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Y3 repro > infant feeding > Flashcards

infant feeding Flashcards

1
Q

trend in breastfeeding rates up to 6mths in UK

A

marked drop off despite WHO recommendation of exclusive BF for 6mths and then alongside complimentary feeds for up to 2yrs

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2
Q

constituents of human milk

A 
cytokines
IL-7
enzymes
milk lipids
oligosaccharides
lactoferrin
leukocytes
immunoglobulins
stem cells
lymphocytes
growth factors
vits and minerals
fats 
carbohydrates
proteins
water
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3
Q

formula milk constituents

A 
vits and minerals
fats 
carbohydrates
protein 
water
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4
Q

main difference between breast milk and formula

A

basic nutritional consituents vary

breastmilk contains many more live constituents that promote health

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5
Q

breast milk vs formula - water

A

water used to make formual can easily become contaminated - climate issues, over use of cleaning products or fluorine

breast milk doesn’t have this issue

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6
Q

breast milk vs formula - protein

A

breast milk - more whey based (60-80%) and easier to digest, main protein (alpha lactalbumin, make up >20% of total protein) has been associated with the destruction of over 40 types of cancer cells

formula - cows milk protein, associated with increased risk of baby developing juvenile onset diabetes

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7
Q

breast milk vs formula - carbohydrates

A

breast milk - lactose is 1y carb, provides ~40% of total calories

formula - lactose is also more prevalent in UK formula; may also see sucrose, fructose and glucose in soya/lactose free formula

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8
Q

breast milk vs formula - fats

A

breast milk - long chain polyuns. FAs support the development of the entire NS (incl. retinol development - improved eyesight)

formula - fats change depending on the market; currently they are mainly vegetable (rapeseed oil, sunflower oil, coconut oil, algal oil), some contain egg or fish oil

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9
Q

why are fats required in infants

A

essential for brain development and absorption of fat soluble vitamins, and are a major calorie source

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10
Q

breast milk vs formula - vitamins and minerals

A

formula - extra vits and minerals and added to the powder to ensure they are sustained for the entire shelf life so amounts vary

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11
Q

why are vitamins and minerals important

A

healing wounds
supporting bone growth
immune system
etc

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12
Q

examples of growth factors present in breast milk

A

epidermal, insulin and transforming factors which promote gut growth

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13
Q

when is epidermal GF higher

A

mothers who have preterm babies

linked to a reduction in necrotising enterocolitis (NEC) and other inflammatory repsonses

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14
Q

what role do growth factors play in early life

A

role in early life programming

may be associated with a reduced risk of obesity and cancer in later life

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15
Q

what is the role of transfer factors

A

enable effective absorption of nutrients in the milk e.g. lactoferrin

also help with absorption of fats and vitamins

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16
Q

role of lactoferrin

A

assists with absorption of iron - reduces amount of free iron which attracts batceria

also bactericidal - kills E coli

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17
Q

what is the role of stem cells in breast milk

A

have the ability to develop into many different cell types

evidence that these cells remain in the system long after BF has stopped

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18
Q

immunoglobulins in breast milk

A

IgA, IgG, IgM, IgD
IgA - provides protective coating to baby’s gut - prevents entry of pathogenic bacteria and enteroviruses (E. Coli, salmonella, streptococci, staph, pnuemococci, rotavirus etc) - protects against gastroenteritis, resp infections etc

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19
Q

role of leukocytes in breast milk

A

destroy harmful bacteria

macrophages - produces lysozyme which disrupts bacterial cell wall

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20
Q

oligosaccharides in breast milk

A

> 200 types of simple carbs in breast milk

influence the development of the microflora by increasing number of beneficial bacteria in baby’s gut - protects baby against infections e.g. otitis media, resp, urine, GI

encourage some cells in the gut to produce an adhesive protein substance which helps seal the gaps between cells in the gut wall - prevents harmful bacteria and allergens from crossing into the baby’s system

