Early infant feeding - Breast vs bottle week/lecture 3 Flashcards

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1
Q

composition of breast milk

A

○ 90% water
○ 4% fat
○ 1% protein
○ 7% lactose
○ Immunological; antibodies, vitamins, minerals

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2
Q

how does breast milk optimise survival?

A

○ Food readily available
○ Food brought to child
○ Risk of predators reduced because no foraging

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3
Q

what does prolactin do?

A

stimulates the cells to produce milk

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4
Q

what does oxytocin do?

A

makes the muscle contract to make the milk flow

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5
Q

flow of milk through the breast:

A
  • Alveolus –> milk duct –> lactiferous duct
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6
Q

Hormones and milk production:

A
  • Baby suckles
    • Sensory impulses pass from the nipple to the brain
    • Anterior part of the pituitary gland secretes prolactin
    • Posterior part of the pituitary gland secretes oxytocin
    • Oxytocin enables stored milk to flow for THIS feed
      Prolactin makes the breast produce milk for NEXT feed
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7
Q

oxytocin reflex: ‘let down’

A

Unconditioned response –> conditioned response
Response to baby suckling –> response to thinking about, touching, seeing, hearing baby

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8
Q

the first feed:
- when?
- why?
- how long does it last?

A
  • Post birth
    • 6mins eyes open
    • 20mins rooting behaviour guided by olfactory cues
    • 80mins suckling begins (lasts about 10mins)
    • Infants suckle between 8-12 times in 24h period
    • Feeds can last 20-40mins
    • Irregular schedule
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9
Q

stages of milk

A
  • Colostrum
    ○ First 3-4 days
    ○ High concentration of immune factors
    • Mature milk
      ○ Antibodies decrease, volume increases
      ○ Still offer immunological protection
      ○ Foremilk and hindmilk at each feed
    • Not affected by mothers diet, BMI, size of breasts etc
    • Can be affected by very low caloric intake
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10
Q

what’s so good about breast milk?

A
  • Nutritionally superior
    • Formula milk can imitate breast milk if:
      ○ Substances are identifiable
      ○ The technology exists to synthesise them
      ○ It is economic to synthesise them
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11
Q

why is breast milk required for digestive health?
- Add Josh et al., (2013) study

A
  • At birth an infant’s gut is full of holes
    • Take many weeks to mature and close
    • Breast milk coats the gut and provides protection
    • Opens junctions and immaturity play a role in gut-related diseases and allergies
    • Formula and breast-fed babies have different gut flora
    • Introduction of formula changes gut flora of breast-fed baby to that of formula fed baby
    • Josh et al., (2013)
      ○ Good bacteria may be transferred from mother’s gut to that of the infant via breast milk
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12
Q

breast vs formula: what does the choice depend on?

A
  • Choice may impact upon:
    ○ Health (mother and infant)
    ○ Eating behaviours
    ○ Cog development
    ○ Mother-child attachment
    ○ Maternal self-esteem
    ○ Maternal body image
    ○ Lifestyle
    • Societal pressure and simultaneous disapproval
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13
Q

individual factors and choice

A
  • Trait personality may be important
    ○ Introverted/anxious significantly less likely to initiate/continue BF
    ○ High prenatal negative = less likelihood of BF
    ○ Higher self-concept significantly associated with exclusive BF
    • Self-objectification
      ○ Those who score higher on body-objectification measures more likely to view BF as indecent
      ○ Young/teen mums?
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14
Q

normalisation via TV ads:

A
  • Too much reality = ‘adult content’?
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15
Q

rates of BF

A
  • UK is lowest in the world
    • 66% babies received breastmilk within first 48 hours in 2005/6, rising to 74% in 2010/11, 72% in 2020/21
    • Rapid decrease in first 6 weeks - hardest period
    • Exclusive BF rates then continue to decrease
      ○ 6 weeks: 24%
      ○ 3 months: 17% (up from 13%)
      ○ 4 months: 12% (up from 7%)
      ○ 6 months: 1%
    • This is an improvement on 2005 figures (NHS infant feeding survey, 2010)
      WHO recommends exclusively BF for 6 months
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16
Q

full and partial BF at 6-8 weeks

A
  • Exclusive and mixed with formula feeds
    • England: 2016-17 is 44.4%
    • Slight increase on previous years at 43.2% (2015-16) and 43.8 (2014-15)
    • Still very low, especially when compared to countries like Norway, which achieves rates of 71% at 6-8 weeks
17
Q

