i presented this on breast feeding week. A very precious presentation for me.

1. MOTHER’S MILK
DR PRIYANKA GUPTA
RESIDENT II
DEPARTMANT OF PEDIATRICS

2. BREAST FEEDING
A WINNING
GOAL FOR LIFE

3. Role of a pediatrician
• They should be able to answer
• Why ?
• How?
• How long to continue ?
• Contraindications to breastfeeding?

4. Why to breast feed?
• Good for the baby
• Good for the mother
• Good for the nation

5. Mother’s Milk – The best milk for Infant
Under any circumstances, “Mother’s Milk” is the
ideal food for infant. No other food is required till
6 months of age.

6. Why mother’s milk???
The mother’s milk:
1. Always available – No preparation time.
2. Proper temperature.
3. Clean & Fresh.
4. Free of contaminating agents.
5. Cheap.

7. Breast is best?
• Contains all the nutrients , growth factors and
hormones that an infant needs in the right amounts .
Its composition changes as the baby grows.
• Anti infective properties: Macrophages, lymphocytes
and polymorphs, Secretory IgA, Lyzozyme,
Lactoferrin (inhibits growth of E.coli.), anti-viral
agents.

8. Advantages of Breast Feeding
To the infant:
1. Meets the full nutritional requirement of infant.
2. Less incidence of allergy & intolerance.
3. Contains antimicrobials factors against various
diseases.

9. Infant health outcomes
Strong or causal evidence:
• GI tract infections
• Upper and lower respiratory
tract infections
• Otitis media
• Acute lymphoblastic
leukemia
• Sudden infant death
syndrome
Evidence in development:
• Cognitive development
• Atopic allergies
• Asthma
• Other pediatric cancers
• Childhood obesity

10. Maternal benefits of breastfeeding
• Breastfeeding may confer immediate and long
term benefits to mothers, especially if
recommendation for exclusivity and duration
are met.
• Such benefits may strengthen motivation and
commitment to breastfeeding

11. Maternal benefits of breastfeeding
Reason to Initiate breastfeeding
• Reduce maternal bleeding after delivery
27% deaths are due to postpartum haemorrhage
• involute uterus
• Facilitate positive metabolic changes
• Reduce stress
• Delay ovulation

12. Maternal benefits of breastfeeding
Reason to continue breastfeeding
• Increase postpartum weight loss
• Prolong lactational amenorrhea
• Decrease visceral adiposity
• Reduce type 2 diabetes risk
• Reduce cardiovascular risk
• Reduce breast cancer risk
• Reduce ovarian cancer risk

13. Maternal health outcomes
Strong or causal evidence:
• Postpartum weight loss
• Lactational amenorrhea
• Breast cancer
Evidence in development:
• Ovarian cancer
• Type 2 diabetes
• Cardiovascular disease
• bonding

14. EVIDENCE BASED MEDICINE
• THE RESET HYPOTHESIS
Stuebe AM, Rich-Edwards JW. The reset hypothesis: lactation
and maternal metabolism. Am J Perinatol 2009;26(1):81–8
• 1)50% higher risk of developing type2 diabetes among
women who never exclusively breastfed
• 2)28%lower risk of developing ovarian cancer among
women who exclusively breast fed.
• 3) 4 to 12% reduction in risk of diabetes for every 12
months of lifetime lactation
• 4)Risk of breast cancer decreases by 4.3% for each year of
breast feeding
1) Schwarz EB, Brown JS, Creasman JM, et al. Lactation and maternal risk of type 2 diabetes: a population-based study. Am J Med
2010;123(9):863–6.
4 )p. S, Chung M, Raman G, et al. A summary of the agency for healthcare research and quality’s evidence report on breastfeeding in
developed countries. Breast- feed Med 2009;4(1):S17–30.

15. HUMAN MILK
• HUMAN MILK COMPOSITION
• TERM MILK VERSUS PRETERM MILK
• MOTHER’S MILK VERSUS TOP FEED
• FOREMILK VERSUS HIND MILK

16. Mother’s MILK
• Dynamic, multifaceted fluid
• Contains nutrients and bioactive factors

17. Colostrum in Human Milk
• Thick, yellow fluid
• Provides 58-70 cal/100 ml.
• High in protein, electrolytes, sodium,
potassium, chloride and vitamin A.
• Low in fat and carbohydrate.
• Lactobacillus bifidus factor.
• Contains antibodies immune system cells.

