Introduction: any other liquids or solids. [5]Introduction: any other liquids or solids. [5]


a way of providing ideal nourishment for adequate growth and development of children
and the advantages range from physiological to psychological for both mothers
and children.1
It is well known that breastfeeding influences a child’s health positively and
improves nutritional status2
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 and development. The infants should thereafter, receive nutritionally
adequate and safe complementary foods, while continuing to breastfeed for up to
two years. 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 beliefs. 6  

For all newborns, irrespective of
mode of delivery, especially 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 & HMB guidelines (Infant
and Young Child Feeding & Human Milk Banking Guidelines) in 2015. 7  since the reflexes in the newborn are highly
active in the first few minutes of delivery, especially those reflexes for
feeding, it is important that the bond between the mother and child for feeding
is built in this crucial time.

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
is very rich in proteins, carbohydrates, vitamin A, and sodium chloride and
contains lower amounts of lipids and potassium than normal milk. It has
essential immunoglobulins which build the child’s immunity, hence can be called
as the 1st natural vaccine. 11
crawl helps in receiving this essential colostrum.

The prevalence of early breastfeeding
has remained low even though there has been adequate information to promote and
support early 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 early 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 knowledge, attitude and practices towards breast crawl
among Indian postnatal mothers’ using the IIFAS and IYCF & HMB guidelines.


To access the knowledge,
attitude and practices of mothers, of rural parts of central Karnataka, regarding and breast crawl.

2.      To
document why the mothers are unable to practice breast crawl.


This is a cross-sectional
study. The study population comprises of post-natal
mothers, who delivered and are admitted in Adichunchanagiri Hospital and
Research centre, B.G. Nagar, Mandya district, Karnataka.

participants will be selected through a random sampling method of post-natal
mothers admitted in the hospital. Those who meet the inclusion criteria will be

 The study criteria;

 a) Mothers of newly delivered healthy infants,

 b) Born between 37weeks and 42weeks of
gestation period,

 c) Without major birth defects such as
congenital heart disease, cleft lip/cleft palate, Down syndrome, etc. 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.

After obtaining the
permission from the hospital authorities, all mothers participating will be
briefed about the purpose of the study. Informed oral consent will be obtained
from each of the participants. A predesigned questionnaire will be administered
to the mothers. 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.


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A, Afifi R. Breast-feeding and feeding practices of infants in a developing
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2.      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.

3.      Van Rossum CT, Büchner FL, Hoekstra J. Quantification
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RIVM; 2006.

4.      WHO. Exclusive breastfeeding for six months best for babies
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Gibney MJ, Elia M, Ljungqvist O, Dowsett J. Ch. 1. 2nd ed. UK: Blackwell; 2006. Clinical
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10.   Alemayehu, T., Haidar,
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11.  Ghai, O.P., Paul,
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and Distributors, New Delhi, 768.

12.   Heather Fisher Senior
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Relationship between the Immunoglobulin Concentration in Holstein Colostrum and
the Total Senlm Protein in Holstein Heifer Calves.

13.  Science Daily
(Homepage on the Internet). Colostrum.

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

15.  BPNI: 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.

17.  Madhu K, Sriram C, Ramesh M. Breast Feeding Practices and
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