7Breastfeeding-Promotion

Promotion,ProtectionandSupportofBreastfeedingDagmarSchneidrováDepartmentofChildandYouthHealth3rdFacultyofMedicineCharlesUniversityPragueNutritionandChildHealthInfantsandyoungchildrenesp.sensitivetoexternalfactors(e.g.nutrition)First2years=acriticalperiodfor:-growthanddevelopment-healthininfancyandchildhood-healthinadulthoodBreastfeeding=anormativemodel(AmericanPediatricAcademy,1997)Breastfeedingisapreferredmodeoffeedingconsideringbenefits:NutritionalImmunologicalHealth(morbidity,mortality)DevelopmentalEconomicalaecologicalNutritionalbenefitsofbreastmilkCompositionchangesinthecourseofdevelopment(preterm,fullterminfants),singlefeeding(foremilk,hindmilk),inrelationtoexposuretoinfection(e.g.IgA)Optimalconcentrationofnutrients,highbioavailability,lowerintakeofcaloriesGrowthfactors–epidermalgrowthfactor,hormonsProtectivefactors-immunoglobulins,lymphocytes,leucocytes,macrophages,lysozym,bifidusfactoretc.Risksofartificialfeeding(indevelopingcountriesrisksareelevatedabovetheselevels)•Increasedriskofacuteillness:Gastroenteritis:3-4xrisk(developingcountries17-25x)Acuteotitismedia:3-4xriskLowerrespiratorytractinfections(e.g.pneumonia)Bacterialinfectionrequiringhospitalization:10xriskMeningitis:4xrisk(e.g.Enterobactersakazakii)Highermortalityfromsuddeninfantdeathsyndrome(SIDS)Risksofartificialfeeding•Increasedriskofchronicconditionsandillnesses:Allergies-atopicdermatitis,asthmaType1,type2diabetesObesityCrohn’sdisease,ulcerativecolitis,coeliacdiseaseChildhoodlymphomas(5-8xrisk),leukaemiaRisksofartificialfeeding•Dose-relateddifferenceinmentaldevelopment:Lowerscoresofmentaldevelopmenttestsat18monthsDifferenceinmentaldevelopmentandschoolperformanceat3-5yearsLowerscoresinprematuresonintelligencetestsat7-8yearsDeficitsinneurologicaldevelopment(lackofessentialfattyacids)DifferenceinvisualacuityRisksofartificialfeeding•Effectsonmother:IncreasedriskofanaemiaduetoearlyreturnofmenstruationIncreasedriskofnewpregnancyHigherriskofimpairedbonding,abuse,neglectandabandonmentofthechildIncreasedriskofbreastandovariancancerBreastfeedingandhealthofinfantsandmothers(AgencyforHealthcareResearchandQuality,USA2007)Systematicepidemiologicalresearch:43studiesoninfantshealth43studiesonmothershealth29systematicmetaanalyses(400studies)comparedhealthoutcomesininfantsbreastfedandartificiallyfed(breast-milksubstitutes)indevelopedcountriesIpS,ChungM,RamanG,ChewP,MagulaN,DeVineD,TrikalinosT,LauJ.BreastfeedingandMaternalandInfantHealthOutcomesinDevelopedCountries.EvidenceReport/TechnologyAssessmentNo.153.AgencyforHealthcareResearchandQuality,April2007.Breastfeeding=lowermorbidityInfantsNonspecificgastroenteritisNecrotizingenterocolitisAcuteotitisInfectionsoflowerrespiratorytractSuddeninfantdeath(SIDS)AtopicdermatitisAsthmainyoungchildrenObesityDiabetes(type1,2)ChildleukaemiaMothersDiabetes(type2)CarcinomaofbreastCarcinomaofovariaOptimalInfantFeedingPractices(WHOGlobalStrategyonInfantandYoungChildFeeding,2002)Basedontheevidenceofnutrition´ssignificanceintheearlymonthsandyearsoflifeLackofexcl.BFduringthefirst6monthsoflife-importantriskfactorforinfantandchildhoodmorbidityandmortality(scientificandepidemiologicalevidence–)•Exclusivebreastfeedingfor6months•Complementaryfeedingwithcontinuedbreastfeedingfrom6to24monthsandbeyond–Timely–Adequate–Safe–AppropriatelyfedOptimalInfantFeedingPractices(WHOGlobalStrategyonInfantandYoungChildFeeding,2002)Acceptablemedicalreasonsforuseofbreast-milksubstitutes(WHO,2009)ContraindicatinsofBF-Galaktosaemia(infantformulawithoutgalactose)-Maplesyrupdisease(infantformulawithoutleucine,isoleucineandvaline)-Fenylketonurie(infantformulawithoutphenylalanine)Breastfeedingandsupplementation-Verylowbirthweight(below1500g)-Prematurebirth(before32ndweek)-Hypoglycaemia(hypoxicstres,motherswithdiabetes,etc.)Healthproblemsintheinfant(WHO,2009)Healthproblemsinthemother(WHO,2009)a)Contraindicationsofbreastfeeding-HIV/AIDSinfection-HTLV-1,2infection(India,Africa,Japan)b)Temporaryinterruptionofbreastfeeding-Seriousillness(e.g.sepsis)-Herpessimplexvirus1infection(HSV-1)-Varicella-ActiveTBC-Medicationinmother(sedatives,antiepileptics,opioids,radioactiveiodine–J-131,cytotoxicchemotherapy)c)Breastfeedingandmanagementoftheproblem-Mastitis,abscessofbreast-HepatitisB,C,TBC(posit.tuberculinetest)-UsingaddictivesubstancesRisksrelatedtousingpowderedinfantformula(PIF)WHOStudy(35countries)-foundpatogens(Enterobactersakazakii,Salmonella)in20%from141samplesofPIF-E.sakazakii–rare,butlethalcasesofmenigitis,NECandsepsis(40-80%mortality)EuropeanCouncilforFoodSafetyandWHO(2007)-issuedguidelinesforhealthworkersandparents–informationonrisk,hygienicpreparationandproperuseofPIFproductsStudyatthe3rdFacultyofMedicine(2009)–-surveyat10hospitals(20departments)-foundshortcomingsinawarenessofpossiblecontaminationofPIFanditspreparationWHO/UNICEFGlobalStrategyforInfantandYoungChildFeeding(2002)Thegoal-toimprovethesurvival,growthanddevelopmentofchildrenduringthefirstyearsoflifethroughprotection