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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students Objective 2: Advantages Objective 3: Composition Objective 4: Risks of not breastfeeding Objective 5: Contraindications. Objective 2
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Bailey’s Golden Start Breastfeeding Curriculum for Nursing Students • Objective 2: Advantages • Objective 3: Composition • Objective 4: Risks of not breastfeeding • Objective 5: Contraindications Property of MN Department of Health/DeJong
Objective 2 Appraise at least three biological advantages of lactation and breastfeeding for the mother and child. Property of MN Department of Health/DeJong
Short- and Long-Term Benefits • Breastfeeding and lactation management have been studied for decades, both nationally and internationally, with considerable recent clinical advances being made in the scientific knowledge of the short- and long-term benefits of breastfeeding. Property of MN Department of Health/DeJong
Compelling Advantages for Infants, Mothers, Families, and Society • As documented in the 1997 AAP Policy Statement on Breastfeeding, “Extensive research using improved epidemiologic methods and modern laboratory techniques, documents diverse and compelling advantages for infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding” (p. 496). Property of MN Department of Health/DeJong
“There was a time when the choice between bottle feeding with formula and breastfeeding was a lifestyle choice. The choice was seen as purely nutritional, and any artificial substance that resembled human milk and resulted in babies gaining weight was obviously good. […] We now know that breastfeeding is a great deal more than just ‘food’ or nutrition.”Foreword by Dr. Nils Bergman, MB ChB, DCH, MPH, MD of Breastfeeding Answers Made Simple: A Guide for Helping Mothers by Nancy Mohrbacher, IBCLC, FILCA Property of MN Department of Health/DeJong
Biological and Psychosocial Child Health Benefits • Microsystem Benefits for Breastfed Babies • Reduced diarrhea • Reduced bacterial infections • Reduced otitis media • Reduced asthma • Reduced nocturnal enuresis • Reduced diabetes • Reduced overweight and obesity • Reduced hypercholesteremia • Reduced ischemic heart disease • Reduced sudden infant death sydrome • Reduced cancer • Enhanced cognitive development • Enhanced analgesia during painful procedures Property of MN Department of Health/DeJong
The Benefits are Dose-Dependent • The health benefits are dose-dependent with infants who breastfeed for longer durations demonstrating a greater reduction in disease states (AAP, 2005; Lawrence, 1997; WHO, 2002). Property of MN Department of Health/DeJong
Otitis Media • Breastfeeding decreases a child’s risk for ear infections in the first 12 months of life (Dewey, 1995). Prolonged breastfeeding acts as prophylaxis for recurrent or chronic otitis media (Saarinen, 1982). Duncan et al. (1993) found that exclusive breastfeeding for at least four months protected against otitis media, and Owen et al. (1993) documented reduced rates of otitis media with effusion in the first two years of life for children, regardless of secondhand smoke exposure and attendance in group childcare. Property of MN Department of Health/DeJong
Diabetes • Evidence suggests a reduction in the incidence of insulin-dependent (type 1) and non-insulin dependent (type 2) diabetes mellitus among children who were breastfed as infants. • In addition, due, in part, to breastfeeding’s effect on obesity, breastfeeding also appeared to protect against diabetes mellitus type 2 (Owen, 2006; Mayer-Davis et al., 2008). Property of MN Department of Health/DeJong
Prevention of Obesity • Did you know that breastfeeding can help PREVENT obesity? • Construct some hypotheses now as to why this may be true. Property of MN Department of Health/DeJong
This is Vital to our Nation’s Public Health • Childhood obesity is considered an epidemic in the U.S. • The risk of obesity starts early in life. Over half of obese children become overweight by the age of 2, and approximately one in five children are overweight or obese by their 6th birthday.”— The White House Task Force on Childhood Obesity Property of MN Department of Health/DeJong
A link exists between overweight and obesity among children who were not breastfed as infants (Dewey, 1993; Grummer-Strawn, 2004; Singhal, 2002; Stettler, 2002). • Armstrong and Reilly (2002) researched a sample of 32,200 Scottish children and found that a history of breastfeeding reduced the overall risk of extreme obesity in children aged 39 to 42 months. Property of MN Department of Health/DeJong
Breastfeeding Duration Matters • According to Arenz (2004), the protective effect against obesity increased with not only the initiation of breastfeeding, but also the overall duration of receiving human milk. Property of MN Department of Health/DeJong
The CDC’s Fight Against Obesity • The CDC has made increasing the rate of breastfeeding as one of its major goals in the fight against obesity and inactivity. • Your future work as a nurse to promote and protect breastfeeding will have a major impact in this fight! Property of MN Department of Health/DeJong
SIDS • It is speculated that breastfeeding protects against infant death (Bernshaw, 1991). • Bottle-fed infants are twice as likely to die from SIDS than their breastfed counterparts (McVea, Terner, & Peppler (2000). Property of MN Department of Health/DeJong
Increased Arousability • Horne et al. (2004) observed improved arousability from sleep among breastfed babies and decreased rates of SIDS in the first year of life among breastfed infants. Chen (2004) and Ford et al. (1993) reported a decreased risk of post-neonatal death in the U.S. among breastfed babies. Internationally, Mitchell et al. (1992) and Scragg et al. (1993) researched major risk factors for SIDS and also found a decreased risk for infant death of babies who were breastfed. Property of MN Department of Health/DeJong
Breastfeeding can Reduce Mortality Risk Babies who are breastfed have a 21% lower risk of death in their first year, compared to babies never breastfed (Chen & Rogan, 2004). This reduction in risk improves to 38% if babies are breastfed for 3 months or more. In US, translated to 720 deaths in one year. New study in Pediatrics – 911 deaths could be prevented if 90% of babies were breastfed (Batok, 2010).
