Breastfeeding

Question 1

Tanner stages of breast development

Answer 1

*breast development starts at the onset of puberty
*“thelarche” (breast development) starts shortly after adrenarche (pubic/axially hair)
*complete breast differentiation occurs only after pregnancy

Question 2

nipple types

Answer 2

*everted (most common)
*flat (flat at rest and when touched)
*inverted (can cause breastfeeding problems)

Question 3

which hormone is responsible for differentiation of the breast lobules (milk producing apparatus)?

Answer 3

*progesterone

Question 4

hormones & breast development

Answer 4

1. estrogen stimulates DUCTAL growth
2. progesterone stimulates ALVEOLAR DIFFERENTIATION

Question 5

breast - blood supply

Answer 5

1. main supply = internal mammary arteries (derived from the internal thoracic artery)
2. lateral thoracic & thoracoacromial arteries (branches of the axillary artery)
3. posterior intercostal artery (branches of the thoracic aorta)

*venous drainage is mainly into axillary vein, plus subclavian, intercostal, and internal thoracics

Question 6

where does the great majority of the breast lymphatic channels drain?

Answer 6

*axillary nodes

Question 7

breast - lymphatic drainage

Answer 7

*most (>75%) of breast drains into the axillary lymph nodes
*remainder of lymph drains to either the parasternal nodes, the opposite breast (medial quadrants), or the inferior phrenic nodes (lower quadrants)

Question 8

mammographic breast density - stages

Answer 8

*ranges from:
A. almost entirely fatty breast
B. a breast with scattered areas of fibroglandular density
C. a heterogeneously dense breast
D. an extremely dense breast

*breast density normally DECREASES with age

Question 9

importance of mammographic breast density

Answer 9

*breast density is an important risk factor for breast carcinoma

Question 10

mammographic breast density & risk of breast cancer

Answer 10

*affects breast cancer risk in 2 ways:
1. dense tissue can obscure an underlying cancer, decreasing the sensitivity of mammography to detect small lesions
2. increased density is an independent risk factor for breast cancer, as most cancers develop in the glandular parenchyma

Question 11

recommendations for breastfeeding

Answer 11

*breastfeed for the infant’s first year of life (primary source for first 6 months, but continue for rest of first year)
*add supplemental Vitamin D at birth
*start solid foods at 6 months
*delay cow’s milk until 1st year, then whole milk until age 2 before switching to low fat / skim
*mother should take prenatal vitamins while nursing

Question 12

benefits of breastfeeding (general)

Answer 12

*better for infant
*better for mother
*benefits to society
*cost to family/society

Question 13

short-term benefits of breastfeeding for the infant

Answer 13

*decreased risk of SIDS
*lower risk of acute illnesses compared to formula-fed babies, including lower risks of:
-GI disease
-respiratory disease
-otitis media
-UTI
-necrotizing enterocolitis (NEC) in preemies

Question 14

long-term benefits of breastfeeding for the infant

Answer 14

*benefits to neurodevelopment
*reduction in adolescent and adult obesity
*possible decreased likelihood for food allergies & dental caries
*benefits for jaw, teeth, speech development, and overall facial development
*less “fincky eaters” because infant exposed to many tastes and scents in mother’s milk

Question 15

breastfeeding and decreased risk of childhood cancers

Answer 15

*reduction in overall risk of childhood cancer, especially leukemia and lymphoma

Question 16

benefits of breastfeeding for mom

Answer 16

*lower risk of breast cancer (nursing for 6+ months decreases risk of breast cancer by 50%) and longer nursing correlates with further reduction in risk
*decreased risk of CVD, T2DM, HTN
*lose weight quicker after pregnancy
*lower risk of endometriosis
*increased prolactin & oxytocin (calming effect, reduce maternal stress, increase infant bonding)

Question 17

barriers to breastfeeding

Answer 17

*lack of knowledge
*uncertainty - majority of women of childbearing age were not breastfed and have no maternal relatives to mentor them
*family is important influence on breastfeednig
*concerns about return to work, appearances of breasts
*embarrassment
*lactation problems

Question 18

what is the name of the first milk secreted after delivery?

Answer 18

*colostrum

Question 19

lactogenesis - step 1

Answer 19

*during pregnancy, gradual transition of breast lobules to type 3 and then type 4
*during the latter half of pregnancy, breast alveolar cells are activated by high progesterone levels to secrete small amounts of lactose & colostrum

Question 20

lactogenesis - step 2

Answer 20

*secretory activation causing copious milk production after delivery
*rapid decrease in progesterone that follows delivery of the placenta and requires the presence of elevated levels of prolactin, cortisol, and insulin
*marked swelling of the breasts from 2-5 days postpartum (milk “comes in” 3-5 days after delivery)

Question 21

maintenance of lactation

Answer 21

*continuous production of milk requires:
1. regular removal (nursing and/or pumping)
2. nipple stimulation → prolactin (from anterior pituitary) and oxytocin (from posterior pituitary)
*breast responds to demand; more nursing → more milk production

Question 22

breastfeeding problems - overview

Answer 22

1. not enough milk produced by mom
   -congenital lack of adequate glandular tissue (uncommon and unrelated to breast size)
   -breast surgery (augmentation or reduction)
   -high androgen levels
2. not enough milk extracted by baby
   -infrequent feeding
   -inadequate latch-on
   -use of supplemental formula

Question 23

breastfeeding problem: inverted nipples

Answer 23

*sometimes difficult for women with inverted nipples to nurse
*solve with shields to draw out the nipples

Question 24

breastfeeding problem: sore nipples

Answer 24

*very common during the first week
*short-lived

Question 25

breastfeeding problem: nipple injury/trauma

Answer 25

*due to poor technique or improper latch

Question 26

breastfeeding problem: mastitis

Answer 26

*Staph aureus from baby’s mouth
*common, esp with first baby
*treat with anti-staph penicillin: DICLOXACILLIN
*keep nursing / pumping - need to keep breast drained

Question 27

who should NOT breastfeed

Answer 27

*HIV positive, active hep C and other infectious diseases
*active, untreated TB
*mother undergoing chemotherapy
*illicit drug use
*fetus with galactomesia (cannot tolerate galactose)
*certain prescription meds