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Breastfeeding is the feeding of an infant or young child with breast milk directly from human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. Most mothers can breastfeed for six months or more, without the supplement of infant formula milk or solid food.

Human breast milk is the best source of nourishment for human infants[1], with few exceptions, such as when the mother is taking certain drugs or is infected with tuberculosis or HIV. Breastfeeding promotes health, helps to prevent disease and reduces health care and feeding costs.[2] In both developing and developed countries, artificial feeding is associated with more deaths from diarrhoea in infants.[3]Experts agree that breastfeeding is beneficial, but may disagree about the length of breastfeeding that is most beneficial, and about the risks of using artificial formulas.[4][5][6]

Both the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend exclusive breastfeeding for the first six months of life and then breastfeeding up to two years or more (WHO) or at least one year of breastfeeding in total (AAP). Exclusive breastfeeding for the first six months of life "provides continuing protection against diarrhea and respiratory tract infection" that is more common in babies fed formula. [7] The WHO[8] and AAP[9] both stress the value of breastfeeding for mothers and children. While recognizing the superiority of breastfeeding, regulating authorities also work to minimize the risks of artificial feeding.[5]

According to a WHO 2001 report,[10] alternatives to breastfeeding include:

The acceptability of breastfeeding in public varies by culture and country. In Western culture, though most approve of breastfeeding, some mothers may be reluctant to do so out of fear of public opinion.

[edit] Lactation

Main article: Lactation

The production, secretion and ejection of milk is called lactation. It is one of the defining features of being a mammal.

[edit] Breast milk

Main article: Breast milk

Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from nutrients in the mother's bloodstream and bodily stores. Because breastfeeding uses an average of 500 calories a day it helps the mother lose weight after giving birth.[11] The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the age of the child.

Research shows that the milk and energy content of breastmilk actually decreases after the first year.[8] Breastmilk adapts to a toddler's developing system, providing exactly the right amount of nutrition at exactly the right time.[9] In fact, research shows that between the ages of 12 and 24 months, 448 milliliters of human milk provide these percentages of the following minimum daily requirements:[12]

Energy: 29%
Folate: 76%
Protein: 43%
Vitamin B12: 94%
Calcium: 36%
Vitamin C: 60%
Vitamin A: 75%

The quality of a mother's breast milk may be compromised by stress, bad food habits, chronic illnesses, smoking, and drinking.[13][unreliable source?][14]

[edit] Benefits for the infant

During breastfeeding nutrients and antibodies pass to the baby[15] while it helps to strengthen the maternal bond.[16] Research has found many benefits to breastfeeding. [17] These include:

[edit] Superior nutrition

Breast milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development.[16] Children aged seven and eight years old who were of low birthweight who were breastfed for more than eight months demonstrated significantly higher intelligence quotient scores than comparable children breastfed for less time. Horwood, Darlow and Mogridge concluded, " These findings add to a growing body of evidence to suggest that breast milk feeding may have small long term benefits for child cognitive development." [18]

[edit] Greater immune health

Breast milk include several anti-infective factors such as bile salt stimulated lipase (protecting against amoebic infections), lactoferrin (which binds to iron and inhibits the growth of intestinal bacteria)[19][20] and immunoglobulin A protecting against microorganisms.[21]

Breastfeeding is a factor in the transmission of HIV from mother to child, but some constituents in breast milk may protect from infection. In particular, high levels of certain polyunsaturated fatty acids in breast milk (including eicosadienoic, arachidonic and gamma-Linolenic acids) are associated with a reduced risk of child infection when nursed by HIV-positive mothers. Arachidonic acid and gamma-linolenic acid may also reduce viral shedding of the HIV virus in Breast milk.[22] Due to this, in underdeveloped nations infant mortality rates are lower when HIV-positive mothers breastfeed their newborns, than when they use formula feed. Bear in mind, differences in infant mortality rates have not been reported in better resourced areas.[23][24] Treating infants prophylactically with Lamivudine can help to decrease the transmission of HIV through mother to child. [25] Avoidance of all breastfeeding is recommended by UNAIDS where formula feeding is acceptable, feasible, affordable and safe.

