Breastfeeding

BREASTFEEDING:BREAST IS BEST FOR BABIES

SUNDARI INDAH WIYASIHATI

SEMINAR ILMIAH IAIFI SURABAYA, 1 OKTOBER 2012

Competing interests:none declared

Modified cow’s milk was first manufactured at the end of the 19th century.

Subsequently breastfeeding rates started to fall, reaching an all time low in developed countries in the 1960s.

Worldwide, exclusive breastfeeding seemed to rise during the 1990s.

(Hoddinott, Tappin & Wright, 2008)

WORLD BREASTFEEDING WEEK

1–7 August 2012

in more than 170 countries

to encourage breastfeeding and improve the health of babies around the world

commemorates the Innocenti Declaration made by WHO and UNICEF policy-makers in August 1990 to protect, promote and support breastfeeding

INDONESIA

PHYSIOLOGY OF LACTATION

(Leung & Sauve, 2005)

McGeorge DD. Br J Plast Surg 1995;48(2):115.

PHYSIOLOGY OF LACTATION• Lactation during pregnancy is inhibited by high levels of

estrogen and progesterone, which inhibit the release of prolactin and interfere with the action of prolactin at the alveolar cell receptor level.

• As the estrogen and progesterone decline abruptly in the postpartum period, the anterior pituitary gland releases very large amounts of prolactin, which stimulates the alveoli to produce significant amounts of milk.

• Milk flow commences usually within 48-96 hours.

(CME Journal of Tropical Pediatrics, 2012; Leung & Sauve, 2005)

PHYSIOLOGY OF LACTATION

(Fox, 2004)

PHYSIOLOGY OF LACTATION• Endocrine control is supplanted by autocrine control as the

mother's baseline levels of prolactin return to more normal levels at about three months postpartum.

• At this time, it is the removal of milk from the breast that maintains the supply of milk.

• The more the mother empties her breast, the more milk is produced.


BENEFITS

NUTRITIONAL CONSIDERATIONS• Human milk contains the appropriate proportions of protein,

carbohydrates, fat, minerals and vitamins for optimal growth, with the exception of vitamins D and K.

• Although human milk has only a small amount of iron (0.3 mg/L to 1 mg/L), iron in human milk is highly bioavailable approximately 50% of the iron in the human milk is absorbed, compared to about 10% of that in whole cow's milk.


IMMUNOLOGICAL ANDANTI-INFECTIVE ADVANTAGES


IMMUNOLOGICAL ANDANTI-INFECTIVE ADVANTAGES

• Secretory IgA predominates in human milk and plays a vital role in the provision of local protection to the mucosal membrane.

• Human milk contains glucosamines promote the growth of lactobacillus bifidu helps to prevent growth of pathogenic flora in the gut.

• Breastfeeding decreases the incidence and/or severity of gastrointestinal tract infection, lower respiratory tract infection, otitis media, urinary tract infection, meningitis, septicemia and necrotizing enterocolitis.

(Hoddinott, Tappin & Wright, 2008; Leung & Sauve, 2005)

PREVENTION OF ALLERGIES• Breastfeeding protects against the development of allergy by

several mechanisms (Leung & Sauve, 2005):

1. Colostrum

PREVENTION OF ALLERGIES

2. Maternal IgA

3. Epidermal growth factor

hastens maturation of intestinal mucosa and epithelium strengthening the mucosal barrier to antigen

4. Secondary to a reduction of infections in the infant

studies shown that respiratory and gastrointestinal infections may lead to the development of allergic diseases

(thevisualMD.com)

Supplementation of the Breastfed Baby “Just One Bottle Won’t Hurt”---or Will It?

Marsha Walker, RN, IBCLC

“when formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached”

ENHANCED COGNITIVE DEVELOPMENT

• Meta-analysis on 11 studies shown children who are breastfed have higher cognitive function than children who are formula-fed. After adjusting for possible confounding variables (socioeconomic status, maternal education etc) the "cognitive development score" was 3.16 points higher. The meta-analysis also found that the duration of breastfeeding correlated with development and cognitive outcome (Anderson, Johnstone, Remley,

1999).

• A study suggests that the effect may last well into adulthood (Mortensen, Michaelsen, Sanders et al, 2002).

PREVENTION OF OBESITY• Breastfeeding reduces the risk of childhood overweight and

obesity.

