breastfeeding[1] - Lactation and breastfeeding u u...

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Unformatted text preview: Lactation and breastfeeding u u cognitive To the infant Why Breastfeed? u nutritional u immunological Cognitive Benefits of Breastfeeding u Breastfeeding and u u Motor skills u Development of: Performance: u Language skills u On standardized tests u In school u u IQ tests Performance on: u Reading & math tests u College preparatory exams u Nutrient Composition u Nutritional Benefits of Breastfeeding Continually changing throughout infancy u Fat Composition u u u Arachidonic (20:4,n6) Major source of energy in breast milk (50%) Of most interest: u Docosahexaenoic (22:6,n3) u Cholesterol u Carbohydrate Composition u Nutritional Benefits of Breastfeeding u Aids in absorption of some minerals (calcium) Primarily Lactose u Facilitates growth of essential intestinal bacteria in the infant u Protein Composition u Nutritional Benefits of Breastfeeding u u u Adequate to meet needs while low enough to avoid stressing infant kidneys 40% casein, 60% whey Easily digestible 40% casein, 60% whey Enzymes to aid in nutrient metabolism Antibodies and Immunuglobulins to aid in establishing infant defense systems u Decreased incidence of: u u u u u Immunologic Benefits of Breastfeeding u u Most significant:breastfed exclusively Benefits extend beyond breastfeeding period GI Tract Disturbances (diarrhea) Ear Infections Upper Respiratory Infections Colic Allergies u u u Release of oxytocin Maternal Health Benefits of Breastfeeding u Hormone that helps in shrinkage of uterus Greater ease returning to prepregnancy weight Amenorrhea provides limited contraception u Conserves iron u Rebuilding of nutrient stores u u Reduced risk of osteoporosis and hip fracture Reduced risk of premenopausal breast cancer u Benefits to society: u Economic Benefits of Breastfeeding u Comparing exclusively breastfed infants and formula fed infants enrolled in WIC Savings in WIC Expenditures u ~$10 savings in food costs per month over the first 6 months for exclusively breastfed infants u u $100 savings over the first 6 months for exclusively breastfed infants Savings in Medicaid Expenditure u Benefits to the family: u Economic Benefits of Breastfeeding u Less infant illness u Less time lost from work Breastfeeding is simply cheaper u Lowincome moms u No formula costs u Cost savings remains even when need for extra calories (for the nursing mother) is taken into account u Inadequate training of healthcare professionals u u Barriers to Breastfeeding Lack of support for nursing mother Bias toward use of human milk substitutes u Trend toward short postpartum hospital stays u Less exposure to hospital lactation consultants u Cultural climate u Barriers to Breastfeeding Breastfeeding is not the cultural norm u u u Marketing of formulas as equally beneficial Lack of support Pressure to minimize duration u Maternal employment u u Separation of child from mother Work environment unsupportive of breastfeeding u More than half of all states have breastfeeding legislation u u u u Breastfeeding Legislation Protecting the right to breastfeed in public Exemption from jury duty Protecting nursing mothers in the workplace Requiring breastfeeding to be considered when determining custody and visitation u California Legislation Breastfeeding Legislation u 1995: Law requiring all hospitals to provide lactation consultant services or u u u u u information on where to receive such services. 1997: Law stating mother's right to breastfeed in any private or public location (except in another's home). 1998: Concurrent Resolution encouraging employers to support breastfeeding mothers upon return to work. 2000: Exempting nursing mothers from jury duty. 2001: Law mandating workplace accommodations for the nursing mother. 2002: Legislation to prohibit the distribution of free formula samples to expectant mother. This legislation failed. u Recommendations of the American Academy of Pediatrics (AAP) u Breastfeeding Encouragement Exclusive breastfeeding for 6 months u Breastfeeding along with complementary food for 12 months u Position of the American Dietetic Association (ADA) and duration." Breastfeeding Encouragement u "... broadbased efforts are needed to break the barriers to breastfeeding initiation u "Exclusive breastfeeding for 6 months and breastfeeding with complementary foods for at least 12 months is the ideal feeding pattern for infants. Increases in initiation and duration are needed to realize the health, nutritional, immunological, psychological, economical, and environmental benefits of breastfeeding." u Goals of Healthy People 2010 u Breastfeeding Encouragement 75% of mothers initiate breastfeeding 50% of mothers breastfeeding at 6 months u 25% of mothers breastfeeding at 12 months u u u In early 1900's almost