082604ANaylorHandouts

California Public Health Grand RoundsAugust 26, 2004: 

California Public Health Grand Rounds August 26, 2004 Effective Strategies to Achieve Optimal Infant and Young Child Feeding for California Presented by Laurie Tiffin, RD Audrey Naylor, MD, DrPH Carol Lopez Melcher, RNC

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Hi Friends: I’m Kimberly and that’s Jason. We’re going to tell you about Optimal Infant and Young Child Feeding and some important things to do to make sure that all California kids can have the opportunity to be optimally fed.

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First, let’s do a quick review of “Optimal Infant and Young Child Feeding”

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Optimal Infant and Young Child Feeding Gestation Complementary feeding Family foods Special Transitional foods Maternal Nutrition Fetal Nutrition B ? ? B ? ? C Adapted from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding

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Optimal Infant and Young Child Feeding Gestation Complementary feeding Family foods Special Transitional foods Maternal Nutrition Fetal Nutrition B ? ? B ? ? C Adapted from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding

Exclusive Breastfeeding: 

Exclusive Breastfeeding All fluid, energy, and nutrients are provided by breastmilk, with the exception of small amounts of medicinal supplements.

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Optimal Infant and Young Child Feeding Gestation Complementary feeding Family foods Special Transitional foods Maternal Nutrition Fetal Nutrition B ? ? B ? ? C Adapted from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding

Complementary Feeding: 

Complementary Feeding The period during which other foods or liquids are provided along with breast milk.

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Optimal Infant and Young Child Feeding Gestation Complementary feeding (weaning) Family foods Special Transitional foods Maternal Nutrition Fetal Nutrition B ? ? B ? ? C Adapted from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding

Weaning: 

Weaning The process of introducing breast milk substitutes and/or complementary foods thereby decreasing lactation stimulation and milk production and eventually ending lactation and breastfeeding.

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Kidneys GI Tract Psycho- Social Brain Metabolic Organs Immune System Cardio- Vascular Oral Motor Infant Development and Readiness To Begin Weaning

Maturation of Immune Factors in the Human Infant: 

Maturation of Immune Factors in the Human Infant Factor Secretory IgA Full antibody repertoire Lysozyme Memory T Cells Age of Maturation 4 to 12 months 24 months 1 to 2 years 2 years

“Premature” Weaning Increases an Infant’s Risks of:: 

“Premature” Weaning Increases an Infant’s Risks of: 1. Gastroenteritis 2. Otitis Media 3. Respiratory Disease 4. Urinary Tract Infection 5. NEC 6. SIDS 7. Insulin Dependent Diabetes

“Premature” Weaning Increases an Infant’s Risks of:: 

“Premature” Weaning Increases an Infant’s Risks of: 8. Lymphomas and Childhood Leukemia 9. Dental Disorders Chronic GI Tract Disorders Allergic Disease 12. Obesity 13. Death between 28 days and 1 year of life

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DIARRHEAL ILLNESS AMONG BREASTFED and FORMULA FED INFANTS Adapted from: Dewey et al (1995): 699-700 % Days ill % Days ill OTITIS MEDIA AMONG BREASTFED and FORMULA FED INFANTS

“More than a tripling in severe respiratory tract illnesses resulting in hospitalizations was noted for infants who were not breastfed compared with those who were exclusively breastfed for at least 4 months” Bachrach, VRG., et al. Breastfeeding and the risk of hospitalization for respiratory disease in infancy. Arch Pediatr Adolesc Med. 2003; 157-237 - 242: 

“More than a tripling in severe respiratory tract illnesses resulting in hospitalizations was noted for infants who were not breastfed compared with those who were exclusively breastfed for at least 4 months” Bachrach, VRG., et al. Breastfeeding and the risk of hospitalization for respiratory disease in infancy. Arch Pediatr Adolesc Med. 2003; 157-237 - 242

Infant Mortality Risk of Not Breastfeeding in the United States: 

Infant Mortality Risk of Not Breastfeeding in the United States Recent report by Chen and Rogan suggests that children who are breastfed have a 20% lower risk of dying between 28 days of age and their first birthday than those who were not breastfed. Chen, A and Rogan, W. Pediatrics, May 2004

Premature Weaning Increases Mother’s Risks of:: 

Premature Weaning Increases Mother’s Risks of: 1. Excessive postpartum bleeding 2. Shortened period of infertility and amenorrhea 3. Anemia 4. Osteoporosis 5. Postpartum depression 6. Obesity 7. Breast and ovarian CA 8. Dysfunctional Maternal Behavior

MATERNAL POSTPARTUM WEIGHT LOSS: 

MATERNAL POSTPARTUM WEIGHT LOSS

MATERNAL POSTPARTUM WEIGHT LOSS: 

MATERNAL POSTPARTUM WEIGHT LOSS

BREAST CANCER AND LACTATION: 

BREAST CANCER AND LACTATION

LACTATION AND EPITHELIAL OVARIAN CA (259 cases, 2123 controls): 

LACTATION AND EPITHELIAL OVARIAN CA (259 cases, 2123 controls)

Predicting Mother Caused Infant Maltreatment: 

Predicting Mother Caused Infant Maltreatment Australia; 7636 reports of maltreatment over 20 years Sample gathered 1981-1984 Final study group: 250 confirmed reports of maternal maltreatment Greatest risk of maternal maltreatment: No Breastfeeding > 20 hours of separation per week Strathern, L, 2003. Reported 10/2003, AAP NCE

LACTATION REFLEXES: 

LACTATION REFLEXES

MATERNAL BEHAVIOR(PERCENT FULLY MATERNAL): 

MATERNAL BEHAVIOR (PERCENT FULLY MATERNAL)

Six Months of Exclusive Breastfeeding is Now the Goal of the:: 

Six Months of Exclusive Breastfeeding is Now the Goal of the: US Department of Health and Human Services The WIC Supplemental Food Programs State of California Department of Health Services

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Optimal Infant and Young Child Feeding Gestation Complementary feeding Family foods Special Transitional foods Maternal Nutrition Fetal Nutrition B ? ? B 6 ? C Adapted from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding

Weaning When should breastfeeding end?: 

Weaning When should breastfeeding end?

