Breastfeeding Flashcards
What is the recommended duration of exclusive breastfeeding according to the World Health Organization (WHO)?
A) 3 months
B) 6 months
C) 9 months
D) 12 months
Correct Answer: B) 6 months
Explanation: WHO recommends exclusive breastfeeding for the first 6 months of life due to its health benefits for both the baby (e.g., passive immunity, healthy growth) and the mother (e.g., weight loss, reduced risk of breast cancer).
Why others are wrong:
A) 3 months: This is insufficient and not aligned with WHO guidelines.
C) 9 months: Exclusive breastfeeding beyond 6 months may not meet the baby’s growing nutritional needs.
D) 12 months: Beyond 6 months, complementary foods are necessary alongside breastfeeding.
What is a key benefit of colostrum in breastfeeding?
A) High calorie content for rapid weight gain
B) Immunity through IgA antibodies
C) Thick consistency to replace mature milk
D) Prevention of all allergic reactions
Correct Answer: B) Immunity through IgA antibodies
Explanation: Colostrum is the first milk produced and is rich in IgA antibodies, lysozymes, and macrophages, which provide passive immunity to protect against gastrointestinal and respiratory infections.
Components
Colostrum (day 2-3): ”liquid gold”, first milk produced,
very thick
Transition milk (day 3-5): colostrum + mature milk Mature milk (day 5-7): thin, more white in colour
Why others are wrong:
A) High calorie content for rapid weight gain: While nutritious, colostrum’s primary benefit is immune protection, not rapid weight gain.
C) Thick consistency to replace mature milk: Colostrum transitions to mature milk, not the other way around.
D) Prevention of all allergic reactions: It reduces allergic risks but doesn’t prevent all reactions.
Which of the following is a contraindication to breastfeeding?
A) Maternal active tuberculosis
B) Mastitis
C) Poor latch by the infant
D) Maternal oral herpes simplex virus
Correct Answer: A) Maternal active tuberculosis
Explanation: Active tuberculosis in the mother is a contraindication due to the risk of transmission to the baby.
Why others are wrong:
B) Mastitis: This is not a contraindication; breastfeeding can continue with proper management.
C) Poor latch by the infant: This is a challenge, not a contraindication, and can be addressed with support.
D) Maternal oral herpes simplex virus: HSV is not contraindicated unless lesions are on the breast.
Contraindications to Breastfeeding
Very rare but there are some Active tuberculosis in mother HIV infected mother
Can be avoided if ART therapy is accessible
Active herpes simplex of the breast in the mother
Not contraindicated if HSV infection is elsewhere in the
mother (like oral or genital herpes)
What is the primary reason for introducing complementary foods at 6 months?
A) Gut maturity and diminished gag reflex
B) Transition from colostrum to mature milk
C) Establishing early taste preferences
D) Reducing reliance on breastfeeding
Correct Answer: A) Gut maturity and diminished gag reflex
Explanation: At 6 months, the infant’s gut is more mature (with IgA antibodies), and the gag reflex diminishes, allowing for safe introduction of complementary foods.
Why others are wrong:
B) Transition from colostrum to mature milk: This transition occurs earlier, typically by day 5-7.
C) Establishing early taste preferences: While important, this is not the primary reason.
D) Reducing reliance on breastfeeding: Breastfeeding continues to be a primary source of nutrition alongside complementary foods.
Which of the following is a potential benefit of breastfeeding for the mother?
A) Increased energy storage
B) Reduced uterine contractions post-partum
C) Lower risk of breast cancer
D) Increased calorie retention for weight gain
Correct Answer: C) Lower risk of breast cancer
Explanation: Breastfeeding reduces the mother’s risk of developing breast cancer and promotes post-partum recovery (e.g., uterine contractions).
Why others are wrong:
A) Increased energy storage: Breastfeeding helps mothers lose weight by burning calories, not storing energy.
B) Reduced uterine contractions post-partum: Breastfeeding stimulates uterine contractions to aid recovery, not reduce them.
D) Increased calorie retention for weight gain: Breastfeeding aids in weight loss, not gain.
- Importance of Breastfeeding
- WHO recommends exclusive breastfeeding for the first 6 months of life
- Newborn maternal bonding
- Passive immunity in the first 2 months of life
i) IgA antibodies, lysozyme, macrophages to aid in protection against GI and UTRIs
ii) Protect against multiple infections: gut RT, allergic/skin
Healthy weight management
Helps uterus contract: early post partum Helps breastfeeding mother to lose weight Reduces risk of breast cancer
What is the most common cause of breastfeeding jaundice?
