CHO found only in mammal milk
lactose
type of milk that is not necessarily lower in fat content
foremilk
milk is composed of 88% _
water
breastmilk is low in this nutrient but it’s very bioavailable
iron
which nerves innervate the breasts
T3-T5
Number one reason why moms stop bfing is due to
milk supply
hormone that increases with nipple stimulation
prolactin
hormone secreted by the placenta
progesterone
what promotes the release of gastrin
touch
leading cause of infant death
diarrhea
three strategies needed for increasing BF initiation and duration
protection, promotion, support
commonly cited reasons why mothers stop BF
work, pain, low supply, latching
which timeframe are the moms most vulnerable to stop BF
first 3-7 days
what do montgomery glands do
secrete protective lipid material during lactation
what does prolactin do
milk production
what does oxytocin do
Milk letdown and uterine contractions
when does prolactin peak and when does it drop
drops: between nursing
peaks: right after nursing at its highest
prolactin is released with
nipple stimulation
oxytocin is released with
nipple stretching
stages of making milk
lactogenesis 1, 2, 3
lactogenesis 1
happens during pregnancy
placenta releases progesterone, which makes colostrum
lactogenesis 2
birth of the placenta- triggers transition of milk from colostrum to mature milk
lactogenesis 3
breastfeeding
needs frequent removal of milk to increase production
foremilk
beginning of the feed
hindmilk
end of the feed
babies that exclusively BF have a more __ gut
acidic
what are secretory Iga (SIGA)
bind to microbes to prevent them from being absorbed. baby gets it from colostrum- not naturally in their body
how long after birth should the baby get back to its birth weight
2 weeks
how many times should they be nursed/day
10-12 times/day
Formula fed babies secrete 50% MORE insulin than BF
true
grade 1 nipple classification
easily pulled out
grade 2 nipple classification
can be pulled out but dont maintain after stimulation stops
grade 3 nipple classification
difficult or impossible to pull out
Sheehan’s syndrome
death of an area in the pituitary gland
What are green/shiny stools a sign of?
Improper latch–> need lactation support to help with proper latch on, good seal
True/false: baby should be pulled into breast.
False! Do not pull baby into breast, let baby tilt head back for optimal latch. Hand on back of baby’s head can interfere baby’s interoral function by restricting the movement of the cranio-cervical spine–> causes nipple trauma. Make sure crook of arm in cradle position does not block baby from being able to fully tilt back.
Should a latch be symmetric or asymmetric?
Asymmetric! A baby should form a teat with breast tissue underneath the nipple as part of a latch
Not a good latch, causes nipple damage
Optimal attachment to the breast, where the baby’s lips are not centered in relationship to the areolar, but rather vertically off-centered with the baby’s chin and lower lip closer to the edge of the areola than the baby’s upper lip. A baby should form a teat with breast tissue underneath the nipple as part of a latch
Continued questions of effectiveness, fear of ingestion by baby
Should a frenotomy be suggested for tongue tie?
No study was able to report that frenotomy led to better long term breastfeeding
What is a fissure straight down the nipple evidence of?
Is there a deep latch with nipple stretching?
How many mL considered oversupply?
normal milk production = 750-1000 mL/day
Treatment of candida on breast
What to do if antifungal treatment for yeast doesn’t work?
Nipple pain and poor milk transfer that is persistent despite optimal latch
When to call PCP for clog/plug
If plug hasn’t moved in 24-48 hrs or systemic signs of inflammation (flu like s/s)
painful stabbing pinpoint pain
Same as clog treatment. Sometimes need t be lanced by HCP
systemic- fever, ill, malaise, redness, pain, one inflamed breast
What bacteria causes infective mastitis
EMERGENT AND UNCOMMON- tissue of both breasts inflamed.
organism cause of double mastitis
strep -potentially fatal, whole body inflammation, sepsis
-not a problem with milk
signs of inflammatory breast cancer
True/false: MRSA can look like mastitis when on breast
Abscess on breast is full of …
PUS not MILK. as many as 60% positive for MRSA.
can you nurse on same side as abscess
can cut through nerves and ducts. try to avoid surgical intervention
Report any suspicious area of the breast to a qualified provider because it could be…
MRSA or herpes- fatal for babies
Signs of neonatal hypoglycemia
Do healthy term newborns need glucose checks
Chart that can be used to determine when bilirubin levels require treatment
develops second week of life
infant thriving, gaining wt, stooling
pathologic causes ruled out
factor in human milk increases the intestinal absorption of bilirubin
-often called breastmilk jaundice actually related to metabolic issues with infant
-do not discontinue breastfeeding, can persist for 12 weeks
can skin to skin help a latch?
skin to skin with twins- each breast…
warms up depending on the temperature of each baby closest to breast
Negative influences on milk production
Why does pressure occur in breast?
Normal fullness vs engorgement
When do engorgment symptoms most commonly occur?
What can decrease risk of engorgement early on?
More time spent BF in the first 48 hours
What causes pressure to build up in breast
Why is breast surgery/injury a concern for BF?
Counseling implications after breast surgery
When counseling moms with breast surgery- ask yourself
With flat or inverted nipples- consider if the hormones are functioning optimally
How does nipple change during a BF?
Inverted nipple counseling implications
-babeis don’t need nipple to latch, must form “teat”
-may evert during pregnancy or postpartum
-flat nipples always evert during suckling
-both may evert from stimulation (cold, sex, finger)
-ask if and when nipple everts
-look over shoulder just after feeding for nipple eversion and compare to pre-feed nipple
-if not seen, intensive follow up
-consider expressure, assure adequate nutrition
Easily pulled out by pump or infant nursing
can be pulled out but doesn’t maintain projection
Difficult or impossible to pull out
How to classify inverted nipples
Women with uncorrected Grade 3 inverted nipples had…
lower prolactin levels and therefore less milk
Does prenatal nipple prep help improve inverted nipples?
Iron deficiency anemia/milk production
Hemorrhage can result in anemia & sheehans syndrome
-pituitary deprived of blood and its funcitons are impaired–> can happen when PP hemorrhage is well managed
-symptoms; Low BP, anemia, fatigue, profound hair loss, dry dull hair
-can have low grade or transient sheehan-like symptoms that resolve fully or partially
Maternal obesity/overweight/milk supply
Breastfeeding helps lower DM odds after GDM
-smoking mothers make less milk
-smoking mothers may have lower prolactin levels
-women who smoke more wean earlier
-smoking and nursing may result in babies who nap less
-quitting smoking during pregnancy is significantly associated with reduced risk of premature birth
-support to quit smoking should help to prolong breastfeeding duration, especially those most at risk for not exclusively breastfeeding
-breastfeeding may mitigate adverse effects of smoking during pregnancy on the child’s cognitive development
-encourage breastfeeding, protect from 2nd hand smoke
should only be used upon approval from PCP
-affects kidneys, liver, lungs, nerves as well as other body systems. cigarettes have cadmium
22% of cases related to maternal smoking during pregnancy
-understudied but transfer of nicotine is minimal
-safe for those not at risk for premature delivery
-nursing two babies not from same pregnacny
-feed newborn first and frequently
-find time for non-nursing interactions with older babies
-milk volume increases faster but less engorgment is experienced with 2 nurslings
-may require specific teaching to manage faster flow
-help parents respond to different needs of each child
Why did 1 oz/day formula lead to giving up BF?
women are more likely to wean early with PPD or depression during pregnancy
-early cessation of BF or not BF associated with increased risk of maternal PPD
-negative experience w/ BF support = higher risk of PP depression
-Mothers with high EPDS score more likely to d/c BF in 4-12 wks, unsatisfied w/ feeding method, more BF problems, lower levels of confience
-negatively early BF experiences = more likely to have depressive symptoms at 2 months
BF discontinuation at 2 wks associated with…
lack of confidence to BF on day 1 or 2.
