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feels\ttired\twith\tless\tenergy.\tA\tnutritious\tdietary\tintake\thelps\ther\tcope\twith\tthe\teveryday\tdemands\tof\ncaring\tfor\ta\tnew\tinfant.\nMilk\n\tcomposition\tvaries\taccording\tto\tthe\tmother’s\tdiet.\tFor\texample,\tthe\tfatty\tacid\tcomposition\tof\na\tmother’s\tmilk\treflects\ther\tdietary\tintake.\tIn\taddition,\tmilk\tconcentrations\tof\tselenium,\tiodine,\tand
|
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within\tand\tbetween\tindividual\tmothers.\tSeveral\tfactors,\tincluding\tlength\tof\tpregnancy,\tmother’s\ndiet,\tstage\tof\tlactation,\tduration\tof\tfeeding,\tand\tthe\ttime\tof\tday\tthe\tfeeding\ttakes\tplace,\tcan\taffect\nthe\tcomposition\tof\thuman\tmilk.\tProtein\tlevels\ttend\tto\tfall\tin\tthe\tearly\tpostpartum\tperiod,\twhereas\nthe\tfat
|
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the\tfat\n\tcomponent\tof\tthe\tmilk\tinitially\tmay\tdecrease\tand\teventually\tincrease\tin\tconcentration\tover\ntime.\tDuring\tan\tindividual\tfeeding,\tfat\tcontent\ttypically\tincreases\tsignificantly\tand\tcan\tresult\tin\ta\nmuch\thigher\tcaloric\tcontent\tin\tthe\tmilk\ttoward\tthe\tend\tof\tthe\tfeeding\t(\nKhan\tet\tal,\t2013\n).\tFat\tcontent
|
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Khan\tet\tal,\t2013\n).\tFat\tcontent\nalso\tmay\tbe\thigher\twhen\tthe\tinterval\tbetween\tbreastfeedings\tis\tcloser\ttogether.\tWhen\tthe\tinfant\n“cluster\n\tfeeds,”\tthe\tmilk\tavailable\tin\tthe\tbreast\tis\thigher\tin\tfat\tcontent.\tWhen\tmore\ttime\tis\tallowed\nbetween\tfeedings,\tthe\tbreasts\tfill\twith\tmilk\twith\thigher\twater\tcontent.\tAt\tthe\tnext\tfeeding,\tthe\tinfant
|
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] |
may\tnot\tbe\table\tto\tconsume\tall\tthe\tmilk\tavailable\tand\tends\tup\ttaking\tmainly\tlow-fat\tmilk.\nEnergy\nMilk\tproduction\tis\t80%\tefficient:\tproduction\tof\t100\tmL\tof\tmilk\t(approximately\t75\tkcal)\trequires\tan\n85-kcal\texpenditure\t(\nLawrence\tand\tLawrence,\t2016\n).\tDuring\tthe\tfirst\t6\tmonths\tof\tlactation,\taverage
|
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] |
).\tDuring\tthe\tfirst\t6\tmonths\tof\tlactation,\taverage\nmilk\tproduction\tis\t750\tmL/day\t(about\t24\toz),\twith\ta\trange\tof\t550\tto\tmore\tthan\t1200\tmL/day.\tBecause\nproduction\tis\ta\tfunction\tof\tthe\tfrequency,\tduration,\tand\tintensity\tof\tinfant\tsuckling,\tinfants\twho\tfeed\nwell\tare\tlikely\tto\tstimulate\tthe\tproduction\tof\tlarger\tvolumes\tof\tmilk.
|
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The\tDRI\tfor\tenergy\tduring\n\tlactation\tis\t330\tkcal\tgreater\tduring\tthe\tfirst\t6\tmonths\tof\tlactation\tand\n400\tkcal\tgreater\tduring\tthe\tsecond\t6\tmonths\tof\tlactation\tover\tthat\tfor\ta\tnonpregnant\twoman.\nHowever,\tconsidering\tmilk\tproduction\tusually\tdrops\tto\tan\taverage\tof\t600\tmL/day\t(approximately\t20
|
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0.00275170779787004,
0.035601358860731125,
0.0557771660387516,
0.052424684166908264,
-0.037487249821424484
] |
oz/day)\tafter\tother\tfoods\tare\tintroduced\tinto\tthe\tinfant’s\tdiet,\tingested\tcalorie\tlevels\tmay\thave\tto\tbe\nadjusted\tfor\tthe\tindividual\twoman\n\twho\twishes\tto\tavoid\tweight\tgain.\tA\tmother\tis\table\tto\tdraw\napproximately\t100\tto\t150\tkcal/day\tfrom\tpregnancy\tfat\tstores.\nHealthy\tbreastfeeding\twomen\tcan\tlose\tas\tmuch\tas\t1\tpound\tper\tweek\tand\tstill\tsupply\tadequate
|
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] |
milk\tto\tmaintain\ttheir\tinfants’\tgrowth.\tThe\tcombination\tof\tdiet\tand\texercise\ttogether,\tor\tdiet\talone\ncan\thelp\twomen\tto\tlose\tweight\tafter\tchildbirth\t(\nAmorim\tAdegboye\tand\tLinne,\t2013\n).\tIn\n\ta\tstudy\tof\t68\nadolescent\tmothers\tand\t64\tadult\tmothers,\tpostpartum\tweight\tloss\tin\tboth\tgroups\twas\tsignificantly
|
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greater\tin\tthose\twho\twere\texclusively\tbreastfeeding\t(EBF)\tcompared\twith\tthose\twho\tdid\tnot\tEBF.\nMoreover,\tthe\tinfants\tof\tthe\tmothers\tcontinued\tto\tgrow\taccording\tto\tthe\t2006\tWHO\tgrowth\nstandards\tdespite\ttheir\tmothers’\tweight\tloss\t(\nSámano\tet\tal,\t2013\n).\tHowever,\tmilk\tproduction\thas\nbeen\tshown
|
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] |
Sámano\tet\tal,\t2013\n).\tHowever,\tmilk\tproduction\thas\nbeen\tshown\n\tto\tdecrease\tin\tmothers\twhose\tintakes\tare\tsuboptimal\t(less\tthan\t1500\tto\t1800
|
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] |
calories/day)\t(\nWest\tand\tMarasco,\t2009\n).\tMothers\tare\tadvised\tto\twait\tuntil\tbreastfeeding\tis\twell\nestablished\t(approximately\t2\tmonths)\tbefore\tconsciously\ttrying\tto\tlose\tweight\tso\tthat\tan\tadequate\nmilk\tsupply\tcan\tbe\testablished.\tAppropriate\tfluid\tintake\t(such\tas\tdrinking\tfor\tthirst)\tand\tadequate\nrest\talso\tare\trecommended.
