A Personal Decision

Choosing whether to breastfeed or formula feed your baby is one of the first decisions expectant parents will make. The American Academy of Pediatrics (AAP) joins other organizations such as the American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) in recommending breastfeeding as the best for babies. Breastfeeding helps defend against infections, prevent allergies, and protect against a number of chronic conditions. The AAP says babies should be breastfed exclusively for the first 6 months. Beyond that, the AAP encourages breastfeeding until at least 12 months, and longer if both the mother and baby are willing. Although experts believe breast milk is the best nutritional choice for infants, breastfeeding may not be possible for all women. For many women, the decision to breastfeed or formula feed is based on their comfort level, lifestyle, and specific medical considerations that they might have. For mothers who are unable to breastfeed or who decide not to, infant formula is a good alternative. Some women feel guilty if they don't breastfeed. But if you feed your baby with a commercially prepared formula, be assured that your baby's nutritional needs will be met. And you'll still bond with your baby just fine. After all, whether with breast milk or formula, feeding is an important time of connection between mother and baby. The decision to breastfeed or formula feed your baby is a very personal one. But here are some points you may want to consider as you decide which is best for you and your new addition.

Breastfeeding: The Advantages

Nursing can be a wonderful experience for both mother and baby. It provides ideal nourishment and a special bonding experience that many nursing mothers cherish. Here are some of the many benefits of breastfeeding: Infection-fighting. Antibodies passed from a nursing mother to her baby can help lower the occurrence of many conditions, including:

ear infections diarrhea respiratory infections meningitis

Other factors help to protect a breastfed baby from infection by contributing to the infant's immune system by increasing the barriers to infection and decreasing the growth of organisms like bacteria and viruses.

Breastfeeding is particularly beneficial for premature babies and also may protect children against:

allergies asthma diabetes obesity sudden infant death syndrome (SIDS)

As a group, breastfed babies have fewer infections and hospitalizations than formula-fed infants. Nutrition and ease of digestion. Often called the "perfect food" for a human baby's digestive system, breast milk's components lactose, protein (whey and casein), and fat are easily digested by a newborn's immature system. As a group, breastfed infants have less difficulty with digestion than do formula-fed infants. Breast milk tends to be more easily digested so that breastfed babies have fewer incidences of diarrhea or constipation. Breast milk also naturally contains many of the vitamins and minerals that a newborn requires. A healthy mother does not need any additional vitamins or nutritional supplements, with the exception of vitamin D. Breast milk does contain some vitamin D, and vitamin D is produced by the body when the skin is exposed to sunlight. However, sun exposure increases the risk of skin damage, so parents are advised to minimize exposure. As a result, the AAP recommends that all breastfed babies begin receiving vitamin D supplements during the first 2 months and continuing until the infant consumes enough vitamin D-fortified formula or milk (after 1 year of age). The U.S. Food and Drug Administration (FDA) regulates formula companies to ensure that they provide all the known necessary nutrients (including vitamin D) in their formulas. Commercial formulas do a pretty good job of trying to duplicate the ingredients in breast milk and are coming closer but haven't matched their exact combination and composition. Why? Because some of breast milk's more complex substances are too difficult to manufacture and some have not yet been identified.

Breastfeeding: The Challenges

Although it is the best nutritional source for babies, breastfeeding does come with some concerns that many new mothers share. Whereas it's easy from the get-go for some, it can be challenging. Sometimes, both mother and baby need plenty of patience and persistence to get used to the routine of breastfeeding. But all the effort is often worth it in the long run for both the mother and her baby. Common concerns of new moms, especially during the first few weeks and months, may include: Personal comfort. Initially, as with any new skill, many moms feel uncomfortable with breastfeeding. But with adequate education, support, and practice, most moms overcome this. The bottom line is that breastfeeding shouldn't hurt.

Latch-on pain is normal for the first week to 10 days, and should last less than a minute with each feeding. But if breastfeeding hurts throughout feedings, or if the nipples and/or breasts are sore, it's a good idea for breastfeeding mothers to seek the help of a lactation consultant or their doctor. Many times, it's just a matter of using the proper technique, but sometimes pain can mean that something else is going on, like an infection. Time and frequency of feedings. There's no question that breastfeeding does require a substantial time commitment from mothers. Then again, many things in parenting do. Some women may be concerned that nursing will make it hard for them to work, run errands, or travel because of a breastfeeding schedule or a need to pump breast milk during the day. And breastfed babies do need to eat more often than babies who are fed formula, because breast milk digests faster than formula. This means Mom may find herself in demand every 2 or 3 hours (maybe more, maybe less) in the first few weeks. This can be tiring, but once breastfeeding has been established (usually in about a month), other family members may be able to help out by giving the baby pumped breast milk if Mom needs a break or is going back to work outside the home. And it's not long before babies feed less frequently and sleep through the night (usually around 3 months). Also, with a little organization and time management, it becomes easier to work out a schedule to breastfeed and/or pump.

