Breastfeeding Flashcards
Mammalian Milk
=
- Components that promote h____ and s_____
- Composed of pro____, pep____, complex l____, oligo_____
Biomaterial that evolved to nourish growing mammals
- health, survivial
- proteins, peptides, lipids, oligosaccharides
Human Development
- Milk -> ____ source of nutrition
- ______ absorbable food
- B____ food - brain grows faster than any other body part
- sole
- Highly
- Brain food!
Human Milk
- Species Specific biological dynamic system
- High quality pro____
- Healthy f___
- Enhanced gastric ______
- Human milk oligo_____
- Bio____ and imm_____
- Species specific gr____ factors
- proteins
- fats
- emptying
- oligosaccharides
- Bioactive, immunoglobulins (IgA, IgG)
- growth
Composition of Breastmilk
- Bio____ molecules
- Gr___ factors
- Preb____
- Dynamic fluid
- _____ within a feeding
- D_____
- Over lactation
- Between mothers and populations
- Bioactive
- Growth
- Prebiotics
- Dynamic
- Varies
- Diurnally
Beginning has more protein, end has more fat
Composition of Breastmilk
(7)
HE FRAIL
Hormones (Growth)
Enzymes (lysozome, amylase, lipase)
Fatty acids (imp for brain development)
MicroRNA (protects for generations)
Essential Amino Acids
Immunoglobulins (IgG, IgA)
Lymphocytes (T and B)
Human Milk
- 3-5 days = _______
- mostly immunologic (more protein against infection)
- 5-14 day postpartum = ________ Milk (mixture)
- 4-6 weeks postpartum = _______ Milk (more fatty)
- D____ fluid over time
-
Preterm Milk < ___ weeks gestation
- Higher in ______
- Colostrum
- Transitional
- Mature
- Dynamic
-
<36.6 wks
- Protein
Benefits to Mother
- Decreased postpartum _____ loss
- More rapid involution of the ______
- Protects against breast and ovarian _____
- Decreased risk of Type 2 ______
- Increased ____ spacing lactation amenorrhea
- Decrease in postpartum _____
- Rate of a____/neglect significantly increased
- Protects against R______ A_____
- Lower Incidence of C_____ disease (HTN, DM, Br/Ov CA)
- blood
- uterus
- cancer
- DM
- Child spacing dt increased prolactin prevents pregnancy
- Depression
- abuse
- Rheumatoid Arthritis
- Carviovascular
Benefits to Baby
- Protects against
- ____ infections, _ _ disorders, r_____ illnesses, U _ _
- D____, C____ disease
- Childhood C____, R_____ A_____, M _, dental c____, severe l____ disease, acute app_____, ob____
- S _ _ S
- Proper j___, t_____, and f____ development
- ear, GI, respiratory, UTI
- Diabetes, Celiac
- Cancer, Rheumatoid arthritis, caries, liver, appendicitis, obesity
- SIDS
- jaw, teeth, facial development (dt exercise of jaw mvement during feeding)
AAP Breastfeeding Policy Statement 2012
- ____feeding and _____ milk are the referenced normative standards for infant in feeding and nutrition
- Documented short and long-term medical and n_____developmental advantages of breastfeeding
- Infant nutrition should be considered a ____ health issue and NOT only a lifestyle choice
- Breastfeeding, human milk
- neuro
- Public
AAP Breastfeeding Policy Statement 2012
- Recommends EBF for first ____ months*
- _____ breastfeeding as complementary ___ are introduced
- Continuation of breast feeding for how long?
- Infant _____ should be monitored with WHO charts
- 6
- Continue, w foods
- 1 yr or longer as mutually desired by mother and baby
- growth
AAP Policy Statement 2012 Chart
- AAP lists following outcomes for infants receiving human or donor milk for first 6 months, REDUCTION of?
