World Breastfeeding Week iscelebrated every year in August, created by the World Health Organization (WHO) as a way of promoting breastfeeding in various countries of the world. In Brazil, according to a report by WHO in 2017, only some 40% of infants are exclusively fed with breastmilk in the first five months of life, a rate that is considered fair, but still short of ideal.

The theme has been treated as a priority in Brazil, with laws that promote and protect breastfeeding, such as the Baby Friendly Hospital Initiative (BFHI), in addition to the work by the Brazilian Network of Human Milk Banks (Rede BLH), the largest and most complex of its kind in the world. Even so, exclusive breastfeeding is not an easy task and is demanding for mothers.

According to Nádia Rodrigues Mallet, a researcher at the Fernandes Figueira National Health Institute for Women, Children, and Adolescents (IFF/FIOCRUZ), “Breastfeeding is one of the most difficult and delicate initial processes after the birth of a term or premature infant, since it requires the combination of various components in the infant, besides close contact with the mother in order for the bond to be formed and breastfeeding to be effective for both.”

Nádia Mallet is responsible for the development of a new device for complementary feeding of high-risk newborns, as a way of favoring maternal breastfeeding, based on her experience at IFF/FIOCRUZ. See the full interview with Nádia:

Breastfeeding sounds simple, but it’s not always simple in practice. What are the main obstacles to breastfeeding?

Prematurity is challenging for both the mother and the newborn infant. Breastfeeding in this scenario is a victory for the mother/infant pair. The most common difficulties in the newborn are poor grasp due to the immature sucking reflex and short lingual frenulum, neuromuscular disorders, respiratory disorders, congenital cardiopathies, prematurity itself, and gastroesophageal reflux. Difficulties related to the breasts include delayed breastmilk letdown, where one of the causes is cesarean section, cracked nipples (fissures), engorgement, mastitis, candidiasis, blocked milk ducts, and others.

Why is breastmilk so important?

Breastmilk is a complete food. This means that in the first six months of life, the baby does not need any other food (tea, juice, water, or other milk). Breastmilk is easier to digest than any other milk and acts as a vaccine, since it is rich in antibodies, protecting the infant against many diseases such as diarrhea, respiratory infections, and allergies, besides decreasing the risk of hypertension, high cholesterol, diabetes, and obesity in adulthood. It is also clean, always ready to use, and warm. Breastfeeding favors more intimate contact between the mother and infant. Sucking at the breast is an excellent exercise for developing the child’s facial muscles, promotes beautiful teeth, and develops healthy breathing, besides helping future development of speech.

Where did the idea for the “little feeding cup” come from?

During my clinical practice in the neonatal unit of the Neonatology Department at the Fernandes Figueira Institute (IFF/FIOCRUZ), I have observed some difficulties in the use of utensils for administering complementary feeding to preterm newborns, since these utensils were manufactured for another purpose. I have also noted that merely decreasing a cup’s size does not adjust it properly for use in administering diet to preterm infants, due to their immature oral anatomy and physiology.

Premature newborns should be considered with their limitations, that are temporary but result in unique opportunities for them to receive optimal nutrition for their development and growth. One such opportunity is breastfeeding. This realization led to the need to develop a utensil (the little cup) that is best adapted to the baby’s physiological and anatomical needs.

What is the benefit from using the little cup for preterm newborns?

The main benefit is to avoid using a baby bottle in preterm newborns that are eligible for breastfeeding, since baby bottles are one of the factors that sometimes hinder maternal breastfeeding. By eliciting the tongue’s thrusting reflex, it increases the efficiency of oral reflexes, favoring a mature oral pattern and adequate grasp during breastfeeding, thereby reducing the time in use of enteral (oral/nasal) feeding tubes.

Since the cup has a milk dosing nipple that is consistent with the size of the preterm newborn’s mouth, it avoids both discomfort in and around the mouth and leaking of the milk through the labial commissures, while improving ingestion. With the dosing nipple, the volume of milk offered to newborns enables them to suck small amounts, assisting in the coordination of swallowing and breathing. The flow reducing device decreases the milk’s velocity before it reaches the dosing nipple, facilitating the volume control by the health professional or mother offering the complementary diet to the newborn.

These two features decrease the waste of milk, help preterm newborns in their oral sensory-motor development, improve the control of the milk volume, assist the grasp of the mother’s breast, and help them receive the food better for their development and growth.

Can we talk about the current progress with the little cup’s development? What are the prospects for launching its use?

We are currently validating the little cup produced in partnership with a Brazilian company, Biomédica, through a scientific research project. The project is currently in the final stage, namely safety in the target public, preterm newborns. According to Biomédica, the forecast for the marketing to start on Brazil’s domestic market is early 2019. And we are currently seeking partners to produce and market the cup on the international market, since we believe in its market potential.

How will the use of this device impact the “10 steps to successful breastfeeding” of the United Nations and UNICEF?

Use of the little cup in complementary feeding for preterm newborns in neonatal units has already proven successful by avoiding the use of baby bottles, increasing the odds of these infants being breastfed. The new little cup’s features will assist sensory-motor oral development and earlier weaning from the oronasal gastric tube, besides providing greater control of the milk volume offered, avoiding the risk of choking and/or bronchial aspiration, favoring the coordination of swallowing and breathing by taking small amounts according to their oral motor competence. The Baby Friendly Hospital Initiative welcomes every measure that helps promote, support, and encourage breastfeeding.

Photo: Ascom IFF/FIOCRUZ