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Advanced NCS Flashcards

1
Q

Approximately, how many brain cells does a baby have at birth and how much of an increase is there in the first month of life?

A

~ 1 billion and it increases 20 fold in the first month of life.

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2
Q

How many lines of communication (synapsis) are there at 4 weeks of age?

A

Over 1 trillion

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3
Q

What does promoting optimal brain development look and not look like?

A

It is having loving care by a consistent caregiver, having proper sleep and nutrition, as well as, proper interaction and engagement at appropriate times.
It is not things such as beginning to teach your infant a foreign language or having them watch educational videos.

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4
Q

What is so great about promoting optimal brain development?

A

Promoting optimal brain development sets baby up to have their best possible life. Strong connections are made in the brain early on that help baby to develop healthy coping strategies, communication skills, feelings of attachment and security, and more.

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5
Q

Why do we want mimic the womb, especially during the first three months?

A

Mimicking the wombs helps baby feel safe and secure which promotes optimal brain development.

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6
Q

How do we mimic the womb?

A
  • swaddling
  • white noise
  • movement (swaying, rocking, bouncing, etc)
  • a dark room.
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7
Q

How do we promote optimal brain development?

A
  • mimicking the womb
  • providing the best possible nutrition
  • Maintaining body temp (esp. in preemies)
  • providing consistent comfort
  • movement
  • ensuring baby feels safe and secure (responds to cries for example)
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8
Q

As caregivers, how can we help promote optimal brain development? The 5 “S’s”

A
  • swaddle
  • sway
  • shush
  • side hold
  • suck
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9
Q

What are the 5 truths we know about infant brain development?

A
  1. Intelligence is both genetic and able to be influenced.
  2. Most major organs are fully developed in miniature at birth except the brain.
  3. Our brains are born unfinished for a reason.
  4. Early development matters.
  5. The overall pattern matters more than each small decision.
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10
Q

Is intelligence fixed at birth?

A

No, but for a long time it was believed to be. Intelligence is both genetic and able to be influenced. It is not fixed at birth. Environmental factors affect a child’s intelligence and future generations as these experiences alter an infant’s genes which they can pass onto their children.

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11
Q

Can a pregnant person’s stress affect baby’s development?

A

Yes, if a pregnant person experiences prolonged stress or a traumatic event it can alter the baby’s gene development and activate negative traits (example, aggression) that they are predisposed to. Once these traits have been genetically activated they will be passed down to the next generation.

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12
Q

How does an infants early experiences affect their genes?

A

Consistent early experiences turn on or protect against genetic traits that baby is predisposed to. Good bonding, especially early on, has a great impact on whether an infant will develop negative behaviors such as aggression, hyperactivity, and compulsivity.

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13
Q

What one part of the body is the same size at birth and death?

A

The cornea

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14
Q

How big is the brain at birth?

A

1/4 it’s full adult size.

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15
Q

When do brain cells (neurons) develop?

A

An infant’s neurons are formed before birth but they do not develop completely until after birth.

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16
Q

What are synapses and when do they develop? What determines their development?

A

Synapses are connections between neurons and they are formed mostly after birth. They form in response to their environment.

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17
Q

What are axons?

A

Axons are neurons that send information.

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18
Q

What are dendrites?

A

Dendrites are neurons that bring in information.

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19
Q

What type of neuron does a child primarily develop in the first three years of life?

A

Dendrites.

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20
Q

Why are our brains not fully developed at birth?

A
  • We cannot be pre-wired to meet every life scenario.

- We grow connections (synapses) as needed.

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21
Q

What happens when we stop using or needing specific synapses?

A

Neural pruning occurs - the connections wither away.

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22
Q

What is myelin and what is it’s purpose?

A

Myelin is a fat layer that develops on synapses that are used frequently. It provides protection for the connection and allows for it to pass faster and be stronger.

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23
Q

How do we create strong synapses? Three “R’s”

A
  • Repetition
  • Routine
  • Reinforcement
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24
Q

How quickly do synapses form? When do they peak and prune?

A

Growth is unfathomably rapid in infancy and early childhood. It peaks and are pruned significantly by adolescence.

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25
Q

At what age does it become very difficult to change a child’s emotional responses?

A

3 years old.

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26
Q

What are some positive experiences we can provide for baby to help them develop healthy emotional responses?

A
  • Sharing interesting experiences with them.
  • Ensuring a strong sense of security.
  • Lots of touch (esp. skin to skin)
  • speaking to them lovingly.
  • Varying what they see and hear
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27
Q

How do we help an infant develop healthy emotional responses?

A

Babies are more likely to grow up emotionally healthy if we create positive experiences for them.

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28
Q

What are some of the earliest connections (synapses) that an infant develops?

A
  • Automatic “unconscious” responses such as blood pressure, heart rate, and body temp.
  • Emotional processing connections, which is why it is so hard for people to change their emotional responses.
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29
Q

What do babies do when they are over stimulated and what should you not do when they are?

A

Babies will avert their gaze from the overstimulating experience. Since faces are what baby primarily sees, they can be overstimulating and you should never get into a child’s face or force them to look at you when they are agitated, fussy, or overstimulated - calm the baby without looking at their face.

