NUTRITION THROUGHOUT THE

LIFECYCLE

Michael Mambiya.
Mmed
[email protected]
om
NUTRITION DURING LACTATION
MAJOR PHYSIOLOGICAL CHANGES THAT
TAKE PLACE DURING LACTATION
• Anatomy of the Mammary Gland
Basic Structure:
• The mammary gland of the human female consists of milk-producing cells and a
duct system embedded in connective tissue and fat.
• The size of the breast is variable, but in most instances it extends from the second
to the sixth rib and from the central breast bone to the arm pit.
• The mammary tissue lies directly over the large chest muscle and is separated from
this muscle by a layer of fat, which is continuous with the fatty tissue of the gland
itself.
 The nipple and areola (the dark area around the nipple) enlarge
and darken during pregnancy. This may help your baby latch on
by providing a clear “target.”

 The small bumps on the areola are called Montgomery glands.

They produce a natural oil that cleans, lubricates, and protects the
nipple during pregnancy and breastfeeding. This oil contains an
enzyme that kills bacteria.
PHYSIOLOGY OF LACTATION

• When the baby nurses, the action of baby’s jaw and tongue pressing
down on the milk sinuses creates suction. This causes the milk to flow out
of the breast and into the baby’s mouth.
• Full lactation does not begin as soon as the baby is born.
• During the first 2 to 3 days post partum, a small amount of Colostrum is
secreted. In the subsequent days, a rapid increase in milk secretion occurs,
and in usual cases lactation is reasonably established by the end of the first
week.
• In first time mothers, the establishment of lactation may be delayed until
the third week or even later. The first two weeks are for initiation of
lactation and the subsequent weeks are for maintenance of lactation.
Milk production stages:
•Initiation and maintenance of lactation constitutes a complex process involving
both nerves and hormones. Lactation involves the sensory nerves in the nipples,
the spinal cord, the hypothalamus and the pituitary gland with its various
hormones. The process of milk production occurs in two stages:

1. Secretion of milk
2. Propulsion or ejection of milk, whereby the milk passes through the
duct system.
• These two events are closely related and often occur
simultaneously in the nursing mother
 1. Secretion of milk
• This involves both the synthesis of the milk components and the passage of
the product into the ducts.

• These events may be under independent control, since the accumulation of

both fat and protein reaches a high level during the latter part of pregnancy.
Shortly before delivery, the accumulated secretory products begin to pass into
the duct system. The secretory process is activated by the suckling stimulus
of the infant.

2. Ejection of milk

• This is where the milk passes through the duct system of the mammary
tissue awaiting the suckling stimulus of the baby
MILK LET DOWN REFLEX
• How a mother’s body responds to the baby’s suckling:
Infant suckling stimulates the nerve endings in the nipple and areola,
which signal the pituitary gland in the brain to release two hormones,
Prolactin and oxytocin.

Prolactin causes the alveoli to take nutrients (proteins, sugars, fats)
from the mothers blood supply and turn them into breast milk.

Oxytocin causes the cells around the alveoli to contract and eject the
milk into the milk ducts. This passing of the milk down the ducts is
called the “let-down” (milk ejection) reflex.

Let-down is experienced in numerous ways including:
o
The infant begins to actively suck and swallow.
o
Milk may drip from the opposite breast.
o
The mother may feel a tingling or a full sensation (after the first week
of nursing) in the breasts or uterine cramping.
o
The mother may feel thirsty
• Interference with let-down
A variety of factors may interfere with let-down:

Emotions such as embarrassment, anger, irritation, fear or resentment

Fatigue

Poor suckling from improper positioning

Not enough time baby is actively nursing

Stress

Negative remarks from relatives or friends

Pain in the breasts or uterus (i.e., sore nipples or afterbirth pains)

Breast engorgement in the first few days
Suggestions for creating a supportive nursing environment


Find a peaceful atmosphere for nursing. Before beginning the feeding,
unplug the phone, turn on relaxing music and do deep breathing. (Take four
or five deep abdominal breaths.)

