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a way of providing ideal nourishment for adequate growth and development of
neonates and the advantages range from physiological to psychological for both
mothers and neonates.1 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.

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The WHO recommends that for the
first six months of life, infants should be exclusively breastfed to achieve
optimal growth, development, and health. The infants should thereafter, receive
nutritionally adequate and safe complementary foods, while continuing to
breastfeed for up to two years or more.4  

Exclusive Breast Feeding (EBF) is
defined as infant feeding with human milk without the addition of any other
liquids or solids.5 The prevalence of breastfeeding differs from one country
to another and from one society to another, this is due to cultural and
religious believes.6  

For all newborns (including 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 & HBM guidelines (infant and young child feeding &
human milk banking guidelines) in 2015. 7

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. 8 The colostrum feeding has significant
effects for immediate and future health of newborn 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, but contains
lower amounts of lipids and potassium than normal milk. 11 12 13

The prevalence of breastfeeding has
remained low even though there have been adequate information to promote and
support 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 exclusive breastfeeding
and breast crawl, are specifically important in developing countries.

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.7 17
18 19 20

In this regard, we are proposing a
study to examine the infant feeding practices, knowledge, attitude and practice
towards breast crawl among Indian postnatal mothers’ using the and IYCF &
HMB guidelines.


1.      To access the knowledge, attitude and practices of mothers,
of rural parts of central Karnataka, regarding breastfeeding, complementary
feeding and weaning.

2.      To
document why the mothers were unable to practice exclusive breastfeeding.


This is a
cross-sectional study. The study population comprises of post-natal mothers admitted for safe-confinement at
Adichunchanagiri Hospital and Research centre, B.G. Nagar, Mandya district,

participants will be selected through a random sampling method of the database
of children visiting the Paediatric outpatient department. 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) and without major birth defects such as
congenital heart disease, cleft lip/cleft palate, Down syndrome and

d) those
who volunteer to participate.

 Mothers of preterm infants, and/or multiple
gestations will be excluded. 

Approximately 200
postnatal mothers will be interviewed. A predesigned questionnaire will be given
to the mothers. After obtaining the permission from the hospital authorities,
all mothers participating will be briefed about the purpose of the study.
Written consent will be obtained from each of the participants.

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.


This 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.


Batal M,
Boulghourjin C, Abdullah A, Afifi R. Breast-feeding and feeding practices of
infants in a developing country: A national survey in Lebanon. Public
Health Nutr. 2005 (1);9:313–9.

Horta BL,
Bahl R, Martines JC, Victora CG. Evidence on the long-term effects of
breastfeeding: Systematic reviews and meta-analyses1. Last accessed on 17
July 2013..

Rossum CT, Büchner FL, Hoekstra J. Quantification
of health effects of breastfeeding: Review of the literature and model
simulation: RIVM report 350040001/2005. Bilthoven: RIVM; 2006.

WHO. Exclusive breastfeeding for six months best for babies
everywhere’. World
Health Organization; 2011. (Cited 2014 July 21).

5.      Gibney
MJ, Elia M, Ljungqvist O, Dowsett J. Ch. 1. 2nd
ed. UK: Blackwell; 2006. Clinical Nutrition; p. 2.

R, Zhao Z, Mokdad A, Barker L, Grummer- Strawn L. Prevalence of breastfeeding
in the United States: The 2001 National Immunization Survey. Pediatrics. 2003;111:1198–201.

and young child feeding & human milk banking guidelines 2015. Page4 technical
guidelines (c).

8.      La Leche League
International. What Is Colostrum? How Does It Benefit My Baby?

9.      Silva, P. (2005)
Environmental Factors and Children’s Malnutrition in Ethiopia: Policy Research.
Working Paper Series No. 3489, The World Bank, Washington DC.

10.   Alemayehu, T., Haidar, J. and Habte, D. (2009)
Determinants of Exclusive Breastfeeding Practices in Ethiopia. Ethiopian
Journal of Health Development, 23, 12-18.

11.  Ghai, O.P.,
Paul, V.K. and Bagga, A. (2009) Textbook of Paediatrics. 7th Edition, CBC Publisher
and Distributors, New Delhi, 768.

12.   Heather Fisher Senior Thesis Project (2000)
Colostrum: Properties, Functions, and Importance: The Relationship between the
Immunoglobulin Concentration in Holstein Colostrum and the Total Senlm Protein
in Holstein Heifer Calves.

Science Daily (Homepage on the Internet). Colostrum.

trends in breastfeeding. Cai X, Wardlow T, Brown DW. Int. Breastfeed J. 2012
sep 28; 7(1):12

10 years of its work. Gupta A. J Indian Med. Assoc. 2002 Aug; 100(8);512-5.

16.  NRHM. National Rural Health Mission (2005–2012) Mission document. New
Delhi: MOHFW, Government of India, New Delhi; Ministry of Health and Family
Welfare (MoHFW); 2006.

K, Sriram C, Ramesh M. Breast Feeding Practices and Newborn Care in Rural
Areas: A Descriptive Cross-Sectional Study. Indian J Community Med. 2009;34:243–6.

18.  Khasawneta
M, Khadu Y, Amarin Z, Alkafeste A. Knowledge, attitude and practices of
breastfeeding in the North Jordan. Int Breast Feed
J. 2006;23:1–17.

RN, Shah T, Raja S. Knowledge and practice of mothers regarding breast feeding:
A hospital based study. Knowl
Pract Breast Feed. 2011;9:194–200.

20.  Kishore
K. Knowledge, Attitude and Practices of weaning among mothers in Gulbarga, MD
thesis; Department of Pediatrics, MR Medical College, Gulbarga, Ranjiv Gandhi
University of Health Sciences; Karnataka, Bangalore. 2008. pp. 1–71.

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