infant and toddler nutrition

Myoepithelial cells contract under the influence of ____ and cause milk to be ejected into the ducts.

oxytocin- hormone produced during letdown that causes milk to be ejected into ducts

composition of milk is to not only nurture but

protect infants from infectious diseases and chronic disease like celiac disease, IBS, diabetes and leukemia

lysozome

protects against enterobacteria and gram-positive bacteria -secreted by neutrophils and macrophages

fat energy content

ranges from 20.9-26.2 cal per oz (65/70kcal / dL)

functional units of the mammary gland are called

the alveoli; they are composed of a cluster cells called secretory cells with a duct in the middle that secretes milk.

Binding proteins in human milk bind iron and vitamin , making

the nutrients unavailable for pathogens to grow in the infant's gastrointestinal tract. Such factors are also responsible for some of the differences in intestinal flora (natural bacteria of the gastrointestinal tract) of breastfed infants versus HMS-fed infants.

What is transcytosis? what is transported and taken into the alveolar cells with this process?

transport of macromolecules across interior of cell. captured in a sac from mother's serum, drawn across a cell and released into milk ducts -proteins; immunoglobulins, hormones, albumin, other plasma proteins

milk fat comes from ___ in mothers blood and from ___ ___ __ produced in the breast becoming fat droplets. These droplets become surrounded by a portion of the cell _____ as they are secreted into the milk duct.

triglycerides new fatty acids membrane

t/f: Comparisons of milk production between mothers of singletons and twins show that the breasts have the capacity to synthesize much more than a singleton infant usually drinks

true

t/f: Infants who are breastfed are thinner for their weight at 8-11 months than infants fed HMS, but these differences disappear by 12-23 months of age and few differences are notable by five years of age

true

t/f: It is rarely necessary to discontinue breastfeeding to manage medical problems or medication use

true

t/f: Milk increases to meet the demand of twins, triplets, or infants and toddlers suckling simultaneously; it can also be increased by pumping the milk

true

t/f: Women may experience tingling or sometimes sharp shooting pain that lasts about a minute and corresponds with contractions in the milk ducts

true

t/f: racial and ethnic disparities in breastfeeding initiation rates remain

true

t/f: Insufficient milk production is a common problem among women who express milk

true -Researchers working with women who pumped their breasts report that 8-12 or more milk expressions per day were necessary to stimulate an adequate production of milk

t/f: Feeding frequency is not consistently related to milk production

true. The rate of milk synthesis is highly variable between breasts and between feedings. However, the amount of milk produced in 24 hours and the total milk withdrawn in that 24-hour period are highly related. Milk synthesis is able to quickly respond to infant demand.

t/f: Women who are able to establish an adequate volume of milk (500 mL per day) in the first two weeks postpartum are more likely to still have enough milk for their infant at 4-5 weeks postpartum

true; This recommendation is consistent with the advice to nurse the infant (or pump) early and often to build a good milk supply

Major class of protein in mature milk from women who deliver at term or preterm

-casein - casein, calcium phosphate, and other ions such as magnesium and citrate appear as an aggregate and are the source of milk's white appearance -digestive products (phosphopeptides) keep calcium in soluble form and facilitate absorption

Vitamin A in milk

-colostrum has twice the concentration of this then mature milk does -some in form of beta-carotene -yellow color in colostrum -amount in mature milk is adequate to meet infant needs for growth and development through 6 mo -infants deficient have increased risk of eye problems, infection, iron deficiency anemia, growth failure -influenced by maternal intake -cochrane review said vitamin A supplementation failed to provide benefits for women or infant

t/f: It is possible that immunological responses could cause unfavorable effects; however, there is no evidence suggesting direct toxicity to the infant (implants)

true; just compression of ducts

trace minerals in milk

-copper, selenium, chromium, manganese, molybdenum, nickel, and fluorine) are present in the human body in small concentrations - essential for growth and development -less known about these and infant health -levels in milk are not altered by mother diet or supplements (except fluoride) -DRI is 0.1 mg daily for infants less than 6 months -fluoride provided in water is safe -most who live in these areas do not need a supplement (vs those who use well or bottled water need a supplement or water with fluoride)

optimal number of expressions for pumping

-differs from women to women (emptying ability and storage capacity)

cholesterol in milk

-essential for cell membranes, growth and replication of cells -varies from 6.5-18.5mg/100mL in milk -varies between women, day to day -breastfed infants have a higher intake of cholesterol (higher serum levels)

