Physiology and benefits of breast feeding

1. Physiology and Benefits of
Breastfeeding and the Risks
of Artificial feeding
Dr. Varsha Atul Shah

2. Play movie
INDICATORS OF ADEQUATE
BREASTMILK INTAKE
•Breasts full before feeding and softer
afterwards
•Let-Down sensation in mother’s
breast
•Wet nappies/diapers (6x or more/24h)
•Bowel movements (several times/day)
•Contented baby between feeds
•Audible swallowing during feeding
•Average weight gain
• 18-30 g/day
• 125-210 g/week

3. Summary of Differences between Milk
Human milk Animal
milks
Infant
formula
Protein correct amount,
easy
to digest
too much,
difficult to
digest
partly
corrected
Fat enough
essential fatty
acids, lipase to
digest
lacks
essential fatty
acids, no
lipase
no lipase
Water enough extra needed may need
extra
Anti-
infective
properties
present absent absent
Adapted from: Breastfeeding counselling:A training course.Geneva, World Health Organization, 1993 (WHO/ CDR/93.6).

4. What makes Breastmilk different?
HUMAN
Fat
Protein
Lactose
COW
Fat
Protein
Lactose
GOAT
Fat
Protein
Lactose
Too much
protein for
muscle building

5. Differences in the Quality of the Proteins
HUMAN
Presence of
Anti-
infective
proteins
35%
Casein
COW’S
80%
Casein
Whey
proteins
Curds
Easy to digest
Harder to digest

6. Vitamins
HUMAN
B vitamins
Vit. C
Vit. A
COW’S
B
vitamins
Vit. A
Vit. C
Small
Amount

7. Iron
HUMAN
50 - 70 g/100ml
COW’S
50 - 70 g/100ml
absorbed
10
50
%
Better absorption of breastmilk iron by
the baby

8. Breast Milk Composition Differences
(dynamic)
• Gestational age at birth (preterm and full term)
• Stage of lactation (colostrum and mature milk)
• During a feed (foremilk and hindmilk)

9. COLOSTRUM
Property
• Antibody-rich
• Many white cells
• Laxative
• Growth factors
• Vitamin-A rich
Importance
• Protects against infection and
allergy
• Protects against infection
• Clears meconium; helps prevent
jaundice
• Helps intestine mature; prevents
allergy, intolerance
• Reduces severity of some
infection (such as measles and
diarrhoea); prevents vitamin A

10. Breast milk in 2nd year of life
0
0
0
0
0
1
1
1
1
1
1
ENERGY PROTEIN VITAMIN A VITAMIN C
%DAILYNEEDSPROVIDEDBY500MLBREAST
MILK
31 38% 45%
95
%
From: Breastfeeding counselling: A training course. Geneva, World Health Organization ,1993(WHO/CDR/93.6).

11. Why should I breastfeed?
- the natural choice for BABIES
- the natural choice of MOTHERS
- the natural choice for the
ENVIRONMENT

12. - The natural choice of
MOTHERS

13. • Nursing uses up extra calories,
making it easier to lose pounds of
pregnancy
• Breastfeeding lowers the risk of
breast and ovarian cancers
• Breastfeeding can help you bond
with your baby
• Save more money, easy,
convenient and more portable
• Breastfeeding has contraceptive
effect

14. The natural choice for
BABIES

15. • Breast milk is the most complete
form of nutrition for infants
• Breastfed babies score higher on
IQ tests
• Ensuring your baby has only
breastmilk for at least 6 months
may help minimize allergy
problems
• Babies breastfeed for comfort
and closeness as well as to
satisfy their hunger and thirst

16. % of Babies Bottledfed and Breastfed for
the 1st 13 weeks that had diarrhoea illness
at various weeks of age during the 1st year,
Scotland
19.5 19.1
22.3 22.4
3.6
7.1
12.9 11.9
0
5
10
15
20
25
0-13 14-26 27-39 40-52
Incidence of diarrhoea illness by age in weeks
%withdiarrhoea
bottle-fed Breast fed
Adapted from: Popkin BM, Adair L, Akin JS ,Black R et al.Breastfeeding and diarrheoa morbidity.Pediatric,
1990,86(6):874-882.

