breastfeeding Flashcards

Question

factors which affect lipid content

Answer 1

Prenatal weight gain Length of gestation – full term with more fat Parity – the more pregnancies, the fattier the milk is Volume of milk: more volume in sugary foremilk, less in fatty hind milk Timing of feed – fore/hind milk

Answer 2

inhibits bacterial growth in baby GI

Answer 3

rolling/stretch twice daily during last 6 weeks to decrease natural adhesions

Answer 4

wear 1-2h qd, increase as tolerated – appliance with silicon base with hole in it so not being flattened by shirt/bra

Answer 5

appliance that looks like nipple shield with a plunger on it to suction nipple through shield to evert it – can be done prenatally or before latching.

Answer 6

``` Hypoplasia Tubular shape Wide-intermammary space Immature nipple/areola Breast reduction- are removing ductal tissue along with fat, and are relocating the nipple – far more challenges with reduction than augmentation! ```

Answer 7

↓ asthma ↓ cow’s milk allergy ↓ food allergy ↓ GI and Resp infections ↓ necrotizing enterocolitis – big advancement for getting donor milk! ↓ DM in lifetime ↓ some immune disorders (Crohn’s, celiac, MS)

Answer 8

new mom position, gives support for baby's head, gives mother support for bringing baby to the chest

Answer 9

good for when mother has an incision after c-section; baby and mom really look into each other’s eyes, can see how open mouth is, top lip, etc.

Answer 10

awesome if woman is dizzy, sore on perineum, has hemorrhoids, tired/sleep deprived; but typically the hardest position to learn because generally lift baby too high and hard to direct nipple with single hand; mom able to sleep

Answer 11

* Belly to belly – ideally have total body contact * Her head faces breast, not tipped * Ear, shoulder and hip are in same line * Align nose to level of nipple – baby more likely to lead this way, will be unable to open jaw as much if in cross-cradle, cradle etc.

Answer 12

* Hand in relation to baby’s mouth * Cup breast with thumb on top in the direction of his nose and fingers underneath in direction of his chin * Keep fingers behind areola * Palm of hand supporting weight of breast * Press fingers towards back and together to narrow area where baby will latch

Answer 13

* Stroke baby’s lips, particularly the top lip is most helpful * Wait for wide open mouth and tongue extending over jaw * Bring baby to breast * Lower jaw and lips touch first * Lips and gums grasp areola behind nipple * Lips turned out, tongue under nipple

Answer 14

* Long rhythmic suck/swallow * Jaw movement to baby’s ears * Rounded cheeks * Hearing swallowing – no clicking * Feeling of gentle tugging or drawing, not pinching or biting

Answer 15

* Chasing the baby with the breast * Holding breast with scissor grip * Not supporting breast * Pulling chin down to open mouth – wait for them to open! Better to tickle their lip with the nipple * Flexing baby’s head – doesn’t give jaw much room to open mouth * Not bringing baby on quickly enough – need to catch moment * Aiming breast to center of mouth – MC first time mom mistake (aim at their nose/palate)

Answer 16

* Pump q2-3 h, 8-12 times/24h during first 2 weeks even at night, for 10-15 minutes * After 2 wks, pump q2-3h, q6h at night * Begin skin to skin contact ASAP * RELAX, warm packs, massage, photo of baby – to help with let-down * Center pump funnels over nipple * After 15 minutes if still flow then continue for 2 minutes after milk slows – want to get as much out as possible to keep supply coming

Answer 17

* Refrigerated breast milk – 24-72h * Freezer in refrig – 2-3 weeks * Separate door freezer – 2-3 mos: depends on how cold the freezer is * Deep freeze – 6-12 mos * No combining – don’t mix frozen milk with fresh milk on top, and don’t mix different pumps into same glass bottle * Thaw in very warm water – NEVER microwave * Use within 24 h – never refreeze

Answer 18

* Ideal volume > 750 ml/d * Borderline volume 350-500 ml/d * Low volume < 340ml/d

Answer 19

* Acetaminophen, Ibuprofen * Most antibiotics * Antiepileptics * Antihistamines – milk supply may be affected * Antihypertensives * Codeine * Decongestants * Insulin * Thyroid

Answer 20

* Bromocriptine * Chemo * Ergotamine * Lithium * Methotrexate * Drugs of abuse * Tobacco

Answer 21

1 on day one, 2 on day two, 3 on day 3 | Day 6 and on 6-8 qd if cloth, 4-6 qd if disposable

Answer 22

gritty, reddish orange, sign of dehydration; urate crystals orange on diaper surface

Answer 23

* Meconium: thick and tarry until mature milk arrives * Loose, curdy, yellow-orange once milk has come in * 3-6/d for first 6 weeks

Answer 24

* On cue, at least 8-10 feedings/24h during first 6-8 wks * Duration of feed 20-60 minutes – BUT baby can feed as little as 5 minutes and extract as much as they need, esp in colostrum phase. An hour may mean baby is expending TOO MUCH energy to get milk out.