A) Overproduction of bilirubin
B) Low intake of breastmilk
C) High caloric density of breastmilk
D) Maternal infections during pregnancy
Correct Answer: B) Low intake of breastmilk
Explanation: Breastfeeding jaundice occurs due to low breastmilk intake, leading to infrequent stooling and poor weight gain in the infant.
Why others are wrong:
A) Overproduction of bilirubin: This is associated with other types of jaundice, not breastfeeding jaundice.
C) High caloric density of breastmilk: This is not a contributing factor to jaundice.
D) Maternal infections during pregnancy: These are unrelated to breastfeeding jaundice.
What is the primary mechanism for maintaining milk supply during breastfeeding?
A) Frequent pumping of milk
B) High maternal caloric intake
C) Supply-demand effect
D) Supplementing with formula
Correct Answer: C) Supply-demand effect
Explanation: Breastmilk production relies on a supply-demand mechanism where frequent nursing or pumping stimulates continued milk production.
Why others are wrong:
A) Frequent pumping of milk: While helpful, it supports the supply-demand mechanism rather than being the primary mechanism.
B) High maternal caloric intake: Nutrition supports lactation but doesn’t regulate milk supply.
D) Supplementing with formula: This can reduce breastfeeding frequency, negatively impacting milk supply.
Which of the following is a reason for using soy protein-based formula for infants?
A. Infants with galactosemia or lactase deficiency
B. Infants with significant malabsorption syndromes
C. Infants with hepatic failure
D. Infants requiring increased caloric density
A. Infants with galactosemia or lactase deficiency*
Correct: Soy protein-based formulas are specifically recommended for infants with galactosemia (inability to metabolize galactose) or lactase deficiency (inability to digest lactose).
- Soy is the most common recommendation for vegetarian diets or cow’s milk intolerance as it contains the required nutrients without relying on cows milk and is a great alternative for those who are lactose intolerant.
B. Incorrect: Significant malabsorption syndromes require semi-elemental or elemental formulas, not soy-based formulas.
C. Incorrect: Hepatic failure often requires special formulas with modified amino acid content, not soy-based formulas.
D. Incorrect: While formula additives can increase caloric density, soy-based formulas are not designed specifically for this purpose.
Which type of formula is recommended for infants with significant malabsorption syndromes?
A. Whole protein cow’s milk formula
B. Semi-elemental or elemental formula
C. Soy protein-based formula
D. Regular cow’s milk
B. Semi-elemental or elemental formula
Correct: Semi-elemental and elemental formulas contain hydrolyzed proteins (e.g., whey or casein), an abundance of EFA’s and are ideal for infants with significant malabsorption syndromes because they are easier to digest and absorb.
A. Incorrect: Whole protein cow’s milk formulas are not suitable for infants with malabsorption issues as they are harder to digest.
C. Incorrect: Soy protein formulas are not typically used for malabsorption syndromes.
D. Incorrect: Regular cow’s milk is unsuitable for infants and does not meet the dietary needs of those with malabsorption syndromes.
Which condition would require the use of special formulas with reduced or modified amino acid content?
A. Lactase deficiency
B. Severe malnutrition
C. Hepatic failure
D. Allergies to cow’s milk protein
C. Hepatic failure
Correct: Special formulas with reduced or modified amino acid content are used in metabolic diseases, hepatic failure, pulmonary failure with carbon dioxide retention, or renal failure to accommodate the specific needs of these conditions.
A. Incorrect: Lactase deficiency is typically managed with lactose-free formulas, not specialized amino acid formulas.
B. Incorrect: Severe malnutrition may require calorie-dense formulas, but not necessarily formulas with altered amino acids.
D. Incorrect: Allergies to cow’s milk protein are managed with hypoallergenic or hydrolyzed protein formulas, not formulas with modified amino acids.
more information
These formulas are designed to reduce the metabolic burden on the affected organs by modifying the protein composition. Here’s how they help:
Hepatic failure:
The liver plays a critical role in metabolizing proteins and converting ammonia (a byproduct of protein breakdown) into urea for excretion. In hepatic failure, the liver cannot effectively process ammonia, leading to its accumulation and causing hepatic encephalopathy. Special formulas reduce or remove specific amino acids like methionine and aromatic amino acids, which produce more ammonia during metabolism, while adding branched-chain amino acids (BCAAs) that are better tolerated.
Pulmonary failure with CO₂ retention:
In pulmonary failure, excess carbon dioxide builds up due to respiratory inefficiency. Metabolism of certain nutrients, like carbohydrates and proteins, produces CO₂ as a byproduct. Special formulas adjust the protein and fat ratios to reduce CO₂ production, easing the metabolic load on the respiratory system.
Renal failure:
The kidneys excrete nitrogenous waste products from protein metabolism. In renal failure, this process is impaired, leading to the accumulation of urea and other toxins. Special formulas limit nitrogen intake by reducing protein content or modifying it with essential amino acids, reducing the production of nitrogenous waste and preventing further kidney strain.