DHA in milk

-essential for retinal development -accumulates during last month of pregnancy -important for premature babies since the highest DHA concentrations occur in delivery of preterm infants -influenced by maternal fat intake and fat stores -FDA provides guidance on fish consumption (considers metal content and nutrient in fish) -cod liver oil during pregnancy associated with higher IQ scores at four years of age (cod liver oil contains high levels of DHA, V a and V d)

iron in milk

-exclusively breastfed infants have little risk of anemia (despite low concentration) duration of breastfeeding can affect risk of anemia though -infants breastfed for 6.5 months are less likely to be anemic vs those 5.5 months

what other stimuli causes letdown?

-hearing a baby cry -sexual arousal -thinking about nursing

economy benefits from breastfeeding

-A decrease in medical care for breastfed infants is the primary socioeconomic benefit of breastfeeding -A 2010 study estimated that the United States could have saved $13 billion and 911 lives, mostly infants, if 90 percent of infants were breastfed -companies benefit through lower medical costs and greater employee productivity -A $1 investment in creating a lactation support program provides two to three times the return

breastfeeding and childhood weight:

-Breastfed infants typically are leaner than HMS-fed infants at one year of age without any difference in activity level or development. -potentially due to metabolic programming (leptin, ghrelin) delivered in milk -self-regulation of energy intake or healthy lifestyle of parents -influence usually disappears by age 5

analgesic effects of breastfeeding

-Breastfeeding during venipuncture seems to reduce infant pain as well as a 30 percent glucose solution followed by pacifier use -Breastfeeding may be used to comfort infants during minor invasive procedures

immunological benefits of breastmilk

-Cells (T- and B-lymphocytes), secretory immunoglobins (sIgA, sIgG, sIgM, sIgE, sIgD), histocompatibility antigens, T-cell products, many nonspecific factors (complement, bifidus factor), carrier proteins (lactoferrin, transferring, vitamin -binding protein, and corticoid-binding protein), and enzymes (lysozyme, lipoprotein lipase, leukocyte enzymes) are components of milk that confer immunological benefits.

milk supply and demand

-The breast responds to the degree of emptying during a feeding, and this response is a link between maternal milk supply and infant demand. Daly proposed that the breast responds to the infant's need by measuring how completely the infant empties the breast (a lot left= low synthesis) -related to a protein called feedback inhibitor of lactation (whey protein that inhibits milk secretion) affects milk quantity only not composition

human milk is changeable by

-a single feeding -over a day -according to the age of the infant -gestation at delivery -presence of infection in the breast -menses -maternal nutrition -geographic location

neutrophils function

-activated and contribute to phagocytosis at the mucosa of infants gastrointestinal tract

unique properties of milk:

-appropriate balance of nutrients; human milk provides optimal nutrition to the infant. -The balance of nutrients in human milk matches human infant requirements for growth and development closely; no other animal milk or HMS meets infant needs as well. -Human milk is isosmotic (of similar ion concentration; in this case, human milk and plasma are of similar ion concentration) and therefore meets the requirements for infants without other forms of food or water. -The relatively low protein content of breast milk compared to cow's milk meets the infant's needs without overloading the immature kidneys with nitrogen. -Whey protein in human milk forms a soft, easily digestible curd. -Human milk provides generous amounts of lipids in the form of essential fatty acids, saturated fatty acids, medium-chain triglycerides, and cholesterol. -Long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), which promotes optimal development of the central nervous system, are present in human milk but are present in only some of the HMS marketed in the United States. -Minerals in breast milk are largely protein bound and balanced to enhance their availability and meet infant needs with minimal demand on maternal reserves.