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30
Q

Do individual stressful events cause long term damage to baby?

A

no, unless it was horrifically traumatic.

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31
Q

What is neuroplasticity?

A

It is the brain’s ability to heal and reorganize its synapses through consistent repetitive improvement measurements. The older we get, the longer neuroplasticity takes.

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32
Q

What are the three main elements that give babies opportunity for optimal developmental?

A
  1. Meeting their nutritional needs.
  2. Attention and environment.
  3. Sleep.
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33
Q

What is the breast crawl?

A

The instinct of newborns to move towards the nipple and attach to it for breastfeeding all by themselves.

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34
Q

What is galactosemia?

A

an intolerance to breastmilk

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35
Q

How do babies know where to go during the breast crawl?

A

Through olfactory cues from glands on the breast.

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36
Q

Who has more olfactory glands: first time mothers or experienced mothers?

A

First time mothers.

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37
Q

What matters more when it comes to nutrition and brain development: quantity or quality?

A

Quality! baby must still meet their caloric needs.

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38
Q

Why is it important for a chest-feeding parent to continue taking prenatal vitamins after giving birth, or postnatal vitamins?

A

They help the parent recover from birth and also provide valuable nutrients to baby that the parent’s body does not typical off naturally.

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39
Q

What two goals should we have in mind when setting up a babies’ environment? (what two types of environment should we set up?)

A
  1. To stimulate; a space for appropriate stimulation.

2. To soothe and rest; a quality space for sleeping.

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40
Q

When a babies’ eyes are bright, glossy, attentive - what does that mean and what is it linked to?

A

It means the baby is alert and paying attention which is linked to intelligence.

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41
Q

How can directly impact the development of an infant’s attention span?

A

We can provide appropriate activities that help increase an infant’s attention span which has a lifelong affect.

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42
Q

Why shouldn’t we hang a mobile over a babies’ crib or other sleeping area? Where would be a good alternative space and why?

A

Most mobiles are too stimulating and have a negative impact on helping develop good sleeping habits for baby.
Hanging one over the changing area gives baby something to focus on while you change them.

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43
Q

Why is it important to provide a positive environment for baby?

A

Positive environments equal a relaxed, alert brain that takes in and responds positively to it’s environment. It has been shown that if a baby is in a chronically negative (stressful) environment their eyes gloss over and they zone out due to their brains being overwhelmed and unable to cope.

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44
Q

What type of lightbulbs are recommended in a babies’ sleep environment?

A

Red lightbulbs.

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45
Q

Why is it important to eliminate or reduce exposure to technology as much as possible, around baby?

A
  • Blue light directly impacts sleep (negatively), even when they are already asleep.
  • EMF exposure from tech devices effect brain development and have been linked to the development of cancer.
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46
Q

What matters most when it comes to providing optimal attention and environment?

A
  • Spending time in face to face with a trusted caregiver.
  • Being exposed to age appropriate play activities.
  • Limiting the amount and quality (sans blue light) of screen exposure.
  • down time, every day - don’t over schedule!
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47
Q

What two skills can we help baby develop that improves their attention span for life?

A
  1. maintaining focus on a new thing.

2. Shutting out other distractions.

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48
Q

Why is developing attention span difficult?

A

It requires coordination of the senses in multiple areas of the brain. It takes awhile for the brain to learn how to shut things out and pay attention for long periods.

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49
Q

How do we know baby is paying attention to something?

A

They are alert and turn towards the object or interest.

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50
Q

What is the Marshmallow experiment?

A

Children are left in a room with one marshmallow. They are told that if they wait to eat the marshmallow until (the adult) comes back (in a few minutes), they will get another marshmallow. Studies show that those who were able to delay gratification had much greater academic, personal, and social success later in life.

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51
Q

What can we do as caregivers to help provide optimal environments for the development of an infant’s attention span?

A
  • no tech zone for you and parents (as much as possible).
  • Take things back to the basics and limit or eliminate tech toys.
  • Keep contrast in mind (black and white, loud and quiet, large and small)
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52
Q

What is parentese talk?

A

a type of speech where an adult talks to a baby in an exaggerated and repetitive way. (baby talk)

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53
Q

Lack of proper deep sleep can lead to what?

A
  • Heart disease
  • High blood pressure
  • Work and traffic accidents
  • Depression
  • Obesity
  • Auto-immune disorders
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54
Q

What is the length of an adult’s sleep cycle, an infants?

A

An adult’s sleep cycle is 75-90 minutes while an infant’s is 30-45 minutes.

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55
Q

Why does the sleep cycle length matter?

A

It informs us on how long it will take baby to go through the 5 stages of sleep. We can use that information to figure out when is the best time to start putting baby to sleep, when they are likely to wake from stimulation, and approximately how long they will sleep for.

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56
Q

Which sleep stages are most critical for brain function and why?

A

The deep sleep stages 3,4, and REM. Deep sleep allows for restoration, without it, neurons and the development of their pathways are impacted - Neural connections are not as strong and can malfunction (go down wrong pathway). Pruning also occurs during deep sleep.