[edit] Higher intelligence

Two initial studies suggest babies with a specific version of the FADS2 gene demonstrated an IQDHA and AA, which are known to be linked to early brain development. Manufacturers of infant formula have been adding DHA and AA fatty acids to their products since this discovery over a decade ago. The researchers state, "further investigation to replicate and explain this specific gene–environment interaction is warranted," and have concluded, "Our findings support the idea that the nutritional content of breast milk accounts for the differences seen in human IQ. But it's not a simple all-or-none connection: it depends to some extent on the genetic makeup of each infant."[26] averaging 7 points higher if breastfed, compared to babies with a less common version of the gene showing no improvement when breastfed. FADS2 affects the metabolism of fatty acids, such as

[edit] Long term health effects

In one study, breastfeeding did not appear to offer protection against allergies.[dubious ][27] However, another study showed breastfeeding to have lowered the risk of asthma, protect against allergies[dubious ], and provide improved protection for babies against respiratory and intestinal infections.[28]

Infants exclusively breastfed have less chance of developing diabetes mellitus type 1 than peers with a shorter duration of breastfeeding and an earlier exposure to cow milk and solid foods.[29]diabetes mellitus type 2,[30][31] at least in part due to its effects on the child's weight.[31] Breastfeeding also appears to protect against

Breastfeeding appears to reduce the risk of extreme obesity in children aged 39 to 42 months.[32] The protective effect of breastfeeding against obesity is consistent, though small, across many studies, and appears to increase with the duration of breastfeeding.[33]

A review of the association between breastfeeding and celiac disease (CD) concluded that breast feeding while introducing gluten to the diet reduced the risk of CD. The study was unable to determine if breastfeeding merely delayed symptoms or offered life-long protection.[34]

A study at the University of Wisconsin found that women who were breast fed in infancy may have a lower risk of developing breast cancer than those who were not breast fed. [35][unreliable source?]

[edit] Fewer urinary tract, diarrheal and middle ear infections

Breastfeeding reduced the risk of acquiring urinary tract infections in infants up to seven months of age. The protection was strongest immediately after birth, but was ineffective past seven months[36] Breastfeeding appears to reduce symptoms of upper respiratory tract infections in premature infants up to seven months after release from hospital.[37] A longer period of breastfeeding is associated with a shorter duration of some middle ear infections (otitis media with effusion, OME) in the first two years of life. The researches concluded, "For a decrease in the amount of time with OME during the first 2 years of life, prolonged breast-feeding and upright feeding position should be encouraged, and cigarette smoke exposure should be minimized. Limiting early child care in large groups might also be advisable.".[38] Another study found that breastfed babies had half the incidence of diarrheal illness, 19% fewer cases of any otitis media infection and 80% fewer prolonged cases of otitis media than formula fed babies in the first twelve months of life.[39]

[edit] Less tendency to develop allergic diseases (atopy)

In children who are at risk for developing allergic diseases (defined as at least one parent or sibling having atopy), atopic syndrome can be prevented or delayed through exclusive breastfeeding for four months, though these benefits may not be present after four months of age. [40] However, the key factor may be the age at which non-breastmilk is introduced rather than duration of breastfeeding.[41] Atopic dermatitis, the most common form of eczema, can be reduced through exclusive breastfeeding beyond 12 weeks in individuals with a family history of atopy, but when breastfeeding beyond 12 weeks is combined with other foods incidents of eczema rise irrespective of family history.[42]

[edit] Less necrotizing enterocolitis in premature infants

Necrotizing enterocolitis (NEC), is an acute inflammatory disease in the intestines of infants. Necrosis or death of intestinal tissue may follow. It is mainly found in premature births. In one study of 926 preterm infants, NEC developed in 51 infants (5.5%). The death rate from necrotizing enterocolitis was 26%. NEC was found to be six to ten times more common in infants fed formula exclusively, and three times more common in infants fed a mixture of breast milk and formula, compared with exclusive breastfeeding. In infants born at more than 30 weeks, NC was twenty times more common in infants fed exclusively on formula.[43]

[edit] More easily aroused from sleep

Breastfed babies have better arousal from sleep at 2-3 months. This coincides with the peak incidence of sudden infant death syndrome.[44]

[edit] Benefits for mothers

Breastfeeding is a cost effective way of feeding an infant, and provides the best nourishment for a child at a small nutrient cost to the mother. Frequent and exclusive breastfeeding can delay the return of fertility through lactational amenorrhea, though breastfeeding is an imperfect means of birth control. During breastfeeding beneficial hormones are released into the mother's body.[15] and the maternal bond can be strengthened.[16] Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point.[45]

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