Counseling implications: fear about milk supply
-avoid giving inappropriate reassurance, gather facts and refer as needed per scope
-undertake complete eval & history & feeding assessment before coming to conclusions- low milk supply rarely has 1 cause
-provide adequate postpartum support: real/perceived cases of insufficient milk
-establish community wide system eliminating the zone of professional unavailability especially days 3-7
Mammal species with high fat/protein and low water content…
mammal species with higher water content
the most rapidly developing organ in human newborns is the…
brain. human milk ideal for brain growth
last trimester, limited milk production, produces colostrum. from placental hormones
moms who have been lactating >1 yr
increased fat and energy content
Breastmilk composition changes
maximum fat levels in breastmilk were obtained…
bioavailability of nutritients
higher in human milk than in other foods or supplements (iron, zinc)
Most readily acknowledged advantage of BF
how breastfeeding protects gut from diarrhea
-pH of gut in breastfed babies is more acidic while formula more basic
-low iron in gut = due to low iron content in human milk
-prescence of bifidus factor in human milk promotes presence of lactobacillus bifidus that maintains low PH and crowds out pathogenic organisms
-presence of hormones, hormone like factors and growth factors stimulate growth and development of GI tract such as prolactin, GI hormones, epidermal growth factor, and prostaglandins
-antimicrobial boosters such as fibronectin and gamma interferon
-AND MORE
reduces amount of B12 in intestines available to microbes. protects against diarrhea
microbes transferred from mother’s skin and in breastmilk…
help to develop infant gut microbiome. there is translocation from mother’s intestine into her milk
when mother is exposed to organisms…
she makes antibodies and secretes them into her milk
cells from baby’s mouth goes into the breast….and
antibodies are made in the breast
breastfeeding changes both immune systems. T/F
gastrin and cholecytokinin promote…
glucose induced insulin release and growth promoting effects in the gut
what increases gastrin and decreases somatostatin in babies?
adult GI hormones are impacted by…
pregnancy causes increased risk for type 2 diabetes in mom…BUT breastfeeding
by 2 weeks at the latest, baby weigh….
infants lose more weight in first postpartum days…
fewer than 4 soiled diapers on day 4 with delayed onset of lactation…
may indicate breastfeeding inadequacy
hypernatremia is a common complication of…
inadequate milk transfer during breastfeeding in the US
pediatrician visits for breastfeeding newborn infants
Does it make a difference if a BF mom is undernourished?
do size of the breasts relate to amount of milk
proportion of glandular and fat tissue and number and size of ducts not related to milk production
is not getting enough fluids related to amount of milk produced
-not related to infant weight gain or growth. rest is not associated with increased milk production
be a symptom of underlying medical problem that is affecting milk supply
Increased worry/stress & milk production
compared to formula feeding mothers…BF mothers have
-more positive moods
-report more positive events
-perceive less stress
stress + oxytocin + female hormones =
lactation has a lower energy cost for humans compared to..
GI hormones during BF mom and baby
how do humans make milk with low amount of energy
how do we assure adequate milk supply
when was breastfeeding recognized as a public health priority in US since…
worldwide, includes breastfeeding
women who do not breastfeed are at risk for what other diseases?
myocardial infarction and aspects of metabolic syndrome
nursing a baby a year or more can decrease risk by 10-15% for…
hypertension, diabetes, hyperlipidemia, cardiovascular disease
what cancers are women who do not breastfeed at greater risk for?
WHO & Unicef 3 strategies for breastfeeding
promotion, protection, support
focuses on advantages of breastfeeding on a personal, community, country or global level
The international code for breastfeeding
breastfeeding protecting in US
focuses on the interaction of helpers with family as well as program development and implementation
10 steps for successful breastfeeding
form basis of baby friendly hospital
why is breastfeeding so difficult that mothers need help? top two reasons:
The international code of marketing of breastmilk substitutes
regulates marketing of breastmilk substitutes which includes infant formulas, feeding bottles and teats
-sets standards for labeling and quality of products and how the law should be implemented and monitored within countries\
-helps to make sure parents choices are made based on full information vs false marketing claims
What contributes to low rates of EBF globally?
Caregiver and societal beliefs favoring mixed feeding, hospital and healthcare practicies and policies that are not supportive of BF, lack of adequate skills and support, aggressive promotion of infant formula and other breastmilk substitutes, inadequate maternity/paternity leave legislation, workplace policies, lack of knowledge about dangers of not exclusively BF and proper BF techniques
increase hospital and health systrem capacity regardign baby friendly hospital initiative
-provide community based strategies including campaigns tailored to local context
-strengthen monitoring and enforcement of the code
-enact at least 6 months paid maternity leave
-invest in training and capacity building in protection, promotion, support
Racial disparities in US & breast feeding
Healthy People 2020 added BF targets
worksite lactation programs, reduce percentage of BF infants who receive formula before DOL2
The US report card on how we are doing on the innocenti declaration is prepared by the
Messages from the breast travel through the ____ to the brain
Hormones travel to the breast via the ___
Glandular tissue is made up of..
clusters of alveoli and small ducts
-the pituitary gland is important to both
Prolactin is more responsive in..
mothers of preemie- milk expression should be initiated ____
before 1 hour, results in significantly more milk when measured on day 7 and 42
conditioned milk ejection reflex
Hormones & emotional/behavioral funtion
aggression, protection, bonding & trust
for every 10 MKD of breastmilk the odds of sepsis decreased by 19%
breastmilk and development preemies
breastmilk and preterm babies coordination
-have better suck swallow coordination and oxygenation vs bottle feeds
-low tone (cues may be hard to spot)
-depressed reflexes (hard to latch on)- gape
-hypotonic perioral muscles, weak suck (enough to decrease mom’s supply- piston, ratio, sustain
-deficiency in the smooth tongue movement (overwhelming amounts of milk may cause sputtering)
-skeletal abnormalities of the mouth and skull will decrease volume of the oral cavity
-significant improved development in the sucking behavior over time is possible
-tongue may look large due to low tone- space inside mouth is smaller
helpful corrective interventions for positioning babies with difficulty sustaining a feed
Expression within _____ of birth creates the highest milk volume through week 8
Hand expressed milk is ______ compared to pumped milk
early hand expression with later addition of pump expression yielded milk that….
exceeded norms for fat and energy
using pump/hand expression for supply:
-need ongoing support person or professional oversight
-use 2 flanges to pump milk @ same time (double stimulation)
-express in proximity to the infant for higher milk volume
-collecting milk on one breast when nursing on the other is an effective strategy
-guided imagery can increase amount via breast pump (water dripping can also help)
-power pumping for a day or two may also help to increase volume –adequate frequency of stimulation plus try 5 min, pause 5 min, try 5 min, pause etc
prescribing and not part of scope of CLC
-may cause reduced absorption of all medications used concurrently
-worsens asthma, diarrhea, maple smelling urine
-cross reaction possible if allergy to chickpeas, peanuts, legumes
-concerns about decrease in blood coagulation and decreased serum glucose
-after 21 days of fenugreek- no statistical difference in prolactin levels or milk volume
-did not improve breastmilk volume or duration of BF in mothers pumping for preemies
-not approved for use in US
-no improvement in long term outcomes of BF
-follows pregnancy, not necessarily BF
-ability to produce milk
-baby’s willingness to milk
-length of time it will take to produce milk
-good strategy for emergencies
-possible for transgender women
-lots of time and effort
-almost never results in full milk supply
-works best when focus should be on experience and relationship rather than amount of milk
-whether use will be long term
-family preference
-whether enhances development of BF
-safety and efficacy of device
-expertise of healthcare staff to help with plan
-parent’s ability to use device safely
rather than looking for magic bullet to increase milk, we should assess
all aspects of comprehensive risk assessment tool
-how often baby is being fed and what is being fed
-whether there is milk expression
-how effective feeding/expressing is
-how much milk baby needs vs getting
-how much milk is being transferred at breast (observe feeding w/ pre/post weight checks)
-need for comprehensive pediatric and maternal medical eval
-when thinking about supplemental feeder device:
things to consider for bottle feeding
-healthy babies fed at breast only are more likely to be BF at 6 months
-breastfeeding support should be offered in NICU before bottles
-babies who are bottle fed are 2 x more likely to empty the cup or bottle in later infnacy than those who are fed directly at breast- bottle feeding may alter self regulation of intake, contributing to later obesity
separation due to work or school
– reexamine individual POV
-assure support 2-3 weeks before return to work or school
-focus on helping with BF 1 wk after d/c
-make support for parents available in workplace/school
-expecting to work in 1st year after baby’s birth does not impact whether or not BF is initiated
-planning to go to work may negatively influence the intention to exclusively BF
-returning to work before 3 months may reduce mother’s ability to BF by at least 3 months
timing of returning to work and ending BF….
