1. Why breastfeeding is important
Alison Taylor
Bournemouth University
2006

2. Intended Learning Outcomes
Define breastfeeding
Discuss the benefits of breastfeeding to the mother, infant, and society as a whole
Describe breastmilk constituents and their function

3. Some definitions Breastfeeding Exclusive breastfeeding
  The infant has received breast milk (direct from the breast or expressed)
Exclusive breastfeeding
The infant has received only breast milk from his/her mother or a wet nurse, or expressed breast milk and no other liquids, or solids with the exception of drops or syrups consisting of vitamins, mineral supplements, or medicines
Unicef 2004

4. Some definitions Predominant breastfeeding – Partial breastfeeding –
most of the baby’s feeds are at the breast but he also receives small amounts of water or water based drinks
Partial breastfeeding –
only some of the baby’s feeds are at the breast and some are artificial feeds such as formula
Unicef 2004

5. Some definitions Bottle feeding Artificial feeding
is giving any drink from a bottle, including expressed breast milk or vitamin preparation
Artificial feeding
describes any feeding with breastmilk substitutes, whether infant formula, dextrose/glucose water or any other substitutes and whether given by tube, spoon or bottle
Unicef 2004

6. So what are the benefits of breastfeeding?
In groups of eight you will be asked to explore the benefits of breastfeeding from a particular angle

7. Benefits of BREASTMILK for the baby
Lower risk of insulin dependent diabetes
Benefits of BREASTMILK for the baby
Less likely to develop childhood cancer
Improved response to immunisation
Lower risk factors associated with cardiovascular disease
Less likely to develop UTI
Protection against gastro-enteritis
Reduces respiratory morbidity
Easy to digest and absorb, human milk best meets an infant’s needs.
Human milk is antiinfective, containing live cells (such as leukocytes and neutrophils), specific antibodies, and numerous antimicrobial factors. As a result, breastfed children have a lower incidence and severity of infectious disease, including otitis media, neonatal septicemia, diarrhea, and respiratory and urinary tract infections
Human milk also stimulates immune system development. Breastfed children produce immune cells sooner than do formula-fed children and respond better to immunizations. One study found that the thymus glands of exclusively breastfed infants were twice as large as those of formula-fed infants. T lymphocytes, which recognize and destroy antigens like bacteria, viruses, and malignant cells, mature in the thymus.
Protection against allergy - IGA in breastmilk coats the baby’s gut and protects against foreign protein leaking through and into blood stream causing allergies
Lower risk factors associated with cardiovascular disease, e.g. obesity, higher cholesterol and raised B/P
Childhood cancers: leukemia, Hodgkin disease, and nonhematologic childhood cancers, Lymphoma
Also noted:
multiple sclerosis and rheumatoid arthritis
ulcerative colitis, inflammatory bowel disease, and celiac disease Crohns disease
Better development especially in preterm infants of brain, CNS, and sight
Less likely to be victims of SIDS
Protection against atopic and allergic disease
Increased cognitive development
Preterm less likely to develop necrotising enterocolitis in preterm infants

8. Possible positive effects on clarity of speech
Benefits of BREASTFEEDING for the baby
Less risk of dental caries
Bonding, where a close loving relationship occurs
Less risk of dental malocclusion
Reduced incidence of otitis media
Bonding, where a close loving relationship occurs, fuelled by the oxytocin release (the love hormone)
Evidence suggests that mothers are less likely to abandon or abuse their babies if they breast feed
Also evidence suggests that they cry less and develop faster if they stay close to their mums and breastfeed from immediately after delivery
The action of breastfeeding helps to develop muscles which keep the eustacian tube open and assist development of the jaw.
This has been shown to have positive outcomes although they may not become apparent until the age of 5-7.
Possible positive effects on clarity of speech

9. Benefits of BREASTFEEDING
FOR THE MOTHER
Higher bone mineral density, less risk of hip fracture
Protection against breast cancer, both pre and post menopausal cancer
Potential psychosocial effects
Breast feeding for at least 3 months can reduce the risk of pre-menopausal cancer by one half
Psychosocial effects enhanced bonding, infant attachment, ///reduction in perceived stress
Protection from ovarian cancer
Delayed resumption of ovulation with increased child spacing
Earlier return of pre-pregnant weight

10. Benefits of BREASTFEEDING FOR THE NATION
Reduces health care costs
Reduction in infant and maternal mortality
A more healthy and intelligent workforce
Reduces health inequalities
Reduces employee absenteeism for care attributed to own or childhood illness
Reduction in healthcare cost include:
More medical visits
Longer hospital stays
More prescriptive drugs
Less waste!
Financial saving to the family and the nation

11. Anti-infective factors of breastmilk
Breastmilk contains white blood cells and a number of anti-infective factors
Breastmilk contains antibodies against infections that the mother has had in the past
The mother’s body is able to manufacture antibodies against new infections with which she comes into contact with
For the first year or so, a baby’s immune system is far from being fully developed and cannot fight infections as well as as that of an older child. Breastfeeding is the natural way to fight against infection.