barriers to BF

A
  • Medications etc
    • Issues producing oxytocin (attachment issues)
    • PND
    • Lifestyle (want to drink alcohol, go to work etc)
    • Lack of support
    • Difficulties with latching
    • Anxiety and lack of confidence
    • Tiredness
    • Lack of family history/encouragement
    • Pressure from friends
    • Sexualisation of breasts
    • Unhealthy relationships (abusive partner)
18
Q

taste sensitivity in infants

A
  • Taste buds 8 weeks gestation
    • Stimulate sweet, sour and bitter tastes in infants
    • Prefer sweet: neonates will consume more water if sweetened
      ○ Evolutionary - survival
      ○ Analgesic - crying and circumcision
    • Insensitive salt <4 months
    • Breastmilk is sweet
19
Q

familiarity and lack of variety

A
  • Formula-fed infants show a preference for their own brand of formula
    • Mennella and Beauchamp, 2005
20
Q

spiked formula and later preferences

A
  • Formula:
    ○ Soy formula ‘spiked’ (+sweet, sour and bitter)
    ○ 2-5 month infants accept ‘spiked’ formula, 6+month reject it. Critical period?
    ○ Greater preference for bitter apple juice at 4-5 years
    Manella & Beauchamp 1991; Manella et al., 2001 (directed reading)
21
Q

tastes in breast milk

A
  • Sensitive to food flavours in breast milk
    ○ Garlic (Mannella ad Beauchamp, 1991)
    § Consume more when flavoured
    § Only initially - sensory-specific satiety?
    ○ Vanilla extract (Manella and Beauchamp, 1996)
    § Feed longer and consume more
    § Same when added to formula
    ○ Alcohol (Mannella and Beauchamp, 1991 and 1993)
    § Consumed less milk after mother ingested alcohol
    § Unpleasant taste? Effects on milk production? Increased fat content of milk?
22
Q

are infants primed in utero

A
  • Taste buds develop around 8 weeks gestation
    • Detect tastes by 14 weeks gestation
    • Detect olfactory molecule by 24 weeks gestation
    • Exposure to flavours in amniotic fluid
23
Q

implications of early exposure in utero

A
  • Variety in pregnant and BF mums is important to increase exposure to children
    • BF baby had early exposure and experience and aren’t as fussy in the weaning stage
24
Q

BF and obesity: what is the risk?

A
  • BF offers a small but consistent protective effect
    • Can cut chances of child becoming obese by 25% (WHO, 2019; study across 16 countries)
    • Infants who are bottle-fed are at significantly higher risk for rapid weight gain compared with infants who are exclusively BF; rapid weight gain in infancy is strong predictor of later obesity risk.
25
Q

BF and obesity: milk content

A

○ Formula milk has increased protein content leading to increased weight gain due to increased insulin
○ Formula milk also has decreased leptin which leads to decreased satiety which may lead to increased intake
○ Also evidence that babies fed formula have higher insulin levels in their blood which can stimulate fat deposition (WHO, 2019)

26
Q

BF and obesity: feeding experience

A

○ Fundamental behavioural difference

	○ Bottle and milk type:
		§ Use of a bottle for feeding is associated with greater weight gain, irrespective of contents (i.e. formula or expressed breastmilk)
			□ Li et al., 2012
		§ % of children who in late infancy drink from a cup until empty
			□ 27% of those who had been exclusively BF
			□ 54% of those who had been. Mixed-fed (breast and bottle)
			□ 68% of those who had been exclusively bottle fed
				® Li et al., 2010

	○ Bottle and visual cues:
		§ Ventura and Golen (2015)
			□ Opaque bottles VS regular, clear bottles
			□ Abolishes cues about consumption to parent/caregiver

	○ Effects on maternal responsiveness and consumption:
		§ Ventura and Golen, 2015
	○ Effects of infant cues:
		§ Ventura and Hernandez (2019)
27
Q

duration of BF and obesity

A

§ McCroy and Layte (2012) - dose-response r-ship:
□ Exclusive BF for 13-25wks = 38% reduction in obesity risk
□ Exclusive BF for 26+ wks = 51% reduction
§ Scott et al., 2012: 2066 Australian 9-16 yr olds
□ BF for 6+ months associated with decreased risk of overweight or obesity
□ Controlled for maternal characteristics, level of physical activity, caloric intake, screen time, sleep duration
§ But others find no effects when controlling for confounding variables

28
Q

why is there more obesity in bottle-fed infants?

