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BREAST FEEDING FOR OPTIMAL

GROWTH AND DEVELOPMENT


Soetjiningsih
Department of Childhealth, School of Medicine,
Udayana University
WHO recommendations exclusive BF for 6 months &
continuation to 2 years or beyond
The benefits of BF go far beyond the nutritional value
anti infective, biological properties, sensory stimulation
and cost saving
The closeness of BF is an important bridge between babys
intrauterine life and his new experience of being out in the
world

AAP Policy statement: Breastfeeding and The Use of Human Milk.


Pediatrics 2012;129e827-841
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GROWTH &
METABOLIC SYNDROME

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BF protect metabolic syndrome
including IDDM & obesity
New components of BM adipokines
(leptin and adiponectin), ghrelin, resistin,
obestatin, and adipocyte fatty acid binding
protein (AFABP) food intake regulation,
energy balance, play a role in the
development of metabolic syndrome later
in adulthood
Savino F et al. Clinical Endocrinology 2009;71:757-765
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Figure 1

Savino F et al. Clinical Endocrinology


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2009;71:757-765
ADIPONECTIN
In human BM was published in 2006
A circulating hormone produced by adipocytes
Regulation of glucose metabolism, increase
insulin sensitivity, slows down progression of
atherosclerosis changes, and a biomarker of
metabolic syndrome
Serum adiponectin concentrations inversely
correlate with obesity and type 2 diabetes
mellitus
Bronsky J et al. JPGN 2011;52:474-477
Martin LJ et al. Am J Clin Nutr 2006;83:1006-11
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ADIPOCYTE FATTY ACIDS BINDING
PROTEINS (AFABP)

AFABP and epidermal fatty acid binding proteins


(EFABP) detected in human BM in 2006
Regulate intracellular transport of fatty acids to
various metabolic pathways and participate in the
pathogenesis of metabolic syndrome

Bronsky J et al. JPGN 2011;52:474-477


Bronsky J et al. Clinical Chemistry 2006;52:1763-1770
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LEPTIN
Produced mainly by the adipose tissue & other tissues:
placenta, stomach, mammary epithelium
Anorexigenic hormone central regulation of energy balance,
decreasing food intake, increasing energy expenditure long
term effect on energy balance and body weight
In colostrum and mature BM was reported in 1997
In BM correlates with the concentration in serum and maternal
BMI
Fully BF infants have higher serum levels of leptin than FF
infants
Bronsky J et al. JPGN 2011;52:474-477, Mirales O et al. Obesity 2006;14:1371-1377
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Figure 2

Bronsky J et al. JPGN 2011;52:474-477 10


Figure 3

Bronsky J et al. JPGN 2011;52:474-477 11


Figure 4

Bronsky J et al. JPGN 2011;52:474-477 12


GROWTH MONITORING
Infant growth should be monitored with the
WHO Growth Curve Standard 2006 to avoid
mislabeling infants as underweight or falling to
thrive
Use of the WHO curves for the first 2 years
allows for more accurate monitoring of weight
and height for age and, in comparison with use
of CDC references curves
AAP Policy statement: Breastfeeding and The Use of Human Milk.
Pediatrics 2012;129e827-841
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A case control study conducted in
Yogyakarta
68 pairs of obese and non obese children
Mean duration of BF shorter in obese group 12.6
mos vs 16.1 mos
Partially BF vs exclusively BF obese higher
OR 4.70 (CI 3.6-4.4)
FF vs exclusively BF obese higher
OR 6.20 (CI 4.67-7.73)
Aspri Sulanto et al. Pediatr Indones 2012;52:1-5
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SENSORY STIMULATION
AND DEVELOPMENT

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The sensory stimulation is like the biochemical
components of BM essential for the normal
growth, development, and functioning of the brain
During BF not only the patterns of maternal
stimulation influence sensory-motor behavior of
the infant the infants behavior itself affect
the mothers behavior

