The Secret to Pain Free Breastfeeding

Breastfeeding Help And Baby Care For New Parents

The Breastfeeding Help Video Compilation By Australian International Board Certified Lactation Consultant Kate Hale is full of useful information about breastfeeding and how to manage low supply. It is very clear and concise in its content. It also has a lot handy tips for new mothers, including how to bath, massage and dress an infant. Learn how to care for a new-born, including how to deeply latch your baby and breastfeed without pain within minutes for a contented baby and an end to sore nipples. It is the only Dvd of which I am aware that is readily available to new mothers with an actual demonstration on how to correctly latch a baby on and off the breast using a couple of alternative feeding positions. Reading about breastfeeding in a book is nowhere near as useful as watching the Dvd. Continue reading...

Breastfeeding Help And Baby Care For New Parents Overview


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Effect of postpartum depression on breastfeeding success

Given the benefits of breastfeeding for both mother and infant, breastfeeding mothers with postpartum depression may benefit from this choice of feeding. However, the additional demands of breastfeeding could also be overwhelming for women experiencing postpartum depression, and care should be taken to support mothers deciding to formula feed. Those women who decide to breastfeed will likely need additional support to foster the continuation of breastfeeding during this difficult time. Although breastfeeding may reduce depressive symptoms during the postpartum period, mothers with depressive symptoms are more likely to discontinue breastfeeding 111-115 . Referrals to area lactation consultants and breastfeeding support groups such as La Leche League can be extremely helpful to mothers with PPD who are interested in continuing breastfeeding.

Breastfeeding and Infancy

The breast is much more than a passive reservoir of milk. The mammary glands in the breast extract water, amino acids, fats, vitamins, minerals, and other substances from the maternal blood. They package these substrates, synthesize many new nutrients, and secrete a unique fluid specifically tailored to the needs of the infant. The glands balance milk production with infant demand, so that the volume of milk produced during lactation is determined by infant need. Milk production in the first 6 months averages about 750 ml day,1 but breastfeeding mothers have the potential to produce far more milk. Mothers who breastfeed twins can produce over 2000 ml day.

Potential contraindications to breastfeeding

Most prescription and over-the-counter drugs are minimally excreted through breast milk and are pharmacokinetically benign to the infant. Illegal drugs of abuse are contra-indicated during breastfeeding (CICH, 1996). Breastfeeding is not advised for infants of mothers who are receiving long-term chemotherapy. Breastfeeding should be temporarily stopped (anywhere from 1 day to 2 weeks depending on the type of isotope used) when radioactive compounds for diagnostic or therapeutic reasons are required (Fulton and Moore, 1990). Some of the drugs that may be contraindicated during breastfeeding include bromocriptine, cyclophosphamide, cyclosporine, doxorubicin, ergotamine, lithium, methotrexate and phencyclidine (AAP Committee on Drugs, 1994). Local drug information lines are useful in keeping up to date with information on drug usage and breastfeeding (CICH, 1996). Herbal remedies may contain pharmacologically active substances. It is recommended that they be used with caution...

Factors influencing initiation and duration of breastfeeding

Duration of breastfeeding has decreased since 1960. Recent Canadian statistics show that while almost 75 of mothers begin breastfeeding in hospital, only 60 and 30 are still exclusively breastfeeding at 3 and 6 months, respectively (Health Canada, 1996). By 9 months, only 18 of mothers still breastfed in a Vancouver cohort (Williams et al., 1996). Breastfeeding trends vary across the provinces rates are higher in the west and drop off from Quebec to the east (Health Canada, 1996). Breastfeeding initiation and maintenance rates increase with increasing education and income levels, suggesting that there are many social factors that influence the method of infant feeding (Health Canada, 1996). Since 1978, the Wfarld Health Organization (WHO) and Health Canada have made the promotion of breastfeeding a primary goal. The WHO currently recommends that breastfeeding exclusively to the age of about 6 months, then continuing breastfeeding and complementary foods for up to 2 years of age or...

Benefits of breastfeeding to infants in Canada

Breastfeeding is recommended for all infants, with very few exceptions. Exceptions include infants with galactosemia, or infants of mothers who are HIV antibody positive or have untreated, active tuberculosis. (i) Reduced incidence of infection. Recent studies have provided evidence that, in developed countries, breastfeeding protects against gastrointestinal and respiratory infections and decreases the risk of otitis media (Beaudry et al., 1995 Duncan et al., 1993 Howie et al., 1990 Boucher et al., 1986). Newborn infants breastfed for 13 weeks or more had significantly fewer gastrointestinal and respiratory illnesses during the first year of life when compared to formula-fed infants (Howie et al., 1990). In comparison to formula-fed infants, infants exclusively breastfed for a minimum of 16 weeks had fewer episodes of single and recurrent otitis media during the first year of life (Duncan et al., 1993). Breastfed infants supplemented with formula or food before 4 months were more...

Nutritional Needs during Breastfeeding

Eating a healthy diet while breastfeeding is important. A healthy infant doubles its weight in the first 4 to 6 months after birth, and, for a mother who is exclusively breastfeeding, breastmilk must provide all the energy, pro tein, and micronutrients to support this rapid growth. Moreover, the diet also needs to support maternal health - allowing the breastfeeding mother to lose weight gained during pregnancy, replenishing nutrient stores depleted by the demands of pregnancy, and maintaining nutrient stores to support milk production. Breastfeeding women need significantly more energy, protein, and micronutrients during lactation to support milk formation. For women exclusively breastfeeding, synthesis and secretion of breast milk requires an additional 750 kcal day and an extra 15-20 g of high-quality protein.1 Requirements for most vitamins and minerals are 50-100 higher, compared with before pregnancy. Figure 4.6 compares the nutritional needs of lactating versus nonlactating...

Antidepressants and breastfeeding

The clinicians of breastfeeding women diagnosed with postpartum depression must consider the different treatment options for their patients including antidepressants, hormonal therapy, or psychotherapy. In situations where the postpartum depression requires antidepressants, the safety of the nursing infant must be considered. Antidepressants taken during breastfeeding can induce adverse symptoms in the infant. The antidepressants that have been particularly problematic are nefazodone 102 , citalo-pram 103 , doxepin 104, 105 , and fluoxetine 106, 107 . Given the negative infant outcomes associated with maternal antidepressant therapies, the US Food and Drug Administration (FDA) has not approved any antidepressant for use during lactation 49 . Alternatively, depression during the postpartum period can impair maternal-infant interactions 108 , which in turn negatively affect infant cognitive development 109 , emotional development 109 , anxiety, and self-esteem 110 . In some cases, the...

Benefits of Breastfeeding

Human milk contains the right balance of nutrients for human growth and development. It is low in total protein and high in carbohydrates, making it more digestible and less stressful on the immature kidneys. In addition, each mammal produces milk that is nutritionally and immunologically tailored for its young. In rare cases, such as galactosemia and phenylketonuria, some infants cannot metabolize human milk or other milk products. A significant benefit of human milk is that it contains many immunologic agents that protect the infant against bacteria, viruses, and parasites. Breastfeeding also provides many benefits for the mother.

The Benefits of Breastfeeding

Mother's milk, designed as it is to nurture babies, contains the ideal amount and proportion of nutrients an infant needs, and the makeup of breast milk changes as the baby grows to satisfy its developing nutritional requirements. Breast milk contains antibodies that protect infants from many common diseases, including ear infections, diarrhea, and pneumonia, and helps develop the baby's immune system. Babies from families with allergies receive a particular benefit, as breast feeding has been shown to reduce allergies, asthma, and eczema. Unlike most formula, mother's milk contains docoso-hexaenoic acid and arachidonic acid, which contribute to brain and retinal development, and some studies have suggested that breastfed infants learn more effectively. In addition, they show a lower rate of obesity as adults. Mothers also benefit from breastfeeding in many ways. Of great psychological value, milk production burns 200 to 500 calories a day, speeding the mother's return to...

Nutrition for Pregnancy and Breastfeeding

Good nutrition is important during pregnancy and breastfeeding, as there is an increased need for calories and for most nutrients. A particularly important nutrient during pregnancy is folic acid, one of the B vitamins. Folic acid reduces the chance of having a baby with birth defects of the brain and spinal cord. Experts recommend that women of childbearing age consume 400 micrograms ( g) of folic acid every day. Pregnant women should consume 600 xg per day. Good sources of folic acid include dark green leafy vegetables, oranges and orange juice, dried beans and peas, and fortified breads and cereals. Adequate calcium intake during both pregnancy and breastfeeding is also important, since calcium is drawn from the mother. The recommended intake of calcium during pregnancy and lactation is 1,000 mg a day. A pregnant or lactating teenager needs 1,300 mg of calcium a day. Before becoming pregnant, a woman should discuss folic acid or calcium supplementation with a physician, as well as...

