1. Breast Milk Composition Carbohydrate – Lactose is primary CHO in milk higher in breast milk vs cow’s milk Protein –casein:lactalbumin (whey) impt. Human milk (40:60) cows milk (80:20) –Amino Acids (Breast milk low in phenylalanine and methionine but high in taurine and cystine

2. Breast Milk Composition (cont.) Protein (cont.) –Total protein 0.7 - 0.9 g/100 ml breast milk vs 3.5g/ 100 ml in cow’s milk Fats –higher in breast milk overall. Specifically in breast milk has more: cholesterol (CNS myelin sheaths; enzymes) linoleic acid (essential fatty acid) carnitine (impt. for fat metabolism) lipases (enzyme for digestion of fats)

3. Breast Milk Composition (cont.) Minerals –Generally lower in breast milk 6x more P; 4x more Ca and 3x more total ash in cow’s milk (higher renal solute load than breast milk). However, bioavailability of some minerals higher in breast milk [e.g. Fe (5x higher absorption than cow’s milk), Zinc] Fe is however low in milk and infant needs alternative source after 6 months

4. Breast Milk Composition (cont.) Vitamins –variable in breast milk depending on diet and drug use –Vitamin E higher in breast milk than cow’s milk and Vitamin K low in both –RDA for most vitamins greater during lactation than pregnancy except Vit. D & B12 (same); & B6 & Folate (lower)

5. Breast Milk Composition (cont.) Anti-Infectious Factors –Bifidus factor, lactobifidus, kills enteropathogenic organisms by the production of lactic and acetic acids –IgA, IgM, IgE, IgD, IgG - bacteria & virus –Lactoferrin (binds iron which bacteria need) –Lysozyme & Lactoperoxidase (bacteria) –Interferon (inhibits viral replication)

6. Types of Formulas Home Prepared - evaporated milk –heat, dilute 13 oz can with 18 oz water, add source of kcal e.g. corn syrup, add vitamin C and D (1:2 milk:water) Commercial (powder or ready mixed) –cow’s milk based –Soy based –special modified Three major producers - Ross, Mead Johnson & Nestle

7. Lactation (The Baby) Benefits –Nutritionally superior –Bacteriologically safe –Anti-infectious agents (Bifidus factor, lactobifidus (GIT infection); lactoferrin (iron absorption), immunoglobulins –least allergenic –SIDS reduced –protects against some chronic diseases e.g. obesity –good jaw and tooth development

8. Lactation (The Baby) Basic Nutritional Principles for feeding infants –overall goal to produce well- not over-nourished baby using pleasurable realistic strategy for diet which is Diet adequate, but not excessive Conducive to sound eating habit dev. Readily digestible Have reasonable distribution of calories from C,P, F Considered within total ecological context

9. Lactation (The Baby - cont.) Problems (Poor intake) –poor suck –infrequent feeds – craniofacial abnormalities –parental problems new nervous parent physician lack of nutritional info. Extensive somewhat confusing published info. Conflicting sources of info.

10. Lactation (The Baby - cont.) –Medical Problems colic (20-30% incidence). Cause still unknown ?? Cow’s milk, Iron, gas, parental Treatment with diet, feeding position, sucking period, no alcohol, reassurance preterm - higher PVM & Kcal. Similac Special Care (Ross) Biliary atresia - defective bile duct. No bile acids. Fat malabsorption. Treat with Portagen (Ross). 87% Medium Chain Triglycerides

11. Lactation (The Baby - cont.) –Medical problems (cont.) Celiac disease - gluten sensitivity. Pregestimil. No gluten and CHO source is dextrose Disaccharidase deficiency - Pregestimil Phenylketonuria - cannot digest or utilize phenylalanine. Lofenalac Diarrhea - Pedialyte, Infalyte Protein allergy including soy protein- Nutramigen