Pgs 528-534

1. Pgs 528-534 BREASTFEEDING (C) AoCH. use without written permission prohibited.

2. Breast Milk • The first fluid produced, colostrum, is rich in immune factors. The diet for breastfeeding is generally similar to that of pregnancy, except for additional fluids, as well as four servings from the milk, yoghurt and cheese group. (C) AoCH. use without written permission prohibited.

3. Recognition of the importance of breastfeeding has contributed to its greater popularity during the last 20 years. Almost all women have the ability to breastfeed. The hormone prolactin stimulates breast tissue to synthesise milk. Some components of human milk come directly from the mother’s bloodstream. Infant suckling triggers a let-down reflex that releases the milk. The more an infant nurses, the more milk is synthesised. The nutrient composition of human milk is very different from that of cow’s milk and changes as the infant matures. Wardlaw: Perspectives In Nutrition. 4th Edition (C) AoCH. use without written permission prohibited.

4. Cont. • Human milk is the best food for newborn infants for the first year of life or longer. • Maternal diet does not significantly alter the protein, carbohydrate, fat and major mineral composition of breast milk, but it does alter the fatty acid profile and the amount of some vitamins and trace minerals. • When maternal diet is inadequate, the quality of milk is more important than the quantity for the majority of nutrients. • Health care policies and procedures and the knowledge and attitudes of health providers affect community breastfeeding rates. (C) AoCH. use without written permission prohibited.

5. Breast milk • Most substances the mother ingests are secreted into her milk. If a woman notices a connection between a food she eats and the infant’s later fussiness, she should consider avoiding that food. However, it is worthwhile experimenting with it later, to see if the same reaction occurs. (C) AoCH. use without written permission prohibited.

6. Other human milk proteins bind iron, reducing the growth of iron-binding, diarrhoea causing bacteria • Certain compounds in human milk, such as essential fatty acids and cholesterol, are not present in cow’s milk of infant formulas. Breast feeding for at least 4 months is recommended to obtain this benefit. (C) AoCH. use without written permission prohibited.

7. Cow’s milk • Generally, cow’s milk should not be used until the infant is 12 months old. It is too high in minerals and protein, does not contain enough carbohydrates to meet the infants needs. • The major protein in cow’s milk, casein, is harder to digest than the major protein in human milk which forms a soft, light curd in the infant’s stomach, easing digestion. (C) AoCH. use without written permission prohibited.

8. Human milk changes in fat composition during each feeding. The consistency of milk released initially (about 60% of the volume) resembles that of skim milk. The next amount (about 35% of the total volume) has a greater fat proportion, similar to whole milk. • Finally, the hindmilk (about 5% of the total) is essentially like cream and is released 10 – 20 minutes into the feeding. The overall energy content of human milk ends up about the same as that of infant formulas (67 kcal/100ml) (C) AoCH. use without written permission prohibited.

9. Composition of 100mL colostrums (days 1-5) and mature milk (day 15)Brown,J. 2008, Nutrition through the life cycle 3rd Edition, Thomson USA p.160 (C) AoCH. use without written permission prohibited.

10. Benefits of breast feeding • Is bacteriological safe and always fresh and ready to go • Provides antibodies while the infant’s immune system is still developing. • The proteoglycans composition also acts as a protective agent for the infant. http://pubs.acs.org/doi/pdfplus/10.1021/pr700793k • Contributes to the maturation of gastrointestinal tract via Lactobacillus bifidus factor; decreases the incidence of diarrhoea and respiratory disease (C) AoCH. use without written permission prohibited.

11. Fewer acute illnesses • Establishes the habit of eating in moderation, thus decreasing the possibility of obesity later in life • Cognitive benefits  fatty acid composition of milk plays an important role in neuropsychological development • Contributes to the mothers early recovery from the pregnancy due to a quicker return of the uterus to a pre-pregnant state (C) AoCH. use without written permission prohibited.

12. Cont. • Reduces the risk of food allergies and intolerances • Facilitates the bonding with the mother (C) AoCH. use without written permission prohibited.

13. Barriers to breast feeding • Obesity and breastfeeding • Overweight and obesity are associated with shorter duration of breastfeeding • This may be related to lower prolactin responses early postpartum • Misinformation and the lack of role models and lack of support from family and friends • Time and social constraints and concerns about loss of freedom • Social reticence and embarrassment (C) AoCH. use without written permission prohibited.

