Breast feeding and its advantages

1. Breast feeding and its advantages Presented by: Rajeev Nepal Lecturer: Universal college of medical sciences, Bhairahawa Email:nepalrajeev11@gmail.com

2. BREAST FEEDING • According to the WHO “Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development.”

3. Contd… • It is the process of women feeding an infant or young child with milk from her breast usually directly from the nipples. • Breastfeeding helps defend against infections, prevent allergies, and protect against a number of chronic conditions. •  No other food is required by the baby until 4-5 month after birth. • Breastfeeding should begin within an hour of birth.

4. Contd… • It should be “on demand” as often as the child wants day and night. • Under normal conditions, mother secrets 450 to 600 ml of milk daily with 1.1 gm protein per 100 ml. The energy value of human milk is 70 kcals per 100 ml. • A child who is breast-fed has greater chances of survival than a child artificially fed. • Bottle feeding should be avoided.

5. Contd… • Prolonged breast feeding does protect the infant from early malnutrition and some infections. • Infant mortality rates in developing countries are 5-10 times higher among non breast-fed or breast-fed for less than 6 months children. • Despite the marked advantages of breast-feeding, its popularity has declined significantly in many parts of the world.

6. ` Breastfeeding FULL PARTIAL TOKEN Breastfeeding episodes have insignificant caloric contribution EXCLUSIVE No other liquid or solid is given to the infant ALMOST EXCLUSIVE Vitamin, water, juice given not more than once or twice per day, not more than 1-2 swallows HIGH More than 80% of feeds MEDIUM 20%-79% of feeds LOW Less than 20% of feeds Fig: Schema for breastfeeding definition

8. Exclusive Breast feeding: • It is the process where the baby is fed exclusively breast milk. • Baby should be fed only breast milk up to 6 months of birth. • WHO and UNICEF suggest that: • Initiate early • Only breast milk not even water • Breast feeding on demand • No use of bottles, pacifiers (artificial nipple).

9. Exclusive Breastfeeding: • Breastfeeding has many health benefits for both the mother and infant. • Breast milk contains all the nutrients an infants needs in the first six months of life. • Breastfeeding protects against diarrhoea and common childhood illnesses such as pneumonia, and may also have longer-term health benefits for the mother and child, such as reducing the risk of overweight and obesity in childhood and adolescence.

10. Types and Composition of Breast Milk

11. Types of Breast Milk

12. Colostrum • The first milk that is produced by the breast for an infant right after birth is thick yellowish or clear coloured fluid called colostrum. • Colostrum is secreted as early as second trimester and during the first week after delivery. • Although colostrum is produced in limited quantity (approximately 3 ounces or 85 ml in 24-hour period), it containslarge quantities of protective, anti-infective and growth factors and has more protein and vitamin A and K than mature milk. • Colostrum provides about 580–700 kcal/L and is higher in protein and lower in carbohydrate and fat than mature milk. • It should never be discarded.

13. Importance of colostrum • Colostrum contains a high concentration of protective constituents, such as immunoglobulins, macrophages, lymphocytes, neutrophils, antibodies and immune cells that assist in the protection of newborn's fragile mucous membranes against microbes and viruses by preventing their entry, transport and/or proliferation. • It is sufficient to meet the caloric needs of a normal newborn in the first few days of life.

14. Contd.. • It enhances the development and maturation of the baby’s gastro-intestinal tract. • Colostrum also has a mild purgative effect, which helps to clear baby’s gut of meconium and helps to prevent jaundice by clearing the bilirubin from the gut. • Being rich in growth factors, it stimulates the baby’s immature intestine to develop in order to digest and absorb milk and to prevent the absorption of undigested protein.

15. Transitional milk • Milk produced between days 4 –10 postpartum. • Contains decreased amounts of proteins and immunoglobulins but higher levels of lactose, water soluble-vitamins, calories and fats when compared with composition of colostrum.