17. • A study in Dundee, Scotland found that
breastfed infants had much less diarrhoea.
• In babies 0 and 13 weeks of age, almost 20%
of bottle-fed infants had diarrhea compared with
only 3.6% of the breastfed infants
- Howie, et al

18. % of Babies Bottlefed and Breastfed for the
1st 13 weeks that had respiratory illness at
various weeks of age during the 1st year,
Scotland
40
54.1
45.547.1
38.9 42.4
36.2
23.1
0
10
20
30
40
50
60
0-13 14-26 27-39 40-52
Incidenceof respiratory illness by age in weeks
%withrespiratoryillness
Bottle-fed Breastfed
Adapted from:Howie PW,Forsyth JS,Ogston SA,Clarke A Florey CV.Protective effect of breastfeeding against
infection.BR Med J,1990,300:11-15.

19. • Another study in Dundee, Scotland found that
breastfed infants had much less respiratory
illness.
• In babies 0 and 13 weeks of age, almost 39% of
the bottle-fed infants had respiratory illness
compared to only 23% of the breastfed infants
Howie et al

20. Breastfeeding Decreases the Prevalence
of Obesity in childhood at age 5 & 6 years
Germany4.5
3.8
2.3
1.7
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Prevalence
(%)
Months Breastfeeding
0 months
2 months
3-5 months
6-12 months
Adapted from: Von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and obesity: cross sextional study
.BMJ, 1999,319:147-150.

21. Lower risk of obesity.
• A study in Germany found that among 9357
children aged 5 and 6 there was an over 5 times
difference in the prevalence of obesity among
those children never breastfed compared to
those breastfed for over one year
• The length of time an infant was breastfed was
inversely proportional to the prevalence of
childhood obesity
von Kries et al

22. The natural choice for the
ENVIRONMENT

23. • The production and feeding of breastmilk have a
far lower impact on our environment and the
world resources than ANY alternative feeding
method
• Breastfeeding saves food resources, fuel and
energy
• No packaging is required and NO CHEMICALS
are needed for preparation and disinfection

24. Benefits for the Hospital
• Warmer and calmer emotional environment
• No nurseries, more hospital space
• Fewer neonatal infections
• Less staff time needed
• Improved hospital image and prestige
• Fewer abandoned children
• Safer in emergencies

25. Risks of Artificial Feeding

27. RISK OF ARTIFICIAL FEEDING
Baby
• More likely to fall sick
• Increase risk of obesity
• More diarrhoea and
respiratory infections
• More allergy and milk
intolerance
• Increased risk of chronic
diseases
• Risk of otitis media
• Risk of NEC in preterm
Mother
• Pregnant sooner
• Increased risk of ovarian
and breast cancer
• Interferes with bonding
• Hip fractures in older age

28. Dangers from the Use of Breast-milk
Substitutes
• Powdered Infant formula is not sterile and during
manufacture may be contaminated with bacteria
such as Enterobacteria Sakazakii & Salmonella
enterica.
• WHO has developed guidelines for careful
formula preparation in order to minimize the risk
to infants
Adapted from:16 guidelines for the safe preparation, Storage and Handling of powdered Infant
Formula, Food Safety, WHO(2007)

29. Impact on Society
• Possible increase in use of health care
services, and increase health care costs, both
as infants and later.

30. Impact on Society

31. Scenario
• You are speaking to 22 years, Jessica,
beautician, who has delivered healthy 2.7
kg baby girl 24 hours ago. Jessica intent to
exclusively breastfeed.
Jessica was concerned about her daughter,
since she has not passed BO since birth and
is passing pink colour urine. She had only
changed diaper 2 times since birth.

32. Your role is to:
• Ask open-ended questions to find out her thoughts and
feelings about her anxiety
• Use probes to better understand what she means.
• Affirm her feelings and release her anxiety
• Your role is to communicate about her concerns and
discuss your action plan.

33. TRUE OR FALSE
1. Giving mothers’ information on risks and benefits of various feeding
options will minimize likelihood of breastfeeding mothers influenced
to use formula True/ False
2. Breast-milk substitutes include formula, teas, and juices (and other
products) True / False
3. Giving supplements increase protective benefits of breastfeeding
True/ False
4. Some of the risks from using breast milk substitutes could be
reduced by attention to process of preparation and hygienic
elements but the differences in the constituents of breast milk and
infant formula remain True/ False
5. Prospective study done on infants of atopic parents found that there
is no difference in the prevalence of atopic disease between
breastfed and artificially fed children True/ False

34. 6. Artificially-fed babies are at greater risk of
the developing the following EXCEPT:
a. Gastro-intestinal infections
b. Respiratory infections
c. Necrotising enterocolitis
d. Urinary tract infections
e. Tonsillitis

35. 7. Women who choose artificial feeding are
at a higher risk of the having the following
EXCEPT:
a. Breast cancer
b. Ovarian cancer
c. Hip fractures and bone density
d. Anaemia
e. Infertility

36. 8. Numerous studies have shown that artificial feeding
places a higher financial burden on the family due to the
following EXCEPT:
a. Cost of buying infant formula and other necessary
supplies
b. Increased medical bills due to frequent illnesses in
children
c. Higher cost to feed a lactating mother
d. Loss of income through a parent’s absence from work
to care for an ill child.

