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Flashcards in Breastfeeding Deck (34)
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Initial yellow fluid that comes out of breast during first few days

1. High in IgA 2. lactoferrin
3. Higher protein,
4. lower fat and lactose
5. Bifidus factor:
-supports growth of non-pathogenic lactobacillus
- Facilitates:
Establishment of lactobacillus
- Passage of meconium (baby's first poop)


Transitional milk

2-14 days
Immunoglobulins and protein decrease
Lactose and fat increase
Increase in calories
Vitamin changes

*fat provides more substrates to support early, rapid fat accumulation in infant


Moms diet FX on milk
- micro vs macronutrients

Macronutrients should not change in babys milk, but mom may just make less milk if she doesnt have enough nutrients
- Same proportion of protein, fat, CHO

Mom low in certain diets
- micronutrients can be decreased in babys milk


Mature milk

Main components
1. water
2. Lipids
- long chain polyunsaturdated FA, w-3
3. Proteins
- whey > casein
- Lactoferrin - inhibits growth of Fe dependent bacteria in GI tract

Also has:
- Immunoglobulins
- Antimicrobial factors
- Carbohydrates
- Trace elements
- Vitamins


Active components of breastmilk that protects against illness in infant

1. Cells (macrophages, lymphocytes)
2. Antibodies - mainly IgA
3. Probiotic, lactoferrin
4. Protection against infections
- Gastroenteritis
- Resp infxns
- Acute otitis media
5. Protection against other diseses
- Atopy (atopic dermatitic, asthma)
- Diabetes
- Death
- Neurodevelopmental


Immediate Benefits for moms who breastfeed

1. Suckling causes uterin contraction (oxytocin) - prevent post partum hemorrhage
2. Lactational amenorrhea: decreases iron loss and higher inter-pregnancy interval
3. More rapid return to post-partum weight (mixed)


Long-term benefits for moms who breastfeed

1. Lower risk of Breast and ovarian CA (premenopausal)
2. Lower risk of Osteoporosis
3. Improved CV outcomes
4. Bonding/stress reduction


WHO feeding recommendations

1. Exclusive breastfeeding for 6 mo
2. Continue until 2 yrs

*American Academy of pediatrics
- say continue to at least 1 yr


Which family member is crucial (other than mom) for breast feeding?



When should healthcare workers help mom initiate breastfeeding?

Within a half-hour after birth


Baby is born, what do?

Infant is placed skin-skin with mom for breastfeeding for first hour


Positive hospital practices for breastfeeding

1. BF in 1st hr
2. Skin to skin contact
3. Rooming in
4. Lactation consultants
5. Peer role modeling
6. Ad lib nursing/feeding


Negative hospital practices for breastfeeding

1. Separation of infant/mom
2. Mother discouraged BF/limited time suckling
3. Covert formula feeding
4. D/C packs with formula
5. lack of support
6. Pacifier use


Lactogenesis stage 2
- Occurs when?
- What stim it?

Occurs about 3-4 days after life "milk comes in"
- supply and demand


Where does the Energy for breast feeding come from in the first 3 days since milk "comes in" at 3-4 days after birth?

1. Glycogen stores (lasts ~12 hrs)
- stimulated by intrauterine GCC
2. Low blood glucose --> decreases insulin and increases glucagon --> gluconeogenesis
3. Stress


Frequency of BF

On demand!
~8-12x a day
Variable duration


Infants lose weight 5-7% after birth weight, when does this stop?

5 days
- Milks in!
- birth weight re-achieved by day 7-10

If weight loss > 7% think inadequate intake


How important is mom establishing effective attachment?


Or else:
1. Pain + dmg to nipples --> engorgement
2. Breastmilk not removed effectively/baby unsatisfied and wants to feed often
3. Mother-frustrated at apparent poor milk supply
Infant frustrated and refuses to suckle
5. less breastfeeding--> less milk
6. infants fails to gain weight


Insufficient milk syndrome

Occurs in ~ 5% of women

Inadequate milk removal --> inadequate milk production

A common cause of weight loss in infants


How common is primary lactation failure?



Is infant formula FDA regulated?

1. Cow milk based
2. Protein load better approach hu milk (casein:whey)
3. High quality aa mix
4. Fortified w. essential vit + min
5. Lipid blend modified, including w-3 FA

*has everything but immunoprotective factors in breast milk


Risk to formula feeding?

- cow milk protein #1 food allergen in infants
- Soy protein #2 food allergen in infants

Bovine serum albumin found in infant formula can trigger autoimmune response (increased risk of diabetes)


Diff between infant growth btwn BF vs FF?

1st 3 months
- Same

after 3 mo:
Formula fed gain more weight

*this was recognized 20 yrs ago


Breastmilk bank
- Where is it typically used?
- What can it reduce in infants?

milk is donated
Screen (donor + milk) and pasteurized
TYpically used in NICUs
- 58% reduction in Necrotizing enterocolitis


Risks of sharing breast milk

not screened
- infectious risks
- mom on medications


WHO vs CDC growth chargs

BF (WHO) vs Formula fed (CDC)

Biggest differences in growth after 6 months

Who can:
- have earlier recognition of "overweight"
- Fewer diagnoses of "growth faltering"


Which Immunoglobulins are in milk?

All of dem
IgA, IgM, I gG, IgD, IgE

*lvls highest in colostrum


Bifidus factor:

- supports growth of non-pathogenic lactobacillus
- Facilitates:
Establishment of lactobacillus
- Passage of meconium (baby's first poop)


Minerals that are found in hu milk that is not dependent on maternal diet

selenium and iodine


Single most important factor in prevention of death in children

Exclusive breastfeeding thru 6 mo