Breastfeeding

Question 1

How many lobes are in the breast? How many are functional? What are the rest?

How does the fat content differ between a lactating and non-lactating breast?

What is the basic secretory unit?
→ What is it lined with?
→ What is it surrounded by? What do these do?

Answer 1

• 20 lobes - About 9 are functional, and the rest are vestigial
• Lactating breast (30% fat) has a lot less fat than a Non-lactating breast (50% fat)
• Alveoli
  → Mammary Epithelial cells (Cuboidal/Low Columnar)
  → Myoepithelial cells, which contracts for milk ejection

Question 2

LACTOGENESIS:
Lactogenesis I:
What is it?

What changes occur in the breast?

Which 2 hormones promote Breast development?

What is the role of Oestrogen and Progesterone here?

Lactogenesis II:
What is it?

Why does the Inhibition of Milk secretion stop at delivery?

How does Suckling cause Milk production?

What stimulates Milk ejection?

What is this Milk ejection reflex called?

How does the collection of milk inhibit further milk production?

Answer 2

• Preparation of lactation during the 1st half of pregnancy
• Proliferation and development of Alveoli and Myoepithelial cells
• Human Placental Lactogen (hPL) and Prolactin
• • Stimulates Prolactin secretion for breast growth and development
  • INHIBITS MILK SECRETION

• Lactation after pregnancy
• Fall in Oestrogen and Progesterone at delivery
• Suckling = Prolactin release = Milk synthesis
  o Led by Infant Demand
• Suckling and Higher centres = Oxytocin release = Myoepithelial contraction and Milk ejection
• Let Down reflex
• Autocrine inhibition from Duct cells

Question 3

What’s the effect of Dopamine on Prolactin secretion?

What can be given to SUPPRESS lactation?
→ How do they work?
→ Give an example drugs

What can be given to INCREASE lactation?
→ How do they work?
→ Give an example drugs

Answer 3

• REDUCES Prolactin secretion
• DOPAMINE AGONISTS
  → ↓Prolactin secretion = Suppresses Lactation
  → e.g. Bromocriptine, Cabergoline
• DOPAMINE ANTAGONISTS
  → ↑Prolactin secretion = Increases Lactation
  → e.g. Domperidone, Metoclopramide

Question 4

BREAST MILK COMPONENTS:
What does it consist of?

How does its Fat content change with suckling?

Which Immune factors does it contain?

Answer 4

• Nutrients (Macronutrients, Trace elements), Immunoglobulins (Secretory IgA), WBCs, Non-specific Immune components, Growth factors
• Fat concentration increases as the baby is suckling
• Lactoferrin - Inhibits bacterial growth, Lysozyme, Cytokines, Enteromammary Axis

Question 5

MECHANISM OF BREASTFEEDING:
How does the baby latch onto the nipple?

What are the 3 stages of the Suck cycle?

What are the 2 patterns of suckling?

What does Effective breastfeeding look like?

What are the signs of Ineffective breastfeeding in the mother and baby?

Answer 5

• Nipple and underlying tissue drawn in during suckling
• 1. Upwards curving of anterior tongue
     
     2. Pressure put onto nipple due to elevation of lower jaw
     3. Wave of compression moves backward
• • Nutritive (Continuous)
  • Non-nutritive (5 seconds bursts)
• Mouth wide open and full, Chin close to breast, Lower lip everted
• • Mother - Sore nipples, Engorgement, Mastitis, Loss of confidence
  • Baby - Frequent feeding, Frustration, Poor weight gain, Jaundice, Hypernatraemia

Question 6

What are the Benefits of breastfeeding on the Baby?

What are the Benefits of breastfeeding on the Mother?

Answer 6

• • Immune protection
  • Brain development, Gut maturation
  • Reduced risk of Sudden Infant Death Syndrome (SIDS) and Necrotising Enterocolitis (NEC)
  • Reduced risk of Obesity and Diabetes
• Reduced risk of Ovarian cancer, Postnatal depression, and Diabetes