Cancer • Lymphoma, leukemia, and Hodgin’s Disease show decreased rates of occurrence in infants who had been breastfed (Bener, 2001; Davis, 1998; Smulevick, 1999). Image used with permission from William Burleson, Office of Statewide Health Improvement Initiatives, Minnesota Department of Health on 2/10/2012. Property of MN Department of Health/DeJong
Cognitive Development Within the child’s own microsystem, improved individual cognitive ability, academic performance, and mental differences of breastfed children are reported in the literature (Anderson et al., 1999; Drane, 2000: Jain et al., 2002; M. M. Smith et al., 2003). Property of MN Department of Health/DeJong
Uniquely Available Fatty Acids • According to Caspi et al. (2007), who examined gene-environment interactions in two birth cohorts (n = 1037 first cohort; n = 2232 second cohort), breastfed babies who had a specific variant of the FADS2 gene, which comprises approximately 90% of all infants worldwide, demonstrated an IQ, on average, of seven points higher than their formula-fed counterparts. Researchers concluded that breastfed babies have higher IQs because of the fatty acids uniquely available in breastmilk. Property of MN Department of Health/DeJong
Long-Term Intellectual Benefits • Horwood, Darlow, and Mogridge (2001) examined the correlations between breast milk feeding and verbal and performance IQ of 280 subjects. They found that children seven and eight years of age who were breastfed for more than eight months after being diagnosed as low-birthweight upon delivery demonstrated significantly higher IQ scores than comparable children breastfed for lesser durations, suggesting that breastfeeding may grant long-term intellectual benefits in some populations. Property of MN Department of Health/DeJong
Premature Infant Benefits • Breastfeeding is essential to the health of all infants; however, babies born prematurely benefit EVENMORE from the ingredients in human milk. • Feeding premature infants food other than human milk increases the risk of seriousinfection. Property of MN Department of Health/DeJong
Problems of Prematurity • 1. • 2. • 3. • 4. • 5. • 6. • What does NEC stand for and how might it be prevented with breastfeeding? Property of MN Department of Health/DeJong
Kangaroo Cares/Skin-to-Skin for the Premature Infant As the nurse, what are you assessing during these kangaroo cares, and what do you expect the infant’s vital signs to be? Get in pairs and discuss. Property of MN Department of Health/DeJong
Maternal Health BenefitsEnhanced infant bondingLactational amenorrhea and child spacingReduction of postpartumweight retentionReduced cancer Property of MN Department of Health/DeJong
Infant Bonding During lactation and the act of breastfeeding, the hormones oxytocin and prolactin are released from the pituitary. This biological event enhances a mother’s capacity to relax and feel nurturing toward her baby (Dettwyler & Stuart-Macadam, 1995). Property of MN Department of Health/DeJong
Lactational Amenorrhea and Child Spacing • Within the mother’s microsystem, frequent breastfeeding can delay the return of fertility through lactational amenorrhea. The lactational amenorrhea method (LAM) for full breastfeeding women has received worldwide approval across various cultures and socioeconomic levels as a means of natural suppression of fertility (Hight-Laukaran et al., 1997; Labbok et al., 1997). However, many providers question its reliability (WHO, 1999). Property of MN Department of Health/DeJong
Reduction of Postpartum Weight Retention • According to Ogden et al. (1999-2004), U.S. women of reproductive age are alarmingly heavy, with 52% of women overweight, 29% obese, and 8% with BMI index scores (BMI: in kg/m2) more than 40. • Researchers caution that mothers who are overweight or obese and who do not initiate breastfeeding, who breastfeed for short periods of time and then terminate, or who have reduced physical activity may not return to their pre-gravid weights during the first six months postpartum (Dorea, 1997). Property of MN Department of Health/DeJong
Maternal Cancer • Accumulating evidence suggests that increasing the duration of lifetime breastfeeding reduces the risk of premenopausal breast cancer in the mother (Labbok, 2001; Newcomb et al., 1994). Property of MN Department of Health/DeJong