If breastfeeding in public makes you uncomfortable, insist on your privacy
and/or drape a light cover over your baby and your shoulder.

Interact with friends and breastfeeding professionals who are supportive of
breastfeeding. Do not let well-meaning friends and relatives who have
different attitudes discourage you.

Restrict visitors until you are comfortable.

Be around other nursing mothers. Attend a postpartum exercise
class and/or support group.

Be sure your baby is positioned properly and allow enough suckling
time.
COMPOSITION OF BREAST MILK

• Colostrum
Colostrum, the early milk made by the breasts, is usually present until
after the
fifth or sixth month post delivery. Once the baby is born, it is present
in small amounts for the first three days to match the small size of
the baby’s stomach.
• Most babies do not need additional nutrition during this time.
• Women are encouraged to begin breastfeeding as soon as possible
after giving
birth.
• They must breastfeed at least 8 to 12 times per 24 hours so that
the baby receives this valuable milk.
• Colostrum and mature milk are designed to meet a newborn’s
special needs.
Colostrum has a yellow color, is thick in consistency, and is high
in protein and
low in fat and sugar. The protein content is three times higher
than mature milk,
because it is rich in the antibodies being passed from the
Mature milk

• The milk will change and increase in quantity about 48 to 72 hours

after giving birth. It may take longer depending on when breastfeeding
was started and how often the baby is breastfed. The change in milk
may occur a little earlier if a mother has breastfed before.

Foremilk
When first starting to breastfeed, the first milk the baby receives is called
foremilk. It is
thin and watery with a light blue tinge. Foremilk is largely water needed to
satisfy the
baby’s thirst.

Hind-milk
Hind-milk is released after several minutes of nursing. It is similar in texture
to cream and
has the highest concentration of fat. The hind-milk has a relaxing effect on
the baby.
Hind-milk helps the baby to feel satisfied and gain weight. The mother needs
to feed the
baby until it appears sleepy and satisfied.
• NOTE:
There is no such thing as “weak breast milk.” The mothers body will combine
the exact ingredients necessary to meet the baby’s needs.
NUTRIENT AND ENERGY REQUIREMENTS DURING LACTATION

•While breastfeeding, it is important to eat a well- balanced diet like the one
during pregnancy.

•After delivery, most women have an increased appetite and thirst. It is important
to eat nourishing foods and drink enough liquids to support the mothers health
and the body’s production of breast milk. A well-balanced diet contains:

Fruits

Vegetables

Milk and other dairy products

Breads and cereals

Protein foods (such as meats, poultry, eggs, beans and peanut
butter)
• Most women need about 500 extra calories per day to establish and
maintain an adequate milk supply. Caloric needs may vary
depending on your activity level, weight gain and desired weight.
Weight loss should be slow and gradual.

• Most women need about 8 to 10 glasses of fluids per day while

breastfeeding. Juice, water, soup or milk can provide the liquid you
need. They should drink enough fluids to satisfy their thirst and/or
produce pale, odourless urine or ease constipation. If they have
concentrated urine, strong-smelling urine and/or constipation,
they may not be drinking enough fluids.

• Almost everything a breastfeeding mother eats or drinks will come

through in her breast milk. Foods that are good for you will be good
for your baby too. It is rare to have to eliminate foods from your
diet. Although some babies may become fussy or cry when a
mother eats certain foods, there may be other reasons for your
baby’s fussiness.
SUBSTANCES TO ELIMINATE OR CUT
DOWN ON WHILE BREASTFEEDING

Coffee, tea and cola beverages containing caffeine may
cause your
 baby to be jittery and restless.

Alcohol in your blood quickly passes into your breast
milk. Too much alcohol in your blood will have the
same effect on your baby as it does on you. It can
also slow the let-down or release of your breast milk
to your baby. Discuss concerns with your health care
provider.

Smoking is not recommended while breastfeeding.
Nicotine is passed through to the breast milk and
may be consumed by your baby.