14. Medical conditions precluding breastfeeding • HIB • Type I Diabetes • Breast Health • Medical promotion of infant formulas through distribution of hospital discharge packs, coupons for free or discounted formula and advertising. • Socioeconomic and the need to work • Limited on site facilities (C) AoCH. use without written permission prohibited.

15. Practices Not Advisable • Alcohol intake • Medicinal drugs • Illicit drugs • Smoking • Caffeine (C) AoCH. use without written permission prohibited.

16. Comparison of Milks • Human and goat milk seldom gives rise to a layer of cream and farmers said goat milk had no cream. However, when water is added to human or goat milk a layer of cream becomes visible. The smaller globules of fat in human and goat milk do not rise as rapidly as he larger globules in cow milk. By forcing cow milk through small openings the large globules are broken up and the tiny globules do not rise noticeably and the product is called homogenized milk. Holstein milk has about 3% fat but Jersey milk has 5% fat. http://www.disknet.com/indiana_biolab/b120a.htm (C) AoCH. use without written permission prohibited.

17. Environmental pollutants that may be found in human milk Brown,J. 2008, Nutrition through the life cycle 3rd Edition, Thomson USA p.201 (C) AoCH. use without written permission prohibited.

18. Formula feeding (Tomas,L, (2009), Best Breastfeeding and formulas, Journal of Complementary Medicine, vol.8, iss.2, pp.32-40) • Major advances in formula use and composition include • the introduction of formulas specifically tailored to the perceived needs of low-birthweight infants • the development of fortifiers to overcome the nutritional deficits of human milk for the pre-term infant • Functional benefits have also been shown for • anti-regurgitation formulas • formulas designed with the potential to soften stools (C) AoCH. use without written permission prohibited.

19. Several bio-active nutrients have been added to starting infant formulas in recent years. These include: • Long-chain polyunsaturated fatty acids (PUFA) for brain composition and neurodevelopment • Prebiotics and probiotics for alteration of faecal flora and improved intestinal immune defence • Nucleotides for promoting the immune response • Various nutrients to better emulate breastmilk nutrient composition (C) AoCH. use without written permission prohibited.

20. It is now known that there are natural circadian nutritional variations in human breast milk, and, on this basis, a specific day/night formula has been developed that improved all nocturnal sleep parameters. • The day formula contained low levels of tryptophan and carbohydrates, with high levels of protein and nucleotides • The night formula milk contained the opposite. (C) AoCH. use without written permission prohibited.

21. Furthermore, the nutrient composition of breast milk changes during lactation and this occurs most dramatically during early lactation. So far, this has not corresponded to changes in the related nutrient composition of formulas. However, this is the challenge for future development of infant formulas. (C) AoCH. use without written permission prohibited.

22. OMEGA-3 FATTY ACIDS AND DEVELOPMENT(Tomas,L, (2009), Best Breastfeeding and formulas, Journal of Complementary Medicine, vol.8, iss.2, pp.32-40) • Premature babies are at a high risk of developmental disorders, learning disabilities and physical health problems. • A 2009 Australian study of 614 pre-term infants demonstrated that the frequency of mild mental delay in infants weighing less than 1250g was reduced by 45% if the mothers took tuna-oil supplements at 3g/day during the pregnancy. Only a small improvement was observed in male babies, however, in female babies the rate of mild delay reduced by 55% and significant delay by 83%. (C) AoCH. use without written permission prohibited.

23. The same researchers also conducted a double blind randomised controlled trial of 657 infants <33 weeks gestation who were either enterally fed high-dose DHA (1% total fatty acids) or standard DHA (0.3% total fatty acids) from days 2 – 4 of life until term corrected age. It was concluded that high dose DHA in early life did not increase 18 month Bayley Mental Development Index (MDI) scores of pre-term infants overall born earlier than 33 weeks, however, it did improve the MDI scores of girls. (C) AoCH. use without written permission prohibited.

24. A 2008 report out of the Women’s and Children’s Health Research Institute, Adelaide has said  • ‘Research demonstrates that when fed human milk or formula supplemented with DHA, pre-term infants achieved normal growth in terms of weight, length and head circumference, and showed improved visual and mental development compared to infants fed unsupplemented formula. In fact, our latest research indicates the requirements of DHA may be even higher for pre-terms than previously thought.’ (C) AoCH. use without written permission prohibited.

