Breastfeeding Flashcards
Describe the 3 stages of lactogenesis, including the time at which they occur. What are the roles of oxytocin and prolactin? What is the function of feedback inhibitor of lactation (FIL)?
- Lactogenesis I: During first postpartum days when suckling is not necessary to initiate milk production and milk begins to form
- Lactogenesis II: 2-5 days postpartum; increased blood flow to mammary gland, changes in breast tissue signal body to increase concentration of lactose for 2 weeks. “milk comes in”
- Lactogenesis III: 2-5 weeks after birth when composition of milk is stable
Describe the functional unit of lactation, anatomy of lactating breast, alveoli, cuboidal cells, and myoepithelial cells.
Breast alveoli are balloon-like structures lined with milk-secreting cuboidal cells, that are surrounded by a net of contractile myoepithelial cells. Milk is secreted from the cuboidal cells, fills the alveoli, and is squeezed into the ducts. Clusters of alveoli that drain to a common duct are called lobules; the lactating female has 12–20 lobules organized radially around the nipple. Milk drains from lactiferous ducts into lactiferous sinuses that meet at 4 to 18 perforations in the nipple, called nipple pores.
Milk is ejected by myoepithelial cells contracting when oxytocin is released
In general, what are the 5 methods by which components of human milk are secreted?
1) Exocytosis (protein, lactose)
2) Secretion into ducts
3) Secretion by passive diffusion (ions, water)
4) Exocytosis of IgA
5) Paracellular pathway (plasma components, leukocytes)
Provide an overview of how the composition of human milk compares to that of formula. What 8 ingredients in human milk are not found in formula?
There are many components of human breast milk that cannon be replicated by formula:
1) Lactoferrin
2) Leptin
3) Living cells
4) Growth factors
5) Probiotics
6) HMO’s
7) Immunoglobulins
8) Enzymes
In Both: vitamins, fat, CHO, protein, water
What is the general composition of colostrum? When is it produced? How much volume is produced in a typical feeding?
Colostrum is produced in the first 1-3 days after birth, and only 2-10 mL/feeding is produced
Composition: lower in fat and CHO, higher in protein. Contains immune components: lactoferrin, secretory immunoglobulin A, white blood cells, growth factors. HIGH in vit A
Describe the size of the newborn stomach from day one to one month.
Day 1: size of a cherry (5-7 ml)
Day 3: Size of a walnut (.75-1 oz)
1 Week: Size of an apricot (1.5-2 oz)
1 Month: Size of large egg (2.5-5 oz)
Do infants who are exclusively breastfed or formula-fed need water? [review statements of ABM and AAP].
When should water be added to the diet (answer: when complementary foods are added)?
Water is NOT needed in the first 6 months of age, it can interfere with correct feeding which can increase risk of jaundice, excessive weight loss, and longer hospital stays
Provide a very specific explanation regarding why breastfeeding may be protective against the development of childhood obesity.
1) Responsive feeding, and Breast fed infants tend to consume fewer calories than formula fed infants:
* Caregivers may try to empty bottles
* Formula w/ high protein can lead to higher serum insulin levels
* Different feeding experience
* Metabolic signaling agents (like leptin) may help regulate satiety – so breastfeeding infants may reach satiety in different way
2) Obesity may also be related to the microbiome
What is paced feeding? Why is it important?
A method of bottle feeding that allows the infant to be more in control of the feeding pace, sitting the baby more up right
Describe the carbohydrate components in breast milk. What are HMOs? What is another term for HMOs? List and describe 6 functions of HMOs. How are HMOs unique? How important are HMOs?
CHO make up 40% of calories, lactose being the primary CHO (enhances Ca absorption)
HMOS = Human oligosaccharides = Glycans
* Mothers produce over 200 unique HMO’s
* Act as prebiotics
* Prevent pathogen attachment
* Stimulate maturation of intestinal epithelium
* Enhance immune response
* Provide potentially essential nutrient for brain development (sialic acid)
* Prevent necrotizing enterocolitis
What is necrotizing enterocolitis? How does dietary intake of the preterm infant impact development of this condition?
Necrotizing enterocolitis (NEC) destroys the intestinal lining. 3-7% of babies develop it, and 50% of those cases die. Breast milk is protective against this.
What is the protein content of human milk compared to that of cow milk? What are the 2 types of proteins? What are their contributions? What is lactoferrin?
Protein makes up 10% of calories in Human milk (compared to 31% in 1% cow milk)
Two types:
1) Whey proteins: a-lactalbumin, lactoferrin (binds iron to increase iron bioavailability, immune function draws iron from microbes)
2) Casein: keeps Ca soluble, imparts white color
Lipids make up what percentage of calories of breast milk? How does the lipid content of human milk compare to that of formula? How does the ‘form’ of the lipids compare (MFGM)? What affects the DHA content? What is the impact of DHA?
- Lipids are 50% of calories
- Human milk is different than formula because the fat percentage actually changes during a feeding, where the end of the feeding is higher in had which help withs baby’s satiety
- DHA or Omega 3 intake is directly correlated to the mom’s omega 3 intake.
- DHA helps with visual acuity and cognitive development
- MFGM = milk fat globule membrane; a complex structure made of proteins and lipids that surround milk fat globules- may benefit intestinal development, cognition, and cardiovascular health
List the 4 micronutrients that may be of concern for infants, especially for breastfed babies, and explain the issues.
Vitamin D, vitamin K, vitamin B12, iron
Vitamin D. What is the most well-known function of vitamin D? What are specific concerns with respect to Vitamin D? Why are infants at risk for deficiency? What are the ramifications of risk? What are official recommendations of the AAP? Is it possible for the breastfeeding mom to take vitamin D to increase the supply in milk to meet the needs of her infant? How much vitamin D would she need to take?
- Function in bone development and growth
- Concerns are risks of Rickets
- Vitamin D is naturally low in breast milk- so infants are at risk if they are exclusively breastfed, have limited sunlight, or have darker skin
- Recommended daily intake is 400 IU of vitamin D
- Mom can take vitamin D supplement, recommended dosage is 6400 IU/day
