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- Breastfeeding is the natural process of feeding human milk directly from the breast.
- Breast milk is the preferred nutritional source and the normal and physiologic way to feed all newborns and infants.
- Breast milk contains over 200 active components which provide nutrition, fight pathogens, promote healthy gut microbiome, and aid in maturity of immune system.
- The American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), American Congress of Obstetricians and Gynecologists (ACOG), WHO, and other medical organizations recommend exclusive breastfeeding for 6 months, with continuation of breastfeeding for ≥1 year as desired by mother and infant (1)[A].
- Maternal benefits (as compared with mothers who do not breastfeed) include the following:
- Rapid involution/decreased postpartum bleeding (due to oxytocin release)
- Association of decreased risk of postpartum depression and increased bonding
- Associated postpartum weight loss
- Decreased risk of breast cancer and association of decreased risk of pre- and postmenopausal ovarian cancer, decreased risk of type 2 diabetes, hypertension, hyperlipidemia, rheumatoid arthritis, and cardiovascular disease
- Decreased risk of prematurity due to child spacing
- Increased bone density
- Convenience and economic savings
- Association of longer continuation in work/school activities
- Infant benefits (as compared with children who are formula-fed) include the following (1):
- Ideal food: easily digestible, nutrients well absorbed, less constipation
- Lower rates of virtually all infections via maternal antibody protection
- Fewer respiratory and GI infections
- Decreased incidence of otitis media
- Decreased risk of bacterial meningitis, pneumonia, and sepsis
- Decreased incidence of necrotizing enterocolitis
- Decreased risk of ear infections
- Decreased incidence of obesity and type 1 and 2 diabetes
- Decreased incidence of allergies, clinical asthma, and atopic dermatitis in childhood
- Decreased risk of developing celiac disease and inflammatory bowel disease
- Decreased risk of childhood leukemia
- Decreased risk of sudden infant death syndrome (SIDS) and decreased mortality
- Enhanced neurodevelopmental performance
- Increased attachment between mother and baby
- Decreased child abuse
- Decreases the risk of urinary tract infection
- According to CDC’s Breastfeeding Scorecard, U.S. breastfeeding rates are on the rise in 2016: any breastfeeding: 81.1% (however, differs among different sociodemographic and culture) (2)
- Breastfeeding at 6 months: 51.8%
- Breastfeeding at 12 months: 30.7%
- Exclusive breastfeeding at 3 months: 44.4%
- Exclusive breastfeeding at 6 months: 22.3%
Etiology and Pathophysiology
- The mechanism of milk production is based on several hormones: Prolactin triggers milk production and oxytocin releases milk based on supply and demand (3). Endocrine control system triggers making of colostrum at 5 months’ gestation.
- Alveoli make milk in response to hormone prolactin. Sucking stimulates secretion of prolactin, which triggers milk production.
- Stimulation of areola causes secretion of oxytocin. Oxytocin is responsible for let-down reflex when myoepithelial cells contract and milk is ejected into milk ducts (3).
- Endocrine/metabolic: Cystic fibrosis, diabetes, galactosemia, phenylketonuria, and thyroid dysfunction may cause delayed lactation or decreased milk.
- Most vaccinations can be given to breastfeeding mothers. The CDC recommends that the diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated influenza virus (as opposed to live attenuated), measles-mumps-rubella (MMR), and inactivated polio and varicella vaccines can be given. The CDC recommends avoiding the yellow fever or smallpox vaccine in breastfeeding mothers (4).
- The inactivated influenza virus is preferred to the live attenuated virus in women with infants’ age 6 to 23 months, regardless of whether these infants are being breastfed (4).
- Protective measures include breastfed infants who are more easily aroused than formula-fed infants, triggering a mechanism for the protective effect of breastfeeding against SIDS (5).