Download Objectives 2, 3, 4, and 5

Bailey’s
Golden Start
Breastfeeding
Curriculum for
Nursing Students
Objective 2:
Advantages
Objective 3:
Composition
Objective 4:
Risks of not
breastfeeding
Objective 5:
Contraindications
Section 2
Section Two Contents:
 Objectives 2 - 5
 Topics
Advantages to mother and child
Composition of human milk
Risks of not breastfeeding
Contraindications to breastfeeding
2
Objective 2
 Appraise at least
three biological
advantages of
lactation and
breastfeeding for
the mother and
child.
3
Short- and Long-Term Benefits
 Breastfeeding and lactation
management have been studied for
decades, both nationally and
internationally, with considerable
recent clinical advances being
made in the scientific knowledge of
the short- and long-term benefits of
breastfeeding.
4
Compelling Advantages for Infants,
Mothers, Families, and Society
 As documented in the 1997 AAP Policy
Statement on Breastfeeding, “Extensive
research using improved
epidemiologic methods and modern
laboratory techniques, documents
diverse and compelling advantages for
infants, mothers, families, and society
from breastfeeding and the use of
human milk for infant feeding” (p. 496).
5
“There was a time when the choice between
bottle feeding with formula and breastfeeding
was a lifestyle choice. The choice was seen as
purely nutritional, and any artificial substance that
resembled human milk and resulted in babies
gaining weight was obviously good. […] We now
know that breastfeeding is a great deal more
than just ‘food’ or nutrition.”
Foreword by Dr. Nils Bergman, MB ChB, DCH,
MPH, MD of Breastfeeding Answers Made
Simple: A Guide for Helping Mothers by Nancy
Mohrbacher, IBCLC, FILCA
6
Biological and Psychosocial
Child Health Benefits
 Microsystem Benefits for Breastfed
Babies
Reduced diarrhea
Reduced bacterial infections
Reduced otitis media
Reduced asthma
Reduced nocturnal enuresis
Reduced diabetes
Reduced overweight and obesity
Reduced hypercholesteremia
Reduced ischemic heart disease
Reduced sudden infant death
syndrome
– Reduced cancer
– Enhanced cognitive development
– Enhanced analgesia during painful
procedures
–
–
–
–
–
–
–
–
–
–
Image taken by Jennifer DeJong; Carolyn at
Home, Summer 2008.
7
The Benefits are DoseDependent
 The health benefits are dosedependent with infants who
breastfeed for longer durations
demonstrating a greater reduction in
disease states (AAP, 2005; Lawrence, 1997; WHO,
2002).
8
Otitis Media



Breastfeeding decreases a child’s risk for ear
infections in the first 12 months of life (Dewey, 1995).
Prolonged breastfeeding acts as prophylaxis for
recurrent or chronic otitis media (Saarinen, 1982).
Duncan et al. (1993) found that exclusive
breastfeeding for at least four months protected
against otitis media, and Owen et al. (1993)
documented reduced rates of otitis media with
effusion in the first two years of life for children,
regardless of secondhand smoke exposure and
attendance in group childcare.
9
Diabetes
 Evidence suggests a reduction in the
incidence of insulin-dependent (type 1)
and non-insulin dependent (type 2)
diabetes mellitus among children who
were breastfed as infants.
 In addition, due, in part, to
breastfeeding’s effect on obesity,
breastfeeding also appeared to protect
against diabetes mellitus type 2 (Owen, 2006;
Mayer-Davis et al., 2008).
10
Prevention of Obesity
 Did you know that breastfeeding
can help PREVENT obesity?
 Construct some hypotheses now as
to why this may be true.
11
This is Vital to our Nation’s
Public Health
 Childhood obesity is considered an epidemic
in the U.S.
“The risk of obesity starts early in life.
Over half of obese children become
overweight by the age of 2, and
approximately one in five children are
overweight or obese by their 6th birthday.”
— The White House Task Force on Childhood Obesity
12
 A link exists between overweight and
obesity among children who were not
breastfed as infants (Dewey, 1993; Grummer-Strawn,
2004; Singhal, 2002; Stettler, 2002).
 Armstrong and Reilly (2002) researched a
sample of 32,200 Scottish children and
found that a history of breastfeeding
reduced the overall risk of extreme
obesity in children aged 39 to 42 months.
Objectives 2-5
13
Breastfeeding Duration
Matters
 According to Arenz (2004), the
protective effect against obesity
increased with not only the initiation
of breastfeeding, but also the overall
duration of receiving human milk.
14
The CDC’s Fight Against
Obesity


The CDC has made increasing the
rate of breastfeeding as one of its
major goals in the fight against
obesity and inactivity.
Your future work as a nurse to
promote and protect breastfeeding
will have a major impact in this fight!
15
SIDS
 It is speculated that breastfeeding
protects against infant death
(Bernshaw, 1991).
 Bottle-fed infants are twice as likely to
die from SIDS than their breastfed
counterparts (McVea, Terner, & Peppler (2000).
