WHYBREASTFEEDINGIS IMPORTANT

JosephineMaryViolet Msn.,R.N,R.M,IBCLC Msn R N R M IBCLC

OUTLINE
1.statetheadvantagesofbreastfeeding 2.thedangersofartificialfeeding 3.PropertiesofBreastMilk 4.BenefitsofBreastfeeding 5.HarmfulEffectsofFormulaMilk

6.WhySomeMothersChooseFormula Vs.BreastMilk 7.maindifferencesbetweenbreastmilk

andartificialmilks
8.definethetermsusedto

describeinfantfeeding;
9.describepresentlyrecommendedinfantfeedingpractices.

BENEFITSOFBREASTFEEDING BENEFITS OF BREASTFEEDING

Ecological: Savesresources Less waste Lesswaste Norefrigeration N Nomanufacturing f t i Nobottles,cans Notrucking Nohandling

BENEFITSOFBREASTFEEDING BENEFITS OF BREASTFEEDING

For Society ForSociety Smarter Healthier Lesscosttohealthcaresystem y Strongerfamilies

BENEFITSOFBREASTFEEDING BENEFITS OF BREASTFEEDING

To Families ToFamilies Lesstripsto doctors,hospitals doctors hospitals Lessprescriptions Lessstress Lessillness Morebonding Inexpensive Inexpensive

BENEFITSOFBREASTFEEDING BENEFITS OF BREASTFEEDING

Benefitstomother: Psychological(Attachment,bonding,security,skin toskin,fulfillmentofbasicneeds,relationship) Easierweightloss Decreasedriskofillness(breastcancer, osteoperosis,hemmorhage,ovariancancer) osteoperosis hemmorhage ovarian cancer) Birthcontrol Pride,empowerment,fulfillment Pride empowerment fulfillment

BENEFITSOFBREASTFEEDING BENEFITS OF BREASTFEEDING

Benefitstobaby: Betterdentalhealth Increased visual acuity Increasedvisualacuity Decreaseddurationand intensityofillnesses intensity of illnesses Lessallergies Betterhealth&lessrisk ofillnesses

2/2

Advantages of breastfeeding Advantagesofbreastfeeding

Breastmilk Breast milk
Perfectnutrients Easilydigested; Easily digested; efficientlyused Protectsagainst infection

Breastfeeding
Helpsbondingand development p Helpsdelayanew pregnancy Protectsmothers health

Costslessthanartificialfeeding C l h ifi i l f di

PhysicalPropertiesofmilk

Ithasawhiteappearanceduetothe p presenceoftheemulsifiedlipids,partlyto p ,p y thepresenceofthecalciumsaltofcasein. ThepHofmilkis6.66.8. Volume;Attheheightoflactation,the humanbreastscanproduceupto1.5litersof milk(about50fluidounces).

TypesofBreastMilk
Therearebroadlythreetypesof breastmilk:

1 Colostrum; afterbirthlastsforseveralday.
Ithasayellowishtocreamcoloredthickappearance. It has a yellowish to cream colored thick appearance Itishighinproteinespeciallyantibodies(thatprovideprotectiontothenewborn againstinfection),vitamines(especiallyfatsolublevitamines),mineralsbutverylowin fatcomparedtomaturebreastmilk. 2

Transitionalmilk;

It occursaftercolostrum stageandlastsforapproximatelytwoweeksuntilitis replacedbymaturemilk. Thetransitionalmilkcontainshighlevelsoffat,lactose,andvitaminstohelpthebaby regainanyweightlostafterbirth. Itcontainsmorefatandlactosethancolostrum andhaswatersolublevitamins. 3 Maturemilk; Itisthefinalmilkthatisproducedandlaststhroughout 3 Mature milk ; It is the final milk that is produced and lasts throughout lactation. Ninetypercentiswater,whichisnecessarytomaintainhydrationoftheinfant.Theother 10%ismadeupofcarbohydrates,proteins,andfats,whicharenecessaryforboth growthandenergy. th d Therearetwotypesofmaturemilk:foremilkandhindmilk.

