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Human Milk and Atopic Disease

Key Points The prevalence of allergy is increasing across the world, and asthma is the most common chronic disease in children. The exact role of genetics and epigenetics in the development of allergy are being explored with newer research techniques. Exclusive breastfeeding does decrease the occurrence of eczema in the first 2 years of life, and a longer duration of breastfeeding decreases wheezing in the first…

Breast Conditions in the Breastfeeding Mother

Key Points The breast is a complex organ with growth, evolution, and regression over life. Its functional capacity changes dramatically throughout pregnancy and lactation. Many benign and malignant conditions affect the breast in general, and some conditions occur specifically during lactation. A careful and complete history, physical examination, and documentation remain essential to understanding, diagnosing, and managing breast disease. A good understanding of the anatomy and…

Medical Complications of Mothers

Key Points Lactation is a two-person system, and breastfeeding both affects and is affected by the mother’s physiology. Both acute maternal health conditions and chronic disorders may have an impact on the mother–baby dyad. Often, the mother’s acute health condition itself does not affect breastfeeding physiology, but the process of navigating the health care system disrupts lactation. It is the healthcare professional’s responsibility to assist her…

Premature Infants and Breastfeeding

Key Points Mother’s own milk, appropriately fortified, is the standard for feeding premature infants. Provision of mother’s own milk for hospitalized premature infants provides short- and long-term health benefits. Neonatal providers play an important role supporting lactation in the neonatal intensive care unit with education, milk expression, skin-to-skin care, and breastfeeding. Pasteurized human donor milk is recommended instead of formula when mother’s own milk is not…

Breastfeeding Infants With Problems

Key Points Infants with special problems may require procedures, surgeries, or hospitalization to maintain and optimize their health or development. Breastfeeding and breast-milk feeding should be protected throughout these interruptions in an infant’s health routine because human milk may offer unique benefits to their health in this period. Breastfeeding is the ideal and preferred feeding method for a newborn. Occasionally infant problems interfere with breastfeeding and…

Transmission of Infectious Diseases Through Breast Milk and Breastfeeding

Key Points The basic tenet concerning breastfeeding and infection is that breastfeeding is rarely contraindicated in maternal infection. The few exceptions relate to specific infectious agents with strong evidence of transmission via breast milk and for the development of illness with infection in the infant leading to significant morbidity and mortality. The frequency and duration of breastfeeding, along with the “amount” of infectious agent in breast…

Medications, Herbal Preparations, and Natural Products in Breast Milk

Key Points Medication use during lactation occurs in almost 50% of breastfeeding women. The most common medications reported include oral contraceptives, systemic antibiotics, “cold preparations,” analgesics/antipyretics, and nonsteroidal antiinflammatory agents. The benefits of continued breastfeeding with maternal medication use almost always outweigh the potential risk to the infant. Every clinical situation is different, based on the specifics for the mother–infant dyad. A careful, informed risk–benefit assessment…

Normal Growth, Growth Faltering, and Obesity in Breastfed Infants

Key Points Optimal growth can be achieved only through the interaction of genetic potential and optimal nutrition at the appropriate times (intrauterine, infancy, childhood, and adolescence) to immediately effect timely active growth and “program” organogenesis and metabolism to optimize future growth and health. The World Health Organization (WHO) growth standards represent appropriate growth references for assessing the optimal growth of breastfeeding infants and children through 24…

Weaning

Key Points Simply stated, weaning is the transition of the infant from dependence on mother’s milk to reliance on other sources of nourishment for nutrition, health and growth, and development. Current recommendations are for 6 months of exclusive breastfeeding and initiation of complementary foods at 4 to 7 months of age with continued breastfeeding through 12 months and beyond. The “how to” for transition to complementary…

Maternal Nutrition and Supplements for Mother and Infant

Key Points Exclusive breastfeeding for 4 to 6 months is capable of nourishing an infant for appropriate growth and development even when the mother’s nutrition is “less than perfect.” The quantity of breast milk produced can be affected by maternal dehydration (when severe, >10% weight loss) or severe maternal malnutrition, but the quality of breast milk as adequate nutrition for the infant is maintained. Maternal conditions…

Practical Management of the Nursing “Dyad”

Key Points Breastfeeding units are best conceived of as physiologically interrelated, or “dyads,” although each family may include multiple interdependent dyads (e.g., those with multiples or more than one lactating parent). Supporting lactation and breastfeeding requires understanding a rich tapestry, including the physiology of milk production, the mechanics of milk transfer, normal infant behavior and growth, and the multiple social forces that enable or prevent achieving…

Population Health and Informed Feeding Decisions

Key Points Breastfeeding is a women’s health issue. Disruption of breastfeeding is associated with higher rates of maternal breast and ovarian cancer, diabetes, hypertension, myocardial infarction, and stroke. Breastfeeding is also a children’s health issue. Not being breastfed is associated with higher rates of infectious morbidity, childhood leukemia, sudden infant death syndrome, and necrotizing enterocolitis, as well as higher rates of obesity and diabetes and lower…

Host-Resistance Factors and Immunologic Significance of Human Milk

Key Points Bioactive factors in human breast milk are not only numerous but they also act in a variety of mechanisms to affect the development, growth, and ongoing health of the infant. Some of those factors also confer benefits for the mother’s breast health. The study of the cells within breast milk has expanded to include the complete hierarchy of breast cells, hematologic cells, and the…

Biochemistry of Human Milk

Key Points Human milk is a highly complex composition of nutrients for infant growth, consisting primarily of fat, carbohydrates, and proteins, as well as minerals, vitamins, and other nutrients. The delicate balance of nutrients and the dynamic lactation process make human milk the only food substance during life that is adequate as the sole source of nutrition. The biochemistry of human milk changes throughout the stages…

Physiology of Lactation

Key Points Lactation represents the completion of the reproductive cycle and occurs as one of the major stages of mammary gland development: (1) embryogenesis; (2) mammogenesis; (3) lactogenesis, or secretory differentiation (stage 1 lactogenesis) and secretory activation (stage II lactogenesis); (4) lactation (or stage III lactogenesis), or full milk secretion; and (5) involution. Hormones play a central role in mammary gland development (estrogen and progesterone in…

Anatomy of the Breast

Key Points The mammary gland, or “breast,” is the only organ that is not fully developed at birth and undergoes dramatic changes from birth to pregnancy, lactation, and involution. The three major structures of the breast are skin, including the nipple, areola, and general skin; subcutaneous tissue; and corpus mammae, which is the breast mass that remains after freeing the breast from the deep attachments and…

Breastfeeding in a New Era

Key Points The long history of breastfeeding has brought us to a better understanding of the crucial role of human breast milk in the nutrition and growth and development of infants and children. Research into lactation, breastfeeding, and human breast milk will guide how we support breastfeeding and the use of breast milk for all children. National and international legislation and policy development are necessary for…

Evidence-based paediatrics

After reading this chapter you should be able to: apply evidence-based medicine to clinical practice interpret a research paper or systematic review appropriately Evidence-based paediatrics requires the paediatrician to use the current best evidence in the assessment of clinical conditions and treatment options and to apply that to the specific needs of the individual young patient. Consequently, an understanding of the scientific evidence that supports clinical…

Patient safety and clinical governance

After reading this chapter you should: be able to apply patient safety thinking understand how human factors detrimental to care can be minimised be able to lead a safe and effective handover Clinical governance This term describes the framework of practice that ensures patients receive the highest possible care from the NHS. All staff—whatever their role and whatever their grade—are required to contribute to the continued…