16
Increased Arousability
 Horne et al. (2004) observed improved
arousability from sleep among breastfed
babies and decreased rates of SIDS in the first
year of life among breastfed infants.
 Chen (2004) and Ford et al. (1993) reported a
decreased risk of post-neonatal death in the
U.S. among breastfed babies.
 Internationally, Mitchell et al. (1992) and
Scragg et al. (1993) researched major risk
factors for SIDS and also found a decreased
risk for infant death of babies who were
breastfed.
17
Breastfeeding can Reduce
Mortality Risk
 Babies who are breastfed have a 21% lower
risk of death in their first year, compared to
babies never breastfed (Chen & Rogan, 2004).
 This reduction in risk improves to 38% if
babies are breastfed for 3 months or more.
 In US, translated to 720 deaths in one year.
 New study in Pediatrics – 911 deaths could
be prevented if 90% of babies were
breastfed (Batok, 2010).
18
Cancer
 Lymphoma,
leukemia, and
Hodgin’s
Disease show
decreased
rates of
occurrence in
infants who
had been
breastfed
(Bener, 2001; Davis, 1998;
Smulevick, 1999).
Image used with permission from William Burleson,
Office of Statewide Health Improvement Initiatives,
Minnesota Department of Health on 2/10/2012.
19
Cognitive
Development
 Within the child’s own
microsystem, improved
individual cognitive ability,
academic performance,
and mental differences of
breastfed children are
reported in the literature
(Anderson et al., 1999; Drane, 2000: Jain
et al., 2002; M. M. Smith et al., 2003).
20
Uniquely Available Fatty
Acids
 According to Caspi et al. (2007), who
examined gene-environment interactions in
two birth cohorts (n = 1037 first cohort; n = 2232
second cohort), breastfed babies who had a
specific variant of the FADS2 gene, which
comprises approximately 90% of all infants
worldwide, demonstrated an IQ, on average,
of seven points higher than their formula-fed
counterparts.
 Researchers concluded that breastfed babies
have higher IQs because of the fatty acids
uniquely available in breastmilk.
21
Long-Term Intellectual Benefits
 Horwood, Darlow, and Mogridge (2001)
examined the correlations between breast milk
feeding and verbal and performance IQ of
280 subjects.
 They found that children seven and eight years
of age who were breastfed for more than
eight months after being diagnosed as lowbirth weight upon delivery demonstrated
significantly higher IQ scores than comparable
children breastfed for lesser durations,
suggesting that breastfeeding may grant longterm intellectual benefits in some populations.
22
Premature Infant
Benefits
 Breastfeeding is essential to the
health of all infants; however,
babies born prematurely benefit
EVEN MORE from the ingredients in
human milk.
 Feeding premature infants food
other than human milk increases
the risk of serious infection.
23
Problems of Prematurity
1.
2.
3.
4.
5.
6.
 What does NEC stand for and how might
it be prevented with breastfeeding?
24
Kangaroo Cares/Skin-to-Skin for
the Premature Infant
 As the nurse, what
are you assessing
during these
kangaroo cares, and
what do you expect
the infant’s vital signs
to be?
 Get in pairs and
discuss.
Image used with permission from Marissa Funkhouser, Summer 2012.
25
Maternal Health Benefits
 Enhanced infant
bonding
 Lactational amenorrhea
and child spacing
 Reduction of
postpartum
weight retention
Image taken by Christian DeJong; Jennifer and
Carolyn DeJong, Spring 2008.
 Reduced cancer
26
Infant Bonding
 During lactation and
the act of breastfeeding,
the hormones oxytocin
and prolactin are
released from the
pituitary. This biological
event enhances a
mother’s capacity to
relax and feel nurturing
toward her baby
(Dettwyler & Stuart-Macadam,
1995).
Image taken by Jennifer DeJong; Christian and Carolyn, Spring 2008.
27
Lactational Amenorrhea and
Child Spacing
 Within the mother’s microsystem, frequent
breastfeeding can delay the return of fertility
through lactational amenorrhea.
 The lactational amenorrhea method (LAM)
for full breastfeeding women has received
worldwide approval across various cultures
and socioeconomic levels as a means of
natural suppression of fertility (Hight-Laukaran et al.,
1997; Labbok et al., 1997). However, many providers
question its reliability (WHO, 1999).
28
Reduction of Postpartum
Weight Retention
 According to Ogden et al. (1999-2004), U.S. women
of reproductive age are alarmingly heavy, with 52%
of women overweight, 29% obese, and 8% with BMI
index scores (BMI: in kg/m2) more than 40.
 Researchers caution that mothers who are
overweight or obese and who do not initiate
breastfeeding, who breastfeed for short periods of
time and then terminate, or who have reduced
physical activity may not return to their pre-gravid
weights during the first six months postpartum (Dorea,
1997).
29
Maternal Cancer
 Accumulating
evidence suggests that
increasing the duration
of lifetime
breastfeeding reduces
the risk of
premenopausal breast
cancer in the mother
(Labbok, 2001;
Newcomb et al., 1994).