|
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rest\talso\tare\trecommended.\n\tA\tslow\tweight\tloss\tof\tno\tmore\tthan\tabout\t5\tpounds\tper\tmonth\tsupports\nmore\tpermanent\tweight\tloss\tas\twell\tas\tallows\tfor\tadequate\tenergy\tand\tnutrition\tfor\tnew\nmotherhood.\nProtein\nThe\tDRI\tsuggests\tan\tadditional\t25\tg\tof\tprotein\ta\tday\tfor\tlactation,\tor\t71\tg\tof\tprotein\ta\tday,\tbased\ton
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with\tpoor\tnutritional\tstatus\tmay\tneed\tadditional\tprotein.\tThe\taverage\tprotein\trequirement\tfor\nlactation\tis\testimated\tfrom\tmilk\tcomposition\tdata\tand\tthe\tmean\tdaily\tvolume\tof\t750\tmL,\tassuming\n70%\tefficiency\tin\tthe\tconversion\tof\tdietary\n\tprotein\tto\tmilk\tprotein.
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0.09829329699277878,
0.038979750126600266,
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0.0942244753241539,
0.07881708443164825,
0.10751180350780487,
-0.04867370426654816
] |
70%\tefficiency\tin\tthe\tconversion\tof\tdietary\n\tprotein\tto\tmilk\tprotein.\nBreastmilk\thas\ta\twhey:casein\tratio\tof\t90:10\tearly\tin\tlactation,\twhich\tchanges\tto\t80:20\tas\tan\naverage,\tand\tto\t60:40\tas\tthe\tbaby\tgets\tolder.\tIt\tis\tspeculated\tthat\tthis\tratio\tmakes\tbreastmilk\tmore
|
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] |
digestible.\tIn\tcontrast,\tthe\twhey:casein\tratio\tof\tcow’s\tmilk\tprotein\tis\t18:82.\tCow’s\tmilk–based\tinfant\nformula\tvaries\tamong\tcommercial\tmanufacturers,\tranging\tfrom\t18:82\twhey:casein,\n\tto\t52:48\nwhey:casein,\tand\teven\tup\tto\t100%\twhey\t(see\t\nChapter\t15\n).\nCarbohydrates
|
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] |
Chapter\t15\n).\nCarbohydrates\nThe\tRDA\tfor\tcarbohydrate\tis\tdesigned\tto\tprovide\tenough\tcalories\tin\tthe\tdiet\tfor\tadequate\tvolumes\tof\nmilk\tand\tto\tmaintain\tan\tadequate\tenergy\tlevel\tduring\tlactation.\tThis\tmay\thave\tto\tbe\tadjusted\ndepending\ton\tactivity\tof\tthe\tmother\tand\tthe\tamount\tof\tbreastfeeding.\tThe\twoman\twith\tpoor\ngestational\tweight\tgain\tmay\trequire
|
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] |
gestational\tweight\tgain\tmay\trequire\n\tmore\tcarbohydrates.\tWomen\twho\thad\tgestational\tdiabetes\nduring\tpregnancy\tshould\tcontinue\ton\tthe\tMNT\tdiet\tthey\twere\ton\tduring\tpregnancy\tfor\toptimal\nmanagement\tof\tblood\tsugar\tif\trecommended\tto\tdo\tso\tby\ttheir\tmedical\tprovider.\tA\tmodified
|
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carbohydrate\tdiet\tis\toften\timplemented\tto\tmeet\tthe\tdietary\tneeds\tin\tthis\tcondition.\nThe\tprincipal\tcarbohydrate\tin\thuman\tmilk\tis\tlactose;\thowever,\tthere\tis\tno\tevidence\n\tthat\tmaternal\nintake\tof\tcarbohydrates\taffects\tthe\tlevel\tof\tlactose\tin\ther\tmilk.\nLipids
|
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] |
infant\tbrain\tdevelopment.\tOne\tto\ttwo\tservings\tof\tfish\tper\tweek\tmeet\tthis\tneed\t(herring,\tcanned\tlight\ntuna,\tsalmon).\n\tMothers\tshould\tavoid\teating\tpredatory\tfish\tto\tprevent\texcessive\tlevels\tof\tdietary\nmercury\t(pike,\tmarlin,\tmackerel,\talbacore\ttuna,\tand\tswordfish)\t(\nAAP,\t2012\n;\tsee\talso\t\nChapter\t16\n).
|
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0.04166598990559578,
0.09379913657903671,
0.05148573964834213,
0.03830533102154732
] |
AAP,\t2012\n;\tsee\talso\t\nChapter\t16\n).\nIntake\tof\ttrans\tfats\tshould\tbe\tkept\tto\ta\tminimum\tby\tthe\tnursing\tmother\tso\tthat\tthe\tpotential\tfor\ttheir\nappearance\tin\ther\tbreastmilk\tis\treduced.\tSee\t\nFocus\tOn:\n\tOmega-3\tFatty\tAcids\tin\tPregnancy\tand\nLactation\n\tfor\tmore\tinformation\n\tabout\tincluding\tDHA\tin\tthe\tmaternal\tdiet.
