MARA CARISCOURTNEY KLEBE

BreastfeedingGive em’ the breast breakfast!

Objectives

Discuss nutritional components and benefits in breast milk

Discuss barriers and how to overcome barriers of breastfeeding

Discuss recommended diet while breastfeeding

Bring awareness to breastfeeding in public Provide programs supporting breastfeeding

History of breastfeeding[1]

Wet nurses were used to breastfeed children of the royal families

Wet nursing began as early as 2000 BC and extended into the 20th century

By 1900 wet nursing was extinct

Breast Milk[2]

Colostrum “First Milk”: Thick yellow fluid Low in fat, and high in Carbohydrates, proteins, and

antibodies Laxative effect 20 kcal/oz Mature milk around day 3 or 4 Defends baby against harmful infections

Infant Stomach Capacity[2]

Components of breast milk:Fats [3,4,5]

“Hind milk” higher in fat

Amount and type related to maternal diet

Essential fatty acids, saturated fatty acids, triglycerides

LCFA(long chain fatty acids): -DHA- 1.3 g/day AI -Arachidonic acid- 13

g/day AI Contains 10-20 mg/dL

of cholesterol, and is not reflected in maternal diet

Components of breast milk:Protein:[3,4,5]

Low levels in breast milk

Mostly alpha-lactalbumin

Whey(60%) and Casein (40%): Ratio makes breast

milk more digestible Great infection-

protection properties

Other proteins:1. Lactoferrin2. Secretory IgA3. Lyzsozymes4. Bifidus Factor

DRI: 25g/day during lactation

Components of breast milk:Carbohydrates [3,4,5]

Lactose: Primary CHO in breast

milk Enhances Ca, P, and

Mg absorption Monosaccharide's:

galactose fructose

Oligosaccharides: Third most abundant

component; 130 types Protective properties

against respiratory and enteric diseases

Promotes growth of bifidobacterium and Bacteroides

Components to breast milk: Vitamins- Fat Soluble[5,6]

Vitamin A: gives colostrum yellow color (beta-carotene)

Vitamin E: Muscle integrity and resistance to RBC breakdown

Components to breast milk: Vitamins- Fat Soluble Cont.[5,6]

Vitamin D: content of milk is related to sun exposure and maternal vitamin D intake Recommended to take

supplementation- 400 IU/day

Vitamin K: very little content until normal gut bacteria start making it

Vitamin K shot at birth

Components of Breast MilkVitamins- Water Soluble

Vitamin CRiboflavinNiacinB6B12

Components of breast milk:Minerals[6]

Largely protein bound and balanced to enhance bioavailability

Sodium: low content

Calcium: content in breast milk not related to maternal intake

Components of breast milk: Minerals Cont. [6,7]

Magnesium: adequate amount for growth and development

Zinc: requirements during lactation are more than during pregnancy

Benefits of Breast Feeding:

Benefits to the Baby[6]

Optimal nutrition for infant Strong bonding with mother

Safe, fresh milk Enhanced immune system

Reduced risk for acute otitis media, severe lower respiratory tract infections, and asthma

Protection against allergies and intolerances

Promotion of correct development of jaw and teeth

Higher IQ and school performance through adolescence

Reduced risk for chronic diseases

Reduced risk for SIDS

Benefits to the Baby: A report by the Agency for Healthcare Research and Quality (AHRQ) [6]

23% reduction in the risk of otitis media in infants if ever breastfed; 50% if breastfed exclusively for 3 months

72% reduction hospitalization for a lower respiratory tract infection during first year of life

15-19% reduction in leukemia if breastfed for first 6 months

27 % reduction of asthma if breastfed for first 3 months without a family history of asthma, 40% reduction with family history

Benefits to the Baby Cont. [4,6]

Easier Digestion Lactose, whey & casein proteins, and fat are easily

digested

Antibodies in breast milk helps build the baby’s immune system

Benefits to the Baby Cont. [4,6]

Brain and growth development Promotes rapid formation of myelin

Possible role in prevention of obesity 4% reduction in adulthood obesity each month of

being breastfed

Benefits to the mother[6]

Strong bonding with infant Increased energy expenditure

Faster shrinking of the uterus Reduced postpartum bleeding and delays the menstrual cycle

Decreased risk for chronic diseases

Improved bone density

Decreased risk for postpartum depression

Enhances self-esteem in the maternal role

Time saved from preparing and mixing formula

Saves money

Benefits to the Mother Cont.[6]

Weight loss Pre-pregnancy weight + total pregnancy weight change +

parity = greatly impact postpartum weight loss

Increase levels of oxytocin stimulates uterine contractions, minimizes postpartum blood

loss, and returns uterus to nonpregnant size Lowers blood pressure before, during, and after sessions

Benefits to the Mother Cont. [6]

Fertility is delayed in most women when breast feeding ovulation is delayed

Increased Bone Health Reduced risk of hip fractures in postmenopausal

women Improved bone mineral density during you adulthood

in adolescent mothers

Benefits to the Mother Cont. [6]

