Infant Feeding Mechanics

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Questions and Answers

What is the primary function of the temporomandibular joint (TMJ) in breastfeeding?

To connect the jaw with the throat

To facilitate the movement of the jaw for sucking (correct)

To stabilize the neck during feeding

To hold the breast in place

Which reflexes are typically present in a newborn to aid in breastfeeding?

Grasp reflex and stepping reflex

Blink reflex and startle reflex

Crawling reflex and hearing reflex

Rooting reflex, sucking reflex, and swallowing reflex (correct)

During which phase of breastfeeding does the baby exhibit short, rapid sucks?

Active feeding

Resting phase

Beginning of feed (correct)

End of feed

What does the 'flutter sucking' phase indicate during breastfeeding?

The feed is near completion with fewer swallows Signup and view all the answers

What is a key aspect of positioning during breastfeeding?

The mother should hold the baby in a way that supports effective attachment to the breast Signup and view all the answers

What characterizes lactogenesis I in terms of hormonal activity?

Colostrum production begins around 16 weeks of gestation. Signup and view all the answers

What is a key feature of colostrum?

Contains protective factors. Signup and view all the answers

How does lactogenesis II begin?

After the expulsion of placenta and membranes. Signup and view all the answers

Which of the following statements about the newborn's blood sugar immediately after birth is true?

It undergoes a self-limiting decline for about the first 3 hours. Signup and view all the answers

What process initiates milk production in lactogenesis II?

Prolactin binding with receptors in lactocytes. Signup and view all the answers

What is not a process involved in counterregulatory compensation?

Ketogenesis Signup and view all the answers

How does early feeding of human milk influence gluconeogenesis?

It decreases insulin secretion. Signup and view all the answers

What effect does artificial feeding have on hormone secretion in newborns?

It increases insulin secretion. Signup and view all the answers

When does prolactin secretion peak after a feed?

About 90 minutes after a feed Signup and view all the answers

Which of the following describes the role of lactocytes in milk production?

To synthesize milk components from maternal blood. Signup and view all the answers

What hormone does prolactin suppress during lactation?

Ovulation Signup and view all the answers

What is the primary substrate used in gluconeogenesis in the liver and kidneys?

Amino acids Signup and view all the answers

Which condition occurs when low blood glucose levels trigger ketogenesis?

Formation of ketone bodies Signup and view all the answers

What role does prolactin play in milk production?

It primes receptor sites for milk production. Signup and view all the answers

How does the expulsion of the placenta affect milk production?

It opens prolactin receptor sites on acini cells. Signup and view all the answers

Which factor can temporarily inhibit oxytocin release?

Stress. Signup and view all the answers

What is the function of the feedback inhibitor of lactation (FIL)?

It blocks further milk production when present. Signup and view all the answers

Which of the following best describes the process of lactogenesis III?

Regulation based on supply and demand of milk removal. Signup and view all the answers

What triggers the oxytocin reflex to ensure milk ejection?

Sensory impulses from the nipple. Signup and view all the answers

Which of the following factors enhances milk production in the early days after delivery?

Frequent suckling and skin contact. Signup and view all the answers

What is the relationship between the presence of feedback inhibitor of lactation (FIL) and milk production?

FIL must be removed for milk production to resume. Signup and view all the answers

Study Notes

How a Baby Breastfeeds

Attachment is how the baby takes the breast into their mouth to feed.

Temporomandibular Joint (TMJ)

The TMJ is a hinge joint between the mandible (lower jaw) and maxilla (upper jaw).
The jaw is innervated by the trigeminal nerve (cranial nerve V).
The TMJ's movements of the tongue, lips, and cheeks are crucial during sucking.
Sucking expands the oral cavity for suction.

Baby Reflexes

Rooting reflex: Turning the head and opening the mouth when something touches the cheek, bringing the tongue down and forward.
Sucking reflex: Sucking to draw something into the mouth when something touches the palate.
Swallowing reflex: Raising the jaw to swallow when the mouth fills with milk.

How Milk is Removed

Cups breast with tongue.
Lowers jaw to create a vacuum, drawing in milk.
Presses upwards with tongue and jaw to close ducts.
Swallows.

Suck/Swallow Pattern

Beginning of feed: Short, rapid sucks.
Active feeding: Long, slow, rhythmic sucking and swallowing, with pauses.
End of feed: "Flutter sucking" with occasional swallows.

Seeing What the Baby is Getting

Active feeding: (1:1 or 1:2 swallowing)
Flutter sucking: (fewer swallows)

Positioning Principles

Baby's head and body in line (with freedom to tilt head back)
Baby held close to the mother.
Nose placed on the nipple.
Sustainable positioning.

Physiology of Lactation

Lactogenesis is the initiation of milk production.
Lactogenesis has three phases.
The first two phases are neuroendocrine responses.
The third phase is autocrine.
Neuroendocrine phase: interaction between the nervous and endocrine systems.
Autocrine phase: a cell secreting a hormone that acts on itself.

