Breastfeeding Flashcards

1
Q

Describe the 3 stages of lactogenesis, including the time at which they occur. What are the roles of oxytocin and prolactin? What is the function of feedback inhibitor of lactation (FIL)?

A
  1. Lactogenesis I: During first postpartum days when suckling is not necessary to initiate milk production and milk begins to form
  2. Lactogenesis II: 2-5 days postpartum; increased blood flow to mammary gland, changes in breast tissue signal body to increase concentration of lactose for 2 weeks. “milk comes in”
  3. Lactogenesis III: 2-5 weeks after birth when composition of milk is stable
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2
Q

Describe the functional unit of lactation, anatomy of lactating breast, alveoli, cuboidal cells, and myoepithelial cells.

A

Breast alveoli are balloon-like structures lined with milk-secreting cuboidal cells, that are surrounded by a net of contractile myoepithelial cells. Milk is secreted from the cuboidal cells, fills the alveoli, and is squeezed into the ducts. Clusters of alveoli that drain to a common duct are called lobules; the lactating female has 12–20 lobules organized radially around the nipple. Milk drains from lactiferous ducts into lactiferous sinuses that meet at 4 to 18 perforations in the nipple, called nipple pores.

Milk is ejected by myoepithelial cells contracting when oxytocin is released

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3
Q

In general, what are the 5 methods by which components of human milk are secreted?

A

1) Exocytosis (protein, lactose)
2) Secretion into ducts
3) Secretion by passive diffusion (ions, water)
4) Exocytosis of IgA
5) Paracellular pathway (plasma components, leukocytes)

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4
Q

Provide an overview of how the composition of human milk compares to that of formula. What 8 ingredients in human milk are not found in formula?

A

There are many components of human breast milk that cannon be replicated by formula:
1) Lactoferrin
2) Leptin
3) Living cells
4) Growth factors
5) Probiotics
6) HMO’s
7) Immunoglobulins
8) Enzymes

In Both: vitamins, fat, CHO, protein, water

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5
Q

What is the general composition of colostrum? When is it produced? How much volume is produced in a typical feeding?

A

Colostrum is produced in the first 1-3 days after birth, and only 2-10 mL/feeding is produced

Composition: lower in fat and CHO, higher in protein. Contains immune components: lactoferrin, secretory immunoglobulin A, white blood cells, growth factors. HIGH in vit A

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6
Q

Describe the size of the newborn stomach from day one to one month.

A

Day 1: size of a cherry (5-7 ml)
Day 3: Size of a walnut (.75-1 oz)
1 Week: Size of an apricot (1.5-2 oz)
1 Month: Size of large egg (2.5-5 oz)

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7
Q

Do infants who are exclusively breastfed or formula-fed need water? [review statements of ABM and AAP].
When should water be added to the diet (answer: when complementary foods are added)?

A

Water is NOT needed in the first 6 months of age, it can interfere with correct feeding which can increase risk of jaundice, excessive weight loss, and longer hospital stays

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8
Q

Provide a very specific explanation regarding why breastfeeding may be protective against the development of childhood obesity.

A

1) Responsive feeding, and Breast fed infants tend to consume fewer calories than formula fed infants:
* Caregivers may try to empty bottles
* Formula w/ high protein can lead to higher serum insulin levels
* Different feeding experience
* Metabolic signaling agents (like leptin) may help regulate satiety – so breastfeeding infants may reach satiety in different way
2) Obesity may also be related to the microbiome

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9
Q

What is paced feeding? Why is it important?

A

A method of bottle feeding that allows the infant to be more in control of the feeding pace, sitting the baby more up right

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10
Q

Describe the carbohydrate components in breast milk. What are HMOs? What is another term for HMOs? List and describe 6 functions of HMOs. How are HMOs unique? How important are HMOs?

A

CHO make up 40% of calories, lactose being the primary CHO (enhances Ca absorption)
HMOS = Human oligosaccharides = Glycans
* Mothers produce over 200 unique HMO’s
* Act as prebiotics
* Prevent pathogen attachment
* Stimulate maturation of intestinal epithelium
* Enhance immune response
* Provide potentially essential nutrient for brain development (sialic acid)
* Prevent necrotizing enterocolitis

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11
Q

What is necrotizing enterocolitis? How does dietary intake of the preterm infant impact development of this condition?

A

Necrotizing enterocolitis (NEC) destroys the intestinal lining. 3-7% of babies develop it, and 50% of those cases die. Breast milk is protective against this.

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12
Q

What is the protein content of human milk compared to that of cow milk? What are the 2 types of proteins? What are their contributions? What is lactoferrin?