Benefits of Extended Breastfeeding: 

Benefits of Extended Breastfeeding Breast milk provides one-third to two thirds of the average total energy intake in the latter part of the first year.

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It is an important source of essential fatty acids. It provides significant amounts of vitamin A and pro vitamin A carotenoids as well as calcium and riboflavin.

Benefits of Extended Breastfeeding (cont.): 

Benefits of Extended Breastfeeding (cont.) Morbidity and mortality rates remain lower in children who are breastfeeding into their second and third year.

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When illness does occur, children will usually continue to breastfeed in spite of an otherwise diminished appetite. Though not as complete, the infertility effect continues resulting in increasing birth intervals.

Weaning: When should Breastfeeding end?: 

Weaning: When should Breastfeeding end? WHO (1995): “up to two years of age and beyond while receiving nutritionally adequate and safe complementary foods”

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American Academy of Pediatrics “ It is recommended that breastfeeding continue for at least 12 months of life and thereafter for as long as mutually desired.” AAP Policy Statement (1997). Pediatrics,100:6;1035-1039

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K A Dettwyler (1998) “Breastfeeding continued until between 2.5 and 7+ years is physiologically and developmentally normal and healthy for human infants.”

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Optimal Infant and Young Child Feeding Exclusive Breastfeeding for 6 months. Nutritionally healthy complementary foods beginning at 6 months. Continue breastfeeding until well into the second year of life and beyond along with healthy complementary foods.

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Optimal Infant and Young Child Feeding Gestation Complementary feeding Family foods Special Transitional foods Maternal Nutrition Fetal Nutrition B ? ? B 6 2-7 yrs C Adapted from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding

U.S. Breastfeeding in 2002: 

U.S. Breastfeeding in 2002 *Ross Mother’s Survey Data **Newborn screening form

California In-Hospital Breastfeeding Choices2002* : 

California In-Hospital Breastfeeding Choices 2002* Total Breastfeeding 83.5% Exclusive 41.9% *Data from Newborn Screening Form

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Is it possible to promote Optimal Infant and Young Child Feeding in the 21st Century?

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Yes !!

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6 Let’s review how to help moms and babies get off to a successful start.

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Optimal Infant and Young Child Feeding Gestation Complementary feeding Family foods Special Transitional foods Maternal Nutrition Fetal Nutrition B ? ? B 6 2-7 yrs C Adapted from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding

Developing Lactation and Maintaining Milk Production Depends On:: 

Developing Lactation and Maintaining Milk Production Depends On: Early and recurrent stimulation of the neuro-endocrine system (lactation reflexes) Frequent and effective removal of milk

LACTATION REFLEXES: 

LACTATION REFLEXES

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IMMEDIATE NURSING

IgA (secretory) AND IgG IN HUMAN MILK (mG PER 24 HOURS): 

IgA (secretory) AND IgG IN HUMAN MILK (mG PER 24 HOURS)

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Frequent and effective milk removal

Perinatal Care as a Barrier to Achieving OIYCF: 

Perinatal Care as a Barrier to Achieving OIYCF Procedures which delay the first feeding. Unnecessary Separation of Mother and baby. Supplementation without medical need. Care providers with inadequate training in managing lactation and breastfeeding. Lack of support. Delayed follow-up care for mother and infant. Distribution of Discharge “gift” bags.

California Model Hospital Policy: 

California Model Hospital Policy

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1. Have a breastfeeding policy that is routinely communicated to all health care staff. 2. Train all health care staff in skills necessary to implement this policy. 3. Inform all pregnant women about the benefits and management of breastfeeding. The Ten Steps

The Ten Steps: 

The Ten Steps 4. Help mothers initiate breastfeeding within an hour of birth. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants. Give newborn infants no food or drink other that breast milk, unless medically indicated. Practice rooming-in – allow mothers and infants to remain together – 24 hours a day.

The Ten Steps : 

The Ten Steps Encourage breastfeeding on demand. Give no artificial nipples or pacifiers to breastfeeding infants. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Optimal Mother/Baby Perinatal Care: 

Optimal Mother/Baby Perinatal Care First breastfeeding within about an hour of birth. No separation. Twenty-four hour rooming-in. Mother/baby (couplet) care. Breast on request with eight or more feedings in 24 hours. No timing of feedings. No supplements; no nipples, no pacifiers. Support for all parents. Follow-up visit within 2 days of discharge. No commercial “gift” discharge packs.

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Optimal Infant and Young Child Feeding Gestation Exclusive Br. feeding Complementary feeding Family foods Special Transitional foods Maternal Nutrition Fetal Nutrition B ? ? B ? ? C Adapted from WHO, 1998 e n e r g y child’s age Breastfeeding exclusive mixed feeding

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Optimal Mother/Baby perinatal care Optimal Infant and Young Child Feeding Optimal Maternal, Infant and Young Child Health

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Babies are Born to be Breastfed. It’s too important not to!

Please note: slide set is for black and white printing. Written material on slides 22, 25 and 47 must be changed to yellow for actual presentation : 

Please note: slide set is for black and white printing. Written material on slides 22, 25 and 47 must be changed to yellow for actual presentation