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    <title>Effects of Breastfeeding alternatives</title>
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      <h1 id="top">1.3 Effects of Breastfeeding alternatives</h1>
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            <td class="body"><img src="images/key_icon.gif" class="icon" alt="" /><h3>Key Points - Case Study A</h3>
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			Joanne, aged 32, a regular patient, comes to see you when she is 12 weeks pregnant with her first baby. She has just returned from a trip around Australia and her pregnancy was confirmed by a doctor in the town they were in at the time. She has copies of her baseline blood tests with her and all are normal.
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			Would you discuss breastfeeding at this visit?
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		<dl><dt><a href="topic_1-1.html"><cite>Topic 1.1: Discussing breastfeeding</cite></a></dt><dd class="topic-paragraph">It is important that doctors discuss infant feeding decisions and breastfeeding with women early in a pregnancy rather than waiting until the third trimester or after the baby is born.</dd></dl>
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			What information would you give?
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		<dl><dt><a href="topic_1-2.html"><cite>Topic 1.2: What information to give</cite></a></dt><dd class="topic-paragraph">When discussing infant feeding with mothers it is important to note that alternatives to breastfeeding have many undesirable outcomes.</dd></dl>
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			Why do breastfeeding alternatives have different effects?
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		<dl><dt><a href="topic_1-3.html"><cite>Topic 1.3: Effects of Breastfeeding alternatives</cite></a></dt><dd class="topic-paragraph">These effects are due in part to the presence in breast milk of substances and systems that act against infections and inflammation.</dd></dl>
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			Why do breastfeeding alternatives have different effects?
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		These effects are due in part to the presence in breastmilk of substances and systems that act against infections and inflammation.
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					<strong>Secretory IgA (SIgA)</strong>
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					Secretory IgA is manufactured in the breast and acts against pathogens to which the mother has been exposed. Stimulated lymphocytes migrate from Peyers patches in the mothers gut and similar lymphoid tissue in the bronchial tree to the breast and produce SIgA in reaction to the pathogens present in the infant's environment (entero-mammary and broncho-mammary pathways). There are high concentrations of SIgA in colostrum to provide protection for the infant postpartum; by 4 months the infant consumes 75mg/Kg/day of SIgA. SIgA prevents the adhesion of bacteria and viruses to epithelial cells as well as neutralising viruses and bacterial toxins. Other antibodies (IgG, IgM and IgE) are also present in breast milk.
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					<strong>Leukocytes</strong>
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					Similar to SIgA, leukocyte numbers are highest in colostrum, and fall to approximately 10<sup>4</sup>  2x10<sup>5</sup> in mature milk<sup><a href="#note1">1</a></sup>. The majority of cells are macrophages (85%) and small lymphocytes and play a role in protecting the breastfed infant and the breast by destroying pathogens by phagocytosis<sup><a href="#note2">2</a></sup>. Macrophages and lymphocytes in breastmilk produce other active agents (SIgA, lactoferrin, complement, prostaglandins). They are also able to enter the infants circulation<sup><a href="#note3">3</a></sup>.
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					<strong>Lactoferrin</strong>
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					Lactoferrin is an iron binding glycoprotein that has a bactericidal effect on gram +ve and -ve bacteria as well having antiviral and antifungal capacity.
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					<strong>Carbohydrates</strong>
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					Carbohydrates - in particular oligosaccharides, glycoproteins and glycolipids promote the growth of non-pathogenic bacteria in the infants gut as well as preventing the attachment of bacteria and other pathogens to the epithelial lining of the gut and other mucosal surfaces.
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					<strong>Fatty Acids</strong>
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					Fatty Acids affect certain bacteria, viruses and parasites. They also enhance the development of the nervous system<sup><a href="#note2">2</a></sup>. It is hypothesised that the fatty acid composition of breastmilk is responsible for the differences in cognitive development between those breastfed and those formula-fed,<sup><a href="#note4">4</a></sup> and may also impact on the development of allergic disease<sup><a href="#note2">2</a></sup>.
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					<strong>Lysozyme, α lactalbumin, complement, cytokines, growth factor, nucleotides</strong>
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					Lysozyme, α lactalbumin, complement, cytokines, growth factor, nucleotides present in breastmilk have all been shown to have an active role against pathogens<sup><a href="#note2">2</a>,</sup><sup><a href="#note3">3</a></sup>.