Answer 25

* Previous low supply – work with consultant before having a baby * PCOS * Hormonal Imbalance * Thyroid dsfxn, Infertility, irreg cycles, adrenal fatigue * Gestational Diabetes * Lack of breast changes in pregnancy * Asymmetry, wide spacing, tubular shape – have consultant work prenatally * Scheduled feedings – can work well for some, but sometimes needs to be addressed if going long times between feedings * Infrequent feedings – have to empty breast – try to make sure mom is not going 8-10 hours without nursing or pumping

Answer 26

* Nicotine – also important to talk about 2nd and 3rd hand smoke; Lobelia can help with cravings * Alcohol * Medications – anti-histamines esp * Herbs

Answer 27

* Baby comes off the breast repeatedly * Baby who tires at the breast * Baby who resists latching/arches * Baby who clicks, chomps, slurps – may be swallowing lots of air gas, spit-up * Mother is in pain * Misshapen/flattened/creased nipple upon unlatching * Inadequate weight gain * Gas, reflux higher incidence of GERD with tongue-tie

Answer 28

Class 1: Frenulum from tip of tongue close to gum line, very easy to identify; can usually feel difference in latch/amount of pain experienced while feeding Loose: can extend tongue beyond lower lip, but it is restricted and becomes heart shaped Class 2: attached further back from tip, and pulls in end of tongue as a notch Class 3: further back on tongue Class 4: posterior tongue tie – notice cupping of tongue when they try and stick it out/lift tongue; may be able to let this tie go if going okay for dyad *need to make sure frenulum is FULLY RELEASED, ie cut completely

Answer 29

Labial frenulum attaches upper lip to gum – generally has more to do with soreness in mom than poor extraction; kids will have a lot more sucking blisters

Answer 30

* Pseudophedrine – decongestant * Progestins & Estrogens (ie on birth control or if period comes back naturally) * Bupropion * Bromocriptine * Ergotamine * Antiestrogens – if trying to conceive again * Clomiphene

Answer 31

1)Prenatal pumping Good for patients who have risk factors – tubular breasts, PCOS, previous difficulty; do in 3rd tri 36 weeks and on (bc may lead to contractions) 2)Traditional pumping in PP Pump after breastfeeding 10 minutes 3 pumpings minimum in addition to baby’s nursing/d (up to 8 times/d is very vigorous!) – will not get much volume, but the purpose is to get future milk, not to build up freezer supply. - if baby is not extracting well, can pump at beginning of feeding and feed baby this at the breast 3)“Power pumping” - Intensive pumping Pump 10 minutes of each waking hour OR pump 5-10 minutes every 20-45 minutes for 1-6 hours

Answer 32

1)Positioning - primary tx – affect the latch to be optimal 2)Breastmilk topically – don’t do this if it is clear that YEAST is causing pain, lactose will < 3)Saline dips 4)Cabbage leaves 5)Dressings: −Hydrogel - Soothies™ (by Lancenot for moist healing if rawness; $12/pair, are sturdy enough to be washed and SHOULD be washed so microbes don’t grow on it), Second Skin™ (wetter, more for blisters and if there is damage to nipple – put small amount over hurt area) −Poultices - althea, cabbage etc −Lanolin – literature is mixed on whether it is helpful or not; has antimicrobial factors, also makes a barrier but it does keep it REALLY moist and may contribute to soreness as skin does not keratinize (if yeast infection, may not resolve if always moist) −Motherlove ® Nipple Cream −Earth Mama Angel Baby −Nipple Butter ®

Answer 33

shiny, bumpy, pink around whole area of mouth; expect that baby has thrush and they are passing back and forth

Answer 34

looks a bit like a pimple, usually come one at a time – single duct gets blocked and milk cannot egress; very painful in specific way; warm compresses can help removal, but MAY need to lance it with tiny sterile 30 gauge hypodermic needle, make gentle incision so blockage can flow

Answer 35

- Can feed on other nipple without outbreak; unlikely that baby will catch this in the neonatal/early months because of passive immunity - By 12mo their titers are waning, do not put baby 6-8mo on an HSV nipple - Want to pump milk and THROW it out until outbreak has passed

Answer 36

−Lilypadz – silicon flower shaped nipple shield that is used so milk doesn’t leak onto shirt −Lansinoh Bosom Buddies – can heat them or freeze them and has hole for nipple −Breast Shells – helps evert an inverted nipple; or for sore/Candida infections because still get airflow to nipple (face vents up so milk doesn’t drip through!) −Supplemental Feeder – SNS – best to give to baby at the breast so they still want to nurse and suck; will eliminate the nipple confusion with bottle; milk worn around neck so it warms to body temp so do not need to heat it; is a gravity feed so even if baby not sucking, it will drip in (made by Modalla – easy to clean) −LactAid – bag worn around neck