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Modified cows milk was first manufactured at the end of the 19th century. Subsequently breastfeeding rates started to fall, reaching an all time low in developed countries in the 1960s. Worldwide, exclusive breastfeeding seemed to rise during the 1990s.
(Hoddinott, Tappin & Wright, 2008)
INDONESIA
WHY?
PHYSIOLOGY OF LACTATION
formation of lobules
PHYSIOLOGY OF LACTATION
Lactation during pregnancy is inhibited by high levels of estrogen and progesterone, which inhibit the release of prolactin and interfere with the action of prolactin at the alveolar cell receptor level. As the estrogen and progesterone decline abruptly in the postpartum period, the anterior pituitary gland releases very large amounts of prolactin, which stimulates the alveoli to produce significant amounts of milk. Milk flow commences usually within 48-96 hours.
(CME Journal of Tropical Pediatrics, 2012; Leung & Sauve, 2005)
PHYSIOLOGY OF LACTATION
(Fox, 2004)
PHYSIOLOGY OF LACTATION
Endocrine control is supplanted by autocrine control as the mother's baseline levels of prolactin return to more normal levels at about three months postpartum. At this time, it is the removal of milk from the breast that maintains the supply of milk.
The more the mother empties her breast, the more milk is produced.
BENEFITS
BENEFITS
Nutritional Considerations Immunological and Anti-infective Advantages Prevention of Allergies
Prevention of Obesity
Prevention of Hypertension
NUTRITIONAL CONSIDERATIONS
Human milk contains the appropriate proportions of protein, carbohydrates, fat, minerals and vitamins for optimal growth, with the exception of vitamins D and K. Although human milk has only a small amount of iron (0.3 mg/L to 1 mg/L), iron in human milk is highly bioavailable approximately 50% of the iron in the human milk is absorbed, compared to about 10% of that in whole cow's milk.
cellular humoral
immungolobulins, lysozyme, nucleotides, lactoferrin, complements, bifidus factor, interferon, lactoperoxidase, oligosaccharides, vitamin B12 binding protein and epidermal growth factor.
(Leung & Sauve, 2005)
PREVENTION OF ALLERGIES
Breastfeeding protects against the development of allergy by several mechanisms (Leung & Sauve, 2005): 1. Colostrum
preventing the entrance of large foreign proteins
prevents the adherence of pathogens
PREVENTION OF ALLERGIES
2. Maternal IgA
Mother IgA passively transferred to the infant protecting the infant's gastrointestinal tract from absorbing antigens stimulates IgA synthesis in the infant
(thevisualMD.com)
when formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached
Supplementation of the Breastfed Baby Just One Bottle Wont Hurt--or Will It?
Marsha Walker, RN, IBCLC
PREVENTION OF OBESITY
Breastfeeding reduces the risk of childhood overweight and obesity. Childhood obesity may persist into adult obesity with associated morbidity, such as type-2 diabetes mellitus, hypertension and hypercholesterolemia.
PREVENTION OF HYPERTENSION
There is evidence that breastfeeding may protect against high blood pressure in later life. Martin et al. found that for every three months of breastfeeding ~ 0.2-mm Hg reduction in systolic blood pressure. The reduction in blood pressure, though small, is significant and may have important public health implications.
Adherence to WHOs International Code of Marketing of Breast-milk Substitutes is also important in both developing and developed countries.
Scope: infant formula other milk products cereals for infants vegetable mixes baby teas / juices follow-up milks (also feeding bottles, teats)
No advertising of above products to the public. No free samples to mothers, their families or health workers. Health care facilities: No promotion of products, i.e. no product displays, posters or distribution of promotional materials. No free or low-cost supplies of breastmilk substitutes to any part of the health care system. Product labels must clearly state the superiority of breastfeeding, the need for the advice of a health worker and a warning about health hazards. No pictures of infants, or other pictures or text idealising the use of infant formula.
