Breast Feeding

Last updated 10.08.13

 

Definition

-  Feeding of newborn baby with breast milk delivered by nipple

-  BF = breast feeding/fed

-  EBM = expressed breast milk

 

Features

-  Recommended as exclusive source of nutrients for feeding term infants for 6/12 then + solids until 12/12+

-  Typical newborn feeds 8-12 times per day

-  Formula fed babies feed less often as greater time to digest

-  Adequate feeding/hydration is estimated by

-  6-8 wet nappies per 24hrs

-  Weight gain of 112-198g per week for first month

-  Consideration on mothers meds/drugs & inclusion in breast milk

-  Premature infants will require fortified breast milk (protein, Ca, PO4, Zn, Na, vitamins, +/-Fe)

-  Human milk whey>casein (protein)

-  Cow milk whey<casein

 

Breast Milk Content

-  Colostrum = first milk

-  Foremilk = first 5 min of breast feeding

-  Hindmilk = subsequent milk after foremilk

-  Content/mix varies over development of baby

-  Foremilk: more protein, less lipid

-  Hind milk: more lipid, less protein

-  Low levels of

-  Vitamin D

-  Supplementation recommended if soley breast fed

-  From 2/12 old 200IU/day

-  Vitamin B12 if mother is vegan

-  Vitamin K

-  Prophylactic dose given at birth

-  Needed to prevent VKDB

-  Iron & Zinc

-  Levels decrease over time

 

Colostrum (First Milk)

-  Initial milk produced by breast (once off)

-  Different in content to mature breast milk: high fat content

-  High density, v thick

-  Protects infants GIT against pathogens

-  Laxative effect on meconium

-  IgA++

 

Benefits of Breast Feeding

-  Immune: Ig, lactoferrin, lysozymes

-  Nutrition: changes over time

-  Cheap

-  Convenient

-  Bonding

-  Contraception (natural)

 

Contraindications

-  HIV (developed countries)

-  Still recommended in 3rd world where water supply uncertain

-  TB

-  Medications

-  Precaution

-  EtOH

-  Smoking

- GA: express prior if possible, avoid if preterm infant or cardioresp concerns

 

Procedure

-  Baby held like rugby ball

-  Skin to skin contact recommended

-  Babys mouth open wide

-  Chin in contact with underside of breast

-  Routing reflex: chin contact opens mouth

-  Effective attachment indicated by

-  Nose free from breast

-  Minimal pain after first few sucks

-  Baby swallowing easily

-  Effective sucking indicated by

-  Lower jaw moves rhythmically + ears wiggle

-  Swallowing can be seen

-  Cheeks are not drawn

 

Mx

-  Lactational mastitis +/- abscess

-  Milk suppression: Cabergoline

-  Milk stimulation: Domperidone

-  Post partum contraception: POP