Illegal drugs, including marijuana, will pass
through breastmilk and are harmful to babies.
 Many medications are passed into breast milk, but
usually in such small amounts that the baby is not
affected.
 To be safe, check with your health care provider
before taking any medication. Always remind health
care providers, including dentists, that you are
breastfeeding
Benefits of breastfeeding to the child

• It is a complete food for the child as it

contains all the nutrients and water in right
proportions for proper growth and
development of the child for the first 6 months
of life

• It protects the child from diseases

• It is easily digested and prevents constipation

 It is a natural food which is readily available and at the right
temperature. It does not need any preparation
 The colostrum acts as a laxative cleaning the child’s stomach.
 It protects the child from allergies such as skin rush and
diarrhoea. Breast milk antibodies protect the child’s gut
preventing harmful substances to pass into the blood.
 Breastfeeding promotes emotional bonding between child and
mother that provides the child with a sense of security and
trust.
 Frequent skin-to-skin contact between mother and infant lead
to better
psychomotor, affective and social development of the child.
 Suckling develops facial muscles which help in jaw and teeth
development
 Benefits of breastfeeding to the
mother
Breastfeeding helps to reduce loss of blood after
delivery. This is because oxytocin (milk secreting
hormone) stimulates uterine contraction which
facilitates expulsion of the placenta thereby helping
the woman’s womb to return to normal.
 It is a method of family planning. Prolactin (milk
production hormone) suppresses ovulation as long as
 The child is exclusively breastfeeding
 The child is less than six months
 Menses have not returned (Post-partum amenorrhea)
 It is cheap
 It is convenient as it does not need any preparation.
• Fosters enhanced bonding between mother and child
 Reduces risks of pre-menopausal breast and ovarian
cancer.
Benefits of breastfeeding to the family
 No expenses in buying formula, firewood or other fuel
to boil water, milk or utensils. The money saved can be
used to meet the family’s other needs.
 Reduced medical expenses due to reduced episodes
and severity of illnesses.
 As illness episodes are reduced in number; the
family
encounters few emotional difficulties associated with
the child illnesses.
 Child births are spaced due to its contraceptive effect.
 Time is saved for other activities
 Benefits of breastfeeding to the
community/nation
Reduce expenditure on importing infant
formula and other supplies
 Healthy children form the basis of a healthy human
capital
 Potential savings in health care due
to reduced episodes and severity of
illnesses
 Protects the environment (trees are notused
for firewood to
boil water, milk and utensils, thus protecting the
environment)
•Benefits of Breastfeeding in the first 6 months
It is protective against gastrointestinal
infections
It prolongs duration of lactational
amenorrhea
It enhances infant motor development
There no adverse effects on infant growth
6 to 12 months
•During this phase, breast milk alone does not provide all the
nutrients required to support optimum growth of the child.
At this point infants are ready to take soft and semi soft
foods in addition to breast milk. Breast milk provides 35 to
40% of energy and it is an essential source of fat, vitamin A,
calcium and riboflavin.
6 months
• Introduce complementary foods. The baby should be given at least 3
spoons of thick phala in the morning and evening complementing the
breastfeeding
6 – 9 months
• The baby should be given at least 2 meals plus a snack mid morning
complementing the breast feeding
9 -12 Months
• The baby should be given at least three meals plus a snack mid morning
and mid afternoon complementing the breast milk
12 – 24 Months

• Should eat from the family meals

• Should learn eat independently
• Should have 3 main meals plus snacks mid morning and mid
afternoon complementing breast milk
Feeding the sick child (during and after illness)