|
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] |
for\tmore\tinformation\n\tabout\tincluding\tDHA\tin\tthe\tmaternal\tdiet.\nHuman\tmilk\tcontains\t10\tto\t20\tmg/dL\tof\tcholesterol,\tresulting\tin\tan\tapproximate\tconsumption\tof\n100\tmg/day,\twhich\thas\tbeen\tdetermined\tto\tbe\tessential\tto\tthe\tdiet\tof\tthe\tinfant.\tThe\tamount\tof\ncholesterol\tin\tmilk\tdoes\tnot\treflect\tthe\tmother’s\tdiet\tand\tdecreases\tover\ttime\tas\tlactation
|
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] |
progresses.\nVitamins\tand\tminerals\nVitamin\tD.\nThe\tvitamin\tD\tcontent\n\tof\tbreastmilk\tis\trelated\tto\tmaternal\tvitamin\tD\tintake\tas\twell\tas\tenvironmental\nconditions.\tNumerous\tcase\treports\tdocument\tmarginal\tor\tsignificant\tvitamin\tD\tdeficiency\tin\tinfants\nof\tlactating\twomen\twho\tare\tveiled,\twho\tare\tdark\tskinned,\twho\thave\ta\tBMI\tof\tmore\tthan\t30,\twho\tuse
|
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] |
sunscreens\theavily,\tor\twho\tlive\tin\tlatitudes\twith\tdecreased\tsun\texposure.\tWomen\twith\tlactose\nintolerance\twho\tdo\tnot\tdrink\tvitamin\n\tD–fortified\tmilk\tor\ttake\ta\tvitamin\tsupplement\tmay\tbe\tat\thigher\nrisk\tfor\tvitamin\tD\tdeficiency.\tHypocalcemic\trickets,\tincluding\tcases\tof\tdilated\tcardiomyopathy,\thave
|
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been\treported\tin\tthe\tUnited\tStates\tin\tbreastfed,\tdark-skinned\tinfants\t(\nBrown\tet\tal,\t2009\n).\nBecause\tof\treports\tof\tclinical\trickets,\tthe\tAAP\trecommends\tthat\tall\tinfants\treceive\t400\tIU\t(10\tmcg)\nof\tvitamin\tD\tas\ta\tdaily\tsupplement\tstarting\n\tat\tbirth,\tallowing\tthe\tinfant\tto\teasily\tachieve\tvitamin\tD
|
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at\tbirth,\tallowing\tthe\tinfant\tto\teasily\tachieve\tvitamin\tD\nsufficiency.\tFor\tformula-fed\tinfants,\tthey\tmay\tcease\tsupplementation\tonce\tthe\tinfant\tis\tconsuming\t1\nliter\tof\tformula\tper\tday.\tCanada\trecommends\t800\tIU/day\tfor\tadults\tliving\tnorth\tof\t45°\tN\tlatitude,\tbut
|
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vitamin\tD\tdaily\tfrom\tfood\tor\tUV\texposure.\tMaternal\tcirculation\tallows\ttransfer\tof\tthe\tparent\ncompound,\tVitamin\tD3\titself,\tand\tnot\tcirculating\t25(OH)D,\tinto\thuman\tmilk.\tAlthough\tmaternal\nbaseline\tcirculating\t25(OH)D\tlevel\tmay\tbe\tadequate,\tit\tcannot\tbe\n\tassumed\tthat\tthe\tvitamin\tD
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0.07497723400592804,
0.029723620042204857,
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0.11253336817026138,
0.0009738675435073674,
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0.11829977482557297,
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0.019590215757489204,
0.08805572241544724,
0.05709569528698921,
-0.04207231104373932
] |
assumed\tthat\tthe\tvitamin\tD\nactivity\tof\tthe\tmother’s\tmilk\tis\tadequate\tfor\tthe\tinfant.\tBecause\tof\tthe\tbinding\taffinity\tto\tvitamin\tD\nbinding\tprotein,\tthe\tcirculating\thalf-life\tof\t25(OH)D\tis\t3\tto\t4\tweeks,\twhile\tthat\tof\tvitamin\tD3\tis\tjust\n12\tto\t24\thours;\tthe\treduced\taffinity\tof\tvitamin\tD3\tallows\tthe\tunbound\tvitamin\tD3\tto\tdiffuse\tacross
|
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] |
cell\tmembranes\tfrom\tblood\tinto\tthe\tmilk.\tIn\torder\tfor\tlevels\tfor\n\tvitamin\tD\tto\tbe\tsustained\tin\tboth\tthe\nmaternal\tcirculation\tas\twell\tas\tthe\tmilk\tsupply,\ta\tdaily\tdose\tof\tvitamin\tD\tis\trequired.\tRecent\tstudies
|
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] |
have\tshown\tthat\ta\tdaily\tmaternal\tintake\tof\t6400\tIU\tof\tvitamin\tD\tis\tsafe\tand\tallows\ta\tmother\tto\nproduce\tmilk\tthat\twill\tprovide\tadequate\tamounts\tof\tvitamin\tD\tto\ther\texclusively\tbreastfed\tnursling,\nwithout\tadditional\tsupplementation\tdirectly\tto\tthe\tinfant\t(\nHollis\tet\tal,\t2015\n).\nCalcium.
|
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] |
Hollis\tet\tal,\t2015\n).\nCalcium.\nAlthough\tbreastfeeding\tmothers\tshould\tbe\tencouraged\tto\tmeet\ttheir\tDRI\tfor\tcalcium\tfrom\ttheir\tdiet,\nthe\tcalcium\tcontent\tof\tbreastmilk\tis\tnot\trelated\tto\tmaternal\tintake,\tand\tthere\tis\tno\tconvincing\nevidence\tthat\tmaternal\tchange\tin\tbone\tmineral\tdensity\tis\tinfluenced\tby\tcalcium\tintake\tacross\ta
|
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broad\trange\tof\tintakes\tup\tto\t1600\tmg/day.\tA\trecent\tstudy\tevaluated\tcalcium\tintakes\tof\t33\tGambian\nlactating\twomen\tduring\ttwo\tdifferent\tlactational\ttime\tperiods.\tThe\tstudy\tfound\tthat\teven\twith\nsuboptimal\tintakes,\tthe\tbone\tmineral\tmobilization\tduring\tlactation\twas\trecovered\tafter\tlactation.
