Anatomy & Physiology of Breastfeeding

1 9 TH S E P T E M B E R
For OPTIMAL health:
• Exclusive breastfeeding for six months
• Continue breastfeeding up to two years and
This is the Gold Standard for infant feeding
Colostrum: the first milk. Various
colours: white, clear, yellow, pink,
brown to name some.
An example: the yellowish colour is
attributed to beta-carotene a precursor
of vitamin A. The presence of this is
important for protection against infection
and eye development.
Amount produced in the first 24
hours 7 – 123mls with the average
production as 35mls.
Photo: Courtesy Rebecca Behre Idaho
The average amount a baby drinks in
the first 24hrs = 15+/-11g (Santoro
W Jr, Martinez FE, Ricco RG, Jorge
SM 2009)
Breastmilk is a dynamic fluid:
• ‘preterm’ milk,
• colostrum,
• transitional milk,
• mature milk,
• weaning milk,
• foremilk and
• hindmilk
 Species specific
 Changes depending on stage of
• Transitional
• Mature
• Weaning
• Foremilk and hindmilk
Flavours variable – similar to
amniotic fluid
Contains antibodies
Colostrum can be several colours:
bright yellow, clear, white, light
brown or pink (bloody) as in the case
of ‘rusty pipes’
 Human milk stimulates the maturation
of the GI tract and stimulates the
baby’s own immune protection
Enzymes, hormones and growth factors
are higher in human milk than in other
Many influences on gut maturation and
protection e.g. enzymes, lipases,
pancreatic amylase
Low in casein; higher whey
Low protein compared to other species
Contains growth hormones, antibodies,
leucocytes and other cellular
Matches 50% of infant’s genetic
Fresh and ready to use
100% natural
Foremilk & Hindmilk showing
different fat content
300+ components
Soft curds
Gastric ½ emptying time = 48mins
Breastfeeding = 645kcals/day=117,390kcals/6months =13kgms fat!
Nutritionally optimal until around 6 months of age
Contains contaminants:
 Chemicals in human milk may mean that 1: 1,000,000 may have an
increased risk of cancer (avoid contact contaminants if possible; for
example solvents in paint, dry cleaners, hair dye)
Contains stem cells
Breastfeeding is a relationship
Formula (A Breastmilk Substitute)
 Derived from a different species or plant base
 Higher in casein than breastmilk
 Genetically different from infant
 Easily contaminated (eg. enterobacter sakazakii)
 Has expiry date
 Manmade
Inert. Highly processed
Fed by bottle – risk of contamination
Shelf life affects ingredients
Same taste every feed, every day
Less than five long chain polyunsaturated fatty acids!
<100 components
Gastric ½ emptying time = 78 minutes
Tough less digestible curds
Costs money = ±$2000 per year
 No cellular component
 More illness = more absenteeism from work place
 Controlled by large multi-billion dollar companies
 Nutritional role only
 More alkaline pH
 Alters gut flora
Risks Associated with Formula Feeding for the Baby
Risks Include:
Asthma (Silvers K et al 2012, Gold M, Kemp A. 2005)
Atopic diseases (Oddy, W 2004, Matheson MC, Balasuriya
A et al 2007)
Lower cognitive function (Lucas, A et al 2001, Michaelson KF,
Lauritzen L et al 2009)
Obesity (Miralles O et al 2006, Weyermann M, Brenner H et al
2007, Huus K, Ludvigsson JF, 2008)
Types 1 & 2 Diabetes (Ip S, Chung M, Raman G et al. 2007)
Lymphoid malignancies (Bener et al 2008)
Rheumatoid Arthritis (Lankarani-Fard et al 2001)
Dental caries (Valaitis R, Hesch R, et al 2000)
Gastroenteritis (Talayero JMP, Lizán-Garcia M et al 2006)
Crohns disease (Klement E et al. 2004)
Coeliac disease (Akobeng AK et al. 2006)
Necrotising Enterocolitis (Sisk P, Lovelady C et al. 2007)
Appendicitis (Pisacane A. et al. 1995)
Risks Associated with Formula Feeding for the Baby
SIDS (Venneman MM, Bajanowski T et al. 2009)
Hypertension (Martin RM, Gunnell D et al. 2005)
Heart disease (Martin RM et al. 2005)
Leukaemia/childhood cancers (Ortega-Garcia JA,
Ferris-Tortajada et al 2007, Bener et al 2008)
Otitis media (Hetzner NM, Razza RA et al. 2008)
Bacterial meningitis (Silfverdal S, Bodin L, Olcén
P 1999)
Botulism (Heinig MJ 2001)
Ulcerative colitis (Rigas A, Rigas B, Blassman M.
et al. 1993)
Diarrhoea (Meinzen-Derr JK, Farkas T et al 2004)
Urinary tract infections (Marild S, Hansson S et
al 2004)
Risks Associated with Formula Feeding for the Mother
By not breastfeeding the mother has an increased risk of:
Bleeding following birth (Chua S et al. 1994)
Uterine Cancer (Rosenblatt KA et al. 1995)
Ovarian Cancer (Ip S, Chung M, Raman G et al. 2007)
Osteoporosis (Ip S, Chung M, Raman G et al. 2007)
Breast Cancer (Ip S, Chung M, Raman G et al. 2007)
Rheumatoid arthritis (Pikwer M, Bergström U et al. 2008)
Risks to infant health
…….. we know that artificial feeding is ‘risky for any baby’ (Minchin 1998)
A formula fed baby is:
five times more likely to go to hospital with diarrhoea
twice as likely to go into hospital with a chest infection
five times more likely to suffer from a middle ear infection
five times as likely to have an infection of their urine
twice as likely to develop eczema or a wheeze if they come from
an atopic family
if premature, twenty times more likely to suffer a rare but serious
condition, neonatal necrotising enterocolitis. A hundred lives per
year could be saved if all babies were fed their mother’s own milk
or donor milk
more at risk of sudden infant death syndrome
more likely to have reduced cognitive development and decreased
visual acuity
Kramer & Kakuma
Exclusive Breastfeeding
“When comparisons are being made with
breastmilk, an appeal of ‘no contest’ should be
recognised. Natural selection is an optimising
process, and the controlled trial for breastmilk,
with human survivability as the outcome
measure, has been in progress for a minimum of
240,000 years – or 8000 generations”
Dr Mike Woolridge
(Senior Lecturer in Infant Feeding at the School of Healthcare, Faculty of
Medicine & Health, University of Leeds)
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