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57
Q

Are the neural connections that infants form while awake the same as when they are asleep?

A

no, they are different.

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58
Q

If parent’s want to use the extinction (cry it out) method, how can we meet them half way?

A
  • Listen
  • Explain that you do not feel comfortable jumping right into and offer to create a weaning plan that starts several weeks before the extinction weekend.
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59
Q

What is a retainer fee?

A

A retainer fee is based on a week’s salary and is provided as a deposit. The retainer fee is applied as the second to last week’s salary (acts as a two-weeks notice from parents). It’s purpose is to guarantee the NCS will be available and shows them the family is serious about hiring one.

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60
Q

If a baby is on medication that is applied to the inside of their cheeks, how can you get them to swallow it?

A

Gently blow on their face.

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61
Q

How do you keep a baby awake during feedings? (Especially for preemies in higher order multiples)

A

Some tricks are:

  • Stroking their cheeks
  • a cold wipe on a foot
  • unswaddling
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62
Q

With preemie multiples, at what point is it fine to not wake a baby for nighttime group feedings?

A

once the baby is taking in approximately 24oz during daytime feedings.

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63
Q

How long should nighttime feedings take with higher order multiples?

A

no longer than 50 mins.

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64
Q

Why are swaddling blankets with Velcro a bad idea?

A

The Velcro is very loud to baby and will interrupt their sleep/peace every time you need to change them.

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65
Q

What is the typically amount of time babies are recommended to be propped up after feedings if they have reflux?

A

20 to 30 mins

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66
Q

How do you night feed with higher order multiples (3 or more)?

A
  • Prepare feeding area in advance: Place all boppies out (each with a clean burp rag), have everything you need for the next 50mins in reaching distance.
  • If baby will be in boppy to feed, prop them up so that they are at a slight angle to the right (helps with reflux).
  • If using a blanket to prop a bottle make sure it is 100% cotton (breathable).
  • When baby is done eating, place them on their belly over the top of the boppy to help with burping.
  • Change babies during feeding time and do not change again before putting back to sleep unless they pooped.
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67
Q

What do you do when you have multiple babies crying?

A
  • Quickly evaluate the situation for safety and health concerns. If none then attend to the baby who is easiest to soothe.
  • Continue to soothe the babies in order of easiest.
  • Ask parents (or volunteers) for help if nothing is working.
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68
Q

Many preemies have sleep apnea and have machines to alert us if they are not breathing correctly. What should we know about using these?

A
  • Make sure you are instructed on how to use one from baby’s healthcare provider.
  • Have a liability release form signed.
  • White wire is placed under the right arm.
  • The bank is placed across the chest.
  • If the band is too loose, the machine will sound false alarms.
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69
Q

What is breastmilk composed of?

A
  • water
  • fat
  • carbohydrates
  • protein
  • vitamins and minerals
  • amino acids
  • enzymes
  • white blood cells
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70
Q

Why is fat an important nutrient for newborns?

A
  • primary source of calories
  • helps with absorption of fat soluble vitamins.
  • essential for brain, retina and nervous system development.
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71
Q

What is the source of carbohydrates in breastmilk.

A

Lactose (milk sugar).

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72
Q

Why is lactose an important nutrient for newborns and how much of the calories does it make up?

A
  • 40% of the calories

- Lactose decreases unhealthy bacteria and promotes absorption of calcium, phosphorus and magnesium.

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73
Q

Is breastmilk stagnant?

A

No, the composition of breast milk changes for various reasons.

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74
Q

When does the composition of breastmilk change?

A
  • Through various stages after delivery and throughout infant growth.
  • In response to illness
  • Changes in response to the climate you live in.
  • Different hormones are produced throughout the day depending on the time which change the composition.
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75
Q

What is lactoferrin?

A

The dominate whey protein in breastmilk. It also acts as an antibody and is a critical player in protecting a newborn from infections.

76
Q

What are the two types of protein in breastmilk? What percentage of the protein molecules does each comprise? Why is this balance important and what does it mean for formulas?

A
  • Whey makes up 60-80% of protein molecules in breastmilk.
  • Casein makes up 20-40%.
  • This balance allows for quick and easy digestion.
  • Formulas often have different balances, inhibiting absorption.
77
Q

Besides helping with digestion, what else does protein help with?

A
  • they have great infection protection properties.
78
Q

What is secretory IgA?

A

An antibody found in breastmilk that helps protect newborns against viral infections, bacteria and allergies.

79
Q

What is lysozyme?

A

An enzyme that protects against E coli and Salmonella; promotes the growth of healthy intestinal flora; has anti-inflammatory properties.

80
Q

What are the other immunoglobulins in breastmilk and what is their function?

A
  • IgG and IgM

- they protect against viral and bacterial infections.

81
Q

What does the Bifidus Factor do?

A
  • supports the growth of lactobactillus, creating an acidic environment where harmful bacteria cannot survive.
82
Q

What is the Bifidus Factor?

A

diverse oligosaccharides in breastmilk that form highly desired intestinal bacteria.

83
Q

What are oligosaccharides?

A

Sugars found in breastmilk that babies do not digest. Instead they feed healthy bacteria in the baby’s intestines as their gut microbiome develops.

84
Q

What vitamins in breastmilk are fat soluble and are vital to a baby’s health and brain development?

A

Vitamins A, D, E, and K.

85
Q

What vitamins in breastmilk are water soluble?

A
  • Vitamin C
  • Riboflavin
  • Niacin
  • Panthothenic Acid
86
Q

What else may be present in breastmilk?

A
  • Food protein, particularly dairy, soy, and peanuts.
  • Vitamins, including iron supplements.
  • Medications.
  • Herbs
  • caffeine (keep it under 300mg-three 5oz cups per day)
  • Nicotine
  • THC
  • Alcohol
87
Q

Why do lactation consultants and doctors have mothers continue taking prenatal vitamins after birth?

A

The vitamins found in breastmilk are dependent on what the mother eats. The standard American diet does not provide enough vitamins for a postpartum mother and a growing infant.

88
Q

What are the benefits of breastmilk?

A
  • Protects against infections
  • Contains antibodies / live antibodies passed from mother to infant.
  • (Directly linked) Reduces later health issues such as diabetes, obesity, and asthma.
  • Proteins are more easily digested.
  • Calcium and Iron are more easily absorbed.
  • proper levels of vitamins and minerals.
  • parent/baby bonding (prolactin and oxytocin release into mother’s body)
  • lower infant mortality rates.
  • quicker recovery from birth
  • lower rates of breast and ovarian cancer (particularly for those who breastfed for extended periods).
  • Lower rates of Type 2 diabetes, rheumatoid arthritis, cardiovascular disease, high blood pressure and high cholesterol.
89
Q

What cannot be replicated in formula that occurs naturally in breastmilk?

A
  • over 100 ingredients.
  • significant differences in the types/quality of carbohydrates, proteins, vitamins and minerals in formula vs bm.
  • direct correlation between later intelligence (larger, smarter brains) for breastfed babies, even in small quantities/short term.
  • While formula has more protein and iron, it is less absorbable, so breastmilk yields higher protein and iron to babies.
90
Q

What is “dry nursing”? When/why would a family do this?

A

Throughout history, before formula, dry nursing was used when breastfeeding was not possible. It is the preparation of homemade baby food with less common ingredients. The ingredients depended on the region and economic status of the family.

91
Q

What is a wet nurse and how long have they been used?

A

A wet nurse is a woman who feeds another’s baby with her own breast/breastmilk. They have been used all throughout history.

92
Q

When did using a wet nurse fall start becoming less popular and why? What did families do instead? (America and Europe specific)

A
  • early 19th century
  • syphilis was killing babies
  • used homemade options
93
Q

When was the first “India Rubber Nipple” invented and what happened within a year? Why?

A
  • 1845
  • There was a sharp rise in infant mortality and illness.
  • Homemade options were more popular but they lacked the proper nutrients for baby.
94
Q

Who invented the first commercial infant formula? When? What was it called?

A
  • 1867
  • Justin von Liebig
  • Liebig’s Soluble Food for babies
95
Q

What were the other first infant formula companies?

A
  • Mellins Infant Food
  • Ridges Food for Infants
  • Nestle (still around)
96
Q

What is the percentage formula? When was it published and by who?

A
  • 1890
  • Thomas Morgan Rotch
  • A homemade formula that listed specific percentages of cow’s milk, water, cream and sugar or honey to more closely approximate what they thought was in breastmilk.
97
Q

What problems occurred from using the Percentage Formula and what did they add to mitigate the issues?

A
  • Scurvy, rickets, and bacterial infections rose with the use of Percentage Formula.
  • In the 1920s they added orange juice and cod-liver oil which greatly reduced those problems.
98
Q

When did evaporated milk dominate the homemade formula scene? What did initial studies who that have now been disproven?

A

In the late 1920s through the 1950s.

- Initial studies appeared to show babies did just as well on evaporated milk as they did with breastmilk.

99
Q

When did Similac and Sobee come onto the market?

A

In the 1920s, but evaporated milk formula dominated the scene until the 1950s.

100
Q

When did homemade formulas decrease in popularity? What was happening during this time that could explain why they decreased in popularity?

A
  • By the late 1960s the use of homemade options decreased immensely.
  • Through the 1950s and 60s, heavy marketing through doctor’s offices helped increase the use of commercial formulas.
101
Q

Globally, how big is the infant formula (0-6months) market?

A

8 billion dollars.

102
Q

When did generic brand formulas hit the market?

A

Late 1990s.

103
Q

When did Enfamil come onto the market?

A

1959.

104
Q

How did Similac change in 1951?

A

They changed their formula to closer mimic breastmilk.

105
Q

What style of feeding dominates the world?

A

There is a resurgence of breastfeeding but formula feeding still dominates the market world-wide, particularly in developed countries.

106
Q

What is dairy based formula based on and what does this mean for newborns?

A
  • Dairy formula is designed to be based on “human milk” at approximately 3 months post-partum.
  • If a newborn is put on dairy formula they will miss out on all the health benefits of colostrum.
107
Q

What are the ingredients of dairy formula?