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] |
They\tconcluded\tthat\tsuccessive\tperiods\tof\tlong\tlactation\tare\tnot\tassociated\twith\tprogressive\tskeletal\ndepletion\t(\nSawo\tet\tal,\t2013\n).\nIodine.\nAdequate\tbreastmilk\tiodine\tlevels\tare\tparticularly\timportant\n\tfor\tproper\tneurodevelopment\tin\tnursing\ninfants,\tand\trequired\tintakes\tare\tnearly\tdouble\tnonpregnant\tvalues.\tIodine\tconcentrations\tin
|
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] |
breastmilk\tare\tconsidered\tto\tbe\tadequate\tto\tmeet\tinfants’\tiodine\tnutritional\tneeds\tin\tareas\twhere\nfood\tsources\tare\tadequate.\tHowever,\tmothers\tliving\tin\tiodine-deficient\tareas,\tespecially\tif\talso\nconsuming\tgoitrogens\tor\texposed\tto\tperchlorate\tcontamination,\tmay\tproduce\n\tmilk\twith\tiodine
|
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milk\twith\tiodine\nconcentrations\tinsufficient\tto\tmeet\tthe\tneeds\tof\tthe\tinfant.\tAs\tmentioned\tearlier,\thyper-\tand\thypo-\nthyroidism\tcan\taffect\tbreastmilk\tproduction,\tand\tso\tmothers\tshould\tchoose\tfood\tsources\tof\tiodine,\nsuch\tas\tiodized\tsalt,\tdairy\tfoods,\tseafood,\tand\tbreads\tmade\twith\tiodide.\tRecent\trecommendations
|
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from\tthe\tAAP\tstate\tthat\tlactating\twomen\tshould\tensure\ta\tdaily\tintake\tof\t290\tmcg\tof\tiodide,\n\twhich\ngenerally\trequires\tsupplementation\tof\t150\tmcg/day.\nZinc.\nThe\trequirements\tfor\tzinc\tduring\tlactation\tare\tgreater\tthan\tthose\tduring\tpregnancy.\tBreastmilk
|
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of\tbreastmilk\tdrops\tdramatically\tduring\tthe\tfirst\tfew\tmonths\tfrom\n2\tto\t3\tmg/day\tto\t1\tmg/day\tby\tthe\tthird\tmonth\tafter\tbirth.\tZinc\tsupplementation\thas\tnot\tbeen\tfound\nto\taffect\tconcentrations\tin\tthe\tbreastmilk\tof\twomen\tin\tdeveloped\tcountries\tbut\tmay\tincrease\tthe\tzinc\ncontent\tof\tthe\tmilk\tof\twomen\tin\tdeveloping\tcountries\twith\tsuboptimal\tzinc\tstatus\t(
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Sazawal\tet\tal,\n2013\n).\nVitamin\tB\n12\n\tand\tthe\tvegan\n\tmother.\nFor\tlactating\tmothers\twho\tfollow\ta\tstrict\tvegan\tdiet\twithout\tany\tanimal\tproducts,\ta\tvitamin\tB\n12\nsupplement\tis\tstrongly\trecommended.\tThe\tmilk\tof\ta\tvegan\tmother\tcan\tbe\tseverely\tdeficient\tin\nvitamin\tB\n12
|
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vitamin\tB\n12\n,\tleading\tto\ta\tdeficiency\tin\ther\tinfant\twhich,\tif\tnot\ttreated,\tcan\tlead\tto\tgrowth\tfailure\tand\npermanent\tdamage\tto\tthe\tnervous\tsystem.\tNursing\tmothers\twho\tfollow\ta\tstrict\tvegetarian\tdiet\nshould\n\thave\ttheir\tinfant’s\tB\n12\n\tlevels\tmonitored.\tLactating\tmothers\twho\thave\tundergone\tgastric\nbypass\tsurgery\tare\talso\tat\tgreater\trisk\tfor\tB\n12
|
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] |
bypass\tsurgery\tare\talso\tat\tgreater\trisk\tfor\tB\n12\n\tdeficiency\t(see\t\nAppendix\t31\n).\nSodium.\nSodium\tintake\tduring\tlactation\tshould\tbe\tcontrolled\twith\tthe\tinclusion\tof\ta\tdiet\tcomposed\tof\tfoods\nhigh\tin\tnutritional\tvalue,\twhich\tare\tnaturally\tlower\tin\tsodium.\tAlthough\tthere\tis\tno\tspecific\nrecommendation\tor\trestriction
|
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] |
recommendation\tor\trestriction\n\tfor\tsodium\tin\tthe\tdiet\tof\tbreastfeeding\tmothers,\ta\trelationship\thas\nbeen\testablished\tbetween\tthe\tsodium\tintake\tof\tmothers\tand\tbreastfeeding\tsuccess.\tA\trecent\tstudy\nexamined\twhether\tmaternal\tsalt\tpreference\tmay\tfacilitate\tbreastfeeding.\tThe\tinvestigators\tfound
|
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] |
that\tmothers\twith\ta\tpreference\tfor\ta\tlow\tsalt\tintake\thad\thigher\trates\tof\tsuccessful\tbreastfeeding\nbeyond\tday\t7\tcompared\twith\tmothers\twith\n\thigh\tsalt\tpreference.\tMothers\twith\thigh\tsalt\tpreference\nhad\tthe\tshortest\texclusive\tbreastfeeding\tduration\tup\tto\tpostnatal\tday\t25\t(\nVerd\tet\tal,\t2010\n).\tFuture
|
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] |
Verd\tet\tal,\t2010\n).\tFuture\nstudies\tare\twarranted\tto\tdetermine\texactly\twhat\teffect\tmaternal\tsodium\tintake\thas\ton\tthe\tsuccess\tof\nbreastfeeding.\nFluids\nA\tnursing\tmother\tmay\tfeel\ta\tneed\tto\tdrink\tsimply\tbecause\tof\tincreased\tfluid\toutput\twhen\nbreastfeeding\ther\tinfant.\n\tShe\tshould\tdrink\tto\tthirst\tbut\tnot\tfeel\tshe\tmust\tforce\tfluids,\twhich\tis\tnot
|
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] |
beneficial\tand\tmay\tcause\tdiscomfort.\tThe\tbeverage\tof\tchoice\tis\twater;\thowever,\twater\tis\tthe\tmain\ncomponent\tof\tmany\tbeverages\tand\tcan\tbe\tused\tas\tsuch\tin\tthe\tbody.\nCaffeine.\nCaffeine\tis\tacceptable\tin\tmoderate\tamounts\t(less\tthan\t300\tmg\tdaily,\tsee\t\nAppendix\t25\n)\tand\tdoes\tnot\npresent\ta\tproblem\tfor\tthe\thealthy\tfull-term\tinfant.
