Lactation, Breastfeeding & Weaning Flashcards
What is mamogenesis?
The growth of the mammary glands where ductal, alveolar and myoepithelial elements all undergo marked hyperplasia in prep. for lactation that begins when they are exposed to oestrogen at puberty and is completed during the 3rd trimester of pregnancy
Why isn’t milk produced during pregnancy?
The high plasma [oestrogen] and [progesterone] present before delivery inhibits the active secretory effects of prolactin on mammary alveolar epithelium
What is colstrum?
The first milk that appears in the acinar glands in the second trimester and builds up to significant amounts in the breast alveoli by the third trimester
What stimulates colstrum to be released post-delivery?
Removal of inhibitory influence of oestrogen and progesterone so prolactin stimulates the acinar alveolar epithelial cells to begin active secretion of colostrum
What does the colostrum contain?
Yellow and viscous fluid containing high carbohydrates and low fat along with:
- Protein
- Abs
- Immunologically active lymphocytes and monocytes
- IFNs
What is the function of interferons (IFNs) in colostrum?
Facilitates the removal of intestinal meconium and is a factor for stimulation of the beneficial Lactobacillus Bifidus in the intestinal tract
What is lactogenesis?
The transition from pre-secretory to secretory state which is complete at 4-5 days post-partum so milk is produced
What is the cellular structure of actively lactating breasts?
Very clear glandular tissue in an acinar arrangement can be seen
What happens when the baby sucks on the breast?
Prolactin stimulates sensory receptors in the nipple that activate nerve impulse which go to endocrine neurons causing a decrease in prolactin-inhibiting factor (PIF) which releases lactotrophs from the inhibitory influence of catecholamines permitting the synthesis/release of prolactin
What is the let-down reflex?
Oxytocin is released after sucking stimulates sensory fibres in the nipple but this becomes a conditioned response in lactating woman that can be stimulated by only visual stimulation or conscious thought - oxytocin causes myoepithelial cells to contract releasing milk into lactiferous ducts/sinuses
Why do breasts feel fuller and more engorged after pregnancy?
Increased blood supply
What is transitional milk?
Begins after the first week of lactation and continues through the 3rd week post-partum - volume of milk produced goes from 100ml to 500ml by the end of the 2nd week post-partum
What is the breast feeding diet?
Significant increase in protein, carbohydrates, lipid, minerals and calories must be maintained if adequate volumes of milk are to be produced (greater dietary requirements than for 3rd trimester of pregnancy)
Why is mature breast milk so beneficial?
- Contains 3-5% fat, 0.% protein and 7% carbohydrates
- Low casein content aids formation of Curd in infants intestinal tract which increases digestibility of milk
- Keeps gastric acidity high leading to increased antimicrobial action
SO formula milk should be as close to it as possible
What is galactopoiesis?
Maintenance of milk production by regular and frequent milk removal from the mammary glands
What are the 3 important mechanisms to enable breast feeding?
- Regular sucking
- Regular emptying
- Demand feeding i.e. feeding when baby wants (if baby is very small do not go longer than 3 hours w/o feeding)
Will a breastfed babies stools look different to a formula-fed baby?
Yes - breastfed baby will have yellow stools with bits in it that will settle down later (NOT a pathology)
Why does the baby have to regularly suck on the breast?
Promotes synthesis/release of prolactin and oxytocin
Why does the breast need to be emptied regularly?
Breasts have a capacity to store milk for a max. of 48 hours before a substantial decrease in milk production occurs - if left unemptied, there is diminished stimulation of glandular epithelium by prolactin and vascular stasis occurs due to increased intra-mammary pressure so mammary ducts/alveoli are distended causing pain
What is the rooting reflex?
If the babies cheek is stroked, they will latch on to the nipple
How can you get a baby to latch on?
Nipple-nose position: hold baby close to you with nose level with nipple, wait until baby opens mouth really wide with tongue down and bring baby onto your breast so baby will tilt their head back and come to your breast chin first
How can you break the seal?
