Lecture 4 Flashcards
What is a wet nurse?
In the 1700s another women who would be able to breastfeed the baby
-someone other than the mom
When did formula feeding become popular?
1900s
- modern, efficient and practical
- Infant separation after delivery
- tech (pumps)
- Fashion industry
When did breastfeeding increase?
1970s
-its efficient, effective and can take it everywhere
Who is more likely to breastfeed?
Higher education
Higher SES
-more likely to at least for 6 months
How does one decide to breastfeed?
Lifestyle
Attitudes
Habits
Why is Brest best?
Simple and natural Enjoyable and easy Anywhere anytime Sterile Appropriate temp Freedom
What is lactation?
Automatic physiological process
- learned behaviour for mom and baby
- listen to the sound to make sure they are swallowing
In order to breastfeed what does one need?
Supportive environments
Early Encouragement and info from health care professionals
Fathers support
Social Acceptance and support
What are the breastfeeding recommendations?
Exclusive for first 6 months
May continue with complimentary feeding up to 2 yrs
-need vitamin D supplement 10micrograms/day starting at birth
When can you introduce solid foods?
6 months
What are the breastfeeding rights?
Right to breastfeed in public anywhere anytime
Right to maintain lactation after returning to work
Does the quality of the milk ever waver?
Quality will always be there
-around 50% fat
Quantity will be affected if nutrition an hydration isnt there
Is there anything to increase milk flow?
Some drugs to help but usually want mom to wait 3 weeks to see if meds are needed
-dont take decongestants cause it will dry up milk ducts
What is bottle feeding?
Breastmilk, formula or a mix
What are the pros and cons to breastfeeding?
Pro
- Easy to prepare sometimes
- other people can feed baby
Con
- needs to be sterilized
- only good for 24hrs
What is lactogenesis?
Breastmilk production
-occurs in 3 stages
What are the 3 stages of breastmilk production?
3rdT
- 1st feed days post partum
- milk forms, lactose and protein increase
- may be compromised with PTV or method of birth
2-5days post partum
- Milk composition and volume change
- Referred to as milk coming in
- can be painful
- colostrum delivered in small amounts
10 days post partum
-Milk comp is stable
What are the mammary glands?
Functional units of the MG are the alveoli which have secretory cells with a dicts at the centre
Small ducts lead to larger ducts and they all come together at the nipple
When do the mammary glands develop?
Puberty
- ovaries mature and release hormones
- MG production is generally complete within 1-1.5 years post start of menstrual cycle
What happens to the MGs during pregnancy?
Proliferative stage
- estrogen: stimulates development of glands that produce milk
- progesterone: supports tubule elongation and duplication of cells that line the tubules
What is prolactin and how does it work?
Milk production
- anterior pituitary gland
- suppressed in 3rdT
- Demand stimulates milk production
- Suckling turns off prolactin inhibitory hormone and signals the production of milk
- Inhibits ovulation
Whats oxytocin and how does it work?
Hormone responsible for milk ejection
- released from posterior pituitary
- Suckling stimulates let down reflex which allows milk to be released from the breast
- Other stimuli can cause let down and lead to leaking in early months of breastfeeding
- Also promotes uterine contractions and helps uterus return to normal size
- Decrease material PP blood loss
What is fore milk?
Milk at the front of the breast Released early in nursing's session -quenches thirst Low fat high nutrients More at start of day
What is hind milk?
Milk released late in nursing’s session
Higher in Fat and satiety
What is colostrum?
First milk or early milk Liquid gold Rich in beta carotene Nutrition and antibodies, WBCs Very small amount
What is transition breast milk?
Mature breastmilk
During first 2 weeks
Increase in energy, lactose, fat, water soluble vits
Decrease in protein, fat soluble vitamins, minerals and immunoglobulins?
What is the composition of breast milk?
Protein: 6% energy
Fat: 55% energy
Carb: 39% energy
Perfect amount of micronutrients except Vitamin D
What is the carb composition in breastmilk?