|
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)\tand\tdoes\tnot\npresent\ta\tproblem\tfor\tthe\thealthy\tfull-term\tinfant.\n\tIf\tthe\tmother\tis\tnursing\ta\tpreterm\tinfant,\nhowever,\tthe\tbaby\tmay\tbe\tparticularly\tsensitive\tto\tlarge\tintakes\tof\tcaffeine.\tIn\tthis\tcase\tthe\tmother\nis\tadvised\tto\tobserve\ther\tinfant\tclosely\tfor\tsigns\tof\toverstimulation,\tsuch\tas\tbeing\tunusually\tfussy\tor
|
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] |
not\tbeing\table\tto\tsettle\teasily.\tIf\tso,\tthe\tmother\tshould\tadjust\ther\tcaffeine\tintake\taccordingly.\tIt\tmay\ntake\ta\tfew\tdays\tafter\treducing\tcaffeine\n\tintake\tfor\tmother\tto\tnotice\ta\tdifference\tin\tthe\tbaby’s\nsymptoms.\tThere\tis\tno\tevidence\tthat\tcaffeine\taffects\tmilk\tsupply,\talthough\tif\ta\tbaby\tis
|
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] |
overstimulated,\the\tmay\tnot\tnurse\twell,\twhich\tcould\tlead\tto\tdysfunctional\tbreastfeeding\tand\neventually\ta\tlowered\tmaternal\tmilk\tsupply.\nAlcohol.\nNo\tsafe\tamount\tof\talcohol\thas\tbeen\testablished\tfor\tthe\tnursing\tmother,\tbut\trecommendations
|
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] |
include\tlimiting\n\tintake\tto\t0.5\tg\talcohol/kg\tmaternal\tbody\tweight\t(\nAAP,\t2012\n).\tFor\ta\t60-kg\tmother,\tthis\nequals\tapproximately\t2\toz\tliquor,\t8\toz\twine,\tor\ttwo\tbeers\tper\tday.\tPeak\talcohol\tlevels\toccur\tin\tabout\n½\tto\t1\thour\tafter\tdrinking,\talthough\tthis\tvaries\tamong\twomen\tdepending\ton\tmother’s\tbody
|
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] |
composition.\tThere\tis\tno\tneed\tfor\ta\tmother\tto\texpress\tand\tdiscard\ther\tmilk\tafter\ttaking\t1\tto\t2\tdrinks,\nthinking\tthis\twill\n\tspeed\tthe\telimination\tof\talcohol\tfrom\tthe\tmilk,\tunless\tit\tis\tfor\ther\town\tcomfort.\tAs\nblood\talcohol\tdecreases,\tso\tdoes\talcohol\tconcentration\tin\tthe\tmilk.\tMothers\tshould\tbe\tdiscriminatory
|
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] |
occurs,\tmoderation\tis\tadvised\tat\tall\ttimes\tfor\tbreastfeeding\tmothers.\nSee\t\nTable\t14.15\n\tand\t\nBox\t14.13\n\tfor\tsummaries\tof\tnutritional\tcare\tduring\tlactation.\nBox\t14.13\nSummary\tof\tNutritional\tCare\tDuring\tLactation\n1.\t\nA\tvariety\tof\tfoods,\tfocusing\ton\tnutrient-dense\tfood\tchoices.\n2.\t\nEnergy\tintake\tto\tallow\tfor\tmaintaining
|
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] |
2.\t\nEnergy\tintake\tto\tallow\tfor\tmaintaining\n\thealth\tand\twell-being;\tcalorie\tlevel\tno\tless\tthan\n1800\tkcal/day.\tIntentional\tweight\tloss\tnot\tadvised\tbefore\tbreastfeeding\tis\twell\testablished\n(approximately\t2\tmonths).\n3.\t\nProtein\tintake\tto\tmeet\tnutritional\tneeds,\tapproximately\tan\tadditional\t25\tg/day\tfrom\tbase
|
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] |
level\tprepregnancy.\tThis\toften\trequires\t20%\tof\tenergy\tintake\tfrom\tprotein.\n4.\t\nDHA\tfrom\tfatty\tfish\t(low\tin\tmethylmercury)\ttwice\ta\tweek.\n5.\t\nMineral\tand\tvitamin\tintakes\tto\tmeet\tthe\trecommended\tdaily\tallowances\t(usually\tmet\tfrom\na\tvariety\tof\tfoods\tin\tthe\tdiet).\tSupplements\tas\tdirected\tfrom\thealth\tcare\tprovider.\n6.
|
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] |
6.\t\nDrink\tto\tthirst;\thave\tbeverages\treadily\tavailable\tduring\tnursing\tand\twhen\texpressing\nbreastmilk.\n7.\t\nIf\tdesired,\talcoholic\tbeverages\tcan\tbe\tconsumed\ton\toccasion,\tin\tmoderation.\tNot\nrecommended\twith\tpreterm,\tvery\tyoung,\n\tor\tsick\tinfants.\n8.\t\nOmission\tof\ttoxins\tand\tnonnutritive\tsubstances\tfrom\tfood,\twater,\tand\tenvironment\tas\tmuch\nas\tpossible.