TypesofMatureBreastMilk

Duringeachbreastfeedingsession,thebaby shouldreceivetwotypesofmaturemilk,the foremilkandthehindmilk t f ilk d th hi d ilk toensurethatthe th t th babyisreceivingadequatenutritiontogrow anddevelopproperly. and develop properly Theforemilk(themilk"infront");isproducedat thebeginningofeachfeeding.Itcontains the beginning of each feeding It contains water,vitamins,andprotein. Thehindmilk ;ispushedoutlatter,itisheavier The hindmilk ; is pushed out latter it is heavier ,richerinlipidandCHO.

BreastMilkat3,7,25and84days post partum postpartum

Theamountofallofthesesubstances(exceptlactose)varieswith:the Th f ll f h b ( l ) i ih h timeofdayofthebreastmilkproduction,thewomanproducingthe breastmilk, betweentheleftandrightbreast,among thebreastlobes,and whetheritisatthebeginningortheendofthefeeding.

CompositionofMatureMilk

2/3

Nutrientsinhumanandanimalmilks Nutrients in human and animal milks

Human
Fat F t Protein

Cow

Goat

Lactose

BREASTMILK carbohydrate BREAST MILK carbohydrate

Carbohydrates(lactose=milksugar Ca bo yd ates ( actose suga predominantlyinhumanmilk,7% concentrationprovidesupto40%caloric needs,essentialfordevelopmentofCNS, d lf d l f enhancescalcium&ironabsorption) Carbohydrates(Bifidus f t Carbohydrates(Bifidus C b h d t (Bifid factor=growthfactor (Bifid th f t presentonlyinhumanmilkrequiredfor establishinganacidicenvironmentinthegut establishing an acidic environment in the gut toinhibitgrowthofbacteria,fungiand parasites)

Protein Lactoferin =>Isolatesexternaliron Secretory IGA=>Mostimportantimmunoglobulin,breastmilk=onlysourceforfirst6 weeks

Differencesinthequalityofproteinsin differentmilks different milks

Humanmilk
Wheyprotein

Cowsmilk

Curds
Easytodigest Difficulttodigest

Proteins in Mature Milk

Proteinsaccountforapproximately75%ofthenitrogencontaining compoundsinbreastmilk Casein (2.7%)ofmilk. Itisthemain proteininmaturehumanmilk. Caseinorcurdsareproteinswithlowsolubilityandarenegatively p y g y charged. Itcomplexeswithcalciumthuspromotingitsabsorption.

Thesearepresentinbreastmilkinmuchlower p concentrationthanincow'smilk.
Whey(0 6%) of milk Whey(0.6%)ofmilk. wheyproteinsarelocatedintheclearliquidleftbehindwhen clottedmilkstands.Thelargestcomponentsarealphalactalbumen, lactoferrin,lyzozyme,albumenandimmunoglobulins.

Protein Composition: Cows Milk vs. Human Milk

Alphaproteinis: Themajorwheyproteininbreastmilk Suppliesthebuildingblocksforprotein thatsupportbaby'sgrowth Easy to digest Associated with less EasytodigestAssociatedwithless stomachupset Arichsourceoftryptophan,anutrient implicatedinsleepregulation implicated in sleep regulation Associatedwithenhancedmineral absorption,suchascalciumandzinc Associatedwiththegrowthoffriendly g y bacteriainthegutandmayhelpto protectagainstinfectionfromharmful bacteria

Differencesinthefatsofdifferent milks. lk
Humanmilkcontainsessentialfattyacidsthatarenotpresentin cow'smilkorformula.Theseessentialfattyacidsareneededfora ' ilk f l Th ti l f tt id d df baby'sgrowingbrainandeyes,andforhealthybloodvessels. Human milk also contains an enzyme lipase which helps to digest Humanmilkalsocontainsanenzymelipasewhichhelpstodigest fat.Thisenzymeisnotpresentinanimalmilksorformula. Sothefatinbreastmilk ismorecompletelydigestedandmore efficientlyusedbyababy sbodythanthefatincow smilkor efficiently used by a baby's body than the fat in cow's milk or formula. Thefaeces ofanartificiallyfedbabyaredifferentfromthoseofa breastfedbaby.Thisispartlybecauseanartificiallyfedbaby's faeces containmoreunusedfood. f i df d