• The first three years of life are very critical for the Survival,
Growth and development of the child
• The child goes through various milestones such as doubling
its birth
weight at 6 months, sitting, crawling, walking and running.
• In addition, the child is prone to infections as they
interact with the surroundings.
• Hence their nutrition requirements are high.
• Appropriate feeding practices are therefore important to ensure
adequate nutrition and health.
• If the child is malnourished during the first 2 years of life, the
effects may be irreversible even if the nutrition status
improves in the later years.
6 – 24 Months (during and after
illness)
• The mother should continue to breastfeed more
frequently
• Offer an extra meal or nutritious snack for a period of
2 weeks after illness.
• A child should be given a variety of foods from the six
food groups in addition to breast milk. Some form of
animal food is vital.
Things to do to improve a Child’s
appetite
• Multimix principle
• Change the texture, taste and colour of food
• Add sugar
• Include citrus fruits
• Give the child plenty of fluids (water & fruits juices and not
carbonated beverages/fizzy drinks)
• Use roasted groundnuts for nsinjiro
• Add vegetables
•Prepare foods and drinks in a clean, safe way to prevent
food borne infections
Importance of feeding the child
adequately during and after illness
Sick child requires more energy and
nutrients to:
Fight the infection
Replace worn out tissues
Replace lost nutrients
Recover from the infection
INFANT AND YOUNG CHILD FEEDING IN
CONTEXT OF HIV & AIDS
• Infant feeding options below may be discussed and
evaluated for their feasibility and practicality

• It should be emphasized that none of the following

options are
easy for the mother to practice without support,
especially if she is HIV infected
 MODIFIED EXCLUSIVE BREAST
Exclusive breastfeeding of infants up to 6 months should be
FEEDING for women who are HIV negative or of unknown HIV
promoted
status. Exclusive breastfeeding should also be supported as
long as replacement feeding is not a viable option for an HIV
infected mother
Early cessation of breastfeeding is recommended after a certain
period of time (usually 6 months) for HIV-infected mothers
when
adequate and hygienic replacement feeds are available
• Cessation is especially important if a mother develops AIDS symptoms
Heat treating expressed breast milk
• Pasteurizing the milk (heating to 62.50Celsius for 30 minutes)
or
boiling it briefly and cooling it immediately in the refrigerator
or by
placing the container in cool water.
• The feasibility and sustainability of this option must be
considered.
Does the mother have time (or well-being) to express and
REPLACEMENT FEEDING
• Replacement feeding refers to feeding a child who is not
receiving any breast milk from birth to 2 years of age
with a diet that provides all the nutrients the child
requires
• The following conditions must be in place for safe
replacement feeding:
i. Access to clean water
ii. Availability of sterilized utensils
iii. A steady supply of commercial or home-prepared formula
to meet the infant’s nutritional needs
iv. Ability to read the instructions on how to prepare formula
v. Adequate time to prepare the formula when required
Replacement feeding options for
children 0-6 months
Commercial infant formula
• This is made from modified cow’s milk or soy protein
but lacks the long-chain essential fatty acids that are
present in breast milk.
• Giving formula requires the following:
• water, fuel, utensils, skills and time to prepare it
accurately and hygienically
• The average quantity needed to feed an infant for 6
months is 20 kg of
powdered formula (44 tins containing 450g each).
• Cup feeding rather than bottle feeding is
recommended for hygienic purposes
Home-prepared formulas
• This can be made from animal milks, powdered
milk, and evaporated milk
Animal milks (e.g. cow, goat, buffalo, or sheep).
• For modified cow’s milk use:
•100ml cow’s milk; 50 ml of boiled water; and 10g of sugar (2
teaspoons) Note : Home prepared formulas are usually
deficient in micronutrients such as iron, zinc, folate, and
vitamins A & C

Powdered full-cream milk and evaporated milk

• Full-cream milk requires the addition of boiled
water as described on the package.
• Increase water by 50 percent and add 10g of sugar for each
150ml of feed
Recommendations for replacement feeding of
children 6-24 months
• Children of this age should be given suitable breast
milk substitutes and complementary foods (nutrient
enriched and appropriately prepared family foods).
• Between 6 and 12 months breast milk generally
provides up to half of an infant’s nutritional
requirements, and between 12 and 24 months, up to
one-third of requirements.
• If suitable breast milk substitutes are not available,
other dairy products should be given,
• such as animal milk, dried skimmed milk, yogurt and
• animal foods such as meat, liver, fish as they are a source of
iron and zinc, and
• fruits and vegetables to provide vitamins (especially A and
C)