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Breastfeeding

Breastfeeding is a topic covered in the 5-Minute Clinical Consult.

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Basics

  • 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].

Description

  • 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

Epidemiology

Incidence
  • 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.

General Prevention

  • 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).

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Citation

Stephens, Mark B., et al., editors. "Breastfeeding." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117678/all/Breastfeeding.
Breastfeeding. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117678/all/Breastfeeding. Accessed April 19, 2019.
Breastfeeding. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117678/all/Breastfeeding
Breastfeeding [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 19]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117678/all/Breastfeeding.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Breastfeeding ID - 117678 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117678/all/Breastfeeding PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -