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NCB IV > breastfeeding > Flashcards

breastfeeding Flashcards

1
Q

mammogenesis begins

A

soon after conception

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2
Q

breast capable of milk production at

A

16-20 wks

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3
Q

estrogens effects on mammogenesis

A

increases sensitivity to prolactin & PL
stimulates mammary growth & development
promotes prolactin secretion by ant pituitary

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4
Q

progesterone effects on mammogenesis

A

enhances lobuloalveolar development

inhibits milk secretion during pg

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5
Q

placental lactogen

A

glandular tissue of alveoli

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6
Q

prolactin

A

acts with other hormones to stimulate development of alveoli and ductal system
pg levels consistent with milk production but progesterone works as deterrent

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7
Q

oxytocin

A

no effect on mammary development
sensitivity of myoepithelial cells up in pg
enzyme from placenta keeps levels low

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8
Q

lactogenesis

A

initiation of milk production takes 4 days to complete but usually pronounced sensation around 2-3days

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9
Q

lactogenesis is suppressed by

A

progesterone

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10
Q

milk production & release is controlled by

A

suckling

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11
Q

what is prolactin’s role in lactogenesis

A

Suckling → Prolactin release from ant pit AND stimulates nipple/areola sending impulses to hypothalamus
Hypothalamus → ↓ prolactin inhibiting factor
↑ Prolactin at end of feed → ↑ milk volume, fat and protein in next feeding

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12
Q

three patterns of secretion

A

week one: base levels high (just from fall of E&P), slight increase with suckling
week two to 3 months: base levels 2-3x higher and suckling levels 10-20x higher
after 3 months: base levels similar to non-lactating & do not rise much with suckling

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13
Q

when is the window to implement interventions that will be successful?

A

week 2 to 3 months

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14
Q

FIL

A

feedback inhibitor of lactation protein

increased when milk left in breast

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15
Q

galactopoeisis is dependent upon

A

periodic suckling
removal of milk
intact hypothalamus/pituitary/Oxytocin – lots of things can mess this up (ex: Sheehans is worst, shift work, excessive exercise, anxiety/stress/excessive weight loss)

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16
Q

oxytocin release is stimulated by

A

thinking of the infant
hearing a baby cry
orgasm

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17
Q

oxytocin release reduced by

A 
anxiety
stress
pain
fatigue
alcohol consumption
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18
Q

synthesis of milk is most active during

A

suckling

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19
Q

colostrum

A

appears first in 2nd trimester – thick, oily, dried in crusts
last 2-3 days PP
highest in protein 3xmore than mature milk (aa’s, IgA, lactoferrin)
lower in CHOs, fat and calories

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20
Q

transitional milk

A

mix of colostrum and mature milk

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21
Q

mature milk

A

replaces transitional over 1-2 weeks
Overall content consistent
Only vitamin & fat content relevant to maternal nutrition
200 known constituents- why we can’t replicate it in formula easily.
Fat 3%
Protein 0.8-1.2%
CHO 6.8-7.2%
Water 87%
Vitamins/Mineral 0.2%
60-75 kcal/dl = 20kcal/oz
500 ml/d at 1 wk to 750-850ml/day at 6 mos

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22
Q

what are some enzymes provided for the baby in the milk?

A

anti-infective: lysozyme, peroxidase, xanthine oxiase

digestive: amylase, lipase

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23
Q

immunoglobulins

A

sIgA - 100mg/ml Highest Ig in human milk
IgG - High for 2 weeks
IgM - High for 2 weeks
IgE - absent in human milk (good, so babies don’t have anaphylactic rxns)

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24
Q

carbohydrate composition

A

lactose- 6.8 g/dl
glucose - 14mg/100ml
galactose - 12mg/100ml
fucose - important in establishing bifidus, good prebiotic

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25
Q

factors which affect lipid content

A

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

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26
Q

role of lactoferrin

A

inhibits bacterial growth in baby GI

27
Q

hoffman exercises

A

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

28
Q

medela- breast shell

A

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

29
Q

avent- niplette

A

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.

30
Q

breast irregularities to note during prenatal inspection

A 
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!
31
Q

immunological benefits of breast milk

A

↓ 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)

32
Q

cradle position

A

classic

33
Q

cross cradle position

A

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

34
Q

football position

A

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.

35
Q

side lying position

A

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

36
Q

position of baby

A
  • 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.
37
Q

position of breast

A
  • 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
38
Q

how to get the baby to latch

A
  • 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
39
Q

signs of good nursing

A
  • 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
40
Q

things to avoid in trying to breastfeed

A
  • 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)
41
Q

what is the pumping schedule for when baby is in NICU

A
  • 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
42
Q

storage of pumped milk

A
  • 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
43
Q

volume of pumped milk

A
  • Ideal volume > 750 ml/d
  • Borderline volume 350-500 ml/d
  • Low volume < 340ml/d
44
Q

what percentage of a drug goes into breastmilk?

A

1%

45
Q

aceptable drugs

A
  • Acetaminophen, Ibuprofen
  • Most antibiotics
  • Antiepileptics
  • Antihistamines – milk supply may be affected
  • Antihypertensives
  • Codeine
  • Decongestants
  • Insulin
  • Thyroid
46
Q

unacceptable drugs

A
  • Bromocriptine
  • Chemo
  • Ergotamine
  • Lithium
  • Methotrexate
  • Drugs of abuse
  • Tobacco
47
Q

no more than __% weight loss

A

10

48
Q

regain birth weight by week

A

2

49
Q

urination

A

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

50
Q

brickdust urine

A

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

51
Q

stool

A
  • Meconium: thick and tarry until mature milk arrives
  • Loose, curdy, yellow-orange once milk has come in
  • 3-6/d for first 6 weeks
52
Q

frequency/duration of nursing

A
  • 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.
53
Q

reasons for lactation consultation

A
  • 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
54
Q

substances that decrease milk supply

A
  • Nicotine – also important to talk about 2nd and 3rd hand smoke; Lobelia can help with cravings
  • Alcohol
  • Medications – anti-histamines esp
  • Herbs
55
Q

signs of tongue/lip tie

A
  • 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
56
Q

classes of tongue ties

A

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

57
Q

lip tie

A

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

58
Q

medications that decrease milk supply

A
  • Pseudophedrine – decongestant
  • Progestins & Estrogens (ie on birth control or if period comes back naturally)
  • Bupropion
  • Bromocriptine
  • Ergotamine
  • Antiestrogens – if trying to conceive again
  • Clomiphene
59
Q

ways to increase supply

A

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

60
Q

sore nipple remedies

A

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 ®

61
Q

what does a candidal infxn of the nipple look like

A

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

62
Q

milk plug

A

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

63
Q

HSV of nipple

A
  • 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
64
Q

nipple products

A

−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

NCB IV (7 decks)

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