Why breastfeeding is important

Alison TaylorBournemouth University

2006

Intended Learning Outcomes

• Define breastfeeding• Discuss the benefits of

breastfeeding to the mother, infant, and society as a whole

• Describe breastmilk constituents and their function

Some definitionsBreastfeeding  The infant has received breast milk

(direct from the breast or expressed)

Exclusive breastfeeding The infant has received only breast milk from his/her mother or a wet nurse, or expressed breast milk and no other liquids, or solids with the exception of drops or syrups consisting of vitamins, mineral supplements, or medicines

Unicef 2004

Some definitionsPredominant breastfeeding – • most of the baby’s feeds are at the

breast but he also receives small amounts of water or water based drinks

Partial breastfeeding – • only some of the baby’s feeds are at the

breast and some are artificial feeds such as formula

Unicef 2004

Some definitionsBottle feeding • is giving any drink from a

bottle, including expressed breast milk or vitamin preparation

Artificial feeding• describes any feeding with

breastmilk substitutes, whether infant formula, dextrose/glucose water or any other substitutes and whether given by tube, spoon or bottle

Unicef 2004

So what are the benefits of breastfeeding?

• In groups of eight you will be asked to explore the benefits of breastfeeding from a particular angle

Reduces respiratory morbidity

Preterm less likely to develop necrotising enterocolitis in preterm infants

Protection against atopic and allergic disease

Lower risk of insulin dependent diabetes

Increased cognitive development

Lower risk factors associated with cardiovascular disease

Benefits of BREASTMILK for the baby

Less likely to be victims of SIDS

Less likely to develop childhood cancer

Protection against gastro-enteritis

Better development especially in preterm infants of brain, CNS, and sight

Improved response to immunisation

Less likely to develop UTI

Benefits of BREASTFEEDING for the baby

Reduced incidence of otitis media

Less risk of dental malocclusion

Less risk of dental caries

Possible positive effects

on clarity of speech

Bonding, where a close loving relationship occurs

Protection against breast cancer, both pre and post menopausal cancer

Protection from ovarian cancer

Higher bone mineral density, less risk of hip fracture

Delayed resumption of ovulation with increased child spacing

Benefits of BREASTFEEDING FOR THE MOTHER

Earlier return of pre-pregnant weight

Potential psychosocial effects

Reduces health care costs

Reduces employee absenteeism for care attributed to own or childhood illnessFinancial saving to the family and the nation

Benefits of BREASTFEEDING FOR THE NATION

Reduces health inequalities

Reduction in infant and maternal mortality

A more healthy and intelligent workforce

Less waste!

Anti-infective factors of breastmilk

• Breastmilk contains white blood cells and a number of anti-infective factors

• Breastmilk contains antibodies against infections that the mother has had in the past

• The mother’s body is able to manufacture antibodies against new infections with which she comes into contact with

Anti-infective factors of breastmilk

How does ‘Mum’ do this?1. She contracts an infection via respiratory or

gastrointestinal tract

2. White cells in her body become active and make antibodies against infection

3. Some of the white cells travel to her breast and make antibodies there

4. These are then secreted in her breastmilk to protect her baby

Anti-infective factors of breastmilk

• The main immunoglobulin in breastmilk is IgA (often known as ‘secretory’ – SIgA )

• For this natural protection from infection to work effectively the ‘Mum’ and baby need to stay near each other at all times

• She will then detect organisms in the baby’s environment that may harm his health

• It all helps the baby build up a store of antibodies for the future

The composition of breastmilk

• The composition of breastmilk is uniquely manufactured by the mother for her own baby.

• It can therefore vary with• The gestational age of an infant• The stage of lactation• The time of day• The amount of milk taken at each feed

Colostrum• Is present before delivery and ready when the baby is

born• Continues to be produced over next few days• Thicker than breastmilk -yellowish or clear in colour• It provides high-density, low-volume feed in the first

few days ideal for newborn• Rich in growth factors helping immature organs to

develop quickly after birth• Rich in some vitamins - Sodium, Potassium, Ash, Vitamins

A and E, Chloride, and Zinc helps to reduce the severity of infections

• Vitamin K is higher in colostrum than mature breastmilk• Lower concentrations of carbohydrate, fat (2%) and

water soluble vitamins

Colostrum

• Contains high levels of immunoglobulins• Contains high levels of proteins, especially SIgA (80-

90%). • Contains more white blood cells than mature milk• Provides baby with ‘first immunisation’ against

diseases• Contains at least two antioxidants – protective

function• Contributes to the healthy establishment of the

bifidus flora in the digestive tract.• Has a protective function - sealing the gut lining to

prevent adherence of pathogens• Mild laxative effect, clearing gut of meconium

including bilirubin

Transitional milk

• After 24-72 hours breasts usually begin to secrete breastmilk

• Constituents of colostrum are not immediately lost but diluted.

