BE 03 Flashcards
In order to properly BF w/ good latch, mother must be competent in which two things?
Positioning
Understanding baby’s “feed me” cues
BREAST ANATOMY:
What is the BF function of the normal, pendulous form of the lactating breast?
Facilitates positioning of baby in arms, easy latching of infant cradled beneath breast.
BREAST ANATOMY:
What is the BF function of the secretions of the Montgomery follicles on areola?
Guide baby to breast and stimulate suckling behavior
BREAST ANATOMY:
What is the BF function of the darker skin color of nipple and areola during pregnancy (in some women)?
May act as a visual guide for baby
BREAST ANATOMY:
What is the BF function of using a wide gap and deep latch by baby?
Infant will form teat from nipple & much of areola, which reaches back of mouth. Flexible and elastic breast tissue facilitates optimal, comfortable lengthening of breast & nipple to facilitate this.
BREAST ANATOMY:
What is the BF function of the thinner layer of subcutaneous fat around areola?
Permits suckling to more easily stimulate 4th intercostal nerve, initiating milk ejection. Meanwhile, the easily compressible ducts can respond to the positive and negative pressures exerted during suckling.
BREAST ANATOMY:
What is the BF function of milk ducts branching close to base of nipple and temporarily increasing in diameter?
To accommodate increase in milk volume at milk ejection.
See BE03 p. 4
Anatomy of the lactating breast
Infant skull is composed of which 3 components?
How many bones total?
Cranium
Facial Skeleton
Mandible (bottom jaw)
22 bones total.
See BE03 p. 6
The bones of the infant cranium
BONES OF INFANT CRANIUM: What is the function of the sutures and fontanelles in infant skull?
Allow movement and overlapping of bones during passage through birth canal.
BONES OF INFANT CRANIUM: List.
2 frontal bones (fuse after birth) - joined by frontal suture
2 parietal bones - joined to frontal bones by coronal suture, joined to each other at sagittal suture.
2 temporals
occipital bone
ethmoid bone & sphenoid bone
INFANT FACIAL BONES: Maxillae
- size
- areas of skull it forms (5)
Largest bone of face
Forms upper jaw, hard palate, floor of nose, part of orbits (eye sockets), tooth sockets for upper teeth
INFANT FACIAL BONES: Palatine and nasal bones form….
Form hard plate and nose
INFANT FACIAL BONES: inferior nasal conchae and lacrimal bones
Remember this.
INFANT FACIAL BONES: zygomatic bones form….
form cheek promonences
INFANT FACIAL BONES: the vomer does…
separates nasal cavity into left and right sides.
INFANT FACIAL BONES: Describe location of mandible
hinged to temporal bones at temporo-mandibular joints
INFANT FACIAL BONES: Describe function and location of hyoid bone. Discuss cartilage vs bone of hyoid. Why is hyoid so important in BF?
Hyoid cartilage provides attachment to tongue above, larynx below, epiglottis and pharynx behind.
Located in neck at level of base of mandible and above thyroid cartilage.
Develops from cartilage to bone during childhood.
Important in BF because extension of head will slide hyoid and tongue forward, while flexion of head will slide the backward.
As a result of moulding (movement and overriding of the cranial bones at sutures and fontanelles) during birth & in utero, how can the bones be moved back into position after birth? Why is this important to BF?
By yawning, sucking and crying. Importatnt because the cranial nerves involved in BF (6/12) follow the sutures.
How many cranial nerves?
How many of these involved in infant feeding?
12 total
6 BF
Where do the cranial nerves originate, how do they reach their destination?
Originate in brainstem; exit through base of brain; follow sutures.
What is the general function of the cranial nerves?
Involved in coordination of suckling, swallowing and breathing. They provide motor and sensory functions.
CRANIAL NERVES: CN V: Trigeminal
- motor/sensory
- what does it supply
- how does it transmit function
- mandibular branches
- motor & sensory
- supplies eyes, mandible, maxilla
- maxilla carries sensory impulses fr mucous membrane of nose, skin of cheek, side of forehead, upper lip and teeth
- mandibular branches: sensory impulses fr side of head, chin, mucous membranes of mouth, lower teeth & anterior 2/3 of tongue
CRANIAL NERVES: CN VII: Facial
- motor/sensory
- what does it supply
- how does it transmit function
- irritation of this nerve can cause….