BREASTMILK fats BREAST MILKfats

Fat(4%concentrationprovides upto50%ofcaloricneeds, cholesterollevelsconstant, lipolytic enzymesaidinfat digestion) Biologic specificity => Longchain Biologicspecificity=>Long Biologicspecificity=>Long chain omega omega3FattyAcids(DHAand AA) I Importantforbrainandretinal f b i d i l development HigherIQs

Vitaminsinmaturemilk
Fat soluble vitamin A, D E & K , Water soluble vitamins in general are present ,their content reflective of the mothers diet .

Low vitamine B12

is seen in women who are vegetarians, malnourished or have had gastric bypass .

Minerals ; The most important salts are calcium,

sodium,potassiumandmagnesium,calcium di i d i l i representingthepredominatingmineral.

Vit D VitD
VitaminDisafatsolublevitaminnecessaryforbone y development. ThevitaminDcontentofbreastmilk islessthanthatof vitaminDfortifiedmilkandvitaminDfortifiedformula. it i D f tifi d ilk d it i D f tifi d f l Abreastfeedingwomanmayproducemilkwithvery littlevitaminDifsheisnotexposedtosunlight,drinks little vitamin D if she is not exposed to sunlight, drinks littlemilk(themajordietarysourceofvitaminD),and isnotcontinuingtotakeprenatalvitamins. InfantswhodonotgetenoughvitaminDintheirdiet candeveloprickets. can develop rickets

Enzymesinmaturemilk
Humanmilkcontainsvariousenzymes; Somearespecificforthebiosynthesisofmilkinthemammary p y y gland(eg,lactosesynthetase,fattyacidsynthetase,

thioesterase),
Othersarespecificforthedigestionofproteins,fats,and carbohydratesthatfacilitatetheinfant'sabilitytobreakdownfood andtoabsorbhumanmilk(suchaslipase,andprotease, and to absorb human milk (such as lipase, and protease, amylase)

Certain enzymes also serve as transport moieties for other Certainenzymesalsoserveastransportmoietiesforother substances,suchaszinc,selenium,andmagnesium. Somehaveantimicrobialactivitysuchaslysozyme.

ironinbreastmilk&differentmilks
Ironisimportanttopreventanaemia.Differentmilks containsimilarverysmallamountsofiron(5070g/100 ml,i.e.0.50.7mg/l). Onlyabout10%oftheironin ml i e 0 5 0 7 mg/l) Only about 10% of the iron in cow'smilkisabsorbed,butabout50%oftheironfrom breastmilk isabsorbed. Iron isnecessaryforhemoglobinformation.Ironin breastmilkispresentinlowamountsbutthe percentageofironabsorbedisveryhigh. Infants older than 6 months of age need another Infantsolderthan6monthsofageneedanother sourceofironbesidesbreastmilk intheirdietsuchas meats,ironfortifiedcereals,orgreenvegetables

Theimmunologiccomponentsofmaturemilk
Whileawaitingendogenousmaturationofthebaby'sownimmunologicsystems,various immunologicandbioactivemilkcomponentsactsynergisticallytoprovideapassive

immunologicsupportsystemfromthemothertoherinfantinthefirstdaysto monthsafterbirth.
Theimmunologiccomponentsinclude;

Immunoglobulins ; Humanmilkcontainsallofthedifferent antibodies(M,A,D,G,E),butsecretory immunoglobulinA(sIgA) ( ) y g ( g ) isthemostabundant. lactoferrin,;whichbindstoiron,thusmakingitunavailableto pathogenicbacteria; lysozyme ,whichenhancessIgA bactericidalactivityagainstgram negativeorganisms; Mucins adhere to bacteria and viruses and help eliminate them adheretobacteriaandvirusesandhelpeliminatethem fromthebody. Leukocytes;withthetransitionfromcolostrum tomaturemilk, thepercentageofmacrophagesincreasesfrom40 60%ofthe the percentage of macrophages increases from 4060% of the cellsto8090%.

