Breastfeeding:

advantages,
composition,
properties of
breast milk,
problems
 Nutrition of young children
• Rational feeding of
infants is the key to
their adequate
growth and
development, as well
as a high quality of
life, both in early
childhood and in
subsequent years.
 Natural feeding (breastfeeding)
• Feeding a child in the first year of life with
female milk, in which feeding is carried out
directly when applied to the breast of his
biological mother; at the same time, it must
be at least ⅘ of the daily diet. "Breastfeeding
is the best thing a person can get at the
beginning of life""Mother's breast is a buffet
for a baby" – A.P.Chekhov.
 Breastfeeding
• The only form of human nutrition that was
formed during the biological evolution of
man!The only physiological adequate
nutrition of a newborn infant!The only
postnatal equivalent of fetal nutrition
("mother-placenta-fetus", "mother-mammary
gland-native milk-baby")!
 Breastfeeding
World Breastfeeding Week
from 1 to 7 August.
In 1990, the Declaration on
the protection,
promotion and support
of breastfeeding was
adopted, signed by 32
countries and 10 UNICEF
agencies.
Today, World Breastfeeding
Week is held in more
than 170 countries.
 Prevalence of breastfeeding
In Russia in 1926, 98.1% of children
were on breastfeeding! Currently,
according to the Ministry of Health
of Russia (Rosstat calculation,
2021), breastfeeding among
children from 3 to 6 months (as a
percentage of the number of
children who reached 1 year in the
reporting year) was 43.9%; from 6
to 12 months it was 39.2%
Novgorod region up to 6 months
58.8%, up to 1 year 38.9%
 Why do so few women
breastfeed!?
• 1. A woman's personal beliefs!
• 2. The inability of health workers to support mothers, teach them how to
feed properly and explain the benefits of breastfeeding!
• 3. Many doctors recommend giving up breastfeeding for some far-fetched
health indicators!
• 4. Censure by many specialists of long-term breastfeeding (feeding up to 2
years of age in the UAE at the legislative level of 2014)!
• 5. There are few consultants of breastfeeding specialists! (There are 300 in
Russia!)
• 6. There are no feeding conditions in public places, negative attitudes of
others!
• 7. Aggressive marketing of adapted milk mixtures! The illusion that they
fully satisfy the needs of the child in all the elements he needs! (countries
where there is a complete ban on advertising adapted mixtures: norway,
brazil, bangladesh)
 Absolute Contraindications to
breastfeeding on the part of the mother
• HIV infection
• Particularly dangerous infections (typhus,
cholera, etc.)
• Acute mental illnesses
• An open form of tuberculosis
• Carrier of T-lymphotropic virus
 Possible contraindications to breastfeeding on
the mother's side
• Eclampsia
• Heavy bleeding during and after childbirth
• Decompensation in chronic diseases of the heart, lungs, kidneys,
liver, severe condition of a woman with infectious diseases
• Herpetic rashes on the skin until recovery
• Nicotine, alcohol, drug addiction
• Mastitis, abscess (feeding from a healthy breast, pumping from a
patient)taking medications (cytostatics, immunosuppressants,
anticoagulants such as phenindione, radioisotopes, lithium
preparations, antiviral, macrolides, tetracyclines, quinolones,
glycopeptides, imidazoles)
• Hepatitis B (subject to vaccination and administration of specific
immunoglobulin after delivery)), in case of acute hepatitis B and C,
feeding is temporarily discontinued
 What can be taken from medications
(International Internet directories)
• APILAM Handbook of the Association for the
Promotion of Cultural and Scientific Research
of Breastfeeding
• The LactMed Handbook of the American
National Library
• The Handbook of Dr. Thomas Hale, Medicines
and mother's Milk (reprinted and updated
almost annually)
 Absolute Contraindications to
breastfeeding on the part of the child
• classical galactosemia—
• congenital alactasia-
• glucose-galactose malabsorption—
• microvilli inclusion disease, congenital bundle
enteropathy-
• violation of the oxidation of fatty acids with
different long chains
 Physiology of lactation
• Lactation – the process of formation,
accumulation and excretion of milk – is a
physiological process.
• The mammary gland consists of alveoli shaped
like bubbles.
• Alveolar cells produce milk from blood
components. The outside of the alveolus is
covered with muscle cells, their contraction
leads to the vigorous movement of milk along
the duct that departs from each alveolus.
 Physiology of lactation
• Dozens of alveoli together with the connecting excretory
ducts form a gland lobe. The mammary gland usually
consists of 15-20 such lobes located around the areola
(the pigmented area around the nipple) and separated by
layers of connective and adipose tissues.
• The milk ducts, descending along all the radii of the gland,
in the area of the areola form a kind of baggy extensions -
sinuses, where milk accumulates, as in cisterns. Channels
from each sinus go to the nipple and open at its tip.
• During pregnancy, the mammary gland reaches full
development and from the middle of pregnancy becomes
able to produce milk. But right up to childbirth, this ability
is inhibited by the hormones of the placenta.
 Lactation – the process of formation,
accumulation and excretion of milk – is a
physiological process.
 Physiology of lactation
• Lactation begins after childbirth and is supported by regular breast-sucking by the
baby. Applying the baby to the breast within 30 minutes after birth contributes to
the earlier formation of lactation!
• Grabbing the breast and squeezing the areola with the gums, the newborn actively
sucks milk, while creating a vacuum of 200-220 mm Hg.
• By sucking, it causes the production of prolactin in the mother's body, a hormone
that triggers the formation of milk in the emptied alveoli and its entry into the milk
passages. Thus, when a child actively suckles, he not only satisfies hunger, but also
starts the process of forming new portions of milk. The more milk he sucks, the
more milk is formed for the next feeding. Thus, there is a natural regulation
system that ensures the production of milk according to the needs of the child.
• Breast–sucking triggers (with some delay) the production of another hormone -
oxytocin. Oxytocin stimulates the contraction of muscle cells surrounding the
alveoli. This ensures the vigorous promotion of milk through the ducts and sinuses
with an active "ejection" of it through the nipple. Oxytocin thus affects the
efficiency of milk excretion from the breast.
• In addition to sucking the baby's breast, the release of milk can trigger other
factors associated with feeding in a nursing woman: touching the baby, his cry,
mental images, etc.
 Physiology of lactation
• In a woman who has given birth, milk excretion, as a rule, begins on the 2nd or 3rd
day after childbirth and is established for some time. This period is critical for
lactation because the milk release reflex is very vulnerable and easily suppressed.
Anxiety, fear, mental stress or trauma, pain and other uncomfortable sensations,
as well as physical fatigue can disrupt the secretion of milk. To maintain stable and
sufficient lactation, psychological comfort, a woman's confidence in her abilities
and a full rest are so important. If the discharge reflex is suppressed, milk is
retained in the breast.
• The process of milk production in the alveoli stops and at the same time inhibits
the release of hormones that stimulate lactation - prolactin and oxytocin. As a
result, naturally, a smaller amount of milk is formed. If the situation with
incomplete emptying of the breast is repeated, this inevitably triggers the process
of suppressing lactation.
• Breast milk retention can also be provoked by irregular and inadequate breast
sucking by a child or insufficient pumping of milk. Therefore, nursing mothers
should remember that regular active sucking of the baby (or pumping) is the main
condition for maintaining effective lactation.
 COLOSTRUM (synthesized from the 22nd week of
pregnancy and the first 5 days after delivery)
• contains more proteins (2.3g/100ml, versus 0.9-1.1g/100 in comparison
with mature milk)
• Albumins (whey protein) prevail
• 2-10 times more vitamin A and carotene
• 2-3 times more ascorbic acid antioxidants
• more vitamin B12 and E, zinc, selenium
• 1.5 times more salts
• a lot of Ig A
• colostrum corpuscles – (leukocytes in the stage of fatty degeneration)
• lymphocytes contribute to the production of Ig
• in 1 ml – 2000 macrophages
• low fat
• oligoaminosaccharides 20-25 g/l
• Lactoferrin 2-8 mg/ml
 Properties of colostrum
• The presence of protective factors-prevents
infection, reduces the risk of purulent-septic
diseases
• Has a mild laxative effect-cleansing the
intestines of meconium and bilirubin, prevents
the development of jaundice
• Promotes the formation of optimal intestinal
flora, reduces the duration of the phase of
physiological dysbiosis
• Positive effect on the maturation of intestinal
functions
Composition and properties of breast milk

