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Nutrition During Lactation



Nutritional needs during lactation::

The nutritive demands of lactation are considerably greater than those of pregnancy. In the first 4–6 mo of the postpartum period, infants double their birth weight accumulated during the 9 mo of pregnancy. The milk secreted in 4 mo represents an amount of energy roughly equivalent to the total energy cost of pregnancy. However, some of the energy and many of the nutrients stored during pregnancy are available to support milk production. The recommended intakes for energy and specific nutrients during lactation are summarized in below table. Most of these recommended intakes are based on our knowledge of the amount of milk produced during lactation, its energy and nutrient contents and the amounts of maternal energy and nutrient reserves. The recommended energy intake during the first 6 mo of lactation is an additional 500 kcal under the assumption that 170 kcal/d will be mobilized from energy stores accumulated in pregnancy. The energy demands of comparable periods of full lactation (780 mL/d) greatly exceed those of pregnancy. The recommended energy intake after 6 mo is reduced to an additional 400 kcal/d because milk production rates decrease to 600 mL/d. Few studies have evaluated maternal nutrient adequacy, milk content and infant nutrient indicators in the second half of the first year of infancy and lactation.



The importance of nutrition during breastfeeding::


During the first six months after delivery, the baby is fed only on breast milk, and the baby depends on the mother for all nutrient requirements. Eating a healthy diet while you are breastfeeding is important because what you eat determines the energy, protein, nutrient and vitamin content of your breast milk. Additionally, some minerals and vitamins are required for body processes such as healing wounds quickly (e.g. vitamin C and zinc). Nutritional demands during lactation are high and can have a negative impact on both you and your infant if they are not met. Your daily diet will be adequate provided that your food selection and preparation is appropriate.



Energy and nutrient requirements during breastfeeding::

Nutritional needs during breastfeeding are increased in response to breast milk production. They must meet the requirements of both baby and mother.


Energy::


An additional 500 kcal for the first six months, and 400 kcal during the next six months, are required for a lactating mother. This can be met by eating, for example, an extra 6-8 slices of bread per day. Simply eating more of the usual balanced diet should allow you to meet the higher energy demand while you breastfeed. On average, 100 ml of human milk gives 70 kcal of energy. During the first six months after delivery, 750 ml of breast milk is produced daily. If the extra demand for energy is not met from dietary sources, then your reserved fat stores will be used instead.


Protein

The increase in protein requirements during lactation are minimal compared to that of energy. However, if your energy intake is low, protein will be used for energy production. The additional protein requirements during lactation can be met by consuming protein rich foods (e.g. one egg or 25 g of cheese or 175 g of milk). If you do not have a high enough protein intake, then the proportion of casein in your milk may be reduced. Casein protein is an important component of your milk, and helps to provide your baby with calcium and phosphate. It also forms a clot in the stomach that allows more efficient nutrition. Insulin resistance is modulated by protein quality, rather than quantity. Proteins derived from fish might have the most desirable effects on insulin sensitivity.


Other nutrients::


Your intake of some nutrients (e.g. vitamins C, A, thiamine, riboflavin, B6, B12, iodine and selenium) is reflected in your breast milk composition. Newborn babies have very little amounts of these particular nutrients, and so they rely on breast milk for an adequate supply. Good sources of iodine are seafood and iodized salt. On the other hand, nutrients in your breast milk such as zinc, iron, folic acid, vitamin D, calcium, and copper are not affected by what you eat. The levels of these nutrients in human milk are constant, despite variations in the mother's diet or body stores. Dietary and supplemental intake of these nutrients during lactation will benefit you more than your baby.




Calcium is essential during lactation because it is required for milk production. An intake of 1000 mg calcium per day is required during the first six months after delivery. 500 ml of milk or milk products per day must be taken in addition to eating calcium rich foods, such as green leafy vegetables and fish. However, some fish can contain high levels of harmful substances such as mercury. Since mercury occurs naturally in the environment all fish contain some amount of this element. Luckily, fish taken from Australian waters generally contain very low levels of mercury but breastfeeding women still need to be aware of the potential for this toxic element to be passed to their baby through their milk.
Comparison of nutrient requirements in pregnancy and lactation::

The table below shows the daily requirements of some important nutrients in pregnancy and lactation. The data shown is for women between 19 and 30 years of age. Some variations in daily requirements may be seen outside of that age bracket. During breastfeeding, more energy and vitamin A are required compared to during pregnancy. Additional increases in calcium during pregnancy and lactation are not needed in women whose usual diet is rich in dairy products and other good sources of calcium. 


Nutrients  Normal Recommended Intake Recommended Intake During Pregnancy Recommended Intake During Lactation 
Energy (kcal)  200 2450 2500
Protein (g)  46 71 71
Vitamin A (μg)  700 770 1300
Iron (mg)  18 27 9
Folic acid (μg)  400 600 500
Iodine (μg)  150 220 290
Calcium (mg)  1000 1000 1000
Zinc (mg)  8 11 12
Vitamin B12 (μg)  2.4 2.6 2.8



                                                            






Things to avoid during breastfeeding ::

Minimize caffeine intake.
Be careful with drugs.
Alcohol and smoking should be avoided. They can make your baby feel sleepy, nervous and irritable.
Resist the temptation of losing weight through diet or medication.
Key messages ::

Drink water, milk and fruit juices as needed.
You need to eat more than usual to replenish energy that is lost through breastfeeding.
Energy is essential, so eat regularly to increase your food intake and meet all your nutritional needs.
Keep your intake of empty calorie foods to the minimum and eat more nutrient-dense foods.