Formula Feeding: The Advantages

Breastfeeding is considered the best nutritional option for babies by the major medical organizations, but it's not right for every mother. Commercially prepared infant formulas are a nutritious alternative to breast milk, and even contain some vitamins and nutrients that breastfed babies need to get from supplements. Manufactured under sterile conditions, commercial formulas attempt to duplicate mother's milk using a complex combination of proteins, sugars, fats, and vitamins that would be virtually impossible to create at home. So, if you don't breastfeed your baby, it's important that you use only a commercially prepared formula and that you do not try to create your own. In addition to medical concerns that may prevent breastfeeding, for some women, breastfeeding may be too difficult or stressful. Here are a few other reasons women may choose to formula feed: Convenience. Either parent (or another caregiver) can feed the baby a bottle at any time (although this is also true for women who pump their breast milk). This allows the mother to share the feeding duties and helps her partner to feel more involved in the crucial feeding process and the bonding that often comes with it. Flexibility. Once the bottles are made, a formula-feeding mother can leave her baby with a partner or caregiver and know that her little one's feedings are taken care of. There's no need to pump or to schedule work or other obligations and activities around the baby's feeding schedule. And formula-feeding moms don't need to find a private place to nurse in public.

However, if Mom is out and about with baby, she will need to bring supplies for making bottles. Time and frequency of feedings. Because formula digests slower than breast milk, formulafed babies usually need to eat less often than do breastfed babies. Diet. Women who opt to formula feed don't have to worry about the things they eat or drink that could affect their babies.

Formula Feeding: The Challenges

As with breastfeeding, there are some challenges to consider when deciding whether to formula feed. Organization and preparation. Enough formula must be on hand at all times and bottles must be prepared. The powdered and condensed formulas must be prepared with sterile water (which needs to be boiled until the baby is at least 6 months old). Ready-to-feed formulas that can be poured directly into a bottle without any mixing or water tend to be expensive. Bottles and nipples need to be sterilized before the first use and then washed after every use after that (this is also true for breastfeeding women who give their babies bottles of pumped breast milk). Bottles and nipples can transmit bacteria if they aren't cleaned properly, as can formula if it isn't stored in sterile containers. Bottles left out of the refrigerator longer than 1 hour and any formula that a baby doesn't finish must be thrown out. And prepared bottles of formula should be stored in the refrigerator for no longer than 24 to 48 hours (check the formula's label for complete information). Some parents warm bottles up before feeding the baby, although this often isn't necessary. The microwave should never be used to warm a baby's bottle because it can create dangerous "hot spots." Instead, run refrigerated bottles under warm water for a few minutes if the baby prefers a warm bottle to a cold one. Or the baby's bottles can be put in a pan of hot water (away from the heat of the stove) with the temperature tested by squirting a drop or two of formula on the inside of the wrist. Lack of antibodies. None of the important antibodies found in breast milk are found in manufactured formula, which means that formula doesn't provide the baby with the added protection against infection and illness that breast milk does. Expense. Formula can be costly. Powdered formula is the least expensive, followed by concentrated, with ready-to-feed being the most expensive. And specialty formulas (i.e., soy and hypoallergenic) cost more sometimes far more than the basic formulas. During the first year of life, the cost of basic formula can run about $1,500. Possibility of producing gas and constipation. Formula-fed babies may have more gas and firmer bowel movements than breastfed babies.

Can't match the complexity of breast milk. Manufactured formulas have yet to duplicate the complexity of breast milk, which changes as the baby's needs change.
Whatever nutritional option you choose, be sure to talk to your doctor about the choices available to help you make the decision that's best for both you and your baby. http://kidshealth.org/parent/growth/feeding/breast_bottle_feeding.html#a_A_Pers onal_Decision

A flood of questions and concerns arises upon confirmation of pregnancy. Certainly one of the important ones is "How will we feed our baby?" In this article, we will review advantages and disadvantages of breast and formula feeding and helpful concepts in preparation for breastfeeding. This article is intended to help parents feel comfortable in making an educated decision about feeding their child based on scientific information.

When should we decide about breastfeeding?

Generally, it is a good idea to meet with the baby's doctor prior to the birth in order for all to get to know each other in a controlled, non-rushed, quiet environment. This is a perfect opportunity to discuss your concerns and wishes about feeding your baby. One important reason to have the decision to breastfeed made before the delivery is that it can be very difficult or even impossible to start using formula and then later try to switch to breastfeeding. This is because the ability of the breasts to produce milk diminishes soon after childbirth without the stimulation of breastfeeding.