2010 healthcare reform ACA act
workplace BF law
-amendment to fair labor standards act; requires employers to provide breakt ime for an employee to express breastmilk for 1 year after the child’s birth
-must be private place other than a bathroom and is shielded from view and free from intrusion by coworkers and public
-only 40% of employed women had access to these things
breastfeeding friendly workplaces
-breaktime for nursing mothers form US dept of labor
-business case for breastfeeding from hrsa.gov
only about half of working women ijn the US are…
covered by Family medical leave act
-paid maternity leave could improve BF rate at 6 months
healthy inter-pregnancy interval
-is the baby younger than 6 months, is there food or suckling except at breast, has menses returned?
-difficult to predict timing
-ovulation first?
-decreased supply?
what is considered ok for contraceptives & BF?
the most modifiable risk factors for child allergy are:
-cow’s milk whey is only substance consistently shown to bother some babies with colic symptoms
-rectal bleeding may occur even in exclusively BF infants (proctocolitis)
-cows milk protein allergy may play a role in the pathogenesis of proctocolitis–> exclude offending protein from mother’s diet
-resolution of visible rectal bleeding took place within 72-96 hours although most took a week
-women on milk free diets should be referred for dietetic counseling (need to support calcium needs)
fetal calcium demand is met by….
increased intestinal absorption during pregnancy
regardless of amount of calcium in diet, breastmilk calcium is met by _____
children are acculturated to the taste of their native foods through…
breastfeeding . longer duration of BF = higher food variety at 3 yrs
-oxytocin levels significantly decreased but prolactin levels increased
-in another study alcohol blocks release of oxytocin
-babies may not like the taste
-alcohol = water soluble, passes in and out of milk as BAC increases, NOT trapped in milk (pumping/dumping does not remove alc)
-no more than 0.5 g of alohol per kg of body wt/day
-130 lb woman = 8 oz table wine or 2 cans beer
Hierarchy of Infant feeding choices for the Term Baby
hospital distribution of breast pumps…getting a pump was associated with …
decreased odds of BF around 10 weeks
distribution of free pumps by WIC…
not associated with increased rates of EBF
lower cost pumps and hand expression may be as effective or more effective than…
cleanest way to collect milk
-hand washing and clean container is all that is needed
a majority of US babies receive infant formula in first 6 months of life T/F
What causes formula supplementation to happen societally?
other routes of contamination/formula feeding
Recommendations for preparing powdered infant formula
-mix PIF with water heated to a temperature of at least 70 degrees celsius/158 degreees F to kill enterobacter sakazakii
-formula made with hot water needs to be cooled quickly to body temp if being fed immediately
-if formula not being fed immediately, refrigerate it right away and keep refrigerated until feeding
reflux may be associated with…
cow’s milk allergy in infants less than 1 yr of age
anaphylaxis to cow’s milk or cows milk formula
possible but rare
-feeding with cows milk formula may also provoke allergy in those at risk
33-50% of infants undergo formula change within the…
first 6 months of life
-focus on helping families build skill in coping with uncomfortable babies
scurvy is a new and severe complication of..
improper use of almond drinks in first year
Until fall 2000…NCHS growth charts were based on growth of babies from …
1928-1978 without reference to how they were fed
WHO released study in 2006 which makes exclusively BF babies…
in 2010 CDC recommended that the WHO growth standards
be used for all kids under 2 yrs
the weight gain patterns of formula fed babies after 2 months may be due to…
hyperinsulinemia
-production of insulin that does not move glucose into cells
-receptor sites on cells blocked by fat? so function of insulin to move glucose out of blood and into cells can’t occur efficiently
-excess insulin causes baby to lay down fat
-cells send out repeat signals to secrete more insulin because of lack of glucose in cells
breastfeeding is a significant protector against ___ in children
gut microbiota may play a part in ___
childhood obesity. breastfed babies have unique profile
CDC’s obesity prevention plan for childhood
1) breastfeeding
2) diet rich in fruit/veggies
3) physical activity
contraindications to feeding of BM (infant)
Galactosemia. rapidly fatal if lactose is not completely removed from infant’s diet
maternal contraindications to BF
HIV
using illicit street drugs such as PCP, cocaine
-ebola (suspected or confirmed)
mother should temporarily not BF or give EBM if:
NO BF, but CAN feed expressed breast milk if w/ TUBERCULOSIS
-untreated active tuberculosis
-mother may resume breastfeeding once she has been treated appropriately for 2 weeks and is documented to be no longer contagious
-airborne and contact precautions may require temporary separation of mother and infant, during which time expressed breast milk should be given to the infant by another care provider
-can BF once no longer spreading infection
-give LC support to help maintain milk production while not BF and how to express milk
No BF but can feed EBM w/ CHICKEN POX
don’t attempt feeding. arms heavy, not much movement, do not try to wake
still body, fixed eye focus, great time to bF
growing restlnessness with hand to mouth activities
open eyed with rooting
sleep wake cycles in first hours
all babies had at least one hour awake time after birth
after first hour wakefullness varies
feeding cues: most common first behavior
1) rooting then usually hand to mouth movements
when do babies show more feeding cues
when they are close to source of milk
when cues are missed or state is not optimal…
solution to missing feeding cues
skin to skin and reteach feeding cues
tummy to mummy
nose to nips
flex the hips
to open the lips
sidelying vs laid back BF for c-section moms
if there is enough milk in back of throat to swallow
1) line up nose to nipple, move baby back an inch or two allowing head to tilt
2) baby should gape
3) baby moved towards breast, head tilts back
a hand should not be on back of head
4) bottom lip and chin reach the breast first
5) nipple will align w/ upper half o mouth when baby is latched optimally, there is more of the lower part of the breast drawn in
6) nose and chin should be close to breast
-angle at corner of mouth at least 140 degrees
7) both lips should optimally seal. make sure in “rose sniffing” position to allow jaw to drop
8) cheek line should optimally be rounded and not broken or dimpled
9)during feeding, a cheek should stay round full
10) bursts of 1:1 or 2:1 in an irregular pattern = nutritive suck
11) baby off center = asymmetrical latch, more of lower breast in mouth
12) rocker motion is optimal
12) baby ends feeding with hands relaxed
more of the areola should be seen…
on the top part of the breast. the lower part of the breast should be drawn in. = asymmetric latch
bursts of 1:1 or 2:1 in an irregular pattern
rocker motion= back and forth jaw
not optimal not nutritive. lots of sucks no swallow
should not see 6:1 suck swallow ratio…
post 1st week of breastfeeding
make sure legs are well supported because
what to teach pregnant moms about bf
importance of exclusive breastfeeding
RISK REDUCTION, not prevention of diseases. while breastfeeding reduces disease risk in population, does not provide 100% protection from illness
postpartum community resources
frequent feeding and having enough milk
breastfeeding management such as responsive feeding, rooming in and sts
to support EBF in community need:
triple negative (aggressive) breast cancer
-need to reduce disparities
trying to support breastfeeding by telling the family prenatally about problems…
could decrease desire to try breastfeeding
-FOCUS ON ONGOING SUPPORT
B) When we reach out to families
timely (proactive) interventions to help mothers tune into baby ages and stages
families are expected to initiate the contact, unlikely to be effective
mothers rate social support more important than…
healthcare system support of breastfeeding
UNICEF/national/international organizational goal for EBF
exclusive breastfeeding until 6 mo of age
other UNICEF goals for newborns
breastfed infants and vitamin D
-400 IU/day beginning at hospital discharge
lower vitamin D levels may be associated with…
passed to fetus and if stores are adequate then to baby via breastfeeding
to enter infancy with sufficient vitamin D
vitamin d supplementation for moms
recommended during pregnancy and lactation to improve vitamin D status
-can take up to 4000 IU /day
-may need to move to quieter place to BF
-regular naps
-separation anxiety
-night fedings?