|
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as\tpossible.\nPrenatal\tbreastfeeding\teducation\nThe\tadvantages\tof\tbreastfeeding\tshould\tbe\tpresented\tthroughout\tthe\tchildbearing\tyears.\tDuring\npregnancy,\tcounseling\ton\tthe\trisks\tof\tformula\tfeeding\tand\tthe\tprocess\tof\tlactation\tshould\tbe\nprovided\tto\twomen\tso\tthat\tthey\tcan\tmake\n\tan\tinformed\tdecision\tabout\thow\tthey\twill\tfeed\ttheir\tbaby
|
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an\tinformed\tdecision\tabout\thow\tthey\twill\tfeed\ttheir\tbaby\nand\tso\tthat\tthey\tunderstand\thow\tto\tachieve\tsuccessful\tbreastfeeding.\tAs\toptimal\tmaternity\tcare\npractices\tbecome\tthe\tnorm\tin\thospitals\tand\tbirth\tcenters,\twomen\tshould\tbe\teducated\ton\tthese\npractices\tin\tadvance\tof\tdelivery.\tPrenatal\tbreastfeeding\teducation\tis\trecommended\tstrongly\tfor
|
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women\tand\ttheir\tpartners.\tThe\temotional\tsupport\tprovided\tby\tthe\n\tmother’s\tpartner\tcontributes\nheavily\tto\tthe\tsuccess\tof\tthe\tbreastfeeding\texperience.\nDuring\tthis\ttime\tthe\tmother\tshould\tidentify\ta\tsupport\tperson\tto\tcall\tupon\tafter\tbreastfeeding\nbegins.\tBecause\tinitiation\tand\testablishment\tof\tbreastfeeding\tcan\tseem\tintense\tand\tfull\tof
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challenges\tfor\tnew\tmothers,\tit\tis\twise\tfor\ther\tto\tknow\twho\tto\tturn\tto\twhen\tquestions\tor\tconcerns\narise.\tA\tknowledgeable\tfamily\n\tmember\tor\thealth\tprofessional,\tdoula,\tpeer\tcounselor,\tor\tchildbirth\neducator\tcan\tprovide\tthe\tencouragement\tso\toften\tneeded\tfor\ta\tmother\tin\tthe\tearly\tpostpartum
|
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] |
period.\tPrenatal\tbreastfeeding\tcounseling\twith\tregular\tfollow-up\tafter\tdelivery\thas\tbeen\tshown\tto\nhave\ta\tpositive\teffect\ton\tearly\tinitiation\tand\tsustained\texclusive\tbreastfeeding,\tespecially\tamong\nprimiparous\tmothers,\twith\tgroup\tcounseling\n\thaving\teven\tmore\tbeneficial\timpact\tthan\tindividual\ncounseling\t(\nWHO,\t2017
|
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] |
counseling\t(\nWHO,\t2017\n).\tWhen\tmore\tcomplicated\tproblems\tare\tidentified,\tan\tInternational\tBoard\nCertified\tLactation\tConsultant\t(IBCLC)\tcan\tintervene,\twhich\tmay\tmean\tthe\tdifference\tbetween\tearly\nweaning\tand\ta\tsuccessful\tbreastfeeding\texperience.\nPhysiology\tand\tmanagement\tof\tlactation\nMammary\tgland\tgrowth\tduring\tmenarche\tand\tpregnancy\tprepares
|
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Mammary\tgland\tgrowth\tduring\tmenarche\tand\tpregnancy\tprepares\n\tthe\twoman\tfor\tlactation.\nHormonal\tchanges\tin\tpregnancy\tmarkedly\tincrease\tbreast,\tareola,\tand\tnipple\tsize\tas\twell\tas\nsignificantly\tincrease\tducts\tand\talveoli\tand\tinfluence\tmammary\tgrowth.\tLate\tin\tpregnancy\tthe
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secretion,\tsetting\tthe\tstage\tfor\ta\tcopious\tmilk\tsupply.\nThe\tusual\tstimulus\tfor\tmilk\tproduction\tand\tsecretion\tis\tsuckling.\tSubcutaneous\tnerves\tof\tthe\nareola\tsend\ta\tmessage\tvia\tthe\tspinal\tcord\tto\tthe\thypothalamus,\twhich\tin\tturn\ttransmits\ta\tmessage\tto\nthe\tpituitary\tgland,\twhere\tthe\tanterior\n\tand\tposterior\tareas\tare\tstimulated.\tProlactin\tfrom\tthe
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and\tposterior\tareas\tare\tstimulated.\tProlactin\tfrom\tthe\nanterior\tpituitary\tstimulates\talveolar\tcell\tmilk\tproduction,\tas\tshown\tin\t\nFig.\t14.9\n.\tWomen\twho\thave\ndiabetes,\twho\tare\tobese,\twho\texperience\tstress\tduring\tdelivery,\tor\twho\thave\tretained\tplacental
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] |
FIG.\t14.9\nPhysiology\tof\tmilk\tproduction\tand\tthe\tlet-down\treflex.\t\nPRH\n,\tPituitary-releasing\thormone.\nOxytocin\n\tfrom\tthe\tposterior\tpituitary\tstimulates\tthe\tmyoepithelial\tcells\tof\tthe\tmammary\tgland\tto\ncontract,\tcausing\tmovement\tof\tmilk\tthrough\tthe\tducts\tand\tlactiferous\tsinuses,\ta\tprocess\treferred\tto\nas\t\nlet-down
|
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] |
as\t\nlet-down\n.\t“Let-down”\tis\thighly\tsensitive.\tOxytocin\tmay\tbe\treleased\tby\tvisual,\ttactile,\tolfactory,\nand\tauditory\tstimuli;\tand\teven\tby\tthinking\tabout\tthe\tinfant.\tOxytocin\tsecretion\talso\tcan\tbe\tinhibited\nby\tpain,\temotional\tand\tphysical\tstress,\tfatigue,\tand\tanxiety.\nStages\tof\tmilk\tand\tvariations\tin\tcomposition
|
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] |
Stages\tof\tmilk\tand\tvariations\tin\tcomposition\nHuman\tmilk\tvaries\tin\tnutritional\tcomposition\tthroughout\tthe\tmaternal\tlactational\tperiod\tand\tseems\nto\tbe\tmore\tsensitive\tto\tmaternal\tfactors\tsuch\tas\tbody\tcomposition,\tdiet,\tand\tparity\tduring\n\tlater\nlactation\tthan\tduring\tthe\tfirst\tfew\tmonths\t(\nLawrence\tand\tLawrence,\t2016\n).\tThis\tfluid\tis\tconstantly
|