Breast Feed or Bottle Feed

If you're a new parent, either approach-breast- or bottle-feeding-can provide adequate nourishment and the strong emotional bond that your growing baby needs. Whenever possible, though, breast milk is best for baby during the first year of life. If you're not sure which approach to use, start with breast-feeding. If it isn't right for you, switch to bottle-feeding. Starting with a bottle, then trying later to breast-feed is difficult. If you choose to breast-feed, you'll find guidance in BreastFeeding Your Baby on this page. For bottle-feeding, see Another Healthful Option Bottle Feeding,also in this chapter. for the first six months, and continue when solids are introduced at about six months. The longer a baby breast-feeds, the greater the benefits. However, your baby benefits even when breast-feeding lasts for only a short time, perhaps only during your six- to eight-week maternity leave. For most nutrients, what a mother eats has little if any effect on the nutritional content of...

For Those Who Breast Feed

The decision to breast-feed is personal. If you decide it's right for you and your baby, make smart eating a priority. Your needs for energy and some nutrients are higher now than during pregnancy. If you're able, breast-feeding is good for your baby and for you. Besides the physical benefits to your baby and the emotional nurturing you share, breast-feeding can help you return to your prepreg-nancy shape and weight, and reduce blood loss after pregnancy. While inconclusive, research suggests that breast-feeding may offer health benefits later reduced risks of breast cancer, ovarian cancer, and osteoporosis. See Breast-Feeding Your Baby in chapter 15.

Perfecting the Breast Feeding Technique

While breast-feeding is nature's way of providing ideal nutrition for infants, the art of breast-feeding might not come as naturally Like learning any new skill, the keys to success are knowledge, practice, and the support of family, friends, and perhaps coworkers and employers. Discuss your decision to breast-feed with your doctor before delivery, and remind hospital staff when you arrive at the hospital. Latching on correctly helps your baby get enough milk and protects you from sore nipples. Ask about breast compression if latching on is a problem. Breast-Feeding About Your Baby Try to skip a pacifier or bottle nipple, at least for the first month. It can interfere with your baby's ability to learn to breast-feed. Breast-Feeding About You Pour yourself some water or juice before nursing. Breast-Feeding Cautions Some Steps in Breast-Feeding Talk to your doctor about taking medications, including over-the-counter medications, and herbal supplements during breast-feeding. Take your...

Breast Feeding for a Backto Work Schedule

To continue breast-feeding, changing from maternity leave to a back-to-work schedule takes adjustment. Some moms express milk during their workday. In that way, their baby can have bottles of mother's milk when mom's away. Other moms breast-feed when they can be with their baby caregivers offer infant formula If you're a back-to-work nursing mom (or need to be away from home regularly), consider these guidelines for breast-feeding success Before you take maternity leave, work out a plan with your employer. Perhaps work at home for a while, or plan your schedule for short days, flextime, or longer breaks. Check your state law for breastfeeding at your job. Select a caregiver for your baby who is supportive of breast-feeding.

Breast Feeding Your Baby

Nature provides ideal nourishment for babies breast milk. Medical and nutrition experts highly recommend breast-feeding at least for an infant's first year of life. Breast milk alone can provide enough nourishment to support your baby's optimal growth and development during the first six months of life. Then when solid foods are introduced, they complement breast milk. Breast milk continues to be important for your baby for the first year and even longer. The decision to breast-feed is a personal one. It takes into account the family's lifestyle, economic situation, and cultural beliefs, along with the mother's physical ability to do so.

Critical role of breastfeeding

Immune Componeent Breastfeeding

When much of the transferred maternal IgG has been catabolized around 2 months of age, the infant becomes still more dependent on antibodies from breast milk for specific humoral immunity. At least 90 of the pathogens attacking humans use the mucosae as portals of entry mucosal infections are in fact a major killer of children below the age of 5 years, being responsible for more than 14 million deaths of children annually in developing countries. Diarrhoeal disease alone claims a toll of 5 million children per year, or about 500 deaths every hour. These sad figures document the need for mucosal vaccines against common infectious agents, in addition to the importance of advocating breast-feeding. Convincing epidemiological documentation suggests that the risk of dying from diarrhoea is reduced 14-24 times in nursed children (Hanson et al., 1993 Anon., 1994). Indeed, exclusively breast-fed infants are better protected against a variety of infections (Pisacane et al., 1994 Wold and...


Before 1900, most mothers breastfed their infants. Breastfeeding rates declined sharply worldwide after 1920, when evaporated cow's milk and infant formula became widely available. These were promoted as being more convenient for mothers and more nutritious than human milk. Breastfeeding rates began rising again in the late 1950s and early 1960s. BENEFITS OF BREASTFEEDING Breastfeeding, or lactation, is, in fact, the ideal method of feeding and nurturing infants. Most health organizations recommend infants be exclusively breastfed during the first four to six months of life, but ideally through the first year. Premature infants also benefit from their mothers' milk. In developing countries, breastfeeding up to age two, with appropriate supplementary solid foods, maintains good nutritional status and prevents diarrhea.

Breastfeeding Trends

Despite the many benefits of breastfeeding, only 64 percent of mothers in the United States initiate breastfeeding, with 29 percent still breastfeeding six months after birth. The U.S. goals for 2000 were to increase to 75 percent the proportion of women who initiate breastfeeding, and to increase to 50 percent the proportion of women who breastfeed for five to six months. In the United States, ethnic minorities are less likely to breastfeed than their white counterparts. Based on a 2001 report by the World Health Organization (WHO), 35 percent of infants worldwide are exclusively breastfed (no other food or drink, not even water) for the first four months of life. Rates are very low in a number of African countries, especially Nigeria, Central African Republic, and Niger. Some countries, such as Benin, Mali, Zambia, and Zimbabwe have had small increases, due mainly to breastfeeding campaigns, baby-friendly hospitals, and the commitment of trained breastfeeding counselors. In...

Estimated Energy Requirements

Milk energy output is tabulated by multiplying the volume of milk produced by its energy density (Table 18.2). The figure used by the Institute of Medicine to estimate the daily volume of milk produced from birth to six months is 0.78 l day 7 . From 7 to 12 months, mean milk production is estimated to be 0.6 l day, reduced with the introduction of solid foods. While the daily volume of breast milk produced among exclusively breastfeeding mothers is remarkably consistent from woman to woman and country to country, it varies considerably, of course, if a woman is partially or totally breastfeeding 6 . The US Institute of Medicine reviewed studies where human milk energy density was measured by bomb calorimetry and found an average value of 0.67 kcal g. Research shows that women meet most of the incremental energy requirements of lactation by eating more calories, decreasing physical activity early postpartum, and mobilizing fat stores laid down during pregnancy 6 . Mobilization of fat...

Nursing Reassuring Signs of Success

Not knowing how much milk their infant consumes, some parents feel uncomfortable about breastfeeding. You probably don't need to worry about having enough milk. Your body is miraculous. If your baby needs and demands more, your body probably will make more milk to satisfy the demands of nursing even when you try to lose extra pounds gained during pregnancy. Even mothers of twins and triplets can produce enough milk to nurse successfully.

IiShortened postpartum length of stay

Shorter postpartum hospital stays (12-48 hours) need not negatively impact on breastfeeding success. When health care professionals in the community and hospital provide consistent, clear, breastfeeding information and support for mothers throughout pregnancy, childbirth, and the postpartum and the breastfeeding period, the breastfeeding experience can be positive and successful for both mother and baby. The effect of distributing discharge packs on the duration of breastfeeding is uncertain. While no study has demonstrated a positive effect of discharge packs on the initiation or duration of breastfeeding, in high-risk populations the provision of formula-containing discharge packs may (Dungy et al., 1992 Frank et al., 1987), or may not (Neifert et al., 1988 Bergevin et al., 1983), decrease the duration of breastfeeding. Criteria for discharge from hospital should include at least two successful nursings managed independently by mother and baby (CPS, 1996 AAI 1995). It is recommended...

Signs and Symptoms of Deficiency

Unrecognized thiamin deficiency can produce ill-defined symptoms, such as irritability, depression, fatigue, and insomnia, particularly in people with increased thiamin requirements (e.g., pregnant and breastfeeding women, women taking oral contraception, adolescents, diabetics, heavy alcohol users, the chronically ill).

Nutritional Needs of the Mother

Milk production requires about 800 calories a day. The Recommended Dietary Allowances for calories during breastfeeding is 500 more calories a day than is required by a nonpregnant woman. Nutritional requirements do not change significantly from pregnancy, with the exception of decreases in folate and iron, and increases in vitamin A, vitamin C, niacin, and zinc. The diet can be the same as during pregnancy, plus an additional glass of milk. Women who are on medication should check with their physicians, since most drugs are absorbed in breast milk.

