BFHI

BABY FRIENDLY HOSPITAL INITIATIVE
INTRODUCTION
The Baby Friendly Hospital Initiative was introduced in 1992 by the World Health
Organization/United Nations Children Fund (WHO/UNICEF) to promote, protect and support
breastfeeding in the hospital or birth setting held at spedale degli innocent, Florence,Italy on 30
july to 1st august,1990.
GOALS
A key element in this promotion, protection and support is outlined in their Ten Steps to
Successful Breastfeeding.
To date, approximately 19,000 hospitals and birth centers in about 125 countries have received
the "Baby Friendly" designation.
CRITERIA
Ten steps to successful breastfeeding recommended by code of practice of WHO/ UNICEF :-
• Have a written breastfeeding policy that is routinely communicated to all health care staff
.• Train all health care staff in skills necessary to implement this policy.
• Inform all pregnant women about the benefits and management of breastfeeding.
• Help mothers initiate breastfeeding within one half-hour of birth.
• Show mothers how to breastfeed and maintain lactation ,even if they should be separated from
their infants.
• Give newborn infants no food or drink other than breastmilk, unless medically indicated.
• Practice rooming in - that is, allow mothers and infants to remain together 24 hours a day.
• Encourage breastfeeding on demand.
• Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
• Foster the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital or clinic.
STEPS
At a minimum, it should include: – The 10 steps to successful breastfeeding – An institutional

ban on acceptance of free or low cost supplies of breast-milk substitutes, bottles, and teats and its
distribution to mothers – A framework for assisting HIV positive mothers to make informed
infant feeding decisions that meet their individual circumstances and then support for this
decision• Other points can be added
Step 1. Have a written breastfeeding policy that is routinely communicated to all health
care staff.
Step 2. Train all health-care staff in skills necessary to implement this policy.
Areas of knowledge:
• Advantages of breastfeeding
• Risks of artificial feeding
• Mechanisms of lactation and suckling
• How to help mothers initiate and sustain breastfeeding

• How to resolve breastfeeding difficulties
• How to assess a breastfeed
• Hospital breastfeeding policies and practices
• Focus on changing negative attitudes which set up barriers
Step 3. Inform all pregnant women about the benefits of breastfeeding.
Antenatal education should include:
• Benefits of breastfeeding
• Early initiation• Importance of rooming-in (if new concept)
• Importance of feeding on demand
• Importance of exclusive breastfeeding
• How to assure enough breast milk
• Risks of artificial feeding and use of bottles and pacifiers (soothers, teats, nipples, etc.)
• Basic facts on HIV
• Prevention of mother-to-child transmission of HIV (PMTCT)
• Voluntary testing and counseling (VCT) for HIV and infant feeding counseling for HIV+
women
• Antenatal education should not include group education on formula preparation

Step 4. Help mothers initiate breastfeeding within a half-hour of birth.
New interpretation of Step 4 in the revised BFHI Global Criteria (2006):Place babies in skin-to-
skin contact with their mothers immediately following birth for at least an hour and encourage
mothers to recognize when their babies are ready to breastfeed, offering help if needed.”
Early initiation of breastfeeding for the normal newborn Why?
• Increases duration of breastfeeding
• Allows skin-to-skin contact for warmth and colonization of baby with maternal organisms
• Provides colostrum as the baby’s first immunization
• Takes advantage of the first hour of alertness
• Babies learn to suckle more effectively
• Improved developmental outcomes
Early initiation of breastfeeding for the normal newborn How?
• Keep mother and baby together
• Place baby on mother’s chest
• Let baby start suckling when ready
• Do not hurry or interrupt the process
• Delay non-urgent medical routines for at least one hour