87.5% consists of water

Dry matter content from 10 to 17 g/100 ml:
1. Carbohydrates 7 g/100 ml
2.Fats 4 g/ 100ml
3. Proteins 1g/100 ml
4.Mineral substances -0.2 g/100 ml
 Protein and amino acids of female milk (0.9-1.3 g/100 ml)
• Identical to the proteins of the baby's blood serum
• Absorbed by diffusion
• Whey proteins (70-80%) (metabolizing proteins) (high digestibility)
• The ratio of whey protein (form a fine clot) and casein (beta fraction) is 3:2 (in cow's
milk 1:4)
• alpha-lactalbumin (25-35%) (rich in tryptophan and cysteine, promotes the growth of
bifidobacteria, the absorption of calcium and zinc, the synthesis of lactose from
glucose)
• alpha-lactalbumin in combination with oleic acid (HAMLET) prevents the growth of
malignant cells
• apolactoferin is a glycopeptide, an analog of blood transferin (binding and transport
of iron),
• a large number of immunoglobulins, especially IgA (95.2%), IgG 2.9%, IgM 1.9%
lysozyme (non-metabolizing proteins), protection against acute intestinal infection,
acute respiratory viral infections and other infections
• The amino acid taurine is a growth modulator that ensures the growth of nerve cells,
sympathetic and sensory neurons, and the epidermal cover
• In early childhood, not 8, but 9 amino acids are indispensable (threonine, valine,
leucine, isoleucine, lysine, tryptophan, phenylalanine, methionine, histidine).
 Amino acid composition of breast milk