Weight Loss Strategies for Prepregnancy and Postpartum

Weight loss is not recommended during pregnancy however, overweight and obese women should be advised to aim for a moderate weight loss prior to conception and postpartum. To help motivate women in their efforts, health care providers and obstetricians should clearly define the risks associated with overweight and obesity in pregnancy and beyond. Consultation with a registered dietitian (RD) should be considered, as these individuals can provide assistance in the assessment of current eating habits and in formulating approaches for healthful weight reduction. Varieties of approaches exist for the management of overweight and obesity among women. These have been reviewed in Chap. 13 (Popular Diets). For women who are overweight or obese, the American Dietetic Association recommends a low-calorie (1,000-1,500 kcal day), low-fat (25-30 of energy) diet with generous amounts of protein (15-25 of energy), and regular exercise as a first-line approach 62 . The rate of weight loss recommended...

Deborah L OConnor Lisa A Houghton and Kelly L Sherwood

Summary Breastfeeding is the gold standard and strongly recommended method of feeding infants. The World Health Organization recommends human milk as the exclusive nutrient source for the first 6 months of life, with introduction of solids at this time, and continued breastfeeding until at least 12 months postpartum. It will come as a surprise to many readers that the energy and nutrient needs of lactating women adhering to these optimal infant feeding guidelines will exceed those of pregnancy. During the first 4-6 months of life, an infant will double its birth weight accumulated during the entire 9 months of pregnancy. The nutrient output via breast milk to support this growth is tremendous. Early postpartum, weight is an issue for many women, as they are anxious to return to their prepregnancy body size. For many, weight management will be difficult given personal circumstances and multiple demands on their time. Given the elevated nutrient requirements of lactation, women will...

Nutrition and Pregnancy

Many active women have sweet dreams about becoming a mom. Others have nightmares about the effect pregnancy will have on their bodies. Competitive athletes, in particular, worry about gaining too much weight. Remember that pregnancy and obesity are very different The approximately 25 to 35 pounds (11 to 16 kg) gained during pregnancy can be accounted for by the weight of the baby (8 lb) placenta (2 to 3 lb) amniotic fluid (2 to 3 lb) uterus (2 to 5 lb) breast tissue (2 to 3 lb) blood supply (4 lb), and fat stores for delivery and breastfeeding (5 to 9 lb). Athletic women who are underweight at the start of pregnancy commonly gain more weight overweight women may gain less.

Postpartum weight retention

Tum period are likely contributors to obesity among women 9 . While many women express a desire to lose weight postpartum and return to their prepregnancy weight, weight loss among women postpartum is highly variable. In general, most women will retain between 0.5 and 3 kg (1.1-6.6 pounds) of weight from their previous pregnancy over the longer term 9, 10 . At 18 months postpartum, 20 of women will be more than 5 kg (11 lb) heavier than they were before pregnancy. Nutrition advice for lactating women has historically been to avoid dieting while breastfeeding to ensure appropriate nutritional status for both infant and mother. Given the global epidemic of obesity and associated health consequences this advice needs to be reevaluated. A woman who is lactating has the same physiologic requirements for regulating body weight as one that is not, except that she is producing a continuous supply of milk creating a much higher energy output. As noted above, the total energy cost to a woman...

Recommended Dietary Intake for Calcium

The Adequate Intake (AI) for calcium during lactation is set at 1,000 mg day for women who are 19-50 years of age 21 . It is recommended that breastfeeding women less than 19 years of age consume 1,300 mg calcium day due to the increased need to support ongoing bone growth of the teen herself 21 . By definition an adequate intake level, as defined by the US Institute of Medicine, is the average daily nutrient intake level of apparently healthy people who are assumed to have adequate

Recommended Dietary Intake for Iron

Iron requirements during lactation are considerably lower than those for nonpregnant, nonlactating women based on the assumption that exclusively breastfeeding women will not resume menses for a period of 6 months postpartum. The RDA for iron for nonpregnant, nonlactating women is 18 mg day, and for lactating women aged 19 to 50 years it is 9 mg day 81 . The RDA for iron for lactating adolescents is slightly higher at 10 mg day to provide additional iron to support the young mother's ongoing growth and development. The UL for all breastfeeding women is 45 mg of iron per day 81 .

Maintenance of acceptable growth

Recent North American cohort studies have demonstrated that the growth rate of infants from similar socioeconomic and ethnic backgrounds who have been breastfed for more than 3 months is slower than that of formula-fed infants (or infants breastfed for less than 3 months) (Dewey et al., 1992, 1993). Behavioural development, activity level and morbidity were not different between breastfed and formula-fed groups, suggesting that there was no health-related significance of the slower growth rate (Dewey et al., 1993). When this slower growth pattern of otherwise healthy and thriving breastfed infants is misinterpreted as growth faltering, it can lead to unnecessary concern about the adequacy of breastfeeding, and interfere with the promotion of breastfeeding for the first 4 to 6 months of life (Grummer-Strawn, 1993 Sheard, 1993a). There is no evidence that breastfed infants are at increased risk because of slower growth. Comparing the growth of breastfed infants to reference data can...

Longterm consequences of early flavor learning

Significant traces of the effects of early feeding experiences may remain as children age. In an 8-year longitudinal study of 70 white mother-child dyads living in Tennessee 59 , interviews were conducted to determine whether food-related experiences at 2-24 months predicted dietary variety when children were between the ages of 6-8 years. Although vegetable variety in school-aged children was weakly correlated with mothers' vegetable preferences, 25 of the variance in school-aged children's fruit variety was predicted by breastfeeding duration and early fruit variety experience. Similar findings were reported in another longitudinal study from France 60 and a retrospective survey study conducted in England 61 . It is important to note that much of the research showing relationships between food habits in childhood and later in life are correlational in nature and consequently inconclusive regarding cause and effect relationships. The generality of such findings may be limited since...

Another Healthful Option Bottle Feeding

Breast-feeding may or may not be right for you. In rare cases, a woman may not be able to breast-feed for physical or health reasons. Some may feel uncomfortable. Others may take medications that wouldn't be safe if passed through their breast milk to the baby. Still others have cultural or work-related reasons. In all of these cases, parents can feel reassured that bottle-feeding is a healthful option. Infant formula also is a good supplement for nursing moms when a mother chooses to skip a breastfeeding, or when the mother doesn't make enough breast milk for her baby. Even after babies take solids, continue infant formula until your baby's first birthday. Similar to breastfeeding, cuddling a baby while he or she takes a bottle also builds a close, nurturing relationship with all those who share the responsibility of feeding dad, siblings, grandparents, and other caregivers.

Fluoride and Oral Health

The relationship of nutrition to oral health includes much more than a simple focus on sugar's relationship to caries. It includes factors such as an individual's overall dietary patterns, exposure to fluoride, and a person's systemic health. see also Baby Bottle Tooth Decay Breastfeeding Fast Foods Obesity.

Outcomes and Evaluation

The WIC program has been deemed a success because it has achieved its initial goals, and because other beneficial outcomes have been identified. The initial goals of increasing length of pregnancies, decreasing early births and low birth weights, increasing use of prenatal care and decreasing the incidence of iron-deficiency anemia in infants and children have all been achieved. This is partially due to a higher intake of ten nutrients, including the targeted nutrients iron and vitamin C. Increased rates of breastfeeding, as well as improved growth rates, have also been attributed to the WIC program. WIC program enrollment has also significantly improved the nutritional status of pregnant women. Unexpected benefits include a savings in health care costs from 1.77 to 3.13 for each dollar spent on WIC. Further,

Other Issues in Infant Nutrition

Encourage exclusive breastfeeding for at least 4 months to decrease the risk of allergy in infants with a positive family history. 41. For infants who are breastfed, continue breastfeeding while supplementing fluid intake with an oral electrolyte solution. 43. Continue exclusive breastfeeding for at least 4 months.

The Dietary Reference Intakes DRIs

We all need the same nutrients, but the amounts we need depend on our age, sex, and a few other factors. For example, women who are pregnant or breastfeeding need more of most nutrients. The Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences, a group of nutritional scientists from the United States and Canada, has established the Dietary Reference Intakes (DRIs), a set of recommendations for nutrient intake. The DRIs are age- and sex-specific. With the exception of fats and carbohydrates (whose requirements depend only on our calorie needs), a separate DRI is set for each of the known nutrients for each of10 different age groups. From the age of 9 years, males and females have separate DRIs, and additional DRIs are set for women who are pregnant or breastfeeding.

