14: Women and Food 2: Focus on Breastfeeding

2. Describe breast milk (e.g., its composition, how its composition varies)

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Amazing thing about breast milk #4

Breast milk composition changes within each feed

T or F: Non-breastfed infants in developed countries are 6-10 times more likely to die in first months of life

F ; developing countries

T or F In emergencies, breast feedings ceases because the mother will be under stress and malnutrition

F; - even when mother is malnourished, she can still synthesize breastmilk from fat stores (depot fat) - protein content is only reduced with chronic protein deficiency - quality will be generally okay, however, less may be produced

Why is colostrum so important? How does it compare to mature milk? How much of it will infant consume in a feeding?

Liquid gold - concentrated -very nutritious -mild laxative - initial bowl movement Thicker, more viscous and yellow ~ 1tsp

when can exclusive breastfeeding be an exception

ONLY if experiencing diarrhea: need oral rehydration solution or medicine

Intro

Optimal breastfeeding was considered exclusive breastfeeding from 0-6 months and any breastfeeding between 6 and 23 months. Compared to infants that were exclusively breastfed from 0-5 months, there was a higher risk of all-cause mortality and infection-related mortality for infants who were predominantly breastfed, partially breastfed, or not breastfed Among children 6-23 months of age, compared to children received breast milk, those who were not breastfed were approximately twice as likely to die.

Define prelacteal feed

anything given to infant before initiating breastfeeding believed to be laxatives, cleansing agents, rehydrating agents, way to clear the meconium

Trend in exclusive breastfeeding rates

worldwide, ~36% of infants are exclusively breastfed for the first 6 months, of that the highest rate is seen at South Asia

Amazing thing about breast milk #3

Breast milk composition changes over time to match the needs of the infant 1. colostrum: - secreted for first 2-3 days after delivery 2. transitional milk - until infant ~ 2 week old 3. mature milk - 2 weeks to ~ 6 months 4. extended lactation - beyond 6 months

How have breastfeeding rates changed in countries that have experienced large-scale humanitarian emergencies (e.g., drought, refugee crises)?

Education & support promotes exclusive breastfeeding when other choices are limited

T or F: Breast feeding reduces the infant mortality rate. This is associated with birth spacing of at least 1 year

F; 2 years, this is when it makes the most difference

T or F For families of pavement and roadside squatter settlements, most mothers discarded colostrum because they thought it was immature & dirty. Instead, they gave them prelacteal feeds.

T

T or F: Diarrhea and pneumonia are more severe in non- breastfed infants

T

T or F: Breastfeeding saves more lives than any other preventive intervention

T

T or F: Exclusive breastfeeding can give a woman 98% protection against pregnancy for 6 months, if her baby feeds frequently day and night, and is not given any other food, drinks or a pacifier.

T

If maternal diet is severely restricted, the breastmilk will resemble .... a) the protein content; it will breakdown to provide nutritional contents b) FA composition of depot fat c) the glucose in her plasma d) none of the above

b) fat stored in her body will mobilize to support breast milk

Identify the difference between foremilk and hindmilk What is the implications of this difference ?

foremilk: blueish hindmilk: high fat, orange-ish from vit. A - if feed isn't long enough; doesn't have time... think she is done... infant would be missing on hindmilk: more fatty more calories where there is EFA & vit. A - need to be fed until breast is drained note: fat in breast milk = 8-9 g (46% of kcal)

T or F complementary feeding is any foods & beverages that are introduced at ~1 year of age (to complement breast milk)

F; 6-23 months is the complementary feeding period

T or F low iron in breast milk is a concern

F; bioavailability is high, therefore, infant stores will last ~6 months ; however, complementary foods need to be introduced at 6 months

T or F Protein content is reduced if maternal diet is low in protein, even in short term

F; it is reduced only with chronic protein undernutrition

T or F Fat content of breastmilk does not resemble fat content of maternal diet

F; it resembles; cholesterol levels do not vary

T or F In 2011, almost all of the countries reporting to WHO have fully implemented its recommendations

F; only about 19%

T or F If maternal diet is severely restricted the quality of the milk will not be good enough

F; quality is generally ok, but lesser amount of it is produced

T or F By the time infants are 6 months old, they can stop breast feeding since they start to have complementary food.

