Breastfeeding Flashcards
Tanner stages of breast development
*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
nipple types
*everted (most common)
*flat (flat at rest and when touched)
*inverted (can cause breastfeeding problems)
which hormone is responsible for differentiation of the breast lobules (milk producing apparatus)?
*progesterone
hormones & breast development
1. estrogen stimulates DUCTAL growth
2. progesterone stimulates ALVEOLAR DIFFERENTIATION
breast - blood supply
- main supply = internal mammary arteries (derived from the internal thoracic artery)
- lateral thoracic & thoracoacromial arteries (branches of the axillary artery)
- posterior intercostal artery (branches of the thoracic aorta)
*venous drainage is mainly into axillary vein, plus subclavian, intercostal, and internal thoracics
where does the great majority of the breast lymphatic channels drain?
*axillary nodes
breast - lymphatic drainage
*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)
mammographic breast density - stages
*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
importance of mammographic breast density
*breast density is an important risk factor for breast carcinoma
mammographic breast density & risk of breast cancer
*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
recommendations for breastfeeding
*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
benefits of breastfeeding (general)
*better for infant
*better for mother
*benefits to society
*cost to family/society
short-term benefits of breastfeeding for the infant
*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
long-term benefits of breastfeeding for the infant
*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
breastfeeding and decreased risk of childhood cancers
*reduction in overall risk of childhood cancer, especially leukemia and lymphoma
benefits of breastfeeding for mom
*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)
barriers to breastfeeding
*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
what is the name of the first milk secreted after delivery?
*colostrum
lactogenesis - step 1
*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
lactogenesis - step 2
*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)
maintenance of lactation
*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
breastfeeding problems - overview
- 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 - not enough milk extracted by baby
-infrequent feeding
-inadequate latch-on
-use of supplemental formula
breastfeeding problem: inverted nipples
*sometimes difficult for women with inverted nipples to nurse
*solve with shields to draw out the nipples
breastfeeding problem: sore nipples
*very common during the first week
*short-lived
breastfeeding problem: nipple injury/trauma
*due to poor technique or improper latch
breastfeeding problem: mastitis
*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
who should NOT breastfeed
*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
