Introduction to Breastfeeding

Question 1

What are the breasts made up of?

Answer 1

Nipple areola, mammary tissue and supporting connective tissue
Fate, lymphatic vessels and nerves

Question 2

Describe the anatomy of the breast

Answer 2

Made up of approx. 20 lobed which contain alveoli
Within alveoli are the milk producing cells lactocytes
Alveoli are surrounded by myoepithelial cells
Nipple has average of 9 opening surrounding the areola

Question 3

What does oxytocin stimulate the myoepithelial cells to do?

Answer 3

Contract, pushing the milk into lactiferous ducts and towards the nipple

Question 4

What are montgomery tubercles?

Answer 4

Glands which secrete a sebaceous fluid that lubricates the nipple and protects the skin
Fluid has aroma which attracts infant to the mother

Question 5

Describe breast development during puberty

Answer 5

Hormones such as oestrogen prompt mammogenesis through development of ductal system within breast as they increase to adult size

Question 6

Describe breast development during pregnancy

Answer 6

Progesterone and human placental lactogen enhance structures that produce milk
Blood supply to breasts increase to provide nutrients

Question 7

What does the event of sucking acting as a stimulus lead to?

Answer 7

Stimulus via higher sensors in hypothalamus to posterior pituitary which secretes oxytocin
Also acts on anterior pituitary to produce prolactin

Question 8

What does prolactin stimulate?

Answer 8

Secretes milk for the next feed

Question 9

Describe the feedback inhibitor of lactation

Answer 9

As lactocytes secrete milk, it accumulates and inhibits new milk production
When breast is full then milk production is ceased

Question 10

What psychological effects does prolactin and oxytocin have on the mother and the infant?

Answer 10

Produces feelings of calmness in both
They help the mother fall in love with her infant and want to hold, stroke and protect them

Question 11

What is the difference of water in human milk and infant formula?

Answer 11

Human - water is filtered at source
Formula - water must be boiled for reconstruction

Question 12

What is the difference in protein between human milk and infant formula?

Answer 12

Human - predominantly whey based and easy to digest, main protein is alpha lactalbumin
Cow’s milk protein has been linked to increased risk of juvenile onset of diabetes

Question 13

What is the difference in carbohydrates between human milk and infant formula?

Answer 13

Human - lactose is primary carbohydrate and provides 40% of total calories, improves absorption of calcium and promotes healthy bacteria production
Formula -lactose is also predominant

Question 14

Describe fats in human milk

Answer 14

Long chain fatty acids are present and contain transfer factors
Essential for brain development and absorption of fat soluble vitamins
Major calorie source

Question 15

Describe fats in infant formula

Answer 15

Mainly vegetable based but some contain egg
Some have docosahexaenoic acid

Question 16

Describe vitamins and minerals in human milk and infant formula

Answer 16

Human - small quantities, absorption dependant on transfer factors
Formula - extra vitamins and minerals

Question 17

What are some constituents of human milk that are not present in infant formula?

Answer 17

Growth factors, stem cells, immunoglobulins, leukocytes, lactoferrin, oligosaccharides, human milk lipids and IL-7

Question 18

What is the function of growth factors in human milk?

Answer 18

Epidermal, insulin and transforming factors promote gut growth

Question 19

What is the function of stem cells in human milk?

Answer 19

These constitute an internal repair system and cells have ability to develop into many different cell types

Question 20

What is the function of immunoglobulins in human milk?

Answer 20

IgA, IgG, IgM and IgD - IgA is most important as it covers the mucosal gut surface to prevent entry of pathogenic bacteria

Question 21

What is the function of leukocytes in human milk?

Answer 21

Destroys harmful bacteria

Question 22

What is the function of lactoferrin in human milk?

Answer 22

Protein which binds to iron, making it unavailable for bacteria which helps prevent gastroenteritis
Also kills bacteria

Question 23

What is the function of oligosaccharides in human milk?

Answer 23

Supports healthy gut microbiota
Also support growth of friendly bacteria and destroy bacteria like group B strep

Question 24

What is the function of human milk lipids in human milk?

Answer 24

Damages the outer surface of certain virus types

Question 25

What is the function of IL-7 in human milk?

Answer 25

Linked to size of thymus
Breastfed infants have a larger thymus - which plays a role in stimulating antibody producing cells

Question 26

Describe the microbiome in breastmilk

Answer 26

Mother transfers her microbial heritage to her infant via vaginal birth, skin to skin contact and breastfeeding
Contains bacterial strains, fungi, parasites and viruses

Question 27

What are the functions of the microbiome?

Answer 27

Producing vitamin K, biotin and folate
Development of immune system
Converts oligosaccharides to short chain fatty acids which provide energy sources for enterocytes
Provides a barrier that may prevent absorption of toxins
Helps immature gut of premature baby to seal

Question 28

What is the first milk produced from the breasts called?

Answer 28

Colostrum - produces from 16 weeks of pregnancy and consists of thick, yellow fluid which increases in days 3-4

Question 29

What are the main components of colostrum?

Answer 29

Rich in vitamin A, creates acidic environment, immunoglobulins, antibodies and anti-infective proteins, high viral fragments, mild purgative and epidermal growth factors

Question 30

Describe immune protection by breastfeeding

Answer 30

Breastfeeding activates broncho-entero-mammary pathway
Mother can share her immunity with her infant - lungs and small intestine LNs manufacture specially sensitive lymphocytes

Question 31

Describe brain development and breastfeeding

Answer 31

Contain docosahexaenoic acid (long chain polyunsaturated fatty acid) which supports brain development and higher performance of intelligence

Question 32

Describe maturation of gut and breastfeeding

Answer 32

Epidermal growth factors promote healing whilst neuronal growth factors promote development of peristalsis - help reduce chance of necrotising enterocolitis

Question 33

Describe protection of mother’s health during breastfeeding

Answer 33

Protects against post partum haemorrhage, postpartum depression, ovarian and breast cancers, heart disease and type 2 diabetes

Question 34

Why is skin to skin contact important?

Answer 34

Trigger lactation and mothering hormones
Triggers calming hormones in baby and counter adrenaline
Stimulates digestion
Stimulates instinctive feeding behaviours
Enables baby’s skin to be colonised by protective bacteria

Question 35

Describe the positioning of breastfeeding

Answer 35

Keep baby close
Baby will tilt head back to allow chin to lead
Baby’s head and body should be in line
Nose to nipple positioning