breast feeding and child immunity and growth

breast feeding

1. Breastfeeding and Immunity
Dr. Maha H. Daghestani

2. Introduction
Breastfeeding provides
unsurpassed امهل ريظن لا natural nutrition to
the newborn and infant. Human
breast milk also contains numerous
protective factors against
infectious disease and may
influence immune system
development.

3. Normal duration breastfeeding
Until recently (last 100 years),
breastfeeding into the second and third
years of life and even longer was a
cultural norm فارعأ in most societies (but
not all).

4. Inuit (Eskimos) were said to
nurse until 5 or 6 years, at least
until the mother became
pregnant again.
Breastfeeding was the “key” to
survival. The more difficult
life was, the longer mothers
tended to breastfeed

5. •The Quran:
Breastfeed two years.
•The Talmud:
Breastfeed at least two
years; four years if the
mother and child want; five
years if the child is sickly.

6. •In addition to being the best source of
nutrition for newborns and infants, human
breast milk also provides immunologic
protection against many infections.
Although most of the immunologic benefit
cited by researchers relates to protection
from
•diarrheal diseases that are especially
prevalent in developing countries.
• breastfeeding has also been shown to
protect infants against extraintestinal
infections يمضهلا زاهجلا تاباهتلا, otitis media ىطسولا نذلأا باهتلا
and respiratory diseases يسفنتلا زاهجلا ضارمأ.

7. What are the advantages of breast
milk or breast feeding?

8. BENEFITS OF BREASTFEEDING
 There are a number of benefits of
breastfeeding, many of which
continue even after breastfeeding is
discontinued.
The benefits for the infant and
mother increase as breastfeeding
continues. However, even
breastfeeding for a short period of
time provides some protection.

9. For infants
•Some of the benefits of breastfeeding for
infants include the following:
•Better gastrointestinal function and
protection from gastrointestinal infections,
such as vomiting and diarrhea.
•A reduced risk of respiratory infections,
ear infections, and wheezing.
•Some studies suggest that breastfeeding
reduces the risk of obesity, cardiovascular
disease, and autoimmune diseases, such as
type 1 diabetes mellitus.

10. For Mother
•Compared to mothers who feed formula,
women who breastfeed experience:
•Reduced blood loss after childbirth as a result
of a hormone, oxytocin, which is released into
the mother's bloodstream while breastfeeding.
•Oxytocin helps the uterus to contract, which
reduces uterine bleeding.
•Reduced levels of stress in the mother as a
result of several hormones released during
breastfeeding.
•Increased weight loss after pregnancy (if
breastfeeding continues for at least six
months).
•Decreased risk of breast cancer

11.  Families who breastfeed experience:
Reduced infant feeding costs. Infant formula and associated
supplies are estimated to cost at least 6000 SR during the first 12
months.
Reduced costs related to healthcare, including doctor's visits,
hospital costs, and lost time from work.
Infants who are breastfed are less likely to become ill and less
likely to be hospitalized, reducing the potential costs and anxieties of
caring for an ill child.
For family

12. Physiology of lactation

13. preparation of breast for lactation:-
a) During pregnancy:
estrogen ;progesterone ; placentae
lactogen development of acini
and duct system.
b) In puerperium:
Milk secretion initiated by
prolactin.

14. c) Maintenance
1) prolactin
2) suckling or breast feeding
reflexes are the most powerful
stimuli.

16. Maternal reflexes:-
Initiated by suckling of the nipple.
1) Nipple erection reflex.
2) Prolactin reflex: sensory stimuli to
hypothalamus → Anterior-Pituitary →
prolactin → glandular cells of breast
acini → milk secretion .

17. (3) Oxytocin reflex (let down reflex or milk
ejection reflex) from post. pit
contraction of neuroepithelial cells
Surrounding alveoli
ejection of milk.

18. Neonatal feeding reflexes:-
1) Rooting reflex: touching the
check or circumaural area leads to
turning the head to the side of the
stimulus leading to opening the
mouth seeking for the nipple.

19. 2) Suckling reflex: tactile stimuli
سمللا تازفحم of the nipple or aereolar
tissue filling the mouth leading
to milking action by tongue
against hard palate.

20. 3) Swallowing reflex: follows
suckling or allows interruption
to breathing to prevent choking
during swallowing.

21. Lactation
•Hypothalamus
releases PRH.
•Anterior pituitary
releases prolactin:
–Stimulates milk
production.
•Prolactin secretion
primarily controlled
by PIH.
•Oxytocin needed for
“milk letdown.”

22. Lactation
•Mammary gland:
–Lobules contain glandular
alveoli that secrete milk of
the lactating female.
•Alveoli secrete milk
into secondary tubule
that converge to form
mammary duct.
•Ampulla:
–Where milk accumulates
during nursing.
•Neuroendocrine reflex:
–Act of nursing maintains
high levels of prolactin.
–Sucking may cause
release of PRH.