Lactogenesis I

Lactogenesis I starts around 16 weeks of gestation with colostrum production by lactocytes.
Prolactin, while present during pregnancy, is suppressed by increased levels of progesterone and estrogen, along with HPL and prolactin-inhibiting factor (PIF).
Milk production is suppressed.

Colostrum Features

Packed with protective factors.
Concentrated nutrition.
Intentionally small volumes.
Laxative effect to clear the meconium.

Lactogenesis II

Lactogenesis II is the onset of milk production.
It occurs after the expulsion of the placenta and membranes.
Prolactin levels increase and bond to prolactin receptors in the lactocytes.
Skin-to-skin contact and early/regular breastfeeding inhibit PIF and stimulates prolactin.

How it Works

Baby suckles, stimulating nerve impulses to the pituitary gland.
The pituitary gland then releases hormones to both breasts.

Counterregulatory Compensation

After delivery, a self-limiting decline in infant blood sugar occurs for the first 3 hours of life.
Then, counterregulatory compensation takes over and alternative fuels are formed.
Glycolysis, glycogenolysis, and gluconeogenesis are important processes.

Ketogenic Response

Ketone bodies are an alternative fuel source for the brain when blood glucose is low.
Breastfed infants display a brisk ketogenic response when blood glucose levels are low, while formula-fed infants do not.
Early feeding of human milk/colostrum enhances gluconeogenesis.

Perils of Artificial Feeding

Artificial supplements after birth increase insulin secretion, suppressing glucogenesis.
They decrease glucagon secretion, reducing glycogen to glucose conversion.
They delay natural gluconeogenesis and ketogenic processes.

Prolactin

Triggered by suckling.
Acts on lactocytes to make milk.
Peaks about 90 minutes after a feed.
Suppresses ovulation.
Needs early and frequent stimulation for long-term effectiveness.

Biosynthesis of Milk within Alveoli

Lactocytes/acini cells extract and synthesize milk components from the woman's blood and extracellular space.
Water, electrolytes, and water-soluble constituents diffuse across the alveolar membrane.
Milk is secreted into the alveolar lumen.

The Prolactin Response

Sensory impulses from the nipple to the brain.
Prolactin is secreted to the breasts via the bloodstream.
Prolactin is secreted at night and suppresses ovulation.
Milk production peaks after a feed for the next feeding cycle.

Setting Up Milk Production

Delivery of placenta allows prolactin receptor sites to open on acini cells.
Prolactin surges to "prime" sites for milk production.
Receptor sites close if not primed.
Frequent skin contact and feeding in early days enhance long-term production potential.

The Prolactin Receptor Theory

Prolactin surges prime receptor sites.
Expulsion of placenta opens receptor sites; unprimed sites close.
Frequent prolactin release maximizes long-term milk supply.

Oxytocin

Triggered by suckling and positive thoughts.
Acts on myo-epithelial cells to eject milk.
Largest peaks occur early in the feeding process.
Effect may be felt as tingling.
Basal levels are higher when the baby is near.
Can be temporarily inhibited by stress.

The Oxytocin Reflex

Sensory impulses from the nipple to the brain.
Oxytocin is secreted to the breasts via the bloodstream.
Myo-epithelial (muscle) cells contract and expel milk.
Helpful factors include sight, sound, and smell of the baby.
Becomes conditioned over time.
Hindered by anxiety, stress, pain and doubt.
Works before or during the feed to make the milk flow.

Prolactin and Oxytocin

Work together to trigger feelings of love and mothering behavior.
Induce calmness and a feeling of well-being.
Enhance the mother-baby bond.

Lactogenesis III

Lactogenesis III: autocrine regulation by supply and demand.
Breast milk supply controlled by milk removal via autocrine or local control.
Feedback Inhibitor of Lactation (FIL) is increasingly secreted by lactocytes as alveoli distend with milk, inhibiting lactogenesis.

The Feedback Inhibitor of Lactation (FIL)

FIL is secreted as part of milk.
Build-up of FIL blocks milk production.
Removing FIL allows milk production to continue.

Reversing the Effect of FIL

Emptying the breast removes FIL, allowing increased milk production.
Each breast functions independently.
Milk production slows as the baby is weaned.
Midwives can help mothers understand this process.

Breastfeeding and Health

Breastfeeding reduces the risk of gastroenteritis, chest infections, ear infections, urinary infections, diabetes, allergies, childhood cancers, Sudden Infant Death Syndrome (SIDS), and heart disease.

Breastfeeding Reduces the Risk Of...

Breast cancer
Ovarian cancer
Hip fracture
Heart Disease

'Instant' Protection from Infection

Antibodies produced and sent to the breasts are incorporated into breast milk.
This protects against inhaled and ingested pathogens.

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Description

Explore the intricate mechanics of how a baby breastfeeds, including essential reflexes and the role of the temporomandibular joint (TMJ) in facilitating the process. This quiz delves into the attachment techniques used during nursing and the suck/swallow patterns that optimize feeding.