Why is the choice so important?

During your baby's first year of life, he/she will more than triple his/her total body weight, and the vast majority of this weight gain will come from the milk that he/she drinks. According to the American Academy of Pediatrics, human milk is the preferred feeding for all infants. This includes premature and sick newborns, with rare exceptions. Of course, breast milk would appear to be the most ideal food for your newborn. It is the food least likely to cause allergic reactions, it is inexpensive, it is readily available at any hour of the day or night; babies accept the taste readily; and the immunity factors in breast milk can help the baby fight off some infections. Although breast milk is the ideal food for human infants, because of medical or other reasons, some women opt for formula feeding. Infant formulas have been developed to artificially duplicate human milk, although no formulas have been developed that are an exact replacement for human milk.

What are the advantages and disadvantages of breastfeeding?

The nutritional advantages of breast milk are certainly numerous. The amino acids in breast milk, the building blocks of proteins, are well balanced for the human baby, as are the sugars (primarily lactose) and fats. The baby's intestinal tract is best aided in its digestion by the vitamins, enzymes, and minerals found in breast milk. Breast milk also contains infectionfighting antibodies from the mother, and breastfed babies are believed to be at a reduced risk for many acute and chronic infections early in life. The cholesterol content is also high in

human milk and very low in formulas. Cholesterol promotes brain growth and provides the building blocks of hormones, vitamin D, and intestinal bile. Breast milk is also the least expensive way to feed an infant. However, the mother must maintain good nutrition and continue taking any vitamin/mineral supplements her doctor recommended during the pregnancy. Formula-fed babies also have the risk of developing an allergy to a particular formula. When a baby develops an allergy to formula, he or she may have symptoms that include irritability, crying after feedings, nausea, vomiting, diarrhea, or a skin rash. Nursing helps most women lose weight (though not fluid) after delivery, as 500 calories or more are used by breastfeeding each day. There is a well-accepted extra closeness that breastfeeding mothers experience that is both hormonal and emotional in nature. The only disadvantages for the baby in breastfeeding occur when things are not going well, for example, if there's an inadequate supply of breast milk or an inefficient suck reflex in the baby. However, it is unusual for a mother not to produce enough milk for her baby unless she is not breastfeeding correctly or frequently enough. The disadvantages that most commonly arise involve the rest of the family. Siblings and dad often feel "left out" of baby care since mom is the only one who can do the nursing. However, other family members can be involved in helping with different aspects of the baby's care, and this gives them a valuable feeling of importance and allows mom a chance to rest. Breastfed babies eat more often than formula-fed babies since breast milk is more quickly digested and leaves the stomach empty more frequently. This puts a little more stress on the mother because of the potential necessity for more frequent feedings. If the mother develops certain medical conditions, whether or not to continue breastfeeding may need to be reassessed. These conditions should always be discussed with the doctor. However, it is rare that breastfeeding would need to be discontinued completely. In any interaction, the mother's doctor and/or pharmacist should be informed that she is breastfeeding. Some medicines should be avoided during breastfeeding. Numerous other medications have not yet been adequately studied in the context of breastfeeding and the possible effects on the baby. If a breastfeeding mother is required to take a medication which has not been fully studied, she may want to consider discussing this matter with her doctor.

What are the advantages and disadvantages of formula feeding?

For some parents, or when the baby has certain medical conditions, it is very important to know exactly how much their baby is receiving at each feeding, and formula/bottle-feeding allows exact measurement. Foods, medications, or physical conditions in the mother are no longer a concern for the baby who is receiving formula. The entire family can immediately become intimately involved in all aspects of the baby's care, including feedings, allowing the mother to get more rest. Formula-fed babies actually need to eat somewhat less often since formula is less readily digested by the baby than human milk. The disadvantages of formulas are primarily their expense, the lack of maternal infection-fighting antibodies that are in breast milk, and the fact that no formula can exactly duplicate the ideal composition of breast milk.

Can we use both forms of feedings for our baby?

According to the American Academy of Pediatrics, exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first six months after birth. Furthermore, it is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired. Infants weaned before 12 months of age should not receive cow's milk feedings but should receive iron-fortified infant formula. Supplementing breastfeeding with formula is usually discouraged, although it may be helpful in cases where the mother is not producing an adequate supply of milk or the baby is not able to breastfeed well. Lactation aids are also available as an option to avoid using a bottle when supplementation is necessary.

Is there any special preparation required for breastfeeding?

