BREAST FEEDING

Contents

1 Lactation
2 Breast milk
3 Benefits for the infant
3.1 Reduced risk of Breast Cancer
3.2 Less Atopy
3.3 Less Celiac disease
3.4 Less Diabetes mellitus
3.5 Less Diarrhea
3.6 Greater immune health
3.7 Higher Intelligence
3.8 Less necrotizing enterocolitis
3.9 Superior nutrition
3.10 Less obesity
3.11 Fewer middle ear infections
3.12 Fewer respiratory infections
3.13 Possible protection from sudden infant death syndrome
3.14 Fewer urinary tract infections
4 Benefits for mothers
4.1 Breast cancer
4.2 Arthritis
4.3 Bonding
4.4 Hormone release
4.5 Weight loss
5 Organisational endorsements
5.1 World Health Organization
5.2 American Academy of Pediatrics
6 Breastfeeding difficulties
7 Infant weight gain
8 Methods and considerations
8.1 Early breastfeeding
8.2 Time and place for breastfeeding
8.3 Latching on, feeding and positioning
8.4 Exclusive breastfeeding
8.5 Expressing breast milk
8.6 Mixed feeding
8.7 Tandem breastfeeding
8.8 Extended breastfeeding
8.9 Shared breastfeeding
8.10 Weaning
9 History of breastfeeding
10 Sociological factors with breastfeeding
11 Economic factors of breastfeeding





Lactation

The production, secretion and ejection of milk is called lactation. It is one of the defining features of being a mammal.



Breast milk



Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from the nutrients in the mother's bloodstream and bodily stores. Some studies estimate that a woman who breastfeeds her infant exclusively uses 400 - 600 extra calories a day in producing milk.[10] The composition of breast milk depends on how long the baby nurses.

"Research shows that the milk and energy content of breastmilk actually decreases after the first year.[8] Breastmilk adapts to a toddler's developing system, providing exactly the right amount of nutrition at exactly the right time.[9] In fact, research shows that between the ages of 12 and 24 months, 448 milliliters of a mother's milk provide these percentages of the following minimum daily requirements:

Energy 29% Folate 76% Protein 43% Vitamin B12 94% Calcium 36% Vitamin C 60%10 Vitamin A 75% "[4]




Benefits for the infant

An African woman with her child in Kabala in 1960s.During breastfeeding nutrients and antibodies pass to the baby[11] and the maternal bond can also be strengthened.[12] Research has demonstrated a variety of benefits to breastfeeding an infant. [13] These include:



Reduced risk of Breast Cancer

A study at the University of Wisconsin found that women who were breast fed in infancy may have a lower risk of developing breast cancer than those who were not breast fed. [14]


Less Atopy
In children who are at risk for atopy (defined as at least one parent or sibling having atopy), atopic syndrome can be prevented or delayed through exclusive breastfeeding for four months, though these benefits may not be present after four months of age. [15] However, the key factor may be the age at which non-breastmilk is introduced rather than duration of breastfeeding.[16] Atopic dermatitis, the most common form of eczema, can be reduced through exclusive breastfeeding beyond 12 weeks in individuals with a family history of atopy, but when breastfeeding beyond 12 weeks is combined with other foods incidents of eczema rise irrespective of family history.[17]


Less Celiac disease
A review of the association between breastfeeding and celiac disease (CD) concluded that breast feeding while introducing gluten to the diet reduced the risk of CD. The study was unable to determine if breastfeeding merely delayed symptoms or offerred life-long protection.[18]


Less Diabetes mellitus
Infants exclusively breastfed have less chance of developing diabetes mellitus type 1 than peers with a shorter duration of breastfeeding and an earlier exposure to cow milk and solid foods.[19] Breastfeeding also appears to protect against diabetes mellitus type 2,[20][21] at least in part due to its effects on the child's weight.[21]


Less Diarrhea
Breastfeeding protects infants against diarrhea as compared to formula-fed peers;[22] compared to formula-fed peers, death rates due to diarrhea in breastfed infants are lower irrespective of the development level of the country.[7]