Image used with permission from Ashley Terhune;
Marissa Funkhouser’s Mom’s Group, Summer 2012.
30
Maternal Cancer
 Although the exact means by which breastfeeding
reduces breast cancer risk is not well understood,
there are several possible hypotheses for the
protective effect, including the reduction of the
lifetime number of ovulatory cycles that occur while
breastfeeding (Clavel-Chapelon, 2002; Freund,
Mirabel, Annane, & Mathelin, 2005; Gray et al., 1990;
McNeilly, Tay, & Glasier, 1994; Russo & Russo, 1994;
Vogel, 2000), the reduced amounts of estrogen in the
body during lactational amenorrhea, and the
differentiation of mammary cells during lactation
(Freund et al., 2005; Russo & Russo, 1994).
31
Maternal Cancer
 According to Vogel (2000) and Russo
(2005), the cell differentiation within
breast tissue transpires during a
woman’s first full-term pregnancy and
may contribute to an overall
decreased breast cancer risk,
especially when she is young.
32
Psychological/Emotional
Benefits
Image from: http://wicworks.nal.usda.gov/wicworks/resources/images.html
Objectives 2-5
33
 And just the
thought of it
makes baby
happy too!
34
Objective 3
 Analyze the
composition
of human
milk
35
Humans are Mammals
 Mammals = ____________ gland
 The Mammary gland is an immunologic organ
 Each species’ milk is ___________ and intended
for the offspring of that particular species.
 Breastmilk is IMPOSSIBLE to _______________!
36
We are “Carriers” – Not “Nesters”
 Water content ~87% (in
both colostrum and
mature milk)
 Lower fat and protein
than most other
mammals
Bird image
taken by
Jennifer
DeJong;
Eagle Lake
bird’s next,
Spring
2012.
 Highest ___________ of
any mammal
Image taken by Brad DeJong; Jennifer
and Carolyn golfing, Spring 2008.
37
 Constant
 Minimal fluctuations
caused by ____________
diet
 Components of breast milk:
 130 different
oligosaccharides
identified
Composition
of Breastmilk
38
Under a Microscope
Formula
Human Milk
Objectives 2-5
39
Interesting Fact!
 The level of cholesterol in breastmilk
remains __________ despite the mother’s
cholesterol intake.
 Why is this important?
 What impact does this have on long-term
health?
40
Colostrum – “Liquid Gold”
 Right amount at the right time.
 Allows baby and mom to __________
feeding.
 Protects the GI tract by ___________ it with
immunoglobulins which prepare the gut for
the mature milk.
41
Compared to mature milk,
colostrum has less:
 Lactose
 Fat
 Calories
 Early milk is supposed to be
protective, not growth-enhancing
42
 Report at least
three risks of
not breastfeeding
for the mother and
child.
Objective 4
Image used with permission from Shannon
Mcgregor on July 25, 2012; Marissa Funkhouser’s
Mom’s Group, Summer 2012.
43
Health Risks Associated with
Not Breastfeeding
 What do you think some of the risks are?
 What does the Surgeon General say? View the
Call to Action at: http://surgeongeneral.gov
 If your clients had all of the information that you
as a health professional are privy to, what do
you think most people would choose to do?
44
Excess Health Risks Associated
with NOT Breastfeeding
 What does the Surgeon General’s Call to
Action to Support Breastfeeding report for the
following conditions?
–
–
–
–
–
–
Acute Ear Infections (Otitis Media)?
Diarrhea and Vomiting (Gastrointestinal Infection)?
Type 2 Diabetes Mellitus?
Sudden Infant Death Syndrome?
Among preterm infants: NEC?
Among moms: ovarian cancer?
45
Not Breastfeeding Increases a
Woman’s Risk of:
 Breast and ovarian cancer
 Osteoporosis
 Short pregnancy interval
 Obesity
 Higher blood pressure
46
 Write a OneMinute Paper:
How Can You
Use this
Information?
47
Objective 5
 Examine at least
two
contraindications
to breastfeeding
Image used with permission of Becky Kiefer on
July 25, 2012; Facebook Photo, Summer 2012.
48
Rare Exceptions
 Galactosemia
 HIV
 Taking antiretroviral medications
 Untreated, active TB
 Using illicit drugs
 Taking cancer chemotherapy agents
 Undergoing radiation therapy
49
Cautious BF Promotion
 Active herpes on breast/nipple
 Breast reduction - wait and see
 History of well-managed, unsuccessful
breastfeeding
 Mothers with adopted baby
 No contraindication with Hepatitis A, B, or C
50
End of:
 Objective 2: Advantages
 Objective 3: Composition
 Objective 4: Risks of not
breastfeeding
 Objective 5:
Contraindications
Next:
 Objective 6:
Social,
institutional, and
community
benefits
 Objective 7:
Anatomy and
physiology
Image taken by
Jennifer DeJong;
Christian and
Carolyn, Spring
2008.
51