Education about the benefits and practice of breastfeeding are keys to optimal preparation. Your local hospital may offer breastfeeding classes as part of the childbirth class, or you can join your local La Leche League or other breastfeeding support group. These classes can put you in touch with a lactation specialist who may later be your personal breastfeeding consultant. These classes can also help you to learn proper positioning and latch-on techniques. Contrary to some popular beliefs, it is not necessary to stimulate or prepare the nipples in advance for breastfeeding. Moreover, some techniques of stimulating the nipples may actually be harmful. No specific physical preparation is necessary for optimal breastfeeding. General good health measures and adequate hydration are helpful measures. Most doctors recommend continuing basic prenatal vitamins while breastfeeding.

When can breastfeeding begin?

Breastfeeding can begin within minutes after birth for most babies. Most babies take a few licks or sucks and then pause at the beginning. Frequent bursts of sucking interrupted by pauses is the usual pattern for the first few hours and sometimes even the first few days. The first milk the mother produces, called colostrum, is the best food for a newborn. The nipple stimulation that occurs during breastfeeding also helps the uterus contract and can help stop uterine bleeding. When a baby begins to open its eyes, look around, and put his or her fist into his or her mouth, then it is time to offer your breast. Breastfeeding experts recommend that the baby not be given sugar water or other types of bottle feedings in the hospital unless specifically prescribed by the doctor.

What is the proper technique for breastfeeding?

Observing other breastfeeding mothers and talking with breastfeeding support organizations can help new breastfeeding mothers learn techniques for optimal breastfeeding that can help reduce the likelihood of any discomfort or complications. These techniques are briefly outlined below. After the mother has assumed a position comfortable for her, she can nestle the baby in a cradle hold (cradling the baby with the mother's arm on the same side as the breast being presented). The baby's body should be on its side, so that the baby does not have to turn his or her head to reach the nipple.
1. First, manually express a few drops of milk to moisten the nipple. 2. Cup the breast with your hand and using the milk-moistened nipple, gently massage baby's lips, encouraging the baby to open its mouth. 3. When the baby's mouth is opened, the nipple is inserted into the center of the baby's mouth while pulling the baby in very close. The baby's gums should take in at least a 1-inch radius of the areola. 4. The mother may have to make adjustments for the baby's breathing by changing the angle of baby's position slightly or using the thumb to press gently on the breast to uncover the baby's nose. 5. Hold the breast throughout the feeding so the weight of your breast does not tire your newborn's mouth. 6. When feeding is over, to avoid trauma to your nipples, do not pull your nipple from baby's mouth without first breaking the suction by inserting your finger into the corner of baby's mouth.

When should breast pumps be used?

Many women find the convenience of a breast pump to be an invaluable aid in breastfeeding. Basically, breast pumps allow the nursing mother to expel (and store, if desired) breast milk at times when she is not available to nurse the baby. There are different types of breast pumps. Large, dual-action pumps are typically used in the hospital setting and may be rented for home use. The options for personal use and purchase include automatic models that are comparable to hospital-grade pumps, small electric or battery-operated units that double- or single-pump, and one-handed manual pumps. Breast pumps may be useful for working mothers who wish to provide a supply of breast milk for their newborn and keep up their own milk production. Sometimes, women must stop breastfeeding on a temporary basis due to an infection or need to take certain medications. In these cases, use of a breast pump can keep milk production active during the breastfeeding hiatus.

Should certain foods be avoided while breastfeeding?

Some babies appear to be sensitive to certain foods in the mother's diet, while other babies never appear to have negative reactions to foods. A baby may become fussy, may have

trouble sleeping, or may develop gas after the mother eats certain types of foods with strong flavors. Some of the most common triggers of fussiness in babies include chocolate, spices, citrus fruits, and gas-causing vegetables like cauliflower, cabbage, and broccoli. However, not all babies will have a reaction to particular foods. Most experts recommend limiting consumption of caffeine while breastfeeding, since high levels of caffeine can make the baby fussy or disturb the baby's sleep patterns. Having more than one alcoholic beverage is also not recommended, since two or more alcoholic beverages at one time can increase blood alcohol levels to a point where the alcohol enters the breast milk. If a nursing mother consumes more than two drinks, she should wait at least two hours until nursing the baby to allow for elimination of alcohol from the body. If the breasts become engorged, it is fine to pump and discard breast milk while waiting. Studies have also shown that alcohol can interfere with the body's ability to "let down" (enable the free flow of breast milk) during breastfeeding. Symptoms of allergy in a nursing baby may or may not be due to something eaten by the mother. If an allergic reaction to mother's food is present in the baby, it usually develops two to six hours after the mother consumed the offending food. Because of concerns about mercury poisoning, the U.S. Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) recommend that nursing mothers limit their exposure to mercury in fish. The FDA and EPA advise eating no more than 6 oz. (about one serving) of canned albacore or "white" tuna a week and limiting intake of canned "light" tuna and other cooked fish to about 12 oz. (about two servings) per week. Nursing mothers should completely avoid eating shark, swordfish, king mackerel, and tilefish (also called golden or white snapper) because of potentially high levels of mercury.