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Lawrence\tand\tLawrence,\t2016\n).\tThis\tfluid\tis\tconstantly\nchanging\tto\tmeet\tthe\tneeds\tof\tthe\tgrowing\tinfant;\tnutrient\tcomposition\tchanges\tthroughout\tthe\nduration\tof\tlactation,\tbut\talso\tover\tthe\tcourse\tof\ta\tday,\tand\teven\tduring\ta\tfeeding.\nThe\tdelivery\tof\tthe\tplacenta\tafter\tthe\tbirth\tof\ta\tbaby\ttriggers\t\nlactogenesis\tI\n,\tor\tthe\tbeginning\tof
|
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] |
lactogenesis\tI\n,\tor\tthe\tbeginning\tof\nmilk\tproduction.\n\t\nColostrum\n\tis\tthe\tthick,\tyellowish\tsecretion\tthat\tis\tthe\tfirst\tfeeding\tfor\tthe\tinfant.\tIt\nis\thigher\tin\tprotein\tand\tlower\tin\tfat\tand\tcarbohydrate,\tincluding\tlactose,\tthan\tmature\tmilk.\tIt\nfacilitates\tthe\tpassage\tof\tmeconium\t(first\tstool\tof\tneonate),\tis\thigh\tin\tantioxidants,\tand\tis\tlower\tin
|
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water-soluble\tvitamins\tthan\tmature\tmilk.\tColostrum\tis\talso\thigher\tin\tfat-soluble\tvitamins,\tprotein,\nsodium,\n\tpotassium,\tchloride,\tzinc,\tand\timmunoglobulins\tthan\tmature\tmilk.\tColostrum\tprovides\napproximately\t20\tkcal/oz\tand\tis\ta\trich\tsource\tof\tantibodies.\tIt\tis\tconsidered\tthe\tbaby’s\tfirst\nimmunization.\nTransitional\tmilk
|
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] |
immunization.\nTransitional\tmilk\n\tbegins\tto\tbe\tproduced\tapproximately\t2\tto\t5\tdays\tafter\tdelivery\tuntil\taround\t10\nto\t14\tdays\tpostpartum.\tDuring\tthis\tstage\tof\t\nlactogenesis\tII\n,\twhite,\tcreamy\tmilk\tis\tproduced\tin\nmuch\tgreater\n\tquantities\tthan\tcolostrum,\tand\tbreasts\tbecome\tlarger\tand\tfirmer.\tThis\tis\tthe\ttime
|
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] |
when\tmothers\tfeel\ttheir\tmilk\t“come\tin.”\tIt\tis\timportant\tfor\tmothers\tto\tbreastfeed\toften\tduring\tthis\nstage\t(8\tto\t12\ttimes/day)\tto\tavoid\tengorgement\tand\tallow\tproper\temptying\tof\tthe\tbreast\tby\tthe\ninfant.\tThis\talso\tensures\tadequate\tfluid\tand\tnutrition\tfor\tthe\tbaby\tduring\tthis\ttime.\tThis\tperiod\tis\tan\nextremely\timportant
|
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extremely\timportant\n\ttime\tto\tbring\tin\ta\tfull\tmilk\tsupply,\twhich\tcan\tbe\testablished\tby\tthe\tinfant\tonly\nwith\tunrestricted\taccess\tto\tbreastfeeding.\nMature\tmilk\n\tis\tthe\tfinal\tstage\tof\tmilk\tproduction\tand\tusually\tbegins\tto\tappear\tnear\tthe\tend\tof\tthe\nsecond\tweek\tafter\tchildbirth.\t\nForemilk\n,\tthe\tfirst\tmilk\treleased\tduring\ta\tbreastfeed,\tis\thigh\tin\twater
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,\tthe\tfirst\tmilk\treleased\tduring\ta\tbreastfeed,\tis\thigh\tin\twater\ncontent\tto\tmeet\tthe\tbaby’s\thydration\tneeds.\tIt\tis\tlow\tin\tcalories\tbut\n\thigh\tin\twater-soluble\tvitamins\nand\tprotein.\tThis\tmilk\tis\tthinner,\tsometimes\twith\ta\tbluish\tcolor,\tand\tresembles\tskim\tmilk\twhen\tfirst\nreleased\tfrom\tthe\tbreast.
|
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released\tfrom\tthe\tbreast.\nAs\tthe\tbaby\tnurses\tduring\ta\tbreastfeed,\tthe\tmilk\tbecomes\tcreamier,\tindicating\ta\thigher\tfat\ncontent.\tThis\tmilk,\thigh\tin\tfat-soluble\tvitamins\tand\tother\tnutrients,\tis\tcalled\t\nhindmilk\n.\tIt\tprovides\nsatiety\tand\tthe\tcalories\tto\tensure\tgrowth\tin\n\tthe\tbaby.\tIt\tis\timportant\tfor\tthe\tmother\tto\tallow\tthe
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milk.\tHindmilk\tis\treleased\tas\tthe\tbreast\tis\temptied\tand\tsignals\tto\tthe\tbaby\tthat\ta\tfeeding\tis\tover.\nThis\tmechanism\thelps\tthe\tinfant\tto\tlearn\twhen\n\tto\tend\ta\tfeeding\tand\tmay\tcontribute\tto\tthe\nprevention\tof\tovereating\tand\tsubsequently\tbecoming\toverweight\tlater\tin\tlife.\tThe\tlonger\tthe\tmother
|
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] |
goes\tbetween\tfeedings,\tthe\tmore\tforemilk\twill\tbe\tstored\tin\tthe\tbreast;\thowever,\twhen\tfeedings\tare
|
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closer\ttogether,\tthe\tbaby\treceives\tmore\thindmilk\tin\teach\tfeeding.\tBabies\tneed\ta\tbalanced\tdiet,\twith\nsufficient\tamounts\tof\tforemilk\tand\thindmilk\tfor\tproper\tgrowth\n\tand\tdevelopment.\nAs\tthe\tmother\tprogresses\tduring\tthe\tlactational\tstage\tof\tmotherhood,\ther\tbreasts\treturn\tto\ther
|
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prepregnancy\tsize\tand\tmay\tappear\tsomewhat\tsofter\tand\tsmaller\tthan\tearlier.\tThis\tdoes\tnot\tindicate\na\tlower\tmilk\tsupply,\tbut\tonly\ther\tbody’s\tadjustment\tto\testablished\tbreastfeeding.\tA\twoman\tcontinues\nto\tproduce\tnutritious\tmature\tmilk,\tas\twell\tas\tenjoy\tthe\temotional\tand\timmunologic\tbenefits,\n\tfor\tas
|
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] |
for\tas\nlong\tas\tshe\tbreastfeeds.\tExclusive\tbreastfeeding\tis\trecommended\tfor\tthe\tfirst\t6\tmonths,\tfollowed\tby\ncontinued\tbreastfeeding\tas\tcomplementary\tfoods\tare\tintroduced,\twith\tcontinuation\tof\tbreastfeeding\nfor\t1\tyear\tor\tlonger,\tas\tmutually\tdesired\tby\tmother\tand\tchild\t(\nAAP,\t2012\n).
