1. l Lactation hormones l Nature and composition of human milk »types »nutrient composition l Nutrition during lactation l Breastfeeding »advantages »incidence l Common problems »counseling »food programs Lactation

2. Hormones of Lactation l ________ from anterior pituitary »stimulates »inhibits l ________ from posterior pituitary »is stimulated by __________ »stimulates contraction of myoepithelial cells »promotes l Let-down is also influenced by mother’s ________ and ___________

3. Milk in general l Composition of milk depends on ____________ l Human milk is relatively __________ and low in ________________ so… »“assumes” that infants will _____________ »need ________ feeding »have __________ of growth

4. Milk in general l __________ of human milk: ______ to over ________ »________ does not hurt output »_______________ does »_______ affected before ______

5. Types of Milk: Stage I = Preterm l lower in l higher in l high in l supplement with kcal, __________________

6. Types of Milk: Stage II l ___________: 0 to 3-6 days »yellowish »high carotene, vitamin A, electrolytes »high ______ (2%), which is full of »low ______ (67/dl), ________ l Transitional: _________ days »shift in CHO, fat, protein (1.5%)

7. Term Milk: 10 days to weaning l kcal: ____/dl l protein: ___% (.8 to.9 g/dl) l carbohydrate: ~__% l lipids: slow increase from _____% »90% triglycerides »carnitine »lipases »high in _____________ l ____milk differs from ____milk

8. Fatty Acids in Human Milk l ______ in linoleic acid (ω-6), linolenic acid (ω-3) l ____ in AA (ω-6), __________ (ω- 3 fatty acids) »AA needed for growth »DHA incorporated into ______________________ »structural integrity of the retina »early visual responses and visual _________ »neural membranes and flexible synapses l lack associated with ___________ in young children

9. Protein in Term Human Milk l caseins l whey »___________, ___________ l ________, hormones l high in __________ l ideal ________ content »low in methionine, high in cystine »low in phenylalanine and tyrosine »rich in taurine –bile acid formation/digestion –brain development?

10. CHO in Term Human Milk l NOT reflective of mother’s diet l high in »provides »stimulates “good” bacteria »inhibits “bad” bacteria »helps ____ absorption l other CHO: »glucose, galactose, oligosaccharides

11. Vitamins in Human Milk l ________-soluble vitamins: »good source of _________ »relatively high in _________ »low in ________; supplement if low sun exposure »give shots of ________ at birth l ________-soluble vitamins: generally reflective of mother’s intake (to a plateau point) »infant acts as parasite for _______ »vitamin B6 reflects mother’s status, but is still _____ »_________ is concern for vegetarian mothers

12. Minerals in Human Milk l high in ___________ l low in l F from water or supplements l Iodine deficiencies known l ____ absorption is __% (vs. __% from cow’s milk and ___% from formula) »infant has sufficient stores for ___ months l ____ bioavailability is __% vs. __% from cow’s milk or from formula

13. Resistance Factors in Human Milk l Bifidus factor: polysaccharide that encourages growth of Lactobacillus bifidus l Immunoglobulins: provide resistance against GI tract infections, etc. l Lysozyme: ____________ enzyme l B-12 binding protein: makes V. B12 unavailable to bacteria l Lactoferrin: ____-binding protein

14. l Lactoperoxidase: protection against streptococci l Prostaglandins: hormone- like __________; protect integrity of GI tract l Complement: immune system proteins l Lymphocytes: synthesize IgA l Macrophages: immune cells that engulf bacteria Resistance Factors in Human Milk

15. Possible Contaminants in Human Milk l Medicines l Aspirin l Penicillin/ antibiotics l Laxatives l Street drugs l Smoking SubstanceRisks

16. Minimizing medicine exposure l ____% of maternal dose will enter milk (less will be absorbed by infant) l Strategies include: »use _______ forms »schedule to minimize transfer to milk »use form less likely to be »watch for ___________

17. l Pesticide residues, PCBs, DDT, heavy metals l AIDS virus Substance Risks Possible Contaminants in Human Milk

18. l Caffeine l Alcohol SubstanceRisks Possible Contaminants in Human Milk These are found in human milk in amounts similar to amounts in the mother’s blood

19. Nutrition during Lactation l Lactation vs. pregnancy l Energy: from fat stores and from diet; l Protein:

20. Nutrition during Lactation l Milk reflects mother’s intake: l Of concern for mother: l Of concern for restricted eaters:

21. Advantages of Breastfeeding for Baby l ________________ l Automatically ________ l __________ properties l ____________ »diarrhea »Type I diabetes, respiratory diseases »celiac disease, Crohn’s disease? l risk for l Promotes better

22. l risk of ___________ l _____ growth past 3-4 months l Best fatty acids for l *__________* »hormonal “mothering” response? »feeling of security for infant Advantages of Breastfeeding for Baby

23. l *Bonding*--emotional ties l Maternal __________ l Necessitates ________ l Ease and ___________ l Recovery from pregnancy l risk of cancer: l Improved ____________ l ________: personal, society, environment Advantages for Mother

24. The Decision to Breastfeed: Concerns l Sufficient __________ »breast size does not matter »weight gain: growth chart l ________ of milk l Schedule: l Pain: nipple soreness –feed on demand –avoid soap, alcohol- and petroleum-based creams –vary feeding position –don’t allow baby to suck after feeding –air dry as much as possible

25. Judging Adequacy of Intake l Frequency of _________ »_____ times/day for newborn l Frequency of ___________ l Weight gain

26. l Engorgement; leaking l Poor let-down: l Clogged milk ducts: l Illness: colds, flu, mastitis... l Necessary separations »safe storage of milk –refrigerator ________ –freezer _________ –don’t heat by microwave! The Decision to Breastfeed: Concerns

27. Contraindications to Breastfeeding l Genetic diseases »_____________ »PKU? l AIDS l Addictions: alcohol, drugs l Maternal _________ l ________ diseases that warrant mother’s isolation l Need for _______ treatment; contraindicated _________ l Environment:

28. Table 6-6, p. 178

29. Recommendations for Breastfeeding l AAP, APHA, ADA recommend: l National Health Objectives: »increase to___% the women who _________ and to ___% those who continue to _________ l ____ considers breastfeeding promotion a goal l ____ is actively promoting

30. % Babies Breastfed:Ever, by State, 2007 Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey

31. % Babies Breastfed: at 6 months, by State, 2007 Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey

32. % Babies Breastfed: at 12 months, by State, 2007 Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey

33. Incidence of Breastfeeding (CDC, 2003) Newborn 6 Mos. Ethnic groups Total71%32% White 79%44% Black55%24% Asian 72%38% Regional Oregon88%54% Indiana61%28% 72%38% Maternal Marital Status Married77%42% Unmarried58%23% New Jersey Louisiana 46% 16%

34. Why don’t women breastfeed? l Maternal attitude; l Lack of ___________ l Correlates: »# hours worked/day: »introduction of bottle: »lower education, age, income:

35. Incidence of Breastfeeding (CDC, 2007) Total Ethnic groups White Black Asian/Pacific Isl. Maternal Marital Status Married Unmarried Regional Utah Indiana New Jersey Mississippi Newborn 6 Mos. 43% 83%56% 60%28% 78%45% 90%58% 70.5%37.8% 72%42% 82%52% 61%25.5% 52.5% 22.5% 75% http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm accessed 2/20/11