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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

what is metabolism
fred Reply
Chemical reaction that takes in place in the cell of a living organism that includes anabolism and Catobolism.
Norman
Catabolism*
Norman
metabolic chemical reaction is of two types, anabolism and catabolism. The break down of larger molecules into smaller molecules is called catabolism.
Ahmad
Metabolism is the chemical reaction that includes anabolism and catabolism
Kedha's
Anabolism is the chemical reaction that combines all the smaller quantities to make large
Kedha's
Catabolism is the chemical process that breaks larger quantities into small
Kedha's
what's abdominal police?
Mohamed
hcl
Annette
hydrochloric acid is the stomach police
Annette
its the stomach omentum
Agama
description of the ears
Nana Reply
which component of mucus allows it to maintain local level of hydration
Loriann Reply
can the teeth be classify under bones?
Ojaga Reply
Bony prominents
guka
What is the largest muscle in the lower leg
Gwen Reply
what's a nervous system
Dante Reply
Is a the group of neurons and glial cells that work together to receive, integrate and responds appropriately to stimulus in the periphery, spinal cord and brain.
Hertzo
study about internal structure, outer structure and their functions
Navdeep Reply
circulatory system on blood pressure
Lakhu Reply
What is ELISA
POULAMI Reply
(enzyme linked immunosorbent assay) is a test that uses antibodies and color change to identify a substance.
luke
tr
Mohamed
what's defense mechanism?
Saintina
psychological strategies that are unconsciously used to protect a person from anxiety arising from unacceptable thoughts or feelings.
Henry
difference between apocrine sweat glands and merocrine sweat glands
Binkheir Reply
I believe the apocrine sweat gland uses a sac under the hair follicle and the merocrine sweat gland releases directly on to the surface of the skin
Mark
normal blood volume in our body
pankaj Reply
5Litres
Albert
Normal blood volume in adults is 6 litres
Kedha's
4.7 to 5ltr.. normal for adult
Clangbhelle
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
what is the difference between phagocytosis and Pinosis
fred
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

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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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