they do not want to participate in the survey, then they could withdraw their participation.

 Besides, students were guaranteed that the data, and information collected was going to be specifically used for the intended purpose. The data and information obtained will not be used for any other purposes apart from the research objectives. Students were also guaranteed that the collected data will not be disclosed to another third part apart from the authorized individuals, who are undertaking the research. Students were given the assurance that, the data and information gathered will be destroyed once the research objectives have been achieved.

3.04 Findings

Findings of Study

The discoveries were separated in to three main categories:

1. Results associated to the infants' health, growth and nutritional status, developmental indicators' progress and behavior conditions going by the absence orpresence of breastfeeding in the 4 to 6 months aged babies.

2. Results related to the mother's breastfeeding practices, socio-demographic status, outcomes for affective trait disorder, of anxiety and depression and their circumcision status according to their persistence of breastfeeding.

3. Results related to support given to mother with child care and house-work, paternal socio-demographic statistics, violence with mother in mother-infant pairs who were breastfeeding currently compared to those who had stopped.

1) Outcomes in infants:

* Growth

 Mean weight for newborns fell within the range of 5.4-8.3 kg in group I and 10.5- 12.4 kg in group II. Average supine length was within the range of 72.2-76 cm in group I and 73.7-78.4 cm in group II.

* Health and nutritional status

The recurrent episodes of respiratory tract infections and diarrhea over three times during the first six months were expressively higher in the group II (76%) and (45%) paralleled to group I (3.5%) and (4.9%) correspondingly at P<0.001. Nonetheless, the mean body mass index (BMI) presented no noteworthy dissimilarity between both groups rising from 17.5 to 20.5 between ages 4 to 6 months.

* Developmental assessment

The average mark of the DDST-R for growth status was 65.47% in group I and 57.4% in group II for fine motor, 70.7% for group I and 55.53 for group II for personal-social, 76% in group I and 65.14 in group II and lastly 70.25% in group I and 56.3% in group II for language,. Therefore, all four sets of development were poorer in the group of infants who were deprived of breastfeeding persistence up to six months of life. The dissimilarity was statistically noteworthy for personal-social and communication or mental development P< 0.5.

* Behavior syndromes detected

Thumb sucking (11%), Pica (14.3%), temper tantrums (10.16%), titubation (8.5%), sleep disorders (9.3%), extreme attachment (6.8%) and head banging (7.8%).Behavior disorders were pointedly higher in group II (76%) compared to (47.3%) in group I at P< 0.05. High mother-infant contact scores of 6-7 had considerably lower incidence rates of behavior syndromes (1.37%) paralleled to those with contact scores of 2-3 and 1-2 of (30.6%) and (27.3%) correspondingly at P< 0.05. High mother-infant contact results (MIS) were suggestively linked with a higher percent of growth achievers at P <0.003 for gross motor, P<0.0001 for cognition and communication and P< 0.0002 for fine motor abilities.

2) Findings in mothers:

Socio-demographic data:

There were no obvious dissimilarities between mothers in group I and those in group II in terms of age, occupation and residence. Nevertheless, mothers who breastfed well into the sixth month of life had a higher likelihood of being highly educated, 27.7% received university education and 57% secondary education compared to 7.3% and 33.7% in group II, the variance was noteworthy at P< 0.0002. Although mothers who withdrew breastfeeding earlier were mostly primiparous mothers (75%) in comparison to (45%) in the respective group, with a statistically noteworthy difference at P<0.0001. Many of the babies of mothers with higher education (secondary and university)(95.5%) did not have any behavior disorders in comparison to only 7.5% of toddlers whose mothers were of a lower level of edification at P<0.002.