- motor & sensory
- motor fibers supply muscles of facial expression
- sensory fibers convey impulses fr taste buds of anterior 2/3 of tongue, also supply submaxillary, sublingual and lacrimal glands for secretion
- irritation can produce Bell’s Palsy (a type of paralysis). Paralysis is unilateral, resulting in distortion of facial expression, inability to close mouth on one side, and difficulty closing eye on affected side.
CRANIAL NERVES: CN IX: Glosopharyngeal
- motor/sensory
- what does it do
- motor: stimulates muscles of pharynx, soft palate, posterior 1/3 of tongue; responsible for swallowing reflex
- sensory: conveys sense of taste fr posterior 1/3 of tongue
CRANIAL NERVES: CN X: Vagus
- motor/sensory
- what does it supply
- how does it transmit function
- Extensive distribution to neck and down to thorax & abdomen
- Motor fibers: supply pharynx, larynx, trachea, esophagus, stomach, etc. Involved in swallowing, peristalsis and secretions from glands of stomach and pancreas and ultimately speech
- Sensory fibers: Provide input fr mucous membranes of larynx, trachea, esophagus, stomach - functions include coughing, sneezing, hunger
CRANIAL NERVES: CN XI: Spinal Accessory
- motor/sensory
- what does it supply
- how does it transmit function
- Motor fibers: control trapezius & sternoleidomastoid muscles (involved in stabilizing head and maintaining airway patency, and raising shoulders)
CRANIAL NERVES: CN XII: Hypoglossal
- motor/sensory
- what does it supply
- how does it transmit function
- motor fibers only
- supply muscles of tongue and muscles surrounding hyoid bone; responsible for mvmt of tongue
What 5 muscles are involved in feeding?
- orbicularis oris (forms lips)
- mentalis (muscle of chin; lifts lower lip)
- buccinator (cheek muscle)
- masseter (one of muscles of mastication, closes jaw)
- temporalis (another muscle of mastication, elevates mandible)
The tongue:
- what muscles involved & their function
- Genioglossus - main muscle, pulling tongue down and out
- Palatoglossus, longitudinal, transverse and vertical muscles create mvmts of grooving, elevation, and lateralization.
See BE03 p. 9
Can’t blow up images of tongue anatomy - find online. Note source.
One study found that XX% of women with BF issues had incorrect ____ & _____
94% had incorrect positioning and latch
Describe components of oral cavity of infant
- small
- tongue fills entire oral cavity at rest
- taste buds primarily on tip of tongue; increased suckling occurs in response to sweet stimuli
- lingual frenulum is fold of mucous membrane extending from floor of mouth to midline of under surface of tongue
- lower jaw (mandible) is small and slightly receding
- cheeks defined by buccinator and masseter muscles; buccal fat pads in cheeks help provide lateral stability for suckling pattern
- labial frenum is membrane attaching upper lip to gum ridge
- lips include orbicularis oris muscle
- roof of mouth formed anteriorly by boney hard palate, and poseteriorly by mobile soft palate.
Describe changes in oral cavity by 6-8 months of age.
- enlarges
- buccal fat pads resorb, creating cavity for mastication
- in infant, larynx sits high in neck @ C1-C3 vertebrae - functionally separates respiratory and digestive tracts. This allows infant to breathe and suckle safely. By 2-3 years, larynx descends, with common channel in oral portion of pharynx for respiration and swallowing.
Role of hard and soft palate
- rugae
- hard palate
- soft palate
- rugae of hard palate assist w positioning and stability of teat
- hard palate provides resistance against which tongue compresses teat
- stimulation of hard palate necessary to elicit sucking reflex
- soft palate joins hard palate to appx. epiglottis until it descends at 3-4 mos. (This, plus size of tongue in oral cavity, is why infants are mostly nose-breathers.)
- muscles of soft palate cause it to elevate during swallow, closing nasal cavity and allowing milk to enter oro-pharynx
- hard & soft palate combined separate oral fr nasal cavity, allowing sealed compartment and creation of negative pressure during suckling.