A
  • Differences in control of milk flow (bottle = less control = overeating)
    • Less control over intake
29
Q

post birth weight loss in mother

A

§ Lactating mother burns 525-625 calories per day producing milk
§ Predicts significantly greater weight loss - up to 12kg (Baker et al., 2008)
§ Less likely to suffer with weight-related health problems

30
Q

BF and obesity: social influences

A

○ Initiation and length tends to vary with social class
○ Associated with education (+), age (+), smoking (-)
○ Targeted education for high risk groups
○ Education in context:
§ The chance of exclusive BF til 6months was 55% less for the female children when compared to male children
□ 50% less in higher SES
□ 90% less in lowest SES (Angadi and Jawaregowda, 2015)
§ Son preference = limited BF of girl children in order to try to have a son (Jayachandran and Kuziemko, 2011)
○ Cultural pressures
§ National family and health survey data, 2015 (Dutta et al., 2022)
□ Girls have 19% less chance of exclusive BF than boys
□ Birth order and sex composition of siblings are important determinants of feeding practices
® E.g. if the last-born child is a girl, she has a 26% lower chance of being exclusively BF in a household that already has two or more daughters but if she is born in a family that has two sons then then chances of fair treatment in access to minimum dietary diversity are 16% higher
○ Empowerment of women:
§ Increase in exclusive BF by 42% for girls and 38% for boys (Dutta et al., 2022)
○ Inclusive support:

31
Q

impact of BF on infant and mother health

A
  • If 45% of babies in the UK were exclusively BF for 4 months and 75% in neonatal units BF before discharge:
    ○ 3285 fewer babies hospitalised for gastroenteritis
    ○ 5916 fewer babies hospitalised with respiratory illness
    ○ 21405 fewer ear infections
    § UNICEF UK
32
Q

sudden infant death syndrome

A
  • Leading cause of death amongst 0-12 months old
    • 2007: meta analysis of 6 studies: BF infants had lower risk of experiencing SIDS than never BF infants
    • 2011: meta analysis: infants who were BF any amount for at least 2 months had significantly less risk than never BF infants (Hauck et al., 2001)
    • Link with BF is unclear but may be related to:
      ○ Immunological and anti-inflammatory qualities of milk
      ○ Lighter sleep
33
Q

direction of effect of obesity and BF - ADHD

A
  • ADHD: Ptacek and Kuzelova (2013)
    ○ 200 mothers (100 ADHD, 100 non-ADHD)
    ○ ADHD children BF significantly shorter time (avg 2.5 mths) than non-ADHD children (avg 7.8 mths)
    ○ But behavioural differences in children may influence mothers behaviour and result in shorter BF duration
34
Q

post-natal depression

A
  • Affects 1 in 8 mothers
    • Early cessation or absence of BF related to PND
      ○ Ip et al., 2009
      ○ Direction or effect?
    • Prolonged feeding associated with less PND
      ○ Protective effect?
    • Evidence related to lactation itself
      ○ Countries where exclusive BF is norm, peaks at 9 mths post-birth
      ○ Countries where formula is norm, peaks at 3 mths post-birth
      § Labbok, 2001
35
Q

benefits of BF on maternal health

A
  • Osteoporosis
    ○ stronger bones, reduction is risk of hip fractures in later life
    ○ (Cumming & Klineberg, 1993)
    • Diabetes
      ○ never breastfed had 1.7x higher chance of developing Type II diabetes than those who had BF for > 2 yr over lifetime
      ○ (Stuebe et al., 2005)
    • Cardiovascular disease
      ○ 10-20% greater risk in those who have never BF compared to BF for 13-24 mths
      ○ (Schwarz et al., 2009)
    • Breast and ovarian cancers
      ○ reduced risk as BF suppresses ovulation and limits estrogen which is implicated in cell differentiation, mutations, and fuelling growth.
      ○ Meta-analysis of 23 studies concluded a protective effect of BF, regardless of duration (Bernier et al., 2000).
36
Q

economic costs of BF

A
  • To mother
    ○ Cost of formula milk, bottles etc not present
    ○ Loss of earnings??
    • To employers
      ○ Time off work
      ○ Sick days
    • To environment
      ○ Reduced carbon footprint