Why is the introduction of complementary foods recommended at 6 months of age?
A. To help the infant sleep through the night
B. Because the gag reflex has diminished and the gut is more mature
C. To transition the infant from formula or breastmilk completely
D. Because the infant can eat dairy products by this time
B. Because the gag reflex has diminished and the gut is more mature
Correct: At 6 months, the infant’s gag reflex diminishes, the gut matures (with IgA antibodies providing additional protection), and the infant is developmentally ready to start complementary foods.
A. Incorrect: While sleep patterns may improve over time, the introduction of complementary foods is not specifically tied to sleep improvements.
C. Incorrect: Complementary foods are meant to complement breastmilk or formula, not replace them entirely at this age.
D. Incorrect: Dairy products are typically postponed until after 12 months to reduce the risk of intolerances and allergies.
Which of the following is a key strategy for introducing complementary foods to infants?
A. Introduce multiple new foods at the same time to save time
B. Begin with dairy products, such as milk and cheese
C. Introduce one food at a time every 3–4 days to monitor for reactions
D. Avoid introducing iron-rich foods in the early stages
C. Introduce one food at a time every 3–4 days to monitor for reactions
Correct: Introducing one food at a time allows parents to monitor for potential allergic reactions or intolerances (e.g., skin, gut, or behavioral changes).
A. Incorrect: Introducing multiple foods simultaneously increases the risk of missing potential food reactions.
B. Incorrect: Dairy products are usually postponed until after 12 months due to potential allergies and intolerance.
D. Incorrect: Iron-rich foods, such as meats and spinach, are important in the early stages to support growth and prevent deficiencies.
What is the primary purpose of adding formula additives?
A. To change the taste of formula
B. To increase caloric density of all nutrients
C. To make formula more suitable for breastfeeding supplementation
D. To eliminate allergens like casein
B. To increase caloric density of all nutrients
Correct: Formula additives are used to enhance the caloric density of the formula, ensuring infants receive adequate nutrition, especially in cases of failure to thrive or growth concerns.
A. Incorrect: Additives are not designed to alter the taste of the formula.
C. Incorrect: While formula can be used as a breastfeeding supplement, this is not the specific role of additives.
D. Incorrect: Formula additives are not used to eliminate allergens but rather to boost nutrient density.
Why would there even be a gag reflex when the baby is just drinking breastmilk before 6 months?
The gag reflex serves as a protective mechanism to prevent choking or aspiration (entry of food or liquid into the airway) in infants. Here’s why it’s present even when infants are exclusively breastfeeding:
Protection during swallowing:
While breastfeeding, there’s always a risk of milk entering the airway. The gag reflex helps ensure milk goes into the esophagus and not the trachea.
Prevention of foreign object aspiration:
Infants often put objects in their mouths. The gag reflex prevents large objects from being swallowed or blocking the airway.
Immature oral motor skills:
Before 6 months, an infant’s ability to coordinate swallowing is underdeveloped. The gag reflex prevents them from managing solid foods that they are not yet ready to handle.
At around 6 months, as the gag reflex diminishes, the infant is developmentally ready to handle solid foods. This coincides with other developments, such as improved head control, chewing ability, and gut maturation
Why is dairy postponed until the baby 12 months old?
- Immature Digestive System
Infants under 12 months may have difficulty digesting the proteins in cow’s milk (like casein) and its higher levels of minerals like calcium, sodium, and potassium.
Cow’s milk can place a strain on the infant’s kidneys due to its high protein and mineral content, leading to dehydration or potential kidney overload. - Nutritional Deficiencies
Cow’s milk is low in iron and can interfere with iron absorption from other sources, increasing the risk of iron-deficiency anemia, particularly if it displaces iron-rich complementary foods.
Cow’s milk lacks essential fatty acids and other nutrients, such as vitamin C and zinc, that are critical for growth and development in the first year. - Potential for Allergic Reactions
Infants may develop an allergic reaction to the proteins in cow’s milk. Delaying dairy introduction reduces the likelihood of severe allergic responses and gives the immune system more time to mature. - Breastmilk or Formula Is Superior in the First Year
Breastmilk or formula is specifically formulated to meet the nutritional needs of infants under 12 months. Introducing cow’s milk prematurely may cause the infant to drink less breastmilk or formula, resulting in insufficient intake of critical nutrients like DHA, fats, and vitamins. - Risk of Intestinal Issues
Cow’s milk can irritate the lining of an infant’s immature gut, leading to tiny amounts of intestinal bleeding in some cases. This can further increase the risk of iron deficiency.
