lactation Flashcards
(28 cards)
colostrum
Yellow in color. High in IgA and lactoferrin. Anti-infection properties. Higher protein, lower fat and lactose. Facilitates- Establishment of lactobacillus and Passage of meconium
transitional milk
2-14 days. Immunoglobulins and protein decrease. Lactose and fat increase. Increase in calories. Vitamin changes
mature milk
Mainly water to maintain infant hydration. Lipids provide 50% of calories. Proteins- casein and whey (primary). Lactoferrin – inhibits growth of Fe dependent bacteria in GI tract. sIgA provides immunity. Carbs- lactose, galactose and glucose. Elements: iron, zinc, Vit D.
foremilk vs hindmil
foremilk is milk at the beginning of a feeding which has less fat than hindmilk, from the end of a feeding.
How does maternal diet influence breast milk
•Malnourished mothers have the same proportions of protein, fat and CHO as well nourished mothers, but they produce less milk. Dehydrated mothers will decrease water loss in urine before diminishing BM output.. Fat intake influences lipid content, not linked to infant health at this point.
Breast feeding advantages to infant
Immunologic protection- Acute illness: reduced rates of gastrointestinal infection, respiratory illness (LRI, wheezing), otitis media, sepsis, necrotizing enterocolitis (premature infants). Chronic conditions: obesity, ? celiac disease, childhood cancer. Immune priming. Neurodevelopmental benefits: bonding; enhanced cognitive performance
Breast feeding advantages to mother
Prevention of post-partum hemorrhage, Weight loss (average return to pre-pregnancy weight after ~ 6 mo of lactation), Lactational amenorrhea/birth spacing; amenorrhea also spares nutrients, esp Fe
WHO infant feeding recommendations
Exclusive breastfeeding for 6 mo., Continue to breastfeed least 2 years with complementary feeding initated at 6 months.
American academy of Pediatrics infant feeding recommendations
Exclusive breastfeeding for 6 mo., Continue to breastfeed least 1 year with complementary feeding initated at 6 months.
Healthy people 2020 goals
82% “ever breastfed”, 61% breastfed for 6 months, 34% breastfed for 12 months. Increase worksite lactation support programs, decrease breastfed infants who receive formula supplementation within first 2 days of life. Increase births in facilities that provide recommended care for BF mother/infant
barriers to breastfeeding
higher socioeconomic status, well educated, married, older >25, non smoker, not employed outside house, caucasians and hispanics > blacks, less acculturated
Baby Friendly Hospital Initiative
written breastfeeding policy, Train all health care staff, Inform all pregnant women about benefits, Help mothers initiate breastfeeding within half hour of birth, show mothers how to breastfeed, No food/drink other than breast milk, rooming in, breastfeeding on demand, no artificial teets or pacifiers, support groups
What happns in first hour after birht
AAP & WHO recommend infants be nursed (skin to skin) within the first hour after birth. Infant typically alert for first hour, then sleeps for several. Thermoregulation with skin-to-skin. Better Breast feeding outcomes at 4 mo
Hospital practices that support successful breastfeeding
breast feed in 1st hour, Skin to skin contact, Rooming in, Lactation consultants, Peer role modeling, Ad lib nursing/feeding
Hosital practices that undermine successful breastfeeding
Separation of inf/mom, Mother discouraged, BF/limited time suckling, Covert formula feeding, D/C packs with formula, Lack of support, Pacifier use
breastfeeding for first 1-3 days
colostrum (high fat, protein, Igs), practice Bfing. Glycogen stores last about 12 hours (stimulated by intrauterine Glucocorticoids). Low glucose leads to decreased insulin & increased glucagon > gluconeogenesis. “Stress” leads to lipase release, then release of TG > glycerol & fatty acids. Brown and white fat provide substrate for energy intake
When does lactogenesis stage 2 begin
3-4 days after birth. “milk comes in”
frequency and duration of breast feeding
Every 30 minutes, to 4 hours (no more). 8-12 times per day in beginning. Thorough emptying of breast important For hindmilk (high fat – good for infant
growth). Good for lactogenesis. 10-30 minute durations
Newborn weight changes
Infants expected to lose 5-7% of their birth weight. Typically stop losing by 5 days then regain birth weight by 7-14 days.
Breastfeeding difficulties
First 1-3 weeks is common time for problems. Mother may have trouble positioning baby due to shape of breast/nipple, infant size, development. Infant needs to have proper rooting, sucking and swallowing reflexes
Insufficient milk syndrome
common. Inadequate milk removal leads to inadequate milk production. Factors may include Maternal – stress, medical problems, separation from infant, older maternal age. Infant – LBW/prematurity, poor suck/latch, neurologic issues, lethargy, illness, formula supplementation
describe components of infant formula
Cow milk base. Protein load modified to better approach human milk (casein:whey ratio). High quality amino acid mix. Fortified with essential vitamins & minerals. Lipid blend modified, including omega-3 FA. Soy protein is 2nd most common choice.
compare infant formula vs human milk
Macronutrients are similar, but there are significant differences in micronutrients. Ie. Iron in IF is 4X human milk
conditions associated with infant formula
Atopy (allergy), type 1 diabetes, obesity