A
  • Whey and casein are the protein source
  • a blend of vegetable oils for fat
  • lactose as the carbohydrate
  • a vitamin/mineral blend
  • other ingredients depending on the manufacturer.
  • corn syrup is often the first list ingredient
  • soy is a close follower, even in dairy based formula
108
Q

What can we do if a mother is very against breastfeeding?

A
  • Listen
  • Explain the benefits of colostrum
  • Focus on the benefits of breastfeeding not the negatives of formula.
  • suggest that she pump or breastfeed for at least the first few weeks and explain that every bit of breastmilk is beneficial to babies’ development.
  • Let it go if she insists.
109
Q

What are some characteristics of babies on dairy based formula?

A
  • They tend to sleep longer because the proteins are much harder to digest.
  • Non-organic dairy formula fed babies tend to have larger heads (not brains) because of the steroids’ in cows milk.
  • Babies often eat less as it takes less to fill them up and they digest it slower.
  • Bowel movements tend to be more solid and adult like than breastfed or organic formula fed babies.
110
Q

What will happen if an infant (fed dairy based formula) has a milk protein intolerance?

A

It can damage the gut, ranging from diarrhea to blood in the stool.

111
Q

What is the difference between milk protein and lactose intolerance?

A
  • lactose intolerance is caused by not having enough enzymes to break down lactose, the sugar in dairy products.
  • A milk protein intolerance is caused by not tolerating the protein in milk.
112
Q

What is the most common protein allergy in infants?

A

dairy

113
Q

What are the possible side effects of soy?

A
  • Early onset puberty in girls; delayed or absence of puberty in boys.
  • Alteration in development of breast tissue.
  • Inhibition of brain growth because of Trypsin inhibitors.
  • Phytic acid in soy inhibits the absorption of iron, calcium, magnesium, and zinc. Can lead to zinc deficiency and lowered IQ.
  • Unexplained infertility.
  • Cancer of the reproductive organs.
114
Q

What is the main source of protein in soy based formula?

A
  • processed ground soybeans.
115
Q

Why is soymilk controversial?

A
  • Isoflavones, a compound found in legumes that have estrogenic activity.
  • Exclusively soy-based formula fed babies have 13,000-22,000 times higher level of Isoflavones in their bloodstream than breastfed or dairy-based formula fed babies.
  • Infants are especially sensitive to the introduction of soy at certain developmental points and the effects of this excess estrogen exposure may not be detectable for many years.
  • Genestein, the main Isoflavone in soy byproducts is also called a phytoestrogen because it mimics estrogen in the body at the level of 5 birth control pills per day.
116
Q

How are hypoallergenic formulas made?

A
  • through intense processing that results in a bitter, unpleasant taste.
  • they have “hydrolyzed” or “pre-digested” proteins, or broken down proteins to make them tiny and less likely to prompt an allergic reaction.
  • because the lactose is removed, manufacturers substitute with sugar, corn syrup and tapioca.
117
Q

How much more salt content is in hypoallergenic formulas?

A

30-90% more.

118
Q

what is Pregestamil?

A
  • a type of hypoallergenic formula that has medium chain triglycerides, a type of fat easier to digest for babies with fat malabsorption disorders.
  • it can be helpful with weight gain
  • it is not a “naturally occuring” fat and its effects are unknown.
119
Q

How much more do hypoallergenic formulas cost than standard formula?

A

up to 4-5 times more.

120
Q

Why should you never give an infant MCT formula unless prescribed by a doctor?

A
  • have no essential fatty acids, critical to babies brain development.
  • hard on the liver
  • possible side effects on the intestinal system and liver if they are not needed.
121
Q

What does it mean for a formula to be organic?

A
  • has the same plusses and minuses as any other commercially made formula.
  • Non GMO
  • Not raised or grown with added hormones or antibiotics.
  • Not sprayed with non-approved pesticides.
  • Given organic feed or started from an organic seed.
122
Q

Is organic worth the hype?

A
  • Organic foods have been shown to have higher nutritional values and higher levels of antioxidants than non organic foods through over 200 studies in the BJN.
  • Dairy in particular is important as so many of the hormones given to cows pass through their milk and into our food supply.
  • Antibiotics in dairy also pass through and are considered to be contributing to antibiotic resistance.
123
Q

Why do people like to use Raw milk in homemade formula recipes?

A
  • it has not had all the helpful enzymes and bacteria destroyed through the pasteurization process and is much easier to digest.
  • Many babies with dairy allergies tolerate raw milk very well.
124
Q

Should we suggest a family use homemade formula?

A

No, do not bring it up. If they do, you can feed it to the infant but:

  • they need to make it themselves and
  • you need a liability release form signed.
125
Q

Why does Dr. Sears recommend goats milk over cows milk based homemade formulas?

A

Goats milk has higher nutritional value and is closer similarity to breastmilk.

126
Q

What is lacking in goats milk that needs to be added in homemade formulas?

A

folic acid.

127
Q

Where can you find raw, unpasteurized goats milk?

