Breastfeeding: New Horizons - Montana State Breastfeeding Coalition

Breastfeeding: New Horizons Caroline Steele, MS, RD, CSP, IBCLC Manager, Clinical Nutrition & Lactation [email protected] Children’s Hospital of Orange County Orange, CA

Areas of Breastfeeding Research  Breastfeeding & Orofacial Development and Reduction

of Risk of Obstructive Sleep Apnea (OSA)  Role of Breastfeeding in Reducing Maternal Risk of Type

II Diabetes  Breastfeeding and Maternal and Infant Response to Stress  The Role of Breastfeeding in Fighting Obesity

 Breastfeeding and Long Term Health

Importance of Breastfeeding to Orofacial Development and Reduction of Risk for OSA

BF and Airway Development  Relationship between soft palate and epiglottis is different in infants than adults  When infant’s mouth is closed, epiglottis and soft palate touch  During BF, epiglottis rises and divides the isthmus faucium into two canals – Allows the infant to breathe and swallow at same time – Adults cannot do this – At this time period, infants have airway more similar to other mammals than adult humans

Risk Factors for Obstructive Sleep Apnea (OSA)  Large BMI  Large neck  High palate  Narrow dental arches  Overjet  Abnormal tongue activity – Genetic – Result of habits • Bottle feeding • Pacifier use • Thumb/finger sucking

Historical Look at Orofacial Structures  Weston Price, MD—1930s  Evaluated nonindustrialized islands/cultures  Evaluated teeth facial contour and mouths of

natives and skulls  Nearly all exhibited: – – – –

Ideal occlusions Normal palate height Wide dental arches Minimal decay

 Common feature: BF was only method of feeding

Craniofacial Development Occurs primarily during first 4 years

90% is complete by age 12 Suggests that features that put adults at risk

for OSA were likely present at age 12

Importance of Breastfeeding “Breastfeeding is important for palate and dental arch shape, alignment of the teeth, as well as the development of a correct swallow and orofacial musculature.” “Breastfed infants have the best chance of developing an ideal occlusion, normal palates, and wide dental arches.” Palmer B. J Hum Lact 1998;14:93-98.

Why??  At birth, natural position for tongue is pushed forward – Protects breast from trauma – Helps compress the lactiferous sinuses

 Coordinated effort of mouth, jaw, and facial muscles that occurs during BF ensures proper development of these muscles  Infant’s palate is soft and malleable – BF infants with normal swallow have better chance of developing normal palate height and a dental arch that has a rounded U shape

BF and Palate Development  Tongue contributes to shaping of palate  Bottle or pacifier inserted between tongue and palate – Tongue cannot reach palate – Physical contact of bottle nipple or pacifier can actually elevate the height of the palate – Vacuum created by strong sucking can also increase height of palate

Swallowing Patterns  Swallowing pattern is developed in infancy  Adult swallowing pattern: – Tip of tongue just behind front teeth – Tongue continues across hard palate in peristaltic motion – During end of swallow, tensor palatini muscles fire and open the eustachian tubes – Muscles elevate and tense so that food/fluid does not escape theough the nose – Tongue does not exert any pressure on the teeth during a correct swallow

Bottle Feeding and Swallowing Less muscle coordination needed

Perioral, facial, and TMJ musculature

development may be suboptimal Artificial nipples vary (size of hole,

compression needed, etc.)

