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When the infant suckles, sensory nerve fibers in the areola trigger a neuroendocrine reflex that results in milk secretion from lactocytes into the alveoli. The posterior pituitary releases oxytocin, which stimulates myoepithelial cells to squeeze milk from the alveoli so it can drain into the lactiferous ducts, collect in the lactiferous sinuses, and discharge through the nipple pores. It takes less than 1 minute from the time when an infant begins suckling (the latent period) until milk is secreted (the let-down). [link] summarizes the positive feedback loop of the let-down reflex    .

Let-down reflex

This figure shows the process of let down reflex, the process in which the brain receives sensory impulses to release the hormones necessary for producing and discharging milk to the suckling newborn.
A positive feedback loop ensures continued milk production as long as the infant continues to breastfeed.

The prolactin-mediated synthesis of milk changes with time. Frequent milk removal by breastfeeding (or pumping) will maintain high circulating prolactin levels for several months. However, even with continued breastfeeding, baseline prolactin will decrease over time to its pre-pregnancy level. In addition to prolactin and oxytocin, growth hormone, cortisol, parathyroid hormone, and insulin contribute to lactation, in part by facilitating the transport of maternal amino acids, fatty acids, glucose, and calcium to breast milk.

Changes in the composition of breast milk

In the final weeks of pregnancy, the alveoli swell with colostrum    , a thick, yellowish substance that is high in protein but contains less fat and glucose than mature breast milk ( [link] ). Before childbirth, some women experience leakage of colostrum from the nipples. In contrast, mature breast milk does not leak during pregnancy and is not secreted until several days after childbirth.

*Cow’s milk should never be given to an infant. Its composition is not suitable and its proteins are difficult for the infant to digest.
Compositions of Human Colostrum, Mature Breast Milk, and Cow’s Milk (g/L)
Human colostrum Human breast milk Cow’s milk*
Total protein 23 11 31
Immunoglobulins 19 0.1 1
Fat 30 45 38
Lactose 57 71 47
Calcium 0.5 0.3 1.4
Phosphorus 0.16 0.14 0.90
Sodium 0.50 0.15 0.41

Colostrum is secreted during the first 48–72 hours postpartum. Only a small volume of colostrum is produced—approximately 3 ounces in a 24-hour period—but it is sufficient for the newborn in the first few days of life. Colostrum is rich with immunoglobulins, which confer gastrointestinal, and also likely systemic, immunity as the newborn adjusts to a nonsterile environment.

After about the third postpartum day, the mother secretes transitional milk that represents an intermediate between mature milk and colostrum. This is followed by mature milk from approximately postpartum day 10 (see [link] ). As you can see in the accompanying table, cow’s milk is not a substitute for breast milk. It contains less lactose, less fat, and more protein and minerals. Moreover, the proteins in cow’s milk are difficult for an infant’s immature digestive system to metabolize and absorb.

The first few weeks of breastfeeding may involve leakage, soreness, and periods of milk engorgement as the relationship between milk supply and infant demand becomes established. Once this period is complete, the mother will produce approximately 1.5 liters of milk per day for a single infant, and more if she has twins or triplets. As the infant goes through growth spurts, the milk supply constantly adjusts to accommodate changes in demand. A woman can continue to lactate for years, but once breastfeeding is stopped for approximately 1 week, any remaining milk will be reabsorbed; in most cases, no more will be produced, even if suckling or pumping is resumed.

Mature milk changes from the beginning to the end of a feeding. The early milk, called foremilk    , is watery, translucent, and rich in lactose and protein. Its purpose is to quench the infant’s thirst. Hindmilk is delivered toward the end of a feeding. It is opaque, creamy, and rich in fat, and serves to satisfy the infant’s appetite.

During the first days of a newborn’s life, it is important for meconium to be cleared from the intestines and for bilirubin to be kept low in the circulation. Recall that bilirubin, a product of erythrocyte breakdown, is processed by the liver and secreted in bile. It enters the gastrointestinal tract and exits the body in the stool. Breast milk has laxative properties that help expel meconium from the intestines and clear bilirubin through the excretion of bile. A high concentration of bilirubin in the blood causes jaundice. Some degree of jaundice is normal in newborns, but a high level of bilirubin—which is neurotoxic—can cause brain damage. Newborns, who do not yet have a fully functional blood–brain barrier, are highly vulnerable to the bilirubin circulating in the blood. Indeed, hyperbilirubinemia, a high level of circulating bilirubin, is the most common condition requiring medical attention in newborns. Newborns with hyperbilirubinemia are treated with phototherapy because UV light helps to break down the bilirubin quickly.