• It is called transitional milk• With an increase in lactose there is also

an increase in fluid volume• Lasts 10-14 days• Then it is called mature milk

Constituents of breastmilk

• Breastmilk is species-specific• It contains water, fat, protein,

carbohydrates, minerals and vitamins

• It also contains (but is missing in artificial formula) - hormones, enzymes, growth factors, essential fatty acids, immunological and non specific protective factors

Constituents - Fats• Principle source of energy - providing up to

50% of the calories• Fat content of colostrum 2%, 2.55% - 3% in

transitional milk and 3.5% - 4.5% in mature milk.

• 98-99% of milk fat are triglycerides• Easily absorbed – combined action of lipases,

infants own lingual and gastric lipases, and one found in human milk alone called (BSSL) bile–salt-stimulating lipase

• Lipases break down long chain fatty acids and triglycerides into free fatty acids and glycerol.

Constituents - Fats• Needed for brain development, essential part of

cell membranes, healthy blood vessels, eyes.• Cholesterol - essential for all membranes, and

essential constituent of brain tissue and myelin sheath. Little or none in AF.

• Fat levels gradually increase during a feed, turning the milk from a bluish watery appearance to creamier, whiter thicker more dense liquid – known as ‘the hind milk’

• Levels of fat also vary with frequency of feeds and over 24 hour period.

• Smoking decreases the fat content of milk

Constituents - Proteins

• Total protein in mature milk is 0.8-1.0% the lowest for all mammals and a large proportion of this are immune factors

• Whey to Casein ratio varies from 90:10 in early lactation to 60:40 in mature milk and 50:50 in late lactation.

• Casein in human milk forms soft curds, easy to digest

Constituents - Proteins• Whey proteins consist of anti-infective proteins• The anti-infective proteins include

– Lactoferrin - binds with iron, prevents growth of bacteria that need iron

– Lysozome – kills bacteria– Immunoglobulins – mostly IgA

• Breastmilk also contains a protein which can reduce or inhibit milk secretion (FIL)

• It protects the breast from the harmful effects of being too full

• If breastmilk is removed effectively, the level of FIL falls and more milk is made

Constituents - Carbohydrates

• Lactose is the main carbohydrate in milk, breaking down into glucose for approx 40% of the baby’s energy needs

• It also enhances calcium absorption• Lactase (intestinal enzyme) is needed for

digestion of lactose. • Lactase is present by 24 weeks gestation. • Anything that damages the gut lining can

cause secondary lactose intolerance • Galactose is also found in milk is used for liver

storage to meet future energy needs

Constituents - Carbohydrates

• Oligosaccharides - stimulate lactobacillus bifidus.

• Lactobacillus bifidus maintains an acid environment in the bowel, thus inhibiting the growth of harmful bacteria

• Gives breastfed babies’ stool their unique ‘yoghurty’ odour

• Also contains small amounts of gycopeptides, fructose

Constituents - vitamins

• Water soluble vitamins include B complex, C and folic acid

• Fat soluble include A,D,E,and K• The higher the fat content the

higher the proportion of fat soluble vitamins

• Vitamin A important for baby’s sight and reduces severity of infections

Constituents - Minerals

• Iron is important for the formation of blood• Breastmilk has relatively low iron content• BUT has a unique ‘bi-available’ digestive

process whereby the iron is bound within the lactoferrin molecule.

• This makes it easily absorbable AND prevents iron-seeking pathogenic bacteria (e.g. ecoli) attaching causing gut infections.

• Levels of sodium, calcium and phosphorous are considered ideal for the term baby.

• Absorption is more complete in breastfed babies

Constituents – water

• 87% - 90% of breastmilk is water• It has a low electrolyte

concentration• The baby has enough free water

even on a hot day• All components dissolved,

dispersed or suspended in the water

Hormones and growth factor

• Hormones were first detected in breastmilk in the 1930’s

• Hormones are thought to play a critical role in the neonatal adaptation to extra-uterine life.

• Growth hormones ( insulin, relaxin)/ adrenal gland hormones (Cortisol) / brain-gut hormones (Somatostatin) / gonodal hormones (oestrogen) and others such as erythropoietin and thyroid stimulating hormone are all present.

“ If multinational company developed a product that was a nutritionally balanced and delicious food, a wonder drug that both prevented and treated disease, cost almost nothing to produce and could be delivered in quantities controlled by the consumers needs, the very announcement of their find would send their shares rocketing to the top of the stock market.The scientists who developed the product would win prizes and the wealth and influences of everyone involved would increase dramatically. Women have been producing such a miraculous substance, breastmilk, since the beginning of human existence, yet they form the half of the world’s people who are the least wealthy and the least powerful.” Palmer 1993 p.19.

References

• Palmer, G. 1993. The Politics of Breastfeeding. London: Pandora

• UNICEF., 2004. Breastfeeding management – A modular course. London: Unicef

• Riordan, J., Auerbach, K.G., 1999. Breastfeeding and Human Lactation. Boston: Jones and Bartlett Publishers