The Quick and Dirty Guide to Breastfeeding: What a Resident Should Know

Why encourage breastfeeding?

1. It’s personally cheap, no need to spend all that $$$ on formula

2. Breastfeeding is associated with a lower incidence of obesity.

3. Breast milk confers extra immunologic protection through a variety of immunogenic proteins, immunoglobulins, and oligosaccharides, THUS…

 Breastfeeding has been associated with a decreased risk of otitis media, diarrhea, lower respiratory tract hospitalizations, hospitalizations in general, and deaths, including death from SIDS, which also means…

à It’s cheap for society!!!  Significant public health savings!

What’s in breast milk (and how is it different from cow’s milk formula)?

Colostrum, secreted in the first several days of life is particularly high in secretory IgA.  Transitional (3-4 days of life) and mature (2-4 weeks) human milk, however have higher protein, fat, and lactose content. Mature human milk contains 70% whey protein to 30% casein protein (vs. 18% whey to 82% casein in formula) for easy digestion, 20% non-protein nitrogen including nucleotides (vs. 5% and ZERO nucleotides in formula), and predominately long chain fatty acids including DHA (vs. predominately medium chain fatty acids in formula).  Both have lactose as the major carbohydrate.

How long and how often should infants’ breastfeed?

Most infants feed for 10 to 15 minutes per breast, with some initially feeding up to 30 minutes on each side every 2 to 3 hours.  Be sure to let mom know that she needs to empty one breast before starting on the next because milk closest to the nipple is called FOREMILK and has a higher water and protein content compared to the HINDMILK which has higher caloric and fat content.  Once baby stops feeding, make sure to have mom begin the next feed on the side she ended with (keeps things even)

Signs of successful breastfeeding:

The baby is making swallowing sounds, is satisfied after feeds and is alerting every 2-3 hours to be fed. Infants should regain their birth weight by 2-3 weeks of age and gain 20-35 grams per day thereafter.

If that doesn’t happen, consider…

A poor latch. It will lead to nipple pain, poor transfer of milk, prolonged feeding, and an unsatisfied baby with poor weight gain.  Infrequent bowel movements can be a sign that there is insufficient milk intake.  Discomfort with initial latch is common but pain should not persist through nursing.  If possible, observe the infant nurse while in the office, and check if the areola is in the infant’s mouth. If the latch is observed to be good, then attention should turn to the mother’s milk supply.

And how about that milk supply?

Mother’s should begin breastfeeding ASAP because prolactin levels may diminish after as little as 16-24 hours without nursing after birth. Colostrum, rich in IgA antibodies, is the first fluid produced in lactating mothers and the volume is quite small  (5-15 mL/feed), which encourages frequent feeds and increased milk production. Milk production begins 1-5 days (average 3 days) after birth and production is determined by supply and demand. The more often mom breastfeeds/pumps and empties her supply, the more often milk will be produced.

Who may have difficulty breastfeeding?

 Not women with small breasts, not women with large breast, not even women with fake breasts, but possibly for women with a history of breast reduction depending on whether the main ducts were severed during the procedure, women with flat or inverted nipples, or women with no change in breast size during pregnancy.

What supplements are needed for the newborns who are exclusively breastfed?

1.     Vitamin D! AAP recommends infants take 400 IU daily.

2.     IRON, man: 1mg/kg/day of elemental iron is recommended for exclusively breastfed infants over 4 months of age (those not taking iron containing foods)

Which commonly used antibiotic causes mom to temporarily stop breastfeeding?

Metronidazole. It is an in vitro mutagen and it is recommended mom discontinue breastfeeding for 12-24 hours if a single-dose therapy is given.

To check for other medication interactions with breast milk, please visit LACTMED

è http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT)

How about that alcohol and caffeine?

Breastfeeding mothers aren’t recommended to consume alcohol when breastfeeding but on occasion they may have one alcoholic beverage, but must wait 2 hours before resumption of breastfeeding.  As for coffee, moderate levels of caffeine have not shown to be harmful to nursing infants.

What is the AAP’s recommendation on the minimum duration for exclusive breastfeeding?

The AAP recommends a minimum of 6 months of exclusive breastfeeding.  After that age, infants should be supplemented with complementary foods that are rich in iron and screened for the need for fluoride supplements.

Breast Milk Storage:

Room Temperature – 6-8 hours (3-4 in a warm climate)

Back of the fridge – 5 days

Freezer compartment- 2 weeks

Regular Freezer with its own door- 3-6 months

Deep Freeze – 6-12 months