Conclusion
After 12 months, the infant’s digestive system is more developed, and their diet is diversified with complementary foods that help provide the nutrients that cow’s milk lacks. At this point, dairy can be safely introduced as part of a balanced diet.
A 30-year-old pregnant patient presents with a sudden, severe headache. Which of the following symptoms would require an emergent workup?
A) Fever and neck stiffness
B) Focal neurological symptoms
C) Mild bilateral headache relieved by rest
D) Sudden onset of headache with photophobia
Correct Answer: A) Fever and neck stiffness: These are red flags for conditions like meningitis or subarachnoid hemorrhage, which require immediate evaluation.
B) Focal neurological symptoms: This is also a red flag, but alone it doesn’t always require emergency intervention unless sudden or progressive.
C) Mild bilateral headache relieved by rest: Incorrect. This is characteristic of a tension headache, which does not require emergent workup.
D) Sudden onset of headache with photophobia: Incorrect. While photophobia can be concerning, this alone without other red flags doesn’t necessitate emergent evaluation.
Which of the following non-pharmacologic interventions is most effective for managing pregnancy-related insomnia?
A) Cognitive Behavioral Therapy for Insomnia (CBT-I)
B) Melatonin supplementation
C) Increasing caffeine intake to reduce daytime fatigue
D) Co-sleeping with a partner to minimize nighttime awakenings
A) Cognitive Behavioral Therapy for Insomnia (CBT-I): Correct. CBT-I is an evidence-based approach that improves sleep efficiency and reduces sleep onset latency without pharmacologic risks.
B) Melatonin supplementation: Incorrect. Insufficient human studies exist on melatonin’s safety in pregnancy.
C) Increasing caffeine intake: Incorrect. Caffeine should be avoided as it can worsen insomnia and disrupt sleep cycles.
D) Co-sleeping with a partner: Incorrect. This may increase disturbances, especially if the partner snores or moves frequently during sleep.
Which of the following is a serious complication of pyelonephritis during pregnancy?
A) Pulmonary edema
B) Preterm labor
C) Neonatal hypoglycemia
D) Oligohydramnios
Correct Answer: A) Pulmonary edema
Explanation:
A) Pulmonary edema: Correct. Pulmonary edema or ARDS occurs in up to 8% of pyelonephritis cases and is life-threatening.
B) Preterm labor: Incorrect. While uterine contractions can occur, it’s not the most serious complication compared to sepsis or ARDS.
C) Neonatal hypoglycemia: Incorrect. This is unrelated to pyelonephritis.
D) Oligohydramnios: Incorrect. Pyelonephritis does not directly lead to reduced amniotic fluid.
more information on why:
1. Inflammatory Response and Capillary Leak
Pyelonephritis triggers a systemic inflammatory response, which can lead to sepsis.
Sepsis increases capillary permeability, causing fluid to leak from the blood vessels into the interstitial spaces, including the lungs, resulting in pulmonary edema.
2. Volume Overload
During pregnancy, there is a natural increase in plasma volume (up to 50%), which the kidneys help regulate. If the kidneys are compromised by severe infection, they may fail to maintain fluid balance, leading to volume overload and fluid accumulation in the lungs.
3. Decreased Oncotic Pressure
Sepsis can also reduce serum albumin levels (a protein that helps maintain oncotic pressure). Low oncotic pressure allows fluid to shift from blood vessels into the lungs, contributing to pulmonary edema.
4. Tocolytic Use
In cases of pyelonephritis, uterine contractions may occur, and tocolytics (medications to stop labor) are sometimes used. Tocolytics like beta-agonists (e.g., terbutaline) can cause fluid retention and worsen pulmonary edema.
5. Acute Kidney Injury (AKI)
Severe pyelonephritis can lead to AKI, reducing the kidneys’ ability to excrete excess fluids, which then accumulate in the lungs.
Summary of Mechanism:
The kidneys’ inability to filter fluid efficiently plays a role, but pulmonary edema in pyelonephritis is primarily driven by the inflammatory cascade, capillary leak, and systemic fluid overload.
It is especially concerning in pregnancy due to the already increased blood volume and changes in cardiac and renal function.
What is the primary maternal benefit of breastfeeding?
A) Reduced risk of uterine atony
B) Increased maternal weight retention
C) Lower oxytocin release
D) Higher risk of ovarian cancer
A) Correct – Breastfeeding stimulates oxytocin release, which helps the uterus contract, reducing the risk of uterine atony and postpartum hemorrhage.
B) Incorrect – Breastfeeding actually aids postpartum weight loss.
C) Incorrect – Oxytocin release increases with breastfeeding, not decreases.
D) Incorrect – Breastfeeding is associated with a lower risk of ovarian cancer, not a higher risk.
