MAAF,
Pak, ASI memang penting bagi bayi apalagi pemberiannya selama 6 bulan, ini
sudah sangat langka ada ibu yang mau
Memberikan ASI selama 6 bulan, tapi masalah anak cerdas dan pintar
tergantung dari didikan dan perhatian orang tua
Walau pun diberi ASI selama 6 bulan kalau orang tuanya tidak baik dalam
kehidupan sehari - harinya, Contoh segi
Makan dan minum, kelakuan terhadap anak dll. saya rasa anak tersebut akan
sangat sulit untuk berkembang dengan
Tingkat kemampuannya. Demikian saja Pak masukan dari saya.
Maaf kalau tidak berkenan.
` Salam dari papanya
Sheika
-----Original Message-----
From: Kristianti Dewi Joris [mailto:[EMAIL PROTECTED]
Sent: Monday, June 07, 2004 6:05 PM
To: [EMAIL PROTECTED]
Subject: [balita-anda] ASI Eksklusif (was: Roti Milna)
Pak Alam,
terus terang saya nggak punya data yang lengkap mengenai bukti bahwa bayi
yang mendapatkan ASI eksklusif selama 6 bulan hasilnya lebih cerdas dari
bayi yang hanya mendapatkan ASI eksklusif selama 4 bulan. Yang bisa saya
lakukan untuk bapak hanya mencuplikkan artikel dari AAP mengenai ASI.
Seperti yang sudah bapak ketahui bahwa ASI mengandung nutrisi yang tidak
dapat digantikan oleh apapun buatan manusia. Dengan pemberian ASI eksklusif
secara optimal tentunya bayi kita juga akan mendapatkan yang terbaik secara
optimal juga kan Pak. Mengenai kecerdasannya nanti bagaimana, tetep harus
didukung oleh faktor lain juga seperti lingkungan dll. Setau saya Pak,
mostly dokter anak baik di Indonesia maupun di luar
negeri juga menyarankan hal yang sama yaitu ASI Eksklusif selama 6 bulan
adalah yang paling ideal, karena itu juga sudah menjadi standard WHO.
Maaf ya Pak kalau kurang membantu dan tidak berkenan.
Salam,
Dewi
==============================================================
PEDIATRICS Vol. 100 No. 6 December 1997, pp. 1035-1039
AMERICAN ACADEMY OF PEDIATRICS:
Breastfeeding and the Use of Human Milk
Work Group on Breastfeeding
ABSTRACT
Top
Abstract
Conclusion
References
This policy statement on breastfeeding replaces the previous policy
statement of the American Academy of Pediatrics, reflecting the considerable
advances that have occurred in recent years in the scientific knowledge of
the benefits of breastfeeding, in the mechanisms underlying these benefits,
and in the practice of breastfeeding. This document summarizes the benefits
of breastfeeding to the infant, the mother, and the
nation, and sets forth principles to guide the pediatrician and other health
care providers in the initiation and maintenance of breastfeeding. The
policy statement also delineates the various ways in which pediatricians can
promote, protect, and support breastfeeding, not only in their individual
practices but also in the hospital, medical school, community, and nation.
HISTORY AND INTRODUCTION
>From its inception, the American Academy of Pediatrics (AAP) has been a
staunch advocate of breastfeeding as the optimal form of nutrition for
infants. One of the earliest AAP publications was a 1948 manual, Standards
and Recommendations for the Hospital Care of Newborn Infants. This manual
included a recommendation to make every effort to have every mother nurse
her full-term infant. A major concern of the AAP has been the
development of guidelines for proper nutrition for infants and children. The
activities, statements, and recommendations of the AAP have continuously
promoted breastfeeding of infants as the foundation of good feeding
practices.
THE NEED
Extensive research, especially in recent years, documents diverse and
compelling advantages to infants, mothers, families, and society from
breastfeeding and the use of human milk for infant feeding. These include
health, nutritional, immunologic, developmental, psychological, social,
economic, and environmental benefits.
Human milk is uniquely superior for infant feeding and is species-specific;
all substitute feeding options differ markedly from it. The breastfed infant
is the reference or normative model against which all alternative feeding
methods must be measured with regard to growth, health, development, and all
other short- and long-term outcomes.