12. Anti-infective factors of breastmilk
How does ‘Mum’ do this?
She contracts an infection via respiratory or gastrointestinal tract
White cells in her body become active and make antibodies against infection
Some of the white cells travel to her breast and make antibodies there
These are then secreted in her breastmilk to protect her baby
1. Although she may be unaware of this

13. Anti-infective factors of breastmilk
The main immunoglobulin in breastmilk is IgA (often known as ‘secretory’ – SIgA )
For this natural protection from infection to work effectively the ‘Mum’ and baby need to stay near each other at all times
She will then detect organisms in the baby’s environment that may harm his health
It all helps the baby build up a store of antibodies for the future
Immunoglobulin - A general term for antibodies, which bind onto invading organisms, leading to their destruction. There are five classes
The different classes of proteins comprising antibodies, eg IgA, IgG, IgM, & IgE. Each type has a different structure and function. For example, IgA antibodies are found in saliva, tears, respiratory and alimentary tract secretions and protect against viruses and bacteria.
It is different to IG G which is carried in the blood
Ig A IgA is often called ‘secretory’ immunoglobulin.

14. The composition of breastmilk
The composition of breastmilk is uniquely manufactured by the mother for her own baby.
It can therefore vary with
The gestational age of an infant
The stage of lactation
The time of day
The amount of milk taken at each feed

15. Colostrum Is present before delivery and ready when the baby is born
Continues to be produced over next few days
Thicker than breastmilk -yellowish or clear in colour
It provides high-density, low-volume feed in the first few days ideal for newborn
Rich in growth factors helping immature organs to develop quickly after birth
Rich in some vitamins - Sodium, Potassium, Ash, Vitamins A and E, Chloride, and Zinc helps to reduce the severity of infections
Vitamin K is higher in colostrum than mature breastmilk
Lower concentrations of carbohydrate, fat (2%) and water soluble vitamins
Itis available quicker in women who have been pregnant before and especially if they have breastfed.
Ideal for the newborn infant - The baby’s physiologic stomach capacity 4-7mls at birth.
Colostrum is available quicker in women who have been pregnant before and especially if they have breastfed.
It has higher concentrations of antibodies and other anti-infective proteins than mature milk

16. Colostrum Contains high levels of immunoglobulins
Contains high levels of proteins, especially SIgA (80-90%).
Contains more white blood cells than mature milk
Provides baby with ‘first immunisation’ against diseases
Contains at least two antioxidants – protective function
Contributes to the healthy establishment of the bifidus flora in the digestive tract.
Has a protective function - sealing the gut lining to prevent adherence of pathogens
Mild laxative effect, clearing gut of meconium including bilirubin
White blood cells together with anti-infective proteins/immunoglobulins provide first immunisation against diseases that the baby may meet after birth
Antioxidants - natural body chemicals or drugs that reduce oxidative damage, such as that caused by free radicals.
Vit A helps to reduce the severity of infections the baby may have

17. Transitional milk
After hours breasts usually begin to secrete breastmilk
Constituents of colostrum are not immediately lost but diluted.
It is called transitional milk
With an increase in lactose there is also an increase in fluid volume
Lasts days
Then it is called mature milk

18. Constituents of breastmilk
Breastmilk is species-specific
It contains water, fat, protein, carbohydrates, minerals and vitamins
It also contains (but is missing in artificial formula) - hormones, enzymes, growth factors, essential fatty acids, immunological and non specific protective factors

19. Constituents - Fats
Principle source of energy - providing up to 50% of the calories
Fat content of colostrum 2%, 2.55% - 3% in transitional milk and 3.5% - 4.5% in mature milk.
98-99% of milk fat are triglycerides
Easily absorbed – combined action of lipases, infants own lingual and gastric lipases, and one found in human milk alone called (BSSL) bile–salt-stimulating lipase
Lipases break down long chain fatty acids and triglycerides into free fatty acids and glycerol.
Easily absorbed by a combined action of several lipases
Lipase -enzyme that breaks down fats BSSL bile-salt-stimulated lipase
The first part of a feed contains high levels of protein,lactose and water, but is low in fat. As the feed progresses the fat content rises, milk taken at end of feed may be very high in calories.
Level of fat changes during a feed, frequency of feeds and during 24 hour period.