16. Mature milk • Produced from approximately ten days after delivery up until the termination of the breastfeeding. • Mature breast milk looks thinner, paler and is more watery than colostrum. • Additionally, it consists of 90% water which is required to maintain hydration of the infant and the remaining 10% consists of carbohydrates, proteins and fats which are important for both growth and to meet energy needs of the baby. • Some people call this the breast milk “Coming in”.

18. Preterm milk • Is breast milk of a mother who delivers prematurely • Contains high quantity protein, minerals, immunoglobulins and lactoferrin than mature milk, making it more suitable for the needs of a preterm baby. • Preterm milk is essential and best suited for the survival and growth of a preterm baby.

19. Fore milk • Early milk – At the beginning of the feeding. • It is watery, has a low level of fat but it is rich in lactose, protein, vitamins, mineral and water and can satisfy the baby’s thirst before 4-6 months.

20. Hind milk • Late milk – comes later towards the end of a feed and is richer in fat content and provides more energy, and satisfies the baby’s hunger. • More opaque and creamy white in colour. • For optimum growth the baby needs both fore and hind milk. • The baby should therefore be allowed to empty one breast. • Babies who are fed fore and hind milk sleep well and grow healthy.

22. Composition of Breast Milk……

24. Composition of Breast Milk…… • Calories: • Colostrum contains approximately 17 kcal/oz. • By 2 weeks, the average caloric content of mature human milk is 20 kcal/oz, increasing to 26 kcal/oz. by 4 months. • Fat: • Provides as much as 50 percent of the infant’s energy needs and is the main source of fat-soluble vitamins and essential fatty acids needed for growth and development of the infant.

25. Composition of Breast Milk…… • Fatty Acids • More than 200 types of fatty acids have been found in human milk including both saturated and unsaturated fatty acids (mono and poly). • Arachidonic acid (AA) from linoleic acid and docosahexaenoic acid (DHA) from linolenic acid are essential for development of visual acuity. • Linoleic and linolenic acids both of which are essential fatty acids, have significance in the quality of myelin laid down. .

26. Composition of Breast Milk…… • Carbohydrates • Includes lactose and oligosaccharides • Lactose is present in mother’s milk in high levels (7 percent). • Lactose provides 40 to 45 percent of the energy. • Its concentration is increases by approximately 10 percent over the first 6 months of lactation. • Lactose enhances calcium absorption, thereby helping prevent rickets.

27. Composition of Breast Milk…… • Oligosaccharides are the third largest solid in human milk, after lactose and lipids, and the most diverse component in breastmilk • Oligosaccharides protect the baby from pathogens by preventing these disease-causing agents from binding to receptor sites in the gut.

28. Composition of Breast Milk…… • Protein: • Whey, lactoferrin, lysozyme, immunoglobulin , α-lactalbumin, casein are presented in lower concentration in human breast milk. Whey and Casein • Whey is the clear fluid in the milk, and casein is the curd portion. • The ratio of these components changes from 90:10 in early milk to 60:40 in mature milk and to 50:50 in late lactation.

29. Composition of Breast Milk…… Lactoferrin: • Lactoferrin, the iron-binding protein in whey, inhibits the growth of iron-dependent bacteria (such as E. coli) in the gastrointestinal tract. Lysozyme: • Lysozyme, another whey protein, is one of the more than 20 active enzymes present in human milk. • It provides an antimicrobial factor against Enterobacteriaceae and Gram-positive bacteria.

30. Composition of Breast Milk…… Immunoglobulins: • These substances protect the infant against harmful micro-organisms that infect the gastrointestinal tract. Taurine: • Mother’s milk contains eight essential amino acids, including taurine. • Taurine is important for vision and general development and improves fat absorption in preterm infants.

31. Composition of Breast Milk…… • Vitamins • Generally, all vitamins are available in sufficient quantities in breast milk. Vitamin A • Vitamin A is essential for proper vision, growth, good appetite, decreased susceptibility to infections, and skin change among infants.

32. Composition of Breast Milk…… Vitamin D • Vitamin D is manufactured in the skin by the action of ultraviolet light (from the sun) on chemicals naturally present in the skin • This vitamin is present in both the water- and fat-soluble portions of human milk. • Vitamin D prevents child from rickets, which is characterized by abnormal bone growth, muscle pain, and weakness.