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21
Q

milk lipids in breast milk

A

damage outer surface of certain virus types

reduce infection rate in baby

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22
Q

enzymes in breast milk

A

aid digestion and absorption

some destroy bacteria

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23
Q

IL-7 in breast milk

A

linked to the size of the thymus - breast fed babies have much larger thymus than formula fed babies - stronger immune system

also has a role in stimulating antibody producing cells

plays a part in reducing risk of childhood leukaemia

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24
Q

cytokines in breast milk

A

important constituent in boosting immune system

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25
Q

special features of colostrum

A 
protective factors
concentrated nutrition
strong anti-inflamamtory factors
stimulates gut growth - helps cells and villi proliferate
small volumes - intentional 
laxative effect
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26
Q

what is the role of the laxative effect of colostrum

A

to clear meconium

helps minimise jaundice

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27
Q

what is the difference between colostrum and mature breast milk

A

colostrum is smaller volumes and more concentrated
new born babies would find the XS water in mature breast milk difficult to process (immature kidneys)
healthy term babies don’t become dehydrated - surfeit of interstitial fluid they need to process in the first few days

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28
Q

not breastfeeding increases the risk of what in babies

A 
gastroenteritis 
resp infections
allergies - mixed evidence 
obesity 
T1 and 2 DM
SIDS
NEC

exclusive BF gives best protection but some is greater than none

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29
Q

not breastfeeding increases the risk of what in mothers

A

breast cancer
ovarian cancer
hip fractures
heart disease

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30
Q

when do babies begin to pick up their microbiome

A

may recieve exposure to maternal microbes in the womb
lactobacilli more prevalent in the vagina during pregnancy (friendly bacteria)
as they pass through the vagina at birth
vaginal birth, skin to skin and breast feeding
through the mother’s milk in the postnatal period and beyond

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31
Q

what is the role of our gut biome

A

generate our energy needs
produce enzymes to digest food
manufacture vitamines B, K and nicotinic acid
regulate fat storage
manufacture amino acids
help w/ iron absorption
create our individual immune system and help immune cells reproduce
train our immune system on what is safe and what to reject

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32
Q

benefits of the first breast feed on gut health

A

live constituents in the milk develop the process of setting up the microbiome w/ high levels of bifidobacteria and oligosaccharides

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33
Q

results of insufficient bifidobacteria in the gut

A

children with insufficient bifidobacteria in their gut in the first year of life have an increased risk of obesity in later life.

34
Q

what is especially important if a child is born by C sectioin

A

miss out on vaginal transfer of microbes

prolonged skin to skin contact and breast feeding

35
Q

epigenetics and breastfeeding

A

breastfeeding may result in epigenetic changes which impact on:
brain development
baby’s immune system
baby’s metabolic system

36
Q

what is epigenetics

A

additional info that may be layered on top of the sequence of molecules that make up our DNA
epigenome attaches to and modifies the original gene

37
Q

epigenetics and generational change

A

changes to our genes can be passed down to future generations via maternal line
e.g. famine in the netherlands - effect could be seen 3 gens later
childhood abuse has been shown to affect DNA patterns - link between victims and ill health in adulthood

38
Q

when is our DNA most receptive to epigenetic changes

A

in utero - 3yrs

alters the way our organs and our predisposition to certain diseases develop

39
Q

what impacts the infant’s epigenome

A

maternal environment during pregnancy

infant’s first recieved nutrition

40
Q

breastmilk and leptin

A

breastmilk has the ability to turn on/off certain epigenetic changes e.g. gene for leptin

appetite is influenced by breastmilk

babies who are breastfed have higher levels of leptin at 1mth of age

formula milk may dampen leptin production and is associated with higher levels of obesity

41
Q

updating the baby’s immune system at each feed

A

broncho-mammary pathway: pathogens inhaled

entero-mammary pathway: pathogens ingested

antibodies produced and sent to breasts
antibodies incorporated into breast milk

42
Q

how does the mother affect the baby’s immune system

A

mother’s body works to monitor her environment and produce antibodies to current infections that she detects in her lungs/gut

antibodies are passed directly to the breastmilk so baby is provided with protection with as little delay as possible

mother and baby need to be together for this to work

43
Q

how can we protect breastfeeding

A

international code of marketing of breastmilk substitutes - the code
UK law - hasn’t yet fully implemented the code
professional accountability

44
Q

what is ‘the code’ with regards to marketing formula milk

A

prohibits all promotion of bottle feeding and sets out requirements for labelling and information on infant feeding.
Any activity which undermines breastfeeding also violates the aim and spirit of the Code.
The Code is not an anti-bottle feeding measure. It is as keen to make sure bottle feeding is done as safely as possible as it is to ensure the protection and promotion of breastfeeding.