Lowers risk of type II diabetes, breast cancer, ovarian cancer, BP, and rheumatoid arthritis 4.3 % reduction in risk of breast cancer development each year

woman breastfeeds Partial inhibition of ovulation results in decreased risk of

ovarian cancer >12 months decreased rheumatoid arthritis

Family Economy

Less prescriptionsLess illnessImproves

communication

Saves money reduces health care cost time off work

Less Bottles = less waste

No manufacturingEnvironmentally

friendly

Benefits [5,6]

Barriers to Breastfeeding

EmbarrassmentLack of supportLack of confidenceConcerns about

diet/health practicesFear of painInfections

Insufficient breastfeeding education

Disruptive hospital policies

Promotion of infant formula

Time

Barriers to Breastfeeding: Solutions

Do what makes you feel comfortable

Don’t judge others who choose to breastfeed

Educate yourself on breastfeeding

Use a breast pump

Wear clothes compatible with breastfeeding

Practice at home Find support

Breastfeeding Conditions[5]

Sore NipplesFlat or Inverted NipplesLet Down Failure Hyperactive LetdownHyperlactationEngorgementPlugged DuctMastitis

Sore Nipples Hyperlactation

Causes: Incorrect positing Suction trauma Poor latch Improper release

Treatment: Nurse on least sore breast Find comfortable position Pump to express milk

Breastfeeding Conditions[5]

Causes: milk volume of the

mother exceeds the intake of the baby

Treatment: Nurse on one breast

while mother expresses on other

Cabbage leaves or cold compresses to decrease production

Letdown Failure Hyperactive Letdown

Causes: Oxytocin is suppressed

and milk can’t be expressed

Treatment: Oxytocin nasal spray Decrease stress

Causes: Milk streams from the

breast as feeding begins

Treatment: Express milk till flow

stops Remove infant from

breast until flow stops

Breastfeeding Conditions[5]

Flat or Inverted Nipples

Breastfeeding Conditions[5,8]

Causes: naturally occurs

Treatment: Correct latch positioning Use breast pump prior to

feeding to draw out nipple

Engorgement

Causes: Milk building up in the

breasts Treatment:

Continue to nurse baby Nurse frequently Pump prior to nursing or

hand express

Breastfeeding Conditions[5,9]

Plugged Duct

Breastfeeding Conditions[5,10]

Causes: Milk duct does not

properly drain and becomes inflamed

Treatment: Correct position of baby

on the breast Wear lose nursing

garments Proper time span

between nursing

Mastitis

Causes: Inflammation, cracked

sore nipples, engorgement, restriction from tight bra or clothing

Treatment: Continue nursing Switch to unaffected side Apply wet or dry heat to

breast Adequate rest/ fluid

Breastfeeding Conditions[5,11]

Tips to ease pain[12]

Correct latching Over the counter breast lotionMassage breast before and after feedingWet or dry heat on breast before feedingHerbs to promote/reduce milk flowPositioning (demo/ pictures)

Position demonstration

Medications and Breastfeeding[5]

90-99% of women who breastfeed take some type of medication during their first week postpartum

Most medications are excreted in breast milkMedications contradicted during

breastfeeding include antineoplastic agents, drugs of abuse and drugs that suppress lactation

Not recommended: Approved with breastfeeding:

EchinaceaGinseng RootSt. John’s Wort

FenugreekGoat’s-Rue

Herbs and breastfeeding[5]

Alcohol and Breastfeeding[5]

Alcohol consumed is concentrated in breast milk and can inhibit milk production

Odor and volume of breast milk changes

Takes a 120 pound woman about 2-3 hours to clear one serving of beer or wine from her body

Sleep patterns and psychomotor development of infants change

Smoking and Breastfeeding[5]

Cigarettes Asthma, respiratory infections, colic, and acid reflux Results in lower milk output, lower fat content, and

slower growth of infant Marijuana

Possible decrease in infants motor development

Maternal Diet[13]

The U.S Department of Agriculture’s MyPyramid Food Guide has set guidelines

Healthy-weight women expend around 500 kcal/day in the first 6 months due to breastfeeding- 400 kcal after 6 months

Maternal Diet Cont.[13]

Well-nourished breastfeeding mothers do not need to take routine vitamin or mineral supplementation

Fluid needs and demands increase

Like pregnancy, should avoid fish high in mercury,

Maternal Diet cont.[5,13]

Caffeine Does not pose as much as a problem; around 5

oz. a day is okay Some symptoms do occur like infants being

wakeful and fussy No long-term effects have been documented

Maternal sample diet[14]

Breastfeeding: YesAge: 26Height: 5 ft. 7 in. Weight: 140 lbs. Baby birth date: Aug 28th, 2013 Physical activity: 30-60 minutes of moderate

activity per day

My SuperTracker Plan [14]

