Breastfeeding Flashcards

Question

Describe characteristics of effective neonatal latch, suck and swallow

Answer 1

Characteristics of a correct latch: * Infant’s mouth opened wide enough (angle of corner of mouth = about 160°) * Nipple and at least 1/4 to 1/2" inch of areola drawn into the infant’s mouth and remain in place during sucking * The nipple should not be flattened, distorted, blanched, creased, or demonstrate blisters, fissures, or cracks when babe comes off * Swallowing should be either heard or seen * Both the upper and lower lips should be flared out (not rolled or tucked under) and form a complete seal with no leakage of milk at the corners of the mouth. * Cheek line should be smooth (not dimpled or drawn in) during sucking. * No smacking or clicking sounds during sucking (indicates that the tongue is losing contact with the nipple/areola)

Answer 2

All health-care providers should have basic core competencies in providing evidence-based breastfeeding care Helpful: * Prenatal information regarding the realities of breast- feeding * Practical help with positioning and latch-on * Provision of effective interventions for early problems * Evidence-based answers to questions such as how long and how often to breastfeed, when to switch breasts, and whether nipple shields and supplementing with bottles of formula will undermine breast- feeding. * Remaining with the mother during early feedings, assuring correct latch, and documenting milk transfer Unhelpful * Inconsistent advice about breastfeeding techniques * Quick intervention with a bottle when feeding diffculties present * Lack of skilled assistance * Rough handling of breast

Answer 3

* Medical causes: * Maternal hypothyroidism * PCOS * Previous breast surgery * Breast hypolplasia * Sheehan’s Syndrome * Retained placenta * Any reason that may limit the infant’s ability to breastfeed effectively and frequently * Poor latch * Early use of pacifiers * Prematurity, Late pre-term * Mother and infant being separated * NICU, employment * Supplementation with formula * Delayed milk ejection secondary to stress and pain * Maternal medications

Answer 4

7% shouldn't be \> 10%

Answer 5

15 – 30 g/day weight gain from day 5 – 2 months

Answer 6

* Audible swallowing sounds while breastfeeding * Adequate weight gain of \> 4 – 7 ounces/week after Day 4 * Adequate amount of wet diapers * Stools that transition from dark, tarry (meconium) to greenish, yellow to soft, seedy, yellow-mustard stools by the 5th day of life * Normal skin turgor

Answer 7

* Facilitate frequent feeding and oxytocin release * Skin-to-skin * Self-breast massage * Relaxation techniques * Help mother-infant dyad to achieve optimal latch-on * Emphasize unrestricted frequency and duration of BF * Advise mother to reduce or stop unnecessary supplementation * Address medical reason, if treatment available * Acupuncture has been successfully used in China since ancient times

Answer 8

Galactagoges: * Research on use inconclusive * Have potential side effects * If prescribing, counsel re: efficacy, timing of use, and duration of therapy * Monitor mother closely * Make peds aware * Prescribe lowest dose for shortest period of time * Gradual discontinuation **_Domperidone (Motilium)_** * 10 mg PO TID x 14 days * SE: drymouth, HA, abdominal cramps * May have "responders" and "non-responders" **_Metoclopramide (Reglan)_** * 10 mg PO TID or QID x 7-14 days * SE: sedation, anxiety, depression, agitation, gastric cramping, diarrhea

Answer 9

* Not a lot of research, traditional use demonstrate safety and possibly efficacy * No standard dosing * Herbs * Fenugreek - 1200mg capsule 2-3x daily * Goat’s rue - 1 tsp of dried herb steeped in 1 cup of water BID or 1–2 mL of tincture TID * Milk thistle (Silybum marianum) * Oat, dandelion, seaweed, anise, basil, blessed thistle, fennel seeds, marshmallow, and many others. * Beer (alcohol could potentially lower production) * A barley component of beer (even nonalcoholic beer) can increase prolactin secretion, but not good studies

Answer 10

* Breast Pump * Can be used to draw out the nipple immediately before breastfeeding * Evert-it Nipple Enhancer * Designed by lactation consultants, the Evert-It consists of a syringe with a soft, flexible tip made of silicone, either end of which may be used to provide suction to help nipples protrude for easier latch-on * Nipple stimulation before feedings * Roll nipple between the thumb and index finger for a minute or two. Afterwards, quickly touch it with a moist, cold cloth or with ice that has been wrapped in a cloth * Avoid prolonged use of ice, as numbing the nipple and areola could inhibit the let-down reflex.

