Lactation Ch 6 FULL Flashcards
What are the time spans with respect to breastfeeding?
6mo - Exclusively breastfeed
>6mo: breastfeed + complements
12mo: can stop or continue
can continue breastfeeding ‘til 2years
What are the benefits for breastmilk?
*immunity (can’t get w/ HMS)
infant bond w/ mother strengthened
What are the factors in the changing composition of milk?
- age of infant
- infection in the breast
- w/ menses
- maternal nutrition status
What are the functions of human milk (HM)?
nurtures and protects infants from infectious diseases
how often does the composition of HM change?
over a single feeding and/or over a day
milk matures overtime (not the same @ beginning&end)
what are the hormones asso w/ lactation? (2)
- prolactin: stimulates milk production
- released when suckling, stress, sleep
- ↓ ovulation & likelihood of getting prego again - oxytocin: stimulates the letdown (release of milk fm the breast)
- helps uterus to get back to norm (uterus contracts/shrink)
what is colostrum?
:1st milk secreted during the 1st few days postpartum (3-5 days)
- mature milk day 15
- transition milk: 5-15 days
- immunity: high in proteins (IgA&lactoferrin)
what does too much lactose cause?
Na?
diarrhea
Na: fluid hydration
what is human milk composed of?
- water
-major component
-isotonic (same osmolality) w. maternal plasma
-helps w/ hydration; easier absorption
(water in GI=>diarrhea) - energy
1oz of BM = 20 kcal
cals vary w/ fat, protein, & CHO
formula feed = ↑ energy intake (intake > amount)
lipids in HM (2)
-lipids provide 1/2 cals in HM (45-55% of all cals)
-maternal diet affect fat composition
recommendation of fat 20-35%
DHA: helps w/ cognition
medium-chain fatty acids
what is foremilk?
what is hindmilk?
- FOREMILK:
- 1st milk baby starts getting
- > watery (helps w/ hydration)
- ↓ lipid content
- some CHO (esp lactose) - hindmilk (2nd half of milk; end of feeding)
- rich in lipids (for energy)
- > CHO (oligosaccharides)
* empty 1 breast before the other to get fore&hindmilk
what fats are in HM? (3)
- DHA: Docosahexaenoic acid (omega-3 fatty acid)
-essential for retinal dev
-asso w/ ↑ IQ scores / cognitive abilities
(few formulas have DHA) - trans fatty acids
-present in HM fm maternal diet - cholesterol
-↑ in HM than HMS
-early intake fm BM related to ↓ blood cholesterol levels later in life
(won’t restrict as much as cholesterol)
What are general info about proteins in HM?
total protein: BM ↓ than whole cow’s milk
-can overload infant’s kidney w/ cow’s milk (early in life)
-HM has antiviral & antimicrobial effects *
-protective immunity
non-protein N
- ~20-25% in HM
-used to make non-essential AAs & other proteins (hormones, ect)
What are the proteins in HM?
- CASEIN: solid product fm the coagulation of milk+acidic/enzyme
-main protein in mature HM
-rich in Ca binds to protein; > absorption - WHEY: liquid product fm the coagulation of acidic/enzyme
-remains soluble in water
-some minerals, hormones,&vita binding proteins
lactoferrin (carrier for iron)
-most immunity function
-protein that remains
-enzymes present aid in digestion & protection against bacteria
what CHOs are in HM?
- lactose
- main CHO in HM
- helps/enhances w/ Ca absorption - oligosaccharides: medium-length CHO
- prevent binding of pathogenic m/o to gut, which prevents infection&diarrhea- works as prebiotic (fosters growth of healthy bacteria)
- <diarrhea & help gut fm bacteria/infection
vitamins in HM
content of vitas in HM reflect mom’s diet
HM not rich in iron, but iron is bioavail
lack Vita B12 (vegan/malnourished) & folate
-vegans, malnourished, gastric bypass
missing fat soluble vitas (ADEK)
(infants may have vita k bleeding ∴ shot right after birth)
(iron rich foods should be the 1st foods introduced to bbs)
minerals in HM
Minerals contribute to osmolality
-most have ↑ bioavailability
easier to absorb & metabolize the minerals
-↓ risk of anemia despite ↓ iron content of HM
easier on kidneys
taste of HM
flavor of foods in mom’s diet influences taste of BM
-change in mom’s diet = change in flavor of BM
-infant > interested bc flavor varies from mom’s diet
- > exposure to variety = < picky in life
bc they accept new flavored
what are the benefits of BF for women?