37. 9. Breastfeeding benefits for the hospital
include all of the following EXCEPT:
a. Warmer and calmer emotional environment
b. No nurseries, more hospital space
c. Fewer neonatal infections
d. Less staff time needed
e. Improved hospital image and prestige
f. No free sponsorship from pharma, samples
of formula and less earnings for hospital

38. 10. Breastfeeding benefits to family,
EXCEPT:
a. Better health, nutrition, and well-being of
mother and child
b. Costs less than artificial feeding
c. Results in lower medical care costs
d. Mother can do house works, can take
care of sibling and save money

39. Benefits of Colostrum, EXCEPT
a. Antibody-rich and has many white cells
b. Has laxative effects
c. Causes high incidence of jaundice
d. Has growth factors
e. Is vitamin-A rich

40. 12. Which of the following is TRUE for a
Mom who uses milk formula…
a. Does not get pregnant sooner
b. Increased risk of ovarian and breast
cancer
c. Interferes with bonding
d. Has higher hip fractures in older age
e. All of the above
f. None of the above

41. 13. AAP guidelines for breastfeeding
advocates
a. Exclusive breast feeding till 6 month
b. Weaning after 4 months in exclusive
breastfed infants
c. Can feed water and juices after 4 months
d. Use pacifier if breast milk is not enough
and baby is hungry

42. 14. Harmful effects of breastfeeding are:
a. Loss of mum’s figure
b. High risk of post natal depression
c. Low self-esteem in mother
d. Baby gets too attached to mum
e. Causes Iron deficiency anaemia in
mother
f. None of the above

43. 15. According to studies, breastfed babies
are at lower risk of the following conditions
EXCEPT:
a. Respiratory and diarrhoea diseases
b. Allergy disorder
c. Obesity
d. Schizophrenia

44. 16. Formula fed babies are constipated
because
a. Formula is low in thyroxin
b. Cow’s milk iron do not absorb well in
baby therefore more iron have been added
into infant formula which increased the risk
of baby having constipation.
c. Formula increases water absorption in
colon
d. Formula has less fibre

45. 17. Which of the following is not an effect of
breastfeeding?
a. Provides superior nutrition for optimum
growth.
b. Protects against infection and allergies.
c. Promotes bonding and development
d. Incur more cost for the family

46. 18. All are true, EXCEPT:
a. Iron is higher in breast milk
b. Iron is better absorbed in breastfed
infants
c. Iron supplements are needed in all
exclusively breastfed full term infants
d. Iron in formula causes constipation

47. 19. TRUE of NEC, except:
a. Exclusively formula fed infants were 6 to 10
times more likely to develop NEC than those who
received breast milk.
b. Although NEC is rare in babies over 30 week’s
gestation, it was 20 times more common if the
baby had received no breast milk.
c. Infection from mothers milk cause NEC in
preterm infection
d. Breast milk is easy to digest and less osmolar

48. Answers
1. 1-T
2. 2-T
3. 3-F
4. 4-T
5. 5-F
6. 2-5
7. 3-5
8. 4-4
9. 5-6
10.6-4

49. Answers
11.7-3
12.8-1
13.9-1
14.10-6
15.11-4
16.12-2
17.13-5
18.14-1
19.15-3
20.BONUS

51. Thank You
DO IT WITH PRIDE... BREASTFEED YOUR CHILD!

52. References:
• Breastfeeding counselling: A training course. Geneva, World Health Organization,
1993(WHO/CDR/93.6).
• Breastfeeding and the use of water and teas. Division of Child Health and
Development UPDATE No.9, Geneva, World Health Organization, November 1997.
(http://www.who.int/child-adolescenthealth/New_Publications/
NUTRITION/Water_Teas.pdf).
• Popkin BM, Adair L, Akin JS, Black R, et al. Breastfeeding and diarrheal morbidity.
Pediatrics, 1990,86(6): 874-882.
• Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity
and the extent of breastfeeding in the United States. Pediatrics, 1997, 99(6).von Kries
R, Koletzko B, Sauerwald T et al. Breast feeding and obesity: cross sectional study.
BMJ, 1999, 319:147-150.
• Saarinen / Kajosaari M: Breastfeeding as prophylaxis against atopic disease
:Prospective Follow up study until 17 years old:Lancet 346: 1065 – 9 , 1995

