How much do you know about breastfeeding?

This is the 4208th article of Da Yi Xiao Hu

Breast milk is the best natural food for babies within a few months after birth, and breastfeeding is an important way of healthy diet for babies advocated worldwide. Breast milk can not only provide high-quality, comprehensive, sufficient and structurally appropriate nutrients to meet the needs of infant growth and development, but also perfectly adapt to its immature digestive ability, while promoting its organ development and functional maturity. Breastfeeding can meet all the liquid, energy and nutrient needs of infants within 6 months. The World Health Organization, the American Academy of Pediatrics, the U.S. Department of Health and Human Services, the UK National Health Service and many other organizations support exclusive breastfeeding for at least six months, and then continue breastfeeding for up to two years. The milk within 7 days after delivery is often called colostrum; 7 to 14 days is transitional milk; and the milk after 14 days is mature milk.

1. What ingredients are contained in breast milk?

(1) Protein

Breast milk has high biological value and is easily used by infants. Breast milk contains an appropriate proportion of essential amino acids. Breast milk protein is mainly whey protein, which forms small milk curds in the infant's stomach, which is conducive to digestion. The casein content is relatively low, and the casein contained is β-casein, which has small curds. The ratio of whey protein to casein in breast milk is 4:1, which is easy to digest and absorb. The taurine contained in breast milk is 10 to 30 times that of cow's milk. Taurine can promote the development of the infant's nervous system and retina.

(2) Carbohydrates

90% of the carbohydrates in breast milk are beta-lactose, which is beneficial to brain development, the growth of bifidobacteria and lactobacilli, the production of B vitamins, and the promotion of intestinal peristalsis; it is beneficial to the absorption of calcium, magnesium and amino acids. Oligosaccharides are unique to breast milk and can prevent bacteria from adhering to the intestinal mucosa and promote the growth of lactobacilli.

(3) Fat

50% of breast milk energy comes from fat, and the lipase in breast milk makes fat particles easy to digest and absorb. Breast milk contains more unsaturated fatty acids, including linoleic acid and linolenic acid, as well as trace amounts of arachidonic acid and DHA, and is also rich in cholesterol, which are beneficial to the development of the baby's nervous system.

(4) Minerals

The electrolyte concentration in breast milk is low, suitable for the immature kidney development level of infants, and easily absorbed by infants. Although the calcium content in breast milk is lower than that in cow's milk, the calcium-phosphorus ratio is appropriate (2:1), and the calcium absorption rate (50% ~ 70%) is higher than that in cow's milk (20%). The zinc absorption rate in breast milk is high; the iron content in breast milk is similar to that in cow's milk, but the iron absorption rate in breast milk (49%) is higher than that in cow's milk (4%).

(5) Vitamins

The content of water-soluble vitamins and vitamin A is related to the mother's diet, while vitamins D, E, and K are not easy to enter breast milk through blood circulation, so they have little to do with the composition of the mother's diet. In addition to vitamins D and K, a well-nourished mother can provide all the vitamins needed by the baby. The content of vitamin D in breast milk is low, so vitamin D should be supplemented as soon as possible after the baby is born, and the baby should be allowed to play outdoors as soon as possible.

(6) Immune substances

Breast milk contains a large amount of immune substances, especially colostrum.

① Immunoglobulin : Breast milk is rich in SIgA, which has anti-infection and anti-allergic effects. Breast milk also contains a small amount of IgG, IgM antibodies and some specific antibodies;

②Cellular components : Breast milk contains a large number of immune active cells, such as macrophages and lymphocytes, which release a variety of cytokines to exert immune regulatory effects;

③ Lactoferrin : Breast milk contains a lot of lactoferrin, which can take away the iron that Escherichia coli, most aerobic bacteria and Candida albicans rely on for growth, thereby inhibiting the growth of bacteria;

④Lysozyme : Lysozyme in breast milk can hydrolyze acetyl polysaccharides in bacterial cell walls, destroying them and enhancing the bactericidal efficacy of antibodies;

⑤Others : The content of bifidobacterial factors in breast milk is also much higher than that in cow's milk. Bifidobacterial factors can promote the growth of bifidobacteria and inhibit the growth of Escherichia coli. Prolactin in breast milk is also an active substance with immunomodulatory effects, which can promote the maturation of the immune function of newborns.

(7) Growth regulatory factors

Such as taurine, hormone-like proteins (epithelial growth factor, nerve growth factor), etc. Taurine is very important for the lung, retina, liver, platelets and brain, especially the developing brain and retina. Epithelial growth factor can promote the differentiation of immature gastrointestinal epithelial cells and liver epithelial cells; nerve growth factor can promote the growth and differentiation of neurons.

2. How should mothers eat after giving birth?

(1) The diet in the first few days after delivery should be light and easy to digest;

(2) Eat a variety of foods but not too much to ensure balanced nutrition;

(3) Appropriately increase the intake of foods rich in high-quality protein, such as fish, poultry, eggs, and lean meat;

(4) Pay attention to the combination of coarse and fine grains, and pay attention to the intake of fresh vegetables and fruits;

(5) Correctly understand the effect of postpartum diet on breast milk secretion, drink plenty of water, and drink more soup according to personal eating habits.

