Breastfeeding and weaning

Question 1

When does mamogenesis start and end?

Answer 1

Begins when the mammary gland is exposed to oestrogen at puberty
Is completed during the third trimester of pregnancy
Ductal, alveolar, and myoepithelial elements all undergo marked hyperplasia in preparation for lactation

Question 2

Why isn’t milk produced during pregnancy?

Answer 2

The high plasma concentrations of oestrogen and progesterone present before delivery inhibit the active secretory effects of prolactin on mammary alveolar epithelium

Question 3

What is colostrum and when is it produced/excreted?

Answer 3

2nd trimester colostrum appears in the acinar glands
3rd trimester the breast alveoli contain significant amounts of colostrum
Post delivery - removal of the inhibitory influence of oestrogen and progesterone:
prolactin stimulates the alveolar epithelial cells to begin active secretion of colostrum

Question 4

Describe the colostrum, what does it contain?

Answer 4

Yellow, viscous fluid, highin carbohydrates,protein, antibodies, and low in fat
Active lymphocytes and monocytes
Contains interferon, which facilitates the removal of intestinal meconium, and is a factor for stimulation of the beneficialLactobacillus bifidus in the intestinal tract

Question 5

Once prolactin is produced, post delivery what happens?

Answer 5

Lactogenesis:
Post delivery there is a transition from a pre secretory to secretory state
Prolactin can NOW exert it’s effects on acinar cells.
By 4–5 days postpartum the secretory maturation of the acinar epithelium is complete.

Question 6

What happens when the baby sucks on the breast?

Answer 6

Prolactin stimulates sensory receptors in the nipple that activate nerve impulse
Impulses go to the endocrine neurons = a decrease in prolactin-inhibiting factor (PIF)
PIF releases the lactotrophs from the inhibitory influence of catecholamines and permits the synthesis and release of prolactin

Question 7

What is the let down reflex?

Answer 7

Oxytocin is released after sucking stimulates sensory fibers in the nipple.
The release of oxytocin becomes a conditioned response in the lactating woman, requiring only visual stimulation or conscious thought.
oxytocin causes the myoepithelial cells to contract, which results in release of milk into the lactiferous ducts and sinuses

Question 8

Describe transitional milk.

Answer 8

Begins after the 1st week of lactation and continues through the 3rd week postpartum.
The volume of milk produced increases from 100–500 ml by the end of the second week postpartum

Question 9

Why is mature breast milk so beneficial?

Answer 9

Fat- 3-5%
Protein - 0.8%
Carbohydrate – 7%
Low casein content which aids formation of Curd in the infant’s intestinal tract
Curd increases digestibility of milk
Keeps the gastric acidity high leading to increased antimicrobial action

Question 10

Describe the diet of the breast feeding mum.

Answer 10

dietary req > 3rd trimester of pregnancy.
Significant increases in protein, carbohydrate, lipid, minerals, and calories must be maintained if adequate volumes of milk are to be produced

Question 11

Most important factor in galactopoiesis (Maintenance of milk production)?

Answer 11

regular and frequent milk removal from the mammary gland

Question 12

What are the 3 important mechanisms to enable breast feeding? Describe each one.

Answer 12

1) Regular sucking - promotes synthesis and release of prolactin and oxytocin
2) Regular emptying - store for 48 hrs before dec; dec stimulation of the glandular epithelium by prolactin; vascular stasis - dec intramammary pressure; Distended mammary ducts and alveoli
3) Demand feeding - amount of milk produced daily is fairly closely related to the demand of the baby

Question 13

What is the nipple to nose position?

Answer 13

Latch baby onto breast
Hold your baby close to you with their nose level with the nipple
Wait until your baby opens their mouth really wide with the tongue down
Bring your baby on to your breast
Your baby will tilt their head back and come to your breast chin first

Question 14

What are advantages of breast feeding for the baby?

Answer 14

Lower risk of: GI, Respiratory, Ear and UTI’s
Necrotising enterocolitis (preterm babies)
Allergic disease (eczema and wheezing)
Insulin-dependent Diabetes Mellitus
Sudden Infant Death Syndrome (SIDS)
Obesity
Childhood leukaemia
BF babies may have improved neurological development

Question 15

What are the advantages of breast feeding for the mother?

Answer 15

Increased skin to skin contact with baby
Promotion of bonding
Involution of uterus
Lower risk of breast and ovarian cancer
Lower risk of hip fractures
Prevention of rheumatoid arthritis

Question 16

What is ankyloglossia?

Answer 16

Lingual frenulum present, tongue-tie
Difficult for latching
Mum might have pain

Question 17

Who should not breastfeed?

Answer 17

Alcohol misuse
Certain drugs-methotrexate, cyclosporine, lithium
Active TB
Infants with galactosemia/phenylketonuria, rare amino acidurias

Question 18

How can you suppress lactation?

Answer 18

Stop sucking
Prolactin falls
Breast binding – wear a supportive bra
Pharmacological methods – Bromocriptine (no longer recommended)

Question 19

What is breast involution and what might cause it?

Answer 19

Begins with diminishing frequency of sucking
Dec frequency of sucking inc the amount of breast milk retained in the breast, resulting in vascular stasis and alveolar atrophy
Less prolactin produced - dec milk synthesis
dec in the size of the alveolar-lobular-ductal units
After 3 months - breasts have regressed maximally
Larger than pre-pregnancy size

Question 20

When should you start weaning foods?

Answer 20

WHO global recommendation that weaning should be commenced at 6 months