Breastfeeding
Breastfeeding is the best way to provide nutrition to infants in the first months of life, and the World Health Organization (WHO) recommends exclusively breastfeeding for the first 6 months of life, and continued until two years of age, with the introduction of complementary foods and other nutrients starting at the end of the sixth month.
The breast milk secreted in the first days after birth is called colostrum, and as shown in the table below, it contains immune factors, macrophages and lysosomes.
Breast milk contains a number of bioactive components and immunomodulatory agents such as secretory IgA, lysozyme, lactoferrin and phagocytes, which provide protection against infections of the intestinal and respiratory tracts
In the United States, breastfeeding has become the common way to feed infants.
In order for the secretion of milk during breastfeeding to be sufficient and good, it must be:
The first feeding as early as possible.
The frequency of feeding in the first month should be large and irregular (random).
Do not prolong the feeding period for more than 20 minutes.
Breast milk composition:
colostrum stage:
From birth to the first 4-5 days.
Rich in proteins, vitamins, minerals and infection-preventing factors.
Low in lactose and fat, it has laxative properties.
Its quantity is small (5-60) ml.
Transitional milk stage:
Between 5-15 days after birth
Its composition is between the colostrum milk and mature milk composition.
At this stage, it increases in quantity and changes qualitatively until we reach the third stage.
Mature milk or final stage of milk:
After 15 days from birth.
Its composition is the same for all mothers, there is no difference in quality, but it may differ in quantity when there is malnutrition in the mother.
Its fat content increases at the end of the feeding to lead to feeling of satiety in the baby.
Lab tests of breast milk is clinically ineffective and has no indication.
Breastfeeding benefits:
Increases the mother-child bonding.
Its composition suits the quantitative and qualitative needs of the child. Casein protein present in breast milk constitutes 20%, while whey protein, similar to albumin, constitutes approximately 80% of the total protein in breast milk. It is easy to digest and speeds up the intestinal transit time, as well as for sugars or fats, and this is what It will be mentioned when comparing mother’s milk and cow’s milk.
Reduce baby’s risk for infections.
Breast milk is always at the right temperature and it is constant during the feeds.
It is easily digested and quickly passes through the stomach, as it does not stay in the stomach for more than an hour and a half to two hours, while the stomach is not emptied when breastfeeding with humanized milk before three hours.
No need for sterilization process.
Benefits of breast milk for the baby:
Breastfeeding reduces the risks of:
• Infections: digestive, ear, nose, throat, pulmonary, urinary and even meningitis,
• Digestive problems,
• Allergies (eczema, asthma…),
• Anaemia,
• Obesity and diabetes, certain types of cancer and inflammatory diseases,
• Orthodontic problems,
• Sudden infant death syndrome.
Benefits of breastfeeding for the mothers:
Breastfeeding promotes:
• Reduced risk of anaemia,
• Repositioning of genital organs,
• Mother-baby bonding,
• Weight loss (in association with a balanced diet),
• Reduced risk of breast and ovarian cancer,
• Reduced risk of osteoporosis after menopause.
Some features of breast milk:
Anti-infective
Immunoglobulin IgA – SIgA secretory Immunoglobulin
It constitutes of 90% of the gamma globulins in breast milk and protects the mucous membranes.
Microbiology related factors:
Stimulates the growth of lactobacilli that convert lactose into lactate and acetic acid, which decreases the pH of stool and inhibits the growth of pathogenic organisms.
Lysosomes
Destroy invading viruses and bacteria.
Interferon
Has the property of inhibiting virus replication
Lactoferrin
Milk-binding protein that inhibits the growth of Escherichia coli (E. coli).
Phagocytes
Phagocytes are the responsible of phagocytosis process, lysosomes, lactoferrin and complement C3 & C4.
Lymphocytes
T-cells mediate delayed immune hyperresponsiveness for infants and B-cells which are responsible for production of IgA.
Nutritional advantages:
Type of protein
Easily digestible because the whey ratio (light) / casein is 40:60
Type of fat
Rich in oleic acid, which improves the absorption and digestion of fats.
Lipid metabolism
Accelerates lipolysis due to the presence of lipase in breast milk.
Calcium/ Phosphorus ratio 2:1
Reduces tetany in infants and reduces calcium absorption
Renal load
low
Iron content
Bioavailability / Absorption rate (40%-50%)
Long–chain polyunsaturated fatty acids
Structured lipid, which is important in the development of the retina.
Breastfeeding contraindications:
Galactosemia in infants (absolute)
Congenital lactase deficiency in infants
Pulmonary and extrapulmonary tuberculosis in mothers (absolute).
Severe chronic diseases and severe infections in mothers.
Breast abscess.
HIV (human immunodeficiency virus) (absolute).
Medicines (antithyroid, diazepam, phenytoin, chloramphenicol, nalidixic acid).
Pregnancy: Breastfeeding during pregnancy is not harmful, but the mother’s nutrition should be given a special importance, and it is preferable to refrain from breastfeeding after the twentieth week.
Incompatibility of blood groups and RH between mother and baby does not prevent breastfeeding.
Hepatitis B is not a contraindicaion if active and passive immunization are applied to infant at the birth.
Breast milk jaundice presents as prolonged physiological jaundice of moderate severity, which generally does not require stopping breastfeeding.
World Health Organization (WHO) recommends continuing breastfeeding even if the mother is pregnant and does not suffer from any other diseases.
Breast milk sufficiency:
Each 100 ml of breast milk provide approximately 67-69 calories.
Signs of breast milk sufficiency include the following:
Weight: The daily, weekly or monthly weight gain is the most important indicator of the breastfeeding sufficiency. In the first three months, the weight increases daily between 20-30 g / day, and in the following three months between 15-20 g / day, from the seventh month until the end of the first year between 10-15 g/day.
Urine: Good urine output and changing wet diapers several times during the day is also a good sign+9.
Sleeping: 2-4 hours after feeding is evidence of breastfeeding sufficiency.
Stools: The stools are soft and golden color with an acidic, not foul smell. Constipation, Oliguria, infant sleep difficulties, agitation and increased crying (may) be evidence of inadequate feeding.
The duration of breastfeeding:
Breastfeeding begins immediately after birth, as soon as the condition of the mother and newborn is stable
The duration of feeding from each breast is 5 minutes on the first day, 10 minutes on the second day, and 10-15 minutes after that. The baby is able to empty the breast within 5-7 minutes.
The ideal period for exclusive breastfeeding is 6 months, especially in case of a family allergy history in children. Additional foods and nutritional supplements should be introduced into the infant feeding after the first six months of age.
Breastfeeding continues until the age of two years, in addition to the complementary foods,
during this period, the child should be provided with Vitamin D3 (400 IU daily).
If exclusive breastfeeding continues for more than six months, the child must be provided with iron as well, and the most important cause of anemia in the case of prolonged exclusive breastfeeding is iron deficiency.
Common problems during breastfeeding:
– Inverted nipples
– A cleft palate
– Cracked nipples
– Preterm and low birth weight
– Sore nipples
– Short breastfeeding period
– Breastfeeding jaundice
– Wrong positions for breastfeeding
– Addiction in mothers
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