Paige Owens 18 March 2010 NTR 302 The Importance of Breastfeeding Breastfeeding is a highly debated issue among mothers

in the United States. Mothers can choose between breast and formula feeding their infant. Many mothers who choose to formula feed their children do so for many different reasons, but breast milk is the more optimal choice. Commercial formulas try to imitate breast milk, and come close, but the exact composition cannot be duplicated, (1). Breastfeeding provides the child with the perfect make up of the nutrients she needs, and changes according to the childs growth and development. Through extensive research, breastfeeding is shown as the optimal health choice for infants, except in rare cases. In addition to being the perfect food, breastfeeding furnishes many other benefits not only for the baby, but for the mother as well. Many studies have been conducted that show breastfeeding supplies the child with many benefits. This is most likely because the child is receiving the proper amount of nutrients it needs to grow and develop. The balance of nutrients in human milk matches human infant requirements for growth and development closely; no other animal milk or HMS [human milk substitute] meets infant needs as well (2). At two weeks old 128 kilocalories of breast milk per kilogram is ingested, at 3 months, 70-75 kcals, and at 5 months, 62.5 is the average number of kilocalories ingested per kilogram (3). Breastfeeding provides sufficient amounts of kilocalories, dependant on the babies needs, without the risk of overconsumption or shortage. Not only the amount of kilocalories ingested, but the chemical and nutrient make-up for breast milk is perfect for the babies needs as well; Breast milk has been termed the perfect food for infants because it contains all necessary nutrients in correct proportions, (4). The essential fatty acids DHA and AA, along with polyunsaturated fatty acids, are present in breast milk and are bestowed to the baby which promotes optimal development of the central nervous system. Also medium-chain-triglycerides

Paige Owens 18 March 2010 NTR 302 and cholesterol are delivered to the baby with promotes higher levels of HDL cholesterol and lower levels of LDL cholesterol later in life (2) Breast milk provides the baby with the proper amount of protein, carbohydrates and fats at 7 percent, 38 percent, and 55 percent respectively, the child is receiving the nutrients it needs to grow properly. Formula can be substituted for breast milk, although not advised, and provide the baby with 913 percent from protein, 39-45 percent from carbohydrates and 45-50 percent total kilocalories from fat. The different composition in formula can and does have different affects on the baby. The proteins in breast milk are shorter-chains, compared to those in formula. These shorter chain proteins form softer curds in the stomach which are easier for the baby to digest, which is a good thing since the babys gastrointestinal tract is immature (2, 3, 5). Because of the simple break down in the GI tract, breast fed infants are less likely to have diarrhea and never become constipated (2, 4, 6). As noted earlier, formula provides the baby with more proteins than breast milk does, but about half of the protein in formula are wasted and burden the GI tract more, while all of the proteins from breast milk are used (5). Along with the nutritional benefits of breast milk, it also bequeaths many immunological benefits to the baby. Breast fed infants are less likely to develop chronic diseases, like diabetes, compared to formula fed infants (7, 8). Children who are fed solely breast milk also show decreased risks of gastrointestinal problems, respiratory illnesses, breast cancer, high cholesterol, heart disease, influenza, polio, and ear infections (1, 2, 5, 7). Also a lowered risk of obesity is linked to breast feeding. Breast fed infants are typically leaner than HMS-fed infants at 1 year of age without any differences in activity level or development. A large body of literature suggests that there is a small reduction in risk of overweight in children greater than 3 years of age who were breastfed, (2, 8). Lowered risk of allergies

Paige Owens 18 March 2010 NTR 302 is also linked to breastfeeding, In one classic study of more than 20,000 infants, those who were artificially fed were seven times more likely to get eczema (a skin disorder associated with allergy) as those who were completely breastfed, (5). When a child is sucking milk from his mothers breast, he uses his jaw muscles more than he would if he were bottle fed. The difference in muscle usage will give the baby a stronger jaw, which may lead to him having healthier and straighter teeth (5). Infants who are breast fed have more acute vision than infants who are bottle fed, this may be because of the vitamin A provided in breast milk or the high amount of AA and DHA (3, 7). Cognitive advantages are showed amongst breastfed infants. There are many studies that support this claim: in a study where infants were fed breast milk was compared to those that were formula fed, The IQ scores for the children fed human milk were 8.5 points higher than those of the groups not fed human milk, (3). Even though these affects are supported, the exact mechanism of the effect on the brain is unknown today (3). The effects may be because of the high levels of essential fatty acids, AA and DHA, and sialic acid. Brian maturation is associated with the concentration of sialic acid (3). Besides the physiological benefits of breastfeeding, the infant will also have mental advantages as well; the child gains a sense of security from the closeness and warmth generated by the skin- to- skin contact between him and his mother while feeding (1, 5). Many women may begin to breast feed for the numerous benefits for the baby, but they may not be aware of the many benefits for themselves. The bond that the baby feels is also experienced by the mother. The mother also feels more confident about raising her child, knowing that she can provide the food the baby needs (2, 4, 5). She is also reassured that she is giving only natural food to her baby without contamination, and with no preservatives (5).

