Breastfeeding

Descriptive text is not available for this imageBASICS

DESCRIPTION

  • Human milk is recognized as the optimal nutrition for infants by the American Academy of Pediatrics (AAP), the World Health Organization (WHO), the Surgeon General, and all major medical groups.
  • Not all persons who feed their baby human milk will identify as women. In clinical settings, care should be used to align terminology (e.g., breast, breastfeeding, and mother) with patient’s preference.

PHYSIOLOGY

  • Human milk production
    • Lactogenesis I: Milk production begins around 16 weeks prenatally.
    • Lactogenesis II: onset of copious milk secretion around 2 to 3 days after vaginal delivery; under hormonal control initiated by the expulsion of placenta and decrease in progesterone levels
    • Lactogenesis III: Mature milk production (maintenance) depends on autocrine (local) control. The amount of milk removed influences milk volume. If milk is not removed, a protein (feedback inhibitor of lactation) accumulates and inhibits prolactin release.
    • Prolactin is released from the anterior pituitary in response to nipple stimulation and triggers milk secretion into the lumen of breast alveoli.
    • Oxytocin is released from the posterior pituitary gland, causing ejection of milk into the breast ducts (milk ejection reflex).
    • Let-down can be triggered by physical stimulation of the breast or by mental stimulation such as hearing a baby cry.
  • Composition
    • Largely independent of maternal diet, except for fatty acids and water-soluble vitamins
    • Colostrum contains high levels of secretory immunoglobulin A for immune protection. Lactoferrin stimulates meconium passage and promotes colonization with protective Lactobacillus bifidus.
    • High whey-to-casein ratio
    • Milk changes within a feed and throughout the day. Hindmilk and milk at night contains higher fat and calories.

EPIDEMIOLOGY

  • 84% of infants born in the United States in 2018 initiated breastfeeding, according to the Centers for Disease Control and Prevention (CDC).
    • At 3 months, 46% breastfed exclusively.
    • At 6 months, 56.7% breastfed, 25.8% exclusively.
    • At 12 months, 35% breastfed.
  • Persistent racial and economic disparities in breastfeeding exist due to structural racism and other factors; lower rates in the Southeast United States, among African American women, and among women living in poverty.

RISK FACTORS

  • Contraindications to breastfeeding:
    • Infant with classic galactosemia
    • Maternal conditions:
      • HIV (in industrialized countries)
      • Illicit drug use
      • Active, untreated tuberculosis
      • Herpes simplex virus lesions on breast
      • Human T-lymphotropic virus (HTLV)-I– or HTLV-II–positive
      • Exposure to radioactive material, while there is radioactivity in the milk
      • Use of some medications, such as cytotoxic drugs
  • Infant conditions that may interfere with breastfeeding:
    • Prematurity
    • Low birth weight
    • Hypotonia
    • Cleft lip or palate
    • Ankyloglossia (tongue-tie)
  • Maternal conditions that may interfere with breastfeeding:
    • History of breast surgery
    • Abnormal breast shape (glandular insufficiency)
    • Inverted nipples
    • Medications that inhibit lactation
    • Endocrine: infertility, hypothyroidism, polycystic ovary, retained placenta, Sheehan syndrome, obesity
  • Common reasons cited for early termination of breastfeeding:
    • Perceived insufficient milk supply
    • Poor latch
    • Sore nipples
    • Returning to work or school

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