Epidemiologic research shows that human milk and breastfeeding of infants
provide advantages with regard to general health, growth, and development,
while significantly decreasing risk for a large number of acute and chronic
diseases. Research in the United States, Canada, Europe, and other developed
countries, among predominantly middle-class populations, provides strong
evidence that human milk feeding decreases the
incidence and/or severity of diarrhea,1-5 lower respiratory infection,6-9
otitis media,3,10-14 bacteremia,15,16 bacterial meningitis,15,17 botulism,18
urinary tract infection,19 and necrotizing enterocolitis.20,21 There are a
number of studies that show a possible protective effect of human milk
feeding against sudden infant death syndrome,22-24 insulin-dependent
diabetes mellitus,25-27 Crohn's disease,28,29 ulcerative
colitis,29 lymphoma,30,31 allergic diseases,32-34 and other chronic
digestive diseases.35-37 Breastfeeding has also been related to possible
enhancement of cognitive development.38,39
There are also a number of studies that indicate possible health benefits
for mothers. It has long been acknowledged that breastfeeding increases
levels of oxytocin, resulting in less postpartum bleeding and more rapid
uterine involution.40 Lactational amenorrhea causes less menstrual blood
loss over the months after delivery. Recent research demonstrates that
lactating women have an earlier return to prepregnant weight,41
delayed resumption of ovulation with increased child spacing,42-44 improved
bone remineralization postpartum45 with reduction in hip fractures in the
postmenopausal period,46 and reduced risk of ovarian cancer47 and
premenopausal breast cancer.48
In addition to individual health benefits, breastfeeding provides
significant social and economic benefits to the nation, including reduced
health care costs and reduced employee absenteeism for care attributable to
child illness. The significantly lower incidence of illness in the breastfed
infant allows the parents more time for attention to siblings and other
family duties and reduces parental absence from work and lost
income. The direct economic benefits to the family are also significant. It
has been estimated that the 1993 cost of purchasing infant formula for the
first year after birth was $855. During the first 6 weeks of lactation,
maternal caloric intake is no greater for the breastfeeding mother than for
the nonlactating mother.49,50 After that period, food and fluid intakes are
greater, but the cost of this increased caloric
intake is about half the cost of purchasing formula. Thus, a saving of >$400
per child for food purchases can be expected during the first year.51,52
Despite the demonstrated benefits of breastfeeding, there are some
situations in which breastfeeding is not in the best interest of the infant.
These include the infant with galactosemia,53,54 the infant whose mother
uses illegal drugs,55 the infant whose mother has untreated active
tuberculosis, and the infant in the United States whose mother has been
infected with the human immunodeficiency virus.56,57 In countries with
populations at increased risk for other infectious diseases and nutritional
deficiencies resulting in infant death, the mortality risks associated with
not breastfeeding may outweigh the possible risks of acquiring human
immunodeficiency virus infection.58 Although most prescribed and
over-the-counter medications are safe for the breastfed infant, there are a
few medications that mothers may need to take that may make it
necessary to interrupt breastfeeding temporarily. These include radioactive
isotopes, antimetabolites, cancer chemotherapy agents, and a small number of
other medications. Excellent books and tables of drugs that are safe or
contraindicated in breastfeeding are available to the physician for
reference, including a publication from the AAP.55
THE PROBLEM
Increasing the rates of breastfeeding initiation and duration is a national
health objective and one of the goals of Healthy People 2000. The target is
to "increase to at least 75% the proportion of mothers who breastfeed their
babies in the early postpartum period and to at least 50% the proportion who
continue breastfeeding until their babies are 5 to 6 months old."59 Although
breastfeeding rates have increased slightly
since 1990, the percentage of women currently electing to breastfeed their
babies is still lower than levels reported in the mid-1980s and is far below
the Healthy People 2000 goal. In 1995, 59.4% of women in the United States
were breastfeeding either exclusively or in combination with formula feeding
at the time of hospital discharge; only 21.6% of mothers were nursing at 6
months, and many of these were supplementing
with formula.60
The highest rates of breastfeeding are observed among higher-income,
college-educated women >30 years of age living in the Mountain and Pacific
regions of the United States.60 Obstacles to the initiation and continuation
of breastfeeding include physician apathy and misinformation,61-63
insufficient prenatal breastfeeding education,64 disruptive hospital
policies,65 inappropriate interruption of breastfeeding,62 early
hospital discharge in some populations,66 lack of timely routine follow-up
care and postpartum home health visits,67 maternal employment68,69
(especially in the absence of workplace facilities and support for
breastfeeding),70 lack of broad societal support,71 media portrayal of
bottle-feeding as normative,72 and commercial promotion of infant formula
through distribution of hospital discharge packs, coupons for free or
discounted formula, and television and general magazine advertising.73,74
The AAP identifies breastfeeding as the ideal method of feeding and
nurturing infants and recognizes breastfeeding as primary in achieving
optimal infant and child health, growth, and development. The AAP emphasizes
the essential role of the pediatrician in promoting, protecting, and
supporting breastfeeding and recommends the following breastfeeding
policies.
