Lactation hormones Nature and composition of

human milk» types» nutrient composition

Nutrition during lactation Breastfeeding

» advantages» incidence

Common problems» counseling» food programs

Lactation

Hormones of Lactation

________ from anterior pituitary» stimulates» inhibits

________ from posterior pituitary» is stimulated by __________» stimulates contraction of

myoepithelial cells» promotes

Let-down is also influenced by mother’s ________ and ___________

Milk in general

Composition of milk depends on ____________

Human milk is relatively __________ and low in ________________ so…» “assumes” that infants will

_____________» need ________ feeding » have __________ of growth

Milk in general

__________ of human milk:

______ to over ________» ________ does not hurt output» _______________ does» _______ affected before ______

Types of Milk: Stage I = Preterm

lower in higher in high in supplement with kcal,

__________________

Types of Milk: Stage II

___________: 0 to 3-6 days

» yellowish» high carotene, vitamin A,

electrolytes» high ______ (2%), which is full of

» low ______ (67/dl), ________

Transitional: _________ days

» shift in CHO, fat, protein (1.5%)

Term Milk: 10 days to weaning

kcal: ____/dl

protein: ___% (.8 to .9 g/dl)

carbohydrate: ~__%

lipids: slow increase from _____%» 90% triglycerides» carnitine» lipases» high in _____________

____milk differs from ____milk

Fatty Acids in Human Milk

______ in linoleic acid (ω-6), linolenic acid (ω-3)

____ in AA (ω-6), __________ (ω-3 fatty acids)» AA needed for growth» DHA incorporated into

______________________» structural integrity of the retina» early visual responses and

visual _________» neural membranes

and flexible synapses

lack associated with ___________ in young children

Protein in Term Human Milk

caseins whey

» ___________ , ___________ ________, hormones high in __________ ideal ________ content

» low in methionine, high in cystine

» low in phenylalanine and tyrosine

» rich in taurine– bile acid formation/digestion– brain development?

CHO in Term Human Milk

NOT reflective of mother’s diet

high in» provides» stimulates “good” bacteria» inhibits “bad” bacteria» helps ____ absorption

other CHO:» glucose, galactose,

oligosaccharides

Vitamins in Human Milk

________-soluble vitamins:» good source of _________» relatively high in _________» low in ________; supplement if

low sun exposure» give shots of ________ at birth

________-soluble vitamins: generally reflective of mother’s intake (to a plateau point)» infant acts as parasite for

_______» vitamin B6 reflects mother’s

status, but is still _____» _________ is concern for

vegetarian mothers

Minerals in Human Milk

high in ___________ low in F from water or

supplements Iodine deficiencies known

____ absorption is __% (vs. __% from cow’s milk and ___% from formula)» infant has sufficient stores for

___ months ____ bioavailability is __%

vs. __% from cow’s milk or from formula

Resistance Factors

in Human Milk

Bifidus factor: polysaccharide that encourages growth of Lactobacillus bifidus

Immunoglobulins: provide resistance against GI tract infections, etc.

Lysozyme: ____________ enzyme

B-12 binding protein: makes V. B12 unavailable to bacteria

Lactoferrin: ____-binding protein

Lactoperoxidase: protection against streptococci

Prostaglandins: hormone-like __________; protect integrity of GI tract

Complement: immune system proteins

Lymphocytes: synthesize IgA Macrophages: immune cells

that engulf bacteria

Resistance Factors

in Human Milk

Possible Contaminants in Human Milk

Medicines Aspirin

Penicillin/ antibiotics

Laxatives Street drugs Smoking

Substance Risks

Minimizing medicine exposure

____% of maternal dose will enter milk (less will be absorbed by infant)

Strategies include:» use _______ forms» schedule to minimize

transfer to milk» use form less likely to be

» watch for ___________

Pesticide residues, PCBs, DDT, heavy metals

AIDS virus

Substance Risks

Possible Contaminants in Human Milk

Caffeine

Alcohol

Substance Risks

Possible Contaminants in Human Milk

These are found in human milk in amounts similar to amounts

in the mother’s blood

Nutrition during Lactation

Lactation vs. pregnancy

Energy: from fat stores and from diet;

Protein:

Nutrition during Lactation

Milk reflects mother’s intake:

Of concern for mother:

Of concern for restricted eaters:

Advantages of Breastfeeding for

Baby

________________ Automatically ________ __________ properties ____________

» diarrhea» Type I diabetes, respiratory

diseases» celiac disease, Crohn’s disease?

risk for

Promotes better

risk of ___________

_____ growth past 3-4 months Best fatty acids for

*__________*» hormonal “mothering”

response?» feeling of security for infant

Advantages of Breastfeeding for

Baby

*Bonding*--emotional ties Maternal __________ Necessitates ________ Ease and ___________ Recovery from pregnancy

risk of cancer: Improved ____________ ________: personal, society,

environment

Advantages for Mother

The Decision to Breastfeed: Concerns

Sufficient __________» breast size does not matter» weight gain: growth chart

________ of milk

Schedule: Pain: nipple soreness

– feed on demand– avoid soap, alcohol- and

petroleum-based creams– vary feeding position– don’t allow baby to suck after

feeding– air dry as much as possible

Judging Adequacy of

Intake

Frequency of _________» _____ times/day for newborn

Frequency of ___________

Weight gain

Engorgement; leaking Poor let-down: Clogged milk ducts: Illness: colds, flu, mastitis...

Necessary separations

» safe storage of milk– refrigerator ________– freezer _________– don’t heat by microwave!

The Decision to Breastfeed: Concerns

Contraindications to Breastfeeding

Genetic diseases» _____________» PKU?

AIDS Addictions: alcohol, drugs Maternal _________ ________ diseases that

warrant mother’s isolation Need for _______ treatment;

contraindicated _________ Environment:

Table 6-6, p. 178

Recommendations

for Breastfeeding

AAP, APHA, ADA recommend:

National Health Objectives:» increase to___% the women who

_________ and to ___% those who continue to _________

____ considers breastfeeding promotion a goal

____ is actively promoting

% Babies Breastfed:Ever, by

State, 2007

Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey

% Babies Breastfed:at 6 months, by State,

2007

Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey

% Babies Breastfed:at 12 months, by

State, 2007

Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey

Incidence of Breastfeeding

(CDC, 2003)

Newborn 6 Mos.

Ethnic groupsTotal 71% 32%

White79% 44%

Black 55% 24%

Asian72% 38%

RegionalOregon 88% 54%

Indiana 61% 28%72% 38%

Maternal Marital Status

Married 77% 42%Unmarried 58% 23%

New Jersey

Louisiana 46% 16%

Why don’t women

breastfeed?

Maternal attitude;

Lack of ___________ Lack of ___________

Correlates:» # hours worked/day:» introduction of bottle:» lower education, age,

income:

Incidence of Breastfeeding (CDC,

2007)

TotalEthnic groups

WhiteBlack

Asian/Pacific Isl.

Maternal Marital Status

MarriedUnmarried

Regional

Utah

IndianaNew Jersey

Mississippi

Newborn 6 Mos.

43%

83% 56%

60% 28%78% 45%

90% 58%

70.5% 37.8%72% 42%

82% 52%61% 25.5%

52.5% 22.5%

75%

http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm accessed 2/20/11