-teething: sore nipples can heppen when baby’s saliva changes and gets new enzymes around same age as teething
-babies may nurse more or much less
-if baby is nursing less and milk is causing compression, maintain milk supply by relieving fullness
-offer cold teethers before nursing to numb mouth
-babies may also have runny noses and difficulty breathing at this tme
-stand and walk
-regular mealtimes and snack nursings
-nursing before bed and naps
-breastfeeding through first year, supports toddler energy adn growth by fostering a shared mother-infant regulation of toddler food intake
-promotes pattern of mother-child interaction during feeding that acknowledges the child’s role in regulating food intake
-part of self image: independence
-time to think up a public name for breastfeeding
In US = closet nursing
normal in other cultures “
strategies for ending breastfeeding
parent led, baby led or societally led
-parent led: choose least favorite nursing, substitute something equally good in eyes of child, watch for emotional/physical reactions, wait and repeat
baby led weaning: babies older than 12 months: stop offering to nurse and change to on request only
societal: historical way of weaning usually from 2-3 to 7 years, same for everyone, everyone knows and expects, ritual and celebration, not matter of when, but feelings about ending BF
sudden, lots of milk not being taken out, not the end of breastfeeding but may thought to be the end
-reason for strike may be obscure but there is somethign wrong in baby’s life (stuffy nose, teething, ear infection, prefers bottle, biting/yelling, reaction to being left unattended/cry it out, family stress, separation
-regularatory problems such as crying, feeding, sleeeping co-evolve, particularly in first 4 months
-from four months of age, sleep consolidated in night time, although many still have night feedings
-behavioral intervention programs fail to help may increase stress
-babies who breastfeed in evening and or at night sleep an average of 40-45 min more than parents of infants given formula and reported less sleep disturbance
6-9 months and sleeping at night
no difference in night waking or night feedings compared to formula fed infants
infants who received more milk or solid feeds during day were…
less likely to feed at night but not less likely to wake
10 steps to successful breastfeeding for hospitals
-outlined by WHO/UNICEF
1) have a written breastfeeding policy for all staff
2) train all healthcare staff to implement this policy
3) inform all pregnant women about benefits/mgmt of EBF
4) help mothers BF within 1 hr post birth
5) show moms how to BF/maintain BF even if separated from infants
6) give newborn infnats no food/drink other than BM unless medically indicated
7) practice roooming in 24 hrs/day
8) encourage BF AL
9) No pacifiers or teats
10) foster establishment of BF support groups and refer mothers to them on d/c from hospital
-support for international code built into BFHI
parenting dimensions of responsive parenting
feeding
soothing
sleep
physical activity
10 steps of successful breastfeeding led to…
more likely to BF at 12 months
more likely to EBF @ 3 and 6 months
less GI infectons
less atopic eczema
not a contraindication
exceedingly low levels of excess thyroid hormones pass into breastmilk
Post birth warning signs- call 911
post birth warning signs- call PCP
reasons to use a nipple shield
how do nipple shields help premature babies
the decision to initiate breastfeeding is influenced more by…
why do families choose not to BF?
-families think formula feeding is easier
-may be more comfortable with the idea of formula feeding
WIC peer counselor contacts associated with womens decision to breastfeed- need peer support
breastfeeding counseling goals
-how, who, what, when, where
-tell me about
-builds empathy and connection between client and counselor
listen for deeper understanding of the situation (underlying meanings/beliefs)
-go over plan
-ask client to demonstrate back a skill or learning
greater counseling support is needed for…
is more info better with counseling?
intrapartum synthetic oxytocin (pitocin)
-need extra BF support
-mixed results
-may have delayed onset of milk coming in
hands off technique of BF support
increased exclusive BF rates by 2 wks
support EBF during hospital stay
perinatal care core measure set
decrease elective deliveries
decrease c-sections
increase antenatal steroids
decrease healthcare associated blood stream infections in newborns
increase exclusive breastfeeding
GOAL is that hospitals will implement strict definition of acceptable criteria for supplementation adn work toward 100% exclusive breastfeeding
increases exclusive breastfeeding. one of most powerful steps in 10 steps to successful BF
breastfeeding
-perhaps due to later intiiation of breastfeeding or more separation or more supplementation or greater weight loss
-better post op pain control improves BF outcomes (a lot of times mom doesnt hold baby enough due to pain)
-baby’s gut microbiome affected by antibiotic use, mode and place of birth
-babies can go sts during section closing, may increase BF initiation & reduce formula supplementation in hospital, maintain infant temp
in hospital formula feeding associated with…
2-6x higher risk of early weaning in first year
Nine stages of skin to skin in first hour
if mother is separated from baby after birth…
the higher temperature of the areola…
what is delayed with a precipitous birth and c-section?
sense of smell which helps attract newborns to breast- this may be delayed due to fluid in sinuses
women are rewarded when they smell…
early skin to skin for 24 hours decreases..
longer skin to skin contact helps to…
improve exclusive breastfeeding
women who reported depressive symptoms in pregnancy
risk of delayed breastfeeding in hours after birth- maternal
risk of delayed breastfeeding in hours after birth-baby
The International Code
addresses improper marketing practices
ex hospital giving out discharge packages with formula
Milking Stool- 3 legs
Protect, promote & Support-want all to be equal
Levels of evidence based pyramid
top – bottom: 1.Metanalysis &systemic reviews 2. Single randomized controlled studies 3. Cohort studies 4. Case Controlled Studies 5. Case Studies
When is greatest risk of stopping breastfeeding?
3-7 days (after going home from hospital)
Top reasons people stop breastfeeding
baby won’t latch, breast pain/soreness, work/school
Russ Labs Marketing Survey
survey 1965-2001 formula company tracking breastfeeding goals
Races in Order most likely to BF
spanish speaking-hispanic, white, hispanic, black
Global Strategy for Infant and young feeding
WHO and UNICEF developed this global strategy to focus world attention on impact of feeding practices on the nutritional status, growth, development and health and thus the survival of infants and young children.
World Breastfeeding trends innitive
help track how they are doing on global outcomes
innocenti ospitale -florence
BF orphan babies increased rate of survival-today UNICEF child resource nutrition center
path of messages to make milk
message to breast-to nervous system -to brain- to hormones to travel to breast- then to blood stream
what cells make milk
alveolar cells
alveolar cells are what?
what are they surrounded by
layer of cells with milk inside, surrounded by myoepitheal cells
Myoepitheal cells will contract when what hits them
oxytocin
Are the ducts in breast evenly spaced?
No varies woman to woman
How many nipple pores each breast?
3-5
Milk is _ &__ from sebaceous gland
antimicrobial and sticky
what are the two major hormone of lactation? Where are they secreted from?
oxytocin and prolactin, pituitary gland
Prolactin is the hormone responsible for?
Milk production
What is the passage of prolactin being produced
baby suckles- message to nervous system tells brain to secrete prolacin in blood- then tranverse into mother body into milk cells where milk is produced
When doe humans have prolactin in them
all the time (non pregnant, non lactating breast and nipples increase level of prolactin when touched)
Prolactin levels go _ in between nursing and _ during nursing.
down, rise
_ nursing leads to lower levels of prolactin and less rise with same amount of contact.
infrequent
If infants do no have frequent times at breast first few days prolactin will be _ and sites will be primed and receptor sites will start to _ __.
low, not, start shutting down
What is in receptor site during pregnancy?
Progesterone
When placenta leaves the body, the body responds by pushing __ out of the receptor sites?
progesterone
When placenta is pushed out of body, progesterone leaves the receptor sites and they are open briefly, what goes inside to set site for lactation?
Prolactin
If prolactin is not set during first few hours after birth-
there will be fewer sites and cause issues with milk supply
Ongoing milk supply is associated with suckling within first __ hours after birth
2
For mothers with preemies initation of milk expression before _ hours resulted in significantly more milk by day 7
one
What hormone T3, T4, T5
Oxytocin
When oxytocin hits myoepitheal cells what happens?
They start retracting
Oxytocin helps ducts to _ in size and lumen to get _
increase, smaller
What triggers oxytocin?
- conditioned response (repeated stimuli over time) 2. Nipple Stretching (happens with proper latch- oxytocin levels goes up and down with suck and swallow)
- baby hand massage (has to do with T3 and T5) each hand movement releases oxytocin
Where is oxytocin and prolactin excreted?
pituitary gland
__ is excreted from posterior pituitary?
Oxytocin
__ is excreted from anterior pituitary?
Prolactin
Prolactin is produced mainly by nipple , by presence of baby stimulation T & T__
stimulation, 4 and 5
hormone is affected by stress and __ hormone is not affected by stress
oxytocin (extreme situation, will stop flowing), prolactin
Milk is species __.
