Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

Reviewed by SIAHMSR medical team.

Breast Feeding; Breast milk nutritional value; Proper breast feeding practices

  Breastmilk is the most important food of the newborn baby and it protects the infant from numerous infections. It is safe, clean and contains antibodies that provide immunity to the baby against illnesses.

  Breastmilk is the major source of energy and nutrients for the infant for the first few months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life.

Breast milk is easily digested and efficiently used by the body of the infant compared to other kinds of milk.

Breast milk also contains bioactive factors that boosts the infant's immature immune system, providing protection against many types of infections.

                     SIAHMSR                                               

Nutritional value & facts

·       Breast milk contains about 3.5 g of fat per 100 ml of milk, which provides about one half of the energy content of the milk.

·       Breast-milk fat contains long chain polyunsaturated fatty acids (docosahexaenoic acid or DHA, and arachidonic acid or ARA) that are not available in other milks. These fatty acids are important for the neurological development of a child.

·       The main carbohydrate is lactose, a disaccharide. Breast milk contains about 7 g lactose per 100 ml, which is more than in most other milks, and is another important source of energy. Another type of carbohydrate present in breast milk is oligosaccharides, which provide important protection against infection

·       The concentration of protein in breast milk (0.9 g per 100 ml) is lower than in animal milks. No overload on kidneys and easily digestible.

·       Breast milk of a healthy mother normally contains sufficient vitamins for an infant except vitamin D. The infant needs to be exposed to sunlight to generate endogenous vitamin D – or vitamin D supplements are given under the directions from a health care provider.

·       The breast milk contains minerals iron and zinc in relatively low concentration, but their bioavailability and absorption are high.

·       Breast milk contains immunity boosting factors to protect against infections

a]  Immunoglobulins:

Mainly secretory immunoglobulin A (sIgA), which coats the intestinal mucosa and prevents bacteria from entering the cells;

          b] white blood cells which can kill micro-organisms;

          c] whey proteins (lysozyme and lactoferrin) which can kill bacteria, viruses and fungi;

           d] oligosacccharides which prevent bacteria from attaching to mucosal surfaces.

The protection provided by these factors is uniquely valuable for an infant as they protect without causing the effects of inflammation, such as fever, which can be dangerous for a young infant.

The secretory immunoglobulin A [ sIgA ]  of breast milk contains antibodies formed in the mother's body against the bacteria in her gut, and also against infections that she had faced already. Therefore they protect against bacteria that are particularly likely to be in the baby's environment.

·       Other bioactive factors

      Epidermal growth factor present in breast milk   stimulates maturation of the lining of the infant's intestine, making them able to digest and absorb nutrients. Also it reduces the chances of being infected or sensitized to foreign proteins.

It has been suggested that other growth factors present in human milk may help the development and maturation of nerves and retina of eyes.

Why is colostrum- The first milk so important to your child?

  Colostrum is the special milk that is secreted in the first 2–3 days after delivery. It is produced only in scanty amounts, about 40–50 ml on the first day. However this first milk is very vital for the baby’s health.

Colostrum is rich in white cells and antibodies.

 This first milk colostrum contains an adequate amount of protein, minerals and fat-soluble vitamins (A, E and K) than breast milk formed on later days.

Vitamin A is important for protection of the eye and vision. It is important for the integrity of epithelial surfaces of gut and other parts of the body.

Colostrum helps to protect the infant from infections due to the presence of white cells and antibodies.

The epidermal growth factor helps to prepare the lining of the gut to receive the nutrients in milk. It is important that infants receive colostrum, and not other feeds, at this time.

Breast feeding

The breast milk production begins in larger amounts between 2 and 4 days after delivery after the initial colostrum milk secretion from breasts in small amounts.

 Once breast milk production begins the breasts feel full and gradually its amount increases. On the third day, an infant is normally sucking about 300–400 ml per 24 hours, and on the fifth day 500–800 ml. From day 7 to 14, the milk is called transitional, and after 2 weeks it is called mature milk.

Why is breast feeding important for the baby as well as mother?

   Breast milk is rich in nutrients and immunity boosting antibodies and other factors. Therefore, to ensure the health of your baby, protecting from infections and deficiency diseases breast feeding is very important. It is the major source of food for the infant for about six months till the intake of other nutrient rich foods begin. It has been found that breastfed children perform better on intelligence tests and they are less likely to be overweight or obese. Women who breastfeed also have a reduced risk of breast and ovarian cancers.