RECOMMENDED BREASTFEEDING PRACTICES
Human milk is the preferred feeding for all infants, including premature and
sick newborns, with rare exceptions.75-77 The ultimate decision on feeding
of the infant is the mother's. Pediatricians should provide parents with
complete, current information on the benefits and methods of breastfeeding
to ensure that the feeding decision is a fully informed one. When direct
breastfeeding is not possible, expressed human milk,
fortified when necessary for the premature infant, should be provided.78,79
Before advising against breastfeeding or recommending premature weaning, the
practitioner should weigh thoughtfully the benefits of breastfeeding against
the risks of not receiving human milk.
Breastfeeding should begin as soon as possible after birth, usually within
the first hour.80-82 Except under special circumstances, the newborn infant
should remain with the mother throughout the recovery period.80,83,84
Procedures that may interfere with breastfeeding or traumatize the infant
should be avoided or minimized.
Newborns should be nursed whenever they show signs of hunger, such as
increased alertness or activity, mouthing, or rooting.85 Crying is a late
indicator of hunger.86 Newborns should be nursed approximately 8 to 12 times
every 24 hours until satiety, usually 10 to 15 minutes on each breast.87,88
In the early weeks after birth, nondemanding babies should be aroused to
feed if 4 hours have elapsed since the last nursing.89,90
Appropriate initiation of breastfeeding is facilitated by continuous
rooming-in.91 Formal evaluation of breastfeeding performance should be
undertaken by trained observers and fully documented in the record during
the first 24 to 48 hours after delivery and again at the early follow-up
visit, which should occur 48 to 72 hours after discharge. Maternal recording
of the time of each breastfeeding and its duration, as well as
voidings and stoolings during the early days of breastfeeding in the
hospital and at home, greatly facilitates the evaluation process.
No supplements (water, glucose water, formula, and so forth) should be given
to breastfeeding newborns unless a medical indication exists.92-95 With
sound breastfeeding knowledge and practices, supplements rarely are needed.
Supplements and pacifiers should be avoided whenever possible and, if used
at all, only after breastfeeding is well established.93-98
When discharged <48 hours after delivery, all breastfeeding mothers and
their newborns should be seen by a pediatrician or other knowledgeable
health care practitioner when the newborn is 2 to 4 days of age. In addition
to determination of infant weight and general health assessment,
breastfeeding should be observed and evaluated for evidence of successful
breastfeeding behavior. The infant should be assessed for jaundice,
adequate hydration, and age-appropriate elimination patterns (at least six
urinations per day and three to four stools per day) by 5 to 7 days of age.
All newborns should be seen by 1 month of age.99
Exclusive breastfeeding is ideal nutrition and sufficient to support optimal
growth and development for approximately the first 6 months after birth.100
Infants weaned before 12 months of age should not receive cow's milk
feedings but should receive iron-fortified infant formula.101 Gradual
introduction of iron-enriched solid foods in the second half of the first
year should complement the breast milk diet.102,103 It is
recommended that breastfeeding continue for at least 12 months, and
thereafter for as long as mutually desired.104
In the first 6 months, water, juice, and other foods are generally
unnecessary for breastfed infants.105,106 Vitamin D and iron may need to be
given before 6 months of age in selected groups of infants (vitamin D for
infants whose mothers are vitamin D-deficient or those infants not exposed
to adequate sunlight; iron for those who have low iron stores or
anemia).107-109 Fluoride should not be administered to infants during
the first 6 months after birth, whether they are breast- or formula-fed.
During the period from 6 months to 3 years of age, breastfed infants (and
formula-fed infants) require fluoride supplementation only if the water
supply is severely deficient in fluoride (<0.3 ppm).110
Should hospitalization of the breastfeeding mother or infant be necessary,
every effort should be made to maintain breastfeeding, preferably directly,
or by pumping the breasts and feeding expressed breast milk, if necessary.
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