How can one manage minor discomforts related to breastfeeding? Clogged milk ducts
Clogged milk ducts may appear as small, red, tender lumps within the breast. Milk ducts may become clogged with dried milk or other material. The goal of treatment is opening these blocked ducts. This can be aided by increasing the breastfeeding frequency and offering the affected breast first, as well as pumping the breast after breastfeeding if the baby is not emptying the breast. Moist heat packs can be applied to the affected area to increase blood flow and healing. A warm shower and massaging of the area may also enhance resolution of this problem. Sometimes, the baby will refuse the affected breast because the milk develops a sour taste. Pump the breast and empty it as well as possible. Continue to offer that breast to the baby until he/she accepts the affected breast again.

Sore nipples
Sore nipples can be relieved by exposing the nipples to the air as much as possible. Using a hair dryer on a low setting to dry nipples after breastfeeding may also provide relief. Nipples should be washed only with water, never with soap, alcohol, benzoin, or premoistened

towelettes. Petroleum-based ointments and other cosmetic preparations should not be used, but unmedicated lanolin may help alleviate nipple cracking.

When should one seek medical care for problems with breastfeeding?
It is important to call your health-care provider if the above techniques do not alleviate the problem or if you develop serious symptoms such as fever or signs of mastitis (a breast inflammation that may be caused by an infection). Symptoms of mastitis include increasing pain in the breast, fever, chills, sweats, breast swelling and/or hardness, and redness of the skin over the affected area. A delay in treating mastitis could lead to a more severe infection and possible breast abscess.

Can supplements or medications increase a low milk supply?

Most experts agree that increasing the number of feedings and receiving coaching and assistance on proper breastfeeding technique can help increase what is perceived to be a low milk supply. Some women find that using breast pumps after each feeding stimulates milk production because of the increased degrees of emptying of the breast. Medications that are reported to increase milk production are known as galactogogues. The most common examples are dopamine receptor antagonists (such as metoclopramide [Reglan, Reglan ODT, Metozol ODT, Octamide] and domperidone). However, there have been no data to demonstrate that these drugs are more effective than interventions that focus on improving breastfeeding technique and increasing breastfeeding frequency. Most doctors do not support the use of these medications to augment milk supply. Likewise, a number of dietary supplements and/or herbal preparations have been claimed to stimulate milk production, including alfalfa, fenugreek, or blessed thistle. There is no scientific data to support the claims that any herbal or dietary supplement can increase milk production.

Is it possible to breastfeed while pregnant?

While breastfeeding typically is associated with a decrease in fertility, it is possible to become pregnant while breastfeeding, and breastfeeding does not afford 100% protection from pregnancy. For most women, it is safe to continue breastfeeding if they desire, provided they ensure that they are receiving adequate nutrition and fluid intake. While breast milk from a pregnant mother is still nutritionally strong, the hormonal changes of pregnancy will result in some changes in the content of the breast milk and the way the breast milk tastes. Some women who have had premature labor in previous pregnancies may be advised to stop breastfeeding if they become pregnant. This is because the stimulation of the nipples that occurs during breastfeeding may trigger contractions of the uterus. In a woman prone to preterm labor, these weak uterine contractions might increase her risk of developing preterm labor. Both pregnancy and breastfeeding place high demands on the body in terms of nutritional support and rest. Other women may be advised to stop breastfeeding during pregnancy if their nutritional status is poor or if they are suffering from extreme fatigue due to the pregnancy.

Is smoking harmful when breastfeeding?

Tobacco smoking is always harmful, and all mothers should be encouraged to quit smoking prior to pregnancy and breastfeeding. However, smoking cigarettes is not considered to be a reason for not breastfeeding, since breastfeeding is the optimal nutrition for newborns. According to the American Academy of Pediatrics' policy statement on breastfeeding, "tobacco smoking by mothers is not a contraindication to breastfeeding, but health-care professionals should advise all tobacco-using mothers to avoid smoking within the home and to make every effort to wean themselves from tobacco as rapidly as possible." Nursing mothers should understand that nicotine is passed to the baby in breast milk, and they should never nurse their baby immediately after smoking or while smoking. Babies exposed to secondhand smoke also are at risk for a number of health issues, so if a woman smokes, she should nurse her baby after smoking, in a room away from cigarette smoke. Of course, the safest policy for both mother and baby is to abstain from tobacco use while breastfeeding and forever thereafter.

Do breast implants, surgeries, or reductions affect breastfeeding?