(6) Appropriately increase the intake of calcium-rich foods such as milk and use nutritional supplements reasonably.

(8) Maintain personal eating habits and respect local harmless eating customs.

(9) Exercise appropriately, keep a happy mood, get enough rest and sleep, and avoid heavy lifting too early.

(10) Start breastfeeding as early as possible (the World Health Organization (WHO) recommends within 1 hour), insist on breastfeeding, and pay attention to the living environment and personal hygiene.

3. How can mothers with infectious diseases breastfeed?

(1) Hepatitis

Mothers infected with hepatitis B virus can breastfeed. Even if the mother has a high viral load or is HBeAg positive, has cracked or bleeding nipples, abnormal liver function, or the baby has oral ulcers or other injuries, it will not affect breastfeeding. Mothers infected with hepatitis C virus can breastfeed. However, if the nipples are cracked or bleeding, or if the newborn has ulcers or lesions in the mouth, direct breastfeeding should be suspended, and the milk can be disinfected before feeding. Mothers infected with hepatitis A or E virus can breastfeed. When the mother's condition is serious, breastfeeding should be suspended to facilitate the mother's recovery.

(2) Maternal cytomegalovirus infection

Breastfeeding is recommended for full-term infants and late preterm infants (gestational age ≥ 32 weeks or birth weight ≥ 1,500 g). For early preterm infants (gestational age < 32 weeks or birth weight < 1,500 g), breast milk should be sterilized before feeding, and then directly breastfed when the corrected gestational age is ≥ 32 weeks or the birth weight is ≥ 1,500 g.

(3) When the mother is infected with herpes simplex virus

If there is no herpes in the breast, breastfeeding can be done directly to prevent the baby from contacting other herpes lesions; if there is herpes in the breast, breast milk should be sterilized before feeding. If the mother is infected with varicella virus, the principle of breastfeeding is the same as that of herpes simplex virus infection. If conditions permit, the newborn can be injected with ordinary immunoglobulin. If the mother is infected with herpes zoster virus, the principle of breastfeeding is the same as that of herpes simplex virus infection. The above infected people, except for breast infection, can breastfeed directly.

(4) Influenza or novel coronavirus infection

After the breast milk is expressed, it can be indirectly breastfed by others, and the milk does not need to be sterilized; if the mother is infected with dengue virus, the milk can be expressed and pasteurized in the early stage of the disease and can be indirectly breastfed, and direct breastfeeding can be allowed 10 days after the onset of the disease. If the mother is infected with Zika virus, breastfeeding is allowed, and the virus exists in the breast milk, but it will not cause infection in the newborn, and no sterilization is required.

(5) Acquired immunodeficiency syndrome (HIV)

When infected with AIDS, try to give up breastfeeding and adopt complete artificial feeding. Mixed feeding is prohibited.

(6) Mother is infected with Mycobacterium tuberculosis

After 14 days of regular treatment and with negative sputum tuberculosis bacteria, breastfeeding is allowed. The following situations cannot be breastfed directly: those who have not received regular treatment, those with positive sputum tuberculosis bacteria, breast tuberculosis, nipple or breast damage, and those with HIV infection; however, breast milk can be fed by others after disinfection.

(7) When the mother is infected with Treponema pallidum, Leptospira, Toxoplasma gondii or Plasmodium

Breastfeeding is allowed directly after standardized treatment. Breast milk before and during treatment can be breastfed after pasteurization. Although pasteurization can partially destroy the nutrients and active ingredients of breast milk, it is still more beneficial to offspring than formula milk.

(8) When the mother suffers from mastitis or breast abscess

Most of them can be breastfed. Emptying breast milk is an important treatment method; mothers can also breastfeed directly while taking antibiotics.

(9) Mothers who are breastfeeding should not be vaccinated against yellow fever

If vaccination is required, breastfeeding must be stopped. Breastfeeding is allowed for other attenuated vaccines during breastfeeding. Babies can be breastfed after receiving any vaccine.

References:

[1] Cui Yan, Yang Shufen. Pediatric Nursing (6th Edition) [M]. People's Medical Publishing House, 2017: 91-93.

[2] Wang Zhixu, Lai Jianqiang, Mao Limei, Zeng Guo, Yang Nianhong, Zhang Caixia, Yi Mingji, Sun Yaowu, Sheng Xiaoyang, Li Guanghui, Zhang Ju, Teng Yue, Xu Xiu, Hu Yan, Li Yan, Tong Xiaomei, Xu Yiqun, Su Yixiang, Yang Yuexin, Zhai Fengying, Cheng Yiyong, Yang Xiaoguang, Guo Junsheng, Guo Changjiang, Xue Changyong. Dietary recommendations for Chinese women during the postpartum period (confinement period)[J]. Journal of Nutrition, 2020, 42(01): 3-6.

[3] Perinatal Medicine Branch of the Chinese Medical Association. Expert consensus on common maternal infections and breastfeeding guidance[J]. Chinese Journal of Perinatal Medicine, 2021, 24(07): 481-489.

Author: Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine

Cui Hengmei Pan Yi Shen Biyu