- hormonal benefits
- ↑ oxytocin stimulates uterus to return to pre-prego - physical benefits
- prolactin: delay on monthly ovulation ∴longer intervals between pregnancies - psychological benefits
- ↑ self-confidence & bonding w/ infant
what are the nutritional benefits of BF for infants?
- widely recognized
- HMS use HM as a standard
- nutrients are balanced
- HM is isosmotic = help w/ hydration
- meet infant’s protein needs w/o overloading kidney
- > digestible
-has soft, easily digestible curd - provides generous amounts of the right lipids
- >energy dense - minerals are > bioavail
(formula mimiks HM)
what are the benefits of breastfeeding for infants? pt 1
- IMMUNOLOGICAL benefits
-↓ infant mortality in developing countries (sanitation)
- reduce acute illnesses - REDUCTIONS IN CHRONIC ILLNESSES
- reduce risk of celiac disease, IBS (irritable bond syndrome), leukemia
- reduce risk of allergies and asthmatic disease- peanut allergies during prego/breastfeeding
= ↓ risk of allergies
- peanut allergies during prego/breastfeeding
- BREASTFEEDIDNG & CHILDHOOD OVERWT
- typically breastfed infants are leaner @ 1 yr of age
what are the benefits of breastfeeding for infants? pt 2
- COGNITIVE BENEFITS
-Studies: ↑ in cognitive ability even after
adjusting for family environment
-edu & socioeconomic status (related to presence of DHA-cognitive ability) - ANALGESIC EFFECTS of BM
- Reduction of infant pain when BF - Socioeconomic benefits
- ↓ illness = ↓ need for medical care- < likely of kid being ill = ↓ days missed at work
-formula is expensive, affect cost of families
- < likely of kid being ill = ↓ days missed at work
BM supply & demand: what is milk synthesis is related to?
Main worry: worry not providing BM to infant
- How vigorously an infant nurses
- How much time the infant is at the breast
- How many times per day infant nurses
* demand of how much milk is being removed from the breast = > milk will be produced
- *important to empty one breast before the other
* demand is going to ↑ the production
what is the main concern of BF mothers?
worry not providing enough milk to infant
BM supply & demand: does breast size limit a woman’s ability to nurse?
NO, the size of the breast does NOT limit a woman’s ability to nurse
- adipose storage is the difference
- smaller breast may hold < milk, BUT milk production is the SAME
BM supply & demand: Is feeding frequency related to the amount of milk a woman makes?
Rate of milk synthesis is variable between breasts & between feedings
-smaller breast may have to feed > frequently bc can store less in breast
BM supply & demand: what are the different methods of pumping or expressing milk?
- Manually
- Hand pumps
- Commercial electric pumps
- Hospital grade electric pumps
bc babies can’t latch on or mouth is small (small surgeries)
↑ frequency esp @ beginning bc will stimulate adequate milk may require 8-12 expressions per day
-comparable to how much mom will be breastfeeding in 1st wks of life of the infant
The Breastfeeding Infant: what are the reflexes babies have?
- Gag reflex—prevents infant from taking food and fluids
into lungs - Oral search reflex—infant opens mouth wide when close to breast & thrusting tongue forward
-swallowing & sucking; following finger when close to mouth
-be attached to nipple&areola *position is key
-appropriate positioning = adequate letdown & milk production - Rooting reflex—infant turns to side when lip stimulated on that side.
-sign of hunger when babies act like they are getting milk from inanimate object
The Breastfeeding Infant: how to identify hunger & satiety?
HUNGER is signaled by infant:
- Bringing hands to mouth, sucking on fingers, & moving head from side to side
- Crying is late sign of hunger
Allow infant to nurse on 1 breast as long as they want to ensure they get foremilk & hindmilk w/ its ↑ fat content that provides satiety
*Note: High lactose content of foremilk may cause diarrhea
The Breastfeeding Infant: what is the feeding frequency for babies?
