Colostrum quality

Someone told me colostrum is dirty. Is that true?

Various cultural, traditional, religious, or health beliefs question the adequacy and health benefits of colostrum. As a result, some babies are given extra liquids instead of, or in addition to breastfeeding in the first few days before the mother’s milk comes in. Such liquids are called pre-lacteal feeds and include: water, tea, infant formula, herbal teas, juice, and honey. This practice reduces the amount of colostrum the baby takes in. There is no scientific reason to withhold colostrum. Under normal circumstances, it is present in amounts that gives babies all the nutrition they need and has many health benefits. Withholding it can harm the baby. Mothers who use additional liquids or who delay the start of breastfeeding until the milk comes in risk their milk coming in late, engorgement, or having a low milk supply. A few newborns need a supplement for medical reasons. If so, any problems should be addressed and if medically needed, they should be given an appropriate kind of milk.

A) Describing pre-lacteal feeds

In the first two to four days after delivery, mothers produce colostrum after which time the breasts start producing milk. This transition is known as the milk coming in. Colostrum provides unique benefits to the newborn baby.

Pre-lacteal feeds consist of a liquid given to the baby before their mother’s milk comes in. Pre-lacteal feeds are given in addition to or instead of breastfeeding.

Pre-lacteal feeds are offered because of various cultural, traditional, religious, and health beliefs, or the mother feeling tired (El-Gilany 2014). One study (Oakley 2018) found that about half of all babies in 57 low- and middle-income countries received pre-lacteal feeds before their mother’s milk came in.

Some mothers will completely avoid giving their babies colostrum out of the belief that it is dangerous, contaminated, or dirty and start breastfeeding only once the milk comes in (Morse 1990). Expressing and throwing out colostrum has been reported in many countries including: Ethiopia, Burkina Faso, Uganda, South Africa, Malaysia, the Philippines, Thailand, Vietnam, Pakistan, and Indonesia (Alemu 2019; Asim 2020; Dixon 1992; Engebretsen 2014).

B) Difference between pre-lacteal feeds and medically-necessary supplements

Pre-lacteal feeds are different from medically-necessary milk supplements. A small number of newborns can have difficulty establishing breastfeeding and require supplementation while breastfeeding problems are addressed. Other liquids should be avoided.

C) Risks of pre-lacteal feeds

There is no scientific reason to giving pre-lacteal feeds. Doing so can damage the baby’s health, delay the start of breastfeeding, and reduce the likelihood of exclusive breastfeeding (Das 2019; Finnie 2019).

Babies given pre-lacteal feed appear to be more likely to develop infection and return to hospital (Nguyen 2019).

One research review (Smith 2017) reported that the risk of dying in the first month after birth increased by 33% in babies who started breastfeeding between 2 and 23 hours after birth compared with babies who started in the first hour. The review said babies were 2.19 times more likely to die if they only started breastfeeding after 24 hours.

Babies who receive pre-lacteal feeds may breastfeed less often or may not breastfeed at all until their mother’s milk comes in. This increases the mother’s risk of:

References

Agho KE, Ogeleka P, Ogbo FA, et al. Trends and Predictors of Prelacteal Feeding Practices in Nigeria (2003-2013). Nutrients. 2016;8(8):462
 
Alemu SM, Alemu YM, Habtewold TD. Association of age and colostrum discarding with breast-feeding practice in Ethiopia: systematic review and meta-analyses. Public Health Nutr. 2019 Mar 8:1-20

Asim M, Ahmed ZH, Hayward MD, Widen EM. Prelacteal feeding practices in Pakistan: a mixed-methods study. Int Breastfeed J. 2020 Jun 8;15(1):53 

Chea N, Asefa A. Prelacteal feeding and associated factors among newborns in rural Sidama, south Ethiopia: a community based cross-sectional survey. Int Breastfeed J. 2018 Feb 20;13:7
 
Das A, Sai Mala G, Singh RS, et al. Prelacteal feeding practice and maintenance of exclusive breast feeding in Bihar, India - identifying key demographic sections for childhood nutrition interventions: a cross-sectional study. Version 2. Gates Open Res. 2019 Jan 28 [revised 2019 Jan 28];3:1
 
Dixon G. Colostrum avoidance and early infant feeding in Asian societies. Asia Pac J Clin Nutr. 1992 Dec;1(4):225-9
 
Engebretsen IM, Nankabirwa V, Doherty T, et al. Early infant feeding practices in three African countries: the PROMISE-EBF trial promoting exclusive breastfeeding by peer counsellors. Int Breastfeed J. 2014 Nov 18;9:19
 
El-Gilany A-H, Abdel-Hady DM. Newborn first feed and prelacteal feeds in Mansoura, Egypt. BioMed Research International. 2014;2014:258470
 
Finnie S, Peréz-Escamilla R, Buccini G. Determinants of early breastfeeding initiation and exclusive breastfeeding in Colombia. Public Health Nutr. 2019 Oct 7:1-10
 
Khanal V, Adhikari M, Sauer K, et al. Factors associated with the introduction of prelacteal feeds in Nepal: findings from the Nepal Demographic and Health Survey 2011. International Breastfeeding Journal. 2013;8:9
 
Morse JM, Jehle C, Gamble D. Initiating breastfeeding: a world survey of the timing of postpartum breastfeeding. Int J Nurs Stud. 1990;27(3):303-13
 
Nguyen P, Binns CW, Ha AVV, et al. Prelacteal and early formula feeding increase risk of infant hospitalisation: a prospective cohort study. Arch Dis Child. 2019 Sep 15. pii: archdischild-2019-316937
 
Oakley L, Benova L, Macleod D, et al. Early breastfeeding practices: Descriptive analysis of recent Demographic and Health Surveys. Matern Child Nutr. 2018 Apr;14(2):e12535
 
Smith ER, Hurt L, Chowdhury R, et al.; the Neovita Study Group. Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis. PLoS ONE 2017;12(7): e0180722