BREASTFEEDING 8.

Prevents dental carries (usually in upper central

Dr. Carmona incisors)
June 17, 2013  In bottle feeding, there is prolonged contact
MunsTHREEfic between sugar and the enamel of the baby,
increasing the risk of dental carries. In breast
A. ADVANTAGES OF BREASTFEEDING feeding, there is no pooling of the milk on the
1. Breast milk provides the necessary nutrients in the teeth
proper quality and quantity to sustain the metabolic  Baby’s bottle syndrome - the rapid decay of
needs of the infant. baby teeth in an infant or child from frequent
2. Anti-infective properties of breast milk are universally exposure, for long periods of time, to liquids
proven and accepted. containing sugars.
 Antibodies from colostrum (substance 9. Economical, safe, available, convenient and at the
present during the early secretion of breast right temperature
milk, usually for the first 3 days)
 Antibodies offer protection against certain B. COMPOSITION OF MATURE HUMAN MILK AND
bacteria like E. coli COW’S MILK
 High lactose in human milk stimulates growth Composition Human Milk Cow’s Milk
of Lactobacillus bifidus, which inhibits growth Water (ml/100ml) 87.1 87.2
of pathogenic bacteria (usual causes of Caloric Density 20 cal/oz 20 cal/oz
diarrhea) Protein (g/100 ml) 1.1 3.5
 Lysozymes are bacteriostatic against Casein (% protein) 40 82
Enterobacteriaceae and Staphylococcus sp. Whey proteins – 60 18
 Promotes colonization of species specific nice stools
nonpathogenic intestinal flora Alpha 2.6 g/L 1.1 g/L
3. Prevents hypersensitivity or allergy lactalbumin -
 IgA in breast milk protects the intestinal Lactoferrin – 1.7 Traces
mucosa from absorbing allergens into the anti-diarrhea
blood stream d/t Fe binding =
 Families with a strong history of ↓Fe for Ecoli
hypersensitivity may have had transient IgA Beta --- 3.6
deficiency lactoglobulin -
4. Psychological advantages allergen
 Mother’s desire is fulfilled Lactose (g/ 100 ml) 6.8 4.9
 Babies feel secure Fat Balanced More
 Mothers are efficient in what they are doing unsaturated saturated
because their infants are healthy and saturated FA
5. Helps in earlier involution of the uterus Iron Efficient
 ↑prolactin and ↓estrogen despite normal or absorption
high levels of gonadotropic hormones which  Proteins – lower protein content is suitable to human
inhibits ovulation infant; lower solute load to the infant’s immature
6. Has contraceptive effects kidney
 The mother must be exclusively breastfeeding  High whey protein – remains in the solution after
for 4-6 months for this to be effective digestion, hence, protein curd in the infant’s stomach
 The increase in prolactin secretion during is smaller, softer and flocculent; efficient and faster
breastfeeding checks estrogen secretion. digestibility and more completed digestion
 Promotes spacing between babies.  Alpha lactalbumin – predominant whey protein in
7. Protective against necrotizing enterocolitis and otitis human milk
media (due to the presence of IgA)  Beta lactoglobulin – predominant whey protein in
cow’s milk; hyperallergenic; can still be secreted in

