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Breastfeeding Breast milk meets all the infants nutritional needs for the rst 6 months of life and is the most vital food for a further 6 months Benets: Readily available at the right temperature and ideal nutritional value Cheaper than formula feeding Associated in a reduction in: Childhood infective illnesses - especially gastroenteritis Atopic illness NEC in preterm babies Juvenile diabetes Childhood cancer - especially lymphoma Pre-menopausal breast cancer Maternal advantages: Aids involution Reduces risk of breast and epithelial ovarian cancer Fertility - lactational amenorrhoea Rates of breastfeeding - 80% at birth, 60% at 3 months, 40% at 6 months Reasons for not breastfeeding (overcome by correct positioning): Inadequate milk production Sore and cracked nipples Positioning: Once the mouth is opened by the rooting reex, the mother should reposition the baby so that the lower rim of the babys mouth ts well below the nipple The mouth should be placed over the nipple and areola with the teat drawn back to the junction of the soft and hard palates and tongue underneath Babies should be fed on demand and left on the breast until feeding nishes spontaneously Colustrum Yellow uid secreted by the the breast that can be expressed as early as the 16th week Replaced by breast milk during day 2 postpartum High concentration of proteins but less sugar and fat than breast milk Proteins are mainly globulins, especially IgA Has a laxative effect to help empty meconium from the babys bowel Breast Milk Major constituents - lactose, protein (lactalbumin, lactoglobulin, caseinogen), fat, water

Composition is never constant between feeds Also contains IgA, IgG and IgM Contains a lower iron concentration than cows milk or formula but it is better absorbed Vitamin K is not found in breast milk - needs to be given to newborn to minimise the risk of HDN Milk Formation PRL from the anterior pituitary is no longer inhibited postpartum (by progesterone and dopamine) due to nipple stimulation from suckling Lactation is suppressed with bromocriptine (DA agonist) Amino acids, glucose, lipids and minerals in blood plasma are transformed into casein, lactalbumin, lactose and milk fats which are secreted into the alveoli by the alveolar epithelial cells (lactocytes) Most milk is synthesised between breastfeeds Ejection (Let-Down Reex) Suckling leads to pulsatile oxytocin release from the posterior pituitary leading to contraction of myoepithelial cells and forcing milk into the lactiferous ducts and ejection of milk Oxytoxin release may also be stimulated by visual, olfactory or auditory stimuli (eg. hearing baby cry) Release is inhibited by stress Oxytocin causes uterine contractions (afterpains) and involution pain The babys gums should be over the lactiferous sinus, the tongue down and the airway clear Non-Breastfeeding Mothers These mothers may suffer considerable engorgement and breast pain DA agonists (bromocriptine, cabergoline) inhibit PRL and suppress lactation Associated with an increased risk of HTN and stroke Fluid restriction and a tight brassiere are effective by the second week Common Problems with Breastfeeding Blood-stained nipple discharge: Typically bilateral and due to epithelial proliferation Usually occurs in the second or third trimester of pregnancy and rarely persists beyond three months postpartum Painful nipples: Due to incorrect positioning of the babys mouth or thrush May lead to ssuring of the nipple Increased risk of breast abscess developing Treatment - resting affected nipple; manually expressing milk; reintroduce breastfeeding gradually

Galactocele: Retention cyst of the mammary ducts following blockage by inspissated secretions Identied as a uctuant swelling with minimal pain and inammation Usually resolves spontaneously but may need to be aspirated or surgically excised if discomfort is increasing Breast fullness when milk starts to ow at 3-4 days postpartum Engorgement should not occur when feeding on demand May give rise to puerperal fever up to 39oC If baby is not removing enough milk it is treated by correct attachment, unrestricted suckling, rm support, simple analgesia, manual/breast pump expression of milk or cool compresses Mastitis Rapid onset with a red, swollen, hot and painful breast Woman feels unwell with inuenza-like symptoms, tachycardia and a fever (develops later and last longer compared with engorgement) Staph. aureus is the most common pathogen and leads to abscess formation and cellulitis - also coagulase-negative staphylococci and Strep. viridans Sources of infection - babys nose and throat, infected umbilical cord May be associated with poor physical health, nipple trauma and untreated blocked milk ducts (milk extravastates into perilobular tissue) Treatment - continue breastfeeding (from unaffected breast while expressing from affected breast) and use oral/IV antibiotics for 10 days (cephalexin, ucloxacillin) and paracetamol; warm packs before breastfeeding; vary feeding positions Drain abscess caused by mastitis (10%) Feeds increase with infants periodic growth spurts (7 days, 6 weeks and 3 months) - normal if the baby is well-hydrated and gaining weight