Breastfeeding

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Basics

  • Breastfeeding is the natural process of feeding human milk directly from the breast.
  • Breast milk is the preferred nutritional source and the normal and physiologic way to feed all newborns and infants.
  • Breast milk contains >200 active components which provide nutrition, fight pathogens, promote healthy gut microbiome, and aid in maturity of immune system.
  • The American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), American Congress of Obstetricians and Gynecologists (ACOG), WHO, and other medical organizations recommend exclusive breastfeeding for 6 months, with continuation of breastfeeding for ≥1 year as desired by mother and infant (1)[A].

Description

  • Maternal benefits (as compared with mothers who do not breastfeed) include the following:
    • Rapid involution/decreased postpartum bleeding (due to oxytocin release)
    • Association of decreased risk of postpartum depression and increased bonding
    • Associated postpartum weight loss
    • Decreased risk of breast cancer and association of decreased risk of pre- and postmenopausal ovarian cancer, decreased risk of type 2 diabetes, hypertension, hyperlipidemia, rheumatoid arthritis, and cardiovascular disease
    • Decreased risk of prematurity due to child spacing
    • Increased bone density
    • Convenience and economic savings
    • Association of longer continuation in work/school activities
  • Infant benefits (as compared with children who are formula-fed) include the following (1):
    • Ideal food: easily digestible, nutrients well absorbed, less constipation
    • Lower rates of virtually all infections via maternal antibody protection
      • Fewer respiratory and GI infections
      • Decreased incidence of otitis media
      • Decreased risk of bacterial meningitis, pneumonia, and sepsis
      • Decreased incidence of necrotizing enterocolitis
      • Decreased risk of ear infections
    • Decreased incidence of obesity and type 1 and 2 diabetes
    • Decreased incidence of allergies, clinical asthma, and atopic dermatitis in childhood
    • Decreased risk of developing celiac disease and inflammatory bowel disease
    • Decreased risk of childhood leukemia
    • Decreased risk of sudden infant death syndrome (SIDS) and decreased mortality
    • Enhanced neurodevelopmental performance
    • Increased attachment between mother and baby
    • Decreased child abuse
    • Decreases the risk of urinary tract infection

Epidemiology

Incidence
  • According to CDC’s Breastfeeding Scorecard, U.S. breastfeeding rates are on the rise in 2016: any breastfeeding: 81.1% (however, differs among different sociodemographic and culture) (2)
  • Breastfeeding at 6 months: 51.8%
  • Breastfeeding at 12 months: 30.7%
  • Exclusive breastfeeding at 3 months: 44.4%
  • Exclusive breastfeeding at 6 months: 22.3%

Etiology and Pathophysiology

  • The mechanism of milk production is based on several hormones: Prolactin triggers milk production and oxytocin releases milk based on supply and demand (3). Endocrine control system triggers making of colostrum at 5 months’ gestation.
  • Alveoli make milk in response to hormone prolactin. Sucking stimulates secretion of prolactin, which triggers milk production.
  • Stimulation of areola causes secretion of oxytocin. Oxytocin is responsible for let-down reflex when myoepithelial cells contract and milk is ejected into milk ducts (3).
  • Endocrine/metabolic: Cystic fibrosis, diabetes, galactosemia, phenylketonuria, and thyroid dysfunction may cause delayed lactation or decreased milk.

General Prevention

  • Most vaccinations can be given to breastfeeding mothers. The CDC recommends that the diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated influenza virus (as opposed to live attenuated), mumps, measles, rubella (MMR), and inactivated polio and varicella vaccines can be given. The CDC recommends avoiding the yellow fever or smallpox vaccine in breastfeeding mothers (4).
  • The inactivated influenza virus is preferred to the live attenuated virus in women with infants’ age 6 to 23 months, regardless of whether these infants are being breastfed (4).
  • Protective measures include breastfed infants who are more easily aroused than formula-fed infants, triggering a mechanism for the protective effect of breastfeeding against SIDS (5).

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