VARIATIONSINTHECOMPOSITIONOF BREASTMILK

2/7

Colostrum
Property
Antibodyrich Many white cells Manywhitecells Purgative Growthfactors RichinVitaminA

Importance
protectsagainstallergy&infection protects against infection protectsagainstinfection clearsmeconium helps to prevent jaundice helpstopreventjaundice helpsintestinetomature preventsallergy,intolerance p gy, reducesseverityofinfection

Differencesbetweencolostrum and Differencesbetweencolostrum maturemilk lk

Foremilk Hindmilk

2/6

Fat Protein

Lactose

Colostrum

Maturemilk

CompositionofMatureMilk

Whenamotherbecomesinfected When a mother becomes infected (1),whitecellsinherbodybecomeactive,and makeantibodiesagainsttheinfectionto make antibodies against the infection to protecther. (2).Someofthesewhitecellsgotoherbreasts andmakeantibodies d k ib di (3)whicharesecretedinherbreastmilk to protectherbaby protect her baby

PROTECTIONAGAINSTINFECTION

PROTECTIONAGAINSTDIARRHOEA PROTECTION AGAINST DIARRHOEA

2/8

Riskofdiarrhoea Riskofdiarrhoea byfeedingmethod

Philippines,infantsaged02months
20 18 16 14 12 10 8 6 4 2 0

17.3 13.3 13 3

3.2 1
Breast milk only Breast milk and non-nutritious liquids Breast milk and nutritious supplements No breast milk

Source:Popkin BM.Breastfeedinganddiarrhealmorbidity.Pediatrics 1990;86:87482.

Protectionagainstrespiratoryinfection Protection against respiratory infection

Pneumonia/lower Pneumonia/lower respiratorytract infection1.7to5times Respiratorysyncytial virusinfection3.9 times Sepsis2.1times Suddeninfantdeath syndrome2.0times Industrializedworld hospitalization3times

www.mamashealth.com/ images/lungs1.gif

IllnessRelativerisk
Allergies,eczema2to7times g , Urinarytractinfections2.6to5.5 times Inflammatory bowel disease 1 5 to 1 9 Inflammatoryboweldisease1.5to1.9 times Diabetes,type12.4times Gastroenteritis3times Hodgkin'slymphoma1.8to6.7times Otitis media 2 4 times media2.4times Haemophilus influenzae meningitis3.8 times Necrotizingenterocolitis 6to10times www.geocities.com/.../ Canopy/4116/stalk.gif

IMMUNOLOGICSPECIFICITY IMMUNOLOGIC SPECIFICITY

Protection against pathogens & allergens Protectionagainstpathogens&allergens Killspathogenicorganismsormodifies theirgrowth their growth Stimulatesepithelialmaturationfor futuredefence f d f Firstimmunization Protectionagainstcommonrespiratory andintestinaldiseases

IMMUNOLOGICSPECIFICITY IMMUNOLOGIC SPECIFICITY

Colostrum = Babys first vaccination =Baby sfirstvaccination Lessriskofillnesssuchas: Earinfections,pneumonia,crohns di i f i i h disease andotherbowelillnesses,stomachfluand otherintestinalillnesses,earinfections, h i i l ill i f i childhoodcancers,diabetes,arthritis, allergies,asthmaandeczema ll i h d

2/9

Psychologicalbenefitsofbreastfeeding Psychological benefits of breastfeeding

Emotionalbonding
close,lovingrelationshipbetweenmotherandbaby mothermoreemotionallysatisfied babycriesless babymaybemoreemotionallysecure

Development p
childrenperformbetteronintelligencetests

HISTORY
Artificialfeedingbecomesreadily availableatturnofcentury By 1940s control of birth & By1940 scontrolofbirth& feedingsgiventodoctors By 1970 historical low in By1970,historicallowin breastfeedingratesinwestern world Ratespeakin1980s Durationratesstillgenerallylow