zinc in milk

-bound to protein and highly available compared to cows milk -zinc intake and requirements decrease after first few months -levels maintained even in face of low maternal intake -rare cases of deficiency cause dermatitis or intractable diaper rash seen in exclusively breastfed infants -defect in mammary gland uptake of zinc is usually the cause of low milk concentration when maternal serum zinc levels are normal; infants here respond to zinc supplements

Lactogenesis stages

-breast milk production 1st lactogenesis 1: begins during last trimester of pregnancy. milk begins to form and lactose and protein content of milk increase extends a few days postpartum 2nd: begins 2-5 days postpartum marked by increased blood flow to M gland onset of copious milk secretion "when milk comes in" significant change in milk composition and quantity delayed is associated with failure to sustain breastfeeding 3rd: begins 10 days postpartum stage where milk composition becomes stable

vitamin D in milk

-calcium absorption and bone metabolism -deficiency in newborns common in breastfed infants; predisposes them to neonatal hypocalcemia and rickets -based on mothers intake -most in form of 25-oH2, D and vitamin D3 -exposure to sun increased D3 level in tenfold -supplement adequacy content not known -infant sunlight exposure is insufficient

bifidus factor

-carb that supports growth of lactobacillus bifidus; probiotic bacterium that stimulates antibody production and enhances phagocytosis of antigens

breastfeeding benefits for mom

-hormonal, physical and psychosocial benefits -increases levels of oxytocin (minimizes maternal postpartum blood loss, helps uterus return to normal size) -ovulation and fertility is delayed during breastfeeding for longer intervals between pregnancies -increased self confidence and bonding with infants -weight loss (or weight gain depending on mother) -women of younger age who nurse for a longer duration can lower their risk of breast and ovarian cancer, rheumatoid arthritis

factors that possibly change energy intake

-human milk vs substitutes -difference in suckling compared to artificial nipple -inability to see the volume of feedings with human milk

taste of human milk

-important taste experience for newborns -flavor often ignored when benefits of milk or composition are considered -slightly sweet -carriers flavors of compounds ingested like mint, garlic, vanilla and alcohol -transfer or flavor is selective and in low amounts -infant responses depend on length of time since mother consumed food, frequency and flavor that mother consumed -infants more interest in milk when new flavors are introduced -Infants nursed at the breast longer if a flavor (garlic) was new to them than if the mother had taken garlic tablets for several days -thus exposing them to a variety of flavors contributes to their interest of consumption of milk and acceptance of new flavors in solid food -breastfeeding duration influences flavor preference at onset of complementary feeding

cognitive benefits of breastfeeding

-increases in cognitive ability associated with breastfeeding are significant even after adjusting for family environment -a study comparing breastfed infants to those fed cows' milk and soy milk-based HMS found all groups scored within normal ranges, but breastfed infants scored slightly higher -higher IQ of infants breastfed for six months appears to be more prevalent among infants born small for gestational age (11 points) than among infants born appropriate weight for age (3 points) -The differences in cognitive function are also greater in premature infants fed human milk than in those fed HMS -due to fatty acid composition and its role in neuropsychological development

dominant carb in human milk is _____. what others are present?

-lactose -monosaccharides like glucose, polysaccharides, oligosaccharides, protein-bound carbohydrates

in pregnancy, what hormones allow further preparation for breastfeeding? which stimulates development of glands that make milk? which allows the tubules to elongate and cells that line the tubules to duplicate?

-luteal and placental hormones -estrogen -progesterone

Women can express milk using several different methods:

-manually -hand pumps -commercial electric pumps -hospital-grade electric

oligosaccharides in milk

-medium-length containing lactose on one end -free or bound to proteins (as glycoproteins) or lipids (glycolipids) or binded to others -conjugated and unconjugated O's are glycans -over 130 different are present in milk -prevent binding of pathogenic microorganisms to the surface receptors of their target cell, preventing infection -innate immune protection in breastfeeding

what is critical for women who suffer from common breastfeeding challanges?