Bottle Feeding/Swallowing Cont’d  Excessive flow may cause tongue to be placed at back of throat to protect airway

 Inadequate flow results in excessive sucking – Potential for collapse of oral cavity

 Bottle nipples firmer than breast – Tongue gets drawn inside mouth to protect bottom side of tongue from trauma from gum pad – Tongue thrust often develops

Concerns Regarding OSA “Excessive vacuum that may be needed during bottle-feeding and the development of a tongue-thrust are the main contributing factors to the malocclusions that put an individual at risk for OSA.”

www.brianpalmerdds.com

Relationship During Childhood  Davis and Bell – Strong association between exclusive bottle feeding and malocclusion – Relationship did NOT diminish with change from primary to permanent teeth

 Labbok and Hendershot – Longer duration of BF, lower incidence of malocclusion – Bottle feeding leads to habit of tongue-thrusting – Significant decrease in tongue-thrusting with increased duration of BF

Conclusions “Breastfeeding reduces the risk of bite relationships the can put an individual at risk for OSA. Since OSA can lead to many health problems, it can be concluded that breastfeeding is critical for the future health of our children.”

www.brianpalmerdds.com

Role of Breastfeeding In Reducing Maternal Risk of Type II Diabetes

Nursing for Good Health  Study of 157,003 women – 2 separate cohorts (83,585 and 73,418)

 For each year of lactation, women with a birth in the prior

15 years had a decrease in risk of DM by 15%  Independent of other DM risk factors (BMI, diet,

exercise, smoking)  Benefit appears to accrue after 6 months of lactation

Nursing and Risk of Type II DM BF mothers have lower glucose and insulin

levels Hormonal changes of a long period of

nursing translate into lower DM risk

Maternal and Infant Response to Stress— Benefits of Breastfeeding

BF & Infant Stress Response Leptin (protein produced in adipose tissue

and present in human milk) – Reduces responses to stress in infant – Acts on both central (hypothalamus and hippocampus) and peripheral (pituitary and adrenal gland) targets – Reduces exposure to glucocorticoids and enhances brain (hippocampal) development

BF & Maternal Stress Response  Reduced cortisol and epinephrine response to physical stress (running on treadmill)  Autonomic response to psychologic stressor

(Trier Social Stress Test) blunted compared to bottle feeding mothers – Blunted reactivity to irrelevant stress – Enhanced reactivity to stress threatening mother-infant dyad

 Plasma ACTH and cortisol secretion are reduced by infant suckling (lower after nursing than

before nursing)

Conclusions Good for babies! – Reduces stress response – Enhances brain development

Good for moms! – Reduces stress response – Assists in filtering irrelevant stress vs. that which poses a “threat” to the infant

Breastfeeding & Obesity

Obesity in the United States  65% of adults are overweight or obese  17% of children 2-19 yrs are overweight  Statistics are on the rise

 Causes are multifactoral  BF may play a key role

Obesity Theory Obesity in bottle fed infants historically

blamed on overfeeding Research suggests there may be other

physiologic factors at work

Role of Hormones in Breastfeeding

Prolactin Released from anterior pituitary gland

Nipple stimulation causes hypothalamus to

signal anterior pituitary to release prolactin Binds to receptor sites on the alveoli Stimulates the alveoli to secrete milk

Oxytocin CRITICAL in breastmilk production Released from the posterior pituitary Released with nipple stimulation or by

visual, auditory, or psychological stimuli Also causes the cells surrounding alveoli in

the breast to contract causing milk “let down” (milk ejection reflex or MER)

Oxytocin and the GI Hormones  Stimulates the release of GI hormones (insulin,CCK, somatostatin, and gastrin) in both mother and baby.  GI hormones stimulate intestinal villi, increasing surface area for absorption of nutrients in both mother and baby.  CCK also helps regulate caloric intake by inducing satiety, post-feeding sedation, and sleep.

Infant Benefits DARLING study – Infants receiving breastmilk as only milk during first yr were lighter than formula fed infants with similar length and OFC – Energy intake of breastfed infants lower than formula fed infants • Even after introduction of solids

– Authors suggest this is a function of selfregulation in breastfed infants

Infant Benefits  Grummer-Strawn, et al – Duration of BF (up to 2 years of age) showed a doseresponse, protective relationship regarding being overweight at age 4 – Those BF >1 yr had a 51% reduction in risk for overweight than those never BF – No protection against being overweight among those BF for