Intro to infant feeding Flashcards
what makes up the Breast?
nipple
areola
mammary tissue
supporting connective tissue
fat
blood
lymphatics
nerves
what is the function of the fatty tissue?
protects the breasts
what is the function of the fatty tissue being divided into lobes by connective tissue?
to protect it from harmful infections
what is the function of the nerve supply to the breast?
creates sensitivity for the milk ejection reflex
how many lobes are in the breast?
20
what do the lobes of the breast contain?
alveoli
what is contained within the alveoli?
milk producing cells - lactocytes
what are the milk producing cells?
lactolytes
what surrounds the alveoli?
myoepithelial cells (smooth muscle)
what does oxytocin do?
stimulates the myoepithelial cells to contract, pushing the milk into the lactiferous ducts and towards the nipple
how many openings does the nipple have?
on average 9
what surrounds the openings of the nipples?
areola
what are Montgomery tubercles?
glands which secrete a sebaceous fluid that lubricates the nipple and protects the skin. the fluid has an individual aroma that attracts the infant to his mother
what stimulates the release of milk?
contraction of the myoepithelial cells pushed milk out from the alveoli into the lactiferous ducts
what breast development occurs during puberty?
hormones such as oestrogen prompt mammogenesis through development of the ductal system within the breasts as they increase to adult size.
what breast development occurs during pregnancy?
Other hormones, such as progesterone and human placental lactogen, enhance the structures that will produce milk for the infant. Blood supply to the breast increases to provide nutrients from which milk will be made.
what effect does suckling have?
sends a powerful stimulus to the hypothalamus to the posterior pituitary which secretes oxytocin
whet effect does oxytocin have?
contracts the smooth muscle which releases the milk
what effect does suckling have on the anterior pituitary gland?
release of prolactin
what effect does prolactin have?
stimulates the lactocytes to produce milk for the next feed
what physiological effects does oxytocin and prolactin have on the mother and baby?
Working together, they produce feelings of calmness in both and they help the mother fall in love with her infant and want to hold, stroke and protect him/her. Keeping her infant close makes breastfeeding easier because it keeps the level of oxytocin in the mother’s bloodstream higher and the oxytocin reflex becomes conditioned over time, so that it becomes easier to ‘think it up’.
what is the protein component of breast milk?
Predominantly whey-based (60-80%) and easy to digest. The main protein is Alpha lactalbumin (20%) and is associated with the destruction of over 40 types of cancer cells.
what is the protein component of formula?
Cows’ milk protein (bovine serum albumen) has been linked to an increased risk of juvenile onset diabetes.
what is the carbohydrate component of breast milk?
lactate is the primary carbohydrate and provides around 40% of the total calories. It improves the absorption of calcium and promotes growth of healthy bacteria
what Is the carbohydrate component of formula?
Lactose is also the predominant carbohydrate here. Sucrose, fructose and glucose are present in some soy/lactose-free infant formula.
what is the fatty component of breast milk?
Fats Long-chain fatty acids are present and contain transfer factors which help absorption. These acids are essential for brain development, absorption of fat-soluble vitamins (such as vitamin A which improves eyesight) and constitute a major calorie source
what is the fatty component of formula milk?
Fats in infant formula are currently mainly vegetable-based, however some contain egg. Certain infant formulas are marketed as containing long-chain fatty acids, specifically Docosahexaenoic acid.
what is the vitamin and mineral component of breast milk?
Present in small quantities, their absorption is dependent on transfer factors.
what are the vitamin and mineral components of formula?
Extra vitamins and minerals are added to the powder.
what constituents are present in human milk, not formula?
growth factors
stem cells
immunoglobulins
leukocytes
lactoferrin
oligosaccharides
human milk lipids
IL-7
Other constituents of human milk include lymphocytes and cytokines which support the immune system. This also contains enzymes which aid digestion and absorption and some destroy bacteria.
what is the benefit of growth factors?