-multilevel (healthcare, community, workplace and family) support

vitamin K in milk

-needed to support development of clotting factors and prevent bleeding in newborns -5 percent of breastfeed infants are at risk for deficiency (based on VK-dependent clotting factors) -they administer this at birth to prevent bleeding since 1961 (high cases of deficiency in those newborns who do not get this)

Health care professionals who wish to manage and promote breastfeeding should understand.... and helping women achieve or maintain appropriate nutritional status to optimize breastfeeding requires consideration of

-physiology of lactation -composition of human milk -benefits to mothers and infants -consideration of energy requirements -weight goals -effects of exercise during breastfeeding -vitamin and mineral supplement needs

vitamin E in milk

-potent antioxidant (protects against oxidative damage and maintains normal neurological structure/function) -total tocopherols in milk related to milk fat content (40 ug of vitamin E per gram of lipid) -alpha-tocopherol concentration decreases from colostrum to transitional and mature milk but beta and gamma tocopherols remain stable through stages -amount in milk adequate to meet needs of full-term infants for muscle and red blood cell integrity -levels of vitamin E in preterm milk are not considered adequate to meet the needs of preterm infants

reduction in chronic illness and breastfeeding

-protects against chronic childhood diseases (celiac, inflammatory bowel disease, diabetes and leukemia) -Risk of asthma, atopic dermatitis, and eczema is reduced among infants with a family history who are breastfed for 3-4 months

T- and B-lymphocytes

-provide protection against organisms in GI tract; this protection may extend beyond acute infection to allergy, necrotizing enterocolitis, tuberculosis, and neonatal meningitis

nonprotein nitrogen in milk

-provides 20-25 percent of nitrogen in milk -urea accounts for 30-50 percent of NN, nucleotides for 20 percent, depending on stage of lactation and diet -some used for producing nonessential amino acids in infant -used to produce other proteins (hormones, growth facts, free amino acids, nucleic acids, nucleotides and carnitine. -role under investigation, but appears to play a role in growth and disease resistance

how to establish a good milk supply in the first month

-putting baby to breast within first half hour or as quickly as possible after birth -encourage rooming so women can feed frequently (10-12 times in 24 hours in first days) -breast pump if seperated -lactation support for positioning of infant and effective feeding (long drawing motion along the jaw and wiggling at the temple) -encourage hydration while nursing -eat well (veggies, fruits, whole grains, lean protein) -both breast are important -nursing for comfort or while fussing -if baby favors one, start at favored breast and move to the other once sucking slows down -skin to skin contact helps infant nurse longer

fewer acute illnesses and breastfeeding

-reduces infant illness in countries w/ high infant illness morbidity and mortality rates, poor sanitation and water supplies -even in the USA -Exclusive breastfeeding for four months is associated with reduced gastrointestinal illness with effects lasting for two months after weaning -Ear infections are 23 percent lower, with a reduction in risk of 50 percent for infants breastfed longer than three months. -risk of hospitalization for lower respiratory infections is 72 percent lower among infants exclusively breastfeed for more than four months

mineral content in milk

-related to growth rate of offspring -much lower than the concentration of cows milk or those animals who infants grow faster -concentration decreases over first 4 months (except magnesium) -lower mineral content easier for kidneys to handle, so it benefits the kidneys human milk package of minerals are very bioavailable infants can use them efficiently so reduces burden to the mother (zinc is 49 percent available In human milk, only 10 percent from cows)

Protein in milk-

-relatively low (0.8-1.0 percent) compared to other mammalian milks -concentration of proteins affected by age of infant, not so much maternal intake -proteins synthesized by breast are more variable due to proteins regulating gene expression -important nutritive and non-nutritive values -digestive products like peptides exhibit a variety of antiviral and antimicrobial effects -enzymes present provide protection in preventing inflammation

whey proteins in milk

-remain soluble in water after casein in precipitated from milk by acid or enzymes -iWhey proteins include milk and serum proteins, enzymes, and immunoglobulins, among others, mineral-, hormone-, or vitamin-binding proteins are also identified as components of whey proteins. (These include lactoferrin, which carries iron in a form that is easy to absorb and can inhibit bacterial growth) The enzymes present in whey proteins aid in digestion and protection against bacteria.