Specific
Mammal species with high fat/protein and low water content have __ feeds.
infrequent
Lactose is essential for milk production because it provides the driving __ force behind the formation of milk.
osmotic
Human milk has the highest _ of all mammal milk.
lactose
human milk is ideal for __ growth
brain
Lactogensis stage 1 is secretory differentiation and production of under influence of hormones.
When placenta is delivered hormones is gone and goes into receptor sites. Then we go to .
colustrum, placental, progesterone, prolactin lactogensis stage 2
Lactogensis stage 2- rapid decrease in and now is in cells. The colustrum will change over to milk and colustrum will go _.
progesterone, prolactin, mature, down
Lactogensis stage 3 is also called ( has two other names)
lactation or galactopoesis
Lactogensis stage 3 has _ from frequent nipple stimulation, there is ____removal of milk and long term production of
prolactin, frequent, milk
As prolactin goes into receptor sites and makes milk the __ disappear
spaces
Preterm milk appears to have higher , _ and _ than term milk (sga, lga does not matter)
protein, fat and electrolytes
Breastmilk changes after 6 months it is more , fat and after a year fat and energy content ___
dense, increases, increases, increases
does it matter if it is foremilk, hindmilk
no think of kalahari desert nurse for 2.5 min at a time
Breastmilk composition __ during a feed.
changes
when doing before and after breastfeeding weight even if volume is low, fat content can be _.
high
the degree of breast _ influences the amount of milk available and breast storage influences the amount of fat transfered.
emptying, capacity
longer times in between feed leds to __ fat concentration
lower
faster milk removal is associated with fat content and longer feeding time is associated with levels of milk transfer and fat
higher, lower, lower
Does one breast or two breast feed matter?
doesnt matter just do whatever seems better for baby
Do male babies haver higher energy content in milk?
yes
Can men produce milk?
What situation?
Men can never produce?
yes, tumor/drugs, colustrum
Formula fed babies have __ extra in the gut
iron
Presence of bifidus factor in milk promotes presence of maintaing. a PH and crowd out pathogenic __.
lactobicillus bifidus, low, organisms
Formula fed babies have increased number of species and over representation of
C-diff
BF babies have antibiodies that bind to _ in GI tract that keep them from getting absorbed. This helps to protect from NEC IN preemies.
microbes
What do human milk oligosaccharides (HMOs) do?
Protect against pathogenic infection, promote development of intestine, help establish gut microbia, stimulate maturity of immune system
Breastfeeding changes immune system in mother or baby
both forever
when baby is suckling it activates her _nervous system. Decreasing levels of ___ and increasing levels of __ causing a feeling of sedation and satiety.
parasympathetic , somatostatin and gastrin
Pregnancy can increase risk for type 2 diabetes, breastfeeding can negate this, suckling changes insulin back to __.
pre pregnancy state
After first few days of birth most babies loose weight (diuresis-loosing fluid after birth) how much weight loss is acceptable? When should weight loss stop? When should baby be back to birth weight?
less that 7% according to AAP, by day 5, by 2 weeks
Breastfeeding stool color change
meconium-dark to start then greenish tinge then seedy orange or yellow
Need at least _ breastfeeds per day?
AAP says should be at least _ formal evaluation and documentation of trained caregiver per shift
one
Does it make a difference if mother is undernourished for breastfeeding? In refugee camp what is safer breastfeeding or formula?
No, breastfeeding – no access to clean water, heating sterilization
Breast size affects milk production? T/F
False
Does increasing fluid increase milk production T/F?
False
Too much exercise can impact milk production? T/F
False
Does stress impact milk production? T/F
False although stress can change behavior
When infant suckles at breast there is outpoor of _ different GI hormones?
19
How many extra calories per day are required when breastfeeding?
500
secretory activation is also called
lactogensis stage 2
the absence of the placenta leads to lactogensis stage, then drop in progesterone leads to lactogensis stage _
2, 3
In nipple engorgement breast is , body temp , brest can be hot and _
hard, increased , shiny
Engorgement typically happens days –, women with c-sections may experience engorgement __
3-5, laet
With engorgement the more time spent breastfeeding in the first 48 hours will result in less _, it pressure is not resolved it will have a impact on breast milk supply.
engorgement, negative
Engorgement can be natures _
dry up method
Inbetween milk making cell systems there is a capillary network delivering nutrients for making milk, if those are crushed nutrient and hormones cannot go where they need to go. What can crush these and cause problems?
Engorgement
Will pumping help engorgement
No can bust capillaries and cause bleeding
How to help with engorgement?
Bucket warm water-immerse breast and within seconds milk will come out, dont want to let all milk into bucket just get some out until plyable and softer, then feed rest to baby
What can cause engorgement?
too much milk left in breast (baby is too weak), breast implants, tight bra
What is a marker that they had a breast augmentation>
really round aeorola, or incision
Can woman with implants/ breast reduction breast feed?
Yes do not know impact until trying, just because colostrum not sure if will get normal milk -colustrum is pregnancy hormone induced, need nerves for rest of milk
Can a baby latch with inverted nipple?
Yes baby can form teat, although thing about the need for nipple stroking (prolactin) and nipple stretching (oxytocin)
3 classification of inverted nipples
grade 1- easily pulled out by breast pump or nursing, at reast look inverted
grade 2 can be pulled out but dont maintain their projection
grade 3 difficult or impossible to pull out
iron deficiency anemia has been associated with milk supply problems due to?
Poor oxygen to milk making cells, or causing mom to feel exhausted or depressed causing lack of bf
Sheehan’s syndrome (postpartum pituitary necrosis)
A patient fails to lactate after an emergency C-section with marked blood loss. Pituitary has been deprived of blood and functions are impaired other symptoms included low blood pressure, anemia, fatigue, profound hair loss, dull hair. Can have symptoms partially or fully resolved.
Maternal obesity/overweight can delay lactogenis _
2
PCOS excess insulin increases production of , higher androgens cause acne, excessive hair growth, wt gain and problems with ovulation and __, possible treatment with
androgens, lactation, metformin
Drug that cause milk delay?
peeudoephedrine (think pseudofed), corticosteriods, betamethason (giving to women who will deliver before 24 weeks) if given 3-9 days before delivery can delay lactogensis 2
Mothers who smoke have lower _ levels if smoked within 12 hrs.
prolactin
Are nicotine patches safe during BF
refer to healthcare provider
Cadmimum is a heavy metal found in _ and _
cigarettes and formula
What types of formulas have more cadmimum?
Soy based
22% of all SIDs contributed deaths can be contributed to
maternal smoking during pregnancy
Are electronic cigarettes safe in pregnancy?
tested by FDA some contain nicotine and carcinogens, nicotrine transfer appears minimal
Cannabis and Breastfeeding?
passive exposure is a concern, no safe threshold, lack of studies and high fat solubility makes cannabis difficult to analyaze in breast milk, opinions vary
THC is still measurable in EBM __ days after maternal marijuana use
6
Pacifiers increase risk for _ and
diarrhea and ear infections
Pacifiers for preemies?
May have earlier hospital discharge, tube fed may gain weight faster, improve physiologic and behavioral responses and reduce the time to oral feeds, will not affect breastfeeding for preemies
Babies that recieve additional water are at risk for? And this can cause
Water intoxication- can cause seizures, stroke, death
Early cessation/negative experience of breastfeeding has a increased risk of postpartum _
depression
What is postpartum depression scale?
Edinburgh Postnatal Depression Scale -EPDS
Mothers with EPDS scores greater than __ are likely to d/c breastfeeding by week 4-12.
12
Womans ways of knowing is by
Mary Belenky
What are the 5 characteristics of womans ways of knowing?
- Silence 2. Recievers of knowledge 3. subjective knowing
- Procedural knowing 5. Constructive Knowing
Silence way os knowling
afraid of words, feels powerless, depends on others, little awareness of intellectual capabilities, having powerful person in charge ex paulette legally blonde
How do we develop relationship with person in Silence?
Few words, short easy, comfortable, nothing to remember advocate
Recievers of Knowledge?