Epidermal, insulin and transforming factors promote gut growth.
what is the benefit of stem cells?
These constitute an internal repair system and the cells have the ability to develop into many different cell types
what are the benefits of immunoglobulins?
IgA, IgG, IgM and IgD - the most important of these is IgA which covers the mucosal gut surface to prevent entry of pathogenic bacteria, e.g. E coli, and enteroviruses, e.g. rotavirus, into the infant gut, thus protecting against infections
what are the benefits of lactoferrin?
A protein which binds to iron, making it unavailable for bacteria and thus helping it to prevent gastroenteritis. It also kills various bacteria, including E coli.
what are the benefits of oligosaccharides?
Support a healthy gut microbiota. There are over 200 types that are unique to human milk and which defend against pathogens that cause otitis media, respiratory tract, urinary and gastrointestinal infections. They also support the growth of friendly bacteria (Bifidus) and destroy bacteria such as group B strep.
what are the benefits of human milk lipids?
Damages the outer surface of certain virus types
what are the benefits of IL-7?
IL-7 is linked to size of the thymus. Breastfed infants have much larger thymus than those who are formula fed, which plays an important role in stimulating antibody producing cells
how does a mother transfer her microbial heritage to her infant?
via vaginal birth
skin to skin contact
breastfeeding
what microbiome does breast milk contain?
contains a diverse and complex microbiome consisting of >800 bacterial strains on average, along with fungi, parasites and viruses which drive the healthy development of infant gut physiology. Oligosaccharides in breastmilk feed the bacteria which form the basis of the baby’s microbiome
what is the function of the microbiome in breast milk?
Producing Vitamin K, biotin and folate
Aiding the development of the immune system
Converting oligosaccharides to short-chain fatty acids which provide energy sources for enterocytes
Binding to sites on the layer of cells lining the gut and providing a barrier that may prevent absorption of toxins.
Helping the immature gut of a very premature baby to seal, thereby preventing colonisation by pathogenic bacteria and reducing the likelihood of them developing Necrotising Enterocolitis (NEC).
what is colostrum?
The first milk produced from the breasts is called colostrum
when is colostrum produced from?
16 weeks of pregnancy
what is colostrum like?
a thick, yellowish fluid which increases in amounts over the first 3-4 days in line with the newborn infant’s needs. It is rich in protein, fat-soluble vitamins and mineral levels
what are the main components of colostrum?
rich in vit A
creates acidic environment
immunoglobulins, antibodies and anti-infective proteins
high viral fragment and white cell count
mild purgative
epidermal growth factors, anti-inflammatory molecules
small in volume, high in value b
how does breast milk provide vital immune protection?
Breastfeeding, activates the broncho-entero-mammary pathway.
When a mother ingests or inhales pathogens Lymph nodes in the lungs and small intestine manufacture specially sensitised lymphocytes which migrate to the breasts and create unique secretory antibodies against that pathogen, which enable the mother to share her immunity with her infant
how does breast milk promote gut maturation?
Epidermal growth factor promotes healing whilst neuronal growth factors promote development of peristalsis. These factors help reduce the chance of necrotising enterocolitis (NEC) which is a complication of extreme premature birth. Formula-fed preterm infants are 6-10 times more likely to develop NEC than a breastfed infant
how does breast milk promote the development of the brain?
Breastmilk contains long-chain polyunsaturated fatty acids such as Docosahexaenoic acid which support healthy brain development and are associated with higher performance in intelligence tests among children and adolescents across all income levels. One trial and many observational studies have found an inverse association between intelligence and attainment and formula feeding. This is seen even in societies where breastfeeding is commonest in the most deprived rather than most affluent strata
how does breast milk promote the mothers health?