Answer 11

Causes * Incorrect latching or unlatching * higher risk with flat/inverted nipples * Vasospasm (Reynaud-like phenomenon) – causes the baby to compress the breast so tightly as to interrupt blood flow to the nipple * Ankyloglossia Relief measures * Alter breast technique * Pain relief * Healing nipple skin * Lanolin * Hydrogel * Peppermint water * Interruption/Rest from breastfeeding

Answer 12

* To improve latch-on when mother has flat nipples. * To overcome latch-on problems due to engorgement. * To assist infants who are nipple confused, preferring an artificial nipple to the mother's breast. * To aid premature infants with tiny mouths, reduced or impaired suck mechanisms, or other physical challenges. * To protect sore or damaged nipples. * To prevent sore nipples (claimed by manufacturers but not proven)

Answer 13

* Due to Candida albicans * Symptoms: * Superficial nipple pain * Deep breast pain * Shooting, burning, stabbing pain * Red, shiny, flaky areola * Treatment * Topical Miconazole 2% - remove excess * Gentian violet painted on areola and nipples – 0.5 – 1.0% strength for 4 – 7 days (potential for toxicity if used for a long period of time). * Dilution pf 0.25% - 0.5% can be used on infant’s mouth 1-2 x daily fro 3 – 7 days * Fluconazole 400 mg loading dose then 100 mg BID x 14 days * Newman’s APNO ointment (mupirocin 2%, betamethasone 0.1%, miconazole powder) – apply sparingly after each feeding until pain free (dont wash off)

Answer 14

* Tender small lumps in breasts usually related to the blockage of a milk duct * Possibly due to large milk supply or pressure from outside the breasts (from bra straps, backpack, purse straps) resulting in a physical obstruction of milk flow and a large collection of milk products * Management: * Warm compress * Direct massage over the lump while infant is suckling * Prompt attention needed to prevent cascade of engorgement and mastitis * Lecithin (phospholipid used by food industry as an emulsifier to keep fat dispersed and suspended in water rather than aggregated in a fatty mass). 1 tbsp/day of oral granular lecithin has been reported to relieve plugged ducts and prevent their recurrence

Answer 15

* Typically occurs 3 to 5 days after birth (or first 2 wks) * Breasts are swollen, firm, tender, and warm to touch * Sudden increase in milk volume, lymphatic and vascular congestion, and interstitial edema * Milk production increases rapidly → milk volume outpaces capacity of alveoli to store → alveolar overdistension → * Flattens milk-secreting cells (can rupture) * Capillary blood circulation surrounding the alveolar cells partially or completly occluded. * Congested blood vessels leak fluid into the surrounding tissue space,→ edema → obstruct lymphatic drainage → predisposed to mastitis * Makes it hard to feed, very painful * Treatment: * Feed Q2H, feeding through the pain * Feed on 1st breast until it softens before switching to other side * Warm shower or warm packs before feeding to relax ptlet-down * Massage to soften breast * Ibuprofen to reduce pain and swelling * Chilled cabbage leaves in bra (evidence mixed)

Answer 16

* Tender, hot, swollen, wedge-shaped area of breast associated with a temperature of \>101° F, chills, flu-like aching and systemic illness. * Occurs most frequently in the first 2-4 wks pp * Predisposing factors: * Nipple trauma, especially if colonized with Staphylococcus aureus * Infrequent feedings or scheduled frequency or duration of feedings * Maternal stress and fatigue ( and not feeding infant as much) * Poor nursing technique – weak latch, uncoordinated suckling, inefficient removal of milk * Oversupply of milk * Rapid weaning * Blocked nipple or duct * Nipple piercing * Insulin dependent diabetes