A

mtcapra.com

128
Q

How is paleo formula made?

A
  • Uses beef or chicken livers simmered in homemade, low sodium beef or chicken stock.
  • It is pureed and then has multiple vitamins and minerals and live cultures and probiotics added.
  • Healthy fats are added through coconut oil, olive oil, expeller pressed sunflower oil and cod liver oil.
129
Q

How do we support a breastfeeding client?

A
  • keep educating yourself
  • limit advice to what you know and is in scope, refer anything else out.
  • Support and encourage her efforts in a gentle, non-pushy manner.
  • At night, bring baby ready to feed, then step aside but be within reach (sight or hearing) in case she needs support.
  • Encourage her to eat well, drink lots of fluids, and get adequate rest.
  • If she opts out of breastfeeding make sure you do not come across as negative or judgmental of the decision.
130
Q

How do we support a breastfeeding client of multiples?

A
  • Discuss in advance what the plan is.
  • If she opts to nurse 2 at once, strongly encourage her to seek the advice of an experienced lactation professional who can teach her various holds.
  • If she opts to nurse 1 per feeding, encourage her to pump if she wants breastmilk fed to the other baby(ies), otherwise select the healthiest formula option she feels safe with.
  • Remind her that even the smallest amount of breastmilk has positive benefits.
131
Q

Why is it especially important to change the position a preemie is in often?

A

Because their bones are soft and more easily moved. They can easily get a flattened head.

132
Q

How should you do tummy time with a preemie?

A
  • needs to be more frequent but for shorter periods.
133
Q

How do preemies sleep in comparison to full term infants?

A
  • they sleep more in a 24hr period but in shorter periods more often.
134
Q

Describe some sensitivities preemies experience

A
  • Their hearing is better than their sight.
  • Can be extra sensitive to touch.
  • They startle more easily.
  • Their skin is very loose due to not having any fat.
135
Q

What can you do when out (like at the doctors) to help a preemie?

A

ask to have the lights turned down or off (with blinds open) when possible.

136
Q

How often should you bathe a preemie?

A

Unless their is a specific reason, once per week is fine.

137
Q

What are some things you can do to make bath time easier for a preemie?

A
  • warm towels in dryer right before bath time.
  • Take temp before and after to monitor.
  • Keep a hat on baby until you wash their hair at the end of bath time.
  • Continuously pour warm water over them to maintain warmth.
138
Q

What is a normal temp for a preemie (under arm)?

A

97.5 - 99.3 F.

139
Q

What is grounding and how do you do it?

A

It is a technique commonly used in Europe that research has shown helps NICU infants recover from EMF overload.
- place baby on the ground (over a 100% cotton blanket) for a few minutes everyday and let Mother Earth do its magic.

140
Q

Why is it so important that preemies are in a non-toxic environment?

A

They have smaller and underdeveloped organs which makes it harder for baby to handle the toxins.

141
Q

Can you use oil on a baby if they are using bili lights?

A

no, the bili lights act like the sun and putting oil on a baby can cause them to burn.

142
Q

NICU babies or those with medical issues, esp involving unresolved pain are at an increased risk of attachment issues (reactive attachment disorder later in life), how can we help them?

A
  • pacifiers
  • sugar
  • warmth
  • swaddling
  • Skin-to-skin
  • encourage parents to utilize “attachment” style parenting to help prevent long term RAD.
143
Q

What are some signs a preemie has trauma?

A
  • very resistant to being touched or held.
  • slow to gain weight.
  • often very nervous
  • unresponsive, glazed over eyes.
144
Q

During pregnancy, which trimester does experiencing trauma have the greatest risk of long term affects for baby?

A

3rd trimester.

145
Q

What should parents consider when choosing a car seat?

A
  • Does it fit the infant properly?
  • Does it fit the car properly?
  • All sellable car seats pass the same test; brands/price doesn’t matter.
  • Does it fit the families budget?
  • Will the parents be able to use the seat correctly 100% of the time?
146
Q

What should we know about Angle Tolerance Test?

A
  • Performed on NICU babies that have concerns of breathing issues and/or will remain on oxygen.
  • Performed with the seat the child will be riding in.
  • performed on a hard flat surface, at the appropriate 45 degree angle.
  • Should be performed for no less than 90 minutes.
  • If baby fails the ATT it is preferred that they stay in the NICU awhile longer.
  • A car bed should always be a last resort.
147
Q

How does a baby properly fit in a car seat?

A
  • Bottom scooted all the way into the back of the seat.
  • Harness straps must come at or below baby’s shoulders while Rear Facing (RF).
  • Top of chest clips is even with armpits.
  • Harness must always be tightened snugly with no pinchable slack as the shoulders.
148
Q

What can you use if a baby needs extra support in their car seat?

A
  • rolled cotton blankets over straps

- No aftermarket head supports or inserts allowed.

149
Q

Which seat is the preference for car seat installation?

A

The center seat, but proper installation matters more.

150
Q

What kind of movement is okay with a properly installed car seat and why?

A
  • The base of the seat should only move an inch or less.

- The top of the seat is free to move which is helpful if their is an accident.