Rosenstein Nils Rosen von

Rosenstein's writings were first disseminated as parts of calendars issued by the Swedish Royal Academy of Sciences, the oldest learned society in Sweden. In 1764, the academy compiled all the parts and put them in book form. According to Nigel Philips, a contemporary of Rosenstein, his book was considered the most progressive which had yet to be written. The book contained chapters on such topics as smallpox and smallpox inoculation, teething, and measles. Also included were suggestions on the frequency of breastfeeding and information on how breastfeeding affects an infant's health. The Diseases of Children and Their Remedies was written so intelligibly and with such universal appeal that the average person of the time could read it.

Catherine A Forestell and Julie A Mennella

Food choices during pregnancy and lactation are influenced by a variety of factors. While internal factors, such as cravings and aversions, play an important role especially during the first trimester of pregnancy, environmental factors such as cultural food practices and beliefs often dictate the types of foods eaten throughout pregnancy and lactation. Such traditional food practices serve to predispose infants to flavors that are characteristic of their mother's culture and geographical region. As discussed herein, amniotic fluid and human milk are composed of flavors that directly reflect the foods, spices, and beverages eaten by or inhaled by (e.g., tobacco) the mother. Because the olfactory and taste systems are functioning by the last two trimesters, these flavors are detected early in life, and early experience can bias behavioral response to these flavors later in life. Although more research is needed to understand the mechanisms involved in early flavor learning, these pre-...

Diet physical activity and excess weight gain and obesity

Be directly attributed to their obesity. Eating behaviours that have been linked to overweight and obesity include snacking eating frequency, binge-eating patterns, eating out, and (protectively) exclusive breastfeeding. Nutrient factors under investigation include fat, carbohydrate type (including refined carbohydrates such as sugar), the glycaemic index of foods, and fibre. Environmental issues are clearly important, especially as many environments become increasingly ''obesogenic'' (obesity-promoting).

Requirements and Supplementation

Dietary calcium requirements depend in part upon whether the body is growing or making new bone or milk. Requirements are therefore greatest during childhood, adolescence, pregnancy, and breastfeeding. Recommended daily intake (of elemental calcium) varies accordingly 400 mg for

Commodity Supplemental Food Program

The Commodity Supplemental Food Program (CSFP) works to improve the health of low-income pregnant and breastfeeding women, other new mothers up to one year postpartum, infants, children up to age six, and low-income elderly persons sixty years of age and older by supplementing their diets with commodity foods. Eligible people cannot participate in USDA's Special Supplemental Program for Women, Infants, and Children (WIC) and CSFP at the same time.

Infant Mortality Rate

A poor diet inhibits development at critical stages in an infant's life, sometimes causing irreversible effects. This can be the case when a mother stops breastfeeding her child too soon. Calories, protein, calcium, iron, and zinc are especially crucial for developing infants.

Unicef Accomplishments Since

During the 1990s, there were many successful efforts by UNICEF to improve health, nutrition, and survival for women and children around the world. In 1990, UNICEF members, who held voting rights, supported the formation of the Convention on the Rights of the Child. During 1991, UNICEF and the World Health Organization (WHO) initiated efforts to improve the health and nutritional status of pregnant women, mothers with babies, and infants, through the Ten Steps to Successful Breastfeeding program. In response, health centers around the world adopted the ten steps, and became baby-friendly hospitals and birthing centers. By 2002, more than 15,000 sites in 136 counties were educating women and promoting healthful behaviors to improve the nutritional status of babies.

Feeding Healthy Children

The most beautiful children I have met or seen have been children raised on raw plant foods. They are alert, content, happy, and eager to explore life. The world's most famous childcare specialist Dr. Benjamin Spock recommended, in the seventh edition of his famous book Baby And Child Care, breast-feeding until solid foods were introduced. He specifically recommended a vegetarian diet at that point and, beyond age two, a vegan diet with an emphasis on raw plant foods. Dr. Spock's own vegetarian diet had given him a new lease on life. He wanted the seventh edition of his book to be in the forefront of linking animal foods and disease. For more information on breastfeeding, natural childbirth, mother-child bonding, and raw-food parenting, please read Hygeia Halfmoon's beautiful book Primal Mothering In A Modern World. Also, The Continuum Concept is another classic book on natural child care.

Body weight changes after pregnancy

In a recent study of over 1,000 mother-child pairs investigators found that mothers with greater gestational weight gain had children with more adiposity at 3 years of age, measured by skin-fold thickness as well as by BMI 51 . This association was independent of parental BMI, maternal glucose tolerance, breastfeeding duration, fetal and infant growth, and child behaviors. Children of mothers who gained more weight also had somewhat higher systolic blood pressure, a cardiovascular risk factor related to adiposity even in young children. Noticeably, mothers with adequate gain, as recommended by the Institute of Medicine 1 , had a substantially high risk of having children who were overweight. This new evidence suggests that the current recommendations for gestational weight gain may need to be revised in this era of epidemic obesity.

Recommended Dietary Intake for Folate

The recommended dietary allowance (RDA) for folate published by the US Institute of Medicine for breastfeeding women aged 14-50 years is 500 mcg DFEs per day. The scientific evidence necessary to establish an RDA is more robust than that for an adequate intake level. An RDA is the average daily dietary intake level that is sufficient to meet the nutrient requirement of nearly all (97-98 ) healthy individuals. The RDA of 500 mcg DFEs per day is the amount of folate estimated to replace the folate secreted daily in human milk plus the amount of folate required by the nonlactating woman to maintain healthy folate status, but does not factor in the metabolic cost of milk synthesis 62 . Lactating women who are planning a subsequent pregnancy, or who are not taking effective precautions to prevent one, should be encouraged to consume 400 mcg folic acid supplement daily for at least 4 weeks before and 12 weeks after conception to reduce the risk of having a subsequent child with a neural...

Diarrhea in Developing Nations

Calorie unit of food energy wean cease breastfeeding Eating patterns before and after diarrheal episodes play an important role in this cycle. In developing countries, environmental factors, such as pervasive bacterial contamination of water used for drinking, cooking, and cleaning, contribute to continued exposure to agents that cause diarrhea. Maternal practices related to feeding are also a factor. Reduced breastfeeding rates in developing nations mean that fewer children receive the protective and nutritional benefits of breast milk. Nursing allows for the delivery of milk high in fats, proteins, and calories in a sterile fashion. When illness causes mothers to wean their children too early, nutritious breast milk is replaced with cereals and gruels that are often low in calories and proteins and are made with contaminated water. Commercial formulas are also often diluted with contaminated water and put in bottles that are not sterile. cent increase in protein intake during the...

Body Fat Why Do We Have It

Women store essential fat in their hips, thighs, and breasts. This fat is readily available to nourish a healthy baby if a woman becomes pregnant. If you are a woman fighting the battle of the bulging thighs, you may be fighting a losing battle. The activity of the enzymes that store fat in women's thighs and hips is very high compared with the enzyme activity in other fat storage areas in women and compared with fat storage in the hips and thighs of men. Moreover, the activity of the enzymes that release the fat is low, making it difficult to lose fat in these areas. The easiest time for women to lose fat in this area is during the last trimester of pregnancy and while breastfeeding. At those times, the activity of the fat-storing enzymes drops, and the activity of the fat-releasing enzymes increases. Nature, again, is protective of a woman's ability to care for her offspring.

Diet nutrition and the prevention of chronic diseases through the life course

Breastfeeding There is increasing evidence that among term and pre-term infants, breastfeeding is associated with significantly lower blood pressure levels in childhood (37, 38). Consumption of formula instead of breast milk in infancy has also been shown to increase diastolic and mean arterial blood pressure in later life (37). Nevertheless, studies with older cohorts (22) and the Dutch study of famine (39) have not identified such associations. There is increasingly strong evidence suggesting that a lower risk of developing obesity (40--43) may be directly related to length of exclusive breastfeeding although it may not become evident until later in childhood (44). Some of the discrepancy may be explained by socioeconomic and maternal education factors confounding the findings. chronic diseases of childhood and adolescence (e.g. type 1 diabetes, coeliac disease, some childhood cancers, inflammatory bowel disease) have also been associated with infant feeding on breast-milk...

Conclusions and implications for practice

Micronutrient deficiencies increase the risk of adverse pregnancy outcomes in HIV-infected women. Multivitamin supplementation (including B-complex, C, and E) has demonstrated a consistent benefit on pregnancy outcomes among HIV-infected women, including a reduced risk of prematurity, low birth weight, HIV transmission via breastfeeding, and fetal death. Current epidemiological evidence supports the use of multivitamin supplements to reduce the risk of adverse pregnancy outcomes in HIV-infected women. However, the aforementioned studies were conducted on antiretroviral-naive pregnant women it is not evident if the observed effect of multivitamin supplementation on pregnancy outcomes is generalizable to HIV-infected women taking antiretroviral therapy. There is also insufficient evidence regarding the relative benefit of administering single versus multiple RDA levels of micronutrients in prenatal supplements for HIV-infected women. Ongoing randomized trials in Tanzania may provide...