A

Protein makes up 10% of calories in Human milk (compared to 31% in 1% cow milk)
Two types:
1) Whey proteins: a-lactalbumin, lactoferrin (binds iron to increase iron bioavailability, immune function draws iron from microbes)
2) Casein: keeps Ca soluble, imparts white color

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13
Q

Lipids make up what percentage of calories of breast milk? How does the lipid content of human milk compare to that of formula? How does the ‘form’ of the lipids compare (MFGM)? What affects the DHA content? What is the impact of DHA?

A
  • Lipids are 50% of calories
  • Human milk is different than formula because the fat percentage actually changes during a feeding, where the end of the feeding is higher in had which help withs baby’s satiety
  • DHA or Omega 3 intake is directly correlated to the mom’s omega 3 intake.
  • DHA helps with visual acuity and cognitive development
  • MFGM = milk fat globule membrane; a complex structure made of proteins and lipids that surround milk fat globules- may benefit intestinal development, cognition, and cardiovascular health
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14
Q

List the 4 micronutrients that may be of concern for infants, especially for breastfed babies, and explain the issues.

A

Vitamin D, vitamin K, vitamin B12, iron

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15
Q

Vitamin D. What is the most well-known function of vitamin D? What are specific concerns with respect to Vitamin D? Why are infants at risk for deficiency? What are the ramifications of risk? What are official recommendations of the AAP? Is it possible for the breastfeeding mom to take vitamin D to increase the supply in milk to meet the needs of her infant? How much vitamin D would she need to take?

A
  • Function in bone development and growth
  • Concerns are risks of Rickets
  • Vitamin D is naturally low in breast milk- so infants are at risk if they are exclusively breastfed, have limited sunlight, or have darker skin
  • Recommended daily intake is 400 IU of vitamin D
  • Mom can take vitamin D supplement, recommended dosage is 6400 IU/day
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16
Q

Vitamin K. What is the most well-known function of vitamin K? What are specific concerns with respect to Vitamin K? What is the name of the deficiency disease? Why do newborns have low vitamin K status at birth (3 reasons)? What are risk factors related to mom? The newborn’s particular conditions? What are recommendations of the AAP?

A
  • Vitamin K plays a role in blood clotting, newborns are low in Vitamin K and are at risk of Vitamin K Deficiency Bleeding (VKDB)
  • There is low vitamin K placental transfer, sterile intestines at birth, and vitamin K cycle isn’t fully functional
  • Risk factors related to the mom would be aspirin, anticonvulsants, barbiturate, antibiotics
  • Risk factors for newborn are premature, low birth weight, difficult birth, and exclusive breastfeeding
  • A vitamin K shot at birth is recommended
17
Q

Vitamin B12. In some cases, vitamin B12 deficiency can be an issue for infants. What are 4 maternal risk factors? What are symptoms? What is the maternal requirement during lactation? What is the advice for the vegan mom?

A
  • Maternal risk factors: vegetarian or vegan diet, maternal pernicious anemia or celiac disease, gastric bypass surgery, some medications
  • Symptoms in baby: seizures, apathy, lethargy, anemia, developmental delay, failure to thrive
  • Maternal requirement is 2.6 qu/day
  • Found in meat, fish, poultry, eggs, dairy, multivitamins, B12 suppliment, fortified cereals, soy
18
Q

Iron. Iron in human milk is transported by _. What factors can lead to iron deficiency in toddlers? Infants are born with enough iron to last for months. How can parents be proactive in order to avoid the risk of iron deficiency in their child?

A
  • Iron is transported by lactoferrin
  • Usually iron deficiency is due to their iron stores running out, and not having enough iron in diet
  • Infants are born with enough iron to last for 4-6 months
  • Parents can be proactive with iron supplements and appropriate complementary foods
19
Q

What is the recommended duration for breastfeeding?

A
  • The recommendation is exclusive breastfeeding for 6 months, followed by continued breastfeeding with complementary foods for at least 2 years
20
Q

Why are health outcomes related to breastfeeding difficult to assess? What is a randomized, controlled trial (RCT)? Are randomized, controlled trials easy to conduct? How can systematic reviews help our understanding?

A
  • It’s not possible to setup a perfect research design for free-living humans
  • RCT is having one placebo/normal and one group that is changes, which is unethical to do in regards to mother and baby trials
  • RCT are not easy to conduct
  • Systematic reviews evaluates all studies that pertain to a topic to find commonalities and truths
  • Understanding of breastfeeding is based on systematic reviews
21
Q

How does breastfeeding affect infant and maternal outcomes? List items for which there is strong evidence and some for which there is some research.