Answer 17

* Effective milk removal * Rest * Fluids * Nutrition * Practical help around the house to allow mother to have adequate rest * Application of heat (hot shower or hot pack) prior to breastfeeding * Cold packs in between feedings

Answer 18

* Analgesia such as acetaminophen and ibuprofen * Antibiotics * Non-severe infection without risk for MRSA: * Cephalexin [Keflex] 500 mg QID x 10 -14 days * Dicloxacillin [Dynapen] 500 mg QID x 10 – 14 days * Clindamycin 300 mg QID x 10 – 14 days * Non-severe infection WITH risk for MRSA: * Trimethoprim-sulfamethoxazole (Bactrim) 1 – 2 tabs BID * Cephalexin [Keflex] 500 mg QID x 10 -14 days * Severe infection: Intravenous therapy * Vancomycin 30 mg/kg IV in two divided doses Q 24 hours

Answer 19

* If sx do not resolve within several days of management, consider differential dx: resistant bacteria, abscess formation, underlying mass, or inflammatory or ductal carcinoma * Complications * Early cessation of breastfeeding * Abscess * Candida infection * Recurrance/resistance - milk culture, infant naso/oropharynx culture

Answer 20

* Localized collection of pus in breast tissue * Most common organism: staph aureus (60% MRSA) * Ultrasound: rounded anechoic image with defined walls. * Management: * Drainage and antibiotic therapy * Needle-point aspiration * Surgical drainage * Complication of surgical drainage: * Milk fistula * Poor cosmetic outcome

Answer 21

* _Pain from birth injuries_ - be careful about positioning * Vacuum extraction associated with poor feeding/breastfeeding cessation by 10 days) * _Oral aversion_ - from NICU care like suctioning, intubation, or just soreness of mouth * Have baby cuddle, play at breast, try cup feeding * _Pre/perinatal medication_ - hypertonia and * Ilicit drugs - irritibility, thrashing, clamp down on nipple, nasal stuffiness * Tobacco - excitability, need holding * SSRIs - agitation, tremors, irritability, and sleep disturbances → try to feed drowsy, low stim * _Hunger_ - poor feeding or limited milk transfer

Answer 22

* Not an indicator that an infant has received enough milk * Sleep more: late preterm, jaundice (including those undergoing phototherapy), born by c-section, and heavier infants of diabetic mothers * May be related to the normal release of cholecystokinin (CCK) - occurs with breastfeeds. * GI hormone released in response to fat * Enhances gut maturation, promotes glucose-induced insulin release, enhances sedation, thought to play a role in regulating food intake by signaling satiety * Keep skin-to-skin as much as possible during the day * Feeding can be subtle: * Rapid eye movements under the eyelids * Tongue, hand-to-mouth, or body movements, * Small sounds * Can use supplemental nursing system

Answer 23

Factors associated with slow weight gain: * Gestational age * Size for gestational age * Oral malformations - cleft lip/palate * Neuro alterations * Increased energy requirements - cardiac disease, respiratory disease, and metabolic disorders * Infant illness or condition * Maternal medications * Intrapartum factors - cesarean birth, fetal hypoxia during labor, maternal medications during labor, epidural analgesia, forceps delivery, and vacuum extraction that may interfere with alertness and ability to feed * Iatrogenic - ie separation Supplemental feedings breast milk are ideal if supply is suffcient. Start with a minimum of 50–100mL/kg/day divided into 6 to 8 feedings

Answer 24

* Breast milk is very important * Should begin pumping within 6 hours of birth * Late preterm infants: * Born with low energy stores, high energy demands, and poor feeding ability * Sleepy/tire easily when feeding * Weak suck and low tone * Easily overstimulated * More prone to positional apnea due to airway obstruction * Should be breastfed in a clutch, cross-cradle, or ventral position * May need to pump for weeks or months until infant can breastfeed or to provide as much breast milk for as long as possible. * Need to have an effcient, automated hospital-grade pump that cycles ~ 48–50 times per minute, with vacuum that does not exceed 240 mmHg. * Double collection kit that pumps both breasts simultaneously and fits properly should be used. * Pump more milk faster when double pumping, esp w/ breast massage.