NUTRITION DURING LACTATION

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In-Hospital Breastfeeding Rates (US, 2001)

8090

Healthy People 2010 Goal

40.723.2

50607080

ent

Mixed

Healthy People 2010 Goal

42.2 46.320304050

Per

ce MixedExclusive

01020

California National

Breastfeeding Rates at 6 mo (2001)

Exclusive Mixed

708090

100

Healthy People 2010 Goal

20 140506070

Per

cent

24.1 17.2

20.115.3

0102030

0Pacific Region National

Breastfeeding : A Learned Behavior

Physiological process virtually all mothers y g p yare capable of doingIs a learned behavior not all mother decide to doMother’s partner also plays an important role

Advantages

Nutritionally superior to any alternativesNutritionally superior to any alternativesBacteriologically safe & always freshContains various antiinfectious factors & Contains various antiinfectious factors & immune cellsThe least allergenic to any infant foodThe least allergenic to any infant food

Breast-fed babies are less likely to be overfedPromotes good jaw & tooth developmentCost lessPromotes close mother-child contactMore convenient once the process is established

A i A d f P di i (AAP) & American Academy of Pediatrics (AAP) & American Dietetic Association (ADA)

Exclusive breastfeeding for 6 months, and breastfeeding with complementary foods for at least 12 months as an optimal feeding patternfor infants

American Academy of Pediatrics (AAP)

Females infected with the human i d fi i i (HIV) h ld b immunodeficiency virus (HIV) should be counseled not to beast-feed

F l h t i k f b i i f t d Females who are at risk for being infected with the virus should be educated about the risk of infecting their infant with HIV risk of infecting their infant with HIV through breast milk

The Baby Friendly Hospital Initiative

Global effort to ↑ the incidence & duration of breast-feedingTo become ‘baby friendly’, a hospital must agree to implement the “Ten steps to Successful Breast-feeding”

Ten steps to successful breast-feeding

Have a written breast-feeding policy that is g p yroutinely communicated to all health care staffTrain all health care staff in the skills necessary to implement this policyInform all pregnant females about the benefits and management of breast-feeding

Help the mother initiate breast-feeding i hi h lf h f bi hwithin a half hour of birth

Show mothers how to breast-feed and how t i t i l t ti if th to maintain lactation, even if they are separated from their infantGive new born infants no food or drink other Give new born infants no food or drink other than breast milk unless medically indicated

Practice rooming-inEncourage breast-feeding on demandGive no artificial teats or pacifiersFoster the establishment of breast feeding support groups, and refer mothers to them

di h f h h i l li ion discharge from the hospital or clinic

Nutritional requirements

Lactation is nutritionally demandingIncreased intake of most nutrient is advisedMilk production is most affected by the p yfrequency of sucklingMilk composition varies according to mother’s diet, but in general the effect is to reduce quantity, not quality

Energy

Production 100 ml of milk need 85 kcal diexpenditure

1st 6 mo of lactation 750 ml/day (550 –1200 l/d )1200 ml/day)RDA : + 330 kcal (1st 6 mo)

400 k l (2 d 6 )+ 400 kcal (2nd 6 mo)

2nd 6 mo - production 600 ml/day E req- consuming solid food Energy intake at least 1800 kcal/dayInadeq maternal fluid intake affects milk volume

After birth women are in a hurry to lose i hweight

In general lose ½ - 1 kg / mo during the 1st 4 6 f l t ti1st 4 – 6 mo of lactationExercise >> ↑ lactic acid of breast milk influence milk tasteinfluence milk taste

Breastfeeding and maternal weight loss(Dewey et al. Am J Clin Nutr 1993;58:162-6)

Fat

20 35% of total calories20 – 35% of total caloriesPresence of long-chain PUFA crucial for fetal & infant retina & brain developmentfetal & infant retina & brain developmentAI n-6 PUFA : 13g/dayAI n 3 PUFA : 1 3 g/dayAI n-3 PUFA : 1.3 g/day

Human Milk Composition

I fl f t l di ta. CHO, protein & minerals → not influenced by maternal dietb. Fat and vitamins → influenced by maternal diet

Influences of maternal diet

↓

↑↑

Human Milk Composition

Influences of maternal nutritional status

- milk composition remains relatively constant unless malnutritionis severe

- the volume of milk produced may ↓ with malnutrition- the volume of milk produced may ↓ with malnutrition

Water

D i k l f ilk j i t t Drink a glass of milk, juice or water at each meal and each time the infant

nurses

Nutrient supplements

Most women can obtain all the nutrients Most women can obtain all the nutrients from a well balanced dietSome may need iron to refill their Some may need iron to refill their depleted iron stores

Particular foods

Foods with strong or spicy flavors (e g Foods with strong or spicy flavors (e.g. garlic) may alter the flavor of breast milkInfants who develop symptoms of food Infants who develop symptoms of food allergy more comfortable if the mother’s diet exclude the most common offenders (cow’s milk, eggs, peanuts)

Increased Requirements

Practices incompatible with lactation

AlcoholAlcohol- easily enters breast milkSmokingSmoking- transfer nicotineMedicinal drugsMedicinal drugsEnvironmental contaminantsCaffeineCaffeine

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