Breast Feeding

Aka: Breast Feeding, Infant Nursing, Lactation, Breast Milk

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II. Epidemiology

  1. U.S. Prevalence of Breast Feeding (AAP recommends Breast Feeding for at least 1 year, exclusively for first 6 months)
    1. Initial: 83%
    2. Exclusively through 3 months: 47%
    3. At 6 months: 58% (25% exclusively)
    4. At 1 year: 36%
    5. CDC Breastfeeding Facts
      1. https://www.cdc.gov/breastfeeding/data/facts.html
  2. Highest Breast Feeding rates:
    1. White
    2. Primipara
    3. Over age 30 years
    4. College educated
    5. Employed
    6. Higher socioeconomic status
    7. Western states
  3. Lowest rates among:
    1. Under age 20 years
    2. Unemployed
    3. Unmarried
    4. Lower socioeconomic class
    5. Poor social support

III. Advantages: Breast Feeding

  1. Lower Incidence of Infantile Colic
  2. Most important method of maternal-infant bonding
  3. Easier to digest than formula (related to Protein)
    1. Human milk is digested in 1.5 hours
    2. Formula is digested in 4 hours
  4. Does not induce allergic response (contrast to formula)
    1. Diarrhea
    2. Gastrointestinal Tract bleeding
    3. Atopic Dermatitis
  5. IQ higher for Breastfed infants
    1. Kramer (2008) Arch Gen Psychiatry 65(5): 578-84 [PubMed]
    2. Horta (2015) Acta Paediatr 104(467): 14-9 [PubMed]
  6. Lower Incidence of feeding problems
    1. Gastroesophageal Reflux (Regurgitation)
    2. Constipation
  7. Colostrum contains multiple immune factors
    1. Macrophages
      1. Complement
      2. Lysozyme
      3. Lactoferrin
    2. Secretory IgA antibodies
      1. Infant receives 0.5 to 1g Secretory IgA per day
      2. Bacterial, Viral, and Protozoal protection
  8. Lower Incidence of infection
    1. Bacteremia
    2. Meningitis
    3. Botulism
    4. Gastrointestinal infection
    5. Lower respiratory infection
    6. Otitis Media
    7. Urinary Tract Infection
  9. Advantages to mother
    1. Faster return to pre-pregnancy weight
    2. Decreased postpartum bleeding
    3. Decreased Postpartum Depression risk
    4. Increased Bone Mineral Density
    5. Lower Incidence of Ovarian Cancer
    6. Lower Incidence of premenopausal Breast Cancer
    7. Lower risk of Type II Diabetes, Cardiovascular Disease and Hypertension

IV. Efficacy: Breast Feeding is not guaranteed Contraception

  1. Bottle Feeding
    1. Postpartum 12 weeks: 100% of women ovulating
  2. Breast Feeding
    1. Postpartum 12 weeks: 20% ovulating
    2. Postpartum 20 weeks: 50% ovulating
    3. Postpartum 30 weeks: 75% ovulating
    4. Postpartum 40 weeks: 85% ovulating
    5. Postpartum 50 weeks: 95% ovulating
    6. Postpartum 60 weeks: 100% ovulating

V. Contraindications: Absolute

  1. Maternal HIV Infection
  2. Untreated Active Tuberculosis
  3. Untreated Brucellosis
  4. Herpes Simplex Virus (HSV) lesions on Breast
  5. Chemical Dependency
  6. Active HSV Lesions on Breast
  7. Hepatitis C Infection with cracked nipples
  8. Important medication use that contraindicates Lactation
    1. See Contraindicated Drugs in Lactation

VI. Contraindications: Relative

  1. Tobacco Smoking in Lactation
    1. Significant Nicotine exposure via Breast Milk
    2. 10x greater exposure than in bottle fed infants
    3. Mascola (1998) Am J Public Health 88:893-6 [PubMed]

VII. Advantages: Higher risk infants could benefit most from Lactation

  1. Respond positively to prenatal education
  2. Physician counseling and support

VIII. References

  1. (1997) Pediatrics 100:1035-9 [PubMed]
  2. Westerfield (2018) Am Fam Physician 98(6): 368-73 [PubMed]

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