20. Constituents - Fats
Needed for brain development, essential part of cell membranes, healthy blood vessels, eyes.
Cholesterol - essential for all membranes, and essential constituent of brain tissue and myelin sheath. Little or none in AF.
Fat levels gradually increase during a feed, turning the milk from a bluish watery appearance to creamier, whiter thicker more dense liquid – known as ‘the hind milk’
Levels of fat also vary with frequency of feeds and over 24 hour period.
Smoking decreases the fat content of milk

21. Constituents - Proteins
Total protein in mature milk is % the lowest for all mammals and a large proportion of this are immune factors
Whey to Casein ratio varies from 90:10 in early lactation to 60:40 in mature milk and 50:50 in late lactation.
Casein in human milk forms soft curds, easy to digest
Softer than the curds that are formed from protein in cows milk which is thick and indigestable
Helping to protect the baby from infection.
This is because the human grows slowly compared to other mammals
Babies fed on artificial formula may develop intolerance to proteins from animal milk developing diarrhoea, wheeze, rashes and other allergic type reactions. Also thought to increase chance of juvenile onset diabetes

22. Constituents - Proteins
Whey proteins consist of anti-infective proteins
The anti-infective proteins include
Lactoferrin - binds with iron, prevents growth of bacteria that need iron
Lysozome – kills bacteria
Immunoglobulins – mostly IgA
Breastmilk also contains a protein which can reduce or inhibit milk secretion (FIL)
It protects the breast from the harmful effects of being too full
If breastmilk is removed effectively, the level of FIL falls and more milk is made

23. Constituents - Carbohydrates
Lactose is the main carbohydrate in milk, breaking down into glucose for approx 40% of the baby’s energy needs
It also enhances calcium absorption
Lactase (intestinal enzyme) is needed for digestion of lactose.
Lactase is present by 24 weeks gestation.
Anything that damages the gut lining can cause secondary lactose intolerance
Galactose is also found in milk is used for liver storage to meet future energy needs
Lactose is higher in human milk than any other mammal, reflecting the human baby’s need fro glucose as a source of energy for the brain.
Anything that damages the gut lining can cause secondary lactose intolerance
such as gastroenteritis, food intolerance, coelic disease or antibiotics

24. Constituents - Carbohydrates
Oligosaccharides - stimulate lactobacillus bifidus.
Lactobacillus bifidus maintains an acid environment in the bowel, thus inhibiting the growth of harmful bacteria
Gives breastfed babies’ stool their unique ‘yoghurty’ odour
Also contains small amounts of gycopeptides, fructose

25. Constituents - vitamins
Water soluble vitamins include B complex, C and folic acid
Fat soluble include A,D,E,and K
The higher the fat content the higher the proportion of fat soluble vitamins
Vitamin A important for baby’s sight and reduces severity of infections
What does this mean. Baby needs to feed for as long as he/she wishes in order to gain a fat rich feed

26. Constituents - Minerals
Iron is important for the formation of blood
Breastmilk has relatively low iron content
BUT has a unique ‘bi-available’ digestive process whereby the iron is bound within the lactoferrin molecule.
This makes it easily absorbable AND prevents iron-seeking pathogenic bacteria (e.g. ecoli) attaching causing gut infections.
Levels of sodium, calcium and phosphorous are considered ideal for the term baby.
Absorption is more complete in breastfed babies
Artificial formula has 5-6 times as much iron, and is free iron, not bound within another compound, which means it is not so bio-available, I.e. not so easily absorbed and supports the growth of iron seeking pathogenic bacteria.
Babies exclusively breastfed do get enough iron and giving extra iron supplements may increase the risk of infection!

27. Constituents – water 87% - 90% of breastmilk is water
It has a low electrolyte concentration
The baby has enough free water even on a hot day
All components dissolved, dispersed or suspended in the water

28. Hormones and growth factor
Hormones were first detected in breastmilk in the 1930’s
Hormones are thought to play a critical role in the neonatal adaptation to extra-uterine life.
Growth hormones ( insulin, relaxin)/ adrenal gland hormones (Cortisol) / brain-gut hormones (Somatostatin) / gonodal hormones (oestrogen) and others such as erythropoietin and thyroid stimulating hormone are all present.

29. “ If multinational company developed a product that was a nutritionally balanced and delicious food, a wonder drug that both prevented and treated disease, cost almost nothing to produce and could be delivered in quantities controlled by the consumers needs, the very announcement of their find would send their shares rocketing to the top of the stock market.The scientists who developed the product would win prizes and the wealth and influences of everyone involved would increase dramatically. Women have been producing such a miraculous substance, breastmilk, since the beginning of human existence, yet they form the half of the world’s people who are the least wealthy and the least powerful.” Palmer 1993 p.19.

30. References
Palmer, G The Politics of Breastfeeding. London: Pandora
UNICEF., Breastfeeding management – A modular course. London: Unicef
Riordan, J., Auerbach, K.G., Breastfeeding and Human Lactation. Boston: Jones and Bartlett Publishers