water soluble vitamins in milk

-responsive to content of maternal diet (thiamin, riboflavin, vitamin , vitamin , and choline are) -nourished women usually meet the needs of the infant for these -b12 deficiency is rare but causes long-term neurological deficits (usually a vegan diet or pernicious anemia) -folate is bound to whey protein in human milk; so the content is less influenced by maternal intake

Can Women Breastfeed after Breast Reduction or Augmentation Surgery?

-scare info about this -evidence says breast reduction can cause unsuccessful lactation (lower rates and duration/insufficient supply) -Almost all (91.8 percent) women with prior breast reduction surgery reported problems with breastfeeding -type of surgery, damage to remaining tissue is crucial -incisions on lower part of breast avoid damage to ductal system vs mid breast or periareolar -augmentation causes compression of ducts =poor milk production -Lactation consultants recommend that the surgery date, type, and incision used, as well as prior breastfeeding experience be ascertained. Infants should be closely followed to prompt intervention when needed

trans fatty acids in milk`

-stem from mothers diet so present in milk -lower in women from european and african countries -FDA banned trans fats

what is colostrum?

-the first milk -thick, yellow fluid produced 1-3 days after birth -infants drink 2-10 mL per feeding in first 2-3 days -provides 580-700 kcal -higher in protein and lower in carbs/fat than mature milk -secretory Immunoglobulin A and lactoferrin are primary proteins present (others are not) -mononuclear cell concentration is high (white blood cell) -high concentrations of sodium, potassium, vitamin E, carotenoids and chloride

immunoglobins and breast milk

-transported from maternal plasma across secretory epithelium to become secretory immunoglobins. -predominant (90%) in milk is secretory immunoglobin A (sIgA): this appears to be the most important in terms of the protection conferred to the infant. blocks colonization with pathogens and limits the number of antigens that cross the mucosal barrier. protects against enteroviruses, cytomegalovirus, herpes simplex virus, respiratory syncytial virus, rubella, retrovirus, and rotavirus - sIgM protects against cytomegalovirus, respiratory syncytial virus, and rubella

Human milk kcal content varies with

.65-.70 kcal/mL -fat, lesser degree of protein and carbs

an average of ___ percent of milk is left after feeding; thus

24 short-term milk storage of the breast does not seem to be a limiting factor to infant milk intake

In the developing world, improving breastfeeding practices could prevent more than __ million deaths annually. this is at the center of ____ and ___ joint effort called the Global Strategy for Infant and Young Child Feeding, to remind the international community of the impact of feeding practices (including breastfeeding) on children's health outcomes

one million WHO's UNICEF's

typical milk production is

600 mL per day in first month, 750-800mL per day by 4-5 months can range from 450-1200mL per day in women who nurse one infant -infant weight, caloric density of milk and age contribute to infant demand of milk

average rate of milk synthesis in a day

64 percent

does milk fat vary on the mothers diet?

no; but the fatty acid profile of human milk reflects variation in the mother's dietary fatty acid intake during pregnancy and postpartum. When a mother is losing weight, the fatty acid profile of her mobilized fat stores is reflected in the milk. When mothers eat very low fat diets with adequate calories from carbohydrate and protein, more medium-chain fatty acids are synthesized in the breast

leukocyte function

offers more protection to the breast than immunocompetence of the infant

minerals in human milk contribute to ____ of human milk

osmolality

International standards for human milk substitutes are set by the

Codex Alimentarius Commission of the Food and Agriculture Organization (FAO) of the United Nations and the World Health Organization (WHO)

infection fighting cellular components in breast milk that are high in colostrum and also present for months in mature human milk

macrophages, neutrophils, T- and B-lymphocytes, and epithelial cells -macrophages functions: phagocytosis of fungi and bacteria, killing of bacteria, and production of the complement proteins, lysozyme, and lactoferrin and immunoglobin A and G

Does the Size of the Breast Limit a Woman's Ability to Nurse Her Infant?

