Chapter 6

Human milk is the best food for newborn infants for ________or longer

6 months

What are the three functional units of the mammary gland?

• Alveoli (milk-making sacs)

• Secretory cells (make/secrete milk)

• Myoepithelial cells (squeeze the milk out)

When is mammary gland development usually complete?

Usually 12–18 months after menarche

Lactogenesis

the process of producing human milk.

What are the 3 stages of lactogenesis?

• Lactogenesis I

  • Milk formation begins.

• Lactogenesis II

  • Increased blood flow to the breast → milk "comes in."

• Lactogenesis III

  • Milk composition is stable.

What happens hormonally after delivery?

After the baby is delivered, the hormonal environment changes abruptly

The placenta is lost.

What happens when the placenta is lost?

Progesterone and estrogen levels fall

What hormone is released in large amounts after delivery?

prolactin

What happens to oxytocin after delivery?

There is an abrupt increase in oxytocin.

Which hormone promotes milk production?

Prolactin.

What stimulates prolactin release?

Suckling.

Which hormone is responsible for ejection of milk from the milk gland?

Oxytocin

What stimulates oxytocin release?

Suckling or nipple stimulation

What is the letdown reflex?

The reflex involved in the ejection of milk from the milk gland.

For how long is human milk the only food needed by most healthy infants?

The first six months

What does human milk do besides provide food?

It nurtures and protects from infectious disease.

Does human milk composition remain constant?

No. Composition changes

When can human milk composition change?

Over a single feeding and over a day.

What factors can affect human milk composition over a day?

Infant age, presence of infection, menses, and maternal nutrition status.

What is colostrum?

The first milk secreted during the first few days after birth.

What proteins is colostrum high in?

Secretory IgA and lactoferrin.

What is the major component of human milk?

Water.

What is the relationship between human milk and maternal plasma?

Human milk is isotonic with maternal plasma

About how many kcal/mL does human milk provide?

About 0.65 kcal/mL.

What can cause the calories in human milk to vary?

Fat, protein, and carbohydrate composition.

How does human milk's calorie content compare with human milk substitute?

Human milk has fewer calories than human milk substitute

What provides half the calories in human milk?

Lipids.

How does lipid content differ between fore milk and hind milk?

Human milk is lower in fat in fore milk and higher in fat in hind milk.

What is DHA?

A fatty acid that is essential for retinal development.

How does maternal diet affect trans fatty acids in human milk?

Trans fatty acids are present in human milk from the maternal diet.

Why is cholesterol important?

Cholesterol is needed for cell replication.

How does total protein in human milk compare with whole cow's milk?

Total protein is lower in human milk than in whole cow's milk.

What protective effects do human milk proteins have?

Anti-infective and anti-microbial effects

What is the main protein in mature human milk?

Casein

What does casein facilitate?

Calcium absorption.

What are whey proteins?

Soluble proteins that precipitate by acid or enzyme.

What types of binding proteins are part of whey?

Some mineral-, hormone-, and vitamin-binding proteins

What is lactoferrin?

An iron carrier that is included in whey proteins.

How much nitrogen in milk is provided by nonprotein nitrogen?

20–25 percent.

What is nonprotein nitrogen used to produce?

Non-essential amino acids.

What is the dominant carbohydrate in human milk?

Lactose.

What does lactose enhance?

Calcium absorption

What are oligosaccharides?

Medium-length carbohydrates.

How do oligosaccharides protect the infant?

They prevent binding of pathogenic microorganisms, which prevents infection.

What happens to vitamin A concentration in colostrum?

Colostrum has approximately twice the concentration of vitamin A compared with mature milk.

What gives colostrum its yellow color?

Beta-carotene

What forms of vitamin D are most common in human milk?

25-OH2 vitamin D and D3.

What maternal factor is mentioned in relation to vitamin D?

Mother's exposure to sun

What is vitamin E level linked to?

Milk's fat content

Is vitamin E adequate to meet the needs of preterm infants?

No.

What is vitamin K deficiency risk based on?

Clotting factors.

Which infants may be deficient in vitamin K?

Infants who did not receive the vitamin K injection at birth.

What does the content of water-soluble vitamins reflect?

The mother's diet or supplements.

What is true of milk from well-nourished women?

It meets the estimated needs for their infants.

What is folate bound to?

Whey proteins.

How is folate affected by maternal intake?