151
Q

What should we know about using multiple car seats?

A
  • each seat needs to be independently installed correctly (one seat can not be helping another be secure).
  • Car seats are not allowed to overlap or press tightly against each other.
152
Q

How do you choose using a seat belt or lower anchors to secure a car seat?

A
  • Use either one (not both!)

- choose the one that offers better/correct install.

153
Q

Should we put car seats on top of shopping carts?

A

No, doing so can damage the locking mechanism of the seat onto its base.

154
Q

What should we emphasize to parents about car seats?

A
  • they should be utilized as little as possible.

- That they are only for travel, not for play, sleeping, or feeding.

155
Q

Why should babies not wear thick outerwear in their car seats?

A
  • It can create a false impression of a properly tightened harness.
156
Q

What is the traditional response when a breastfed baby is not gaining weight well or has lost weight in the few days following birth?

A
  • Supplement with formula
157
Q

What should we consider if a breastfed baby is not gaining weight well or has lost weight in the few days following birth?

A
  • Was the birthing parent on extensive fluids? This can cause a false weight in baby at birth and baby’s true weight becomes apparent 3-5 days following.
  • Is baby nursing effectively? Long enough? proper latch?
  • Does the baby have tongue or lip tie?
158
Q

What are some alternative response options when a breastfed baby is not gaining weight well or has lost weight in the few days following birth?

A
  • Have baby evaluated by pro-breastfeeding doctor.
  • Find a way to use donor breastmilk
  • encourage mom to syringe feed if appropriate.
  • If formula is the only option, encourage them to use organic or Non-US formulas. (Europe has much stricter regulations)
159
Q

What is the traditional response when a baby has reflux?

A
  • Use Zantac (acid reducer) or Prevacid (proton pump inhibitor).
160
Q

What are some alternative response options when a baby has reflux?

A
  • Remove the two most common “protein” intolerance issues from mom’s milk. (change mom’s diet)
  • If formula feeding, switch to organic, or non-us, or hypoallergenic if necessary.
  • Cranial-sacral therapy
  • chiropractor
  • Amber bead necklaces
  • Vinegar
  • Compounded medications
  • home remedies
  • We do not suggest, we offer information if asked.
161
Q

What are common problems with prescribing Zantac and Prevacid to babies?

A
  • Unless compounded they contain alcohol.
  • They are weight dependent and often underdiagnosed.
  • Dose needs to be changed often as baby grows.
  • technically not approved for babies but drs can prescribe them.
162
Q

If a baby needs to be on Zantac, what can we discuss with the doctor?

A

Having the prescription be at its highest safe dose and instead of splitting the pill in half, split it in thirds so baby will:

  • Take 1/4 in the morning.
  • 1/2 right before the period in which the experience the worst reflux (usually afternoon/early evening)
  • 1/4 at night
163
Q

What is the traditional response when a baby is congested?

A

saline rinse

164
Q

What are some alternative response options when a baby is congested?

A
  • diffuse essential oils, particularly Eucalyptus and lemon.
  • Determine the cause - possibly mom’s diet.
  • If virus is suspected, mix breastmilk into saline rinse.
  • a steamy bathroom
  • if bottle fed, serving colder than normal.
165
Q

What other things can chiropractic care help with for baby?

A
  • Ear infections
  • General fussiness
  • Birth trauma
166
Q

What other things can cranial-sacral therapy help with?

A
  • Birth trauma from extraction or c-section
  • constipation
  • reflux
  • gas
  • sleep
  • teething pain
  • head shape issues
  • ear aches
  • developmental delays
167
Q

What are some other things can diffusing essential oils help with?

A
  • sleep
  • relaxation
  • infections
168
Q

What are some other things can breastmilk help with?

A
  • pink eye
  • preventing and healing diaper rash.
  • acne
  • Eczema and cradle cap
  • pain relief
  • ear infections
  • cuts
  • scrapes
  • itching of pox
  • insect bites
169
Q

What is cluster feeding?

A
  • when a baby feeds very frequently or almost continuously over a period of a few hours.
170
Q

Why should we encourage cluster feeding during the day (especially in the early evening)?

A
  • It prepares baby to not feed during the night which is essential to get baby to sleep through the night.
171
Q

Every families’ sleep goals and needs will be different, what should be consistent though to get baby to sleep through the night?

A
  • Daytime feedings meet baby’s 24hr calorie needs.
  • Little to no snacking (for baby), especially if breastfeeding.
  • Encourage cluster feedings when they occur (helps with supply)
  • Follow a consistent pattern of eat, play, sleep even before baby is actively sleep training. Work towards a solid routine but always put baby’s needs above (don’t be rigid).
  • Have a pre-sleep routine that is short and simple. Do it before every sleep. Parents can have a different routine than you but it should be similar.
  • Do not make eye contact when trying to get a baby to sleep!
172
Q

How can we help babies learn how to stay asleep between sleep cycles?

A

Initially, babies wake every time they go through a sleep cycle (20-50mins).
- We can help train them to sleep through using shushes, rocking cradle, ect - nurture but don’t pick up unless they are upset and can’t calm themselves.

