Infant feeding Flashcards
In terms of Breast milk, what constituents does it have, that formula milk lacks, that make it more beneficial for the baby?
- Protein
- Protein in breastmilk is more whey based and is easier to digest.
- The main protein (alpha lactalbumin) has been associated with the destruction of over 40 types of cancer cells including bladder and brain.
- Fats
- breast milk contains long chain polyunsaturated fatty acids that support the development of the entire nervous system including retinol development.
- Immunoglobulins
- IgA, IgG, IgM and IgD, the most important is IgA, which provides a protective coating to the baby’s gut; it covers the mucosal gut surface to prevent entry of pathogenic bacteria and enteroviruses (E Coli, Salmonella, Streptococci, Staph, pneumococci, rotavirus etc.), protecting against gastroenteritis, respiratory infections etc.
- Leukocytes
- Enzymes
- IL-7
- Linked to the size of the thymus. Breast fed babies have a larger thymus which demonstrates a stronger immune system.
- Growth factors
- Lymphocytes
- Stem cells
- Milk lipids
What is Colostrum?
‘First milk’ - The fluid your breasts produce in the first few days after birth is called colostrum.
- It is a concentrated version of mature breastmilk
- It is present in the breasts for 3-4 days after birth.
Special features of colostrum
- Packed with protective factors
- Concentrated nutrition
- Strong anti-inflammatory factors - help reduce the risk of Necrotising Enterocolitis (where part of the bowel dies), especially in preterm babies.
- Stimulates gut growth - by helping cells and villi in the gut proliferate
- Small volumes – intentionally as the kidneys are immature and couldn’t cope with large vol of feed. Colostrum contains all the nutrients and protective factors the baby needs without all the excess water.
- Laxative effect – helps to minimise jaundice by assisting the passage of meconium (that contains bilirubin)
Choosing not to breastfeed can increase risk of disease for both the baby and the mother. What are the risks for both?
For babies
- Gastroenteritis
- Respiratory infections
- Allergies
- Obesity
- Type 1 and 2 diabetes
For mothers (in later life)
- Breast cancer
- Ovarian cancer
- Hip fractures
- Heart disease
Human milk helps set up the baby’s immune defences. What things pass through the baby’s gut from the mother in order to do this?
- Fluid
- Nutrients
- Metabolites - stimulation of enzyme release in babies, provision of signals from mother to baby about threats in the environment (allergies, potential infections) and support of growth and development.
- Immunity - maternal antibodies
- Hormones
- Microbes
When do babies begin to pick up their familial microbiome?
Babies may receive exposure to maternal microbes in the womb, however, it is more common that they are passed on:
- As they pass through the vagina at birth
- Lactobacilli is more prevalent in mother’s vagina during pregnancy, the baby is exposed to this and the setting up of the immune system within the baby’s gut begins
- Through their mother’s milk in the postnatal period and beyond
- With the first breastfeed the live constituents in breastmilk continue to develop this process with its high levels of bifidobacteria and oligosaccharides
Therefore vaginal birth, skin-to-skin contact and breastfeeding will provide the baby with the best start in life.
What are the microbes in our gut responsible/necessary for?
- Generate our energy needs
- Produce enzymes to digest food
- Manufacture vitamins B, K and nicotinic acid
- Regulate fat storage
- Manufacture amino acids
- Help with iron absorption
- Create our individual immune system and help immune cells reproduce
- Train our immune system on what is safe and what to reject.
What constituent of human milk feeds the new ‘friendly’ microbes in a baby’s gut?
Oligosaccharides
What is really important if a mother has a c-section in order to not leave the baby’s gut flora compromised?
As the baby has missed out on vaginal transfer of microbes now more than ever prolonged skin-to-skin contact and breastfeeding are especially important
Epigenetics and breastfeeding
Breastmilk and breastfeeding can potentially change the epigenome to affect lifelong health of the baby. It can impact on:
- Brain development
- Baby’s immune system
- Baby’s metabolic system
How is the baby’s immune system updated at each breastfeed?
- The mother’s body works to monitor her environment and produce antibodies to current infections/pathogens that she detects via her lungs or gut.
- These antibodies are passed directly to the breastmilk so that the baby is provided with protection with as little delay as possible.
- Sent to the breasts via Broncho-mammary pathway or Entero-mammary pathway. This is sometimes known as GALT and BALT
What information do parents that opt for formula need to know?
- 1st milk = most appropriate formula for babies in first year – no need for follow on!
- All brands are similar
- Information on preparing and sterilising
- Cows’ milk from one year
- Responsive bottle feeding - reduce overfeeding and obesity
What are the 3 stages of lactation?
- Lactogenesis 1 – Breast development and colostrum production from approx. 16 weeks gestation
- Lactogenesis 2 – Onset of copious milk secretion occurring between 32 and 96 hours after birth
- occurs in response to rise in prolactin and decrease in pregnancy hormones, and milk will ‘come in’ regardless of whether a woman wants to breastfeed or not.
- Lactogenesis 3 – Maintenance of milk production
What changes occur in the mother after birth in order to begin breast feeding?
- Oestrogen and progesterone levels drop as soon as the placenta is delivered.
- Prolactin (the hormone responsible for milk production) and Oxytocin levels rise in response to touch, smell and sight of baby
- Baby begins spontaneous breast seeking behaviour
- Mothering behaviours initiated
What is the prolactin receptor theory?
- Prolactin receptors line the cell wall of each lactocyte in the breasts.
- As Prolactin levels in the blood stream rise in response to touch and suckling by the baby, there is more circulating prolactin.
- The more circulating prolactin = greater the number of lactocytes being activated.
- The more early, frequent surges of prolactin there are, the greater the number of receptor sites that become primed. Maximum numbers of receptor sites primed means maximum numbers of functioning lactocytes from that point onwards. It also means maximum triggering of the mothering response.