• Childhood obesity may persist into adult obesity with associated morbidity, such as type-2 diabetes mellitus, hypertension and hypercholesterolemia.


PREVENTION OF INSULIN-DEPENDENT DIABETES MELLITUS

• Bovine serum albumin may provoke an immunological response in genetically susceptible individuals, which then cross-reacts with a beta-cell surface protein mediate destruction by immune attack diabetes mellitus.

• The American Academy of Pediatrics recommends breastfeeding and avoidance of cow's milk and products containing intact cow's milk protein during the first year of life in families with a strong history of insulin-dependent diabetes mellitus.


PREVENTION OF HYPERTENSION• There is evidence that breastfeeding may protect against high

blood pressure in later life. Martin et al. found that for every three months of breastfeeding ~ 0.2-mm Hg reduction in systolic blood pressure.

• The reduction in blood pressure, though small, is significant and may have important public health implications.


PREVENTION OF GASTROINTESTINAL DISEASES

• Several studies have suggested that breastfeeding may prevent or delay the onset of celiac disease, Crohn's disease and ulcerative colitis, and also may be protective against sudden infant death syndrome.

PREVENTION OF SUDDEN INFANT DEATH SYNDROME


WHAT TO DO FROM HERE?• All health professionals should actively support breast feeding

as an important way to improve child health.

• Better implementation of existing evidence—particularly the baby friendly initiative—is needed, as are improvements in the education of healthcare professionals.

• Adherence to WHO’s International Code of Marketing of Breast-milk Substitutes is also important in both developing and developed countries.


WHAT TO DO FROM HERE?WHO CODE ON MARKETING OF BREASTMILK SUBSTITUTES

Scope:•infant formula •other milk products •cereals for infants •vegetable mixes •baby teas / juices •follow-up milks (also feeding bottles, teats)

No advertising of above products to the public.

No free samples to mothers, their families or health workers.

Health care facilities: No promotion of products, i.e. no product displays, posters or distribution of promotional materials.

No free or low-cost supplies of breastmilk substitutes to any part of the health care system.

Product labels must clearly state the superiority of breastfeeding, the need for the advice of a health worker and a warning about health hazards. No pictures of infants, or other pictures or text idealising the use of infant formula.

WHAT TO DO FROM HERE?• New approaches are required at policy and individual level to

deal with health inequalities, consider incentives to breast feed, facilitate breast feeding outside the home, and to find the most effective ways of teaching and learning breastfeeding skills.

• Meanwhile, the early days after birth are crucial and everyone in health care should chip away at the complex psychological, social, cultural, and health service organization factors that undermine breast feeding.


WHAT TO DO FROM HERE?

Tips for non-specialists

When opportunities arise, inform pregnant women and breastfeeding mothers of the health benefits of breast feeding their infant for six months

Encourage mothers and boost their confidence in their ability to breast feed

Prevention and early help with breastfeeding problems are crucial. Ensure that pregnant women and breastfeeding mothers know where they can get skilled professional or lay help 24/7

If you do not have the skills to assess whether breast feeding is effective, refer the woman to someone who does have the skills and also has the time to observe breast feeds


POLICY IN INDONESIA

Konvensi Hak Anak, diratifikasi oleh Keppres No. 36/1990

UUD Pasal 27 ayat 2, Pasal 28B ayat (2)

UU No.13/2003 tentang Ketenagakerjaan Pasal 82 ayat (1), Pasal 83

UU No. 23/2002 tentang Perlindungan Anak Pasal 22

UU No. 49 tahun 1999 tentang Hak Asasi Manusia, Pasal 49 ayat (2)

PP NO. 69/1999 tentang LABEL DAN IKLAN PANGAN Pasal 44 (1) Pasal 47 (4) Pasal 51

UU No 36/2009 tentang KESEHATAN Pasal 128 Pasal 129

KEPMENKES NO 450/MENKES/SK/VI/2004 Tentang Pemberian ASI Secara Eksklusif di Indonesia

KEPMENKES NO 237/MENKES/SK/1997 Tentang Pemasaran Pengganti Air Susu Ibu

Peraturan Bersama Menteri Negara Pemberdayaan Perempuan, Menteri Tenaga Kerja dan Transmigrasi dan Meteri Kesehatan No 48/MEN.PP/XII/2008, PER.27/MEN/XII/2008 dan 1177/MENKES/PB/XII/2008 tahun 2008 tentang Peningkatan Pemberian Air Susu Ibu Selama Waktu Kerja di Tempat Kerja

