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NUFS 356 > L7 Breast Feeding and Breast Milk > Flashcards

L7 Breast Feeding and Breast Milk Flashcards

1
Q

What are the current recommendations for infant feeding?

A

Exclusive breastfeeding for first 6 months and can continue for 2+ years.

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2
Q

What is the only alternative for breast milk in the first 6 months?

A

iron fortified formula

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3
Q

What is exclusive breast feeding?

What does it not include?

A

breast milk from the breast and expressed breast milk with inclusion of supplements, medicines

Does not include water, formula, other liquids or solids

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4
Q

What are the benefits of breastfeeding for the infant (X4)?

A
  • contains all the needed nutrients in ideal proportions
  • helps development on GIT and immune system
  • lower risk of infections, allergies, SIDS
  • enhanced cognitive development and lower risk of obesity
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5
Q

What are the benefits of breastfeeding for the mother (X5)?

A
  • cheap and convenient
  • promotes weight loss
  • physiological benefits from the physical contact
  • delayed return of fertility
  • associated with lower risk of breast and ovarian cancer
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6
Q

What is the difference between lactation and breastfeeding?

A

Lactation is the production of milk.

Breastfeeding is nourishing the infant at the breast

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7
Q

When does the mammary gland develop?

A

During puberty but remains non-functioning until pregnancy

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8
Q

Mammary alveoli are sacs that store and produce milk. They cluster into groups called lobules of about 15-20. What are the components that make the milk and what components contract to help to secrete the milk into the ducts?

A

epithelial milk-secreting cells

myoepithelial cells

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9
Q

In lactation, where do the “raw materials come from?

A

From the maternal circulation of stores and diet. Materials may be processed or just transported across into the ducts. Final product is secreted into the ducts in center of alveoli.

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10
Q

In lactation, what products are synthesized and what are transported through the alveolar cell and what pass through by passive diffusion?

A
  • Gland cells synthesize lactose, protein, TG from raw materials in the endoplasmic reticulum and the Golgi apparatus which are then secreted into the alveoli duct
  • plasma proteins, immunoglobins are transported through the alveolar cell
  • water and electrolytes pass through passive diffusion
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11
Q

Why is breastfeeding at the beginning of lactation so important?

A

The para cellular pathways are open in early lactation and close as lactation proceeds. While the pathways are open, immune protective compounds can pass through this way.

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12
Q

What are the 3 stages of lactaion

A

Stage 1: Increased lactose, protein, immunoglobulin in gland in 3rd trimester. Colostrum is the 1st fluid after delivery and lasts about 1-3 days.

Stage 2: 3 -10 days post partum. Secretory activation and transitional milk is formed. there is an increase in blood flow and glucose uptake when the milk comes in

Stage 3: 10 days post partum. Mature milk comes in.

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13
Q

What causes the initiation of lactation?

A

At delivery, the placenta leaves the body ad there is an abrupt decrease in hPL, estrogen, and progesterone. This decrease of estrogen and progesterone triggers milk secretion.

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14
Q

How is lactation maintained?

A

Prolactin and oxytocin
Prolactin (ant. pit.) milk production- very high in the first weeks but gradually decline and then rise again with sucking.

Oxytocin (post. pit) and milk release - stimulated by sucking. Triggers contraction of myoepithelial cells to permit milk ejection = let-down reflex

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15
Q

what are the basic principles of breast feeding?

A
  • start within the alert period immediately after delivery
  • feed on demand rather than by schedule (8-12 times per 24 hours)
  • go from 1st breast and the to the other
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16
Q

Early infant cues of hunger

A

hands to mouth, head movement

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17
Q

How long is active feeding normally?

A

5 -20 min

satiety cue - release of breast spontaneously

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18
Q

What is colostrum?

A

Yellow in colour (low in volume (2 -10 ml/feed)
lower in energy but high in protein and growth factors.
enough to meet infants needs in the first few days

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19
Q

What components of breast milk is dependent on maternal diet and what is not?