45
Q

the code states that companies must not…

A

promote their products in hospitals, shops or to the general public
give free samples to mothers or free/subsidised supplies to hospitals or maternity wards
give gifts to health workers or mothers
promote their products to health workers: any information provided by companies must contain only scientific and factual content
promote foods or drinks for babies
give misleading information
have direct contact with mothers.

46
Q

UK law regarding formula milk

A

intended to ‘regulate labelling and restrict advertising and presentation of infant and follow-on formula so as not to discourage breastfeeding.’

not as robust as the Code and companies are able to find ways around the law. One of the biggest weaknesses is that, while the Code considers follow-on formula (i.e. milk intended for babies over six months) to be a breastmilk substitute, the UK law does not. This allows the companies to promote their brand name and logos via advertising of follow-on milks.

47
Q

conflict of interest re. formula milk

A

Sponsored study days / smaller education sessions / meetings offered for staff or parents on public service premises
Staff attending sponsored study days
Individual staff engaging with the companies e.g. by speaking at sponsored events, writing articles, blogs etc. for the companies
Awards and other gifts being made to individual staff by the companies or by a separate organisation which is being sponsored by the companies.

48
Q

what parents using formula need to know

A 
1st milks for 1st yr - no need for follow on
all brands are similar
information on prep and sterilising
cow's milk from 1yr
responsive bottle feeding
49
Q

what is responsive bottle feeding

A

baby is held close and feeds are paced

important to reduce overfeeding and obesity

50
Q

what are the 3 stages of lactation

A

lactogenesis 1 - breast development and colostrum production from ~16wks gestation
2 - onset of copious milk secretion occurring between 32 and 96hrs after birth
3 - maintenance of milk production

51
Q

what does lactogenesis 1 involve

A

differentiation of alveolar epithelial cells into lactocytes that secrete colostrum from ~3-4mths of pregnancy

52
Q

what causes lactogenesis 2

A

occurs in response to risk in prolactin and a decrease in pregnancy hormones
milk will come in regardless of whether a woman wants to breastfeed or not

53
Q

external changes to the breast during pregnancy - Montgomery’s tubercles

A

appear on the areola to secrete an antiseptic sebum to lubricate the area

sebum also creates a scent to entice the baby to begin to search in the area for their first feed

54
Q

changes in hormones after birth

A

oestrogen and progesterone levels drop
prolactin and oxytocin levels rise in response to touch, smell and sight of baby
baby begins spontaneous breast seeking behaviour
mothering behaviours initiated

55
Q

prolactin-receptor theory

A

the more early, frequent surges of prolactin there are, the greater the number of receptor sites that become primes

max number of receptor sites = max numbers of functioning lactocytes from that point onwards, max triggering of the mothering response

56
Q

prolactin - role, responsive to, levels highest, long term production

A

responsible for milk production
responsive to touch and stimulation
levels higher at night
frequent contact/feeds sets up for long term production

57
Q

oxytocin - role, levels highest, what can delay ‘let down’

A

responsible for milk delivery
acts on muscle cells in pulsatile action
levels higher when baby is near
stress can temporarily delay ‘let down’

58
Q

rise and fall in prolactin levels

A

increase the most in the immediate postpartum period
rise and fall in proprotion to the frequency, intensity and duration of nipple stimulation

concentration in the blood doubles in response to suckling and peaks ~45mins after the beginning of a breastfeeding session

levels fall ~50% in the first week after birth in breasfeeding women

if women don’t breastfeed, levels reach non-pregnant levels by 7 days postpartum

59
Q

oxytocin release

A

levels will remain high as long as baby is kept close and milk will start to be release in response to early feeding of behaviour clues

if baby is away from mum these early clues might be missed, if mum can only respond when her baby is crying and distressed her own cortisol levels will be raised and compete w/ oxytocin

60
Q

prolactin and oxytocin - mum and baby bonding

A

prolactin and oxytocin work together to help a new mother feel calm yet protective of her baby

oxytocin helps form a bond between mother and baby

61
Q

feedback inhibitor of lactation (FIL)

A

Circulating prolactin within bloodstream controls milk production especially in the early weeks post birth.
Volumes can be irregular at first so mothers may experience full breasts and leaking as the supply and demand establishes itself.
As breasts become very full either through ineffective milk removal or long spacing of feeds a whey protein in the milk called FIL slows down synthesis by signalling to the cells to stop production.
In addition it is believed that the down regulation (reduced milk production) is also caused by pressure within the full breast flattening and expanding the cells and the receptor sites, making it difficult for prolactin to attach to and enter the cells.

