l lactation hormones l nature and composition of human milk »types »nutrient composition l...
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Lactation hormones Nature and composition of
human milk» types» nutrient composition
Nutrition during lactation Breastfeeding
» advantages» incidence
Common problems» counseling» food programs
Lactation
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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 ___________
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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
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Milk in general
__________ of human milk:
______ to over ________» ________ does not hurt output» _______________ does» _______ affected before ______
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Types of Milk: Stage I = Preterm
lower in higher in high in supplement with kcal,
__________________
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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%)
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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
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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
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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?
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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
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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
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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
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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
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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
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Possible Contaminants in Human Milk
Medicines Aspirin
Penicillin/ antibiotics
Laxatives Street drugs Smoking
Substance Risks
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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 ___________
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Pesticide residues, PCBs, DDT, heavy metals
AIDS virus
Substance Risks
Possible Contaminants in Human Milk
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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
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Nutrition during Lactation
Lactation vs. pregnancy
Energy: from fat stores and from diet;
Protein:
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Nutrition during Lactation
Milk reflects mother’s intake:
Of concern for mother:
Of concern for restricted eaters:
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Advantages of Breastfeeding for
Baby
________________ Automatically ________ __________ properties ____________
» diarrhea» Type I diabetes, respiratory
diseases» celiac disease, Crohn’s disease?
risk for
Promotes better
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risk of ___________
_____ growth past 3-4 months Best fatty acids for
*__________*» hormonal “mothering”
response?» feeling of security for infant
Advantages of Breastfeeding for
Baby
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*Bonding*--emotional ties Maternal __________ Necessitates ________ Ease and ___________ Recovery from pregnancy
risk of cancer: Improved ____________ ________: personal, society,
environment
Advantages for Mother
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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
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Judging Adequacy of
Intake
Frequency of _________» _____ times/day for newborn
Frequency of ___________
Weight gain
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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
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Contraindications to Breastfeeding
Genetic diseases» _____________» PKU?
AIDS Addictions: alcohol, drugs Maternal _________ ________ diseases that
warrant mother’s isolation Need for _______ treatment;
contraindicated _________ Environment:
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Table 6-6, p. 178
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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
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% Babies Breastfed:Ever, by
State, 2007
Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey
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% Babies Breastfed:at 6 months, by State,
2007
Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey
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% Babies Breastfed:at 12 months, by
State, 2007
Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey
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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%
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Why don’t women
breastfeed?
Maternal attitude;
Lack of ___________ Lack of ___________
Correlates:» # hours worked/day:» introduction of bottle:» lower education, age,
income:
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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