Effect on productive mucosal immunity development

Therapy', it is important to emphasize the positive nutritional effect of breastfeeding on immune development (Brandtzaeg, 1996b). Also, as mentioned above, breast milk contains a number of immune cells, cytokines and growth factors that may exert a significant biological effect in the suckling's gut, apparently enhancing in an indirect way even the long-term health of the individual (Wold and Hanson, 1994 Newman, 1995). Numerous studies of the effect of breast-feeding on secretory immunity have been performed with salivary IgA measurements as a read-out system. Discrepant observations have been made, probably to some extent reflecting different cytokine levels in the milk as discussed above. The influence of contaminating the saliva sample with milk SIgA, shielding of the suckling's mucosal immune system by maternal SIgA antibodies, and altered growth and composition of the infant's gut flora have been discussed as additional uncontrollable variables (Brandtzaeg et al., 1991)....

After dietary assessment recommend nutrient supplements for vegan diets which are found to be nutrit

The ability to prevent food hypersensitivity is being debated. Exclusive breastfeeding for at least 4 months has been shown to decrease the risk of allergy in infants at increased risk of food allergies. The use of protein hydrolysate formulas and the delayed introduction of solid foods have been studied for prophylaxis of food hypersensitivity. Many of the studies are conflicting. (For further discussion of this topic, see the sections on breastfeeding and the prevention of allergies, and protein hydrolysate formulas.) A single recent study showed that exclusive breastfeeding, or feeding a formula containing a partially hydrolyzed whey-hydrolysate, was associated with lower incidence of atopic disease and food allergy compared to feeding soy or conventional cow's milk formulas electrolyte solutions containing specific concentrations of carbohydrate, sodium, potassium and chloride promote fluid and electrolyte absorption, while fluids such as juices, carbonated soft drinks, tea,...

Strength of evidence

Home and school environments that support healthy food choices for childrend Breastfeeding Breastfeeding (protective). Breastfeeding as a protective factor against weight gain has been examined in at least 20 studies involving nearly 40 000 subjects. Five studies (including the two largest) found a protective effect, two found that breastfeeding predicted obesity, and the remainder found no relationships. There are probably multiple effects of confounding in these studies however, the reduction in the risk of developing obesity observed in the two largest studies was substantial (20-37 ). Promoting breastfeeding has many benefits, the prevention of childhood obesity probably being one of them.

Vitamin Mineral supplementation of breastfed infants

The quality of the breastfeeding mother's diet is important for her health and energy, but has a variable effect on milk production and on milk composition (Riordan and Auerbach, 1993). Minerals and fat-soluble vitamin (A,D,E,K) levels in breast milk are minimally influenced by recent maternal diet as these can be drawn from storage in the body. Water-soluble vitamins (eg. ascorbic acid, nicotinic acid, thiamin, riboflavin, pyridoxine, B12) are readily influenced by the maternal diet (Riordan and Auerbach, 1993 Atkinson, 1992). However, if the mother is well nourished, there is no need for supplementation. Only if a mother eats a very restricted diet (e.g. vegan) should supplemental nutrients be recommended to ensure adequate nutrient intake for her and adequate delivery of vitamins to the breastfed infant. With the exception of vitamin D, vitamin and mineral supplementation of breastfed term infants in the first 6 months is not recommended.

Clinical Application and Intervention Strategies

Breastfeeding Promotion of breast-feeding should be continued. The anti-infective properties of human milk are well known and depend in part upon various cellular and soluble factors, as well as its buffering capacity and several antigen-nonspecific protective factors (see also Brandtzaeg, Chapter 14, this volume). Secretory IgA antibodies against a variety of common pathogens have been found in human milk and correlate negatively with morbidity due to specific diseases, such as cholera (Chandra, 1992). The protective effect is particularly dramatic in underprivileged communities with poor sanitation, inadequate housing and contaminated food and water. Furthermore, breast-feeding contributes to birth spacing, an important factor in both maternal and child health.

Transition to Solid Foods

Within this age range have been considered physiologically and developmentally ready for new foods, textures and modes of feeding. Most evidence suggests that introduction before 2 to 3 months or later than 6 months has more risks than benefits (Schmitz and McNeish, 1987). The early introduction of weaning foods may satisfy the hunger of the infant, resulting in less frequent breastfeeding and ultimately less milk production in the mother. Because iron absorption from human milk is depressed when the milk is in contact with other foods in the proximal small bowel, early use of weaning foods may increase the risk of iron depletion and anemia. It has been suggested, but with little proof, that early introduction of weaning foods may increase the risk of infections and allergies and predispose the infant to obesity, hypertension and arteriosclerosis later in life. On the other hand, potential risks of delayed weaning are faltering growth, nutrient deficiencies (iron, zinc, vitamins A and...

Vitamin K status and health Adults

Newborn infants are a special case in vitamin K nutrition for several reasons lipids are not easily transferred across the placenta, the neonatal liver is immature with respect to prothrombin synthesis, breast milk is low in vitamin K and the infant gut is sterile at birth. As a result of this unique combination of factors infants can develop a condition known as haemorrhagic disease of the newborn (HDN). The term HDN was first used in 1894 by Townsend who described it as a self-limiting bleeding disorder of newborns of unknown origin (Shearer, 2000). Until the late 1960s HDN was thought to be a problem of the first week of life however, two other forms have now been identified late HDN, a more serious condition, that occurs between weeks 3 and 6 of life and early HDN occurring in the first 24 hours, probably caused by antagonistic drugs taken during pregnancy. Late HDN is rare, about 4-70 cases per 100000 births but world-wide is a significant cause of infant morbidity and mortality....

Macronutrients Energy

The goal is to avoid both ends of the spectrum, both excessive energy intake as well as inadequate energy intake. Overnutrition and excess weight gain in pregnancy impart risk of gestational diabetes, macrosomia, delivery complications such as shoulder dys-tocia, cesarean delivery and post operative problems, difficulty initiating breastfeeding, and risk of subsequent maternal and child obesity 8-10 . Conversely, undernutrition and inadequate weight gain during pregnancy can lead to impaired intrauterine growth and consequent low birth weight of the newborn. In addition to complications at birth, intrauterine growth retardation has been associated with metabolic abnormalities in adulthood, such as hyperlipidemia, hypertension, cardiovascular disease, glucose intolerance, and type 2 diabetes 10, 11 .

Breast Implants and Breast Reduction

Many women with breast implants breastfeed successfully, though it is not known whether the health of the infant is affected by breast implants. Human milk contains nutrients and antibodies that keep babies healthy. Although it is considered the ideal feeding method for infants, 36 percent of mothers in the United States do not breastfeed at all. Photograph by Jim Trois. Photo Researchers, Inc. Reproduced by permission. Human milk contains nutrients and antibodies that keep babies healthy. Although it is considered the ideal feeding method for infants, 36 percent of mothers in the United States do not breastfeed at all. Photograph by Jim Trois. Photo Researchers, Inc. Reproduced by permission. Women who have had a breast reduction may not be able to breastfeed, since the surgical procedure removes glandular tissue and realigns the nipple.

Policies and Recommendations

A woman's ability to breastfeed for the optimal recommended time depends on the support she receives from her family, health care providers, and the workplace. Health care institutions should adopt policies and initiatives that include A written breastfeeding policy A breastfeeding education program Breastfeeding on demand With the increased number of women in the workforce, employers can do a lot to support and encourage breastfeeding, such as providing adequate breaks flexible hours job sharing part-time work refrigerators for storage of breast milk and on-site child care. A public health campaign can greatly increase the initiation and duration of breastfeeding. These campaigns should target all social groups, including men, future parents, grandparents, health care providers, and employers. In addition, culturally appropriate programs and materials should be available. Breastfeeding saves lives and money, and it benefits all of society. see also Beikost Infant Nutrition Mastitis...

How the Program Works

WIC currently serves 45 percent of all babies born in the United States. As the name of the program implies, babies up to twelve months of age are considered infants. They are eligible to receive iron-fortified infant formula, infant juice, and dry infant cereals. Children up to five years of age receive iron-fortified cereal, fruit and vegetable juices that are a good source of vitamin C, eggs, milk, cheese, peanut butter, and dried beans and peas. Pregnant women receive larger packages of the same foods that children receive. Following pregnancy, mothers who exclusively breastfeed their babies may receive more foods, including raw carrots and canned tuna, and they are eligible up to one year after the birth of their baby. Those women who do not breastfeed may be eligible up to six months after the birth of their baby. The WIC foods may be obtained at grocery stores. Further, participants can obtain fresh, locally grown fruits, vegetables, and herbs at WIC-authorized Farmers' Markets...