Overcoming Breastfeeding Issues


Breastfeeding (nursing) your baby can be a comfortable and relaxing experience. But it takes time and practice. Start breastfeeding your baby in the hospital, right after birth. Request the help of a lactation consultant or nurse to get you started. Read about breastfeeding before your baby is born.

NIPPLE SORENESS

It is common to have some pain or discomfort when your baby first latches on and begins feeding in the first few days or weeks. Some breastfeeding mothers describe nipple soreness as a pinching, itching, or burning sensation. Over time, you should feel little discomfort or pain when breastfeeding.

Nipple soreness may be caused by many things, including:
Poor feeding techniques
Wrong position of the baby when breastfeeding
Not taking care of your nipples

For many women, there is no clear cause of nipple soreness. A simple change in your baby's position while feeding may relieve nipple soreness.

You might have sore nipples if your baby keeps sucking as he or she comes off the breast. You can help your baby learn to let go (and reduce your discomfort) by gently inserting a finger into the side of the mouth to break the suction.

Skin that is too dry or too moist can also cause nipple soreness. Moisture may be due to wearing bras made from man-made (synthetic) fabrics. These fabrics may increase sweating and slow evaporation. Using soaps or solutions that remove natural skin oils can cause dry skin. Olive oil, expressed milk, and ointments containing lanolin can help soote dry or cracking nipples.

Some baby's chew or bite on the nipples when they start teething. This can cause discomfort. To help prevent this, give the baby something cold and wet to chew on a few minutes before breastfeeding. A clean, wet washcloth from the refrigerator works well. Offer the baby another cold, wet washcloth before feeding on the other breast.

BREAST ENGORGEMENT OR BREAST FULLNESS

Breast fullness is the slow buildup of blood and milk in the breast a few days after birth. It is a sign that your milk is coming in. It will not prevent you from breastfeeding.

Breast engorgement is caused by congestion of the blood vessels in the breast. The breasts are swollen, hard, and painful. The nipples may not stick out enough to allow the baby to latch on correctly.

The let-down reflex is a normal part of breastfeeding. Milk made in the milk glands is released into the milk ducts. Pain, stress, and anxiety can interfere with the reflex. As a result, milk will build up. Treatment includes:
Learning to relax and finding a comfortable position
Reducing distractions during nursing, performing a gentle massage, and applying heat to the breast

Nursing often (8 times or more in 24 hours) and for at least 15 minutes at each feeding can also prevent engorgement.

Other ways to relieve breast engorgement:
Feed more often or express milk manually or with a pump. Electric breast pumps work best.
Alternate between taking warm showers and using cold compresses to help relieve the discomfort.

NOT ENOUGH MILK FOR THE BABY'S NEEDS


The baby's milk demand determines the mother's supply. Frequent feedings, adequate rest, good nutrition, and adequate fluid intake can help maintain a good milk supply.

Checking weight and growth frequently is the best way to make sure your baby is taking enough milk. If you have concerns about how much breast milk your baby is getting, talk to your health care provider.

PLUGGED MILK DUCT


A milk duct can become plugged if the baby does not feed well, if the mother skips feedings (common when the child is weaning), or if she wears a constricting bra. Symptoms of a plugged milk duct include tenderness, heat and redness in one area of the breast, or a lump that can be felt close to the skin.

Sometimes, a tiny white dot can be seen at the opening of the duct on the nipple. Massaging the area and putting gentle pressure on it can help to remove the plug.

BREAST INFECTION

A breast infection (mastitis) causes aching muscles, fever, and a red, hot, tender area on one breast. Consult your health care provider if you develop these symptoms.

Breast infections often occur in mothers who:
Are stressed and exhausted
Have cracked nipples, plugged milk ducts, or breast engorgement
Have been skipping feedings
Wear a tight bra

Treatment often includes:
Antibiotics for the infection
Moist, warm compresses over the infected area
Rest
Wearing a comfortable bra between feedings

Continuing to nurse from the affected breast will promote healing. Breast milk is safe for the baby, even when you have a breast infection.
It is important to continue breastfeeding from both breasts. This will prevent further breast engorgement.
If nursing is too uncomfortable, pumping or manual expression is recommended. You can try offering the unaffected breast first until let-down occurs, to prevent discomfort. Consult your physician for help.

THRUSH

Thrush is a common yeast infection that can be passed between the mother and the baby during breastfeeding. The yeast (called Candida albicans) thrives in warm, moist areas.

The baby's mouth and the mother's nipples are perfect places for this yeast to grow. A yeast infection can be difficult to cure, but fortunately this is uncommon. Yeast infections often occur during or after antibiotic treatments.

Symptoms of yeast infection in the mother are deep-pink nipples that are tender or uncomfortable during and immediately after nursing. White patches and increased redness in the baby's mouth are symptoms of thrush (a yeast infection in the baby's mouth).

The baby may also have a diaper rash, a change in mood, and will want to suckle more frequently. Contact your health care provider to get a prescription for an antifungal medication for affected members of your family.

ILLNESS

If you develop a fever or illness, contact your health care provider. You can safely continue breastfeeding during most illnesses, and the baby is likely to benefit from your antibodies. 



Disclaimer : Please Note : All nutrition tips shared are per standard nutrition guidelines, however, it might effect from body to body. 
Each individual’s dietary needs and restrictions are unique to the individual. You are ultimately responsible for all decisions pertaining to your health.
Please speak to your Nutritionist before following any diet. Swasthlife does not hold responsible for any kind of claims. 


Thanks ,
Tripti Khanna
Msc. Nutrition
NIBM-Pune
care@swasthlife.com




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