Protein composition of human colostrum and mature breast milk (per litre)Constituent Measure
Colostrum Mature Milk (1-5 days) (>30 days)Total protein G 23 9-10.5Casein mg 1400 1870α-
Lactalbumin mg 2180 1610Lactoferrin mg 3300 1670IgA mg 3640 1420
• Step 5. Show mothers how to breastfeed and how to maintain lactation, even if they
should be separated from their infants
 Contrary to popular belief, attaching the baby on the breast is not an ability with which a
mother is rather it is a learned skill which she must acquire by observation and experience.
Milk removal must be continued during separation to maintain supply.
 The amount of breast milk removed at each feed determines the rate of milk production in the
next few hours.
 Milk removal stimulates milk production.
• Step 6. Give newborn infants no food or drink other than breast milk unless medically
indicated
• Decreased frequency or effectiveness of suckling
• Decreased amount of milk removed from breasts
• Delayed milk production or reduced milk supply
• Some infants have difficulty attaching to breast if formula given by bottle
Acceptable medical reasons for supplementation or replacement Infant conditions:-
• Infants who cannot be BF but can receive BM include those who are very weak, have sucking
difficulties or oral abnormalities or are separated from their mothers.
• Infants who may need other nutrition in addition to BM include very low birth weight or
preterm infants, infants at risk of hypoglycemia, or those who are dehydrated or malnourished,
when BM alone is not enough.
• Infants with galactosemia should not receive BM or the usual BMS. They will need a galactose
free formula.
• Infants with phenylketonuria may be BF and receive some phenylalanine free formula.
Maternal conditions:-
• BF should stop during therapy if a mother is taking anti-metabolites, radioactive iodine, or

some anti-thyroid medications.
• Some medications may cause drowsiness or other side effects in infants and should be
substituted during BF.
• BF remains the feeding choice for the majority of infants even with tobacco, alcohol and drug
use. If the mother is an intravenous drug user BF is not indicated.
• Avoidance of all BF by HIV+ mothers is recommended when replacement feeding is

acceptable, feasible, affordable, sustainable and safe. Otherwise EBF is recommended during the
first months, with BF discontinued when conditions are met. Mixed feeding is not recommended.
• If a mother is weak, she may be assisted to position her baby so she can BF
.• BF is not recommended when a mother has a breast abscess, but BM should be expressed and
BF resumed once the breast is drained and antibiotics have commenced. BF can continue on the
unaffected breast.
• Mothers with herpes lesions on their breasts should refrain from BF until active lesions have
been resolved.
• BF is not encouraged for mothers with Human T-cell leukaemia virus, if safe and feasible
options are available.
• BF can be continued when mothers have hepatitis B, TB and mastitis, with appropriate
treatments undertaken.
Step 7. Practice rooming-in — allow mothers and infants to remain together — 24 hours a
day.
• Rooming-in• A hospital arrangement where a mother/baby pair stay in the same room day and
night, allowing unlimited contact between mother and infant
Rooming-in Why?
• Reduces costs
• Requires minimal equipment
• Requires no additional personnel
• Reduces infection
• Helps establish and maintain breastfeeding
• Facilitates the bonding process
Step 8. Encourage breastfeeding on demand.
• Breastfeeding on demand:• Breastfeeding whenever the baby or mother wants, with no

restrictions on the length or frequency of feeds
On demand, unrestricted breastfeeding Why?
• Earlier passage of meconium
• Lower maximal weight loss

• Breast-milk flow established sooner
• Larger volume of milk intake on day 3
• Less incidence of jaundice
Step 9. Give no artificial teats or pacifiers (also called dummies and soothers) to
breastfeeding infants.
Alternatives to artificial teats• cup• spoon• dropper• Syringe
• Cup-feeding a baby
Step 10.Foster the establishment of breastfeeding support groups and refer mothers to
them on discharge from the hospital or clinic.
The key to best breastfeeding practices is continued day-to-day support for the breastfeeding
mother within her home and community.
Support can include:
• Early postnatal or clinic checkup
• Home visits
• Telephone calls
• Community services – Outpatient breastfeeding clinics – Peer counseling programs
• Mother support groups – Help set up new groups – Establish working relationships with those
already in existence
• Family support system

Beside promotion of breastfeeding,BFHI also proposes to provide:
 Improved antenatal care