Lavelli M, Poli M. Infant Behavior & Development 1998;21:667-684


Golding J et al. Early Human Development 49 Suppl 1997;S175-S184
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BREASTFEEDING
Increase intimacy between mothers and their
babies
Tactile stimulation essential component of mother-
infant interaction
Early sucking has a positive influence on the
mother-infant relationship
Physical contact learning about the mother and
establishing a close affectional relationship
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..breastfeeding
Keep up warm mothering style even after the feeding
session is completed
BF mothers tend to touch, cradle and smile to their
babies
Gaze elsewhere decreased significantly in BF
mothers mothers focus of attention
More prepared to catch signals on the infants part
and able to maintain visual contact
Lavelli M, Poli M. Infant Behavior & Development 1998;21:667-684
Clark KM et al. Ambulatory Pediatrics 2006;6:65-71
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Figure 5

Lavelli M, Poli M. Infant Behavior & Development 1998;21:667-684 21


Figure 6

Lavelli M, Poli M. Infant Behavior & Development 1998;21:667-684 22


Figure 7

Lavelli M, Poli M. Infant Behavior & Development 1998;21:667-684 23


INTERACTION DURING BF
DIFFERED FROM FF
Interaction during BF mutual touch
During BF longer mutual gaze
Sucking from the breast is paced between than
sucking from the bottle, and regulated by the
infant infant can easily coordinate sucking
with other actions
BF mothers gazed at their infants and caressed
the significantly more than FF mothers
Lavelli M, Poli M. Infant Behavior & Development 1998;21:667-684
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NEURODEVELOPMENT

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Consistent differences in
neurodevelopmental outcome
between BF and FF fed infants have
been reported

AAP Policy statement: Breastfeeding and The Use of Human Milk.


Pediatrics 2012;129e827-841

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Anderson et al a meta-analysis (n=11 studies) to
examine the confounders, including the level of
maternal education
the unadjusted benefit in IQ atributed to BF was 5.32
points (CI:4.51-6.14)
after adjusting for socio-economic confounders, the
adjusted benefit in IQ declined to 3.16 points still
statistically significant (CI:2.35-3.98)
premature infants benefit more intelectually from
BF than normal BW infant 5.18 points (CI:3.59-6.77)
vs 2.66 points (CI:2.15-3.17)
Anderson JW et al. Breastfeeding and cognitive development: a meta analysis.
Am J Clin Nutr 1999;70:525-35
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Ferguson et al Birth cohort study of 1307
children were assessed at age 3, 991 at age
5, and 954 at age 7 years
The results even when a number of
control factors were taken into account
tendency for BF children to have slightly
higher (2 points) test score than FF infants
Ferguson DM et al. Breastfeeding and cognitive development in first seven years of life.
Soc.Sci.Med 1982;16:1705-1708
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BF and BM normative standards for infant
feeding and nutrition
Short- and long-term medical and
neurodevelopmental advantages of BF should be
considered a public health issue and not only a
lifestyle choice
Increased IQ levels in BF children the value of the
unique components of BM and the bioavailability of
PUFAs brain development
AAP Policy statement: Breastfeeding and The Use of Human Milk. Pediatrics 2012;129e827-841
Escamalia-rafael perez. Encyclopedia on Early Childhood Development, 2005
Uauy R, Andraca. J Nutr 1995;125:2278S-2280S
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CHILD ABUSE AND NEGLECT

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A total of 7223 Australian mother-infant pairs
were monitored prospectively over 15 years
Maternal maltreatment for nonbreastfed
children being 4.8 times the odds for children
breastfed 4 months
After adjustment for confounding, the odds for
nonbreastfed infants remained 2.6 times higher
BF may help to protect against child abuse,
particularly child neglect
Strathearn L et al. Pediatrics 2009;123:483-493.
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ATTENTION DEFICIT
HYPERACTIVITY DISORDERS

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Retrospective study was
conducted in 60 ADHD
and 40 normal children
The short duration of BF
as environmental factor
may be considered a risk
factor of ADHD
symptoms

Kadziela-Olech H. Piottrowska-Jastrzebska. J. Anales Academiae


Medicae Bialotocensis 2005;50:302-306
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Conclusion
BM : nutritional value, brain development, anti-
infective, anti-allergy, biological properties, protect
metabolic syndrome
During BF sensory stimulation, mutual touch,
mutual gaze
Protect against child abuse, particularly child
neglect
The benefits of BF optimal growth and
development
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THANK YOU...

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