San Jose State University



Chapter 6, p. 207-208 & AND Position Paper? LactationKey Nutrition ConceptsHuman milk is the best food for newborn infants.Breastfeeding in beneficial for baby, mother & societyAdequate milk supply is monitored by infant growth and # of soiled diapers/d.When maternal diet is inadequate, the quality of the milk is preserved, maybe not the quantity.Infants may need additional vits K & D and fluoride & ironHealth care policies, societal attitudes, family support and work environment affect BF rates.Hormonal Control of LactationProlactinStimulates milk production Released in response to suckling, stress, sleep & sexual intercourseOxytocinStimulates letdown (release)Tingling of the breast from contractions in milk ductCauses uterus to contract, seal blood vessels & shrink in sizeHuman Milk CompositionHuman milk is the only food needed by most infants for ~ 6 monthsProvides nutritionImmune protectionProtection from chronic DzThe composition changes over a single feeding, over a day, based on age of the infant and infant needsColostrumMilk secreted during the first few days postpartumVery high in proteins such as secretory IgA & lactoferrinFrom Table 6.2 Compositions of 100 mL colostrum (days 1-5 postpartum) and mature milk (day 15 postpartum)Water and Energy in Human MilkWaterMajor component in human milkIsotonic with maternal plasmaEnergy~ 0.65 kcal/mL (~ 22 kcals/oz) but varies with fat, protein and carbohydrate compositionMore calories than human milk substitute (HMS) and cow’s milkMature milk??Foremilk & HindmilkFirst milk during a feedingWatery for hydrationLow lipid contentSome CHOMore rich in lipid for energyHigher CHOLipids in Human MilkLipids—provides ~40-80% of kcals depending on duration of feedingFA profile reflects maternal dietDHAEssential for retinal developmentMay be associated with higher IQ scoresCholesterolHigher in human milk than HMSEarly consumption of cholesterol through breast milk may be related to lower blood cholesterol levels later in life (previous edition) Proteins in Human MilkTotal proteinsLower than in whole cow’s milk (0.32 vs. 0.98 g/oz)Have antiviral & antimicrobial effectsAffected most by age of infantCaseinMain protein in mature human milkPromotes calcium absorptionWheyLiquid – immunoglobulins, lactoferrin for Fe- absorptionNon-protein nitrogenUsed to make non-essential amino acids & hormonesMilk Carbohydrates LactoseEnhances calcium absorptionOligosaccharides = medium length poly Second most abundant CHOPrevent binding of pathogenic microorganisms to gut, which prevents infection & diarrheaVitamins & Minerals of concernVitamin A, D, E & KWater soluble vits in generalContent reflective of mother’s dietVitamin B12 and folateLow B12 seen in women who:are vegans or malnourishedhave had gastric bypass Minerals: concentration related to age of babycontribute to osmolalityMost have high bioavailabilityVery low risk of anemia despite low iron content of human milkBenefits for MomHormonal benefitsOxytocin stimulates uterus to contractPhysical benefitsMay delay monthly ovulationLower rates of breast & ovarian CA and rheumatoid arthritisMay speed fat and wt lossPsychosocial benefitsIncreased self-confidenceBonding with infantCheapFewer sick-baby daysBenefits for InfantsNutritional benefits: dynamic, matches needsImmunological benefitsLower infant mortalityReduces SIDSReduction in acute & chronic illnessesCognitive benefitsBenefits to SocietyDecreased need for medical careRenewable resourceNo pollutionSpacing kids outGood for mom & babyThe Breastfeeding InfantSupply will = demandMilk synthesis is related to:Degree of emptyingBreast size does not dictate production, only storage.Optimal duration of breastfeedingAAP & AND 1 year or longerU.S. Surgeon General exclusively for 6 months & best to breastfeed for 12 monthsReflexes & CuesGag reflex—prevents infant from taking things into lungsOral search reflex—infant opens mouth wide when close to breast & thrusts tongue forwardRooting reflex—infant turns to side when stimulated on that sideIdentifying hunger and satiety cuesInfant bringing hands to mouth, sucking on them & moving head from side to side (rooting) = hungerCrying = late sign of hungerAllow infant to nurse on one breast as long as he/she wants to ensure hindmilk for satietyInfant Recommendations?AAPTooth decaySee dentist by 12 mosVitamin suppsVit K @ birth400 IU/d vit D starting @ 2 mos600 IU vit D @ 1 yrFluoride after 6 mos, prn. Mom supplements diet.Fe- dependingMaternal DietMyPlate for pregnant and breastfeeding womenDietary GuidelinesModerate weight reduction can be achieved without compromising the weight gain of the infantAppropriate balance of nutrients at specified calorie levels for each stage of breastfeeding Energy Balance during LactationE cost: 500 kcal/day for the 1st 6 months & 400 kcal/d afterwardDRI: possibly +330-400 kcal/d for -0.8 lb/mo weight loss but highly individualizedProtein-calorie malnutrition results in reduction in volumeWeight loss during breastfeedingMost women do not reach prepregnancy weight by 1 year after birthModest or short-term energy reductions do not decrease milk productionExercising and BreastfeedingModest energy restriction + increased activity may = weight & body fatExercise does not inhibit milk production or infant growthAerobic activity enhances maternal fatty acid mobilization differently than during calorie restrictionOther Factors of Maternal DietVitamin and mineral supplementsNot needed for those eating a balanced dietFluidsWomen should drink to keep urine paleVegans: B12 Of concern: kcals, protein, Ca, vit D, Fe, ZnComponents of maternal diet may be linked to colic.Culprit foods: cow’s milk, eggs, peanuts, tree nuts, wheat, soy, fish, cruciferous vegetables & chocolate Breastfeeding Goals for the United StatesWho shouldn’t BFBabies with galactosemiaIllicit drug useTBHIV/AIDSBreastfeeding ?Promoters BarriersSupport provided by health care systemPrenatal breastfeeding educationLactation support in hospitals and birthing centersLactation support after dischargeThe work placeThe communityLactation problemsEmbarrassmentTime & social constraintsLack of support from family & friendsLack of confidenceEmployment & child careConcerns about diet & healthFear of painLack of BF knowledge ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download