Breast-feeding

Breast-feeding

·        Advantages: 

o  Prevention of disease: passive immunity against gastro-enteritis and ¯otitis media due to better Eustachian tube drainage 

o  Bonding 

o  ¯PPH

o  ¯SIDS

o  Cheap and convenient (available, portable, sterile – cf bottle feeding, especially in 3^rd world)

o  Contents vary with circumstances (fore milk has ­ water content)

o  No constipation

o  Less spilling, less irritating than bottle feeding

o  Supply matches demand

o  Smells nicer at both ends.  No constipation with breast milk

o  ?Higher IQ

o  Males can‟t do it!

·        Disadvantages:

o  Discomfort establishing

o  Limits mum

o  Limited iron and phosphate, Vit D and C if preterm (cf bottle feeding which can be fortified)

o  Can‟t easily measure intake

o  Leaking

o  Maternal drugs are included (eg lithium)

o  Breast milk jaundice

·        Establishing breast feeding:

o  Babies don‟t feed much for 1^st 48 hours

o  Breast milk comes in around day 3 (especially 1^st baby) Þ baby‟s hungry on day 3

o  Can hurt – usually uncomfortable

o  Growth is best way of proving adequacy 

o  Very hard to overfeed compared with bottle feeding (sucking is a reflex ® will keep bottle feeding even if they don‟t want the feed)

·        Ongoing issues: 

o  If feeding too regularly then baby will be getting CHO rich foremilk but not fat rich hind milk ® hungry 

o  Attachment to the breast is key: Is the baby nipple feeding or breast-feeding. If nipple then repeated trauma ® pain, cracked nipples, etc

o  Mastitis or blocked duct ® express lots (try it in the bath)

·        Establishing bottle feeding:

o  Day 1: average intake 60 ml/kg (= 40 calories/kg) 

o  ­ by 15 ml/kg/day until average of 150 ml/kg/day

o  If too much then ­stools, ­vomiting, ­misery

o  Alternatives to cows milk: goat (but no folate), soya, hydrolysed (if allergic to everything else)

§  Allergy: eczema reaction mainly to casein proteins, but can also be allergic to whey protein

§  Can be intolerant (ie non allergic reaction) to: 

·        Lactose (galactose + glucose): ¯lactase ® osmotic diarrhoea + ­fermentation by bacteria ® ­gas ® frothy acid stools ® acid burns round perianal skin. More common as secondary intolerance (eg following Rotavirus). Breast milk has lactose too.

·        Fructose (eg fruits)

·        Sorbitol (artificial sweeteners)