33. Composition of Breast Milk…… Vitamin E • Protects vitamin A and essential fatty acids in the body and prevents the breakdown of tissues in childhood Vitamin K • Vitamin K is present in small amounts in human milk. • Prevents fatal brain hemorrhage among Infant.

34. Composition of Breast Milk…… • Minerals : • The mineral balanced in breast milk meets the baby’s needs perfectly. • Breast milk contains major minerals (calcium, phosphorus, magnesium, sodium, and potassium) as well as trace minerals (iron, copper, zinc, manganese, selenium, iodine, and fluoride) in lower percentage.

35. Composition of Breast Milk…… Other substances: • Enzymes • Prostaglandins • Hormones • Bile salts • Lipases • Growth factors • Anti-inflammatory agents • Protective substances (macrophages, polymorphonuclear leukocytes, antiviral lipids, antistaphylococcal factor, T and B lymphocytes, B12 binding protein, fibronectin, comlement (C3 and C4), lactoperoxidases and interferon.

36. WHO recommendations • Start breastfeeding within 1/2-1 hour of birth • Breastfeed exclusively from birth to four months of age • Complementary foods can begin between 4-6 months (exact age varies) • Give complementary foods to all children from 6 months of age • Continue breastfeeding up to 2 years of age or beyond.

37. Advantage of Breast Feeding • It is safe, clean, hygienic, cheap and available to the baby at correct temperature. • Breastfeeding requires no preparation, sterilization, etc. of bottles and formula . • It fully meets the nutritional requirements of the infant in the first few months of life. • It contains antimicrobial factors such as macrophages, lymphocytes, IgA, antistreptococcal factors, lysozyme etc. which protects baby from diarrhoeal diseases, necrotising enterocolitis and respiratory infection.

38. Contd… • Breastmilk is rich in essential fatty acids, lactose, long chain polyunsaturated fats and phospholipids. • Easily digested. • It promotes “bonding” between mother and infants. • Prevents malnutrition • It protects baby from the tendency to obesity. • Lower risk of childhood onset of allergies, diabetes, heart diseases, asthma and eczema. • Decrease risk of developing psychological disorders.

39. Contd… • Sucking is the good for the baby-it helps in the development of jaws and teeth. • Provides several biochemical advantages such as prevention of neonatal hypokalaemia and hypomagnesaemia. Note: According to UNICEF: 15-25 times higher risk of morbidity, mortality of child in the 1st 6 months, who has not received breast milk.

40. Contd… • Breastfeeding is associated with decreased risk of childhood cancers (including childhood leukaemia) and chronic diseases. • It is associated with decreased infant mortality, particularly, during the first year of life and lower hospitalization rates. • Long-chain polyunsaturated fats promote brain growth and reduce the risk of dyslexia and hyperactivity.

41. Protein in breastmilk is predominantly whey protein (80%) and is rich in α–lactoglobulin and lactoferrin. Lactalbumin is rich in tryptophan, a precursor of serotonin which plays an important role as a neurotransmitter. Lactoferrin ensures absorption of iron and zinc is bacteriostatic. • Enhances learning, hearing, visual abilities

42. Contd… • Breastfed child have higher IQ and perform better in school. Note: Children who are not breastfed could have IQ level lower by upto ten points.

43. Benefits for mother • It increase level of oxytocin which encourages the uterus to contract more quickly which helps to decrease bleeding after birth. • Frequent and exclusive breastfeeding can delay the return of fertility through lactational amenorrhea, though breastfeeding is an imperfect means of birth control.

44. Contd… • Reduced risk of pre-menopausal breast cancer and ovarian cancer. • Reduced risk of endometrial cancer. • Reduced risk of obesity, cardiovascular disease and osteoporosis. • Weight management • Help to protect a mothers iron status by minimizing postpartum maternal blood loss. • Promotion of healthy lifestyle and emotional well being. • Mother who exclusively breastfeed their babies are better adjusted with their babies as far as rearing and behavior adjustments are concerned.

45. THANK YOU