Believe all authorities tell truth, like to learn right answer and tell it to the teacher, cannot tolerate ambiguity ex: vivian pretty woman
How to teach to receiver of knowledge?
only show right way and have them do return demo
Subjective Knowers?
knowing is personal and based on inuition or thought, inner voice guides them , distrust male figure, find female support groups helpful, trust woman with similar experiences ex: Cher
How to teach subjective knowers?
create time for them to talk about themselves and what they know about BF, offer help with possible misconceptions
Procedural Knowing?
position in which techniques for acquiring, validating and evaluating knowledge claims are developed and honored, invested in learning and takin in new info, want diff point of view
How to teach procedural knowers?
Limit personal stories, understand the option change is part of the process
Constructed Knowing
truth is contextual, knowledge is tentative, avoid compartments, they want to be same person no matter who they are with, empathetic
Hierarchy of Infant feeding choices?
- baby at mothers breast
- Mother own expressed milk
- cow milk formula
- soy formula
No one flange size for each mom- too tight if nipple is rubbing against______
tunnel
milk hand expression has a higher __ content then pumped with electric pumped and is the _____way to collect milk
fat, cleanest
how to hand express
push back and squeeze gently
thawed milk is good at room temp for?
1-2 hrs
_ and its spores has been found in infant formula.
clostridia
WHO and CDC recommend mixing water at what temp with powder formula?
70 degrees
Other issues associated with formula fed babies is?
Reflux (cow milk allergy), reflux, colic, anaphylaxis
LCPUFAs
do not lead to better outcomes
Complication of improper use of almond drink in first year?
Scurvy
Babies that are fed goat milk may have?
electrolyte imbalances, metabolic acidosis, folate deficiency
How much milk does a woman make a day?
750-1000 mls per day
WHO study in 2006 said what are the growth standard for babies?
exclusively BF babies
weight gain pattern of formula fed babies at 2 mo might be sign of
hyperinsulinemia
higher weight gain by 3 mo of formula fed babies is because of
hyperinsulinemia, also higher protein in cows milk
_ is part of CDC prevention of obesity?
breastfeeding
Condition to not breastfeed
galactosemia
Galactosemia
recessive genetic disorder; characterized by body’s inability to tolerate galactose, causes damage to liver, cns and body system
Viruses in which you should not breastfeed?
HIV, T cell lymphotrophic virus or type 2, ebola, untreated brucellosis, HSV with lesions present, untreated TB or chicken pox
Can a mom breastfeed while using illicit drugs?
No unless on methadone program
What medications can a mom not breastfeed?
chemo drugs, rheumatoid arthritis, check book, undergoing radiopharmaceuticals
What is a example of loaded language?
you have a good baby
Late preterm babies are what age? What is our concern about them?
34-37 weeks pretend to be swallowing go home and tank
How should a counseling session go?
Listen and gather information, use questions that cant be answered with a single word, verify what youve heard, offer individualized information, work together and form a plan, fine tune plan and ask what they are going to be doing when leaving, make sure they understand, listen and help with referrals, document
Women with history of what are at higher risk for post partum disorder
premenstrual syndrome and dysphoric disorder
When discussing things postpartum should you give a ton of information?
No recall is less during post partum tiredness, limit discussion keep it client centered, educate with truth, validate confidence and counter negativity
Babies born during what time of the day are more likely to be supplemented?
the night and early morning
Pitocin decreases what needed for breastfeeding? Risk factors? Apgar, NICU?
Oxytocin, lower apgar and increased nicu risk
What to do for clogs?
Find out cause if recurring, massage (side of hand) warmth, double nursing (start on the side of the clog, go to the other breast go back to clog)
when to contact health care provider about clog?
Does not move 24-48 hours or parent develops systemic issues-achey, fever, flu like may need antibiotics
What is a bleb?
clog on nipple tip, look like milk blisters, one duct opening covered, stabbing pin point pain, may exit like clog, may need to be lanced
common mastitis
breast inflammation, infective or non-infective, milk making cells squeeze out of normal compartment and body reacts like invader
What can cause mastitis?
blocked ducts from engorgement, hurried feeding, use of nipple shield, attachment difficulties, tight bra, use of breast shield
First things to try to help with mastitis
NSAIDS, keep milk flowing and breasts soft and comfortable, avoid abcess develop, if you dont want to feed can hand express or pump
If mastitis treatments do not help what should be considered?
anemia ductal or inflammatory breast cancer
uncommon and emergent mastitis
2 hot red inflammed breasts, tissues of both breasts inflammed, strep is propable organism, potential fatal whole body inflammation
MRSA on breasts
can look like mastitis, new issues, lesion or abcess
Abscess on breast
pus not milk, 60% positive for MRSA, nursing on other breast is possible, no clear answer nursing on breast, ultrasound guide with needle aspiration
What is deadly concerns of something appearing on breast?
MRSA or herpes
What is torticollis?
neck muscles contract, causing the head to twist to one side, can cause feeding issues
Goldsmith sign
baby will only nurse on one breast, try nursing on the one breast then without moving baby move to other breast
cutoff for hypoglycemia, symptoms
40m cyanosis, apnea, hypothermia, poor body tone, lethargy, seizures
hypoglycemia occurs commonly in what babies?
SGA, LGA, diabetic mother, late preterm
What can give for low blood sugar and can still nurse?
gel in cheek, can still breastfeed
What is jaundice caused by?
uncongugated bilirubin (waste product of hemoglobin breakdown taken up by the liver, it is converted by the enzyme into uncongugated bilirubin), recycling problem, baby’s liver enzymes and intestines are immature and took a while to get out of baby’s system, can cross blood brain barried, damage brain, spinal cord and become kerniicterus, bilirubin encelopothy, CP, dental impairements, mental retardation, death
Kernicterus
severe jaundice, untreated too long, is a type of brain damage, can cause CP and hearing loss
what is considered late preterm?
34-35/6
early term babies
37-38/6
how might preterm and early term babies struggle with breastfeeding?
less alert, less stamina, greater difficulty latching, issues transfering milk
PIBBS
preterm infant breastfeeding behavior scale
what breastfeeding technique is good for hypotonic like down syndrome
dancer breastfeeding position
breastfeeding with cleft lip or palate
making a seal/vaccum the challenge, use alternitive massage, mother nipple point to intact part of palate, mother keep up coordinate with baby suck and swallow
Does breastfeeding lower cases of otitis media?
yes
What can you do right away to increase milk volume?
hand expression within 1 hour of birth, express in proximity to infant, double stimulation (send x3 messages to brain), collect milk on one breast while nursing on other
Power pumping
for a day or 2 might increase volume, pump 5 min, pause 5 min, pump 5 min
What is protocolitis?
When might it occur?
rectal bleeding may occur in exclusively breastfeeding- cows milk protein allergy, standard treamtent offending protein from mothers diet (cows milk, corn, soy, milk, egg and chocolate), resolution of visible rectal bleeding took place 72-96 hrs in most babies
Why is it important to support calcium needs in breastfeeding?
breastmilk calcium is met by renal calcium conservation and lost of bone (3-9% decrease in bone density during lactation) but gain after weaning
how much alcohol per kg is safe for breastfeeding mother
0.5 g of alcohol per kg
9 stages of skin to skin
- birth cry 2. relaxation 3. Awakening 4. activity 5. rest 6. crawling/sliding
- famerilization
- suckling 9. sleeping
WBTi
World breastfeeding trends initative-assists countries to assess the status and benchmark progress of the global strategy for infant and young child
breastfeeding considerations at 4-6 months
easily distractible, may need to be quieter place, seperation anxiety, sore nipple can happen as teething and saliva changes and new enzymes
Complementary feeding
refers to anything other than breastmilk and infant formula-both solids and liquids, when milk no longer sufficient to meet nutritional requirements
6-9 months development
mobile, teething, regular naps, periods of concentration, nught feeding, may bite breast-say no end feeding be calm and offer breast normal at next feed
9-12 development
stand/walk regular mealtimes, snack nursing, nursing before bed and naps
3 types of weaning
parent led, baby led, society led
what is baby strike?
how to end baby strike?