18. Colostrum
Benefits of colostrum feeding:
1. Perfect food for infants in initial days.
2. Laxative effect – clears infant’s intestines of
initial stools; prevents jaundice.
3. Contains leukocytes which prevent
infection.
4. Contains IgA which also provides immunity.

19. Change in Milk Composition During
Feeding
• Foremilk
– Released first
– Higher in carbohydrate
– Lower in fat
• Hindmilk
– Resembles cream
– Higher in fat
– Lower in carbohydrate
– Released after 10-20 minutes into the feeding

20. Foremilk and Hindmilk
Baby starts feeding
Foremilk
Low fat,
High Lactose milk
MILK EJECTION REFLEX
Milk & sticking fat
on ducts squeezed
Hindmilk High fat milk

21. Specific Nutrients in Human Milk
Human Milk Composition (per liter)
Milk Component Early Milk Mature Milk
Lactose (g) 20-30 67
Total protein (g) 16 9
Fat% 2 3.5
Calories 0 2730-2940
Retinol (mg) 2 0.3-0.6
Caretenoids (mg) 2 0.3-0.6
Riboflavin (ug) 0 400-600
Niacin (mg) 0.5 1.8-6.0
Vitamin B6 (mg) 0 0.9-0.31
Pantothenic acid (mg) 0 2-2.5
Biotin (ug) 0 5-9
Folate (ug) 0 80-140
Vitamin B12 (ug) 0 .5-1.0
Vitamin C (mg) 0 100
Vitamin D (microgram) 0 0.33
Vitamin E (mg) 2-12 3-8
Vitamin K (microgram) 2-8 2-3
Calcium (mg) 250 200-500
Phosphorus (mg) 120-160 120-140
Magnesium (mg) 30-35 30-35
Copper (mg) 0.5-0.8 0.2-0.4
Iron (mg) 0.5-1.0 0.3-0.9
Zinc (mg) 8-12 1-3

22. Hind milk
• Hind milk has been successfully used to
improve growth outcome of very premature
infants
• Recommended for their nutritional
management
Valentine CJ. Optimizing human milk fortification for the preterm infant. PNPG Building
Block for Life 2011;34(4):9–11. 1

23. Preterm Vs term milk
• Preterm milk contains more protein and fat
• Preterm milk contains higher levels of EGF
than term milk
• BDNF can enhance peristalsis, a function
frequently impaired in preterm gut.
• Preterm milk contains less VEGF than term
milk
Liao Y, Alvarado R, Phinney B, et al. Proteomic characterization of human milk whey proteins during a twelve-month lactation
period. J Proteome Res 2011; 10(4):1746–54. 1
. Gao X, McMahon RJ, Woo JG, et al. Temporal changes in milk proteomes reveal developing milk functions. J Proteome Res
2012;11(7):3897–907.

24. Composition of breast milk vs cows milk
• Carbohydrate: Human milk 7%
Cows milk 4.5% lactose
• Fat : mother’s milk is rich in PUFA,
• Minerals Cows milk contains more of all the
minerals (esp sodium, calcium and phosphate)
except iron and copper.
• Vitamins Cows milk is low in vitamin C and D but
more thiamine and riboflavin.

25. Mature Human Milk
• Provides 65kcal/100ml
• High in linoleic acid and cholesterol content for brain
development
• High in fat content and lactose
• Docosahexaenoic acids (DHA)
– Used for synthesis of brain tissues, central nervous
system and eyes
• DHA and cholesterol not found in human milk
substitutes

26. Mature Human Milk- PRO
• Protein
– Low content
• Dependent on infant’s age
– Antiviral and antimicrobial effects
– Whey (lactalbumin and lactoglobulin)
• Major protein in mature milk
• Easily digestable
• Ideal ratio of cystine, taurine and methionine to
support development of CNS AND PNS

27. Mature Human Milk- CHO
• Lactose
– Dominant carbohydrate in human milk.
– Enhances calcium absorption.
• Other carbohydrates
– Monosaccharides ( glucose)
– Stimulate the growth of bifidus bacteria in the gut
• Inhibit the growth of E. coli and other bacteria

28. Micronutrients
• Vary in human milk according to maternal diet
and body stores.
• Continuing multivitamins during lactation is
recommended.
• Vitamin K is extremely low in human milk.
• Vitamin D is low in human milk.