• In early childhood, not 8, but 9 amino acids

are indispensable
• Children with natural feeding have higher
intelligence
• The amino acid taurine is a growth modulator
that ensures the growth of nerve cells,
sympathetic and sensory neurons, and the
epidermal cover
 Lipids of human milk (triglycerides,
phospholipids, fatty acids, sterols - from 31-35
g/l to 41-52 g/l)
• PUFA predominates (57%) over saturated
• Two irreplaceable fatty acids – linoleic and α-linolenic (precursors of
phospholipids, prostaglandins),
• Polyunsaturated fatty acids: arachidonic and docosahexaenoic -are
necessary for brain development, cell proliferation, myelination of nerve
fibers, retinal formation
• The high degree of dispersion facilitates the emulsification of fat and its
absorption
• Fat absorption 80-95% (from cow's milk – 60%)
• Triglycerides contribute to high fat utilization (98%)
• Triglycerides are resorbed without the participation of pancreatic lipase
• Cholesterol - a high level (formation of cell membranes, tissues of the
nervous system, a number of BAS, including vitamin D)
• Lipase of female milk – compensates for the low activity of pancreatic lipase
 Carbohydrates of female milk
(from 68-74 g/l)
• Lactose (disaccharide) – milk sugar, 85% in women's milk; have 2 times
more energy value, but the same osmolarity as monosaccharides
• β-lactose (a-lactose in cow's milk) is absorbed more slowly, manages to
reach the large intestine, stimulates the growth of G+ flora, stimulates the
synthesis of B vitamins and bifidum flora (properties of a prebiotic);
improved absorption of Ca, Fe, Zn, P
• Lactose consists of (galactose – promotes the synthesis of
galactocerebrosides of the brain, receptors and signaling molecules of
cellular recognition) and glucose
• Oligoaminosaccharides – provide protection against viruses, bacteria,
toxins, have a probiotic effect (15% of carbohydrates), are present in the
amniotic fluid already at 14 weeks of pregnancy (study by Jantscher-
Krenn, 2022)
 Lactase (enzyme)

• Lactose is necessary for the complete

digestion and fermentation of lactose
• In some children, the enzyme lactase matures
late, may be completely absent
• Breast milk contains its own enzyme lactase
Children with lactase deficiency need to
continue natural feeding
 Oligosaccharides (10-15 g/l)

• They are not broken down by enzymes of the

digestive tract, are not absorbed
• They are fermented in the colon, where they
are a substrate for the growth of
bifidobacterial
• Reduce the production of anti-inflammatory
cytokines
• Direct immunomodulatory effect
• Effect on gene expression
 Minerals of women's milk

• The content of minerals in colostrum is higher

(salts Na, Fe, Zn, Cu, K)
• In women's milk, the ratio of Ca : P, 2 : 1 (in
cow's milk 1: 1), Ca is associated with whey
proteins (digestibility 58%, from cow- 38%)
• Assimilation of Fe from female milk - 50%
(high bioavailability due to lactoferrin); from
cow's milk – 10 – 30%
 Vitamins of women's milk

• There are more fat-soluble vitamins (A, D, E)

in women's milk than in cow's milk
• Vitamin D activity is significantly higher due to
active metabolites (from 14 IU/l to 180 IU/l)
 Biologically active compounds contained in
women's milk (more than 4000)
Regulators of metabolism
•Vitamins and vitamin-like compounds, including carnitine
•trace elements
•hormones and hormone-like substances (prolactin, oxytocin,
growth hormone,thyroxine, estrogens, progesterone, leptin,
ghrelin, bombesin, neurotensin, etc.)
•free amino acids, including taurine
•cyclic nucleotides
•Enzymes
•proteins with opioid-like action: B-casomorphins (regulate
psychoemotional, intellectual development of a person)
 Biologically active compounds
contained in women's milk
• Growth and differentiation factors
• epidermal growth factor, stem cells
• insulin-like growth factor
• lactoferrin, taurine, polyamines
• prostaglandins
 Biologically active compounds
contained in women's milk
• Protective factors
• macrophages, lymphocytes, neutrophils
• Immunoglobulins
• Interferon
• Lysozyme
• Lactoferrin
• bifidogenic factors
 10 commandments of breastfeeding
(WHO)
1. Start breastfeeding within half an hour after delivery
(milk secretion and uterine contraction).
2. For the first 2 hours, the child and the mother should
be together and transferred to the postpartum ward
together.
3.Feed the baby often, on demand, day and night.
4. Do not give newborns any other food or drink.
Exclusively for the first 6 months!
5. After 6 months, when complementary foods are
introduced, breastfeeding should precede.
 10 commandments of
breastfeeding (WHO)
6. Continue breastfeeding and in the second year of life, up to 2
years. The unique content of Ig, especially A, prevents diseases.
7. A mother with tuberculosis, hepatitis, acute respiratory viral
infections can breastfeed a child and can be together with the
child
8. Do not give children breast-imitating devices on breastfeeding.
9. A nursing mother should not limit herself in drinking and
eating, i.e. according to appetite
10. Mom is the best incubator. To practice round-the-clock
presence of the mother and newborn in the same ward, which
prevents infection and hypothermia.