Have You Ever Wondered

. . . if you can breast-feed if you're sick Yes-usually it's safe to continue breast-feeding. It even offers added protection for your baby, who already has been exposed to any bug before you experienced any symptoms. In breast milk you pass on some immunity through the antibodies your own body produces to fight the infection. If you're taking any medications to treat an illness, talk to your pediatrician to make sure they're compatible with breast-feeding. Severe illness may require weaning again consult your doctor. Breast-Feeding Positions Other signs of breast-feeding success your baby's A father can play a very important role in the success of breast-feeding. He can offer support, encouragement, and confidence to a new mother. Ways that fathers can get involved include attending prenatal breast-feeding classes with an expectant mother, reading a book on breast-feeding, arranging pillows, and bringing a snack or a beverage for mom when breast-feeding. A father also can burp the...

Do Babies Need Extra Water

What about long-term benefits Women who have breast-fed have a lower risk of developing pre-menopausal breast cancer, ovarian cancer, and osteoporosis and hip fractures. Breast-feeding also helps with blood glucose levels for women with gestational diabetes. To learn more about eating while breast-feeding, see For Those Who Breast-Feed in chapter 17.

What about Supplemental Bottles

Breast-feeding abides by the law of supply and demand. Nursing stimulates the flow of milk and increases its production as baby demands more to meet his or her needs. So supplemental bottles usually aren't needed unless your pediatrician advises it, perhaps if your baby loses weight and doesn't regain it. If you choose to offer a supplemental bottle or a pacifier, wait about four weeks after birth, or until breast-feeding is well established. Because the nipple on a bottle or a pacifier is different from the breast, it can confuse a baby who is just learning to breast-feed.

What Are Infant Formulas

Cow's milk-based infant formulas offer a nutritious complement to breast-feeding and can be used in place of it. These formulas, such as Similac , Enfamil , and Good Start (Nestl ), are different from breast milk in that they are taken from cow's milk and also do not contain all of the beneficial immune factors and certain other nutrients. However, manufacturers are constantly modifying these formulas to more closely match breast milk. Cow's milk-based formulas generally contain casein as a protein source, which has been partially digested by heat treatment. This improves infant digestion of this protein and drastically decreases the likelihood of the formation of a discomforting curd in the digestive tract. Some formulas include only whey protein that is partially digested to ease digestive complications.

Dietary Hazards Caffeine and Alcohol

About 1 of a maternal dose of caffeine (whether from coffee, tea, soft drinks, chocolate, or medicines) is transported into the breastmilk. Infants metabolize caffeine more slowly than adults, and caffeine in breast milk may cause irritability and wakefulness. High intake of alcohol can inhibit milk production. Moreover, infant exposure to alcohol during breast-feeding may have serious adverse effects on development. Ethanol itself readily passes into the milk at concentrations approaching those in maternal blood and can produce lethargy and drowsiness in the breast-feeding infant. Heavy alcohol consumption (more than 4-5 drinks day) by nursing mothers may impair psychomotor development in their infants.10 The effects of occasional light drinking are unknown.

Have You Ever Wondered 109

. . . if avoiding certain foods during pregnancy can prevent food allergies in the baby There's no conclusive evidence that restricting foods during pregnancy makes any difference. In fact, it's not recommended. Babies born to mothers who have restricted their diets during pregnancy often have lower birthweights. And eating a known food allergen during pregnancy won't cause a food allergy in the infant either. See Food Sensitivities and Your Baby in chapter 15 for more guidance. if breast-feeding can prevent food allergies in the baby Perhaps so. For those with a family history of allergies, breast-fed babies are less likely to have food allergies. As a precaution against potential allergens in breast milk, the American Academy of Pediatrics suggests that nursing mothers of susceptible infants (with a family history of allergies) are wise to skip peanuts and peanut-containing foods. See Breast-Feeding Your Baby in chapter 15 for more information.

Are Vitamin and Mineral Needs Greater During Infancy

Complementing breast-feeding with a vitamin D-fortified infant formula can assist in meeting an infant's needs. Because the iron content of breast milk is relatively low, the introduction to solid foods between ages 4 to 6 months becomes very important in supplying this nutrient. Iron-fortified cereals are very good choices. Many pediatricians will recommend an iron supplement for infants during their first few months of life. Again, complementing breast-feeding with an iron-fortified infant formula can assist in meeting an infant's needs. Furthermore, infants fed a vegan or other meat-restrictive diets would need a vitamin B12 supplement.

Fiber How Much Is Enough

How much total fiber do you need That depends on your age and gender. For men up to age fifty years, the Institute of Medicine advises an Adequate Intake (AI) of 38 grams daily for women that age, it's 25 grams daily. During pregnancy and breast-feeding, the advice is slightly higher. If you're age fifty-one years or more, the AI is less 30 grams of total fiber daily for men 21 grams for women. Chapter 16 gives fiber recommendations for children and teens.

Effect on oral tolerance development

On the suckling's GALT (see above) may contribute to the establishment of oral tolerance not only against the indigenous microflora, but also against dietary antigens, such as gluten. Antibodies to gluten peptides are present in breast milk (Juto and Holm, 1992) and breast-feeding has in fact been shown to protect significantly against the development of coeliac disease in children, an effect that is unrelated to the time of solid food introduction (Brandtzaeg, 1997a). Early exposure to cow's milk has been suggested to be associated with predisposition to type 1 (insulin-dependent) diabetes, and investigations have particularly focused on immune stimulation by bovine serum albumin (Karjalainen et al., 1992), -lactoglobulin (Dahlquist et al., 1992) and insulin (Vaarala et al., 1999). In a recent study, short-term breast-feeding and early introduction of cow's milk were found to be associated with progressive signs of type 1 diabetes-related autoimmunity (Kimpim ki et al., 2001). The...

Throughout Life Tfflfe

Identify when your energy needs are changing (i.e., changes in physical activity levels, pregnancy, breast feeding) and adjust your diet appropriately to maintain your health and fitness. Each individual should eat the appropriate number of servings from each food group based on their EER (refer to Chapter 1 and Table 3-2). Seek the help of a Registered Dietitian if you have any concerns about your diet or the diet of a family member. Even if you do not cook your meals or if you eat in the galley, you can make healthy food choices (see Appendix A). When eating in the galley, ask for the Healthy Navy Options menu items (available in the larger galleys and ships). Make high-fat foods the exception rather than the rule in your diet.

Bottles and Nipples Baby Feeding Supplies

There are four basic baby-bottle nipple types a regular nipple with slow, medium, or fast flow (the number and size of the holes will determine flow) a nipple for very small or premature babies an orthodontic nipple, which imitates the shape of a human nipple during breast-feeding and a cleft-palate nipple. A cleft-palate nipple is meant for babies who have a lip or palate problem that keeps them from sucking properly.

Striking species differences

In contrast to the animal species mentioned above, the human fetus acquires maternal IgG via the placenta (Mackenzie, 1990) and perhaps, to some extent, from swallowed amniotic fluid via FcRn expressed by fetal enterocytes (Israel et al., 1993). Indeed, a bidirectional transport mechanism for IgG was recently demonstrated in a human intestinal epithelial cell line (Dickinson et al., 1999), but the functional significance of FcRn on enterocytes in the human newborn remains unknown. Intestinal uptake of secretory IgA (SIgA) antibodies after breast-feeding appears of little or no importance in the support of systemic immunity (Ogra et al., 1977 Klemola et al., 1986), except perhaps in the preterm infant (Weaver et al., 1991). Although gut closure in humans normally seems to occur mainly before birth, a patent mucosal barrier function may not be established until after 2 years of age the different variables involved in this process are poorly defined (van Elburg et al., 1992)....

Spartan Diet Principle on Dairy

Firstly, let's get one thing straight, dairy products are not needed by people. We can do quite well without them. Once you have finished breast-feeding you never really need milk again. No other animal drinks milk after it has been weaned. I've gone up to year without any milk or yogurt and done just fine.

Pathophysiology transmission and progression of HIV disease

However, mother-to-child transmission of HIV through breast feeding depends on a number of risk factors other than the susceptibility of the gut to HIV. Increased viral load in breast milk is correlated with high plasma viral load and decreased CD4 count in the mother, and is associated with higher transmission.8-10 These conditions are found in the early stages of new infection or in advanced disease. It is not clear, however, whether it is cell-associated or cell-free virus that is more important for transmission. Other breast-milk factors such as HIV-1-specific IgG and secretory leukocyte protease inhibitor (SLPI) have HIV-1 inhibitory activity in vitro.11 SLPI acts on the target cell rather than the virus and inhibits internaliza-tion of HIV-1 rather than initial binding.12 Infant feeding practices may significantly influence the way in which these non-intestinal factors interact exclusive breast feeding results in a greater volume of milk being ingested and hence increases the...