Breast milk Cow’s milk-based formula

7 % of calories from protein

38% of calories from carbohydrates

55% of calories from fats

9-12% of calories from protein

41-43% of calories from carbohydrates

48-50% of calories from fats

Breast milk vs. formula[4,5,6]

Formula[4,5,6]

Made under sterile conditions Babies who are formula-fed aren’t as hungry

as babies who are breastfed Some reasons as to why women choose to

formula feed:1.Convience 2.Flexibility3.Time and frequency of feedings4. Diet

Healthy People 2020 on breastfeeding[15]

42 focus areas, one of which is Maternal, infant, and Child Health

“New objectives will take on some of the most challenging barriers to breastfeeding success faced by U.S. mothers.” [4]

Healthy People 2020 Objectives[15]

Increase the proportion of infants who are ever breastfed.

Increase the proportion of infants who are breastfed at six months and one year

Increase the proportion of infants who are exclusively breastfed through three and six months

Healthy People 2020 Objectives Cont.[15]

Increase the proportion of employers that have worksite lactation support programs.

Reduce the proportion of breastfed newborns who receive formula supplementation within first two days of life

Programs promoting breastfeeding[16]

WICBaby Friendly Hospital InitiativeAcadamey of Pediatrics (AAP)WHOThe U.S. Department of Health and Human

Services (DHHS)Wellstart International

Conclusion

The American Academy of Pediatrics (AAP) recommends that mothers breastfeed exclusively for the first 6 months, followed by breastfeeding in combination with the introduction of complementary foods for at least 12 months.

Breastfeeding provides many benefits to the baby, mother, family, and community.

Questions???

References

1. Stevens E, Patrick T, Pickler R. A History of Infant Feeding. J Perinat Educ. 2009; 18(2): 32-39. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684040/pdf/jpe-18-032.pdf. Published Spring 2009. Accessed Sept 20 2013.

2. What is Colostrum? How does it benefit my baby? La Leche League International. http://www.llli.org/faq/colostrum.html. Updated Oct 2006. Accessed Oct 2013.

3. What’s in Breast Milk? American Pregnancy Association: Promoting Pregnancy Wellness. http://americanpregnancy.org/firstyearoflife/whatsinbreastmilk.html. Updated Jan 2013. Accessed Sept 20 2013.

4. Mahan K, Escott-Stump S, Raymond J. Krause’s Food and the Nutrition Care Process. 13th. St. Louis (MO): Elsevier Saunders; 2012.

5. Brown J, Isaacs J, Krinke B, Lechtenberg, Murtaugh M. CHAPTER. Nutrition Through the Life Cycle. 4th. Belmont (CA): Wadsworth; 2011.

6. Position of the American Dietetic Association: Promoting and Supporting Breastfeeding. J Am Diet Assoc. 2009 Nov;109 (11): 1926-942.

7. Naturalwellnessgirl. [image from the internet] [Updated 2013] Available from: http://www.naturalwellnessgirl.com/2011/10/mineral-monday-zinc/

8. Medela. [image from the internet] Available from: http://www.medela.com/CA/en/breastfeeding-consumer/breastmilk-information/flat-or-invert-nipples.html

9. Pretty Mom Guide. [image from the internet] [update 2011 Jan 05] Available from: http://prettymomguide.com/engorgement-if-youre-not-breastfeeding.html

10. Breastfeeding Challenges. [image from the internet] [Updated 2010 Dec 04] Available from: http://breastfeedingchallenges.wordpress.com/2010/12/04/plugged-milk-duct/.

11. Beliefnet. [image from the internet] [Updated 2007 Nov] Available from: http://www.beliefnet.com/healthandhealing/getcontent.aspx?cid=11684

12. Breastfeeding FAQs: Pain and Discomfort . Kids health. http://kidshealth.org/PageManager.jsp?lic=44&cat_id=161&article_set=44020. Accessed Sept 20 2013.

13. Lyn S, Khan P. Maternal Nutrition During Breastfeeding. NEW BEGINNINGS. 2004; 21(2): 44. http://www.llli.org/nb/nbmarapr04p44.html Published April-May 2009. Updated Aug 29 2006. Accessed Sept 20 2013.

14. ChooseMyPlate.gov. [internet] United States Department of Agriculture. [Cited Oct 15 2013]. Available from : http://www.choosemyplate.gov/pregnancy-breastfeeding.html

15. Healthy People 2020 Objectives Combat the Barriers to Breastfeeding. United States breastfeeding Committee. http://www.usbreastfeeding.org/NewsInfo/NewsRoom/201012HP2020andTJCToolkit/tabid/185/Default.aspx Published Dec 13 2013. Accessed Oct 8 2013.

16. Hospital Support for Breastfeeding: Preventing obesity begins in hospitals. Centers for Disease Control and Prevention. http://www.cdc.gov/VitalSigns/BreastFeeding/ Published Aug 2011. Accessed Sept 21.