Strictly speaking, neither breast augmentation surgery nor breast reduction surgery are indications that a woman should not breastfeed. However, all types of breast surgery can interfere with milk production. In women who have received implants, the location of the implant and the type of incision used in the procedure will determine the extent, if any, to which the implant may affect breast milk production or nursing ability. In some cases, operations on a woman's breast may have involved incisions in the nipple area (such as surgeries for biopsies), and in these cases, the milk ducts may have been disrupted. Surgical disruption of milk ducts and scar tissue may also predispose women to plugged ducts, mastitis, or milk retention cysts during breastfeeding. Concerns have been expressed in the past that the content of breast implants (particularly with silicone implants) could leak out and be absorbed into breast milk, but studies have failed to show that this is a risk. Ideally, a woman who is planning breast surgery should discuss in advance with her surgeon the risks that the procedure may pose to future breastfeeding.

How should one wean a baby from breastfeeding?

Weaning is the process of transitioning from breastfeeding to other sources of nourishment. There are no established standards on when to wean a baby, although the American Academy of Pediatrics recommends that babies receive only breast milk for the first six months of life and a combination of solid foods and breast milk until the baby is at least 1 year old. Sometimes babies will signal their mothers that it is time to begin weaning; they may nurse for shorter periods of time or appear indifferent, fussy, or distractible when nursing. Other babies may even be resistant to weaning even when the mother is ready. As babies begin to eat more solid foods, their consumption of breast milk may decrease, making breast engorgement less of a problem for the mother. Weaning does not have to take place all at once. For example, a woman may choose to continue breastfeeding only in the evening, and to wean during the day. Weaning is also

easier when the baby has been exposed to another source of milk, such as taking breast milk from a bottle. No matter when weaning occurs, experts suggest that the process take place gradually. Many women wean by dropping one breastfeeding session a week. Slowing down the process can also help milk production gradually decrease, making engorgement less of a problem. Some mothers prefer to leave the weaning process up to the child; when a child is eating solid foods at every meal, there is often a decreased interest in breastfeeding.
Breastfeeding At A Glance

The ability of the breasts to produce milk diminishes soon after childbirth without the stimulation of breastfeeding. Infants triple their total body weight during their first year of life. The immunity factors in breast milk can help the baby to fight off infections. Breast milk contains vitamins, minerals, and enzymes which aid the baby's digestion. Breast milk is the ideal form of nutrition for infants.

http://www.medicinenet.com/breastfeeding/article.htm

Human breast milk

From Wikipedia, the free encyclopedia (Redirected from Breast milk) Jump to: navigation, search

Two 25ml samples of human breast milk. The left hand sample is foremilk, the watery milk coming from a full breast. The right hand sample is hindmilk, the creamy milk coming from a nearly empty breast.[1]

Human breast milk refers to the milk produced by a human mother to feed her baby. It provides the primary source of nutrition for newborns before they are able to eat and digest other foods; older infants and toddlers may continue to be breastfed. The baby nursing from its own mother is the most ordinary way of obtaining breastmilk, but the milk can be pumped and then fed by baby bottle, cup and/or spoon, supplementation drip system, and nasogastric tube. Breastmilk can be supplied by a woman other than the baby's mother; either via donated pumped milk (for example from a milk bank), or when a woman nurses a child other than her own at her breast - this is known as wetnursing.

The World Health Organization recommends exclusive breastfeeding for the first six months of life, with solids gradually being introduced around this age when signs of readiness are shown. Supplemented breastfeeding is recommended until at least age two, as long as mother and child wish.[2] Breastfeeding continues to offer health benefits into and after toddlerhood. [3] These benefits include; lowered risk of Sudden Infant Death Syndrome (SIDS),[4] increased intelligence[citation needed] , decreased likelihood of contracting middle ear infections, cold, and flu bugs, a tiny decrease in the risk of childhood leukemia, lower risk of childhood onset diabetes, decreased risk of asthma and eczema, decreased dental problems, decreased risk of obesity later in life, and decreased risk of developing psychological disorders.[5][6][dubious discuss] Breastfeeding also provides health benefits for the mother. It assists the uterus in returning to its pre-pregnancy size and reduces post-partum bleeding, as well as assisting the mother in returning to her pre-pregnancy weight. Breastfeeding also reduces the risk of breast cancer later in life.[7]

