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母乳喂养详解

母乳是婴儿（尤其是6个月以下的婴儿）最适宜的食物，应大力提倡母乳喂养，宣传母乳喂养的优点。

　　1．母乳成分及量 母乳成分随产后不同时期而有所改变，可分为初乳、过渡乳、成熟乳和晚乳。初乳一般指产后5~7天内的乳汁，质略稠而带黄色，含脂肪较少而球蛋白较多，微量元素锌、白细胞、S1gA等免疫物质及生长因子、牛磺酸等都比较多，对新生儿生长发育和抗感染十分重要。量较少，每次喂哺量仅18~45m1，每天250~300ml；过渡乳指产后7天到满月时乳汁，含脂肪最高，蛋白质与矿物质逐渐减少，量增多至每天平均590mI；成熟乳为第2—9个月的乳汁，其成分见表4—3，每日乳量增至700~1000ml：晚乳指10个月以后的乳汁，量和营养成分都渐减少。每次哺乳时最初分泌的乳汁及最后分泌的乳汁，成份也相差甚多，初分泌时蛋白高而脂肪低(11．8g／L和17．1g/L)，而最后分泌的乳汁则蛋白质低而脂肪高(7．1g／L，和55g／L)。

2．母乳喂养的特点

(1)营养丰富易消化吸收，蛋白质、脂肪、糖的比例适当。①蛋白质总量虽较少，但其中白蛋白多而酪蛋白少，(母乳蛋白35％为酪蛋白；牛乳为80％)，故在胃内形成凝块小，易被消化吸收。且母乳蛋白质含量少，对肾脏负担也较牛乳为小；②含不饱和脂肪酸的脂肪较多，供给丰富的必需脂肪酸，脂肪颗粒小，又含较多解脂酶，有利于消化吸收；②乳糖量多，又以乙型乳糖为主，促进肠道乳酸杆菌生长；④含微量元素如锌、铜、碘较多，尤其在初乳中，铁含量虽与牛乳相同，但其吸收率却高于牛乳5倍，故母乳喂养者贫血发生率低；⑤钙磷比例适宜(2：1)，易于吸收，较少发生低血钙症，且矿物质总量低，对肾脏负担小；⑥含较多的消化酶如淀粉酶、乳脂酶等，有助于消化。

(2)母乳缓冲力小，对胃酸中和作用弱，有利于消化，在胃内停留时间较牛奶为短。

(3)母乳含优质蛋白质、必需氨基酸及乳糖较多，有利于婴儿脑的发育。人乳中的卵磷脂可作为乙酰胆碱前体；鞘磷脂可促进神经髓鞘形成；长链不饱和脂肪酸可促进大脑细胞增殖；乳糖有利于合成脑苷脂和糖蛋白，可促进中枢神经系统发育。此外人乳中尚有较多的生长调节因子，如牛磺酸等。这些都是促进神经系统发育的重要因素。

(4) 母乳具有增进婴儿免疫力的作用：1含有SIgA，尤以初乳中为高，在胃肠道内不受酸碱度影响，不被消化，可结合肠道内细节力、病毒等病原体和过敏原，阻止其侵入肠粘膜，有抗感染和抗过敏的作用。此外母乳尚有少量IgG和IgM抗体、B及T淋巴细胞、巨噬细胞和中性粒细胞，也有一定免疫作用；2含有比牛乳较多的乳铁蛋白可抑制大肠杆菌和白色念珠菌的生长，有抗感染作用；3其他如双岐因子可促进双歧杆菌、乳酸杆菌生长，抑制大肠杆菌，减少肠道感染，溶酶菌、乳酸过氧化氢酶、抗葡萄球菌因子、补体等在预防小儿肠道或全身感染中起一定作用等。

