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I. Physiology of Breast milk production

As soon as delivery of the placenta is over there will be an abrupt decrease on both Estrogen and Progesterone -----> this will stimulate the APG to secrete PROLACTIN.

note: Be aware that sucking also stimulates Prolactin secretion as this will stimuate the nerves and impulse will travel from the nipple to the Hypothalamus

PROLACTIN will act on the acini cells (alveolar cells) of the breast to produce milk. This milk is called FOREMILK and is stored in the lactiferous sinus. FOREMILK is contiously being produced.

What happens next?

When the baby sucks on the breast of the mother OXYTOCIN is stimulated and oxytocin will act on 2 organs.

1. Breast (Let down reflex)
2. Uterus (promotes Involutions)

OXYTOCIN will cause the mammary galnds to contract and push the milk forward making it available for the baby.

What will stimulate the Let Down reflex?
1. Sucking of the baby
2. Sound of the baby's cry

note: After the Let Down Reflex a new milk will be formed and this is called HINDMILK and this contains more FATS that is needed for the growing newborn

1. Colostrum - 2-4 days present
-content: decrease fats, increase IgA, dec CHO, dec CHON, inc minerals, -inc fat soluble minerals
2. Transitional milk- 4 – 14 days
-content: inc lactose, inc water soluble vit., inc minerals

3. Mature milk- 14 & up
-content: inc fats (linoleic acid) – resp for devt of brain & integrity of skin
-inc CHO- lactose – easily digested, baby not constipated.- esp of sour milk smelling odor of stool.

-Lactose intolerance- deficiency of enzyme LACTASE that digest LACTOSE
-Decrease CHON- lactalbumin

Difference with cow's milk

Cows milk
–inc fats -Dec CHO
-Inc CHON – casing- has curd that’s hard to digest.
-Inc minerals–traumatic effect on kidneys of babies. Can trigger stone formation.
-Inc phosphorusnote:

Note Baby who are breastfed are least likely to develop tetany. It is seen that botlle fed infants have more difficulty in regulating calcium and phosporus. Because cow's milk have more fat contents, this fatty acids may bind with calcium in the GIT causing more decrease in calcium.

Note: Breast feeding can be iniated
if had Cesarian Section- after 4 hours

Advantages of Breast feeding
1. Economical
2. Always available
3. Breastfed babies have higher IQ than bottle fed babies.
4. It facilitates rapid involution
5. Decrease incidence of breast cancer.
6. Has antibodiesI(gA), lactoferrin, lyzozymes and interferon (inhibit and/or destroy pathogenic bacteria and viruses)
7. Has lactobacillius bifidus- interferes with attack of pathogenic bacteria in GIT
8. Has macrophages
Store milk- plastic storage container
Store milk – good for 6 months from freezer- put rm temp. don’t heat

1. Possibility of transfer HEP B, HIV, cytomegalo virus.
2. No iron
3. Father can’t feed & bond as well

Proper breast feeding technique

1. Be in a comfortable position
(Most appropriate is Upright sitiing for this position avoids tension)
2. Entire body of teh baby should be turned towards the mother's breast.
3. Initiate feeding by stimulating the Rooting reflex- by touching the side of lips/cheeks then baby will turn to stimulus. Disappear by 6 weeks- by 6 weeks baby can focus. Reflex will be gone-
Purpose rooting- to look for food.

Sucking Mechanism (breast)
a. Lips of the infant should clamp a C-shape
b. The tounge thrusts forward to grasp nipple and areola
c. The nipple is brought against the ahrd palate as the tounge pulls the areola into the mouth
d. the gums compresses the areola, squezing milk at the back of the throat

Sucking mechanism (bottle)
The large rubber nipple strikes the soft palate and interferes with the action of the tounge. The tounge moves forwards against the gum to control overflow of milk in the espphagous (same reason why dental malocllusion is prone to bottle fed babies, because they thrust their tounge FORWARD causing problem in the formation od the dental arch)

4. Burp or Bubble the babyduring and after feeding to allow escape of air (preventing colic). Sit infant on lap, flexed forward, then rub or pat the back (note: avoid jarring the infant)

Criteria of Effective Sucking
a.) Baby’s mouth is hiked up to areola
b.) Mom experiences after pain.
c.) Other nipple is also flowing with milk.

NOTE: Make sure that the mother feeds the baby at the same breast she last feed her baby. THis is to facilitated complete emptying of the breast and thereby promote complete filling of milk.

Contra Indications in Breast Feeding:
a. Maternal Conditions:
1. HIV, CMV, Hepa B
2. Recieving Coumadin, Lithium or Methotrexate
3. has breast cancer
4. has herpes lesion on breast

b.Newborn Condition - Inborn errors of metabolism usch asErythrobastosis Fetalis – Rh incompatibility, Hydrops Fetalis, Phenylketonuria, Galactosemia, Tay Sachs disease

Problems experienced in Breastfeeding :

3RD day changes in breast post partuma.1
1)Engorged breast- feeling of fullness & tension in breast. - sometimes accompanied by fever known as MILK FEVER.
Mgt:Warm compress- for breastfeeding momCold compress
– for bottle feeding & wear supportive bra.
When is involution of breast- 4 weeks

b.) Sore nipple – cracked with painful nipple
Mgt: 1.) exposure to air – remove bra & wear dress, if not, expose to 20 Watt bulbavoid wearing plastic liner bra-will create moisture, cotton only

c.) Mastitis- inflammation of breast : staphylococcus aureus
1. Improper breast emptying
2. Unhealthy sexual practices
- manually express inflamed breastfeed on unaffected breast- give antibiotics
– can still feed on unaffected breast

Type of stools with different milk products:

1. Transitional stool - - green loose & shiny, like diarrhea to the untrained eye
2. Breastfed stool
- golden yellow, soft, mushy with sour milk smell, frequently passed
- recur every feeding
3.. Bottlefed stool –
- pale yellow, formed hard with typical offensive odor, seldom passed, 2–3 x/day
- with food added -brown & odorous

Jeddah's note: Hope this helps. God bless us all

it really helps! tnx...

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