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Breastfeeding is 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. It is well known that breastfeeding influences a child’s health positively and improves nutritional status . Breast milk is the best gift a mother can give her child. 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.  Exclusive Breast Feeding (EBF) is defined as infant feeding with human milk without the addition of any other liquids or solids.  The prevalence of breastfeeding differs from one country to another and from one society to another, this is due to cultural and religious beliefs.  For all newborns, irrespective of mode of delivery, especially those delivered by cesarean 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.  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. 
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 years.  Colostrum 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.    breast 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 breastfeeding.  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 of breastfeeding.
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. 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.      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.
Objectives: 1. 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. Methodology: This is a cross-sectional study. The study population comprises of post-natal mothers, who delivered and are admitted in Adichunchanagiri Hospital and Research center, B.G. Nagar, Mandya district, Karnataka. Study 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 interviewed. The study criteria; a) Mothers of newly delivered healthy infants, b) Born between 37weeks and 42weeks of a 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. Implication: 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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