Breast Feeding Flashcards
What’s Mamogenesis? What triggers it?
Growth of mammary gland
Begins when mammary gland is exposed to oestrogen at puberty -> completed at third trimester of pregnancy
What changes occur during mamogenesis?
Ductal, alveolar and myoepithelial cells all undergo hyperplasia for lactation
Why isn’t milk produced during pregnancy?
High plasma concentrations of oestrogen and progesterone present before delivery inhibit active secretory of prolactin on mammary alveolar epithelium
When does Colostrum appear?
In second trimester in acinar glands
By third trimester alveoli contain significant amounts
When is prolactin able to cause colostrum secretion?
Post delivery
Inhibitory influence of oestrogen and progesterone removed = prolactin able to stimulate alveolar epithelial cells to being active secretion of colostrum
What does colostrum contain/look like?
Yellow viscous fluid - the first milk
Carbohydrates Protein Antibodies Interferon Immunologically active lymphocytes and monocytes
Low in fat
What does interferon in colostrum facilitate?
Facilitates removal of intestinal meconium
Factor for stimulation of lactobacillus bifidus in intestinal tract
= basically prepares GI tract
When is secretory acinar epithelium completely matured?
By 4-5 days postpartum = lactogenesis
What hormone stimulates sensory receptors in the nipple to active nerve impulse? How does this work?
Prolactin
Nerve impulses to endocrine neurones -> decrease in prolactin inhibiting factor -> lactotrophs released to permit synthesis and release of prolactin
Outline the let down reflex
Oxytocin released after sucking on nipple stimulates sensory fibres
Oxytocin becomes conditioned response requiring only visual stimulation or conscious thought
Myoepithelial cells contract to release milk into lactiferous ducts and sinuses
What does the volume of transitional milk change to by the end of the second post partum week?
100 - 500ml
What’s beneficial for a breast feeding diet?
Increases in protein, carbohydrate, lipid, minerals and calories must be maintained
Low casein content - easily digested by baby stomach
Recommend first stage milk -> second stage milks sit in stomach for longer (these are formula milks)
What’s galactopoiesis and its most important factor?
Maintenance of milk production - regular and frequent milk removal from the mammary gland
What are the 3 important mechanisms to enable breast feeding?
Regular sucking - promotes synthesis and release of both prolactin and oxytocin
Regular emptying
Demand feeding - amount of milk produced daily is related to the demand of the baby
Why does the breast need to be emptied regularly?
Breast has a capacity to store milk for a maximum of 48 hours before there’s a substantial decrease in milk production (if milk left in there)
Left unemptied glandular epithelium is less stimulated by prolactin
Vascular stasis caused by increased intramammary pressure
What’s the nipple to nose position?
Nose level to nipple - latching position
Baby should open mouth really wide with tongue down and tilt head back -> to breast with chin first
What’s ankyloglossia?
Tongue tie - seen in neonatal examination, decrease mobility of tongue by short thick frenulum
Can affect feeding
What are the advantages for the baby with breast feeding?
Lower risk of GI, Resp, Ear and UTIs Lower risk of allergic disease (eczema, asthma etc) Lower risk of insulin dependent DM Obesity Sudden infant death syndrome Childhood leukaemia Improved neurological development
What’re the advantages for mother with breastfeeding?
Increased skin to skin contact with baby Promotion of bonding Involution of uterus Lower risk of breast and ovarian cancer Lower risk of hip fractures Prevention of rheumatoid arthritis
What’s uterine involution?
The return of the gravid uterus to its original size and shape (but never its nulliparous state)
When do you monitor uterine involution?
Only in high risk pregnancies (maybe lochia discharge is indicating part of placenta still inside)
What suppresses lactation?
Stop in sucking
Fall in prolactin
Breast binding (wear a supportive bra)
Pharmacological methods (eg in stillbirth)
What’s breast involution?
Decrease in size of alveolar lobular ductal units
Stimulated by reduced frequency of sucking = increases amount of milk retained in breast = vascular stasis = alveolar atrophy
What’s the difference between breast involution and the decrease in size during the menopause?
Involution decrease in size of alveolar-lobular-ductal units
Menopause is reduction in quantitative loss
How many months after cessation of lactation have the breasts fully regressed?
By 3 months
Breasts retain some of increased fatty tissue, so will remain slightly larger than pre-pregnancy size
Who shouldn’t breast feed?
Women misusing alcohol
Drugs: Methotrexate, Lithium
Active TB
Infants with galactosemia/phenylketonuria
When do you start weaning foods?
6 months
How long does a baby’s iron store last for?
6 months (if full term baby)
Premature baby’s may not have much iron store as in the last month of pregnancy is when iron is stored in fat
How many toddlers are anaemic?
35% among minority ethnic children and white children
When would you pick up coeliac disease in an infant?
When you’re introducing weaning foods - fatty stools present in nappy
What are some common food allergies?
Egg, milk, soy, tree nuts, wheat
Which food allergy are children most likely to grow out of?
Tree nuts
What’s the prevalence of vitamin D deficiency in young children?
12%
40% below optimal threshold
What % of toddlers consume sugar-sweetened beverages? What’s the major problem?
70% - dental caries
Which guideline aims to prevent obesity and promoting physical activity - how many minutes/day
UK Physical activity guideline 2011
Early years (children under 5) physically active for 180 minutes spread throughout the day
What’s the mechanism of breastfeeding as a contraceptive?
Regular feeding stimulates production and release of Prolactin from anterior pituitary
Prolactin has negative feedback (inhibitory) effect on the release of GnRH and FSH from the pituitary to suppress ovulation
(Only reliable for first 6 months and regularly, exclusively breastfeeding)