Breastfeeding practices:

* Early exclusive breastfeeding at birth:

Mothers who persisted to breastfeed for up to six months were introduced no pre-lacteals or enhancements in the first week of post-delivery (69%), or nipples in that retro paralleled to group II mothers, whose use of enhancements was 58.7% and nipples was 59.7%. The dissimilarity was statistically momentous at chi-square= 7.7 P< 0.006for enhancements given and chi-square= 19.28, P <0.0002 for nipples presented.

* Exclusive breastfeeding during the first 6 months:

More mothers in group I persisted to exclusively breastfeed for the leading 4 months (38.7%) matched to group II mothers (13.7%) at chi-square = 13.5P<0.001. Many mothers in group I did not introduce bottles (89.3%) or pacifiers (85%) for the first six months whereas 68.3% of group II mothers gave bottles chi-square = 38.7, P<0.0001 and 65.7% gave pacifiers to their babies before six months of age chi-square=25.5, P<0.0001. Other milk formulas were presented to babies before 4 months by 70.3% by group II mothers in comparison to 23.3% of group I mothers, the variance was substantial at chi-square = 16.7, P< 0.0001. Many mothers of both groups had started to present foods by 4 months of age (85.7%) of group I and (71.3%) of group II, with no statistical dissimilarity amid both groups.

* Affective trait disorders in mothers

Nervousness scores were expressively higher in 85% of group II mothers in comparison to 13% of group I mothers at chi-square = 14.5 with P< 0.0001. Melancholy scores were likely to to be high in both group I mothers (54.22%) and group II mothers (44.98%) at chi square = 0.7 with P=0.34. High outcomes of melancholy in mothers seemed to be associated with lower scales of mental and communication developmental classes in their babies at P<0.05. High apprehension results were ominously related with lower developmental scales in the fields of intellect (personal-social) (66.37%) and communication (language) (68.46%) and fine motor (65.88%) in their babies in comparison to mothers with lower nervousness scores (45%, 47% and 51%) respectively.

4.0 Discussion

In this research, we have revealed how unrelenting breastfeeding for up to six months is advantageous to the communication and cognitive features of development of toddlers at that age. Furthermore, we have demonstrated that the psychological condition of mothers and the manifestation of affective disorder in the parent in the form of anxiety or depression may be harmful to the toddler's behavior and development. This study is reinforced by the discoveries of other scientists who have demonstrated superior cognitive development amongst breastfed babies. Studies disclose that in preterm infants, mother's choice to offer colostrums was linked with higher developmental scores at 6 months. They also testified superiority of intelligence quotient (IQ) in the same kids seen at seven to eight years with an 8.5 point benefit in IQ continued even after modification for differences among groups in mother's social class and education. Pollock (1994), stated that some features of intellectual achievement at five and ten years of age can be established to be inferior amid children who were formula-fed in comparison to those who were entirely breastfed for at least four months. Gomez-Sanchez et al. (2004), testified that results on the Bayley Scales of kids' capabilities were considerably higher as the period of breastfeeding increased. Morrow-Tlucak et al. (1988)reported a noteworthy dissimilarity between bottle-fed kids, children breastfed less than or equal to four months and those breastfed more than four months using Mental Development Index of the Bayley Scales at ages 1 and 2 years, backing the breastfed children. Lucas et al. reported that formula-fed preterm infants had inferior Bayley Mental Development scores at 6 months, even after fine-tuning for demographic and social impact. Oddy et al. revealed that cognitive growth of breastfed children is superior on the performance on developmental tests at the age of four years. Further studies revealed the positive outcome of continued breastfeeding on the later psychosocial correction during adolescence. Quinn et al. (2001) demonstrated the superior influence of continuous breastfeeding on the mental development at age 1 and five years. This research also validates the precise effect of continuity of breastfeeding up to six months on the advance of behavior disorders. Nonetheless, it is contentious whether breastfeeding alone or the incidence of anxiety too heightened the manifestation of such conditions among these babies. Fisher and Mitchell (1992)assert that some behavior conditions might be as a result of the mother's psychological state and labeled it "Munchausen's Syndrome by proxy or factitious illness by proxy". The steadiness of breastfeeding in this research was affected by numerous influences including social status, education of the mother and breastfeeding practices after birth and during the first six months of life. Houston (2004)verified that the early breastfeeding does and social class inclined the duration of breastfeeding. Another momentous discovery was the high percent of parental apprehension in those who were not breastfeeding. The high percentage of apprehension amongst those mothers, in this research, might have been as a result of the child's frequent illness, low social standards, and father’s violence with mother or child, with superimposed social factors of poverty, occupation of father and low levels of education.            Furthermore, those children of mothers with high nervousness scores had deprived growth outcomes. Due to the fact that many of these mothers were also not breastfeeding, therefore, the developmental result was due to the collective consequence of cessation of breastfeeding and parental unease. Melancholy also had harmful effects on child growth. However, in this study we observed that the persistence of breastfeeding appeared to modify this effect, as the children who were breastfeeding had higher tallies of development. It could thus be assumed that breastfeeding can protect the baby from the perils of affective disorder in the mother. The means by which breastfeeding could be defensive is unclear, but it could be hypothesized that high mother-infant relations present in the cluster of mothers who continued to breastfeed might be the protective aspect. Mothers with emotional disorders may elude interaction with their babies as a stigma of their condition. Nevertheless, breastfeeding coerces them to relate with their children, thus sustaining continued inspiration of their toddlers needed for sufficient development predominantly in the social, intellectual and emotional fields.           Through the study we have displayed through focus group discussions that mothers who are exposed to tension from ill treatment by their extended family members or husband frequently found mitigation of their sorrow by playing and intermingling with their children. Anxiety and depression and are connected with conciliations in infant emotional and social functioning and relations of mother particularly midst infants who are not breastfed or deprived of early interaction at birth with their mothers. Fathers had a weighty role on the development of the baby and the behavior pattern. It is unclear whether his influence was straight on the child, or through his part in supporting the mother in childcare and housework. It was obvious that father's backing was linked with high mother-infant communication scores.