By putting a finger in the babies mouth to get them off of the breast for e.g. if they have fallen asleep
What is different about the feeding of babies by breastfeeding or bottles?
Breastfeeding: they have to suck so milk squirts to back of palate and baby swallows (will do this a lot and make noise if hungry) - breast does not have to be sterilized (beneficial for increased immunity as babies guts are hypermobile allowing molecules through easier)
Bottles: baby doesn’t have to do much as teets/holes come in all different shapes/sizes (make sure air doesn’t get in) - bottle has to be sterilized
What is ankyloglossia? Why is it a problem?
When the lingual frenulum is tight so the baby cannot extend tongue as fully making breastfeeding more difficult - this may resolve itself or may have to get cut
What are the advantages for the baby of breastfeeding?
Lower risk of:
- GI, resp., ear and UTIs
- Necrotising enterocolitis in pre-term babies
- Allergic disease e.g. eczema and wheezing
- Insulin-dependent DM
- SIDS
- Obesity
- Childhood leukaemia
Improved neurological development
What are the advantages for the mother of breastfeeding?
Increased skin-to-skin contact with baby Promotes bonding Involution of uterus Lower risk of breast/ovarian cancer Lower risk of hip fractures Prevention of RA
What is the recommended age a baby should be breastfed up until?
12 months
What is uterine involution?
The return of the gravid uterus to its original size and shape as a pelvic organ although it will never return to its nulliparous state - it is not routinely monitored or measured in new mums unless there is risk factors for involution failure
How is lactation supressed?
- Baby stops sucking so prolactin falls
- Breast binding by wearing a supportive bra
- Pharmacological methods e.g. Bromocriptine (no longer recommended)
How does breast involution occur?
Diminished frequency of sucking decreases prolactin decreasing milk synthesis and increases the amount of breast milk retained in the breast resulting in vascular stasis and alveolar atrophy where there is a decrease in size of alveolar-lobular-ductal units (rather than quantitative loss in menopause) - by 3 months after cessation of lactation the breasts have regressed maximally remaining slightly larger than pre-pregnancy size due to increased fatty tissue and connective tissue retainment
When should breastfeeding be avoided?
- Alcohol misuse
- Certain drugs e.g. Methotrexate, Cyclosporine and Lithium
- Active TB
- Infants w/ galactosemia/phenylketonuria or rare amino acidurias
When should weaning be commenced?
5-6 months
How should the baby be weaned?
Baby-led weaning where baby takes charge starting with rice mixed with a bit of expressed breast milk for e.g. - dont add salt or sugar and dont add gluten before 6 months
How long does babies iron stores last for?
6 months in full-term babies (less in pre-term)
How common is iron deficiency anaemia in babies?
Much more common in pre-mature babies but 1/8 toddlers are anaemic with ~35% among minority ethnic children and white children from impoverished inner-city areas
When would coeliac disease start to present in babies?
When they start weaning if gluten is introduced
How would you know if a baby had coeliac?
Fatty/smelly stools
Grumpy baby due to tummy ache
Over time dropping through centile charts and not growing properly
What else must you keep an eye out for when weaning babies?
Food allergy/sensitivity/intolerance
What are the common food allergy culprits?
Egg Milk Soy Tree nuts Wheat
What food allergy are children LEAST likely to grow out of?
Tree nuts
How common is vitamin D deficiency in children?
12% - 40% of young children have levels below accepted optimal threshold - resurgence in rickets
What are the food sources of vitamin D?
Cheese Margarine Butter Fortified milk Healthy cereals Fatty fish
70% of toddlers consume sugar-sweetened beverages. What can you do to reduce the harm of this?
Dilute toddler’s juice drinks with water so dont give them straight from a cartoon
What is the most common problem as a result of toddlers consuming sugar-sweetened beverages?
Dental caries
What is the recommended amount of physical activity for a child under 5 who can walk unaided?
180 minutes SPREAD throughout the day