A

Infant: GI infections, respiratory infections, SIDS, necrotizing enterocolitis, obesity, ear infections (some research: autoimmune, cognitive development, asthma)

Maternal: postpartum hemorrhage, delay in ovulation, postpartum depression, hypertension, cancer, diabetes (some research: postpartum weight, infant bonding)

22
Q

How does breastfeeding affect families and society? If most families were able to breastfeed their infants, how might that affect the planet and health care costs?

A

Families: Free, decreased medical costs, less lost work time, decreased emotional stress from illness
Society: Higher work productivity, reduced environmental impact, lower health care costs

If 90% of US families breastfed exclusively:
$13B/year could be saved, 17.4B/year if mothers still breastfed at 1 year

23
Q

In general, what are some problems with the formula industry?

A
  • Marketing is a huge issue: in developing countries with low water quality, in the US through free samples and coupons in hospitals
  • Nationwide shortage in 2022
  • Expensive
24
Q

How should the first breastfeed go? (In a perfect world!)

A
  • Skin-to-skin contact from the moment of birth
  • Vitamin k shot and eye ointment after first feeding
  • Ideally first feed within 30 minutes, doesn’t have to be optimal
  • Formula not offered
25
Q

List & describe features of WHO International Code of Marketing of Breastmilk Substitutes. What is the point of this document?

A
  • No advertising of breast milk substitutes to public
  • No free samples to mothers
  • No promotion of products in health-care facilities
  • No gifts or personal samples to health workers
  • Info to health care workers should be scientific and factual
26
Q

List and describe tenets of Baby Friendly Hospitals. What is the comparable plan in Texas?

A
  • written breastfeeding policy, train all health care staff on policy, inform all pregnant women about benefits of BF, help mothers initiate BF within ½ h of birth, show mothers how to BF, no artificial pacifiers, no food/drinks for infant
  • Texas 10 steps
27
Q

What are the signs of good breastfeeding (i.e. enough milk is being produced and consumed) during the newborn period? Why does it matter to know about these signs?

A

-frequent feedings, 8 times every 24 hours, rhythmic sucking and audible swallows
- what goes in comes out: 1-2 wet diapers first 2 days, 6-8 every 24 hrs after
-yellow stool by day 4
-at least 3 bowel movements per day after day 3

28
Q

What is a latch? What is the importance of positioning, knowing about latching, knowing barriers to good latching, perception of insufficient milk, obtaining assistance, etc.?

A
  • The latch is how the infant connects to the breast to feed
  • Poor positioning, tongue tie, and lack of wide open mouth can cause latch issues
  • Perception of insufficient milk can lead to formula supplementation which decreases supply, only 4-5% of women are physiologically incapable of producing adequate milk
29
Q

What is ankyloglossia? How can it affect breastfeeding success?

A

-Tongue-tie
-infant isn’t able to latch appropriately or have good sucking

30
Q

What is mastitis? Recommendations for prevention? Treatment?

A

-mastitis in a bacterial infection of the breast tissue that causes inflammation and can be painful
-improve breastfeeding techniques, rest and fluids for mother, warm packs, keeping infant close, antibiotics

31
Q

What are potential causes of low milk supply? What are potential problems? Solutions? Sometimes women feel that their supply is low (and it may not be). How should they proceed?

A

-causes: poor latch, infrequent feedings, failure to empty breast, lack of lobules, perception of insufficient milk
-potential problems: poor infant weight gain, breastfeeding cessation, formula supplementation
-Solutions: monitor infant weight, lactation consultant, empty breasts fully after each feeding, watch for infants swaller during feeding

32
Q

How common is insufficient milk? Please consider our class discussion.

A

-only 4-5% of women are physiologically incapable of producing adequate milk
-50% perceive insufficient milk: offering formula, decreases supply

33
Q

What source provides information about the rate of breastfeeding in the US?

A

CDC breastfeeding report card

34
Q

List conditions in which breastfeeding is contraindicated and when it is NOT contraindicated (and expressed milk can be offered). What are current recommendations about women with COVID?

A

-untreated tuberculosis
-herpes lesions on breast
-chickenpox
-flu
-covid: nurse and wear a mask

35
Q

A new mother asks your advice regarding alcohol consumption. What would you tell her?

A

It is not recommended to drink alcohol, but when it is done 2+ hours is needed prior to baby being breastfed after drinking.

36
Q

Summarize the many barriers to breastfeeding. Review the lecture and compile a list.

A

-work/school schedule
-fatigue
-medical conditions
-difficulties breastfeeding
-lack of family support
-perception of insufficient milk