Medical Outreach by APPNET

 The medical outreach at Afikpo (AGC Amachara) on 22/11/25 was very successful.

The APPNET in collaboration with HASCF decided to sensitize people this year on the effects of tobacco use on health and also to attend to people with certain medical issues.

The atmosphere was warmly welcoming and the audience were expectant. All the Doctors, Dietitians, Nurses, etc.,were wonderfully efficient in making the event successful.

My colleague Soromfechi first delivered his health talk before I came on board.

I delivered a health talk on Breastfeeding and nicotine/tobacco use. Unfortunately, I gave the shortest health talk in my entire years of practice because of time (time is a bitch !...Lol).

Nevertheless, the short time was judiciously used to the satisfaction of the audience.

I was permitted to answer only one question because of time; some still came like Nicodemus for their questions after the talk, while others probably swallowed theirs, i guess.

After other professionals of various designations delivered their talks, rearrangement took place, tables and chairs were set with professional tags on them, and private consultation of patients began.

Meanwhile, I would like to bring up just 3 of their questions:

1) Is breast milk into types? 

2) "Doc you said we should do exclusive breastfeeding, please why can't we give water alongside?"

3) What is this nicotine you were mentioning? Again, is there any problem of tobacco use by the mother to the child?

In answering, I'll try to be succinctly plain reducing professional jargons.

[1] When a woman gives birth, the deep yellowish milk that is first secreted which runs for about 6 days from delivery, is called COLOSTRUM. This breast milk component is the richest in nutrients (about 5x that of mature milk), antibodies, etc. In fact, it is the foundation of the immunity of the neonates, allowing initial helpful microbial colonization of the gut (G.I.T), and suppressing pathogenic (disease-causing)ones.

In the olden days in a lot of climes in Africa, it was said that people ignorantly discarded this breast milk component due to it's colour.

After colostrum, the next milk component that starts flowing about 7-10 days after delivery is called Transitional milk. As the name sounds, it is when the colostrum is trying to change(transit) to mature milk.It is intermediate between colostrum and mature milk.

It contains more nutrients than mature milk and less than colostrum.

Next is mature milk which is the breast milk component that flows from about 10 days after delivery to as long as breastfeeding lasts. 

Mature milk is made up of:

(a)Fore milk  (b) Intermediate milk  (c) Hind milk.

[2] The actual reason you shouldn't give water while exclusively breastfeeding:

The entire breast milk contain about 90% water, of which fore milk alone contain eighty something percent of this water. Now, nature made it that during breastfeeding, fore milk flows out first whether you like it or not. 

Fore milk contains little milk and more water, thereby satisfying the water need of the child, before the child will begin to access the nutrient dense Hind milk(rich in fats, carbohydrates, proteins, etc).

Again, the stomach of the newborn in day one is very small like the size of udara (Igbo) agbalumo (Yoruba), amounting to about 5-7mL capacity, although it grows very fast to about 80-150mL capacity by first month.

Giving exogenous water means making the small stomach full while the child is still on fore milk. And this, if it persists, can lead to serious neonatal Malnutrition including reduced IQ(since DHA, an essential fatty acid responsible for brain development is in hind milk).

Remember you have to patiently feed for 10-20 minutes in one breast for the child to be able to access the hind milk. There are a lot to be talked about here...

[3] The owner of this question must have been distracted at a point during the talk...lol.

Nicotine is a poisonous alkaloid in some plants. It is the chief chemical in tobacco. The addictive property of nicotine is the reason tobacco users (smokers &. smokeless users) find it very difficult to quit.

Furthermore, the two hormones separately in charge of milk production and letdown are prolactin and oxytocin, respectively. Tobacco messes(negatively interacts) with both hormones to bring about diminished milk volume, protein & fat in breast milk; meaning both quality & quantity of breast milk are negatively affected by tobacco use.

Other effects of tobacco use in this regard include:

1) Low birth weight (2x-3x lower than is supposed).

2) Presence of congenital defects like cleft lips & palates.

3) Still birth.

4) Cognitive and behavioral issues.

5) A lot of researches are pointing at nicotine as the major disruptor of embryonic progress, leading to deformities, decline in growth & even death (ie still birth).

6) Chemicals in tobacco including nicotine, passes into breast milk and negatively affect immunity of the child.

7) Higher risk of lower respiratory illnesses such as bronchitis & pneumonia.

8) Ear infections and stomach issues.

9) Disruption in babies' sleep patterns.

10) Sudden infant deaths (SIDs).

11) Possible addiction to tobacco in future when the child grows.

© Okereke Dickson O.,RDN, mDAN.

          (Clinical Dietitian).