Transcript FN303-WSV
Lactation Lactation hormones Nature and composition of human milk » types » nutrient composition Nutrition during lactation Breastfeeding » advantages » incidence Common problems » counseling » food programs Hormones of Lactation ________ from anterior pituitary » stimulates » inhibits ________ from posterior pituitary » is stimulated by __________ » stimulates contraction of myoepithelial cells » promotes Let-down is also influenced by mother’s ________ and ___________ Milk in general Composition of milk depends on ____________ Human milk is relatively __________ and low in ________________ so… » “assumes” that infants will _____________ » need ________ feeding » have __________ of growth Milk in general __________ of human milk: ______ to over ________ » ________ does not hurt output » _______________ does » _______ affected before ______ Types of Milk: Stage I = Preterm lower in higher in high in supplement with kcal, __________________ Types of Milk: Stage II ___________: 0 to 3-6 days » yellowish » high carotene, vitamin A, electrolytes » high ______ (2%), which is full of » low ______ (67/dl), ________ Transitional: _________ days » shift in CHO, fat, protein (1.5%) Term Milk: 10 days to weaning kcal: ____/dl protein: ___% (.8 to .9 g/dl) carbohydrate: ~__% lipids: slow increase from _____% » 90% triglycerides » carnitine » lipases » high in _____________ ____milk differs from ____milk Fatty Acids in Human Milk ______ in linoleic acid (ω-6), linolenic acid (ω-3) ____ in AA (ω-6), __________ (ω3 fatty acids) » AA needed for growth » DHA incorporated into ______________________ » structural integrity of the retina » early visual responses and visual _________ » neural membranes and flexible synapses lack associated with ___________ in young children Protein in Term Human Milk caseins whey » ___________ , ___________ ________, hormones high in __________ ideal ________ content » low in methionine, high in cystine » low in phenylalanine and tyrosine » rich in taurine – bile acid formation/digestion – brain development? CHO in Term Human Milk NOT reflective of mother’s diet high in » provides » stimulates “good” bacteria » inhibits “bad” bacteria » helps ____ absorption other CHO: » glucose, galactose, oligosaccharides Vitamins in Human Milk ________-soluble vitamins: » good source of _________ » relatively high in _________ » low in ________; supplement if low sun exposure » give shots of ________ at birth ________-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 Minerals in Human Milk high in ___________ low in F from water or supplements Iodine deficiencies known ____ absorption is __% (vs. __% from cow’s milk and ___% from formula) » infant has sufficient stores for ___ months ____ bioavailability is __% vs. __% from cow’s milk or from formula Resistance Factors in Human Milk Bifidus factor: polysaccharide that encourages growth of Lactobacillus bifidus Immunoglobulins: provide resistance against GI tract infections, etc. Lysozyme: ____________ enzyme B-12 binding protein: makes V. B12 unavailable to bacteria Lactoferrin: ____-binding protein Resistance Factors in Human Milk Lactoperoxidase: protection against streptococci Prostaglandins: hormonelike __________; protect integrity of GI tract Complement: immune system proteins Lymphocytes: synthesize IgA Macrophages: immune cells that engulf bacteria Possible Contaminants in Human Milk Substance Medicines Aspirin Penicillin/ antibiotics Laxatives Street drugs Smoking Risks Minimizing medicine exposure ____% of maternal dose will enter milk (less will be absorbed by infant) Strategies include: » use _______ forms » schedule to minimize transfer to milk » use form less likely to be » watch for ___________ Possible Contaminants in Human Milk Substance Pesticide residues, PCBs, DDT, heavy metals AIDS virus Risks Possible Contaminants in Human Milk Substance Caffeine Alcohol Risks These are found in human milk in amounts similar to amounts in the mother’s blood Nutrition during Lactation Lactation vs. pregnancy Energy: from fat stores and from diet; Protein: Nutrition during Lactation Milk reflects mother’s intake: Of concern for mother: Of concern for restricted eaters: Advantages of Breastfeeding for Baby ________________ Automatically ________ __________ properties ____________ » diarrhea » Type I diabetes, respiratory diseases » celiac disease, Crohn’s disease? risk for Promotes better Advantages of Breastfeeding for Baby risk of ___________ _____ growth past 3-4 months Best fatty acids for *__________* » hormonal “mothering” response? » feeling of security for infant Advantages for Mother *Bonding*--emotional ties Maternal __________ Necessitates ________ Ease and ___________ Recovery from pregnancy risk of cancer: Improved ____________ ________: personal, society, environment The Decision to Breastfeed: Concerns Sufficient __________ » breast size does not matter » weight gain: growth chart ________ of milk Schedule: 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 Judging Adequacy of Intake Frequency of _________ » _____ times/day for newborn Frequency of ___________ Weight gain The Decision to Breastfeed: Concerns Engorgement; leaking Poor let-down: Clogged milk ducts: Illness: colds, flu, mastitis... Necessary separations » safe storage of milk – refrigerator ________ – freezer _________ – don’t heat by microwave! Contraindications to Breastfeeding Genetic diseases » _____________ » PKU? AIDS Addictions: alcohol, drugs Maternal _________ ________ diseases that warrant mother’s isolation Need for _______ treatment; contraindicated _________ Environment: Table 6-6, p. 178 Recommendations for Breastfeeding AAP, APHA, ADA recommend: National Health Objectives: » increase to___% the women who _________ and to ___% those who continue to _________ ____ considers breastfeeding promotion a goal ____ is actively promoting % Babies Breastfed:Ever, by State, 2007 Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey % Babies Breastfed: at 6 months, by State, 2007 Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey % Babies Breastfed: at 12 months, by State, 2007 Breastfeeding Among U.S. Children Born 1999—2007, CDC National Immunization Survey Incidence of Breastfeeding (CDC, 2003) Newborn 6 Mos. Ethnic groups Total Asian White Black 71% 79% 72% 55% 32% 44% 38% 24% Regional Oregon New Jersey Indiana Louisiana 88% 72% 61% 46% 54% 38% 28% 16% Maternal Marital Status Married 77% Unmarried 58% 42% 23% Why don’t women breastfeed? Maternal attitude; Lack of ___________ Lack of ___________ Correlates: » # hours worked/day: » introduction of bottle: » lower education, age, income: Incidence of Breastfeeding (CDC, 2007) Total Ethnic groups Asian/Pacific Isl. White Black Newborn 6 Mos. 75% 43% 83% 78% 60% 56% 45% 28% 90% 72% 70.5% 52.5% 58% 42% 37.8% 22.5% Regional Utah New Jersey Indiana Mississippi Maternal Marital Status Married Unmarried 82% 61% 52% 25.5% http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm accessed 2/20/11