Lactation Flashcards
1
Q
Advantages of breastfeeding, for infant (3)
A
- Confers immunologic protection for the child
- Nutritional composition tailored to nutritional needs of human infant
- Neurodevelopmental benefits
- Bonding and increased cognitive performance (data controversial(
2
Q
Immunologic protections conferred by breastfeeding
A
- Acute infections
- GI infection - ↓ 64%
- Lower respiratory infection - ↓ 72%
- Acute otitis media - ↓ 50%
- Chronic conditions
- Asthma - ↓ 27%
- Obesity - ↓ 24%
- Type 2 DM - ↓ 39%
- Leukemia - ↓ 19%
3
Q
Nutritional composition of breastmilk & advantages for child
A
- Macronutrient and micronutrient balance
- High fat content –> efficient weight gain
- Low renal solute load beneficial for immature kidneys
- Modest protein content (primarily whey, 60%)
- Enhances mineral absorption
- Presence of long-chain polyunsaturated fatty acids (omega-3’s)
- Good for baby’s brain development
- High lactose
- All components present in amounts that provide adequate intake to baby while minimizing demand on mother
4
Q
Advantages of breastfeeding, for mother
A
- Prevention of post-partum hemorrhage
- Oxytocin stimulates uterine contraction
- Weight loss
- Average return to pre-pregnancy weight after approx. 6mo of lactation
- Lower rates of obesity associated with breastfeeding - suggesting protective effect
- Lactational amenorrhea/birth spacing - free birth control
- Also spares nutrients, especially iron
- BF > 6 months associated with increased inter-pregnancy interval to one year
- Provides > 98% protection from pregnancy of about 6 months, if exclusively breastfeeding
- Requires frequent nursing episodes with intervals < 5 hours
- Reduced risk of osteoporosis, breast, and ovarian cancer
- Bonding/stress reduction
- Associated with decreased steroid hormones in breastfeeding women
- Economic benefit
- Savings in medical expenses & not buying formula or pumps
5
Q
Nutritional composition of breast milk
A
- Fat
- Total: 4.2 g/100mL
- trace fatty acids
- 14% polyunsaturated fatty acids
- Protein
- Total: 1.1 g/100mL
- Casein 0.3g/100mL
- a-lactalbumin: 0.3g/100mL
- Lactoferrin: 0.2g/100mL
- IgA: 0.1 g/100mL
- IgG: 0.001 g/100mL
- Lysozyme: 0.05
- Serum albumin: 0.05
- Carbohydrate
- Lactose: 7g/100mL
- Oligosaccharides: 0.5g/100mL
- Minerals
- Calcium: 0.03g/100mL
- Phosphorus: 0.014g/100mL
- Sodium: 0.015g/100mL
- Potassium: 0.055g/100mL
- Chlorine: 0.043g/100mL
6
Q
Impact of maternal diet on nutritional composition of breastmilk
A
- Maternal malnutrition –> reduced milk supply
- But minimally altered macronutrient and mineral content
- Exceptions: selenium & iodine
- But minimally altered macronutrient and mineral content
- Maternal diet does affect content of vitamins in human milk
- In adequately nourished women, additional energy and fluid intake does not affect volume
7
Q
Immune factors in human milk
A
- Lactoferrin
- Bacteriostatic effect by binding iron
- Secretory IgA
- Mucosal protection
- Oligosaccharides and glycoproteins
- Prevent attachment of pathogenic agents to epithelial lining of mucosal surfaces by encouraging growth of non-pathogenic flora
- Immune cells including macrophages
8
Q
Recommendations for breastfeeding (WHO & AAP)
A
- Exclusive breastfeeding for 6 months
- Continue to breastfeeding through:
- 1 year of life (AAP)
- 2 years of life (WHO)
- With appropriate complementary feeding initiated at 6 months
9
Q
Recommendations for breastfeeding for women with HIV
A
- WHO, 2009: Women and infants should receive antiretroviral therapy (ART) and breastfeed for 12 months
- If ART not available, carefully consider alternatives to breastfeeding (formula, wet nurse)
- CDC: HIV-infected women in US should not breastfeed infants
10
Q
U.S. Healthy People 2020 Goals for breastfeeding
A
- Don’t worry about specific numbers
- Increase proportion of infants who are breastfed; targets:
- 81.9% “ever breastfed” initiation rates
- 60.6% at 6 months
- 34.1% continue breastfeeding at 1 year
- Goals for exclusive BF at 3 months = 46.2%, 25.5% at 6 months
- Increase proportion of employers with worksite lactation support programs 25% –> 38%
- Decrease proportion of breastfed newborns who receive formula supplementation within first 2 days of life 25% –> 10%
- Increase proportion of live births in facilities that provide recommended care for lactating women and infants 4 –> 8.1%
11
Q
10 steps to improve breastfeeding encouragement in hospitals
A
- Maintain written breastfeeding policy that is routinely communicated to all healthcare staff
- Train all healthcare staff in skills necessary to implement this policy
- Inform all pregnant women about benefits and management of breastfeeding
- Help mothers initiate breastfeeding within 30 minutes - 1 hour of birth
- Show mothers how to breastfeed and how to maintain lactation, even if separated from infants
- Give infants no food or drink other than breast milk unless medically indicated
- Practice rooming in - allow mothers and infants to remain together 24 hours/day
- Encourage unrestricted breastfeeding
- Give no pacifiers or artificial nipples to breastfeeding infants
- Foster establishment of breastfeeding support groups & refer mothers to them on discharge from hospital/clinic
12
Q
Biggest barrier to encouraging breastfeeding in US hospitals
A
- Acceptance of free formula from pharmaceutical companies
13
Q
Socioeconomic and cultural factors influencing breastfeeding in US
A
- Who breastfeeds in US?
- Women who are older (> 24 years)
- More highly educated
- Employed part-time or not employed
- Not participating in WIC
- Live in New England, Mountain, or Pacific regions
- Caucasians and Hispanics tend to breastfeed more than Blacks
14
Q
Reasons for recommending breastfeeding within 1 hour of birth
A
- Infants placed on abdomen that self-attach to breast and nurse within 1 hour have better breastfeeding outcomes
- Increased number who continue breastfeeding 2-4months post partum
- Skin-to-skin contact in delivery room helps baby maintain body temp
- Infant typically alert & active for about 1 hour after delivery, then increased sleepiness
- Can be achieved by delaying routine procedures as possible:
- Weighing, vitamin K shot, eye prophylaxis
15
Q
Hospital practices with a negative impact on breastfeeding
A
- Mother-infant separation at birth
- Mother-infant housed on separate floors
- Mother encouraged to “get your rest,” “take it easy,” or discouraged from breastfeeding
- Pictures of bottle feeding
- Formula feeding in nurseries
- Discharge packs with formula kit