23. Insert fig. 20.55
Milk-Ejection Reflex

24. Composition of breast milk
a) Colostrum:
Bright lemon yellow ; alkaline ;
viscous fluid secreted during first 5-
7 days : compared to mature milk it
is :
1)More rich in protein (2.3gm/dl) but
less CHO or fat.
2)Very rich in immunoglobulin especially IgA

25. 3) rich in cholesterol , Na , K , Cl ,
Zinc , Copper , leucocytes
( macrophages , lymphocytes )
Antibacterial ( lactofissin ,
lactofirrin ) more rich in Vit.A than
mature milk.

26. 4) Laxative effect نيلم ريثأت by enhancing GIT motility
leading to prevention of meconium blood
formation which is the most common cause
intestinal destruction.

27. 5) reducing enterohepatic circulation and prevent
hyperbilirubinaemia.

28. * In summer weather when colostrumn is in
small amount and due to hot weather dehydration
may occur manifested by fever ; when baby is
alert and reddish in colour.
R: oral hydration ; if severe degree leading to IV
fluids should be given.

29. Advantages of breast feeding:-
1) Balanced diet.
2) Anti-anaemic.
3) Anti-allergic.
4) Anti-rechitic.
5) Anti-infective.

30. 1) Balanced diet:
1- protein: 70% soluble ; easily
digested.
2- fat: essential long chain ; needed for
brain develop.
3- high fat: in hind milk satiety .
4- high cholesterol: myelination of
nervous system.
5- high lactose galactose brain
growth.

31. 6- colostrum: increasing zinc prevent
necrotizing enterocolitis.*
7- high content of E,C,D,A and niacin.
8- decreasing phosphate prevent neonatal
hypoealcemic convulsions.
*Necrotizing enterocolitis is a serious bacterial infection in the intestine, primarily
of sick or premature newborn infants. It can cause the death (necrosis) of intestinal
tissue and progress to blood poisoning (septicemia).
.

32. 2) Anti-anaemic:
Lower risk of iron deficiency during
the first 6 months of life because:
a- Higher iron content (1.5 times cow's
milk).

33. b- Better iron absorption due to
acidic lawer medium and to the
presence of large amounts of
vitamins C,E and copper.
c- No iron loss in stools .

34. 3) Anti-allergic:
It protects against allergic
diseases such as infantile
eczema , allergic rhinitis ,
asthma and allergic
gastroenteropathy*.
*Any disease of the stomach and intestine.

35. Mechanism:
As in the intestinal tract there are minute pores
which can pass high molecular protein directly
into the circulation leading to antibodies
formation i.e. complement formation in GIT 
vasculitis ةيومدلا ةيعولأا باهتلا oozing of blood  anaemia (
on long run ).

36. Breast milk has secretory
immunoglobulin A (IgA) which
lines the GIT and closing the
pases leading to no leakage of
lactoproteins into the circulation
and no formation of antibodies.

37. 4) Anti-ricketic:
Breast milk lower incidence of
richetic due to :
a- higher content of biologically
active vit.D.
b- Ideal Cal/phosph ratio helps
optimal absorption of both. (Ca/P
ratio = 2:1).

38. c- higher lactose content enhances
calcium absorption from the gut.
d- no calcium loss in stools in the
form of calcium palmitate
(insoluble)

39. Early rickets:-
Early signs symptoms:
-Sweating; irritability;
sleeplessness.
- No exposure to direct
sunlight.

40. •Craniotabes:- "up to 9 months only“
It is used to determine the hardness of
the skull.
•It can be present in premature infants
i.e. softness at the periphery of bones.
* Ricketsial softness is at the centre;
near the ossification centres.

41. 5) Anti-infection property:
i.e. protection from GIT and
respiratory infections:-
Breast milk has a living property ; it
contains living cells from the mother
i.e. Pyer's batches in the mother
circulating blood reach the bowel of
the baby ( supplying it with
macrophages and lymphocytes ). They
reach the baby Pyer's batches in the
intestine and increasing it's cell-
mediated immunity.

42. Characteristics:-
1- Contains bacterial and viral antibodies
(immunoglobulins).
2- Secretory IgA  protectine coating of
GIT mucosa.
3- Lactoferrin (iron-binding protein)
inhibits growth of E-coli by depriving it
from iron.
4- Lactose and bifidus factor promote
growth of protecting flora (lactobacilli).

43. 5- Lipase cells giardia lamblia and entamebia histolytics.
6- Milk macrophages phagocytose and kill bacteria and
fungi.
7- Milk macrophages synthesize complement ,lysozyme
and lactoferrin.
8- Milk B-lymphocytes secrete IgA.
9- Milk T-lymphocytes involved in cell-mediated
immunity.