all infants in U.S. were initially breastfed As formulas became available, rates declined steadily u Dipped to 30% in 50's and 60's u Rose in 70's, peaking in 1980's at 60%, and declined until early 90's Breastfeeding Goals (History) u Increasing for past decade, but still below Healthy People 2010 breastfeeding goals for nation u Objective: Breastfeeding Objectives for the Nation Healthy People 2010: u Increase the proportion of mothers who breastfeed their babies u u u Breastfeeding Status ('02) GOAL Postpartum: 70% 75% 6 months: 33% 50% 1 year: 18% 25% BF Status in San Luis Obispo County = 92% women initiate. u u REFERENCE: K.Buckshi Factors Influencing Breastfeeding Initiation & Duration u Breastfeeding Rates by Maternal Age Breastfeeding Rates Obstacles encountered that interfere with successful breastfeeding include: u Embarrassment u Time & social constraints (loss of freedom) u Lack of support from family and/or friends u Lack of confidence u Fear of pain u Concerns about diet or health u Health care apathy and misinformation u Maternal employment u Early hospital discharge with insufficient education, especially on breastfeeding How does breastfeeding work? u During puberty, ovaries mature Breast Development u Release of estrogen & progesterone increases u u Cyclic release of these hormones govern development of breasts Cells that can secrete milk develop, nipples grow, fibrous and fatty tissues increase around ducts Breast Development, con't. u In pregnancy, placental lactogen & chorionic gonadotropin are secreted in preparation for breastfeeding u u Estrogen stimulates development of milk producing glands Progesterone helps ducts elongate & cells duplicate Breast Development u u Alveoli: rounded or oblong cavities in breast u Composed of cluster of secretory cells with a duct in center u Myoepithelial cells line alveoli and surround secretory cells u Contract under influence of oxytocin, causing milk to be ejected into ducts Anatomy of mammary gland (breast): (puberty to lactation) Lactation Physiology Lactiferous ducts: extend out from nipple toward chest wall with numerous branches; expanding to become Lactiferous sinuses: large containers for milk storage behind nipples u u In order to establish milk supply need two hormones Prolactin: u u Hormonal Control of Lactation Breast: side view Stimulates milk production Stimulated by suckling, stress, & sleep Hormonal control of lactation u Oxytocin: u u u Main role is "letdown;" ejection of milk into milk ducts & sinuses Also acts on uterus causing it to contract & shrink Stimulated by suckling or nipple stimulation can also be stimulated by hearing a baby cry or thinking about nursing u u Milk production related to infant demand u Milk Production: Supply & Demand Removing milk from breast appears to be signal to "make more" u If a lot of milk is left after nursing, production is low to prevent engorgement u If breast is fully emptied, production is high to replenish u Infant weight, caloric density of milk, and infants age contribute to demand Milk Production: Supply & Demand (2) u Studies show that mothers of twins have capacity to make more milk than mothers u Size of breast does NOT determine amount of milk woman is able to produce with one baby Latch on: first get baby to open wide! u Sore nipples Poor attachment Common Breastfeeding Conditions u u u u u u u Overactive letdown Letdown failure Engorgement Plugged ducts Infection (mastitis) Maternal medications Poor milk production Main Reasons Cited for Discontinuation of Breastfeeding u American Academy of Pediatrics (AAP) NEW guidelines (Feb. 2005) u u u Breastfeeding Recommendations Exclusive breastfeeding for first six months Breastfeeding + foods for 1 year or more Continue as long as desired Summary of breastfeeding and lactation Review of benefits of breastfeeding u u u u u u u u Maternalinfant bonding Inexpensive Convenient Perfect temperature Delays ovulation Loss of adipose tissue Reduced cancer risk Improved bone mineralization BF infant advantages u u u u u u Immunologic protection Decreased illness incidence and duration (otitis, diarrhea, respiratory infections, bacteremia, meningitis, botulism, UTI, NEC) GI hormones, trophic and growth factors Lipid profile Neurodevelopment Easily digested Allergy prophylaxis u u u u u u Greater nutritional burden than pregnancy (except for folate and fe) Energy needs ~ 25% higher Milk production determined by demand Maternal obesity is a risk factor for unsuccessful lactation Diet has little effect on conc of pro, total fat and cho Diet can affect most vits and some min Summary - Lactation ...
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This note was uploaded on 04/02/2008 for the course ES 212 taught by Professor Gamboa during the Spring '08 term at Cal Poly.

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