What tools can be used to teach proper latch technique
- flexible doll (for you and, if mother still pregnant, for her too)
- otherwise, mom holds her own baby
Teaching tools to demonstrate to mom how it feels when infant is in various positions:
- positioning of head (water)
- latch depth (suck thumb)
- photo
- have mom swallow water when head turned to side, or w/ chin to chest. Helps understand why baby’s head needs to be in line with body or slightly extended.
- Have mom suck her thumb, put it midway, then back of mouth and such - compare effort required in each position. Remember: proper latch prevents nipple damage
- have photo of well-latched baby to show mom how wide and deep latch is, and a baby who is poorly latched (discuss differences)
Mother can optimize success of BF by (6/10 steps)
- cuddling skin to skin after birth for 2+ hours (& as often as possible when baby is imprinting)
- give priority to BF & establishing milk supply; baby bathing and visitors not important
- delay first bath for a few days.
- room in 24 hrs/day
- avoid having visitors handle baby - limit handling by other family members
- create quiet, calm atmosphere in room
What does skin to skin (SSC) contact do?
- triggers babys innate response (pre-programmed neurobehavior) which guides him to provide for own needs, eg seeking breast
- prone position of baby on mom’s chest ensures positional stability, allowing baby to use arms to lift upper body and extend neck, before placing chin on breast prior to latching.
- allows for sensory stimulation of smell, touch, warmth - cause oxytocin surges in mom which heats chest skin temp, triggers nipple erection and decreases maternal anxiety.
Effects of SSC on baby (list of 7)
- thermoregulation
- optimal oxygenation; stabilizes heart rate
- lowers serum cortisol
- reduced crying
- stabilizes blood glucose
- stimulates self-latching
- stimulates coordinated suckling
Effects of SSC on mom (list of 7)
- temp regulation
- increased oxytocin
- adequate milk volume
- stimulates right brain intuition
- promotes bonding
- fewer BF problems
- heightens confidence
What is the “sensitive period”
The period of transition from in-utero to adaptation to life outside uterus
What system triggers pre-programmed sequences of reflexes of baby in mom’s presence?
Limbic system
SSC should be considered at times of BF difficulty, including (5)…
- difficulty latching, or not latching
- low milk supply
- breast refusal
- relactation
- induced lactation
List 6 states of arousal
- sleep
- drowsy
- quiet alert
- active alert
- fussy
- crying
After an unmedicated birth, a health newborn in the first 90 minutes, will transition between ____ and ____ states - perfect to BF!
From quiet and active alert states
Which state of arousal is the best time to learn and process sensory information?
Quiet alert state
When is the best time to feed infant?
When he first exhibits cues that he is ready to feed - do not wait for hunger!
Why to respond to early feeding cues and not wait for hunger.
If early cues ignored, infant’s behavior will become more agitated until crying, making latching difficult. If feed is further delayed, infant may tire quickly and feed poorly.
List early feeding cues (5)
- subtle body mvmts, wiggling
- hand-to-mouth movements with or without sucking on hand
- mouthing and non-nutritive sucking - infant moves mouth in searching or sucking manner
- rooting when face touched
- pecking, head bobbing or thrusting when in arms of mother
Facilitating feeding: What 2 sensory inputs stimulate feeding?
- Firm contact against mom’s body - allows to orient and focus.
- If needed a drop of milk can be expressed and wiped on mom’s nipple & areola.
Facilitating feeding: What 3 positional aspects stimulate feeding?
*Baby needs EXTERNALLY CONTROLLED positional stability to control head movements.
- Babies more calm when chest and tummy touching/supported (no startle reflex in this position).
1. Stable base - provided for head by shoulder girdle.
2. Proximal stability - head & neck in alignment & supported.
3. Midline symmetry - optimal function in neck, head and mouth depends on equal muscle mvmts on both sides of body.
What two inputs are necessary for baby to assume the “instinctive position” to feed?
- sensory input
- positional stability
Describe the “instinctive position” for a feed.
Baby tilts head back and leads with jaw and mouth to breast where mouth opens wide, tongue down and over bottom gum line, ready to take breast into mouth.