Peraturan Kepala Badan Pengawas Obat dan Makanan Republik Indonesia No. HK. OO.O5.1.52.3572 tgl 10 Juli 2008 tentang Penambahan Zat Gizi dan Non Gizi dalam Produk Pangan

Keputusan Kepala Dinas Kesehatan Provinsi Daerah Khusus Ibukota Jakarta No. 435/2008 tentang Pemberian Asi Secara Dini (Inisiasi Menyusu Dini) Bagi IbuMelahirkan di Provinsi Daerah Khusus Ibukota Jakarta

Peraturan Kepala Badan Pengawas Obat dan Makanan Republik Indonesia No. HK.00.05.52.0085 tentang Pengelompokan Produk Formula Bayi dan Formula Lanjutan

Perda Kabupaten Klaten No. 7/2008 tentang Inisiasi Menyusu Dini dan Air Susu Ibu Eksklusif

Peraturan Menteri Negara Pemberdayaan Perempuan dan Perlindungan Anak Republik Indonesia No 03 Tahun 2010 tentang Penerapan Sepuluh Langkah Menuju Keberhasilan Menyusui

(AIMI, 2010)

WHAT IF…..?

CURRENT HOT TOPICS


GROWTH CHARTS

1977 GROWTH CHARTS

Based on a study conducted in Ohio from 1929 to 1975:

•were primarily fed formula or a combination of breastmilk and formula

•often started solids before 4 months

Not a reliable indicator of the growth of children who:

•are breastfed only

•delay solids until around six months

THE WHO MULTICENTRE GROWTH REFERENCE STUDY (MGRS)

Undertaken between 1997 and 2003, approximately 8500 children from widely different ethnic backgrounds & cultural settings (Brazil, Ghana, India, Norway, Oman and the USA)

•to provide a single international standard that represents the best description of physiological growth for all children from birth to five years of age

•to establish the breastfed infant as the normative model for growth and development

WHO SAFE FORMULA FEEDING CRITERIAWHO guidelines endorse formula feeding over breastfeeding only in situations where six specific conditions are met.

(WHO, 2010)

DONOR BREAST MILK BANKS

NUTRITION• A varied and balanced diet is recommended to sustain breast

feeding.

• Little vitamin D is secreted into breast milk, and NICE recommends supplements for all pregnant and breastfeeding mothers. Recommendations about supplements vary between countries.

SUMMARY• The best option is exclusive breast feeding for six months, with

no solids or other fluids, and supplemental breast feeding for two years or more

• Breast feeding has important health benefits, including reduced risk of infection in babies, potential long term health benefits in children—reduced blood pressure, cholesterol concentrations, and obesity

• Promote, protect, and support breastfeeding

• New WHO growth charts will establish the breastfed infant as the biological norm with which all children should be compared and will be applicable to all ethnic groups

REFERENCESAnderson JW, Johnstone BM, Remley DT. 1999. Breast-feeding and cognitive development: a

meta analysis. Am J Clin Nutr 70:525-35 [abstrak].

Asosiasi Ibu Menyusui Indonesia (AIMI). 2010. Rangkuman Peraturan Perundangan di Indonesia Menyangkut ASI. http://aimi-asi.org/peraturan [diakses pada 25/10/2012: 14.00 WIB].

CME Journal of Tropical Pediatrics. 2012. Mother and Child Nutrition in the Tropics and Subtropics, Chapter 5 Breast Feeding. http://www.oxfordjournals.org/our_journals/tropej/online/mcnts_chap5.pdf [diakses pada 25/10/2012: 13.00 WIB]

Fox, SI. 2004. Human Physiology, 8th Edition. McGraw Hill.

Hoddinott P, Tappin D, Wright C. 2008. Breast feeding. BMJ 336:881-7.

Leung AKC, Sauve RS. 2005. Breast Is Best for Babies. J NatI Med Assoc 97:1010-1019.

Mortensen EL, Michaelsen KF, Sanders SA, et al. The association between duration of breastfeeding and adult intelligence JAMA. 2002;287:2365-2371 [abstrak].

World Health Organization. 2010. Guidelines on HIV and infant feeding. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. WHO, Geneva.

Sundari Indah Wiyasihati

THANK YOU

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Breastfeeding

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