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 breast milk if the mother is drinking cow’s milk in high b. External structures of the human breast
amount and could still lead to allergy
 Lactoferrin – has been suggested to contribute to
marked resistance against diarrhea in breastfed
infants
- Bacteriostatic – binds with iron and therefore
deprives e. coli of Iron that they need in order to
survive
 Lactose
- Promotes absorption of calcium, magnesium and
protein
- Promotes the growth of intestinal bacteria that
are able to synthesize B complex vitamins
- The stool flora is fermentative rather than
putrefactive in the presence of lactose
C. ANATOMY OF THE BREAST
a. Pathway of milk:
From lobules → ducts → lactiferous sinuses which serve
as reservoir (found behind areola) → pores in the nipple
(during let down reflex)
 Nipple
 Areola
 Glands of Montgomery
– oil and sweat secreting glands around the
areola; softens the nipple for protection; kills
microorganisms
c. Internal Structures
 Fatty tissues
 Connective tissues
 Glandular tissues
d. Functions
 Each breast has a mammary gland, a modified
sudoriferous (sweat) gland that produces milk
 Mammary gland - consists of 15 to 20 lobes, or
compartments, separated by a variable amount of
adipose tissue.
 Lobules - compartments composed of alveoli
embedded in connective tissue.
 Alveoli - grapelike clusters of milk-secreting
glands which is made of:
a. Milk secreting/acinar cells - produce the milk
b. Myoepithelial cells- contracts when
breastfeeding starts, causing the expulsion of
milk into the ducts
 Near the nipple, the mammary ducts expand to
form sinuses called lactiferous sinuses, where
some milk may be stored before draining into a
lactiferous duct.
e. Hormones involved
 Estrogen – duct system and increase fat
deposition resulting in enlargement of the breast
 Progesterone – glandular tissue resulting in the
development of alveoli of secretory cells in
preparation for milk production
The size of the breast does not affect its capacity
to produce milk.
D. PHYSIOLOGY OF LACTATION
2 Key reflexes in lactation:
1. Prolactin reflex – stimuli is the sucking of the breast
 During breastfeeding, signals are sent to the
hypothalamus → ANTERIOR pituitary gland
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 stimulation → prolactin secretion → stimulate
acinar cells → milk production
2. Let down reflex - activated even without sucking of
breast; the mere thought of the mother of the baby
can bring about this reflex
 Simultaneously, the signals sent to the
hypothalamus → stimulates POSTERIOR pituitary
gland → release oxytocin → contraction of
myoepithelial cells → letdown reflex
Both breasts should be used alternately. If only
one breast is emptied while the other is allowed
to congest, there is inhibition of prolactin reflex
so that the period of lactation is shortened
E. MANAGEMENT OF BREASTFEEDING
1. Preparing for breastfeeding:
 for normal nipples, toughen the nipples to
eliminate the chances of nipples being sore during
breastfeeding
-pull nipples gently in all directions
-wear loose clothing
 for flat or inverted nipples:
Hoffman maneuver- both thumbs on the side of
the nipple, pull gently outwards
2. Start of breastfeeding:
-put baby to the breast as soon as possible after
delivery
-feed colostrums
-help the baby suck utilizing rooting, sucking and
swallowing reflex
“Fore” milk “Hind” milk
st
1 milk expressed Last milk obtained at
during nursing period end of feeding
Clear, thin, bluish color Thick, creamy white
↓fat ↑water content ↑fat (highest at day,
lowest at night)
3. Techniques of breastfeeding:
 should be done in comfortable position-lying,
sitting or football position
 frequent feeding
 let baby suck on demand
 pure bf for 4-6 months for the contraceptive
effect to take place as well
 cleanliness is important - bathing once a day is
enough cleanliness (no need for soap and water
since the drop of milk at the breast is
bacteriostatic)
Expressed breast milk can be collected by hand or by
breast pump. Can be stored for 4 hours (clay pot with cold
water), 24 hours (fridge) to 3 months (freezer). Store
separately every extraction in a sterile, numbered
container.
When the baby is fed with rubber nipple first, it may lead
to “nipple confusion” since the rubber nipple is easier to
suck
Stool of breastfed infants is softer, smaller and sweeter
smelling than stool of formula-fed infants; digestion is
more efficient and more complete.
F. CONTRAINDICATIONS OF BREASTFEEDING
 Baby – if with galactosemia
 Mother – if with severe psychosis, severe
infections
 Viruses secreted in milk:
 HIV: if mom is a known carrier or has HIV
infection, she is NOT prohibited to let the
baby breastfeed especially if the family is very
poor and could not afford substitute milk
 Cytomegalovirus: does not affect term babies
significantly, but preterm babies may be
affected
 Rubella
 Hepatitis B: if mom is known to have Hepa B,
give hepatitis B immunoglobulin within 12
hours so baby can be immunized and can be
breastfed
 Herpes simplex – breastfeeding is
contraindicated
 Human Lymphotrophic Virus: Not a common
condition
Cleft lip / palate are NOT a contraindication!
G. INTEGRATED MANAGEMENT OF CHILDHOOD
ILLNESSES (IMCI)
Recognizing good attachment and good positioning
Signs of good attachment:
 Infant’s chin should touch the breast
 mouth should be wide open
 lower lip turn outward
 more areola showing above
Signs of good positioning:
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  infant’s head and body should be straight
 infant’s head and body facing breast
 infant’s body close to the mother
 mother is supporting infant’s entire body

Signs of effective sucking:

 slow deep sucks
 may pause occasionally
 the mother should allow the baby to finish the
feeding and let the infant release the breast itself
 infant is satisfied after the feeding
 if the mother wants to be released from the
feeding, just hold back a little and allow air in
between breast and infant’s mouth and the baby
will just release

REFERENCES according to Doc:

 del Mundo
 Nelson
 Atria and Silverman

REMINDERS:
2 exams on Monday from Dr. Carmona!
 PE and history taking of newborn
 Breast feeding