53. References:
• Aniansson G,Alm B. Anderson B,Hakansson A, Larsson P.Nylen O,Peterson H,Rigner P.Svanborg M,Sabharnal Het al.A
prospective study on breastfeeding and otitis media in Swedish infants:Pediatr.Infect Dis J,1994 Mar 13(3)183-8
• Lucas A & Cole TJ (1990). Breast milk and neonatal necrotising enterocolitis. Lancet 336: 1519-1522
• Rosenblatt KA, Thomas DB, and the WHO collaborative study of neoplasia and steroid contraceptives. Lactation and the risk
of epithelial ovarian cancer. International J Epidemiol 1993;22:192-7..
• Cumming RG, Klineberg RJ. Breastfeeding and other reproductive factors and the risk of hip fractures in elderly
women.Int J Epidemiol. 1993 Aug;22(4):684-91. Erratum in: Int J Epidemiol 1993 Oct;22(5):962. PMID: 8225744 [PubMed -
indexed for MEDLINE]
• Ravelli ACJ, van der Meulen JH, Osmond C, et al. Infant feeding and adult glucose tolerance, lipid profile, blood pressure,
and obesity. Arch Dis Child 2000;82:248–52.
• Newcomb, P.A. et al. 1994. "Lactation and a reduced risk of premenopausal breast cancer." The New England Journal of
Medicine 330(2):81-87.
• Ball TM, Wright AL. Health care costs of formula-feeding in the first year of life.
• Pediatrics. 1999 Apr;103(4 Pt 2):870-6.PMID: 10103324 [PubMed - indexed for MEDLINE]

54. References:
• Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993(WHO/CDR/93.6).
• Breastfeeding and the use of water and teas. Division of Child Health and Development UPDATE No.9, Geneva,
World Health Organization, November 1997. (http://www.who.int/child-adolescenthealth/New_Publications/
NUTRITION/Water_Teas.pdf).
• Fergusson DM, Beautrais AL, Silva PA. Breastfeeding and cognitive development in the first
seven years of life. Social Science and Medicine, 1982, 16:1705-1708. Howie PW, Forsyth JS,
Ogston SA,Clark A, Florey CV. Protective effect of breastfeeding against infection. BMJ, 1990,
300:11-15.
• Popkin BM, Adair L, Akin JS, Black R, et al. Breastfeeding and diarrheal morbidity. Pediatrics, 1990,86(6): 874-
882.
• Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity and the
extent of breastfeeding in the United States. Pediatrics, 1997, 99(6).von Kries R, Koletzko B,
Sauerwald T et al. Breast feeding and obesity: cross sectional study. BMJ, 1999, 319:147-150.

55. Breast cancer and breastfeeding:
Analysis of data from 47 epidemiological studies
in 30 countries (Beral V et al Lancet 2002)
Longer you breastfeed-relative risk of breast
cancer decreases
Adapted from: Beral V et al. (Collaborative group on hormonal factors in breast cancer). Breast cancer and breastfeeding:
collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries. Lancet 2002; 360: 187-95.

56. Risk of Ovarian cancer
• This multinational study showed a 20-25%
decrease in the risk of ovarian cancer among
women who lactated for at least 2 months per
pregnancy, compared to those who had not.
Rosenblatt KA et al. (1993). Lactation and the risk of epithelial ovarian cancer - The WHO Collaborative Study of
Neoplasia and Steroid Contraceptives. Int J Epidemiol 22: 499-503

59. Breastfeeding Savings per year (2012)
• For first 3 months of life baby needs average 2
tins of I kg powdered milk per month
– Each tin costs $44.60
– 24 tins will cost $1070.40
• Savings for each year by
breastfeeding is $1070.40
per year