NO. variation is due to amount of fat in breast. breast can expand with the ducts. however; women with small breasts can produce the same amount of milk as women with large breasts, although the latter woman may be able to feed her infant less frequently to deliver the same volume of milk compared with a woman with smaller breasts

hormones necessary for establishing and maintaining a milk supply

Prolactin: stimulates milk production suckling stimulates this; doubles it stress, sleep and sex stimulate these levels suppressed by prolactin-inhibiting factor that is release by hypothalamus to allow mothers body to prepare for milk production during last three months of pregnancy actual level of prolactin in blood is not related to the amount of milk made necessary for milk synthesis oxytocin: stimulated by suckling/nipple stimulation main role is. letdown of ejection of milk from acinus into milk ducts also acts on uterus during and after delivery causing contractions, seal blood vessels and shrink in size

T/F: Breastfeeding to any duration and to any extent reduces the risk of sudden infant death syndrome (SIDS)

TRUE; A meta-analysis of 18 studies demonstrated a 60 percent reduction in risk of SIDS with any level of breastfeeding, although the influence was greater with exclusive breastfeeding and greater duration. This analysis suggests that breastfeeding was an independent factor associated with reduction in risk. These results are consistent with the American Academy of Pediatrics' recommendation of breastfeeding exclusively for 4-6 months where no contraindications are present.

sodium and potassium and water are transported via __ ___ from the cell into the milk

active transport

alveoli ducts are arranged like ____ of a ____, leading to the nipple. _____ cells surround the secretory cells.

branches of a tree myoepitheial cells

lactose enhances ____ absorption 2nd largest oligosaccharides contribute cals at low ____, stimulate growth of ___ in gut and inhibit _____ in gut

calcium osmolality growth of bifidus bacteria escherichia coli (harmful bacteria)

as the ductal system matures

cells that can secrete milk develop the nipple grows and its pigmentation changes. Fibrous and fatty tissues increase around the ducts.

letdown reflex stimulates: how does it occur?

milk release from breast -infant suckling stimulation passes through nerves to hypothalamus, which then promotes oxytocin to release from posterior pituitary gland oxytocin causes myoepithial cells to contract, milk is then releases through ducts

water in the milk allows suspension of

milk sugars, proteins, immunoglobulin A, sodium, potassium, citrate, magnesium, calcium, chloride, and water-soluble vitamins.

____ ____ secretion is managed closely by the alveolar cells, in balance with lactose, to maintain the isosmotic composition of human milk

monovalent ion

Leukocytes and other components from the mother's plasma pass ____ between cells

directly; paracellular pathway

which are more efficient, hand or electric pumps?

electric; increases prolactin more

What two hormones govern pubertal breast development?

estrogen and progesterone

lactose is made by the secretory cells and secreted into the ducts by the process of

exocytosis

Breasts and nipples begin to be sore in the ____ trimester of pregnancy, but the tenderness usually subsides by the end of the first trimester

first

fat content varies

from mother to mother, and varies across the day and in a feeding.

companies that make HMS use ___ ___ as the standard

human milk

___ ___ ___ and other milk components (oligosaccharides, gangliosides, and glycoconjugates) resulting from digestion of human milk are antimicrobial

individual fatty acids

milk synthesis is related to

infant demand; the removal of milk from the breast seems to be the signal to make more milk, and most women are able to increase their milk production to meet infant demand

breast milk is ____ with plasma; meaning

isotonic- babies do not need water or other fluids for hydration, even in heat

second largest component of breast milk

lipids; 3-5 percent in mature milk. they provide half the energy. low in the beginning of a feeding and higher at the hindmilk at the end

the mammary gland develop into its ___ ___ (lobes) under the cyclic production of progesterone and is usually complete within ___ ___ months after menarche.

lobular structure 12-18