It is less influenced by maternal intake.

What do minerals contribute to?

Osmolality.

What is mineral content related to?

Growth of the infant.

What happens to mineral concentration during the first four months?

It decreases over the first four months, except for magnesium.

What does bioavailability help explain about iron?

Exclusively breastfed infants have a very low risk of anemia despite the low iron content of human milk.

How is zinc found in human milk?

Zinc is bound to protein and highly available

What can a rare defect in mammary gland uptake of zinc cause?

Zinc deficiency that appears as diaper rash.

What trace minerals are listed in the slideshow?

Copper, selenium, chromium, manganese, molybdenum, nickel, and fluoride.

Are trace minerals generally altered by the mother's diet?

No, except fluoride.

Can the mother's diet affect the taste of breast milk?

Yes

How does the mother's diet affect the taste of breast milk?

The flavor of foods in the mother's diet influences the taste of breast milk.

What does exposure to a variety of flavors through breast milk provide?

Exposure to a variety of flavors.

What three broad categories of breastfeeding benefits are listed?

Hormonal, physical, and psychological benefits.

What are the nutritional benefits of breastfeeding listed on the slide?

Optimal nutrition, balanced, isosmotic, meeting protein needs without overloading the kidney, soft easily digestible curd, long-chain polyunsaturated fatty acids, and enhanced availability of minerals.

How does breastfeeding meet protein needs?

It meets protein needs without overloading the kidney.

What type of fatty acids are listed as a benefit of breastfeeding?

Long-chain polyunsaturated fatty acids.

What happens to the availability of minerals in human milk?

Human milk has enhanced availability of minerals.

What are the immunological benefits of breastfeeding ?

Lower infant mortality, fewer acute illnesses, and reductions in chronic illnesses.

What topics are listed under other breastfeeding benefits?

Breastfeeding and childhood overweight, cognitive benefits, analgesic effects, and other benefits.

What determines milk synthesis?

• How vigorously an infant nurses

• how much time the infant is at the breast

• how many times per day the infant nurses.

How does how vigorously an infant nurses relate to milk synthesis?

Milk synthesis is related to how vigorously an infant nurses.

How does time at the breast relate to milk synthesis?

Milk synthesis is related to how much time the infant is at the breast.

How does the number of daily feedings relate to milk synthesis?

Milk synthesis is related to how many times per day the infant nurses

Does breast size limit a woman's ability to nurse her infant?

No. Size of the breast does not limit a woman's ability to nurse.

What question does the slide ask about feeding frequency?

Whether feeding frequency is related to the amount of milk a woman can make.

What question does the slide ask about pumping?

Whether women can pump or express enough milk

What question does the slide ask about breast surgery?

Whether women can breastfeed after breast reduction or augmentation surgery.

What are the three parts of the breastfeeding process listed?

Preparing the breast for breastfeeding, breastfeeding positioning, and presenting the breast to the suckling infant.

What three infant reflexes?

Gag reflex, oral search reflex, and rooting reflex

What does the gag reflex do?

It prevents the infant from taking food and fluids into the lungs.

What happens during the oral search reflex?

The infant opens its mouth wide when close to the breast and thrusts its tongue forward.

What happens during the rooting reflex?

The infant turns to the side when stimulated on that side

What are signs of hunger?

The infant brings hands to mouth, sucks on them, and moves the head from side to side.

What is a late sign of hunger?

Crying

Why should an infant be allowed to nurse on one breast?

To account for the difference between foremilk and hindmilk during a feeding.

How many feedings a day are normal for newborns?

10 to 12 feedings a day.

How long does stomach emptying occur in about?

1½ hours.

How much weight loss is normal for a newborn during the first five days?

Up to 7% of birthweight.

What are signs of a malnourished infant?

The infant may become sleepy, non-responsive, have a weak cry, and wet few diapers.

By day five to seven, how many wet diapers should an infant have?

Six wet diapers

By day five to seven, how many soiled diapers should an infant have?

Three to four soiled diapers.

What dental problem is discussed in the breastfeeding infant?

Tooth decay, or caries.

What breastfeeding behavior is associated with caries?

Frequent nursing at night after one year.

When should all children be seen by a dentist according to the slide?

Six months after the first tooth erupts or at one year of age.

What vitamin supplements are listed for breastfeeding infants?

Vitamin K and vitamin D.