|
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] |
AAP,\t2012\n).\nAs\tmentioned\tpreviously,\tbreastmilk\tis\ta\tdynamic\tfluid,\tchanging\tthroughout\tthe\tlactational\tperiod\nof\tthe\tmother.\tBreastmilk\n\tcontinues\tto\tprovide\tan\tinfant\twith\tneeded\tamounts\tof\tessential\tnutrients\nwell\tbeyond\tthe\tfirst\tyear\tof\tlife,\tespecially\tprotein,\tfat,\tand\tmost\tvitamins.\tBreastfed\tinfants\ttend\tto
|
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gain\tless\tweight\tand\tusually\tare\tleaner\tthan\tare\tformula-fed\tinfants\tin\tthe\tsecond\thalf\tof\tinfancy,\nwhich\tdoes\tnot\tseem\tto\tbe\tthe\tresult\tof\tnutritional\tdeficits,\tbut\trather\tinfant\tself-regulation\tof\tenergy\nintake.\n\tThe\tnutrients\tmost\tlikely\tto\tbe\tlimiting\tin\tthe\tdiets\tof\tbreastfed\tinfants\tafter\t6\tmonths\tof
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exclusive\tbreastfeeding\tare\tminerals\tsuch\tas\tiron,\tzinc,\tand\tcalcium.\tThese\tnutrients\tare\treadily\navailable\tthrough\tan\tage-appropriate\tdiet\tconsisting\tof\tmeats,\twhole\tgrains,\tdairy\tfoods,\tfruits,\tand\nvegetables.\nDuring\tgrowth\tspurts,\tor\ttimes\tof\trapid\tinfant\tdevelopment—typically\taround\t2\tweeks,\tagain\n\tat\t4
|
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at\t4\nto\t6\tweeks,\tand\tanytime\tbetween\t3\tand\t6\tmonths—babies\tmay\tincrease\ttheir\tdesire\tto\tnurse\tto\tmeet\ncaloric\tneeds.\tIf\tallowed\tto\tdo\tso,\tthis\ttriggers\tan\tincrease\tin\tthe\tmother’s\tprolactin\tlevel,\tand\tafter\ta\nfew\tdays,\tshe\twill\tbegin\tto\tmake\tmore\tmilk.\tIf\tsupplements\tare\tintroduced\tat\tthese\ttimes\tto\tsatisfy
|
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the\tinfant’s\thunger,\tthe\tmother\twill\tnot\thave\tthe\tadvantage\tof\tincreased\tstimulation\tfrom\n\tthe\tinfant’s\nsuckling\tand\twill\tnot\tbe\table\tto\tkeep\tup\ther\tsupply\tto\tmeet\tthe\tbaby’s\tnutritional\tneeds.\tMany\nmothers\tdo\tnot\tunderstand\tthis\tconcept\tof\t“supply\tand\tdemand”\tand\tunintentionally\tmay\tsabotage\ntheir\tbreastfeeding\trelationship.
|
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their\tbreastfeeding\trelationship.\nInitiation\tof\tbreastfeeding\nBreastfeeding\tis\ta\tlearned\tskill\tfor\tmother\tand\ther\tinfant.\tAll\tbabies\tshould\tbe\tput\tskin-to-skin\nimmediately\tafter\tbirth\tand\tremain\n\tin\tdirect\tskin-to-skin\tcontact\tuntil\tthe\tfirst\tfeed\tis\taccomplished\nor\tas\tlong\tas\tthe\tmother\tdesires\t(\nWHO,\t2017\n;\t\nWHO,\t2018a
|
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] |
or\tas\tlong\tas\tthe\tmother\tdesires\t(\nWHO,\t2017\n;\t\nWHO,\t2018a\n).\tWithin\t48\tto\t96\thours\tafter\tbirth\tthe\nbreasts\tbecome\tfuller\tand\tfirmer\tas\tthe\tmilk\tvolumes\tincrease.\tSkin-to-skin\tcontact\tin\tthe\tfirst\thour\nimproves\tbreastfeeding\texclusivity\tand\tduration\tand\thelps\tto\tregulate\ttemperature,\tblood\tsugar,\tand\nblood\tpressure\tof\tthe\tinfant.
|
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blood\tpressure\tof\tthe\tinfant.\n\tThis\tpractice\tis\trecommended\tregardless\tof\tdesired\tfeeding\tmethod.\nExclusively\tbreastfed\tbabies\tdo\tnot\tneed\tadditional\twater\tbecause\t87%\tof\tbreastmilk\tis\twater.\nHowever,\tcases\tof\thypernatremic\tdehydration\tin\tbabies\tcaused\tby\tsuboptimal\tbreastfeeding\tdo
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] |
occur.\tMost\tcases\tare\tdue\tto\tlack\tof\tsupport\tfor\tmothers\twho\tfeel\tintimidated\tand\toverwhelmed\tat\ndelivery,\tlack\tbreastfeeding\teducation,\tand\tare\n\tunaware\tof\tthe\tconsequences\tof\tdehydration.\nExtreme\theat\tor\thot\tweather\talso\tmay\tincrease\tthe\tneed\tfor\tmore\tfrequent\tbreastfeeding\tto\tavoid
|
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] |
dehydration.\tThe\tconsequence\tof\thypernatremic\tdehydration\tcan\tbe\tpermanent\tbrain\tdamage\tor\ndeath.\tTherefore\tit\tis\tvital\tthat\tan\texperienced\thealth\tcare\tprofessional\tevaluate\tthe\tbreastfeeding\nwithin\t2\tto\t4\tdays\tafter\tbirth;\tproblems\tidentified\tcan\tbe\taddressed\n\tand\ta\tplan\tof\tcare\tcan\tbe\nimplemented\t(\nWHO,\t2018a\n).
|
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and\ta\tplan\tof\tcare\tcan\tbe\nimplemented\t(\nWHO,\t2018a\n).\nDuring\tthe\tfirst\tdays\tand\tweeks\tof\tbreastfeeding,\tmothers\tshould\tfeed\ton\tdemand\tor\t“on\tcue.”\nWatching\tand\tlistening\tto\tthe\tinfant\tguides\ta\tmother\tto\tknow\twhen\tto\toffer\ta\tfeeding.\tWhen\ta\nmother\tresponds\tto\ther\tinfant’s\thunger\tcues,\tnursing\t“on\tdemand,”\tshe\tprovides\tthe\tquantity\tthe
|
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] |
baby\tneeds,\tas\tlong\tas\tsupplements\tare\tavoided,\tand\tpacifiers\n\tare\tnot\tused\tto\t“mask”\tthe\tbaby’s\nhunger.\tA\tnewborn’s\tstomach\tis\tvery\tsmall\tand\tholds\tonly\tabout\ta\tteaspoon\tor\ttwo\tof\tfluid\tat\ta\ttime,\nmatching\tthe\tsmall\tamount\tof\tcolostrum\tavailable\tfrom\tthe\tmother.\tThe\tcolostrum\tis\tvery\teasily
|
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] |
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