[edit] Production
Under the influence of the hormones prolactin and oxytocin, women produce milk after childbirth to feed the baby. The initial milk produced is often referred to as colostrum, which is high in the immunoglobulin IgA, which coats the gastrointestinal tract. This helps to protect the newborn until its own immune system is functioning properly, and creates a mild laxative effect, expelling meconium and helping to prevent the build up of bilirubin (a contributory factor in jaundice). Actual inability to produce enough milk is rare, with studies showing that mothers from developing countries who are experiencing nutritional hardship still produce similar amounts of milk of similar quality to mothers in developed countries.[8] There are many reasons a mother may not produce enough breast milk. Some of the most common are an improper latch (i.e. the baby does not connect efficiently with the nipple), not nursing or pumping enough to meet supply, certain medications (including estrogen-containing hormonal contraceptives), illness, and dehydration. A rarer reason is Sheehan's syndrome, also known as postpartum hypopituitarism, which is associated with prolactin deficiency; this syndrome may require hormone replacement. The amount of milk produced depends on how often the mother is nursing and/or pumping; the more the mother nurses her baby, or pumps, the more milk is produced.[9][10][11][12][13] It is very helpful to nurse on demand - to nurse when the baby wants to nurse rather than on a schedule. If pumping, it is helpful to have an electric high grade pump so that all of the milk ducts are stimulated. Some mothers try to increase their milk supply in other ways - by taking the herb fenugreek, used for hundreds of years to increase supply[14] ("Mother's Milk" teas contain fenugreek as well as other supply-increasing herbs); there are also prescription medications that can be used, such as Domperidone (off-label use) and Reglan.[citation needed] Increasers of milk supply are known as galactagogues.

[edit] Composition
Composition of human breast milk[15]

Fat total (g/100 ml) 4.2

fatty acids - length 8C (% trac ) e polyunsaturated acids (%) Protein (g/100 ml) total casein 0.4 a-lactalbumin lactoferrin IgA IgG lysozyme serum albumin -lactoglobulin 1.1 0.3 0.3 0.2 0.1 0.00 1 0.05 0.05 fatty 14

Carbohydrate (g/100 ml) lactose oligosaccharides Minerals (g/100 ml) calcium phosphorus sodium potassium chlorine 0.03 0.01 4 0.01 5 0.05 5 0.04 3 7 0.5

The exact integrated properties of breast milk are not entirely understood, but the nutrient content after this period[citation needed] is relatively consistent and draws its ingredients from the mother's food supply. If that supply is found lacking, content is obtained from the mother's bodily stores. The exact composition of breast milk varies from day to day, depending on food consumption and environment, meaning that the ratio of water to fat fluctuates. During the first few days after delivery the breasts produce colostrum. This is a thin yellowish fluid which is the same fluid that leaks from the breasts during pregnancy. It is rich in protein and antibodies that provide passive immunity to the baby (the baby's immune system is not fully developed at birth). Colostrum also helps the newborn's digestive system to grow and function properly. After 3 to 4 days breasts will begin producing milk that is thin, watery, and sweet. This quenches the baby's thirst and provides the proteins, sugar, and minerals the baby needs. Over time the milk changes and becomes thick and creamy. This satisfies the baby's hunger.[16] Foremilk, the milk released at the beginning of a feed, is watery, low in fat and high in carbohydrates relative to the creamier hindmilk which is released as the feed progresses. The breast can never be truly "emptied" since milk production is a continuous biological process. The level of Immunoglobilin A (IgA) in breast milk remains high from day 10 until at least 7.5 months post-partum.[17] Human milk contains 0.8% to 0.9% protein, 4.5% fat, 7.1% carbohydrates and 0.2% ash (minerals).[18] Carbohydrates are mainly lactose; several lactose-based oligosaccharides have been identified as minor components. The fat fraction contains specific triglycerides of palmitic and oleic acid (O-P-O triglycerides) and also quite a large quantity of lipids with trans bonds (see: trans fat) that are considered to have a health benefit. They are vaccenic acid, and Conjugated linoleic acid (CLA) accounting for up to 6% of the human milk fat.[19][20] The principal proteins are casein (homologous to bovine beta-casein), alpha-lactalbumin, lactoferrin, IgA, lysozyme and serum albumin. In an acidic environment such as the stomach, alpha-lactalbumin unfolds into a different form and binds oleic acid to form a complex called HAMLET that kills tumor cells. This is thought to contribute to the protection of breastfed babies against cancer.[21] Non-protein nitrogen-containing compounds, making up 25% of the milk's nitrogen, include urea, uric acid, creatine, creatinine, amino acids and nucleotides.[22][23] Breast milk has circadian variations; some of the nucleotides are more commonly produced during the night, others during the day.[24] Mother's milk has been shown to supply a type of endocannabinoid (the natural neurotransmitters which marijuana simulates), 2-Arachidonoyl glycerol.[25] Though it now is almost universally prescribed, in some countries in the 1950s the practice of breastfeeding went through a period where it was out of vogue and the use of infant formula was considered superior to breast milk. However, it is now universally recognized that there is no commercial formula that can equal breast milk. In addition to the appropriate amounts of carbohydrate, protein and fat, breast milk also provides vitamins, minerals, digestive enzymes and hormones - all of the things that a growing infant will require. Breast milk also