Greater immune health
Breast milk include several anti-infective factors such as bile salt stimulated lipase (protecting against amoebic infections), lactoferrin (which binds to iron and inhibits the growth of intestinal bacteria)[23][24] and immunoglobulin A protecting against microorganisms.[25]

Despite also being a factor in the transmission of HIV from mother to child, some constituents in Breast milk may be protective of infection. In particular, high levels of certain polyunsaturated fatty acids in breastmilk (including eicosadienoic, arachidonic and gamma-Linolenic acids) are associated with a reduced risk of child infection when nursed by HIV-positive mothers. Arachidonic acid and gamma-linolenic acid may also reduce viral shedding of the HIV virus in Breast milk.[26]

Breastfeeding does not appear to offer protection against allergies.[27]


Higher Intelligence
Babies with a specific variant of the FADS2 gene (approximately 90% of all babies) demonstrate an IQ an average of 7 points higher if breastfed.[28]


Less necrotizing enterocolitis
Necrotizing enterocolitis (NC), found mainly in premature births, is six to ten times more common in infants fed formula exclusively, and three times more common in infants fed a mixture of breast milk and formula, as compared to exclusive breastfeeding. In infants born at more than 30 weeks, NC was twenty times more common in infants fed exclusively on formula.[29]


Superior nutrition
Breast milk contains the ideal ratio of the amino acids cystine, methionine, and taurine to support development of the central and peripheral nervous system. Children aged seven and eight years old who were of low birthweight who were breastfed for more than eight months demonstrated significantly higher intelligence quotient scores than comparable children breastfed for less time, suggesting breastfeeding offers long-term cognitive benefits in some populations.[30]
The quality of a mother's breast milk may be compromised by stress, bad food habits, chronic illnesses,smoking, and drinking.[31] If the mother is heavily subjected to any of above factors, additional resources in particular for protein must be found. A ration must contain a heavy percentage of protein. Protein is the building block for nerves and bones. To make brain, bone and tissue, the baby must be given protein. And from two days old to at least three years. That makes strong, pretty, alert babies that sleep well and do well.[32])


Less obesity
Breastfeeding appears to reduce the risk of extreme obesity in children aged 39 to 42 months.[33] The protective effect of breastfeeding against obesity is consistent, though small, across many studies, and appears to increase with the duration of breastfeeding.[34]


Fewer middle ear infections
Increased duration of certain types of middle ear infections (otitis media with effusion, OME) in the first two years of life is associated with a shorter period of breastfeeding, in addition to feeding while lying down and maternal cigarette smoking.[35] A reduced proportion and duration of any otitis media infection was associated with breastfeeding rather than formula feeding for the first twelve months of life.[22]


Fewer respiratory infections
Breastfeeding appears to reduce symptoms of upper respiratory tract infections in premature infants up to seven months after release from hospital.[36]


Possible protection from sudden infant death syndrome
Breastfed babies have improved arousal from sleep, which may reduce the risk of sudden infant death syndrome.[37]


Fewer urinary tract infections
Breastfeeding reduced the risk of acquiring urinary tract infections in infants up to seven months post-partum. The protection was strongest immediately after birth, and was ineffective past seven months[38]


Benefits for mothers

Zanzibari woman breast feedingBreastfeeding is a cost effective way of feeding an infant, and provides the best nourishment for a child at a small nutrient cost to the mother. Frequent and exclusive breastfeeding can delay the return of fertility through lactational amenorrhea, though breastfeeding is at best an imperfect means of birth control. During breastfeeding beneficial hormones are released into the mother's body.[11] and the maternal bond can be strengthened.[12] Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point.[39]


Breast cancer
Breastfeeding mothers have less risk of endometrial,[40][41] breast and ovarian cancer,[9][12] and osteoporosis.[9][12] Mothers who breastfeed longer than eight months also benefit from bone re-mineralisation[42] and breastfeeding diabetic mothers require less insulin.[43] Breastfeeding helps stabilize maternal endometriosis,[9] reduces the risk of post-partum bleeding[44] and benefits the insulin levels for mothers with polycystic ovary syndrome.[45]

Some breastfeeding women have pain from candidiasisor staphylococcus infections of the nipple[46] though these can be managed with medical attention with little concern for mother and child.


