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- 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.
- Breast 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.
- 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.
- Breast milk production
- 81% of infants born in the United States in 2013 initiated breastfeeding, according to the Centers for Disease Control and Prevention.
- At 3 months, 44% breastfed exclusively.
- At 6 months, 52% breastfed, 22% exclusively
- At 12 months, 31% breastfed.
- Racial and economic disparities in breastfeeding exist; lower rates in the SE United States among African American women and women living in poverty
- 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
- 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:
- Low birth weight
- 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