Whysomemotherschooseformulavs. breastmilk b ilk

Distressedbyphysicaldiscomfortofearlybreastfeeding problems. problems Convenienceissues Pressuresofemployment/school Worriesthatbreastshapewillchange Formulamanufacturersmanipulatepeoplethroughtheirads Doctorsandnursesneedmorelactationtraining

www.hasslefreeclipart.com/. ../baby_crying.gif

Whysomemotherschooseformulavs. breastmilk b ilk

Momsgivenverylittletimetoadjusttochangesofpostpartum Familydemands Nonsupportivefamily/healthprofessionals E b Embarrassment t Lackofconfidenceinself Feelingthatonecannotproduceenoughmilk

www.dreamstime.com/ thumb_27/11304631444pJ47D.jpg

Mother smilkvs.formulamilk Mothers milk vs. formula milk

Formulamilkfor3daysold babiesisnodifferentthan formulamilkfor3monthsold infants.

store.enfamil.com/ media/pr_prosobee_lipil.jpg

Breastmilkisingeniously differenteverysingleday; adaptedtothechangingneeds adapted to the changing needs ofthebaby.

breastfeeding.8k.com/ Resources/breastfeeding.jpeg

2/10

Disadvantagesofartificialfeeding Disadvantages of artificial feeding

Interfereswithbonding p Morediarrhoea andpersistentdiarrhoea Morefrequentrespiratoryinfections y Malnutrition;VitaminAdeficiency Moreallergyandmilkintolerance Increasedriskofsomechronicdiseases Obesity Lowerscoresonintelligencetests Mothermaybecomepregnantsooner Increasedriskofanaemia,ovariancancer,andbreast cancerinmother i h

Mother smilkvs.formulamilk Mothers milk vs. formula milk

Humanmilkisdesigned tosupportthe developmentoflarge brains,capableof b i bl f processingandstoring lotsofinformation.

www.babymall.com.au/ images/readingroomcartoon.gif

Cowsmilkisdesignedto supportfunctions,like constantgrazing. constant grazing

myxo.css.msu.edu/danimal/ quiz/cow_picture.png

HARMFULEFFECTSOFFORMULA MILK

26/2

TheInternationalCode The International Code

1981 World Health Assembly adopted The Code 1981WorldHealthAssemblyadoptedTheCode, whichaimstoregulatepromotionandsaleofformula The Code is a code of marketing TheCodeisacodeofmarketing TheCodecoversallbreastmilksubstitutes including infantformula,othermilksorfoods,includingwater , , g andteasandcerealfoodswhicharemarketedfor infantsunder6months,andteatsandbottles

26/3

Donatedsupplies Donated supplies

Wheredonatedsuppliesofinfantformula Where donated supplies of infant formula aredistributedtheinstitutionor organizationshouldtakestepstoensurethe organization should take steps to ensure the suppliescanbecontinuedaslongasthe infantsconcernedneedthem infants concerned need them

2/11

Breast milk in second year of life Breastmilkinsecondyearoflife

100%

P Percentage eofdailyneeds

Gap

75% 50% 25% 0% Energy Protein Iron VitaminA

Providedby 550mlbreast milk

Nutrient

TERMSFORINFANTFEEDING TERMS FOR INFANT FEEDING

Baby1isexclusively breastfed. f
Exclusive breastfeeding: Exclusivebreastfeeding:
Exclusive breastfeeding means Exclusivebreastfeedingmeans givingababynootherfoodor drink,includingnowater,in drink including no water in additiontobreastfeeding ( (exceptmedicinesandvitamin p ormineraldrops;expressed breastmilk isalsopermitted).

Baby2ispredominantlybreastfed.He isbreastfeeding,butthereisalsoa is breastfeeding but there is also a smallcuponthetablewithsome waterinit.

Predominant breastfeeding: Predominantbreastfeeding:
Predominantbreastfeedingmeans breastfeedingababy,butalsogivingsmall amountsofwaterorwaterbaseddrinks such astea.