Paige Owens 18 March 2010 NTR 302 Weight loss and the return to pre-pregnancy weight are more easily obtained by a lactating mother (1, 2, 4, 6). Even though slightly more energy intake is needed when lactating, it is burnt off by the production of milk (1, 5, 6). With Lactation more oxytocin, the hormone that stimulates milk ejection, is produced in the hypothalamus which promotes uterine contractions (1, 2, 4-8). These contractions may actually be felt by the mother as abdominal cramping, but the pain usually ceases in a couple of weeks. Lactation can also act as a contraceptive. During lactation more prolactin is also produced, which is the hormone that promotes milk production. The increased levels of prolactin temporarily stop menstruation (2), though bleeding may continue for about 27 days (3). With this lack of menstruation, the mother is less likely to conceive again in the near future (2, 4- 7). The risk of post partum ovarian and breast cancers is also reduced in mothers who breast feed their children (1, 2, 7). Also post partum diabetes is less likely to occur; the risk of Type II diabetes in women with gestational diabetes, diabetes during pregnancy, is lowered as well (3). Also a lower risk of developing Rheumatoid arthritis is associated with breastfeeding (2), along with less risk of hip fractures (7). The mothers diet and body are the only things that affect breast milk composition. Therefore the mother does not have to worry about giving her baby food that is not safe. Breast milk can never be contaminated with pesticides or other chemicals, and the mothers breasts are far less affected by bacteria (5). There are very few worries about the child developing an allergy; no baby is allergic to breast milk. However, some babies can have a reaction to something from the maternal diet, but this can easily be monitored (5). With breastfeeding, the mother does not have to worry about preparing formula, wondering if the bottle is clean enough, or if she even has time to prepare one. Breastfeeding can be convenient in

Paige Owens 18 March 2010 NTR 302 this way, no worries about washing the bottles, preparing the correct amount in a clean bottle, or heating the formula to a suitable temperature (5). Breast milk is always fresh and ready, at the right temperature and the same consistency, so the mother doesnt have to worry about over heating or dilution (5). No mistakes can be made in its preparation. If a mother travels with her baby, she does not have to worry about packing formula, bottles, nipples, or pacifiers. She never has to worry about how the baby will get his food; as long as the mother is close the baby will be provided for (5). The mother also does not have to worry about taking her baby to the doctor as often. Never breastfed infants have an excess of care for lower respiratory tract illness, otitis media, and gastrointestinal disease compared to infants breastfed for at least 3 months. Each 1000 never breastfed infants has 2033 more sick care visits, 212 days of hospitalization, and 609 more prescriptions, (2). Breastfeeding can be socioeconomically and environmentally gratifying as well. From the socioeconomic stand point, it is less expensive. The small amount of extra food that the mother will need to consume is far less than formula costs (5, 7). If a mother is breastfeeding her child, this can also reduce the cost of health care (7). On the environmental side, far less waste is produced with breast milk. There is no usage of disposables, or even throwing out nipples and bottles (5, 7). With formula feeding, bottles, nipples, and pacifiers constantly have to be cleaned and sanitized, using up much water and soaps (5). The formula that the baby does not want is usually discarded, wasting more water. With breastfeeding, there is no extra waste of energy or water wastes to wash bottles, or discard unwanted milk (5, 7). After a mother knows the benefits and decides to breast feed her child she will need to know how to begin. The first feeding should occur immediately after birth, and within the first hour. Nursing within the first hour takes advantage of the newborns wakefulness. After this first period of alertness,

Paige Owens 18 March 2010 NTR 302 the baby will sleep for much of the next 24 hours, and it may become difficult to get the baby to latch on (8). The first milk that the baby will be receiving is called colosturm, which is usually thick and yellowish. Colostrum will flow very slowly and the baby will only drink about 2 to 10 ml in the first 2-3 days. But colostum is very nutrient dense, providing the baby with 580-700 kilocalories/L so the baby is getting plenty to eat (2, 8). After the initial feeding the mother needs to recognize the signs that the baby is hungry. Some hunger signs include: moving the head from side to side, opening the mouth, sticking out tongue, putting hands in mouth, puckering lips as if to suck, nuzzling toward the breast and showing the rooting reflex (where a baby moves it mouth in the direction of something that is stroking or touching its cheek (8). Crying is a late sign of hunger and the mother should not wait until the baby is crying to feed him. When the baby is showing these hunger signs, it is important for the mother to make sure that the baby is latched on correctly, held correctly, and is on the breast long enough. There are four different nursing positions that the mother can try. They are: the cradle hold, where the mother holds the baby across the chest and supports the baby with the arm on the same side as the nursing breast, the clutch or football hold, where the baby is held at the mothers side and is supported by the arm on the same side, the cross-cradle or crossover hold, similar to the cradle hold, but the baby is supported by the opposite arm, and lastly the side-lying position, where the mother lies on her side facing the baby (2, 4, 8). The duration of nursing averages to about 10 to 15 minutes on each breast (2, 8), the mother should pay close attention to make sure that the baby is sucking and swallowing correctly. When the baby is finished eating he will let you know. Some of the signs the baby will show are slow, uninterested sucking, and turning away from the breast (8).