baby refuses to feed for some reason- stuffy nose teething, ear infection, prefers bottle, biting-yelling, family stress, seperation- to end lots of support, skin to skin dont force it, avoid the bottle- offer breast to sleeping baby
when does breastfeeding put protection on SIDS
2 months and beyond
exlusive breastfeeding at 1 month did what to SIDS
halved sids, gut microbome differed in SIDS baby 27% vs 7% healthy babies
What does breastfeeding friendly health initiative do?
protects, support breastfeeding through `0 steps outlined by UNICEF/WHO
10 steps of BFHI
- Breastfeeding policy communicated to staff, 2. train staff 3. inform all pregnant women benefits of breastfeeding 4. help mothers initiate breastfeeding within 1 hr of birth 5. show mothers how to breastfeed or pump 6. Give newborn infants no other food or drink unless medically indicated 7. practice rooming in
- Encourarage responsive parenting-feeding, soothing, sleep, physical
- Give no pacifier or artifical nipples 10. Foster the establishment of breastfeeding support groups
mothers pose the greatest risk of stopping at
The fastest dropoff is in __ days after hospital discharge
Regulates the marketing of breastmilk substitutes and sets standard for labeling
World Breastfeeding Trends Initiative WBTi
Track, assess and monitor the implementation of the global strategy
Breastmilk composition changes…
over course of lactation, within the day, and within a feeding
pH in gut of breastfed babies if more _____ while formula guts are more _____
By ___ weeks at the latest, the baby should have regained to its birth-weight
Women who do not breastfeed are at greater risk for what?
Women who do not breastfeed are at greater risk of what types of cancers?
Breast, endometrial, and ovarian
Why is breastfeeding so difficult that mothers need help?
Unrealistic expectations and lack of timely interventions
Infants lose more weight in the first postpartum days when…
Labor meds are used, more intrapartum fluids have been given, and no labor prior to C-section.
Negative Influences on milk production
Engorgement symptoms occur most commonly between what days?
easily pulled out with a breast pump or infant nursing
can be pulled out but don’e maintain their projection
difficult or impossible to pull out
Do smoking mothers make more or less milk?
Smoking mothers generally have lower levels of what hormone?
___% of SUID can be directly attributed to maternal smoking during pregnancy?
Nursing two babies not from the same pregnancy
Women in Silence are in a position of…and feel…
Subjective knowing believes knowing is…
Personal, private and based on intuition rather than on thoughts and ideas defended with evidence
Hierarchy of Infant Feeding Choices
Babies born during ____ had double the odds of supplementation compared to babies born ____
How many nipple pores are functioning per breast?
Where is oxytocin secreted from?
Where is prolactin secreted from?
True or False? All humans have prolactin all the time?
What hormone is responsible for milk production?
1. Secretory differentiation
2. Secretory activation
3. Lactation
What type of milk is produced in Lactogenesis 1?
What has to take place for Lactogenesis 2 to start?
Complete delivery of placenta.
What type of milk is produced in Lactogenesis 2?
True or False? Gut bacteria of supplemented babies is the same as exclusively formula fed babies?
With breast implants, what type of incision is most associated with milk insufficiency?
Expressed breast milk can be stored how long in the refrigerator and freezer after being expressed?
2 days in fridge and 3 months in freezer
True or False? Exclusive breastfeeding rates are increased by increased education?
When is the best time to bring a baby to the breast for a feeding?
True or False? Babies show more feeding cues when they are close to the source of milk?
An ideal suck/swallow ratio for breastfeeding baby is what?
off-center, not bullseye. More of the lower portion should be in babies mouth
How should babies hands look at the end of a feeding
Relaxed (not clenched or in a fist)
When should a nursing mother see a PCP if a lump doesn’t move in her breast?
24-48 hrs after first detection
True or False? Pumping results in increased milk volume compared to hand expression?
True or False? Hand expressed milk has a higher fat/calorie content than pumped milk?
What point does baby blues occur in the pp period?
What point in the pp period does baby blues occur?
What point in the pp period does pp depression occur?
What point in pp does pp panic disorder occur?
pp panic disorder characteristics
difficulty breathing, extreme anxiety, dizziness, tremors, shaking
dysphoric milk ejection reflex (D-MER)
How many deaths occurred in 2015 in the neonate period?
What was the number one cause of deaths in the neonate period in 2015?
How much would it cost to scale up to do everything to prevent neonate deaths?
includes 270 days of pregnancy up to 2 years
worldwide and includes breastfeeding
What are the characteristics of baby blues?
Women who do not breastfeed are at a greater risk for which 5 things?
MI and metabolic syndrome
breast, endometrial and ovarian cancer
3 strategies that WHO and UNICEF set out to increase BF initiation and duration
breastfeeding promotion according to WHO and UNICEF
focuses on advantages of breastfeeding on a personal, community, country or global level
interaction of helpers with family as well as program development and implementation
why is BF so difficult that moms need help?
#1-unrealistic expectations
#2-lack of timely interventions
When do moms usually quit breastfeeding?
International Code of Marketing Breastmilk Substitutes
World Breastfeeding Trends Initiative is intended to
what contributes to low rates of exclusive breastfeeding globally?
How to support exclusive breastfeeding
Increase hospital and health system capacity including revitalizing, expanding, and institutionalizing the baby-friendly hospital initiative in health systems
Provide community based strategies including communication campaigns tailored to the local context
Strengthen the monitoring, enforcement, and legislation related to “The Code” and subsequent resolutions.
Enact at least 6 months paid maternity leave
Invest in training and capacity building in breastfeeding protection, promotion, and support
nipple ducts have how many pores
what 2 hormone pathways are involved in making milk?
dependent on nipple stimulation (stroking)
not decreased by stress
go up and down in between nursing
influenced by nipple stretching (proper latch)
temporarily affected by stress
Feeding within the first 2 hours of life can do what to milk
significantly increase milk supply by day 4
Receivers of Knowledge believe
Seek information from a variety of sources
like evidence
limit personal stories
Truth or myth: increasing vacuum on a pump will not increase the amount of milk expressed
what is the cleanest way to collect milk?
what’s different about the content of hand expressed milk versus pumped?
higher fat content in hand expressed
What is screened on donor milk?
history, serology, bacteriology, heat treatment/pasteurization
with soy formula, what do we worry about?
Recommendations for prepping powdered infant formula from WHO and CDC
mix PIF with water heated to 158° to kill bacteria
Vitamin C deficiency
severe complication of improper use of almond drinks in the first year
how much milk does a mom make per day?
does the left breast usually make less milk
What is the growth standard per WHO?
How do breastfed babies grow? (like the pattern/rate)
gain more at first then the rate slows
CDC says the WHO growth standard should be used for kids under what age?
insulin does not move glucose into cells
occurs in formula babies
What is a contraindication to breastfeeding?
If you have triplets, how should you breastfeed?
1&2 at the same time
then 3 on both sides
rotate for next feeding
What are contraindications for temporarily not breastfeeding or hand expressing?
what are contraindications for temporarily not breastfeeding but you can express BM?
What do we know about why families choose not to breastfeed?
they think formula feeding is “easier”
they might be more comfortable with the idea of formula
How to normalize breastfeeding?
OARS: steps to motivational interviewing from bershad
Greater support is needed for what kind of parents
first time
LPT infants
financial problems
postpartum adjustment disorder
Babies born 10pm-9am. What do we know about their odds of supplementing?
At one month, exclusive breastfeeding was significantly higher
TJC created perinatal care core measure set
what is step 4 of the 10 steps?
If a mom has had labor pain medication…
baby needs at least 2 hours to do skin to skin
dec. rate of pp hemorrhage
faster expulsion of placenta
correct suckling
less crying
risks of delayed breastfeeding in the hours after birth
production of lactose in mammary glands
when does lactogenesis 1 occur?
when does lactogenesis 2 occur?
what happens in lactogenesis 2?
drop in progesterone
transitional milk to mature milk
what happens in lactogenesis 3?
prolactin from frequent nipple stimulation
frequent removal of milk
high protein, fat and electrolytes
diff the first 5-7 weeks than a term delivery
does SGA or LGA change milk composition?
After one year of lactation, what happens to the milk composition
fat and energy contents increase
Beginning of a feed is called?
Which time of day are the calories the highest in BM?
When lactose and volume are high, then the fat is….
