Member - Academy Of Nutrition & Dietetics. USA.
Lactation Nutrition
Since time immemorial breast-feeding has been advocated as the best method of infant feeding for at least 4 to 6 months since child birth. Though promoted and advised by nutritionists, the breast-feeding rates have never been great or even appreciable. This scenario could change for the better if the advantages of breast-feeding in reducing various infections and diseases are highlighted.
Physiology of Lactation
Mammary glands grow during menarche and pregnancy equipping it for lactation. Colostrum, a thin yellow milky fluid rich in antibiotics, may be discharged a few weeks before delivery and for a couple of days after birth. Estrogen and progesterone circulating levels decrease and prolactin secretions increase after child birth. Oxytoxin, the milk releasing hormone, helps in the movement of milk down to the nipple. This phenomenon may be repressed due to stress, pain, fatigue and anxiety. Delayed milk production is common among women with diabetes due to stress during delivery.
Nutritional Requirements of Lactation
A healthy mother nurtures a healthy baby. Lactation is highly exacting with milk composition varying nutritionally according to the mother’s dietary intake. In scenarios where the mother is malnourished, the breast-fed infant may go through suboptimal nutrition levels.
Energy
Infants who feed well trigger more milk production. Energy intake during lactation should be 330kcal higher during first six months of breast-feeding and 400kcal higher during second six months for lactating mothers. Maternal fat provides for about 100 to 150kcal of energy while the rest can be acquired through dietary intake. Infants require about 750ml/day during the first six months while the desirable quantity reduces to 600ml/day during the second 6 months of lactation as the infant starts to feed on solids as well. 1800kcal/day is the recommended energy levels for feeding mothers.
Protein
The DRI suggestions are 25g additional protein intake a day or 71g of protein a day. The requirement may be greater for women with surgical delivery and malnourished women who are pregnant. The protein requirement is generally derived from milk composition data and milk requirement data as 70% of dietary protein is converted to milk protein.
Carbohydrates
Carbohydrate requirement is between 160 to 210 g/day to aid in sufficient milk production and to maintain blood glucose levels during lactation. For underweight mothers the carbohydrate requirement is higher.
Lipids
The lipid requirement is directly proportional to the energy expenditure of lactating mothers. The fat presence in breast milk is influenced by the maternal diet.
Vitamins and Minerals
Vitamin D levels in mothers indicate the Vitamin D levels in the breast-fed milk. Many lactating mothers have decreased vitamin D levels which impact the infant directly. Additional vitamin D supplementation of 200 units is recommended for infants from their second month. Likewise, iodine content in breast milk is related to maternal intake. Iodine deficiency is common among lactating women as access to seafood products, one of the richest sources of iodine, is limited in many countries. Zinc requirements are greater for lactating women than in pregnant ladies.
Breast-Feeding an Infant
Preparation
The main method to promote breast-feeding is to put forth its advantages. Counseling should be provided for pregnant women who have opted for breast-feeding. This must happen in the presence of the expectant father as the emotional support provided by them helps in a successful lactation period.
The Technique
Physical touch is the best key for a lovely mother-child bonding. The newborn baby must be fed with colostrum, the first thin milk available after birth, which initiates a skin-to-skin contact between the infant and its mother. Breast-feeding requires patience and determination to become a learned skill. The baby must be placed comfortably and allowed to nurse on one breast until satisfied. If the mother has too much milk, feeding on one side of the breast is sufficient. If not, then other side breast must be offered for feeding. To end a feed the mother has to gently place a finger near the infant’s mouth to stop sucking. Feeding may happen around 8 to 12 times in a day as 87% of mother’s milk contains only water. Too much of milk stored in the mother’s breast can be expressed manually and stored in bottles for future feeds. But it is recommended to avoid using nipples during the first month as this may hamper the sucking action of the baby nursing on the breast.
Duration of Breast Feeding
Though exclusive breast-feeding is recommended for first 6 months it may continue up to 1 year or more depending on the mother and child. Usually mothers reduce the feeding frequency and start to introduce weaning around the 9th or 10th month. Reducing breast-feeding should be done gradually and then stopped totally in a smooth manner.
Exercise and Breast-Feeding
Though traditions advice against women involving themselves in exercise until breast-feeding is completely stopped, the trend has changed presently. Many mothers involve themselves in aerobic and light physical exercises after a few weeks post delivery, as advised by their doctors. Exercise improves lipid and insulin responses in lactating women without disturbing the maternal and infant immune status.
Transfer of Drugs into Human Milk
Every drug consumed by the mother will have its effect on the milk passed on to the child. The drug composition in the milk is quite small. Many drugs have adverse effects while others have unknown effects which may concern us. It is wise to undergo maternal medication which is suitable for lactation.
Other Problems of Breast-Feeding
Overweight lactating mothers should reduce their fat and sugar intake while consuming more fruits and vegetables loaded with calcium and vitamin D for nutrition-rich milk. Low- and very-low-birth-weight infants in neonatal intensive care are a challenge for feeding mothers. The feeding process must be initiated through counseling without causing stress and fear to the lactating mother. If the baby does not suck properly, the mother may assist the baby by pressing the baby’s chin upward. Also some babies tend to sleep while feeding. This must be avoided with some physical touch or interaction with the baby to prevent sleep. If these do not work out it is better to postpone the feed. Any problems during breast-feeding are of utmost concern and must be handled with care and a positive approach.
Pregnancy and lactation are a unique gift to every woman. It is in the hands of the mother to nurture a healthy and active baby which grows on to become a wholesome adult.