BothBaby1andBaby2arefully breastfed. Full breastfeeding: Fullbreastfeeding:

Fullbreastfeedingmeansbreastfeedingeither exclusivelyorpredominantly.

Baby3isbottlefed. Bottle feeding: Bottlefeeding:

Bottlefeedingmeansfeedingababyfroma bottle,whateverisinthebottle,including expressedbreastmilk.

Baby3isalsoartificiallyfed.
The terms "bottle fed"and"artificially fed"are Theterms bottlefed and artificiallyfed are bothnecessary,becauseababymaybefed breastmilk from a bottle, or artificial feeds fromabottle,orartificialfeeds withoutabottle,forexamplefromacup.

Artificial feeding: Artificialfeeding:

Artificialfeedingmeansfeedingababyon artificialfeeds,andnotbreastfeeding artificial feeds and not breastfeeding atall.

Baby4isbreastfeeding,buthis motheralsohasabottleofan mother also has a bottle of an artificialfeedforhim.Heis partiallybreastfed. f Partialbreastfeeding:

Partialbreastfeedingmeansgivingababy somebreastfeeds,andsomeartificial some breastfeeds, and some artificial feeds,either milkorcereal,orotherfood.

Baby5ismorethan46monthsold,andhis motherisgivinghimsomefoodinabowlin additiontobreastfeedinghim.Thisistimely complementaryfeeding.

Timelycomplementaryfeeding:
Timely complementary feeding means giving a Timelycomplementaryfeedingmeansgivinga babyotherfoodinadditionto breastfeeding,when itisappropriate,from breastfeeding when it is appropriate from about6monthsofage.

RECOMMENDATIONS
START BREASTFEED WITHIN HALF ONE STARTBREASTFEEDWITHINHALFONE HOUR Exclusivebreastfeedinguntil6months ofage Introducecomplimentaryfoodswith continuedbreastfeeding continued breastfeeding Optimumtobreastfeedfor2yearsor longer

BarrierstoBonding Barriers to Bonding

*ABottleplacesaphysicalbarrier betweenmomandbaby Lessskintoskincontact *Less skin to skin contact *Lesseyecontact *Thehormonalconnection betweenthebreastfeeding motherandbabycannotbe th db b tb experiencedbythebottle feedingmother

www.photohome.com/.../ mom-and-baby-1a.jpg

THEEND THE END

Thereisnofreedomofchoiceforhumans There is no freedom of choice for humans ifithasbeentakenaway fromthem atthebeginning. Breastfeedingisnotachoice, butanobligationtothechoice, Giveyourchildthefreedomofchoice. Give your child the freedom of choice
www.13.waisays.com/ image006.jpg

AdditionalResources Additional Resources

La Leche League LaLeche WorldHealth Organization CommunityHealth Nurses Lactation Consultants PublicHealth AgencyofCanada

References
Mohrbacher,Nancy,andStock,Julie.TheBreastfeedingAnswerBook,3rd Edition.Illinois:LaLeche Edition Illinois: La Leche Leage International 2003 International,2003. TheBreastfeedingCommitteeforCanada.TheBabyFriendlyIniative in CommunityHealthServices:aCanadianImplementationGuide.BCC, 2002. WorldHealthOrganization.EvidencefortheTenStepstoSuccessful World Health Organization Evidence for the Ten Steps to Successful Breastfeeding.Geneva:WHO,1998. ClassNotes GoogleImages http://www.fda.gov/FDAC/features/895_brstfeed.html http //www fda gov/FDAC/features/895 brstfeed html http://medicalreporter.health.org/tmr0297/breastfeed0297.html http://www.mamadearest.ca/en/info/benefits_breastfeeding.htm http://www.lambtonhealth.on.ca/infant/benefits.asp p p http://www.babyfriendly.org.uk/health.asp http://www.phacaspc.gc.ca/rhsssg/factshts/brstfd_e.html http://www.caaws.ca/mothersinmotion/baby/feeding_benefits_e.html