25. PREBIOTICS AND PROBIOTICS(Tomas,L, (2009), Best Breastfeeding and formulas, Journal of Complementary Medicine, vol.8, iss.2, pp.32-40) • There is growing evidence of the local effects within the GI tract and the systemic functions of human milk oligosaccharides (HMO). • Despite the role of milk to serve as a sole nutrient source for infants, most of these oligosaccharides are actually not able to be digested by human infants. • The nutritional function of HMO is as a prebiotic – that is, an indigestible carbohydrate that is selectively fermented by desirable intestinal microflora. (C) AoCH. use without written permission prohibited.

26. The ability of HMO to protect the infant seems to be primarily due to their inhibition of pathogen binding to their host-cell target ligands. HMO strongly attenuate inflammatory processes in the intestinal mucosa and are able to induce growth inhibition in intestinal cells by inducing differentiation and / or by influencing apoptosis. • Therefore, this may be the underlying aetiology for non-breast fed infants having a higher incidence of diarrhoea and respiratory disease than those who are breastfed. (C) AoCH. use without written permission prohibited.

27. Several recent studies have also demonstrated a relationship between gut microflora in infancy and subsequent development of allergic disease. • Probiotic supplementation (Lactobacillis rhamnosus GG, L. Reuteri) to the mother during pregnancy and / or her infant has been shown to reduce breast milk cytokine TGF-β2 which is associated with less infant sensitisation and possibly less IgE-associated eczema in breast fed infants. • L. Rhamnosus GG in particular was found to reduce the severity of atopic dermatitis in half of the RCT’s recently reviewed and could be effective for the prevention of atopic dermatitis. (C) AoCH. use without written permission prohibited.

28. In recent years, both probiotics and prebiotic oligosaccharides have been added to infant formulas to more closely stimulate the gut microbe composition and activity seen with breastfeeding. • Several clinical trials have shown that they can mimic the beneficial effects of HMO, stimulating the establishment of a predominantly ‘bifidus flora’ in the gut, while simultaneously decreasing the proportions of Bacteroids and Clostridia species. (C) AoCH. use without written permission prohibited.

29. Nutrition Guidelines to Support Lactation • Continue with healthy eating patterns • Ensure the dietary guidelines are being met and portion sizes are appropriate for energy and nutrient needs. • Kj increase approx 2000kj/day • Ensure adequate water to maintain hydration status • Be aware of some foods that may alter the taste of the milk and the babies tolerance to some chemicals. Some times cruciferous vegetables, legumes, curries or spices can irritate the child. (C) AoCH. use without written permission prohibited.

30. From the Infants Perspective Breast Feeding and Nutrition Text pgs 541:548 (C) AoCH. use without written permission prohibited.

31. Neonatal Requirements • Within the first 5 months, their birth weight almost doubles in size, by 1 year, tripled. • A baby’s energy per kg is considerably greater than an adult, and at times of major growth spurts the needs and hunger go up. • It is also vital to ensure adequate nutrition to sustain growth and activity as the infants ‘wake up’. Along with sufficient fluid to prevent dehydration that can occur. • Breastfeeding is encouraged as the only source of nutrition for the first six months as its composition is suitable to attain and maintain health of the infant. 544 (C) AoCH. use without written permission prohibited.

32. At Birth • An new born only consumes milk, preferably breast milk for its protective and adjusting needs of the infant. • It has the correct balance of CHO: Fats: Protein • Includes highly bio-available minerals; • vitamins; • protective factors such as • Colostrum • Bifidus factors • Lactoferrin • Lactadherin • Digestive enzymes • Growth factors. (C) AoCH. use without written permission prohibited.

33. Has protective measures against • allergies and • later age diseases such as CVD and diabetes • Overweight • If breastfeeding isn’t an option for the mother, then a suitable infant formulae is required. • Formula is designed to be as similar to breast milk as possible and include EFA and probiotics in some formulas (C) AoCH. use without written permission prohibited.

34. Introducing Solids • It is recommended for children to be solely nourished by breast or formulae until 6months of age. • One reason is the child’s oral development and reflex actions . • It is vital for the child to be able to manipulate and swallow ‘foods’ to minimise chocking. (C) AoCH. use without written permission prohibited.