Although the exact means by which breastfeeding reduces breast cancer risk is not well understood, there are several possible hypotheses for the protective effect, including the reduction of the lifetime number of ovulatory cycles that occur while breastfeeding (Clavel-Chapelon, 2002; Freund, Mirabel, Annane, & Mathelin, 2005; Gray et al., 1990; McNeilly, Tay, & Glasier, 1994; Russo & Russo, 1994; Vogel, 2000), the reduced amounts of estrogen in the body during lactational amenorrhea, and the differentiation of mammary cells during lactation (Freund et al., 2005; Russo & Russo, 1994). According to Vogel (2000) and Russo (2005), the cell differentiation within breast tissue transpires during a woman’s first full-term pregnancy and may contribute to an overall decreased breast cancer risk, especially when she is young. Property of MN Department of Health/DeJong
Psychological/Emotional Benefits • Image from: http://wicworks.nal.usda.gov/wicworks/resources/images.html Property of MN Department of Health/DeJong
And just the thought of it makes baby happy too! Property of MN Department of Health/DeJong
Objective 3 Analyze the composition of human milk Property of MN Department of Health/DeJong
Humans are Mammals • Mammals = ____________ gland • The Mammary gland is an immunologic organ • Each species’ milk is ___________ and intended for the offspring of that particular species. • Breastmilk is IMPOSSIBLE to _______________! Property of MN Department of Health/DeJong
We are “Carriers” – Not “Nesters” Water content ~87% (in both colostrum and mature milk) Lower fat and protein than most other mammals Highest ___________ of any mammal
More about the Composition of Breastmilk • Constant • Minimal fluctuations caused by ____________ diet • Components of breast milk: • 130 different oligosaccharides identified Property of MN Department of Health/DeJong
Under a Microscope Formula Human Milk
Interesting Fact! • The level of cholesterol in breastmilk remains __________ despite the mother’s cholesterol intake. • Why is this important? • What impact does this have on long-term health? Property of MN Department of Health/DeJong
Right amount at the right time Allows baby and mom to __________ feeding Protects the GI tract by ___________ it with immunoglobulins which prepare the gut for the mature milk Colostrum – “Liquid Gold”
Compared to mature milk, colostrum has less: Lactose Fat Calories Early milk is supposed to be protective, not growth-enhancing
Objective 4 Report at least three risks of not breastfeeding for the mother and child. Property of MN Department of Health/DeJong
Health Risks Associated with Not Breastfeeding What do you think some of the risks are? What does the Surgeon General say? View the Call to Action at: http://surgeongeneral.gov If your clients had all of the information that you as a health professional are privy to, what do you think most people would choose to do? Property of MN Department of Health/DeJong
Excess Health Risks Associated with NOT Breastfeeding • What does the Surgeon General’s Call to Action to Support Breastfeeding report for the following conditions? • Acute Ear Infections (Otitis Media)? • Diarrhea and Vomiting (Gastrointestinal Infection)? • Type 2 Diabetes Mellitus? • Sudden Infant Death Syndrome? • Among preterm infants: NEC? • Among moms: ovarian cancer? Property of MN Department of Health/DeJong
Not Breastfeeding Increases a Woman’s Risk of: Breast and ovarian cancer Osteoporosis Short pregnancy interval Obesity Higher blood pressure
Write a One-Minute Paper: How Can You Use this Information? Image used with permission from William Burleson, Office of Statewide Health Improvement Initiatives, Minnesota Department of Health on 2/10/2012.
Objective 5 Examine at least two contraindications to breastfeeding. Property of MN Department of Health/DeJong
Rare Exceptions • Galactosemia • HIV • Taking antiretroviral medications • Untreated, active TB • Using illicit drugs • Taking cancer chemotherapy agents • Undergoing radiation therapy Property of MN Department of Health/DeJong
Cautious BF Promotion • Active herpes on breast/nipple • Breast reduction - wait and see • History of well-managed, unsuccessful breastfeeding • Mothers with adopted baby • No contraindication with Hepatitis A, B, or C Property of MN Department of Health/DeJong
End of: • Objective 2: Advantages • Objective 3: Composition • Objective 4: Risks of not breastfeeding • Objective 5: Contraindications Next: • Objective 6: Social, institutional, and community benefits • Objective 7: Anatomy and physiology Property of MN Department of Health/DeJong