Chapter review

The lactating mother supplies all the hydration and nutrients that a growing infant needs for the first 4–6 months of life. During pregnancy, the body prepares for lactation by stimulating the growth and development of branching lactiferous ducts and alveoli lined with milk-secreting lactocytes, and by creating colostrum. These functions are attributable to the actions of several hormones, including prolactin. Following childbirth, suckling triggers oxytocin release, which stimulates myoepithelial cells to squeeze milk from alveoli. Breast milk then drains toward the nipple pores to be consumed by the infant. Colostrum, the milk produced in the first postpartum days, provides immunoglobulins that increase the newborn’s immune defenses. Colostrum, transitional milk, and mature breast milk are ideally suited to each stage of the newborn’s development, and breastfeeding helps the newborn’s digestive system expel meconium and clear bilirubin. Mature milk changes from the beginning to the end of a feeding. Foremilk quenches the infant’s thirst, whereas hindmilk satisfies the infant’s appetite.

Questions & Answers

normal blood volume in our body
pankaj Reply
5Litres
Albert
what are the advantages of the concave shape of red blood cells?
Amy Reply
This structure is VERY flexible. It can allow these cells to get into the most tiny places in our bodies. a VERY good design! The advantage of red blood cells' biconcave shape is that the surface area is increased to allow more haemoglobin to be stored in the cell.
Saafi
They can stack so that they can move to capillaries
Nejat
action of gluteus medius and minimus
Green Reply
Lateral rotation of the hip joint
Hertzo
Briefly explain location of ecg on a patient
Prince Reply
it is a machine that gives a graphical representation of heart beat
Nani
Briefly explain location of ecg leads on a patient?
Prince
in ecg we use electrical leads over the chest ,ancle and wrist
Nani
what is the anatomical and function difference between paravertebral and prevertebral ganglia ?
Rada Reply
types of tissue in human
Preety Reply
charactetistic Of cartilaginous tissue
Preety
what is theRecurrent infection?
pankaj Reply
what do you mean about recurrent infection
pankaj
Recurrent or persistent infection is a manifestation of primary immuno deficiency
Kedha's
weakens the immune system, allowing infections and other health problems to occur more easily
Kedha's
lysis of RBC
Abdirizack
What is barometric pressure
Kedha's Reply
what is the agglutination advantage
Gopal Reply
the functions of the liver
Nana Reply
it produces bile juice which is used to make the food smaller
Kedha's
it also plays an important role in conversion of amino acid into urea
Komal
it also has role in gluconeogenesis in which amino acids and lipids convert into glucose.
Komal
during fetal life it's a center for hemopoiesis (formation of blood cells)
Komal
it filters, or removes, harmful substances from the blood
Kedha's
It stores nutrients, such as vitamins and iron,for the body
Kedha's
what is the largest gland in human body
Shahid Reply
liver
rachna
correct
Said
correct
dominic
thyroid gland
Kedha's
thyroid is largest endocrine gland
Komal
describe microscopic structures of the kidney
Nana Reply
kidney is covered by fibrous capsule, consists of an outer cortex and inner medulla with medullary pyramids. The microscopic structure is seen as 1-2 millions of nephrons and collecting tubule.
Komal
identify the four major tissue types
Binkheir Reply
connective epithelial
Nana
two ramining
Binkheir
muscle nervous
Nana
epithelial, connective, muscle, and nervous tissue
Mel
tell me about urine formation
Nana Reply
it includes three steps. ultrafiltration selective reabsorption tubular secretion
Komal
ultrafiltration also known as glomerular filteration. All solutes up to 4nm size and water can freely pass through the filtering membrane.
Komal
selective reabsorption : About more than 99% of water ,electrolytes and other substances are reabsorbed by the tubular epithelial cells. The reabsorbed subtances move into interstitial fluid and then into blood of peritubular capillaries .
Komal
The substances like water ,glucose,amino acids and electrolyte are reabsorbed
Komal
tublar secretion: the substances are transported from blood to again into the renal tubules
Komal
and then those are excreted out as urine
Komal
internal and external structures of the kidney
Nana Reply
how the kidney works
Nana
on the bases of pressure and filtration
Said
General
Nana
excretion of wasts, role in hb, role in vit D synthesis
Said
care to explain?
Okoye
yes plx
Nana

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Source:  OpenStax, Anatomy & Physiology. OpenStax CNX. Feb 04, 2016 Download for free at http://legacy.cnx.org/content/col11496/1.8
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