Breast Feeding

This article was checked by pedagogue

This article ws checked by pedagogue, but later was changed. Checked version of the article can be found here. See also comparation of actual and checked version.

Breastfeeding

Woman breastfeeding

The World Health Organization (WHO) recommends breast milk as the only food or drink offered to infants during the first 6 months of life . To promote breastfeeding, mothers should be empowered to initiate skin-to-skin contact with their infant immediately after birth for at least one hour . Exclusive breastfeeding is recommended for the first 6 months, with continued breastfeeding for 2 years or more, with the appropriate introduction of solid foods .

The first milk produced by the mother is known as colostrum. This thick creamy milk is rich in protein and antibodies, which help the baby ward of infection . Colostrum is highly nutritious and is the perfect first food for the infant .

Exclusive breastfeeding promotes optimal growth and development. In developing countries, “the most important benefit of breastfeeding is the infant’s immediate survival ”. The chance of survival in the early months is at least six times greater among children who are breastfed compared to those who are not . Breastfeeding reduces the risk of death from acute respiratory infection and diarrhea, as well as other infectious diseases .

Each mother’s milk is unique and provides the right amount of protein, carbohydrate, fat, vitamins and minerals for her infant at each stage of development . In addition to its nutritional components, breast milk also contains immune factors that help protect the infant from infection and disease . Breastfeeding supports the development of the infant’s immune systems and helps decrease the risk infection and illness during childhood, as well as the risk of chronic conditions, such as obesity and diabetes later in life .

Vitamin D

Vitamin D is necessary for proper bone development. Vitamin D deficiency may occur among breastfed infants who do not receive much exposure to sunlight . In developed countries, mothers are recommended to give breastfeed infants Vitamin D drops to help prevent deficiency. Breast milk substitutes are fortified therefore supplementation is not necessary in infants who are not breastfed.

Importance of Breastfeeding

There are many reasons why a mother should breastfeed. Breastfeeding is associated with important short and long-term health outcomes for both mother and child. Breastfed infants are at lower risk of ear infections, respiratory illnesses, allergies, diarrhea and sudden infant death syndrome . Long term, breastfed children are at lower risk of childhood leukemia, diabetes, asthma, obesity, and have higher IQ scores .

For the mother, breastfeeding helps reduce the risk of post-partum haemorrhage, postpartum depression, and delays the return to fertility. Long term mothers who breastfeed are at decreased risk of osteoporosis, ovarian and breast cancer . Both mother and child benefit from early skin-to-skin contact as this helps to establish a bond that promotes healthy social emotional development .

Complementary Feeding

At 6 months, the child’s nutritional needs begin to change and developmentally they are ready to begin eating small amounts of family foods. Breast milk continues to be the child’s main source of nourishment well beyond the first year of life . At 6-8 months, the child should be offered small meals of complementary foods 2-3 times per day. The first foods introduced should be smooth in texture to minimize the risk of choking. Parents and caregivers should be encouraged to increase the quantity of food, as the child gets older, while maintaining frequent breastfeeding . By 9 months, meals of complementary foods should be offered 3-4 times per day with nutritious snacks offered between meals 1-2 per day .

Parents and caregivers should offer a variety of foods to ensure the child’s nutrient needs are met . Early on, iron rich foods are particularly important because by 6 months the infant’s iron stores have been depleted . Therefore, meat, poultry, fish or eggs should be eaten daily, or as often as possible .

Continue to modify the texture, progressing from smooth to a slightly more lumpy texture, and finally to small pieces of food when the child is developmentally ready . As the child continues to grow, offer a variety of foods from each food group. Parents and caregivers should be encouraged to pay attention to their child’s hunger and satiety cues, sit with their child while eating, and make meal times pleasant.

Contraindications to breastfeeding

Absolute contraindications:

• from the child's side:
  • classic form galactosemia with zero activity of gal-1-puridyltransferase in erythrocytes;
• on the mother's side:
  • HIV/AIDS infection (applicable only in developed countries);
  • HTLV 1, 2 infection.

Partial Contraindication:

• from the child's side:
  • phenylketonuria – according to individual phenylalanine tolerance;
  • other metabolic defects – according to consultation with the center of metabolic defects;
• on the mother's side:
  • drug abuse.

Temporary Contraindication:

• on the mother's side:
  • herpes zoster, herpes simplex on the breast – do not breastfeed the child from the affected breast until the lesions disappear (regularly express and pour milk), you can breastfeed from the other breast;
  • cytomegalovirus – for premature babies of seropositive mothers, consider the benefits and risks of breastfeeding;
  • chickenpox that appears within 5 days before delivery and within 2 days after delivery - isolate the mother from the child until the blisters burst, give the child varicella-zoster immunoglobulin; the baby can be given expressed mother's milk;
  • active tuberculosis – separate the mother from the child until the treatment begins to work and the mother is no longer infectious, give the child vaccination and chemoprophylaxis; the baby can be given expressed mother's milk;
  • radioactive isotopes – use radionuclides with the shortest possible half-life; interrupt breastfeeding for a period 5 times longer than the half-life;
  • chemotherapy;
  • some drugs (the list is available on the website TOXNET).

Medicines absolutely contraindicated during breastfeeding:

• cytostatics, immunosuppressants, estrogens (they reduce lactation), addictive substances (heroin, cocaine, amphetamine); ergot alkaloids (bromocriptine, ergotamine), lithium, gold salts, radioactive isotopes.

'No contraindications:

• on the mother's side:
  • hepatitis A, B, C (consider breastfeeding in acute HBV infection of the mother, i.e. if the mother is HBsAg and HBeAg positive and anti-HBe negative);
  • febrile conditions, viruses, mastitis, vaccination, diseases of the digestive or uropoietic tract;
  • smoking – the mother is advised to stop smoking;
  • occasional consumption of alcohol 2 hours apart from the next breastfeeding.

Physiology of Lactation

File:Breastfeeding.webm

Breastfeeding (video).

Breast milk is formed 'in the epithelial cells of the alveoli of the mammary gland and is secreted into the alveoli, from where it flows through the small and large milk ducts into the wide sinuses in the area of ​​the areola. These sinuses then open on the nipple. Growth and differentiation of the mammary gland as well as milk production are under endocrine control.

After the expulsion of the placenta during childbirth, a large amount of prolactin is released from the adenohypophysis, which triggers the production of milk in the first days after childbirth. The hormone prolactin plays a key role in lactation. Frequent breastfeeding early after birth stimulates the development of prolactin receptors in the mammary gland. Delaying suckling after birth leads to lower prolactin levels and thus fewer stimulated prolactin receptors.

'During sucking of the baby, nerve impulses are sent from the breast to the neurohypophysis, which releases oxytocin. Under the influence of oxytocin, the myoepithelial cells of the milk ducts contract and the milk moves from the alveoli towards the nipple ("milk ejection reflex" or "let-down reflex"). Initially an unconditioned reflex, it soon becomes conditioned and can be inhibited by anxiety and pain.

Initially, lactation is hormonally controlled and colostrum production occurs independently of suction. Colostrum is thick, produced in small quantities (4-14 ml at each feeding). Over the next 48-96 hours, milk production increases significantly and the amount produced is controlled by suction and demand (the amount of milk removed). These events are crucial for the continuation of lactation. After 1-2 weeks, the average milk production is 700-800 ml/day (with significant individual variability of 450-1200 ml/day). At the end of each feeding, about 100 ml of milk remains in the breast. Infants appear to be able to self-regulate their milk requirements to grow normally, so assessment of breast milk intake is only appropriate if weight gains are unsatisfactory.