Breast Feeding-physiology of Lactation,Composition of Breast Milk,Colostrum,Initiation &

8/6/2019 Breast Feeding-physiology of Lactation,Composition of Breast Milk,Colostrum,Initiation &

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Anatomy

y Milk producing glands

y Lactiferous canaliculi

y Lactiferous sinuses

y Myoepithelial tissue

yAdipose tissue


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PHYSIOLOGY OF LACTATION

y Milk is produced as a result of the interaction between

hormones and reflexes.

y Two hormones come into play during lactation.

y PROLACTIN

y OXYTOCIN


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PROLAC

TI

REFLEX(ALSO K OWN AS MILK SECRETIONREFLEX)


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PROLACTIN REFLE


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y More the baby sucks at breast, greater is the milkproduction.

y Earlier the baby is put to breast, sooner is the reflexinitiated.

y The greater the demand, more is the milk produced.


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y Feed early, frequently and completely

y

Empty both breasts at each feed

y Ensure that the baby is properly attached to the breast.

y Prolactin is produced during night


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OXYTOCIN REFLEX(ALSO CALLED IL EJECTION REFLEX)


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PROLACTIN REFLEX


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y Oxytocin is post. pituitary hormone which causescontraction of the milk from the glands into the

lactiferous sinuses and the lactiferous ducts.

y Suckling, thought, sight and sound of the babystimulation of nerve endings oxytocin secreted

contraction of glands breast milk secreted


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OXYTOCIN REFLEXHELP HINDER

THINKS LOVINGLY OF BABY WORRY

SOUND OF BABY STRESS

SIGHT OF BABY PAIN

CONFIDENCE DOUBT


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yThis stresses the importance of asupportive health professional or arelative to reassure the mother andhelp her gain confidence so that shecan successfully breastfeed her baby.


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Neonatal reflexesy Rooting Reflex

y Suckling Reflexy Drawing nipple and areola to form a elongated teat inside

mouth

y Pressing streched nipple & areola with the jaw and tongueagainst the palate

y Drawing milk from the lactiferous sinuses by wave likeperistaltic movement of the tongue on the underneath ofareola & nipple compressing against palate above.


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Neonatal reflexes

y Swallowing Reflex

y One to three suckles fill baby's mouth with milkfollowing which baby swallows and then breathe.

y Suck-swallow-breathe cycle lasts for one second


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CO POSITIONy Different at different stages after birth:-

y Colostrum

y Transitional milk

y Mature milk( Fore milk & Hind milk)

y Preterm milk


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CO POSITION :- COLOSTRUy Milk secreted during the initial 3-4 days after delivery.

y

Yellow and thick

y Containsy More minerals & Proteins

y More antibodies and cells

y Increased amounts of vitamins A, D,E and K.


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CO POSITION:- Transitionalmilk

y The milk secreted after 3-4 days and until 2 weeks.

y The immunoglobulin and protein content decrease

y The fat and sugar content increases.


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CO POSITION:- ature ilk

y Mature milk follows transitional milk.

y It is thinner and watery but contains all the nutrientsessential for optimal growth of the baby.


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CO POSITION:- ature ilky FOREMILK :- Milk secreted at the start of a feed.

y It is watery and is rich in proteins, sugar, vitamins,

minerals and water that satisfies the babys thirst.

y HINDMILK:- Milk produced at the end of feed and isricher in fat content and provides more energy, and

satisfies the babys hunger.


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CO POSITION:- ature ilky Bacterial & Viral antibodies esp IgA

y Many factors which inhibit growth of virus & bacteria

y

Macrophages which synthesize :-y Complement

y Lysozyme

y Lactoferrin (inhibitory effect on E.Coli)

y

Bile salt stimulated lipase (inhibit giardia lamblia &entamoeba histolytica.

y Breast milk is defecient in Vitamin D, K iron &flouride.