29. Bioactive components and their
sources
• CELLS
macrophages: protection against infection
stem cells : regeneration and repair
• Immunoglobulins : IgA, IgM,IgG
• Cytokines :IL-6,IL-7,IL-8 ,IL-10, IFN-y , TGF-beta
• Chemokines : G-CSF, MIF

30. BIOACTIVE COMPONENTS
• GROWTH FACTORS- EGF, VEGF, NGF, IGF,
Erythropoetin
• HORMONES- calcitonin,somatostain
• Antimicrobials –lactoferrin,lactadherin/ MFG
• METABOLIC HORMONES- Adiponectin, leptin,
ghrelin

31. Why NO to top feed?????
Mother’s Milk
• Wide range of composition
• Dynamic
• Varies with in a feeding
• Diurnal variation
FORMULA FEED
• Narrow range
• fixed

32. Why no to top feed?????
• Formula feeding delays lactogenesis
• Formula feeding increases the risk of
engorgement .
• It alters infant intestinal flora
• Formula feeding affects bioactive factor
interactions within the intestine
• Formula feeding is associated with increased
childhood acute and chronic illnesses

33. WHAT STUDIES SAY
A study by Davis, California found that after 4
months postpartum, the macronutrient
concentrations of human milk are associated with:
• maternal body weight for height
• Protein intake
• Parity
• Return of menstruation
• Nursing frequency
. Nommsen LA, Lovelady CA, Heinig MJ, et al. Determinants of energy, protein, lipid, and
lactose concentrations in human milk during the first 12 month of lacttion: the DARLING
Study. Am J Clin Nutr 1991;53(2):457

34. What studies say
• Some evidence that Erythropoetin may help
protect against mother to child transmission of
HIV
• Erythropoetin may reduce the risk of necrotizing
colitis.
• One study found a 9 fold increase in risk of
diarrhoea who were not breast fed
Shiou SR, Yu Y, Chen S, et al. Erythropoietin protects intestinal epithelial barrier function and lowers the incidence of experimental
neonatal necrotizing entero- colitis. J Biol Chem 2011;286(14):12123–32.
. Arsenault JE, Webb AL, Koulinska IN, et al. Association between breast milk erythropoietin and reduced risk of mother-to-child
transmission of HIV. J Infect Dis 2010;202(3):370–3.
. Claud EC, Savidge T, Walker WA. Modulation of human intestinal epithelial cell IL-8 secretion by human milk factors. Pediatr Res
2003;53:419–25.

35. Potential novel therapeutics based on
human milk components
1)Lactoferrin may significantly reduce late onset
sepsis
2) Stem cells are also found in mother’s milk,
use is under trial
1)Agennix. Phase 1/2 study of talactoferrin oral solution for nosocomial infection in preterm infants: Available at:
http://clinicaltrials.gov/ct2/show/NCT00854633. Accessed August 23, 2012.
2)Indumathi S, DhanasekaranM, Rajkumar JS, et al. Exploring the stem cell and non-stem cell constituents of human
breast milk. Cytotechnology 2012. [Epub

36. EVIDENCE BASED MEDICINE
1) 72% lower risk of hospitalisation for
respiratory infections.
2)One study reviewed breast fed infants have
64% less chances of contracting GI infections.
3) Studies have reported that infants
breastfed greater than 6 months had a 24%
reduction in risk of ALL
1.Bachrach VR, Schwarz E, Bachrach LR. Breastfeeding and the risk of hospitalisation for respiratory disease in infancy: a meta-analysis.
2.p S, Chung M, Raman G, et al. A summary of the agency for healthcare research and quality’s evidence report on breastfeeding
in developed countries. Breast- feed Med 2009;4(1):S17–30. )
.
Arch Pediatr AdolescMed 2003;157(3):237–43
3. Kwan M, Buffler P, Abrams B, et al. Breastfeeding and the risk of childhood leukemia: a meta-analysis. Public Health Rep
2004;119(6):521–35.

37. Achieving MDG’S
• So breast feeding helps a nation to acheiving
MDG
• Decreasing poverty
• Education for all
• Equality of sexes
• Decreasing infant mortality rate
• Improving mother’s health
• Environmental conservation
• National and international support

38. FOLLOW
• A
• L
• P
• A
• C