week 11: infant nutrition Flashcards
describe benefits of human milk
Human milk provides optimal growth, health, and development in infants and children. Contains many unique properties that cannot be replicated in formula like growth factors, hormones, enzymes and immune properties and this benefits the infant and breastfeeding individual.
You may breastfeed while pregnant except for the rare times when there are contraindications like threatened preterm labour and insufficient cervix.
Human milk is the gold standard - formula cannot replicate the immunological properties in breast milk.
WHO and unicef global recommendations for breastfeeding
Exclusive breastfeeding for the first 6 months, only supplementation that is recommended is vitamin D.
Continued breastfeeding for a minimum of 2 years and beyond, after 6 months can do complementary feeds in foods that are high in iron supplies.
Campaign from health Canada on breastfeeding
The natural age from a biological perspective that children should wean from breastfeeding is 2-7 yrs old. There is no upper limit to breastfeeding and no documentation of harm of breastfeeding into the third year or longer.
Ontario human rights commission on breastfeeding
“You have rights as a breastfeeding mother, including the right to breastfeed a child in a public area. No one should prevent you from breastfeeding your child simply because you are in a public area. They should not ask you to “cover up,” disturb you, or ask you to move to another area that is more “discreet.”
Lactation care for lesbian, gay, bisexual, transgender, queer, questioning, plus patient
Avoid assumptions, use appropriate pronouns, discuss expectations and goals
May induce lactation by taking hormones of pregnancy and then of lactation.
Chestfeeding:
Term used for many masculine-identified trans people to describe the act of feeding their baby from their chest, regardless of whether they have had chest/top surgery (to alter/remove mammary tissue).
Colactation:
When more than one parent breast/chestfeeds their child.
Anatomy and physiology of lactation
Breasts consist of glandular, fibrous and adipose tissue. Each mammary gland* is made of 15-20 lobes, which are divided into lobules.
Lobules are clusters of alveolus that merge to form large ducts that drain the lobe and secrete breast milk.
Alveoli are the structures that contain the cells that secrete breast milk.
Myoepithelium contracts to expel milk from the alveolus.
Milk ducts transport milk through the breast and end at the nipple.
Nipple and around areola contains 15-20 openings from lactiferous ducts.
Smooth muscle fibers in the areola contract to stiffen the nipple and assist with latching.
Montgomery glands lubricate the nipple, secreting a cleansing agent and scent for infants to identify the source of breastmilk
Breast size may sometimes impact milk storage but not milk supply.
Clients with flat nipples may have more challenges breastfeeding but there are techniques to draw the nipple out and elongate it.
Clients who have undergone a breast augumentation/breast reduction may still breastfeed depending on the type of technique that the surgeon used and if glandular and nipple tissue has remained intact.
describe breast assessment
-Part of the antenatal assessment should be a breast exam and this should be done post-partum aswell. There are some situations where the breast may have insufficient mammary glands and may have marked asymmetry, a wide space in the chest or a tubular shape.
Inspection
Size
Symmetry
Shape
Nipple (inverted, flat?)
Palpitation
Mammogenesis
Breast development begins in the early gestational period, in the embryo’s life.
In childhood, mammary glands are latent and their development is limited to general growth.
During puberty primary and secondary ducts grow and divide, during each menstrual cycle proliferation and active growth of duct tissue occurs.
Complete development of mammary function occurs only in pregnancy.
Lactogenesis, stage I
Mid-pregnancy to day 2 postpartum.
Milk synthesis begins mid-pregnancy. Milk production initially comes from an endocrine driven state, therefore due to hormonal changes milk supply will arrive.
Differentiation of alveolar cells from secretory cells.
Prolactin stimulates epithelial cells to produce milk.
Lactogenesis stage II
Day 3-8 postpartum.
Closure of the tight junction in the alveolar cells.
Triggered by a rapid drop in progesterone levels, more heaviness in the breast as there is an onset of copious milk.
Switches from the endocrine to autocirne system with the establishment of stimulation at the breast
Delays in milk coming in may come from excessive blood loss from PPH, c-section, increased stress, PCOS, diabetes.
Milk composition in those who have delivered a preterm infant is different.
Galactopoiesis
Day 9 to the beginning of involution, is the maintenance of milk supply with the shift from endocrine to autocrine system.
Controlled by supply and demand. When emptying the breast the glandualr tissue will produce more, if emptying the breast less often there will be a decrease in the production of breast milk.
Involution
Occurs on avergae 40 days after the last breastfeeding session, when there are additions of regular supplementation in the infants diet.
There is a natural buildup of milk supply which causes cellular death and inhibits milk supply from occuring. The glands become distended and this releases inhibiting peptides that stop milk production.
High sodium levels arise in the breast milk, infants dislike this naturally promoting weaning.
(4) postpartum hormones
Estrogen
Concentration falls sharply after birth which is essential for the development of mammary glands and beginning milk supply.
Progesterone
Required to maintain pregnancy and falls rapidly following birth to initiate milk production.
Prolactin
Released from anterior pituitary and is essential for initiating and maintaining milk production.
Initially increases immediately postpartum, but rise and fall is in proportion to the frequency, intensity and duration of breast stimulation (hand expression, infant sucking, pumping).
Oxytocin
Released from the posterior pituitary gland resulting in the milk-ejection reflex or letdown.
Triggered by stimulation at the breast.
Causes uterine contractions which helps to prevent PPH, the uterus may even contract for about 20 minutes after the individual is done breastfeeding.
benefits of human milk
Short and long term protection
Protective against certain diseases (Type 2 diabeties, etc).
Protective from infections (necrotizing entercolitis, resp, GI, ear, meningitis).
Maturation of gastrointestinal tract.
Lower incidence of certain allergies.
Decreased risk of SIDS
Enhanced cognitive development (related to the long chain poly-saturated fats found in breastmilk).
Analgesic effect (for blood work or injections).
benefits of lactation
Promotoes uterine involution.
Decreases risk for PPH.
Return to pre-pregnancy weight more quickly (uses an extra 500 cals per day, benefits for the CVS).
Decreased risk of ovarian, uterine and breast cancer.
Protection against osteoporosis.
Unique bonding experience.
Convenient and cost effective (there is a time cost which is important to recognize).