Recommendations for food allergen avoidance

With respect to primary prevention, there are areas of clear concordance, and both statements support the limitation of primary prevention to high-risk infants only, and the use of hypoallergenic formulas (ideally extensively hydrolyzed) but not soy milk for bottle-fed high-risk infants. High risk is defined on family history grounds rather than any perinatal testing, although the AAP defines a positive family history as two first-degree relatives with atopic disease and the ESPACI ESPGHAN definition requires only one. Neither recommend maternal exclusion diets during pregnancy and both recommend exclusive breast feeding (AAP 6 months, ESPACI ESPGHAN 4-6 months). While the European bodies do not recommend a maternal exclusion diet during lactation, the American body recommends exclusion of peanuts and nuts, and consideration of further exclusions. The European regulations are also less restrictive about the introduction of solid foods, suggesting introduction at 5 months, rather than...

Have You Ever Wondered 104

Breast milk is the best first food for babies. When breast-feeding isn't chosen, commercial infant formulas, including soy formulas, are a healthful option. Caution Cow or goat milk, regular soy beverage or rice beverage, or homemade formula are not suitable substitutes for commercial infant formula

Vitamin C More than Citrus

How much you need The RDA for females and males ages fourteen to eighteen is 65 milligrams and 75 milligrams of vitamin C daily, respectively. Adult males need 90 milligrams daily adult females, 75 milligrams of vitamin C daily for everyday needs (about the amount in 3 4 cup of orange juice). Women need somewhat more during pregnancy (80 to 85 milligrams) and breast-feeding (115 to 120 milligrams).

Bcell homing to mammary glands

Lactating mammary glands are part of the integrated mucosal immune system, and milk antibodies reflect antigenic stimulation of MALT in the gut as well as in the airways. This fact has been documented by showing that SIgA from breast milk exhibits antibody specificities for an array of common intestinal and respiratory pathogens (Goldman, 1993). The secretory antibodies are thus highly targeted against infectious agents in the mother's environment, which are those likely to be encountered by the infant during its first weeks of life. Therefore, breast-feeding represents an ingenious immunological integration of mother and child (Fig. 14.4). Although the protection provided by this humoral defence mechanism is most readily demonstrable in populations living in poor sanitary conditions (Hanson et al., 1993 Anon., 1994), a beneficial clinical effect is also apparent in the industrialized world (Wold and Hanson, 1994),

Effects of antigen exposure and nutrition on secretory immunity

In human lactating mammary glands the immunocyte density is much less, one gland showing an IgA-producing capacity similar to that of only 1 m of intestine (Brandtzaeg, 1983). Thus, the daily output of IgA kg-1 wet weight of tissue (minus fat) is no more for lactating mammary glands than for salivary glands. In fact, it remains an enigma how any terminal plasma cell differentiation at all is accomplished in these secretory effector organs, which are at considerable distances from antigen-exposed mucosal surfaces (Brandtzaeg et al., 1999a). Anyhow, the large capacity for storage of pIgA SIgA in the mammary-gland epithelium and duct system, rather than a high immunocyte density, explains the remarkable output of SIgA during breast-feeding (Brandtzaeg, 1983).

Enteric infections in HIVinfected children

Specific as an indicator of HIV infection recurrent episodes are better markers of HIV-infection in both children and adults. Thrush is often reported as a risk factor for breast-feeding transmission of HIV, presumably by inducing mucosal breaks facilitating viral entry, but the direction of causality is unclear from the available data.96,97 Gut colonization follows oral infection with Candida species. Candidiasis of the mouth and esophagus is associated with poor appetite and weight loss. Esophageal inflammation is reported in up to 40 of children with AIDS and can be severe 45,98 occasionally a necrotizing esophagitis which may bleed or even perforate can occur. The main differential diagnosis is herpes, CMV and Mycobacterium avium intracellulare. Candida may also produce inflammation and erosions in the gastric mucosa and the large and small intestines. The parasite can occasionally cause local abscesses, which may disseminate resulting in generalized candidiasis. Endoscopy and...

Specific food allergies

To specific foods.8,14,24,51 Many cases appear to sensitize through maternally ingested antigens during exclusive breast feeding, with the small amounts of dietary proteins either sufficient to sensitize or insufficient to tolerize. A specific defect in oral tolerance for low-dose antigen has been postulated as a cause of this phenomenon,114 supported by recent data of a defective generation of Th3 cells within the mucosa of affected chil-dren.34 Affected children may show residual intolerance of hydrolysates.5,14,52

Counseling The Vegetarian Mother

Dietary intake is known to affect the concentration of many nutrients in human milk, whereas others appear less affected.22,92,93 A very high percentage of vegetarian mothers breast-feed their infants and they do so for extended periods of time.94 Protein concentration was observed to decrease in the milk of macrobiotic women with increasing stage of lactation and, after adjustment for stage of lactation, it contained less calcium, magnesium, vitamin B12, and saturated fatty acids and more polyunsaturated fatty acids.94 In keeping with other studies, milk from the macrobiotic mothers contained lower concentrations of contaminants. Because of the great likelihood that vegetarians will breast-feed their infants for extended periods of time, it is important that they are provided with the appropriate dietary guidance to assure an adequate nutrient intake over the entire period of lactation. Particular nutrients of concern have been identified and suggestions have been made for obtaining...

Nonfoods Effect on Breast Milk

While you breast-feed, take the same precautions you did during pregnancy. Food, beverages, or other substances what you consume may be passed to your baby. The Dietary Guidelines advise Alcoholic beverages should not be consumed by lactating women. Alcohol passes into breast milk drinking alcoholic beverages can decrease milk production. For a celebration drink, do so after breast-feeding, or postpone nursing for at least two hours. Nicotine passes into breast milk. If you're a smoker and quit during pregnancy, breast-feeding isn't the time to start again. Nicotine can reduce your milk supply, and increase your baby's chance for colic, a sinus infection, or fussiness. Smoking near your baby is risky, exposing him or her to secondhand smoke and possibly getting burned. Too close to a nursing session, smoking may inhibit your letdown reflex. Smoking is also linked to the increased rate of lung cancer.

The Women Infants and Children WIC Program

By helping participants achieve recommended weight gain. Nutritional food choices and calorie levels based on recommended weight gain are emphasized. The program has been shown to significantly reduce a number of negative pregnancy outcomes, including low birth weight. see also Adolescent Nutrition Breastfeeding Low Birth Weight Infant Pica Small for Gestational Age Women's Nutritional Issues.

General guidelines for treatment of diarrheal diseases

As outlined in the various sections of this chapter (see also Chapter 37), the treatment of the majority of infectious diarrheal episodes is supportive, with ORS representing the cardinal intervention to minimize life-threatening dehydration, particularly in young children.105 Breast feeding should be continued, as it may confer protection. Intravenous rehydration should be reserved for high-risk patients who are unable to tolerate enter-als due to recurrent vomiting or diminished mental status. The use of antimotility agents, such as bismuth subsalicylate (Pepto-Bismol ), loperamide (Imodium ), and atropine sulfate with diphenoxylate hydrochloride (Lomotil ) should be discouraged, owing to the possible risk of sali-cylate intoxication, ileus, toxic megacolon, bowel perforation, and HUS in subjects infected with EHEC. Probiotics, such as Lactobacillus GG, have been recently shown to be effective both in the prevention, and in the treatment of viral (rotavirus) and...

Gene Diet Interactions

Although most of the gene-diet interactions have focused on dietary fats, other habits such as coffee drinking have been studied in a recent case-control study (Cornelis et al., 2007a) that examined the interaction between the adenosine A2A receptor (ADORA2A) and the CYP1A2 genes and caffeine intake (see Table 1.2) and reported a modulation of caffeine intake due to genetic variability at the ADORA2A gene. Several other phenotypes have been investigated in relation to gene-diet interactions beyond dietary fats. One of the most solidly established is the 5',10'-methylenetetrahydrofolate reductase (MTHFR) gene which has been comprehensively reviewed (Cummings and Kavlock, 2004 Friso and Choi, 2005). Another less explored example is the one provided by investigators in the UK and New Zealand who tested whether children's intellectual development was influenced by both genetics and early nutrition - i.e. breastfeeding versus formula feeding (Caspi et al., 2007). These researchers showed...

