Why do most women not breast feed/stop?
90% of women have problems and stop breastfeeding before they want to. Common problems, such as painful nipples, sore breasts and feelings of having insufficient milk, can be prevented or solved with appropriate care.
What are the beneficial health outcomes for breast fed infants over formula fed infants ?
Breast-fed infants have been shown to have better outcomes in the following conditions:
- Acute otitismedia
- Non-specific gastroenteritis
- Severe lower respiratory tract infections
- Atopic dermatitis
- Childhood leukaemia
- Sudden unexplained death in infancy (SUDI)
- Necrotising enterocolitis
In addition, later in life, they have been shown to have:
- Lower mean BP
- Lower total cholesterol
- Reduced likelihood of developing Type 1 and 2 diabetes
- Higher IQ
What conditions arebreastfeeding mothers less likely to suffer from compared to formula feeding mothers?
Breastfeeding mothers are less likely to suffer from:
- Type 2 diabetes
- Breast cancer
- Ovarian cancer
- Postnatal depression
- Early return of fertility (could be a problem as may not have started contraception yet)
What are the recommendations for breast feeding ?
WHO recommends exclusively breast-feeding for the first 6 months of an infant’s life (no other food or drink including water should be given during first 6 months), it is recommended breastfeeding should continue beyond 6 months, alongside the introduction of appropriate solid foods, for upto 2 years of age or as long as the mother chooses
When should solid foods be introduced for breast-fed and forumla- fed babies ?
Recommended time of introduction is about the same
Around 6 months solid foods should start to be introduced
What are the recommendations for vitamin D supplementation for all pregnant and breastfeeding women ?
All pregnant and breastfeeding women should take 10 μg/day
What are the recommendations for vitamin D supplementation for infants and when should supplementation be started?
All breast-fed infants from 6 months 7 μg/day
If the mother was not taking vit D supplements during pregnancy how does this change the recommendations for vit D supplementation in the infant ?
It should be started from 1 month old rather than 6 months
Why are vit D supplements given in the mother and infant ?
Because 1 in 4 women of childbearing age have low vit D levels
When can HIV be transmitted from mother to child ?
During pregnancy, labour and breastfeeding
What are the recommendations for breast feeding in mothers with HIV ?
HIV women are recommended to avoid all breastfeeding to reduce any potential risk of transmission of HIV to the baby (unless no access to nutritionally adequate breast milk substitutes)
If a HIV positive mother decides to start breast-feeding what should you recommend ?
To breastfeed exclusively and stay on medication that keeps viral counts low or non-detectable
How frequently do exclusively breast-fed infants feed?
- Each infant will develop its own feeding patterns so not set answer
- In first 48hrs feeding may be infrequent due to little milk produced
- After this frequency of feeding of breast-fed infants have found medians ranging from six to 15 feeds in 24 hours.
When does milk supply generally start to increase and switch from colostrum to normal breast milk?
Around 3 days
Does breast size determine the amount of milk produced ?
What is tongue tie/ankyloglossia ?
It is a congenital oral anomaly that may decrease mobility of the tongue tip and is caused by an unusually short, thick lingual frenulum
What problems can Ankyloglossia cause ?
May cause the infant to have problems in achieving a widely-gaped mouth
This can cause problems with:
- Attaching effectively to the breast
- Drawing enough breast tissue deep into the infant’s mouth
- Achieving coordinated sucking
When does the composition of breastmilk change ?
- It changes throughout months etc breastfeeding in response to infants needs
- It also changes from the beginning to the end of a feed
Why should you allow a baby to decide when it wants to come of the breast during a feed?
The baby learns to regulate his own appetite in response to the changing composition and volume of the milk.
When is colostrum produced ?
From mid-pregnancy to the first few days after birth
How much colostrum does an infant need at each feed and what does it contain ?
- Only need a few millimeters at each feed
- It contains high levels of immune proteins (IgA antibodies predominantely) so helps colonise baby with normal bacteria and nutrients
- Also has laxative effective to help pass meconium and prevent jaundice
Does mature milk have the same overall daily intake of immune proteins as colostrum?
When does the production of mature milk start to increase ?
From 20-48hrs after delivery
What are the things which breast milk in general supplies the baby - irrespective of talking about colostrum or mature milk
Proteins, carbs, water, fat, immune proteins (mainly IgA)
How does the composition of mature milk differ from the beginning to the end of the feed?
At beginning high in water, sugars, and protein but low in calories and fat.
At/near the end fat and calorie content of the milk increases
What are the components of mature breastmilk?
- Free water
- Carbohydrates main one is lactose.
- Minerals, vitamins, and trace elements e.g. vit A,C,D calcium, phosphorus, iron, sodium
- immunoglobulins (mainly IgA), digestive enzymes, hormones and growth factors
How does colostrum differ from mature breastmilk?
It contains a higher amount of protein, less fat and a number of immunising factors for the newborn.