62
Q

oxytocin - the love hormone

A 
works on feeling and emotions
lowers BP and improves sleep
reduces stress levels by 'taking on' cortisol 
reduces pain sensitivity
boosts immune system
63
Q

skin to skin contact - baby friendly standard

A

all mothers have skin to skin contact w/ baby after birth at least until after the first feed and for as long as they wish
all mothers are encouraged to offer the first feed in skin contact when the baby shows signs of readiness to feed
mothers and babies who are unable to have skin contact immediately after birth are encouraged to commence skin contact as soon as they are able

64
Q

why should skin contact be prolonged

A

triggers lactation and mothering hormones
regulates temp, HR and breathing in baby
colonises baby w/ microbes from mother, father and their environment
stimulates feeding behaviour
reduces stress hormones in mother and baby

65
Q

why is skin to skin still important in bottle fed babies

A

triggers mothering hormones
regulates temp, HR and breathing in baby
colonises baby w/ microbes - esp important if not recieving breastmilk
reduces stress hormones in mother and baby
starts mother-baby bond

66
Q

9 stages baby goes through after birth

A 
birth cry
relaxation
awakening 
activity 
rest
crawling
familiarisation
suckling 
sleeping
67
Q

stage 1 - birth cry

A

after birth

distinctive cry familiar to midwives as baby expands his lungs

68
Q

stage 2 - relaxation

A

after birth cry
no mouth movement
hands and body totally relaxed

69
Q

stage 3 - awakening

A

2-4 mins after birth
small thrusting movements of head and body
eyes beginning to open
some shoulder movement

70
Q

stage 4 - activity

A

4-12 mins after birth

stable open eyes, rooting, salivating, hand to mouth, hand to breast to mouth, tongue protrusion

71
Q

stage 5 - rest

A

frequent after birth

lots of rest periods after activity

72
Q

stage 6 - crawling

A

18-54 mins after birth
crawling, sliding, leaping and drawing up knees to push forward
lots of rooting searching

73
Q

stage 7 - familiarisation

A

29-62 mins after birth
VERY important stage - can last 20 mins or more
licking nipple, touching, massaging breast
begins to interact with mum and dad
stimulating mum’s hormones

74
Q

stage 8 - suckling

A

49-90 mins

self attaches after working out best approach and begins to feed

75
Q

stage 9 - sleeping

A

90-120 mins

76
Q

catecholamine levels in baby after birth

A

raised after birth - help support transition to extra uterine life
these decrease when baby begins to feel safe in a known environment

as levels drop baby begins to display activity and becomes more awake and interested in their environment

77
Q

what is the role of the rest periods during the instinctive search

A

enables baby to consolidate and integrate what they have already experienced
all to do with imprinting and shouldn’t be rushed

78
Q

what is the role of the crawling stage

A

helps baby move closer to the breast

massages mother’s uterus, helping it to contract - important for oxytocin release but also helps prevent PPH

79
Q

what is the role of familiarisation

A

baby approaches mother’s breast, spends time imprinting and working out how best to approach and attach for feeding

if rushed by staff (putting baby onto the breast) this can result in baby struggling to attach at subsequent feeds - biggest reason many mothers stop breastfeeding in the early weeks

80
Q

separation and stress

A

term baby separated for 6 hrs has increased stress
pre-term baby receiving high-tech care has greatly increased stress

one hour of skin contact can reduce stress hormone levels by 75%

81
Q

what can skin contact help with

A

attachment challenges - overhelped, pain and discomfort
boosting milk supply
unsettled babies and mothers
breast refusal
postnatal depression or low mood - oxytocin and prolactin and released which are both mood boosters, baby will also feel nurtured and safe
just because it feels good - mums and dads

Y3 repro (47 decks)

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