feeding

• Breast-feeding


  Feedings should be initiated soon after birth unless medical conditions preclude them
• The American Academy of Pediatrics (AAP) and World Health Organization (WHO) strongly advocate breast-feeding as the preferred feeding for all infants

  
• The AAP recommends exclusive breast-feeding for a minimum of 4 mo and preferably for 6 mo
• Macrophages in human milk

  • May synthesize complement, lysozyme, and lactoferrin

  
• Lactoferrin in human milk


  • An iron-binding whey protein that is normally about one-third saturated with iron and has an inhibitory effect on the growth of Escherichia coli in the intestine
• Lower pH of stool of breast-fed infants

  • Contributes to the favorable intestinal flora of infants fed human milk vs. formula (i.e., more bifidobacteria and lactobacilli; fewer E. coli), which helps protect against infections caused by some species of E. coli

  
• Human milk


  • Contains bile salt–stimulated lipase, which kills Giardia lamblia and Entamoeba histolytica

  
• Breast-feeding


  • Associated with fewer feeding difficulties incident to allergy and/or intolerance to bovine milk, including diarrhea, intestinal bleeding, occult melena, "spitting up," colic, and atopic eczema

  
• Breast-fed infants


  • Appear to have a lower frequency of certain allergic and chronic diseases in later life than formula-fed infants

  
• Human milk


  • Contains bacterial and viral antibodies, including relatively high concentrations of secretory IgA that prevents microorganisms from adhering to the intestinal mucosa, and substances that inhibit growth of many common viruses

  
• Outstanding characteristics of human milk

  • Relatively low but highly bioavailable protein content, a generous quantity of essential fatty acids, a relatively low sodium and solute load, and low but highly bioavailable concentrations of calcium, iron, and zinc

  
• Breast milk


  • Does not need to be warmed, does not require a clean water supply, and is generally free of pathogenic microorganisms

  
• Colostrum


  The initial secretion from the breasts immediately after delivery, a yellowish thick liquid containing extremely useful substances for the baby
• Colostrum


  • Contains a large number of white blood cells, which further protect the baby from infection, has a mild purgative action which helps to clear the baby's gut of Meconium, thus reducing the chances of jaundice in the baby, and contains growth factors which stimulate the growth of immature intestines of the baby
• Colostrum


  Contains high amounts of vitamin A
• Foremilk


  Early portion of feeding, more dilute, less fat
• Hindmilk


  Secreted later in feeding, 4-5 times fat content of foremilk
• It is unknown whether mothers with COVID-19 can transmit the virus via breast milk, but the limited data available suggest this is not likely to be a source of transmission
• Mothers should perform hand hygiene before and wear a mask during breast-feeding
• No food need be withheld from the mother unless it is known to cause, or is strongly suspected of causing, distress to the infant
• Few therapeutic drugs are absolutely contraindicated; these include radioactive compounds, antimetabolites, lithium, and certain antithyroid drugs
• The mother should be advised against the use of unprescribed drugs, including alcohol, nicotine, caffeine, or street drugs
• Mothers should be encouraged to nurse at each breast at each feeding starting with the breast offered 2nd at the last feeding


  It is not unusual for an infant to fall asleep after the 1st breast and refuse the 2nd, and it is preferable to empty the 1st breast before offering the 2nd in order to allow complete emptying and therefore better milk production
• No factor is more important for successful breast-feeding than a happy, relaxed state of mind

  
• Mothers are often upset by any suggestion that their milk may be lacking in quantity or quality, and they may be disturbed by the scanty supply of colostrum, nipple tenderness, and the fullness of the breasts on the fourth or fifth day after delivery
• Adequacy of milk intake


  Can be assessed by voiding and stooling patterns of the infant, with a well-hydrated infant voiding six to eight times a day with colorless urine, and passing loose yellow stools at least four times a day by 5 to 7 days

  
• Rate of weight gain

  Provides the most objective indicator of adequate milk intake, with total weight loss after birth not exceeding 7% and birth weight regained by 10 days

  
• Growth of the Breast-fed Infant


  Breast fed baby double birth weight by 4-5 months and triple birth weight by one year
• Stool of breast fed baby

  Unformed, yellow, and seedy in appearance, with stool frequencies varying and breastfed infants tending to produce stool more frequently than formula-fed infants in the first 4 to 6 weeks, then possibly going several days without passing a stool after 6 to 8 weeks
• Signs of Correct Attachment

  • Mouth wide open, lower lip turned outside, chin touching the breast, black part of the breast not visible below the lower lip, large black portion of breast and nipple including milk collecting ducts inside baby's mouth, tongue under the teat
• Incorrect Sucking Position


  • Mouth not wide open, chin away from the breast, baby sucking only nipple, most black portion of the breast outside the baby's mouth, tongue away from the teat
• Nipple Pain


  Most commonly due to poor infant positioning and improper latch, may require treatment for nipple candidiasis or manual milk expression until healing occurs

  
• Engorgement


  Physiologic fullness of the breast occurring in the 2nd stage of lactogenesis, may require frequent breast-feeding or manual milk expression before feeding
• Mastitis


  Occurs in 2-3% of lactating women, usually unilateral, manifesting with localized warmth, tenderness, edema, and erythema, caused by various organisms and usually resolved with oral antibiotics and analgesics while promoting breast-feeding or emptying of the affected breast, but can progress to a breast abscess requiring intravenous antibiotics and incision and drainage

  
• Inadequate Milk Intake


  May be due to insufficient milk production, failure of established breast-feeding, or health conditions in the infant that prevent proper breast stimulation, requiring counseling on minimum feeding frequency and observation of technique
• Breast-feeding jaundice


  A common reason for hospital readmission of healthy breast-fed infants, largely related to insufficient fluid intake and potentially associated with dehydration and hypernatremia, generally declining in the 2nd week of life but requiring evaluation for other causes if severe or persistent, potentially requiring temporary change to formula by spoon and/or phototherapy without cessation of breast-feeding
• Breast Milk Collection


  Requires good handwashing and hygiene, use of electric breast pumps, cleaning of collection kits, refrigeration or freezing of expressed milk, and avoidance of microwaving
• The AAP recommends vitamin D supplementation (400 IU/day starting soon after birth) for breast fed infants
• The AAP recommends giving breast-fed infants 1 mg/kg/day of liquid iron supplement at age 4 months until iron-containing foods are introduced at about 6 months of age
• Breast feeding in the 2nd year


  Breast milk can still provide a good proportion of nutrients' needs of the baby, up to half of vitamin A, one third of calories and most of vitamin C needed by the baby during the second year of life