Since time immemorial breast-feeding has been advocated as the best method of infant feeding for at least 4 to 6 months since child birth. Though promoted and advised by nutritionists, the breast-feeding rates have never been great or even appreciable. This scenario could change for the better if the advantages of breast-feeding in reducing various infections and diseases are highlighted.
Physiology of Lactation
Mammary glands grow during menarche and pregnancy equipping it for lactation. Colostrum, a thin yellow milky fluid rich in antibiotics, may be discharged a few weeks before delivery and for a couple of days after birth. Estrogen and progesterone circulating levels decrease and prolactin secretions increase after child birth. Oxytoxin, the milk releasing hormone, helps in the movement of milk down to the nipple. This phenomenon may be repressed due to stress, pain, fatigue and anxiety. Delayed milk production is common among women with diabetes due to stress during delivery.
Nutritional Requirements of Lactation
A healthy mother nurtures a healthy baby. Lactation is highly exacting with milk composition varying nutritionally according to the mother’s dietary intake. In scenarios where the mother is malnourished, the breast-fed infant may go through suboptimal nutrition levels.
Energy
Infants who feed well trigger more milk production. Energy intake during lactation should be 330kcal higher during first six months of breast-feeding and 400kcal higher during second six months for lactating mothers. Maternal fat provides for about 100 to 150kcal of energy while the rest can be acquired through dietary intake. Infants require about 750ml/day during the first six months while the desirable quantity reduces to 600ml/day during the second 6 months of lactation as the infant starts to feed on solids as well. 1800kcal/day is the recommended energy levels for feeding mothers.
Protein
The DRI suggestions are 25g additional protein intake a day or 71g of protein a day. The requirement may be greater for women with surgical delivery and malnourished women who are pregnant. The protein requirement is generally derived from milk composition data and milk requirement data as 70% of dietary protein is converted to milk protein.
Carbohydrates
Carbohydrate requirement is between 160 to 210 g/day to aid in sufficient milk production and to maintain blood glucose levels during lactation. For underweight mothers the carbohydrate requirement is higher.
Lipids
The lipid requirement is directly proportional to the energy expenditure of lactating mothers. The fat presence in breast milk is influenced by the maternal diet.
Vitamins and Minerals
Vitamin D levels in mothers indicate the Vitamin D levels in the breast-fed milk. Many lactating mothers have decreased vitamin D levels which impact the infant directly. Additional vitamin D supplementation of 200 units is recommended for infants from their second month. Likewise, iodine content in breast milk is related to maternal intake. Iodine deficiency is common among lactating women as access to seafood products, one of the richest sources of iodine, is limited in many countries. Zinc requirements are greater for lactating women than in pregnant ladies.
Breast-Feeding an Infant
Preparation
The main method to promote breast-feeding is to put forth its advantages. Counseling should be provided for pregnant women who have opted for breast-feeding. This must happen in the presence of the expectant father as the emotional support provided by them helps in a successful lactation period.
The Technique
Physical touch is the best key for a lovely mother-child bonding. The newborn baby must be fed with colostrum, the first thin milk available after birth, which initiates a skin-to-skin contact between the infant and its mother. Breast-feeding requires patience and determination to become a learned skill. The baby must be placed comfortably and allowed to nurse on one breast until satisfied. If the mother has too much milk, feeding on one side of the breast is sufficient. If not, then other side breast must be offered for feeding. To end a feed the mother has to gently place a finger near the infant’s mouth to stop sucking. Feeding may happen around 8 to 12 times in a day as 87% of mother’s milk contains only water. Too much of milk stored in the mother’s breast can be expressed manually and stored in bottles for future feeds. But it is recommended to avoid using nipples during the first month as this may hamper the sucking action of the baby nursing on the breast.
Duration of Breast Feeding
Though exclusive breast-feeding is recommended for first 6 months it may continue up to 1 year or more depending on the mother and child. Usually mothers reduce the feeding frequency and start to introduce weaning around the 9th or 10th month. Reducing breast-feeding should be done gradually and then stopped totally in a smooth manner.
Exercise and Breast-Feeding
Though traditions advice against women involving themselves in exercise until breast-feeding is completely stopped, the trend has changed presently. Many mothers involve themselves in aerobic and light physical exercises after a few weeks post delivery, as advised by their doctors. Exercise improves lipid and insulin responses in lactating women without disturbing the maternal and infant immune status.
Transfer of Drugs into Human Milk
Every drug consumed by the mother will have its effect on the milk passed on to the child. The drug composition in the milk is quite small. Many drugs have adverse effects while others have unknown effects which may concern us. It is wise to undergo maternal medication which is suitable for lactation.
Other Problems of Breast-Feeding
Overweight lactating mothers should reduce their fat and sugar intake while consuming more fruits and vegetables loaded with calcium and vitamin D for nutrition-rich milk. Low- and very-low-birth-weight infants in neonatal intensive care are a challenge for feeding mothers. The feeding process must be initiated through counseling without causing stress and fear to the lactating mother. If the baby does not suck properly, the mother may assist the baby by pressing the baby’s chin upward. Also some babies tend to sleep while feeding. This must be avoided with some physical touch or interaction with the baby to prevent sleep. If these do not work out it is better to postpone the feed. Any problems during breast-feeding are of utmost concern and must be handled with care and a positive approach.
Pregnancy and lactation are a unique gift to every woman. It is in the hands of the mother to nurture a healthy and active baby which grows on to become a wholesome adult.