A

Dependent:

  • f.a. only changes type of fat not the amount
  • water soluble vitamins thiamin, riboflavin, niacin, b12, b6, choline, vit c
  • fat soluble vits a, and D
  • minerals iodine

Not dependent:

  • CHO and protein
  • water soluble folate
  • fat soluble vit E
  • minerals all except iodine
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20
Q

How does the composition of milk change over time?

A

In the morning and at night the fat is lower.

The foremilk is higher in lactose and lower in fat than the hindmilk.

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21
Q

What is the nutrient composition of mature milk?

About how much is produced each day?

A 
Energy = 0.67 kcal/g
55% lipid 
38% lactose 
7% protein 
700-900g
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22
Q

What is the CHO composition of breast milk?

A

almost 100% lactose

contains oligosaccharides (medium length CHO) which prevent pathogens from binding to the gut wall and promote growth of good bacteria

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23
Q

what is the protein composition of breast milk?

A

10g protein / L

mostly casein, alpha-lactalbumin, lactoferrin, sIgA, lysozyme, serum albumin

20% of nitrogen containing non-protein compounds including urea, free amino acids, nucleotides

24
Q

How is the protein in breastmilk different than in cows milk?

A

human; 70% whey, 30% casein
Cows milk: 20% whey, 80% casein

Whey protein is soluble in acid and more easily digested so it is more rapidly emptied from the stomach. Casein is just digested slower

25
Q

What is the lipid composition of breastmilk?

A

Lipids are about 50% of the calories and mostly long chain.
They are contained in milk fat globules which are protein carriers for TG.
Most variable component of breast milk but quantity doesnt change.
AA and DHA are influenced by the diet.. More fish will give more DHA.

26
Q

What is the composition of vitamin D in breastmilk?

A

about 22 IU/L and is fairly constant throughout.
Likely inadequate to meet the needs.
Supplementation is recommended but not necessary for formula fed.

27
Q

What is the composition of vitamin K in breast milk?

A

All infants are receive vitamin K at birth.

Usually synthesized in the micro flora but usually low in breast milk.

28
Q

What does Health Canada recommend for supplementation for infants?

A

Vitamin K 1mg IM at birth

vitamin D - 400 IU/d at birth to 12 months

29
Q

What are preterm infants usually supplemented with?

A

iron

30
Q

What is not recommended to supplement an infant with?

A

water, other milks, multivitamins supplements

31
Q

What is the composition of calcium and phosphorous in breastmilk?

A

it is lower than in cows milk but more bioavailable becasue calcium is bound to casein. Lactose also enhances calcium absorption.
Amounts are stable throughout pregnancy.

32
Q

What is the iron composition in breast milk?

A

Content is very low but very bioavailable. Attached to the protein lactoferrin.
Does not meet the nutrient requirements after 6 months so need to introduce an iron food source.

33
Q

What is the compostion of zinc in breast milk?

A

higher than in the mothers plasma.

bound to protein which makes it very bioavailable

34
Q

What is the composition of choline in breast milk?

A

Many women do not meet the needs of choline. there is an increased need during lacation - amount in milk reflects the amount in the diet. It is important for brain development, lipid digestion/absorption/transport, and intestinal health

35
Q

What are the AI for non-pregnant, pregnant and lactating women for choline?

A

non-pregnant: 425 mg/d

pregnant: 450 mg/d
lactating: 550 mg/d

36
Q

What are some non-nutritive compounds that are not found in formulas?

A 
bioactive compounds: 
Immune properties
growth factors
leptin
adiponectin
ghrelin
obestatin
37
Q

What are 9 immune properties found in breastmilk?