newborn: 10-12 feedings/day are normal for newborns
-Feeding ↓s overtime
Stomach is small
- ∴ stomach emptying occurs every ~1.5-2 hours
-feeding & diaper changes are often
(1st few days bbs drink 1 tbsp/feeding)
Identifying Breastfeeding Malnutrition: generalization facts
Normal weight loss for newborns
- ~7% of birthweight in 1st week / 1st 5days
- Weight loss of 10% or > needs evaluation by lactation consultant
- not enough nutrients
Identifying Breastfeeding Malnutrition: signs of malnutrition (4)
Malnourished infants become sleepy, non-responsive, have a weak cry, & wet few diapers
-By day 5 to 7, infants should have 6 wet diapers & 3-4 solid diapers per day -towards end of 1st wk (start happening around day 5)
amount of wet diapers will give you an idea of how much milk they’re intaking
Tooth Decay (3)
Cavities can occur in children who are breastfed
Risk factor is frequent nursing at night after 1 yr
All children should be seen 6 months after 1st tooth erupts or @1 yr of age
(water after 6mo bc BM is exclusive in 6months)
how to evaluate infant malnutrition?
Evaluate at mom & infant - what is the cause?
MATERNAL CAUSES:
1. Poor production of milk:
Mom have poor energy intake? <1500 cals?/day
-illness?
Poor letdown
-smoking? latching? stimulation from bb?
infant causes: POOR INTAKE -sucking inefficiencies or mouth -excess times between feedings ILLNESS: vomiting, diarrhea, infection ↑ ENERGY NEEDS: baby may need additional supply besides BM
Benefits of HM: tooth decay
HM has antimicrobial components (not in HMS)
- HM helps prevent cavities in 1st yr of life
- helpful, but does not mean infant will not develop cavities
Vitamin Supplements: what are the vitamin supplements for breastfeeding infants?
Bbs exclusively breastfed don’t usually develop deficiencies
Vitamin K (bleeding): all U.S. infants receive vitaK injections at birth
-5% births in US
-but parents can opt out
Vitamin D: exclusively breastfed infants need supplements @ 2 months
No recommendations for fluoride or iron
Ricketts: childhood bone disorder where bones soften & become prone to fractures and deformity. ( ) legs
Maternal Diet: What are the dietary guidelines for prego & breastfeeding women?
MyPlate Food Guide has been adapted for prego & breastfeeding women
DIETARY GUIDELINES
-Moderate wt reduction can be achieved w/o
compromising the wt gain of the infant
Diets formed around a MyPlate food plan for prego & breastfeeding women provide
-Healthy assortment of nutrients at specified calorie levels for each stage of breastfeeding
Energy and Nutrient Needs for Lactation (3)
- Energy needs vary by activity level
- DRI is +500 kcal/day for the 1st 6 months & +400 kcal/
day afterward - A single recommendation for energy needs could never address all of the individual variation in energy needs
Maternal Energy Balance and Milk Composition
- Protein-calorie malnutrition (meet min cals to produce milk)
- Results in reduction in milk volume but not quality- quantity > quality
- Wt loss during breastfeeding
- caloric DRI assume a loss of 0.8 kg/month
- Most women do not reach prepregnancy wt by 1 yr after birth
- Modest or short-term energy reductions do not ↓ milk production (~500 kcal, but not <1500 kcal/d)- ie: 2300+500-500, if want to lose wt
Exercising and Breastfeeding (2)
Modest energy restriction combined w/ ↑ activity may help women lose wt & body fat
Exercise does not inhibit milk production or infant growth
Other Factors of Maternal Diet
Fluids (milk is 87% water)
-Women should drink to thirst
-check if urine is pale yellow
Infant Colic
-Defined as crying for >3 hrs a day – no medical
cause
-Components of maternal diet may be related to infant colic
-More likely with cow’s milk, onions, cabbage, broccoli, & chocolate
*tip: drink water while BFing/pumping
10mins/breast; feeding & pumping
Breastfeeding Goals for the United States:
- Healthy People 2020 breas4eeding objectives:
- ↑ proportion of infants breastfed
- ↑ duration of breastfeeding
- ↑ worksite lactation programs
- ↓ formula supplementation in first 2 days of life
- ↑ births in facilities providing recommended care for breastfeeding mothers
Discuss barriers to breastfeeding initiation.
- Embarrassment
- mom can train body for < frequency, but > volume - Time & social constraints
- Lack of support from family & friends
- Lack of confidence
- Concerns about diet & health
- Fear of pain: not done properly & pain (esp in 1st wk)
Discuss barriers to breastfeeding at the workplace.
Breastfeeding Promotion, Facilitation, and Support
- Barriers exist such as lack of on-site day care
- Insufficiently paid maternity leave
- Rigid work schedules
- Lack of understanding/knowledge by employers
- Legislation is in progress to support breastfeeding or pumping in the workplace