 What is Effective suckling?

   If a baby is well attached at the breast, then he or she can suckle effectively. This is very important in breast feeding. Mothers and care givers during post delivery period must ensure that baby is suckling the breast in the proper way and breast milk intake is going on smoothly.

Effective suckling indicates that milk is flowing into the baby's mouth. The baby takes slow, deep suckles followed by a visible or audible swallow about once per second. Sometimes the baby pauses for a few seconds, allowing the ducts to fill up with milk again.

When the baby starts suckling again, a few times suckling will be done quickly, stimulating milk flow, and then the slow deep suckles begin. The baby's cheeks remain rounded during the feed.

Towards the end of a feed, suckling usually slows down, with fewer deep suckles and longer pauses between them. This is the time when the volume of milk is less, but as it is fat-rich hindmilk, it is important for the feed to continue suckling.

 When the baby is satisfied, he or she usually releases the breast spontaneously. The nipple may look stretched out for a second or two, but it quickly returns to its resting form.

Signs of ineffective suckling

A baby who is poorly attached with the breasts is likely to suckle ineffectively. In this situation baby may suckle quickly all the time, without swallowing, and the cheeks may be drawn in as he or she suckles showing that milk is not flowing well into the baby's mouth.

 When the baby stops feeding, the nipple may stay stretched out, and look squashed from side to side, with a pressure line across the tip, showing that the nipple is being damaged by incorrect suction.

Consequences of ineffective suckling

If suckling is ineffective, transfer of milk from mother to baby doesn’t happen. As the breast gets engorged , milk is not removed ,ducts may get blocked  and inflammation sets in. Moreover, as the baby doesn’t get sufficient milk due to poor suckling the weight of the baby reduces or child fails to gain weight .

The  baby may pull away from the breast out of frustration and refuse to feed;

the baby may be very hungry and continue suckling for a long time, or feed very often;

the breasts may be over-stimulated by too much suckling, resulting in oversupply of milk. All these are the out come of poor or ineffective suckling.

Positioning the mother and baby for good attachment & effective suckling

To be well attached at the breast for effective suckling of milk , a baby and his or her mother need to be appropriately positioned. There are  many positions for effective suckling during feeding, but a few important  points need to be followed in any position.

Position of the mother

The mother can be sitting or lying down  or standing, if she wishes. However, she needs to be relaxed and comfortable, and without strain, particularly of her back. If she is sitting, her back needs to be supported, and she should be able to hold the baby at her breast without leaning forward.

Position of the baby

The baby can breastfeed in several different positions in relation to the mother: across her chest and abdomen, under her arm , or alongside her body.

Whatever the position of the mother, and the baby ,four key points about the position of the baby's body that are important to observe.

The baby's body should be straight, not bent or twisted.

 The baby's head can be slightly extended at the neck, which helps his or her chin to be close in to the breast.

The baby should be facing the breast. The nipples usually point slightly downwards, so the baby should not be flat against the mother's chest or abdomen, but turned slightly on his or her back able to see the mother's face.

The baby's body should be close to the mother which enables the baby to be close to the breast, and to take a large mouthful.

The infant should be supported. The baby may be supported on the bed or a pillow, or the mother's lap or arm. She should not support only the baby's head and neck. She should not grasp the baby's bottom, as this can pull him or her too far out to the side, and make it difficult for the baby to get his or her chin and tongue under the areola.

These points about positioning are especially important for young infants during the first two months of life.

 A few interesting facts about breast milk

·     Hind milk [ milk secreted at the end of feeding] rich in fat

Breast milk contains about 3.5 g of fat per 100 ml of milk, which provides about one half of the energy content of the milk.

The fat is secreted in small droplets, and the amount increases as the feed progresses. As a result, the hindmilk secreted towards the end of a feed is rich in fat and looks creamy white, while the foremilk at the beginning of a feed contains less fat and looks somewhat bluish-grey in colour.

·      Breast milk is easily digestible than other milk

The breast milk is superior to cow’s milk or other kinds.  The  animal milks can overload the infant's immature kidneys with waste nitrogen products. Breast milk contains less of the protein casein, and this casein in breast milk has a different molecular structure. It forms much softer, more easily-digested curds than that in other milks. So no overload on kidneys.

Bile-salt stimulated lipase facilitates the complete digestion of fat once the milk has reached the small intestine. Fat in artificial milks is less completely digested.

 Written by dr sanjana vb[ copyright]

References

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