Highly educated fathers were more empathetic to mothers by being supportive in housework and cooperative with their kids. Fathers, as childcare providers, have substantial effects on their child growth as revealed by other scientists. Studies on early mother pleasure with care set at delivery and support with breastfeeding from health staff and family have exposed the women's needs for psychosocial, informational, tangible and medical care sustenance during the first six months after delivery. Concrete support mostly cited was that in the form of maintenance with childcare and housework. When the women’s passionate needs from their husbands were not met, they were inclined to compensate for it by looking for relaxation through relations with their kids. Increasing stress made women react by being violent with their offspring. Lacks of husband’s sensitive backing, troubleshooting in-laws were triggering reasons. Husbands undoubtedly play a critical role by supporting mothers during delivery and thus facilitating successful breastfeeding and bonding.

Limitations: Sometimes the mothers may not be able to meet me for observation. Being an outsider, some mothers may fail to confide fully in me concerning the development of their infants. In case an infant is admitted in a hospital due to sickness, I may not be able to continue collecting the necessary data. Some infants may develop conditions that are beyond the scope of my study.

Delimitations: I am choosing not to observe mothers that reside outside XXX Division because of distance and travel costs. I will not user closed-ended questionnaires in my study to allow the respondents provide as much information as possible.

5.0 Conclusion

It is concluded that breastfeeding up to six months is vital for the developmental outcome, health and behavior patterns of infants at that age. Women's psychosocial wellbeing and health should be supported as they affect breastfeeding stability and the health and wellbeing, emotional and intellectual growth of their children. Husbands and fathers play significant roles in the result of their children's development and health by offering the needed emotional and tangible support for the breastfeeding mothers. Study recommends a comprehensive primary method to women and family care. We, consequently, strongly endorse that health care groups and women support organizations should set strategies or protocols for the sustenance of breastfeeding during the initial months of life. 

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