1. Breastfeeding Support and Promotion Joan Younger Meek, MD, FAAP AAP Section on Breastfeeding

2. Process of Breastfeeding Breast anatomy Physiology of milk production Breastfeeding positions Latch

3. Mammary Gland Alveoli Ducts Nipple Areola Fat and connective tissue Robert McBride, Medical Illustrator

4. Anatomy of Breast, Baby’s Mouth, Latch and Suckling Robert McBride, Medical Illustrator

5. Pituitary releases prolactin and oxytocin Hormones travel via bloodstream to mammary gland to stimulate milk production and milk ejection reflex (let-down). Infant suckles at the breast. Stimulation of nerve endings in mother’s nipple/areola sends signal to mother’s hypothalamus/ pituitary.

6. Maternal Factors That Support Optimal Lactation Normal breast anatomy Intact neuroendocrine reflex Good general health and nutritional status Effective support system

7. Nutrition During Lactation Generally healthy diet Drink fluids to thirst Adequate protein Additional 450-500 kcal/day Calcium and vitamin D 200-300 mg docosahexaenoic acid (DHA) per day Consider multivitamin/mineral supplement

8. Human Milk Colostrum –Earliest stage of milk –Present before delivery and in first days after delivery –Low volume ideally matched with small gastric capacity of the newborn (~5-7 ml) –High in host defense proteins and secretory immunoglobulin A –Infant’s “first immunization"

9. Human Milk Colostrum Transitional milk –Occurs between 2-5 days postpartum until 10-14 days –Transitional in composition between colostrum and mature milk –Volume of milk available increases –Gastric capacity increases from about 20 ml (< 1 oz) to 60-80 ml (2-3 oz)

10. Human Milk Colostrum Transitional milk Mature milk –Occurs after 10-14 days –Volume continues to increase –Milk appears more watery in consistency –Breasts appear softer

11. Twins breastfeeding Premature infant breastfeeding Photo © Nancy Wight, MD, FAAP Photo © Ruth A. Lawrence, MD, FAAP

12. Breastfeeding Positions Mother comfortable Infant head in straight line with body Tummy-to-tummy or chest-to-chest Photo © Ruth A. Lawrence, MD, FAAP

13. Cradle Position

14. Cross-cradle or Transitional Position Photo © Joan Meek, MD, FAAP

15. Side-lying Position Photo © Roni M. Chastain, RN

16. Clutch or Football Position Photo © Lori Feldman-Winter, MD, MPH, FAAP

17. Latch Stimulate rooting reflex. Take sufficient areola into mouth. Flange lips around the breast—“fish lips.” Have wide angle at corner of mouth.

18. The Process of Breastfeeding Better understanding of the process of breastfeeding and milk production can help physicians and others address early concerns about supply. Better education may decrease early weaning and unnecessary supplementation.