A

secretory IgA: line the mucosal surfaces, prevent microial attachment

Lactoferrin: antimicrobial activity

Lactadherin: prevents rotaviral infection

Lysozyme: cleaves bacterial cells walls

lymphocytes: cytokine production
cytokines: protection, inflammation
oligosaccharides: prebiotic

38
Q

What are 3 growth factors in breastmilk?

A

epidermal growth factor (EGF): maturation, and healing of the intestinal mucosa

neuronal growth factors: maturation of enteral nervous system
insulin-like growth factor (IGF) and binding protein: regulation of tissue growth

39
Q

Leptin, adipoectin, ghrelin and obestatin are bioactive components of breast milk. What do they do?

A

not totally understood.
involved with regulation of metabolism and or appetite
possible link btwn lower risk of obesity

40
Q

What are the energy recommendations for breastfeeding women?

A

0 - 6 months:
it is the EER of a non-pregnant woman + 500 (energy costs of milk production) - 170 (to promote weight loss)

7 - 12 months
EER non-pregnant + 400 - 0 (no weight loss promotion)

41
Q

What are the macronutrient recommendations for CHO, protein, and lipids during lactation?

A 
CHO RDA = 210 g/d
protein RDA = 1.3 g/kg/d
both are higher in than in pregnancy 
Essential f.a. Intake: 
linoleic 13 g/d 
linolenic 1.3 g/d
200mg DHA/d
42
Q

Breastmilk is 88% water/ What is the AI of water in non-pregnant, pregnant, and lactating women?

A

non-pregnant: 2.7L/d
pregnant: 3.0L/d
Lactating: 3.8L/d

43
Q

Which micronutrients have higher recommendations in lactation than in pregnancy?

A

Vitamin A, riboflavin, B6, B12, vitamin C, E, chromium, ect.

44
Q

What are the characteristics of women who exclusively breast feed for at least 6 months?

A
  • support network
  • older
  • higher income
  • have had previous breastfeeding experience
45
Q

When should women not breastfeed?

A
  • HIV infection
  • drug abuse
  • infant galactosemia ( cannot digest galactose and build up in blood)
  • infant lactase deficiency ( builds up in the GIT and can cause severe diarrhea)
46
Q

Why should a women cease to breastfeed for a short period of time?

A
  • herpes lesions on both breasts
  • active TB
  • use of some medications like chemotherapy, radioactive isotopes
47
Q

What are some reasons a woman may not breastfeed?

A
  • lack of support/confidence
  • perception of inadequate milk production or adverse infant response to breastmilk
  • discomfort, infections
  • other demands
48
Q

How to know if there is enough milk?

A
  • short term weight gain after initial weight loss
  • about 3 yellow bowel movements/d
  • urine is clear, light coloures about 6X a day
  • baby settled and comfortable for 2-3 hours after feed
  • meeting growth and developmental milestones
49
Q

What are some reasons for not meeting the expected growth patterns?

A
  • inadequate intake or digestion, excessive losses, requirements above predicted
  • <5th percentile weight for age, <50th percentile weight for length
50
Q

What is a temporary solution to the lack of sucking not stimulating let down?

A

inhaled oxytocin

relaxation techniques

51
Q

What is hyperactive letdown?

A

rapid flow

feed when flow slows and increase emptying

52
Q

What can a mother do when she has a plugged duct?

A

warm compress, massage, complete emptying

53
Q

What is mastitis and how do you treat it?

A

Bacterial infection

antibiotics, continue breastfeeding

54
Q

Do you change feeding with colic?

A

no, usually resolves within 4 months. small percentage with severe colic respond to maternal restriction of cow protein.

55
Q

How often do bf infants have bowel movements?

A

3-4 days

56
Q

Should you change feeding if baby has reflux?

A

no - very normal

57
Q

Should you change feeding with acute gastroenteritis?

A

strongly encourage to continue breast feeding.
diarrhea is sign of viral infection.
may require oral rehydration for mild to moderate but IV if severe. - kidney fnx is impaired so at risk of diarrhea

NUFS 356 (24 decks)

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