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Nutrient Content/100 ml

MacronutrientCalories

ProteinsFatLactose

67 kcal

1.1 gm3.5 gm7.0gm

MicronutrientsSodium

PotassiumCalciumPhosphorusIronZinc

0.9meq

1.4meq35mg15mg30-50 ugm120 ugm

VitaminsVitamin A Vitamin C

5.2 mg


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CONSTITUENT BREAST MILK(gms/ltr)

PROTEINS: 11

casein 04

soluble proteins 07

lactalbumin 3.5

beta-lactoglobulin 00

lactotransferrin 1-2

immunoglobulin 1-2lysozyme 0.5

Non protein nitrogenous substances: 0.32


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CO POSITION:- Preterm ilky Milk produced by mother who delivers prematurely,

contains more:-

y proteins,

y sodium,

y iron,

y immunoglobulins

y calories


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Parameter Human milk Cow milk

Bacterial contamination None Likely

Anti infective subtance Many None

Protein 1% total & 0.5 % casein 4% & 3%

Amino acid More for growing brain &retina

less

Fat 4% but more unsaturated

& essential fatty acid

4% but less EFA & more

saturated

Lipase Present Absent

Lactose 7% 4.5 %

alts (Na, , l ) orrect amount ery ig

Minerals ( a, PO4) orrect amount ery ig

Iron mall amount but wellabsorbed

mall amount but poorlyabsorbed

itamin Enoug Extra needed


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INITIATION OF BREASTFEEDING

BREASTFEEDING SHOULD BE INITIATEDAS EARLY AS POSSIBLE,WITHIN 30 MINSIN VAGINAL DELIVERY AND 4 HRS IN

CEASERIAN DELIVERY.


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POSITIONING:- OTHER

y Mother can take any position that is comfortable to

her.

y Her back should be well supported and she should notbe leaning on her baby.


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POSITION OF BABYy Babys whole body must be well supported not just

neck or shoulders.

y Babys head and body are in a line without any twist inthe neck.

y Babys body turned towards the mother with thebabys abdomen touching the mothers abdomen.

y Babys nose is at the level of the nipple.


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GOOD

POSITION


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ATTACH ENTyAfter proper positioning, the babys cheek is touched

and that will make the baby open her mouth(rootingreflex)

yAllow the baby to have a wide open mouth and thebaby should be quickly brought on to the breastensuring that the nipple and most of the areola is

within the babys mouth.

y It is important that baby is brought on the motherrather than mother leaning on to the baby.


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SIGNS OF GOODATTACH ENTy The babys mouth is wide open.

y Most of the nipple and areola in the mouth , onlyupper areola visible, not the lower one.

y The babys chin touches the breast.

y The babys lower lip is everted.


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INCORRECT SUCKING POSITIONy Mouth is not wide open

y Chin is away from the breast

y Baby is sucking only nippley Most black portion of the breast is outside the babys

mouth

y Tongue away from the teat


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y MOTHERS AT RISK FOR PROBLEMS IN BREAST

FEEDING.-Primipara mothers

-Mothers who have had problems in breastfeeding inprevious pregnancy.

-Mothers with inverted nipple , retracted nipple.

-Mother who have not been motivated to breastfeed.


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EFFECTIVE SUCKLING

y Baby suckles slowly pauses in between two swallow.

y Babys cheeks are full and not hollow or retractingduring sucking.


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Global Recommendations for Infantand

YoungChild Feedingy Exclusive breastfeeding for 6 months

y Continue breastfeeding for up to 2 years or beyond.

y Introduce nutritionally adequate and safecomplementary foods after the infant reaches 6

months of age, while continuing to breastfeed for 2years or beyond.


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What is

Exclusive Breastfeeding?y Giving an infant only breastmilk, with the

exception of drops or syrups consisting of

vitamins, mineral supplements, or drugs

y No food or drink other than

breastmilknot even water


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BREAST ILK:BENEFITSy Nutritional superiority-contains all the nutrients.

y Carbohydrates-contains lactose in high conc.(6-

7mg):- helps in absorption of calcium & enhances thegrowth of lactobacilli in the intestine.

y Proteins-low protein content as baby cannotmetabolize high protein load.

contains lactalbumin & lactoglobulin which are easilydigested.


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y Contains taurine and cysteine,necessary forneurotransmission & neuromodulation.

y Fats-rich in pufas,necessary for the myelination of thenervous system.

Contains omega 2 & omega 6important forformation of prostaglandins and cholesterol,base for

steroid hormones.


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BENEFITS OF BREAST FEEDINGTo the Mother

y Reduces post delivery bleeding and anemia

y Helps delay next pregnancy

y Protective effect against breast and

y ovarian cancer

y Helps to loose weight

Breast Feeding-physiology of Lactation,Composition of Breast Milk,Colostrum,Initiation &

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