 Mother friendly delivery services
 Standardized institutional support
 Diarrhea management
 Promotion of healthy growth and nutrition
 Widespread adoption of family planning
Govt. of india has significant efforts to promote and protect BF by enacting law “The Infant Milk
Substitute” .The act prohibits advertizing of Infant Milk Substitute to health workers.Voilation of act can
lead to fine or imprisonment.
CONCLUSION:
Breastmilk contain all that a infant in need ,and safetest form of feeding a infant can have.Promotion of
BFHI is required for better and healthy growth and development of infants as well better recovery of
mother.
SUMMARY:
Here dealt with the introduction, goals, criteria ,steps and purposes of BFHI.
REFRENCES
1. PARUL DUTTA, “PEDIATRIC NURSING” JAYPEE BROTHERS MEDICAL

PUBLISERS,NEW DELHI,SECOND EDITION,PAGE NO. 24-25.
2. SURAJ GUPTE, “ESSENTIALS OF PEDIATRICS”, ELSIVER PUBLISERS ,NEW

DELHI,11TH EDITION, PAGE NO. 345-346.
3. O.P.GHAI , “ESSENTIALS OF PEDIATRICS,9TH EDITION,NEW DELHI,PAGE NO. 49-51.

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BABY FRIENDLY HOSPITAL INITIATIVE

Ten steps to successful breastfeeding recommended by code of practice of WHO/ UNICEF :-

• Help mothers initiate breastfeeding within one half-hour of birth.

• Encourage breastfeeding on demand.

At a minimum, it should include: – The 10 steps to successful breastfeeding – An institutional

• Risks of artificial feeding

• Mechanisms of lactation and suckling

• How to help mothers initiate and sustain breastfeeding

• How to assess a breastfeed

• Hospital breastfeeding policies and practices

• Focus on changing negative attitudes which set up barriers

Step 3. Inform all pregnant women about the benefits of breastfeeding.

Antenatal education should include:

• Early initiation• Importance of rooming-in (if new concept)

• Importance of feeding on demand

• Importance of exclusive breastfeeding

• How to assure enough breast milk

• Basic facts on HIV

• Prevention of mother-to-child transmission of HIV (PMTCT)

• Antenatal education should not include group education on formula preparation

Early initiation of breastfeeding for the normal newborn Why?

• Increases duration of breastfeeding

• Provides colostrum as the baby’s first immunization

• Takes advantage of the first hour of alertness

• Babies learn to suckle more effectively

• Improved developmental outcomes

Early initiation of breastfeeding for the normal newborn How?

• Keep mother and baby together

• Place baby on mother’s chest

• Let baby start suckling when ready

• Do not hurry or interrupt the process

• Delay non-urgent medical routines for at least one hour

Milk removal must be continued during separation to maintain supply.

 Milk removal stimulates milk production.

• Decreased frequency or effectiveness of suckling

• Decreased amount of milk removed from breasts

• Delayed milk production or reduced milk supply

• Some infants have difficulty attaching to breast if formula given by bottle

Acceptable medical reasons for supplementation or replacement Infant conditions:-

• BF should stop during therapy if a mother is taking anti-metabolites, radioactive iodine, or

• Avoidance of all BF by HIV+ mothers is recommended when replacement feeding is

• Requires minimal equipment

• Requires no additional personnel

• Helps establish and maintain breastfeeding

• Facilitates the bonding process

Step 8. Encourage breastfeeding on demand.

• Breastfeeding on demand:• Breastfeeding whenever the baby or mother wants, with no

On demand, unrestricted breastfeeding Why?

• Earlier passage of meconium

• Lower maximal weight loss

• Larger volume of milk intake on day 3

• Less incidence of jaundice

Alternatives to artificial teats• cup• spoon• dropper• Syringe

Support can include:

• Early postnatal or clinic checkup

• Community services – Outpatient breastfeeding clinics – Peer counseling programs

• Family support system

 Improved antenatal care

1. PARUL DUTTA, “PEDIATRIC NURSING” JAYPEE BROTHERS MEDICAL