Arthritis
Women who breast feed for longer have a smaller chance of getting rheumatoid arthritis, suggests a Malmo University study published online ahead of print in the Annals of the Rheumatic Diseases (See Women Who Breast Feed for More than a Year Halve Their Risk of Rheumatoid Arthritis). The study also found that taking oral contraceptives, which are suspected to protect against the disease because they contain hormones that are raised in pregnancy, did not have the same effect. Simply having children but not breast feeding also did not seem to be protective.


Bonding
The hormones released during breastfeeding strengthen the maternal bond. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates.[47] Support for a mother while breastfeeding can assist in familial bonds and help build a paternal bond between father and child.[48]

If the mother is away, an alternative caregiver may be able to feed the baby with expressed breast milk. The various breast pumps available for sale and rent help working mothers to feed their babies breast milk for as long as they want. To be successful, the mother must produce and store enough milk to feed the child for the time she is away, and the feeding caregiver must be comfortable in handling breast milk.


Hormone release
Breastfeeding releases the hormones oxytocin and prolactin which relax the mother and make her feel more nurturing toward her baby.[49] Breastfeeding soon after giving birth increases the mother's oxytocin levels, making her uterus contract more quickly and reducing bleeding. Oxytocin is similar to pitocin, a synthetic hormone used to make the uterus contract.[44]


Weight loss
As fat accumulated during pregnancy is used to produce milk, extended breastfeeding—at least 6 months—can help mothers lose weight.[50] However, weight loss is highly variable among lactating women, and diet and exercise is a more reliable way of losing weight.[51]


Organisational Endorsements

World Health Organization
" [the] vast majority of mothers can and should breastfeed, just as vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother's milk be considered as unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative - expressed milk from the infant's own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast milk substitute fed with a cup, which is a safer method than a feeding bottle or a teat - depends on individual circumstances. [52] "

The WHO recommends two years of breastfeeding and exclusive breastfeeding for the first six months of life.


American Academy of Pediatrics
" Extensive research, especially in recent years, documents diverse and compelling advantages to infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding. These include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits.[9] "

AAP recommends at least one year of breastfeeding and exclusive breastfeeding for the first six months of life.


Breastfeeding difficulties
Main article: Breastfeeding complications
Despite being a natural human activity, breastfeeding difficulties are not uncommon. Putting the baby to the breast as soon as possible after birth helps to avoid many problems. The AAP breastfeeding policy says: Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed.[9] Many breastfeeding difficulties can be resolved with proper hospital procedures, properly trained midwives, doctors and hospital staff, and lactation consultants.[53] There are some situations in which breastfeeding may be harmful to the infant, including infection with tuberculosis or HIV, some medications and some drugs.


Infant weight gain
Breastfed infants generally gain weight according to the following guidelines:

0–4 months: 170 grams per week†
4–6 months: 113–142 grams per week
6–12 months: 57–113 grams per week
† It is acceptable for some babies to gain 113–142 grams (4–5 ounces) per week. This average is taken from the lowest weight, not the birth weight.
The average breastfed baby doubles birth weight in 5–6 months. By one year, the typical breastfed baby will weigh about 2½ times birth weight. At one year, breastfed babies tend to be leaner than bottle fed babies.[54] By two years, differences in weight gain and growth between breastfed and formula-fed babies are no longer evident.[55];


Methods and considerations
There are many books and videos to advise mothers about breastfeeding. Lactation consultants in hospitals or private practice, and volunteer organisations of breastfeeding mothers such as La Leche League also provide advice and support.


Early breastfeeding
In the half hour after birth, the baby's suckling reflex is strongest, and the baby is more alert, so it is the ideal time to start breastfeeding. [56]. Early breast-feeding is associated with fewer nighttime feeding problems [57]