Breastfeeding Flashcards

1
Q

Current breastfeeding recommendations

A

Until 6 months old
Can be done until 2year with complementary foods

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2
Q

Benefits of breast feeding
-for child
-for mother

A

Child - decreased incidence of
-asthma, atopic conditions
-diarrhoea, vomiting
-necrotising enterocolitis
-obesity and CVD
-acute infections (OM, Hinfluenzae meningitis, UTIs)
-SIDS
-T1, 2DM

Mother - decreased incidence of
-breast and ovarian cancer
-CVD
-obesity
-osteoporosis
-PND
-PPH
-T2DM

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3
Q

Renal and liver function of infant

A

Preterm - eGFR 0.6-0.8
Term - eGFR 2-4
2-4wks - eGFR 50

Liver function - immature at birth with delayed maturation of drug metabolising enzymes

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4
Q

How does the number of feeds affect medication choice

A

Number of feeds fluctuates based on baby’s needs and milk supply

Weaning at 6 months => no of feeds decreases

Decreased no of feeds => decreased exposure to medication

IF BALANCING MEDICATION WITH BREASTFEEDING, PRIORITISE BREASTFEEDING

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5
Q

How does medication enter breastmilk
-what medication characteristics have reduced passage into breast milk?
-what medication groups are trapped in milk due to lower pH of milk
-vaccinations that are compatible with breastfeeding

A

Diffusion => equilibrates with maternal plasma levels
If it enters CNS, it will enter milk

High molecular weight - insulins, heparins
High protein binding - warfarin, NSAIDs
Low lipid solubility - loratidine
Lower pH - amoxicilin

Active chemical ingredients in iodine barbiturates are changed by the lower pH of milk => get trapped

All vaccines are ok EXCEPT YELLOW FEVER

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6
Q

How to medically stop milk supply
-dose 1st day PP
-dose once lactation already established
-why might you do this?
-when should you not do this

A

Cabergoline 1mg single dose 1st day postpartum => stops PRL production

Cabergoline 250mcg every 12hrs for 2days if lactation already established

-stillbirth, neonatal death
-transfer of infection to baby via breastmilk
-toxic treatment that may be transferred
-by choice

DO NOT GIVE IN HTN, PRE-ECLAMPSIA
CAUTION IF RISK OF PPPsychosis

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7
Q

Safety of ABx

A

Penicillins
Cephalosporins - cefalexin
Trimethoprim
Tetracycline - avoid if possible
-if needed, use tetracycline for U3wks

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8
Q

Safety of painkillers

A

NSAIDs - ibuprofen, diclofenac preferred
-avoid aspirin due to risk of Reye’s syndrome

Avoid opioids - ESPECIALLY CODEINE
-if using, prescribe for shortest period, lowest effective dose, under strict monitoring
-monitor child for sedation, resp depression, poor feeding
-TRAMADOL safe but be alert to signs of overdose in child

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9
Q

Use of antidepressants
-which ones are safe
-what to avoid
-timings of breastfeeding where possible

A

SERTRALINE, PAROXETINE

TCA - safe to use in term children
MONITOR FOR SEDATION, POOR FEEDING, BEHAVIOURAL DISTURBANCES

Avoid St John’s Wort, MAOIs

Breastfeed immediately before medication taken

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10
Q

Use of contraception
-COCP
-POP
-IUS, IUD

A

COCP - O affects milk production
-less problematic after 6 months

POP - safe during breastfeeding, can start anytime

IUS, IUD - safe when breastfeeding
-insert within 48hrs or 4wks after birth - risk of perforation

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11
Q

Use of antihistamines
-suitable routes
-sedating vs non sedating

A

Use intranasal CS spray, drops, eye drops where possible
-sodium cromoglicate - eyes
-xylometazoline - nasal decongestant (risk of rebound congestion if used for 1wk+)
-azelastine - intranasal antihistamine
-fluticasone, beclometasone - intranasal CS

Non-sedating preferred - don’t cross BBB
-ceterizine, loratidine :)

Sedating - cross BBB
-chlorphenamine used for the shortest period, at lowest effective dose
MONITOR FOR DROWSINESS AND IRRITABILITY

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