（5）乳量随小儿生长而增加，温度及泌乳速度也较合宜，几乎为无菌食品，直接喂哺手续简便，又十分经济。

(6)母亲自己喂哺，有利于促进母子感情，密切观察小儿变化，随时照顾护理。

(7)产后哺乳可刺激子宫收缩，促使母亲早日恢复；哺乳期推迟月经复潮，不易怀孕，有利于计划生育；哺乳母亲也较少发生乳腺癌、卵巢癌等。



3. 喂养方法

(1)时间 目前主张越早开奶越好。正常足月新生儿出生半小时内就可让母亲喂奶，既可防止新生儿低血糖又可促进母乳分泌。母乳腺分泌乳汁是一个复杂的神经内分泌调节过程，婴儿反复多次有力吸吮，可反射性地使乳母血中催乳素的浓度保持较高水平，一般哺乳后30分钟达高峰，尤以夜间哺乳为高，有利促进乳汁分泌。母亲哺乳时婴儿的吸吮刺激引起感觉冲动传至大脑垂体后叶，促使催乳素分泌经血循环达到乳房，使泌乳细胞周围的肌细胞收缩，将乳汁挤至乳腺导管及乳晕下的乳突，并排出体外，母亲感到乳房胀满，有乳汁从乳头流出，这就是射乳反射。建立了射乳反射才能将乳房中的乳汁挤出乳房，便于婴儿吸入。因此在最初几日母乳分泌量较少时，要坚持按需喂哺母乳，最好产后母婴同室，乳量会逐渐增多，不宜过早加喂牛奶或乳制品。第一二个月不需定时喂哺，可按婴儿需要随时喂。此后根据小儿睡眠规律可每2~3小时喂1次，逐渐延长到3—4小时1次，夜间逐渐停1次，一昼夜共6—7次。4~5个月后可减至5次。每次哺乳约15~20分钟。根据吸吮能力及生活能力的不同，适当延长或缩短每次哺乳时间，以吃饱为准。但每次哺乳应将乳房吸空，否则多量乳汁存留在乳房内，可使母乳中的抑制因子(一种多肽)产生抑制泌乳细胞作用，使乳量逐渐减少。

(2)方法 为了使乳房尽量排空，以刺激乳汁分泌，每次喂哺时应吸空一侧乳房，再吸另一侧：下次喂哺则从未吸空的一侧开始，这样就能使每侧乳房轮流吸空。哺乳前乳母先为小儿换尿布，清洗双手，用温开水拭净乳头，将小儿抱于怀中，取坐位哺乳最为适宜。哺乳时应将乳头和大部分乳晕送入婴儿口中，婴儿下唇略外翻，母乳晕下方几乎全部进入婴儿口中，而乳晕上方暴露稍多，使婴儿舌头从下向上裹住母乳头与乳晕，吸吮时舌头由前向后呈波浪运动，与硬腭相对，挤压拉长乳头，将乳晕下乳窦中乳汁挤入口中咽下。婴儿口与乳房含接良好，吸吮才有效，并可预防乳头皲裂。哺乳完毕后将小儿轻轻抱直，头靠母肩，轻拍其背，使吸乳时吞入胃中的空气排出，以防发生溢乳。

4.母乳喂养注意点

(1)母亲在孕期就应树立自己喂孩子的信心，并作好具体准备，如孕晚期每日用温开水擦洗乳头，向外轻拉几次，使乳头皮肤坚实及防止乳头内陷，以利小儿吸吮。

(2)乳母应注意营养，睡眠充足，心情愉快，生活有规律，不随便服药，每日应较平时增加能量3－4MJ(700—1000kcal)和水份1—1．5L。

(3)母乳量不足时，常有哺乳前乳房不胀，哺乳时小儿吞咽声少，哺乳后小儿睡眠短而不安；常哭闹，体重不增或增加缓慢。需找寻原因加以纠正，或服催乳药。经各种措施而仍乳汁不足时可考虑混合或人工喂养。

(4)母患急、慢性传染病、活动性肺结核等消耗性疾病，或重症心、肾病等均不宜或暂停母乳喂哺。暂时不能直接喂哺时，可定时将乳汁挤出，以免乳量减少。

(5)注意防止母乳头、乳房疾病，母乳头应经常保持清洁，如发生乳头裂伤，应暂停直接喂乳，可用手或吸乳器将乳汁吸出消毒后喂哺，并以鱼肝油软膏擦涂乳头，防止感染，促使痊愈。经常排乳不畅或每次喂哺未将乳汁吸空，引起乳汁淤积于乳房，可发生乳房肿胀有小硬块(乳核)，有胀痛。初起时应及早进行局部湿热敷及轻轻揉摩将其软化，婴儿频繁有力的吸吮将乳汁吸空或于喂乳后用吸乳器将乳汁吸尽，以防乳腺炎。患乳腺炎时应暂停患侧喂乳。

(6)不应让婴儿口含乳头(或橡皮乳头)睡觉，不仅不卫生，且易引起窒息、呕吐。

5.断奶随小儿年龄增长，母乳的量和质逐渐不能满足小儿肪需。而小儿的消化吸收功能也渐臻成熟，乳牙萌出，咀嚼能力增强．已可适应半固体和固体食物，自4—5个月起可添加一些辅助食品，以补充小儿营养所需，又为断奶作准备。在增加辅食同时逐渐减少哺乳次数，一般小儿于10－12个月可逐渐完全断奶，母乳量仍多者也可延至1．5—2岁，但切忌骤然断奶，以免因小儿不适应其他食品而引起摄食量突然减少，甚至发生营养不良。断奶后应注意调配易消化的、适宜于年幼儿食用的膳食，不宜与成人膳食混同。

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