Lactation and Infant Feeding Clare Mashford

Breast Development

Milk Glorious Milk Initial Milk - Colostrum  Lasting for approx 1 week  40 ml/ day  High in protein and IgA  Less water, fat and sugar  Thick yellow/ cream colour Mature Milk  Develops over the first few weeks  Decline in Igs and Protein  Increase in Fat and Sugar 90% Water; 7% Sugar (Lactose) 2% Fat; Minerals & Vitamins  Foremilk and Hindmilk  Develops as baby grows to cater for individual needs

Let Down Reflex – A Neuroendocrine Reflex NB: Prolactin is controlled by Dopamine via tonic inhibition

Cessation Two primary reasons for cessation of milk production:  Weaning onto solids  Unable to breastfeed Weaning onto solids To maintain production, accumulated milk needs to be removed regularly (via nursing or expressing) If not prolactin levels fall as does milk production. As babies are weaned onto solids demand for milk naturally reduces. Unable to BF Most women can breast feed, but some should not.  Alcohol misusers  Certain drugs – methotrexate, cyclosporine, lithium  Active TB  HIV  Breast Cancer Tx  Infant with Galactosemia If not BF, do not bind, but wear supportive bra, and use ice packs and NSAIDS to ease pain. It will pass in 7-10 days when the body produces PIF (prolactin inhibiting factor

Breast Feeding Difficulties 2 in 3 women have difficulties with BF; Breast Feeding is not easy!!!  Cracked Nipples  Mastitis  S. Aureus  Thrush  Leaky boobs – not a problem as such, but irritating and embarrassing. There are dedicated breastfeeding support groups run by hospitals to give advice and support to breastfeeding mums.

Breast Feeding Statistics  81% BF at Birth, falling to 69% at 1 week and 55% at 6 weeks  1 in 3 BF to 6 months compared to 1 in 4 in 2005  However… only 1 in 100 EBF at 6 months  Breast feeding levels highest in certain demographic groups:  Mothers in Managerial/ professional occupations  Leaving education aged over 18  Aged over 30  Living in less deprived areas  From a minority ethnic group (Chinese and Black in particular)  BF levels are lowest in Under 20’s and those in the lowest socio-economic groups.

Advantages of BF For Baby: Lower Risk of…  Infection (GI, Resp, UTI, Ear)  Necrotising enterocolitis  Allergic disease  Insulin dependent DM  SIDS  Childhood Leukaemia Likely to…  Have higher IQ For Mum:  Promotes attachment  Involution of the Uterus  Prevention of RA  Lower risk of Breast and Ovarian Ca  Lower risk of hip fractures  Aids weight loss? e/PIIS X(15) /abstract For the Country: £45 million could be saved by across the board increases in BF resulting in medical interventions necessary for both mother and child. /2014/11/12/archdischild abstract

Weaning  Not recommended before 6 months unless necessary; reduces risk of infection and allergies.  Allows for optimal development of the GI tract and certain developmental miles stones before hand to make it safer.  Able to sit up (S) and hold head up  Can bring things to mouth  Shows interest in food  Makes chewing motions  No Cow’s milk until 1 year then Full Fat Milk until 2 years  Slowly introduce potential allergens one at a time … eggs, wheat, nuts etc.  Balanced diet with plenty of Vitamins and Minerals (particularly iron and Vit D)  Food is for fun before one

Spoon Feeding  Using pureed and mashed foods fed to the child  Slowly introduce lumps and texture Baby Led  Finger food  Small portions of your adult meal (without salt etc)  Let’s them discover with all their senses Weaning

Obesity  In a recently published study 94% of parents to overweight children did not recognise them as such… they were “Just about right”  Obese child (2-19 years) defined as a child with a BMI for age percentile above 95 th  Approx 70% of toddlers regularly consume sweetened beverages  National Child monitoring programme  BMI measured in reception and year 6