44. 6) Anti-inflammatory:-
Contains - tocopherol Vit A;
antioxidants , cytoprotectine
agents.

45. Immunologic Factors in Human
Breast Milk
•For the fetus and newborn, immunologic
defenses are present, but immature.
• To compensate, the mother’s
immunoglobulin (Ig) G antibody moves
across the placental barrier to provide
some protection. After birth, these
maternal antibodies wane in the first 6 to
12 months of human life. The neonate and
infant can receive additional maternal
protection from breast Milk.

46. •Human breast milk contains large
quantities of secretory Ig A (sIgA).
•These antibodies, which have formed
as a consequence of the mother’s
previous exposure to infectious agents,
can bind to potential pathogens and
prevent their attachment to the infant’s
cells.
•Secretory IgA is adapted to survive in
the respiratory and gastrointestinal
mucosal membranes and resist
proteolytic digestion. Secretory IgA
neutralizes infectious agents while at
the same time limiting the damaging
effects of tissue inflammation that can
occur with other antibody types.

47. •Human breast milk, and especially the
early colostrum, contains measurable
levels of leukocytes.
• Colostrum contains approximately 5106
cells per ml, an amount that decreases
tenfold in mature milk.
•Most of these leukocytes are
macrophages and neutrophils, which
phagocytose microbial pathogens.
• Lymphocytes, including T cells, natural
killer cells, and antibody-producing B
cells, make up 10% of the leukocytes in
human breast milk.

48. There is evidence to suggest that
these cells survive passage
through the infant’s
gastrointestinal system where
they are absorbed and influence
the infant’s immune response.
Much of this evidence comes
from animal studies

49. Some can say “If the baby keeps
breastfeeding, the antibodies will prevent
him from developing his own immunity”.
Is that true or what?

50. Immunizations
Immunizations help prevent against infections
by stimulating the child’s production of
antibodies in response to a challenge by an
organism.
Breastfeeding provides passive protection
PLUS stimulation of the child’s immune
system so that s/he can respond to a challenge
by an organism.

52. Not just passive immunity
Breastmilk contains elements which stimulate
the development and maturity of the immune
system and the breastfed baby has a more
mature immune system
White cells and cytokines produced by white
cells
Anti-idiotypic antibodies
Certain hormones such as leptin

53. •In addition to these immunologic
components, breast milk contains several
nonspecific factors that have
antimicrobial effects. These factors
include:
• the enzyme lysozyme, which inhibits the
growth of many bacterial species by
disrupting the proteoglycan layer of the
bacterial cell wall. Lactoferrin, one of the
most abundant proteins in human milk,
also limits bacterial growth by removing
essential iron.

54. •Nucleotides in human milk have been
shown to enhance immune function in
infants.
•Complex sugars are found only in trace
amounts in cow milk but make up a
substantial portion of human milk sugars,
where they may prevent adherence of
various microbial pathogens by acting as
decoy receptors.

55. •A BYU-Harvard-Stanford
research team has identified a
molecule that is key to
mothers' ability to pass along
immunity to intestinal
infections to their babies
through breast milk.

56. •The study highlights an
amazing change that takes place
in a mother's body when she
begins producing breast milk.
For years before her pregnancy,
cells that produce antibodies
against intestinal infections
travel around her circulatory
system as if it were a highway
and regularly take an "off-
ramp" to her intestine. There
they stand ready to defend
against infections such as
cholera or rotavirus.

57. •But once she begins lactating,
some of these same antibody-
producing cells suddenly
begin taking a different "off-
ramp," so to speak, that leads
to the mammary glands. That
way, when her baby nurses,
the antibodies go straight to
his intestine and offer
protection while he builds up
his own immunity.

58. •This is why previous studies have
shown that formula-fed infants have
twice the incidence of diarrheal
illness as breast-fed infants.
Until now, scientists did not know
how the mother's body signaled the
antibody-producing cells to take the
different off-ramp. The new study
identifies the molecule that gives
them the green light.

59. •
"Everybody hears that breastfeeding is
good for the baby," said Eric Wilson, the
Brigham Young University microbiologist
who is the lead author on the study. "But
why is it good? One of the reasons is that
mothers' milk carries protective antibodies
which shield the newborn from infection,
and this study demonstrates the molecular
mechanisms used by the mother's body to
get these antibody-producing cells where
they need to be."

60. •Understanding the role of the molecule,
called CCR10, also has implications for
potential future efforts to help mothers
better protect their infants.
"This tells us that this molecule is
extremely important, so if we want to
design a vaccine for the mother so she
could effectively pass protective
antibodies to the child, it would be
absolutely essential to induce high levels
of CCR10,".

61. Dr Maha H. Daghestani / KSU
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