Nutrition During Lactation (Part 2)

Nutrition During Lactation (Part 2)

• General Outcomes:

• Summarize the benefits of breastfeeding

• Understand the factors affecting breastfeeding

• Specific Outcomes:

• Describe the benefits of breastfeeding for mother and infant

• Describe barriers to breastfeeding and ways to overcome them

What is Exclusive Breastfeeding?

• Exclusive breastfeeding involves only human milk consumption for the first six months of life, aside from oral rehydration solutions and medicines/drops/syrups of vitamins and minerals.

Signs of Infant Hunger

• Early Cues (baby says "I'm hungry"):

• Stirring

• Mouth opening

• Turning head

• Seeking/rooting

• Mid Cues (baby says "I'm really hungry"):

• Stretching

• Increasing physical movement

• Hand-to-mouth

• Late Cues ("Calm me, then feed me"):

• Crying

• Agitated body movements

• Colour turning red

Time to Calm a Crying Baby

• Cuddling
• Skin-to-skin on chest
• Talking
• Stroking

Signs of Infant Satiety

• Turns away from the breast
• Gets hiccups
• Relaxes hands
• Lets out wet burps
• Slows down sucking
• Baby's body feels at ease

Feeding Frequency

• Stomach emptying takes about 1.5 hours for breastfed infants.
• 10-12 feedings per day are normal for newborns.
• Infants who did not feed overnight tend to consume more during other feedings.
• Milk intake and weight gain of infants who feed frequently are similar to infants who feed every 24 hours within the first 4 months.

Identifying Breastfeeding Malnutrition

• A normal newborn can lose up to 7% of their weight in the first 5 days.
• After 5 days, no further weight loss is expected.
• Malnourished infants become sleepy, unresponsive, cry weakly and have few wet diapers.
• By days 5-7, infants should have 6 wet diapers (pee) and 3-4 soiled diapers (poop).

Tooth Decay

• Human milk has infection-fighting components that inhibit dental caries formation.
• Tooth decay can occur in breastfed children, often if breastfeeding continues at night beyond their first year.
• See a dentist 6 months after the first tooth erupts or by 12 months of age.

Vitamin Supplements for Breastfeeding Infants

• All Malaysian infants receive vitamin K injections at birth.
• Exclusively breastfed infants need vitamin D supplements by 2 months of age.
• There are no recommendations for fluoride or iron supplements.

Newborn's Stomach Size

• Day 1: Size of a cherry (5-7ml, 1-1.4 teaspoons)
• Day 3: Size of a walnut (22-27ml, 0.75-1 oz)
• One Week: Size of an apricot (45-60ml, 1.5-2 oz)
• One Month: Size of a large egg (80-150ml, 2.5-5 oz)

Maternal Energy Needs During Lactation

• Maternal energy needs increase by 25-30% during lactation.
• Breastfeeding mothers need an extra 500 kcal per day (according to Recommended Nutrient Intakes for Malaysia, 2017).
• Postpartum weight loss is highest in the first 3 months, especially in women who exclusively breastfeed.

Maternal Nutrients Needs During Lactation

• Carbohydrate: 160-210 grams per day to maintain adequate milk production and prevent ketosis.
• Protein: 1st 6 months = 19 g/day, 2nd 6 months = 13 g/day.
• Fat: 66-79 grams per day (first 6 months), crucial building material for membranes and energy.

Maternal Nutrients Needs During Lactation (PUFA & MUFA)

• PUFA (Polyunsaturated Fatty Acids): 5-7% of total calorie intake, essential for retinal growth and the development of the central nervous system for infants
• MUFA (Monounsaturated Fatty Acids): 12-15% of total calorie intake, essential for cardiovascular health

Benefits of Breastfeeding

• Benefits for Mothers:

• Hormonal: Increased oxytocin to stimulate uterus returning to pre-pregnancy status, longer intervals between pregnancies

• Physical: Delay in monthly ovulation, minimizes maternal postpartum blood loss

• Psychological: Increased self-confidence & bonding with infant

• Benefits for Infants:

• Balance: nutrients in human milk match infant growth and development requirements.

• Isosmotic: Human milk is naturally isosmotic, meeting infant needs without overloading kidneys with nitrogen.

• Low protein: Easily digestible, meeting infant's immature kidney needs.

• DHA: Contains docosahexaenoic acid, promotes optimal brain and visual development

• Protection: Offers protection against infections.

• Reduced illness: Reduces gastrointestinal and other illnesses

• Reduced risk of chronic diseases: Reduced risk of asthma, allergies, and diseases such as diabetes and leukemia.

• Easy digestion: Easily digested

• Benefits for Infants (continued):

• Leaner: Breastfed infants tend to be leaner than formula-fed infants at the first year of age.

• Cognitive ability: Increases cognitive ability

• Analgesic: Breastfeeding seems to work as an analgesic

• Higher IQ: Infants breastfed for six months may have higher IQ

• Reduced pain during procedures: Breastfeeding during procedures such as venipuncture may reduce pain.

• Benefits for Fathers:

• Save cost

• Enhancement of baby-father bonding

Barriers to Breastfeeding & Ways to Overcome Them

• Barrier 1: Latch Issues:

• Problem: A poor latch can cause nipple pain, low milk supply, & difficulties breastfeeding

• Solution: Seek guidance from a lactation consultant or support group to ensure proper latch technique; try different breastfeeding positions.

• Barrier 2: Painful Nipples/Engorgement:

• Problem: Swollen, painful breasts due to overproduction of milk that can make latching difficult.

• Solution: Use lanolin or other nipple creams; frequent breastfeeding or pumping; warm compresses; breast massage.

• Barrier 3: Low Milk Supply:

• Problem: Mother not breastfeeding enough, supplementing with formula milk, feeling anxious, or insufficient nutrition.

• Solution: Ensure frequent breastfeeding or pumping; hydration; balanced diet; consult a lactation consultant to address low milk supply, evaluate and possibly recommend breast compression or herbal supplements

• Barrier 4: Inverted/flat nipples:

• Problem: Difficulty breastfeeding due to inverted/flat nipples.

• Solution: Use nipple shields temporarily; practice using a breast pump to help draw out the nipple. Lactation consultant can provide specific techniques

• Barrier 5: Lack of Confidence:

• Problem: Some mothers feel uncertain about their breastfeeding ability, or that their milk production isn't enough.

• Solution: Seek support from other experienced mothers, lactation consultants, or peer support groups

• Barrier 6: Postpartum Depression/Anxiety:

• Problem: Postpartum depression or anxiety can negatively impact the mother's ability to breastfeed.

• Solution: Speak to a healthcare provider, find support, or seek medication and/or counseling if needed.

• Barrier 7: Inconvenience:

• Problem: Difficulty breastfeeding due to a lack of access to facilities for pumping after returning to work.

• Solution: Develop a routine, organize pumped milk, or create a comfortable space for breastfeeding.