62. Intelligence Quotient by Type of Feeding
BF 2POINTS
Higher than FF
Study in 3-7
Years old
1982
BF 2.1 points
higher than FF
Study in 6 months
to 2 years old,
1988
BF 12.9 points
higher than FF
Study in 9.5 year-olds
1996
BF 8.3 points
higher than FF –
Study in 7.5-8 year
-olds 1992
BM 7.5 points
higher than no BM
Study in 7.5-8 years-old
1992
References:
•Fergusson DM et al. Soc SciMed 1982
•Morrow-Tlucak M et al. SocSciMed,1988
• Lucas A et al. Lancet 1992
•Riva Eet al. Acta Paediatr 1996
Atleast 35 studies in the world show
BF babies score 3 to 9 IQ points higher than FF babies

63. Duration of breastfeeding associated with
higher IQ scores in young adults, Denmark
Adapted from: Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The association between
duration of breastfeeding and adult intelligence. JAMA, 2002, 287: 2365-2371.
99.4
101.7
102.3
106
104
96
97
98
99
100
101
102
103
104
105
106
Duration of breastfeeding in
months
<1 month
2-3 months
4-6 months
7-9 months
>9 months
LONGER U FEED = MORE BENEFIT

64. Breastfeeding Decreases the Risk of Allergic
disorders - A Prospective Birth Cohort
Study
Type of
feeding
Asthma Atopic
dermatitis
Allergic
rhinitis
Children
exclusively
breastfed 4
months or more
7.7% 24% 6.5%
Children
breastfed for a
shorter period
12% 27% 9%
Adapted from Kull I. et al. Breastfeeding and allergic diseases in infants - a prospective birth
cohort study. Archives of Disease in Childhood 2002: 87:478-481.

65. Lower risk of allergies.
• It is generally agreed that allergies are less
common in completely breastfed babies. A recent
study in Sweden in which a birth cohort of 4089
infants was followed prospectively found that
exclusive and partial breastfeeding reduced the
risk of allergic disorders
• Children exclusively breastfed during four months
or more exhibited less asthma (7.7% vs. 12%),
less atopic dermatitis (24% vs. 27%) and less
allergic rhinitis (6.5% vs. 9%)
Kull et al.

66. Risk of Allergy and Milk intolerance
• Artificial milk has different proteins from human
milk – slow and difficult to digest
• Some babies develop intolerance to proteins in
formula and develop rashes, diarrhea and other
symptoms

67. Artificial Feeding and Risk of Allergy
• Prospective study on Finnish infants of atopic
parents for 17 years found that the prevalence of
atopy was highest in the group of children not
breastfed at all or were breastfed less than a
month
Saarinen UM,Kajosaeri M(1995)
Breastfeeding as a prophylaxis against atopic disease: propsective follow up study until 17
years of age, Lancet 346:1065-1069

68. Increased Risk of Chronic Diseases
• Study done in Amsterdam on 625 adults aged 48-53
years
• Those who are bottle fed at hospital discharge had
greater risk factors for cardiovascular disease than
those who were exclusively breastfed
Adapted from Ravelli AC et al(2000)infant feeding and adult glucose tolerance, lipid profile,
blood pressure and obesity. Arch Dis Child 82:248-52

69. Risk of Otitis Media
• A study in Sweden found that breastfed infants
had less otitis media than artificially fed infants
• At one to three months of age, 6 % of the weaned
infants had otitis media, compared to only 1% of
the breastfed infants
Anaiansson et al

70. Necrotizing Enteritis in preterm infants
• 926 preterm infants were studied, 51 of whom
developed NEC.
• Exclusively formula fed infants were 6 to 10
times more likely to develop NEC than those
who received breast milk.
• Although NEC is rare in babies over 30 weeks
gestation, it was 20 times more common if the
baby had received no breast milk.
Adapted from Lucas A & Cole TJ (1990). Breast milk and neonatal necrotising
enterocolitis,Lancet 336:1519-1522

71. Risk of Breast cancer
• This multi-centre trial in the USA included more
than 14000 pre- and post-menopausal women. It
concluded that breast cancer risk was 22%
lower among pre-menopausal women who have
breastfed than among those who have never
breastfed.
Newcomb PA et al. (1994). Lactation and a reduced risk of premenopausal breast
cancer. New Engl J Med 330: 81-87

72. Risk of hip fractures in elderly women
• In one study of 311 cases of hip fractures in
women over 65 years of age, it was found that
parous women who had not breastfed had twice
the risk of hip fractures as nulliparous women
and those who did not breastfed
Adapted from Cumming RG & Klineberg RJ(1993)Breastfeeding and other reproductive
factors & the risk of hip fractures in elderly women.Int Epidermiol:022:684-691