Breastfeeding has been shown to protect against postpartum haemorrhage, postpartum depression, ovarian and breast cancers, heart disease and type 2 diabetes. It also supports the mother-baby relationship and the mental health of both the baby and mother
what are non breastfed babies at a higher risk of?
sudden infant death syndrome
necrotising enterocolitis
what are non breastfed babies at a higher incidence of?
obesity and diabetes
dental decay/malocclusion
what do non breastfed babies have reduced levels of?
immune protection
development of the brain and gut maturation
educational attainment
where is oxytocin produced?
posterior pituitary gland
what is the function of long chain fatty acids in breast milk?
stimulate development of infant brain
where is the feedback inhibitor of lactation produced?
alveoli of breasts
what are Montgomery tubercles?
glands which secrete a sebaceous fluid that lubricates the nipple and protects the skin. This fluid has an individual aroma that attracts the infant to its mother
what is lactoferrin?
protein present in breastmilk which binds to iron, making it unavailable for bacteria and thus helps to prevent gastroenteritis. It also kills various bacteria including E coli
not present in formula
what are some benefits of the gut microbiome?
-production of Vit K
-prevention of absorption of toxins in the gut
-reduction in the liklihood of developing NEC
why is skin to skin contact important?
-triggers lactation and mothering hormones and enables mothers to recognise their infants’ feeding cues
-Triggers calming hormones in the baby and counters adrenaline which in turn regulates heartbeat and breathing
-Stimulates digestion
-Stimulates instinctive feeding behaviours including seeking the breast as well as rooting and suckling
-Enables the infant’s skin to become colonised by protective bacteria from his mother’s skin. These are bacteria relevant to their home circumstances and will mostly be ‘friendly’ bacteria. –They are preferable to the bacteria likely to be present on the doctor’s clothing or a hospital towel/blanket.
what is the acronym for positioning and attachment?
CHIN
Keep the baby CLOSE so he can scoop the breast into his mouth
The baby will tilt his HEAD back to allow his chin to lead as he comes onto the breast
The baby’s head and body should be IN LINE (i.e. not twisted), and
NOSE to nipple positioning is the starting point for effective attachment.
why is it normal for babies to be fed through the night?
Babies grow quickly in the early weeks and months of their lives and have very small stomachs. Therefore, they need to feed around the clock to meet their needs. Keeping baby close at all times, including at night (in a cot beside the bed), enables the mother to feed her baby responsively.
what is the normal considered length of a feed?
5-40 mins
why do some women opt to not BF?
-negative attitudes in public
-worried about shame or judgment
-lack of support
-worries baby getting enough milk
-want a regular routine
-dont want to feed over night
-breast/pain discomfort
-cracked nipples
-infection
what are some medical reasons women can’t breastfeed?
anti cancer drugs
bone anticonvulsants
recreational drugs
untreated HIV or TB
previous breast surgery may limit support
how does the size of a baby stomach vary?
day 1- cherry
day 3 - Brussel sprout
1 week - apricot/plum
1 month - large egg
what are some early cues for hunger?
stirring
mouth opening
turning head
what are some mid cues for hunger?
stretching
increasing physical movement
hand to mouth
what are some late cues for hunger?
crying
agitated body movements
turning red
what are some societal issues with breast feeding?
There are numerous practical, emotional and cultural barriers
There is little support for breastfeeding in public or longer-term breastfeeding
Infant formula advertisements (follow on) appear on TV, bus shelters and more
Media, toys, TV, films, etc., all portray bottle feeding, not breastfeeding
Breastfeeding in public is still frowned upon
Breasts are seen as items of sexual display and not a source of feeding.
when would exclusive bottle feeding be recommended?
patient that has a physical or clinical reason that excludes breastfeeding as an option. If the reason is due to the mother’s health, then some health boards do receive donated breastmilk from breastfeeding mothers, obtained using a breast pump to extract and store their breastmilk, and this may be an option for some mothers.
what is complementary feeding?
where breastfeeding may not be physically possible to start with. In this instance, encouraging the mother to express milk with a pump to give to the infant in a bottle, would still ensure the infant gets the nutrients from the breastmilk, and overtime could be combined with the introduction of breastfeeding.