F; they definitely still need the nutrient and other contributions of breast milk, although they should start having complementary foods to provide more energy and nutrients

Describe the nternational Code of Marketing of Breast-milk Substitutes

Formula should not be promoted to mothers Formula labels need to state the benefits of breastfeeding and health risks posed by substitutes

What affects whether woman breastfeeds her child or not?

1. Opportunity to feed right away Why is this important: - infant is receptive - initiate soon = develop relationship faster 2. Sociocultural context - ie how people approach & value breast feeding 3. Direct information and support - education for women: how to feed, how to develop latch - family member support - peer to peer

4. Explain why foods need to be introduced to complement breast milk when an infant is ~ 6 months old

At ~6 months: infant needs more energy and nutrients than can be provided by breast milk alone - but they definitely still need the nutrient and other contributions of breast milk! - limited to iron & vit. D - by 6 months will not provide sufficient iron — iron rich foods need to be introduced 6 - 9 month = highest rate of iron deficiency prevalence

Amazing thing about breast milk #2

Breast milk composition

T or F Fat is the major constitute of energy for breast milk, next to carbohydrates

T

intake of what in late pregnancy is associated with fat content of colostrum? a) eggs b) nuts c) olive oil d) Rapeseed oil e) marine fish f) two of the above g) none of the above

f) rapeseed oil and marine fish note: especially low amt of EPA & DHA for inland regions ( compared to coastal, river/lake regions) - land locked

What are some of the challenges of having complementary foods

- may be introduced too early or too late - may not be nutritionally adequate - may be unsafe; physical process of eating can be unsafe - first 2 months : leaky gut - larger protein can slip in between cells -> allergies

Breastfeeding should begin within ______ of birth - Should be "________________" - Bottles and pacifiers should be _____

1 hour - first 45 min - 1 hr when infant is alert & receptive to what is going on, in need of nutrition - hard to initiate after the hr when they get sleepy - breast crawl: they can make their way up to the breast & latch on on demand - if showing hunger cues - first weeks or months avoided - nipple confusion: bottle release more liquid than human breast, may no longer have energy and initiative to seek breast

Why is it a bad idea to market formula in rural areas who are not economically strong?

1) not sustainable - breast milk production is driven by demand; how much they are drinking & sucking - if demand falls off (on supplement) production will cease & therefore when mother can no longer afford the supplement, the baby won't be able to go back to breast feeding 2) Economic well-being of community - money goes to multinational companies - won't support local economy 3) - emotionally manipulative - praying upon vulnerable group : "this is the best choice" 4) - powders need to be mixed water — can be contaminated - need to be boiled and cooled before mixed - sterilize water/bottles? - formula lacks non-nutritive benefits -antibody (depending on environment, i.e. if theres a flu, the mom will make antibody for that through breast milk) - may dilute formula to make it last ($)

Exclusive breastfeeding is recommended up to _________of age, with continued breastfeeding along with appropriate complementary foods up to ___________of age or beyond

6 month; 2 years

Amazing thing about breast milk #1

Breastfeeding benefits both infant & mother 1. reduced risk of infant mortality 2. reduced risk of postpartum hemorrhage if mother can breastfeed shortly after delivery - hormones that are induced by breast feeding help contraction of uterus expel uterine lining that needs to be expelled - help to return to pre-pregnancy physiology 3. increased birth spacing

3. Discuss current rates of exclusive breastfeeding and identify strategies to promote optimal breastfeeding

Indonesia passed a law that every baby had to be exclusively breastfed (or given breast milk from donors) for the first 6 months of its life result: 10% higher Why are rates still relatively low? - formula companies promote breast milk substitutes - health professionals lack education regarding breastfeeding - lack of support for breastfeeding in the workplace

What can/should be added as a supplementation during breastfeeding? How can this be administered?

Vit D - breast milk doesn't contain enough - won't be out in the sun too much - drop of Vit. D on nipple