contains antibodies and lymphocytes from the mother that help the baby resist infections. The immune function of breastmilk is individualized, as the mother, through her touching and taking care of the baby, comes into contact with pathogens that colonize the baby and consequently her body makes the appropriate antibodies and immune cells. This is the reason breast milk contains very little iron as iron is a essential pre-cursor to the activation of microbacteria and gut flora and so providing iron in the milk would lead to infection. However the internal iron supplies of the infant, held in the hepatic cells of the liver, are exhausted at 4-6 months hence this is the time that complimentary feeding is introduced as to prevent anaemia (recommened by WHO). Women who are breastfeeding should consult with their physician regarding substances that can be unwittingly passed to the infant via breast milk, such as alcohol, viruses (HIV or HTLV-1) or medications. Most women who do not breastfeed use infant formula, but breast milk donated by volunteers to human milk banks can be obtained by prescription in some countries.[26]

Alternative uses for breast milk

Assertions that breast milk consumption is of benefit to adult humans are questionable because many of its components undergo digestion in the adult stomach, including antibodies and other proteins.[citation needed] In addition to providing essential nourishment to infants, human milk; i.e., breast milk, has a number of valuable uses, especially medicinal uses, for both children and adults. It has been used medicinally for thousands of years.[31] The antibacterial and healing properties[citation needed] of breast milk are often overlooked, even by the nursing mothers themselves. [32] Breast milk contains strong antibodies and antitoxins that many people believe promote healing and better overall health. However, breast milk lacks sterile and antiseptic properties if a nursing mother is infected with certain communicable diseases, such as HIV and various bacterial infections like Group B streptococcus, as breast milk can transmit such diseases to infants and other people.[33] Breast milk has been used as a home remedy for minor ailments, such as conjunctivitis, insect bites and stings, contact dermatitis, and infected wounds, burns, and abrasions. Breast milk has also been used alternatively to boost the immune system of ill persons having viral gastroenteritis, influenza, the common cold, pneumonia, etc., because of its immunologic properties. However, breast milk should never be seen or construed as a "cure all". Some medical experts are convinced that breast milk can induce apoptosis in some types of cancer cells, however, more research and evidence are needed in this area of cancer treatment. [34][dead
link]

A minority of people, including restaurateur Hans Lochen of Switzerland, have used human breast milk, or at least advocated its use, as a substitute for cow's milk in dairy products and food recipes.[35] Tammy Frissell-Deppe, a family counselor specialized in attachment parenting, published a book, titled A Breastfeeding Mother's Secret Recipes, providing a lengthy compilation of detailed food and beverage recipes containing human breast milk.[36] The animal rights organization known as PETA ignited a firestorm of criticism when it urged a dairy company to replace the cow's milk they use in their ice cream products with human breast milk as a way to stop cattle abuse.[37][38] Human breast milk is not produced or

distributed industrially or commercially, because the use of human breast milk as a dairy food or recipe ingredient is considered bizarre and counterintuitive to the vast majority of cultures around the world, and most disapprove of such a practice, as it has never been widely accepted historically.[39] Attempts to formulate soap from breast milk have also been made, and those who use it claim that its effectiveness as a cleanser is greater than, or equal to, that of traditional soaps.[40]

[edit] Passing of unwanted substances

Despite the risk of substances transmitting from the mother to the child through breast milk, breastfeeding has far more advantages than infant formulas, and, with few exceptions, the WHO recommends exclusive breastfeeding for the first 6 months of life.[41] The milk producing cells are most permeable to drugs during the first postpartum week.[42] Drug characteristics that increase excretion in milk include:[42]
1. 2. 3. 4. 5. Not plasma protein binding Non-ionized Low molecular weight Lipid solubility rather than water solubility Weakly alkaline rather than weak acid

Drugs are transferred from blood plasma across ductal cells to the milk by diffusion or active transport. The latter may result in higher concentration of the drug in the breast milk than in the plasma of the mother.[42] The amounts of most drugs in milk do not exceed 2% of the total ingested dose.[42]

[edit] Environmental pollutants

Environmental pollutants found in breast milk are usually not harmful, and should only be considered when environmental levels are unusually high. In addition, there has been a decrease in environmental levels, also resulting in a decrease breast-milk levels. Pollutants that are of most concern are pesticides, organic mercury and lead. DDT and dieldrin are unavoidable, and can also be detected in infant formulas.[43] Pesticides and other toxic substances bioaccumulate, i.e. creatures higher up the food chain will store more of them in their body fat. This is an issue particularly for the Inuit, whose traditional diet is predominantly meat. Studies are looking at the effects of polychlorinated biphenyls and persistent organic pollutants in the body; the breast milk of Inuit mothers is extraordinarily high in toxic compounds.[44]