Breastfeeding

Question 1

Contents of breast milk

Answer 1

90% water with fat, protein, lactose, antibodies, vitamins and minerals
optimises survival as readily available, easily brought to child, reduces risk of predators as no foraging

Question 2

Breast components

Answer 2

alveolus - secreting milk cells
hormones produced in pituitary gland drive breastfeeding:
prolactin - stimulates cells to produce milk
oxytocin - makes muscles contract to make milk flow

Question 3

Hormonal process of milk production

Answer 3

baby suckles, sensory impulses pass from nipple to brain
anterior part of pituitary gland secretes prolactin, posterior part secretes oxytocin
oxytocin enables stored milk to flow for this feed by making milk ducts contract
prolactin makes breast produce milk for next feed
brain can produce more prolactin if baby needs more food
oxytocin reflex - unconditioned response to baby suckling becomes conditioned response to thinking about, seeing, touching or hearing baby

Question 4

First feed

Answer 4

6 minutes - baby opens eyes
20 minutes - rooting behaviour guided by olfactory (smell) cues
80 minutes - suckling begins and lasts about 10 minutes
infants suckle between 8-12 times a day for 20-40 minutes on an irregular schedule

Question 5

Stages of milk

Answer 5

colostrum - first 3-4 days, high concentration of immune factors (encouraged even if you don’t continue BF)
mature milk - antibodies decrease, volume increases, still offers immunological protection, splits into foremilk (thirst quenching) and hindmilk (more fat, helps growth)
if baby stops too early they won’t get nutrients from hindmilk
not affected by diet, BMI, breast size but can be affected by very low calorie intake

Question 6

Benefits of BF

Answer 6

nutritionally superior - species specific, passes immunity properties from mum to child
formular can only imitate is substances are identifiable, technology exists to synthesis them and it’s economic
formular has issues with sterilisation and keeping bottles/water clean
breast is better for eating behaviours, cognitive development, mother-child attachment
WHO recommends exclusive BF for 6 months
duration positively associated with acceptance of new foods (Phalen 2013) and inversely associated with feeding problems (Babik et al 2021)

Question 7

Infant digestive health

Answer 7

infants guts born full of hole, takes weeks to mature and close
breast milk coats gut and provides protection
formula and BF babies have different gut flora
introduction of formula changes gut flora of BF baby to that of FF baby
good bacteria may be transferred from mother’s gut to infants via breast milk (Jost et al 2012)

Question 8

Individual factors of mums

Answer 8

trait personality - introverted/anxious may be less likely to BF, higher self-concept associated with exclusive BF
self-objectification - high on body-objectification measures more likely to view BF as indecent

Question 9

Barriers to BF

Answer 9

lifestyle
post-natal depression
lack of support
difficulties latching
anxiety or lack of confidence
tiredness
returning to work
lack of encouragement
pressure from friends/society
unhealthy relationships

Question 10

Taste bud development

Answer 10

taste buds develop 8 weeks gestation and detect taste by 14 weeks (Witt & Reutter 1998)

Question 11

Taste sensitivity

Answer 11

FF show preference for their own brand (Mennella & Beauchamp 2005)
consume more, feed longer when vanilla extract added to formula (Manella & Beauchamp 1996)
infants prefer sweet - neonates consume more water if sweetened
consume less after mother ingested alcohol (taste, effect on production, increased fat?) (Manella & Beauchamp 1993)

Question 12

Taste impacts on eating behaviour

Answer 12

lack of variety promotes food rejection in later life, BM influenced by mother’s diet and has greater variety than formula
evidence of stable, long-term retention of foetal experiences of flavour can affect food acceptance postnatally (Ustun et al 2022)

Question 13

BF impacts on obesity

Answer 13

BF can cut chances of child obesity by 25% (WHO 2019)
BF for 6+ months associated with decreased risk of obesity (Scott et al 2012)
relationship between BF length and obesity may disappear age 10 when confounding variables are controlled for (Seach et al 2010)

Question 14

Bottle feeding impact on EB

Answer 14

bottle feeding associated with weight gain, irrespective of contents (takes away control from baby so may overfeed) (Li et al 2012)
may be more likely to drink from a cup until it’s empty - less able to regulate body as learn to ignore signals (Li et al 2010)
opaque bottles take away visual cues, less pressure to eat, increases other responsiveness to babies cues (Ventura & Golen 2015)

Question 15

Formula effects on EB

Answer 15

tends to be higher in protein so may be higher risk of weight gain (Farrow et al 2012)
can be manipulated to have less protein to reduce risk (Koletzko et al)
leptin is absent so may contribute to increased intake (Lawrence 2012)
more likely to offer solids earlier, may have detrimental impact on adiposity but may be these are hungrier babies likely to be bigger anyway (Farrow et al 2010)

Question 16

BF impacts on health

Answer 16

Exclusive BF may lead to fewer hospitalisations for gastroenteritis, respiratory illness and ear infections (UNICEF UK)
BF infants have lower risk of sudden infant death syndrome
early cessation/absence related to post-natal depression but direction of effect unclear (Ip et al 2009)

Question 17

BF impacts on maternal health

Answer 17

reduced risk of osteoporosis (Cumming & Klineberg 1993), diabetes (Stuebe et al 2005), cardiovascular disease (Schwarz et al 2009), breast and ovarian cancer (Bernier et al 2000)