POLICY IN INDONESIA
Konvensi Hak Anak, diratifikasi oleh Keppres No. 36/1990 UUD Pasal 27 ayat 2, Pasal 28B ayat (2) UU No.13/2003 tentang Ketenagakerjaan Pasal 82 ayat (1), Pasal 83 UU No. 23/2002 tentang Perlindungan Anak Pasal 22 UU No. 49 tahun 1999 tentang Hak Asasi Manusia, Pasal 49 ayat (2) PP NO. 69/1999 tentang LABEL DAN IKLAN PANGAN Pasal 44 (1) Pasal 47 (4) Pasal 51 UU No 36/2009 tentang KESEHATAN Pasal 128 Pasal 129 KEPMENKES NO 450/MENKES/SK/VI/2004 Tentang Pemberian ASI Secara Eksklusif di Indonesia KEPMENKES NO 237/MENKES/SK/1997 Tentang Pemasaran Pengganti Air Susu Ibu
Peraturan Bersama Menteri Negara Pemberdayaan Perempuan, Menteri Tenaga Kerja dan Transmigrasi dan Meteri Kesehatan No 48/MEN.PP/XII/2008, PER.27/MEN/XII/2008 dan 1177/MENKES/PB/XII/2008 tahun 2008 tentang Peningkatan Pemberian Air Susu Ibu Selama Waktu Kerja di Tempat Kerja
Peraturan Kepala Badan Pengawas Obat dan Makanan Republik Indonesia No. HK. OO.O5.1.52.3572 tgl 10 Juli 2008 tentang Penambahan Zat Gizi dan Non Gizi dalam Produk Pangan
Keputusan Kepala Dinas Kesehatan Provinsi Daerah Khusus Ibukota Jakarta No. 435/2008 tentang Pemberian Asi Secara Dini (Inisiasi Menyusu Dini) Bagi Ibu Melahirkan di Provinsi Daerah Khusus Ibukota Jakarta
Peraturan Kepala Badan Pengawas Obat dan Makanan Republik Indonesia No. HK.00.05.52.0085 tentang Pengelompokan Produk Formula Bayi dan Formula Lanjutan
Perda Kabupaten Klaten No. 7/2008 tentang Inisiasi Menyusu Dini dan Air Susu Ibu Eksklusif
Peraturan Menteri Negara Pemberdayaan Perempuan dan Perlindungan Anak Republik Indonesia No 03 Tahun 2010 tentang Penerapan Sepuluh Langkah Menuju Keberhasilan Menyusui
(AIMI, 2010)
WHAT IF..?
Nutrition
(Hoddinott, Tappin & Wright, 2008)
GROWTH CHARTS
1977 GROWTH CHARTS Based on a study conducted in Ohio from 1929 to 1975: were primarily fed formula or a combination of breastmilk and formula often started solids before 4 months Not a reliable indicator of the growth of children who: are breastfed only
THE WHO MULTICENTRE GROWTH REFERENCE STUDY (MGRS) Undertaken between 1997 and 2003, approximately 8500 children from widely different ethnic backgrounds & cultural settings (Brazil, Ghana, India, Norway, Oman and the USA) to provide a single international standard that represents the best description of physiological growth for all children from birth to five years of age
to establish the breastfed infant as the normative model for growth and development
(WHO, 2010)
NUTRITION
A varied and balanced diet is recommended to sustain breast feeding. Little vitamin D is secreted into breast milk, and NICE recommends supplements for all pregnant and breastfeeding mothers. Recommendations about supplements vary between countries.
SUMMARY
The best option is exclusive breast feeding for six months, with no solids or other fluids, and supplemental breast feeding for two years or more Breast feeding has important health benefits, including reduced risk of infection in babies, potential long term health benefits in childrenreduced blood pressure, cholesterol concentrations, and obesity Promote, protect, and support breastfeeding New WHO growth charts will establish the breastfed infant as the biological norm with which all children should be compared and will be applicable to all ethnic groups
REFERENCES
Anderson JW, Johnstone BM, Remley DT. 1999. Breast-feeding and cognitive development: a meta analysis. Am J Clin Nutr 70:525-35 [abstrak]. Asosiasi Ibu Menyusui Indonesia (AIMI). 2010. Rangkuman Peraturan Perundangan di Indonesia Menyangkut ASI. http://aimi-asi.org/peraturan [diakses pada 25/10/2012: 14.00 WIB]. CME Journal of Tropical Pediatrics. 2012. Mother and Child Nutrition in the Tropics and Subtropics, Chapter 5 Breast Feeding. http://www.oxfordjournals.org/our_journals/tropej/online/mcnts_chap5.pdf [diakses pada 25/10/2012: 13.00 WIB] Fox, SI. 2004. Human Physiology, 8th Edition. McGraw Hill. Hoddinott P, Tappin D, Wright C. 2008. Breast feeding. BMJ 336:881-7. Leung AKC, Sauve RS. 2005. Breast Is Best for Babies. J NatI Med Assoc 97:1010-1019.
Mortensen EL, Michaelsen KF, Sanders SA, et al. The association between duration of breastfeeding and adult intelligence JAMA. 2002;287:2365-2371 [abstrak].
World Health Organization. 2010. Guidelines on HIV and infant feeding. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. WHO, Geneva.
THANK YOU
Sundari Indah Wiyasihati