173
Q

How much of a preemie’s sleep is in REM and why?

A

Up to 90%

- Growth occurs during REM sleep

174
Q

What are some causes of night waking?

A
  • pain
  • illness and fever
  • hunger
  • neurological issues we cannot yet see
  • Developmental milestones (cognitive and physical)
  • Unusual disturbances (sharp, sudden, loud noises)
175
Q

Steps to successfully getting a baby to sleep through the night?

A
  • Recreate the womb
  • Follow a pattern of eat, play, sleep.
  • Make sure daily calories are met.
  • consistent routine prior to sleep periods.
  • no screen time 1hr before nighttime sleep.
  • have a quiet, low light environment at least 30mins before nighttime sleep.
  • Help baby learn to drift off on their own by putting them in sleep spot while drowsy but still awake. As they get comfortable with that, start putting baby down when they are more awake.
  • Try not to pick a fussy baby up-soothe in other ways.
  • Throughout the night avoid lights, talking, singing, eye contact, etc.
176
Q

What should we know about Dream Feed?

A
  • can help a baby who doesn’t meet calorie needs during the day. Often helps baby keep the sleep stretch between 10:30/11 and 6-7am sooner.
  • If baby is consistently waking at say 2am, you may need to help hold him off for a few days, stretching his early AM feeding 15-30mins each day until you move it later. Usually only takes a few days.
  • a dream feed of expressed breastmilk is a great way for partners to get involved.
  • Dream feeds should be gradually dropped between 10-12 weeks of age to avoid night feeding dependency.
177
Q

What is dream feeding?

A
  • when you rouse your baby - without fully waking - to feed one more time before you go to bed.
178
Q

What is the wake to sleep method and why do you use it?

A

The wake to sleep method involves knowing when your baby usually wakes, gentle waking them right before hand and comfort them back to sleep with the 5’s. This helps babies who habitually wake at night or take short (30-40) minute naps. It helps by interrupting the sleep pattern causing them to wake up.

179
Q

How long does it take to break habitual waking using the wake to sleep method?

A

Usually over a period of 2-3 weeks.

180
Q

At what age can we start stretching night time feedings and for how long?

A
  • Around 6 weeks, begin to stretch the night time feeding by 15-30 mins every 3-5 days depending on baby’s size, growth, and response to efforts.
  • go slower (5-10 min increments) if longer periods are too much for baby.
181
Q

How do you hold a baby off from feeding when they wake for it?

A
  • Use a pacifier or a soothie
182
Q

How do we prepare the family for getting baby to sleep through the night?

A
  • Get parents to follow a routine:
  • establish a fairly consistent AM wake time, even if that means waking the baby (preemies exempt)
    Wake baby, rouse fully by unswaddling, change diaper, wash face with a cool washcloth and turn on lights or open blinds.
  • feed baby fully, play, sleep routine
  • baby should be ready for sleep (in crib) between an hour and hour 15 minute mark.
  • After 1.5-2 hours, gently wake baby and repeat the pattern throughout the day until nighttime.
  • At around 6 weeks, assuming baby is growing well, begin to stretch the awake time to approximately 90 minutes. Do not push baby to be over tired.
  • At around 12-18 weeks, you can begin to stretch wake time 100-120 mins.
183
Q

What do you do when a when a newborn begins to wake 30-45 mins into a nap?

A
  • allow them 2 minutes to attempt to resettle, but do not allow them to full-on cry.
  • if they cannot resettle, soothe them using the 5’s but try not to pick them up unless they get too upset.
184
Q

Assuming the baby is healthy, what can their sleep patterns look like by 4-6 months?

A
  • AM nap of 1.5-2 hours
  • Afternoon nap of 1.5-2 hours
  • a late afternoon or early evening nap of 1 hour.
  • overnight for 10-12 hours.
  • Awake times should be approximately 2 hours from the point of waking to the point of returning to sleep.
  • Every baby will vary depending on their temperament, health, family situation and that days routine.
185
Q

Does where baby sleeps or what happens during the day matter?

A
  • for some babies, yes, but only during the first 6 weeks until good patterns are established.
  • for more sensitive babies, it always matters.
  • Occasionally, you will encounter a baby who can sleep anywhere anytime-for some this is fine, for others it is not true sleep and it can disrupt nighttime sleep significantly.
186
Q

If I am doing everything right, and baby still isn’t sleeping well, then what?

A

Consider:

  • Is there anything consistently there that shows a pattern of sleep disruption (mailman, school pick-up, ect?)
  • Is baby truly eating well during the day?
  • Is baby being put down for naps before they are over tired?
  • Is baby being picked up too quickly and not allowed to self-soothe?
  • Is baby napping somewhere other than their normal sleep location?
  • is baby sick?
  • is baby at a possible cognitive or developmental milestone?
  • Has something changed in the home that is causing stress?
187
Q

If you find or have a problem at work, what should you consider?

A
  • Can I fix it myself?
  • Do I need to approach the parents about it?
  • How will I approach the parents about it?
  • What if they won’t or can’t fix it?
  • Decide to stay or move on.

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