Pathophysiology of functional constipation

Symptoms of constipation in most children start in more than 38-65 before the age of 6 months, and some have even described bowel problems in 40 of children in the first months of life. Stool habits might change, owing to stress factors and change in nutrition, for instance change from breast feeding to formula feeding. Specific questions regarding the presence of soiling and encopresis should be asked, and also regarding the frequency and whether it is present at night-time. These children produce an enormous amount of stool once every 7-30 days, which is almost never spontaneously presented as a symptom during a first doctor's visit. It must also be asked whether this enormous amount of stool has been produced just before the visit to the doctor (the rectum might then be empty for rectal examination). Questions about retentive posturing should be asked, but might be difficult to answer nevertheless, the parents might notice whether stools are produced

Risk factors for persistent diarrhea

Risk Factors For Acute Diarrhea

The association of prolongation of diarrhea with starvation and inappropriately prolonged administration of parenteral fluids has been recognized for over half a century. Continued breast feeding is important unnecessary food withdrawal, and replacement of luminal nutrients, especially breast milk, with non-nutritive agents is a major factor in prolonging mucosal injury after diarrhea. In particular, blanket administration of antibiotics and anti-motility agents and semi-starvation diets should be avoided in cases of prolonged diarrhea.39,40 While parenteral nutrition has been occasionally life saving in selected cases in developing countries,41 it is clearly an impractical option for most of the developing world. There is now clear evidence supporting the enteral route for nutritional rehabilitation of malnourished children with persistent diarrhea.12 Starvation has been shown to have deleterious effects on the intestinal mucosa,42 with a reduction in the nutritive transporters for...

Principles of management of persistent diarrhea

Continued breast feeding Reduce lactose load by It is exceedingly rare to find persistent diarrhea in exclusively breast-fed infants, and with the exception of situations where persistent diarrhea accompanies perinatally acquired HIV infection, breast feeding must be continued. Most children with persistent diarrhea are not lactose intolerant, although administration of a lactose load exceeding 5 g kg per day is associated with higher purging rates and treatment failure. In general therefore withdrawal of milk and replacement with specialized (and expensive) lactose-free formulations is unnecessary. Alternative strategies for reducing the lactose load in malnourished children with persistent diarrhea include the addition of milk to cereals as well as replacement of milk with fermented milk products such as yogurt. These dietary interventions have now been extensively evaluated in several studies in South Asia, and found to be of equivalent efficacy to expensive formulations.51,52...

Weight gain recommendations and consequences of noncompliance

This lack of adherence to weight gain recommendations during pregnancy should be cause for concern. Excessive gestational weight gain has been shown to be a risk factor for maternal and neonatal complications, independent of prepregnancy BMI. For example, among the 7661 pregnant women in New Jersey examined by Jain et al. 56 , women who gained greater than 35 lb during pregnancy increased their risk of macrosomia and delivery by cesarean section by 60-180 and had lower rates of breastfeeding by 30 . In another study, Hilson et al. 57 showed that mothers who exceeded IOM weight gain recommendations failed to initiate and or sustain breastfeeding in all categories of prepregnancy BMI. Excessive gestational weight gain may lead to child adiposity. In a recent prospective study of over 1,000 mother-child pairs, mothers with greater gestational weight gain had children with greater BMI and skin fold thicknesses (triceps and subscapular) at 3 years of age 58 . This association was...

Micronutrients and postpartum depression Iron

Folate deficiency has been associated with problems in nerve development and function and has classically been thought to pose more of a risk to fetuses, infants, children who are growing however, recent reports have linked folate deficiency with depression 87-91 . Neural tube defects have been associated with inadequate folate intake prior to conception and during pregnancy are described in Chap. 17, Folate a Key to Optimal Pregnancy Outcome). Excellent sources of folate include liver, yeast, asparagus, spinach, oranges, legumes, and fortified cereals grain products 79 and see Chap. 17 . During the postpartum period, folate needs are 400 mcg day unless the woman is breastfeeding, which increases the need to 500 mcg day 79 . Riboflavin is important in the formation of key enzymes necessary for energy production via the citric acid cycle electron transport chain. Based upon this role, adequate riboflavin intake during pregnancy and the postpartum period could be beneficial to maternal...

Risk Factors for Vitamin A Deficiency

And boys are affected more often than girls. Breast-feeding practices such as no breastfeeding, early weaning, or rapid weaning are associated with an increased risk of vitamin A deficiency. Pregnant women and nonpregnant women of childbearing age are at higher risk of vitamin A deficiency. Vitamin A deficiency tends to cluster in households and in villages, with higher risk of xerophthalmia among children within the same family, and within mothers and their children. The relationships of risk factors for vitamin A deficiency are shown in Fig. 17.

Vegetarianism at Different Ages

When choosing vegetarian eating, it is important to be aware that there are special nutritional needs at different stages of life. Pregnancy and breastfeeding require additional calories and nutrients. A well-planned vegetarian diet can provide these in the amounts needed for a healthy mother and baby.

Michelle Price Judge and Cheryl Tatano Beck

Nutrition plays an integral and complex role in the brain. Nutrients provide structural substrates and serve as cofactors in many biological reactions. There are wide varieties of nutrients that are attributed to having a role in normal function. To name a few, the macronutrients, B vitamins and some trace minerals have been noted as factors integral to central nervous system (CNS) function. In order to describe the important role of nutrients in mental health it is important to first discuss general principles of CNS anatomy and physiology including nerve impulse conduction, neuroanatomy relating to mood and emotions, and the role of neurotransmitters in the brain. The latter section of this chapter outlines the potential role of key nutrients in postpartum depression with practical nutritional strategies for the postpartum period. This chapter closes with a discussion of the current literature related to breastfeeding and postpartum depression.


There are no contraindications to lactation for the woman with diabetes, and women should be encouraged to breastfeed. The meal plan is adjusted to include additional snacks to avoid hypoglycemia, which may be more frequent during lactation. Women with type 2 diabetes and choosing to breastfeed are advised to continue insulin therapy for the duration of lactation 35, 50 . Oral antidiabetic agents may resume once breastfeeding is terminated or if the woman chooses to formula feed her infant.


Mastitis is a common infection among breastfeeding women. The infection causes the breast to become tender, red, and hot. The woman also experiences flu-like symptoms, such as fever, tiredness, and sometimes nausea and vomiting. Breast infections can occur when the milk ducts become plugged or when the nipples become cracked. In rare cases, the connective tissues of the breast may become infected. Mastitis usually affects only one breast, and is treatable with antibiotics. Women with mastitis are encouraged to continue to breastfeed, or to pump the milk from both breasts, to prevent the breasts from becoming abscessed. Mastitis is not dangerous to the infant, since the milk is not infected. see also Breastfeeding.


Breastfeeding is the gold standard and strongly recommended method of feeding infants. The World Health Organization recommends human milk as the exclusive nutrient source for the first 6 months of life, with introduction of solids at this time, and continued breastfeeding until at least the first 12 months postpartum. Early postpartum weight is an issue for many women as they are anxious to return to their prepregnancy body size. For many, weight management will be difficult given personal circumstances and multiple demands on their time. Given the elevated nutrient requirements of lactation, women will need to plan meals with care to maximum nutrient intake while limiting energy dense foods. Women are encouraged to use the USDA Dietary Guidelines and My Pyramid or Canada's Food Guide or guides from their country of origin to select food choices including number and portion size. Following this dietary guidance should facilitate adequate intakes of key nutrients including calcium,...

Pyridoxine Vitamin B

Inadequate dietary intake of vitamin B6 intake leads to decreased production of pyri-doxal phosphate a key compound in the metabolism of all energy nutrients. This vitamin is also important for the synthesis of nonessential amino acids, which in turn effect the production of both important neurotransmitters, and the lipids that comprise myelin in nerve tissue 79 . Deficiency causes neurological symptoms including depression, headaches, confusion, and numbness and tingling in the extremities and seizures 79 . Vitamin B6 is found in a variety of foods including chicken, fish, pork, organ meats, whole-wheat products, brown rice, soybeans, sunflower seeds, bananas, broccoli, and spinach 79 . During the postpartum period, women require 1.3 mg of B6 daily if not breastfeeding. Breastfeeding women need 2 mg day of B6.

Flavor variety

Another advantage to breastfeeding is that it provides infants with rich and varied sensory experiences. That is, in contrast to formula-fed infants who become familiar with only a small set of invariant flavors, breastfed infants have extensive exposure to a wide range of flavors within their mothers' milks. As a result of these early and varied flavor experiences, breastfed infants are more willing to eat similarly flavored foods at weaning 53, 54 , a finding that is consistent with research in a wide variety of mammals 49, 55 . In a recent study 54 , breastfed infants showed greater liking of a fruit than did formula-fed infants, as did their mothers who reported eating more fruits in general when compared with mothers who formula fed. Similar findings were not observed among formula-fed infants despite their mothers eating more of a particular food. Although it remains unknown how much exposure the baby needs to enhance acceptance, our recent studies indicate that breastfeeding...

New Mothers Guide to Breast Feeding

New Mothers Guide to Breast Feeding

For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.

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