Mom’s of male infants produce milk that is….than female infants
Men with high prolactin levels (from drugs or brain tumors) can…
Faster milk removal is associated with
Mechanisms by which exclusive BF protects babies from diarrhea
pH of gut of BF babies is more acidic
low iron in gut (low iron in BM)
hormones
antibodies
WBCs
What is normal weight loss by day 5?
When should baby be back up to birth weight
Infants lose more weight in first pp days when….
labor meds are used
more intrapartum fluids are given
no labor prior to c-section
What is goal for pee and poop diapers after day 4 pp?
True or myth:
size of breast relates to amount of milk
True or myth:
Not getting enough fluids causes BF problems
True or myth:
Exercise when breastfeeding was not related to infant weight gain or growth
How many times a day should we be feeding?
Infant states in the first hour
hand to mouth movements
rooting
what angle should corner of baby’s mouth make?
If air seeps into the lip seal, baby will have?
What should the cheek line look like?
What is the ratio of suck to swallow?
What kind of latch should baby have?
Which kind of motion should the baby have?
What should baby’s hands be when the feeding is over?
What are some negative effects on milk production?
breasts feel hard
temp is normal
feel discomfort
breast hot, shiny
nipple is difficult to latch
When does engorgement usually occur?
more time spent BF in the first 48 hours is associated with
low prolactin
less milk
can’t be pulled out no matter what
Can you breastfeed during pregnancy?
yes as long as you aren’t at risk for premature delivery
What does using a paci increase the risk of?
What should you ask new moms when you want to know about their BF history?
What should you ask moms that have been BF for more than 3 months?
Was yesterday a normal breastfeeding day for you and baby?
fever
ill feeling
redness
pain one inflamed breast
if infective its staph
NSAIDs
keep nursing
IF EMERGENt mastitis, both breasts inflammed
strep is probable
sepsis and possibly fatal
not a prob with the milk!
How long should a mom breastfeed before giving complementary food?
what deficiency is common in BF infants?
vitamin D
can give 400iu/daily after discharge
separation anxiety
may need to move to quiet place so they aren’t distracted
teething
runny noses
mobile
teething
playful
concentrating more
biting
stand and walk
regular mealtimes
nursing before bed and naps
time to think of public name for breast
baby chooses
substitue something equally good in the eyes of the child
older than 12 months
on-request only and stop offering to nurse
2-7 years
same for every one in society
everyone knows and expects
10 steps for successful breastfeeding
which has higher calories…pumping or hand expression
can caused reduced absorption of medication
doesn’t show an increase in milk
the most important modifiable risk factors for childhood allergy are
maternal smoking
type of feeding
c section
consuming allergenic foods reduces allergies
what do we feed a baby with PKU?
Joint Commission created the EBMF term
also receiving water based drinks, vitamins, meds but no formula
how to calculate baby’s daily needs
weight of baby X 2.5 = ounces/day
how much should baby gain in ounces in the early months
If you freshly pumped milk, how long can it sit on the counter?
If you thawed milk, how long can it sit out?
If you pumped, how long can it stay in the fridge?
If you thawed milk, how long can it stay in the fridge?
If you pump, how long can you deep freeze it for?
Until baby’s are 10 lbs, how long do they sleep?
What do we recommend with moms that smoked during pregnancy?
pseuophed causes what with milk supply?
triglycerides can cause baby’s to be
fluoxetine does what to babies
What do you do if mom becomes preggo while BF?
mom’s milk might go to colostrum
new baby should feed first if tandem nursingg
how long can you keep milk in fridge freezer?
if mom has implants what do we watch for?
engorgment and tight bras
insuff milk
tanks with bra
report surgery to pedi
what do we watch for with reductions?
milk supply
clogged ducts
engorgment
weight checks
at breast supplementation
what do we watch for with flat nipples
asymmetric latch technique
hand expression
nipple shield (1 or 2 times)
what do we watch for with inverted nipples
solutions for inverted nipples
weight checks
hard plastic shell inside bra
What do we watch for with nipple pain at beginning then lowers?
solution for nipple pain at beginning then lowers
moms posture, hands and arms
try diff baby position
Nipple is misshaped after latched on. What do we do?
what to do if my baby has a cardiac defect or down syndrome?
may need to hand express after feeding to top off
Who collects the most comprehensive bf stats in the US?
Cause contractions which move the milk
What causes oxytocin to be released
Frequent feeding and milk removal
Lactogensis III requires what to succeed
Frequent milk removal and nipple stimulation
The fat content of milk suckled by the baby is determined by
The speed in which the Baby removes the milk
What is the most effective at increasing gastrin and cck
Feeding with species specific milk
Studies on childhood obesity demonstrate that
Breastfed babies are less likely to be obese
When undernourished moms were supplemented with extra energy in their diet they
Responded to their infant appropriately
Harmful bacteria have difficulty growing in breastfed baby’s gut because the composition of milk
Fosters the growth of good bacteria that crowd out other organisms.
Smooth muscle cells that move the milk
The two pathways that control lactation are
Associated with obesity in formula fed infants
GI hormone that causes fullness
Muscle cells around the alveolus
Period when baby is not at breast
Elevated prolactin levels close this
Produced by hormones of pregnancy
Cellular lock for a chemical key
Carb found only in mammal milk
Cholecystokinin helps babies feel a sense of
Glands that secrete lactation hormones
A cluster of milk making cells
Stage that begins with the delivery of the placenta
Hormone responsible for milk ejection
Breastmilk is low in this nutrient but it’s almost all bioavailabile
The number one reason that mothers stop breastfeeding is concern about low
Hormone that increases with frequent nipple stimulation
Hormone secreted by the placenta
Promotes the release of gastrin
Smoking moms may wean early because
Pacifier use by tube fed babies who were born prematurely may
There’s no consistent pattern of who does and doesn’t make formula safely.
Pituitary function may be impaired permanently with
Cows milk allergy is associated with about how many cases of reflux
Formula contamination is greater in what type formula
Formula fed babies are more likely to get
Third in the hierarchy of infant feeding
Reduction in risk of hypertension
Physiological reason for low milk supply
Believes all authorities tell the truth
Can make enough milk for two or more babies
May alter pattern of postpartum bleeding
Not bf increases the risk of these cancers
Best technique for dealing with engorgement
Type 2 inverted nipples do or don’t retain projection
Behavior that may lead to low milk supply
Most often associated with milk insufficiency
Frequently used inappropriately
Affects up to 20% of post partum women
Women who use these are at greater risk of early weaning
Knowers who seek information from a variety of sources
In lactogensis 3 this can reduce supply
May reduce breast storage capacity
It’s best to use few words with these knowers
Mothers who formula feed need to prepare it
“final rule” on formula spring 2014
May be prevented or delayed with longer bf periods
Concerns especially if powdered
May be prevented with frequent effective feedings
This depression is associated with early weaning
Can result in Sheehan syndrome
May be an indicator of sore nipples
May cause lower rise in prolactin
These nipples easily drawn out by baby
Allows for nipple stretch and oxytocin release
Increases exclusive breast milk feeding
The joint commission perinatal core measure outcome
Associated with latch difficulty
Creates changes in breast appearance
This latch allows room for the nipple to stretch
The baby’s chin digs into the moms breast in this back and forth motion
Nose should be where to start the latch process
May impact the baby’s ability to orient to the breast
Helps babies transition to extrauterine life safely
What suggests milk is being transferred?
Sucking and skin contact lead to increases in
Act through gi tract leading to release of gi hormones
More will bf if they consider it the
Act through the adrenal glands. Causes catabolism
Splanchnic nerves (sympathetic)
Inhibits GI secretion and release of GI hormones
Cause release of catecholamines
Vasoconstriction and reduced blood flow to an extremity of the body in response to cold stress
Group of proteins which provide immunity
Causes passive systemic immune protection and forms antibodies to bacteria AND viruses
Forms antibodies against bacteria
The structure of the breast reveals
The best advice for a mom with mastitis
Keep bf frequently on both sides
Nipple stretching helps induce
Usually occurs due to sepsis or blood incompatibility
Vasospasm of the nipple causing pain
Caused by compression of a duct
White spots on the face of the nipple
Breast inflammation that may or may not be infected
A bacterial infection that is resistant to antibiotics
Seen in Mastitis on one breast
Seen in Mastitis on both breasts
Largely causing uterine exposure
When a baby refuses one breast