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        <h3>Notes</h3>
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          <li id="note1"><a href="references.html#xant95" title="See full details">#</a> Xanthou M et al. (1995) Human milk and intestinal host defense in newborns: an update</li>
          <li id="note2"><a href="references.html#hans04" title="See full details">#</a> Hanson L (2004) Immunology of Human Milk: How breastfeeding protects babies</li>
          <li id="note3"><a href="references.html#hans07" title="See full details">#</a> Hanson LA (2007) The role of breastfeeding in the defense of the infant</li>
          <li id="note4"><a href="references.html#casp07" title="See full details">#</a> Caspi A et al. (2007) Moderation of breastfeeding effects on the IQ by genetic variation in fatty acid metabolism</li>
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      <div id="footer"><a href="topic_1-2.html" rel="prev" class="prev">&laquo; Previous</a><a href="topic_1-4.html" rel="next" class="next">Next &raquo;</a><br style="clear: both" /><a href="#top" id="topLink">Back to top</a><a href="javascript: window.print()" id="printLink">Print this page</a><span class="noPrint"> | </span>&copy; 2011 Health e-Learning<p class="printOnly">COPYRIGHT: You are permitted to print ONE (1) copy for your personal use only. No graphics, tables, quizzes, videos, etc, may be used in any form without express written consent. Author: Denise Fisher</p></div>
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      <h1>Breastfeeding Essentials</h1>
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        <li>0.1 <a href="topic_0-1.html">Introduction</a></li>
        <li>1.0 <a href="topic_1-0.html">Case Study A (Joanne)</a><ol><li>1.1 <a href="topic_1-1.html">Discussing breastfeeding</a></li><li>1.2 <a href="topic_1-2.html">What information to give</a></li><li class="current">1.3 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_1-3.html">Effects of Breastfeeding alternatives</a></li><li>1.4 <a href="topic_1-4.html">Common breastfeeding concerns</a></li><li>1.5 <a href="topic_1-5.html">Breast examination</a></li><li>1.6 <a href="topic_1-6.html">Contraindications to breastfeeding</a></li><li>1.7 <a href="topic_1-7.html">Conditions related to lactation outcomes</a></li><li>1.8 <a href="topic_1-8.html">Medications</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Case Study B (Joanne)</a><ol><li>2.1 <a href="topic_2-1.html">Preparation Before Birth</a></li><li>2.2 <a href="topic_2-2.html">Birthing Factors that Affect Breastfeeding</a></li><li>2.3 <a href="topic_2-3.html">Management After Birth</a></li><li>2.4 <a href="topic_2-4.html">Poor Attachment</a></li><li>2.5 <a href="topic_2-5.html">Hypoglycaemia</a></li><li>2.6 <a href="topic_2-6.html">Relationship between Jaundice and Breastfeeding</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Case Study C (Joanne)</a><ol><li>3.1 <a href="topic_3-1.html">Early problems</a></li><li>3.2 <a href="topic_3-2.html">Risk of SIDS</a></li><li>3.3 <a href="topic_3-3.html">Contraception</a></li><li>3.4 <a href="topic_3-4.html">Milk composition</a></li><li>3.5 <a href="topic_3-5.html">Slowing of growth</a></li><li>3.6 <a href="topic_3-6.html">Introducing solids</a></li><li>3.7 <a href="topic_3-7.html">Weaning</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">Case Study D (Sally)</a><ol><li>4.1 <a href="topic_4-1.html">Initial assessment</a></li><li>4.2 <a href="topic_4-2.html">Milk production</a></li><li>4.3 <a href="topic_4-3.html">Causes of inadequate infant growth</a></li><li>4.4 <a href="topic_4-4.html">Increasing milk supply</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Case Study E (Anna)</a><ol><li>5.1 <a href="topic_5-1.html">Sore nipples</a></li><li>5.2 <a href="topic_5-2.html">Factors causing nipple damage</a></li><li>5.3 <a href="topic_5-3.html">General treatment for sore nipples</a></li><li>5.4 <a href="topic_5-4.html">Further causes of nipple pain</a></li><li>5.5 <a href="topic_5-5.html">Mastitis – diagnosis</a></li><li>5.6 <a href="topic_5-6.html">Mastitis – treatment and complications</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">In conclusion</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
        <li class="appendix"> <a href="contents.html">Course contents</a></li>
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