Lactose, easily digested and facilitates Ca absorption
Oligosaccharides
-decrease binding of pathogenic bacteria/toxins to intestines of infants
What is composition of carbs in breastmilk?
Low protein concentrate (hard on kidneys)
- Varies with infant age
- immunological properties come from these proteins
Contains all essential AAs
What are the 2 kinds of protein in milk in general?
Casein
- more in cows
- facilitates CA absorption
Whey
- More in breast in greater proportion
- Efficiently digested and absorbed
- richer in sulfur containing AAs
- aid digestion nd protect against bacteria
What are bifidfus factors?
Reduces amount of bad bacteria that would grow within the gut
-microbial growth factors
N-containing sugars
Increase growth of lactobacillus bifidus
Decrease growth of pathogenic bacteria like ecoli
What are n containing sugars?
Non protein N compounds provides 20-25% of the nitrogen in milk
This N is available so that the infant can produce non essential AAs as well as produce other proteins with biological roles
Why is lactobacillus bifidus important in breastmilk?
Beneficial bacteria protect baby against harmful bacteria by secreting acid compounds
What type of milk can you find bifidus factors in?
In breastmilk
-cant be replicated in formula
What kind of fat makes up breastmilk?
Fa profile changes with the diet
- PUFA like DHA
- Trans fat
What other form of lipid is in breastmilk?
Cholesterol which helps with myelinization of CNS
-this is not present in formula
What does the content if most vitamins vary with?
Moms diet but all re there except Vitamin D
When does mineral content start to decrease?
Over the first 4 months post partum to reduce load on kidneys
What are the vitamins of interest in breastmilk?
A: higher in colostrum
-beta carotene form, bone, eyes, immunity
D: increases with sun
E: Dependent on fat content
K: need supplementation
-Gut flora helps increase the amount of vit K to get them through the first 2 weeks
B12 and Folic Acid: Bound to wheel proteins
-low dependence on maternal diet
What are the minerals of interest in breastmilk?
Zn: bound to protein
- highly Available for absorption
- important in overal growth and development
How long do babies need vitamin D supplements?
Need 10 micrograms or 400IU/day for 1 year or until diet provides this amount
- D3 better
- Becasue direct sun exposure is not recommended for infants
What are the other nutritional benefits of breast milk?
Low electrolyte content
- leads to low renal solute load
- human milk is isotonic
Efficient absorption of nutrients
Amylase enzymes increase starch digestion
What are the maternal benefits of breastmilk?
Hormonal
Physical
Psychosocial
Economical
What are the infant benefits of breast milk?
Nutritional
immunological
Social
Cognitive
What does breastmilk decrease the rates of in infants??
Acute illness Chronic illness Perinatal Mortality SIDS Allergies Obesity
What are the 5 protective factors in breast milk?
Immunoglobulins Lipase activity Lysozyme Lactoferrin Intestinal growth Factor
What are immunoglobulins?
Rich in breast milk, especially colostrum Fights disease Protect infant GI Decrease intestinal infection Decrease risk of chronic disease Secretory IgA
What is secretly IgA?
Predominant Ig
Resistant to digestion
Binds harmful bacteria
Helps prevent diarrhea
What is lipase activity?
Antimicrobial effect
-decrease viral and bacterial growth
Due to Increase in FFA and monoglycerides formation
-compared to milk rich in TG like cows
What are lysozyme?
Secreted by neutrophils and macrophages
Enriched in breastmilk
Breaks bacterial cell walls
Inhibits GI bacterial growth
What is lactoferrin?
Fe binding protein in breastmilk
-makes Fe unavailable for pathogens to grow in GI tract
No support of intestinal bacterial growth
May increase Fe bioavilability
Participates in imbue system
Growth factor
What is intestinal growth factor?
Epidermal growth factor
Increase intestinal cell growth
Allows damaged cells to be replaced more rapidly
increase resistance to infection
What is the rooting reflex?
Prompts infants to turn the head to the side when stimulated by touch to the lips or cheek
What is the suckling reflex?
Especially strong in the first months
What are the positions for breast feeding?
Cradle hold
Football/Clutch hold
Cross cuddle
Saddle