Paige Owens 18 March 2010 NTR 302 With breastfeeding, there is no way of measuring how much a baby is ingesting. So the mother must look for the signs of adequate intake. These signs can be found in the amount of stools and wet diapers, signs of satisfaction, weight gain, and sleep patterns. The breastfed infant should have three to five loose, yellow stools per day, and four to six or more wet diapers after about the first week of life; digestive expenditures are usually lower during the first week (1, 3-5). Weight gain should be steady, though it may fluctuate; in the first month, the child will gain four to six ounces a day. This rate will increase to six to eight ounces per day during the next three months (1, 5). Growth charts are used to access whether the baby is growing properly; weight length and head circumference are measured and placed on the chart. The child is considered a healthy weight if he falls between the 10th and 90th percentile on the chart (2). Some of the signs of satisfaction are: when the baby is awake, he is alert and calm, he is not fussy or crying, and when he sleeps well (1, 3). Although breast milk is produced upon demand, the baby should not go more than four hours without a feeding (1). The mother is recommended to feed her child every three to four hours, even if he is sleeping. Most nutrients, vitamins, and minerals are adequate enough in the maternal diet, and are passed along to the child, therefore, very few supplements are needed for the breast fed infant. However, occasionally, they are needed, depending on the maternal diet. If the mother is a vegetarian or vegan, for example, the baby will need to supplement folic acid, zinc, vitamin B12, vitamin D, and iron (2). All breast infants may need vitamin D, especially if the baby stay indoors a lot and is not exposed to the sun. Although it is synthesized by the skin from sun exposure, there is a slight risk of skin damage or sunburn. Just getting the infant in the sun for a few minutes a day should supply her with adequate levels. However, for mothers who do not want to take the risk supplementation is advised. Vitamin D is

Paige Owens 18 March 2010 NTR 302 very important for growth and development, and is recommended to be supplemented by 2 months of age (1, 2, 5). Vitamins A and C may also need to be supplemented through the first year of life, if the mother is not consuming plenty of fruits and vegetables. Even so, these vitamins may be prescribed by a pediatrician as a precaution (5). Iron supplementation for breastfed infants is recommended by the American Academy of Pediatrics because the infants that do not receive plenty of iron are more likely to become anemic between the ages of eight and twelve (5). This supplementation may not be necessarily needed, however. Although iron is present in both human and cows milk in small quantities (0.5 to 1 ml), the healthy breastfeeding infant of a mother who maintained a reasonable adequate diet during pregnancy rarely needs iron supplementation before 6 months of age, (4). This argument is supported by two main facts. First, iron stores are ample at birth and do not deplete until four to six months of life, by that time the child should be receiving iron fortified solid foods. Second the high levels of lactose and vitamin C in breast milk facilitate a higher absorption of iron in the infant (4). Breastfeeding is very rewarding for a mother and her child, in addition to being socioeconomically favorable and helpful toward the environment. After the mother has decided to breastfeed her infant, she needs to recognize the hunger and satiety signs. She also needs to know when and how to feed her baby properly, and for how long. Though formulas are manufactured imitate breast milk, their compositions do not purely match. Breastfeeding is the way best way to nourish an infant, the benefits are substantial.

Paige Owens 18 March 2010 NTR 302 References: 1. Nemours Foundation, Kids Health. Feeding your newborn. 2008. Available at: http://kidshealth.org/parent/growth/feeding/feednewborn.html#. 2008. Accessed March 5 2010. 2. Brown, JE. Nutrition Through the Life Cycle. 3rd ed. United States of America. Thomson Wadsworth. 2008. 160-169, 241 3. Riordan, J. Breastfeeding and Human Lactation. 3rd ed. Sudbury, Massachusetts. Jones and Bartlett Publishers. 2005. 97, 218-219, 463-464. 4. Riordan, J. A Practical Guide to Breast feeding. Boston, Massachusetts. Jones and Bartlett Publishers. 1991. 31. 5. Olds, SW, Eiger, MS. The Complete Book of Breastfeeding. New York. Workman Publishing Company, Inc. 1972. 2-15, 104-105, 141, 168, 176, 178. 6. National Institute of Child Health and Human Development: Womens Health Research: Pregnancy and Birth-Breastfeeding. Research on breastfeeding. 2006. Available at: http://www.nichd.nih.gov/womenshealth/research/pregbirth/breastfeed.cfm. Accessed March 5, 2010. 7. Cadwell, K, ed. Reclaiming Breastfeeding for the United States. Sudbury, Massachusetts. Jones and Bartlett Publishers. 2002. 11-13. 8. Nemours Foundation, Kids Health. Breastfeeding FAQs: getting started. 2008. Available at: http://kidshealth.org/parent/pregnancy_newborn/breastfeed/breastfeed_starting.html#. Accessed March 5, 2010.