Infant Outcomes
- Risk of hospitalization for lower _____ tract infections in first year of life is reduced 72%
- If BF exclusively for 4 mos
- _____ Media - reduction 23%
- EBF > 3 mos decreases OM reduced by 50%
- Serious c____, ear, nose, ____ infectiosn reduced by 63%
- Any breastfeeding -> reduction by 64% in nonspecific ___ infections
- this effect lasts 2 mos after cessation of breastfeeding
- respiratory
- Otitis media
- colds, ear, nose, throat
- GI
Benefits to Society
- Ec____
- Ec____
- Reduces healthcare ____
- Reduces infant ____
- Estimate 911 lives saved each year
- ______ benefit -> less absenteeism
- Economical
- Ecological
- costs
- mortality
- Employers
Healthy People 2020 Objectives
- Increase the proportion of infants who are breastfed _____, at __ months, __ years, Exclusively through ___ or ___ months
- Increase the proportion of _____ that have worksite lactation support _____
- Reduce the proportion of breastfed newborns who receive ____ supplementation within first 2 days of life
- Increase proportion of live births in facilities that provide ______ care for lactating mothers and their babies
- Ever, 6m, 1y, Excusively 3m and 6m
- employers, programs
- reduce formula
- increase live births in facilities that provide recommended care
Overall moving in right direction
Healthy People 2030 Breastfeeding Obective
2 Goals
Disparities in feeding rates are mainly because of?
- Increase in proportion of babies EBF through 6 months
- Increase proportion of infants who are breastfed at 1 year
Variations in hospital routines
Increasing Breastfeeding Duration
- Key issues Identified
- Education of (2)
- ____ system in the early weeks postpartum
Education of HCPs, Patients
Support system
AAP Breastfeeding Policy Statement 2012
- Hospital routines should encourage and support
- WHO/UNICEF “___ ____ to Successful Breastfeeding”
-
National Strategies involved to facilitate breastfeeding practices in US hospitals and communities
- Surgeon _____ Call to Action
- C _ _
- The ____ Commission
- A _ _
- Breastfeeding is P_____
- _____ coverage for lactation help
- Free p_____
- 10 steps
- General
- CDC
- Joint
- ACA
- Preventative
- Insurance coverage
- Pumps
Recommendations
for
- Full Term Infants?
- Pre Term Infants
- EBF first 6 months
- Continue with complementary foods 1+ y
- All on human milk (mom’s own or pasteurized donor milk)
- Fortifified for <1500 grams
New York Strategies
(3)
- Lactation Rooms
- Paid Family Leave
- Medicaid Reimbursement for Donor Milk
Exclusive Breastfeeding
=
- Supplementing
- ___ own milk
- _____ milk
Feeding at the breast
- Mom’s
- Donor’s
Who has the Highest EBF rates?
Hospitals that follow the?
Ten Steps to Successful Breastfeeding
Ten Steps to Successful Breastfeeding
- _____ based policy and practice steps
- Demonstrated to _____ feeding outcomes
- Additive effect
- Each additional step increases the chances that baby will be EBF at time of _____
- Mothers are __x more likely to achieve exclusive breastfeeding in a hospital practicing the Ten Step
- Evidence
- improve
- discharge
- 6x
Baby Friendly Hospitals
- What organization? Baby-Friendly Hospital Initiative
WHO/UNICEF
- Highest breastfeeding rates*
- 1,074,446 births/yr,* 605 hospitals in US , 28.34% of annual US births , 37 hospitals in NYS, 134 maternity hospitals
WHO/UNICEF Baby Friendly Hospital Initiative Steps
- Step 1 = Written Breastfeeding ______
- Step 2 = ____ all health care ____ in skills necessary to implement BF policy
- Step 3 = _____ all pregnant women on Be____ and Ma_____ of breastfeeding
- Step 4 = Nurse within how long after birth?
- Step 5 = ___ mothers ___ to breastfeed and maintain lactation if they are separated from their infants
- Policy
- Train all staff
- Inform all women on benefits and management
- within 60min of birth!
- Show how
Steps 6-10
- Step 6 =
- Step 7 =
- Step 8 =
- Step 9 =
- Step 10
- BREASTMILK ONLY! - NO other food or drink unless medically indicated (no formula, water, glucose water), NO free samples, items bearing formula company names, coupons. Purchase formula at market value
- 24 hour Rooming In
- Encourage Breastfeeding on demand (of the baby)
- No artificial teats or pacifiers!
- Foster the establishment of BF support groups and refer mothers to them at discharge
More Significant Opportunity for Improvement of EBF
- Continuous, untinterrupted ___-___ contact immediately after brith until first feeding occurs (and continued during hospital stay)
- R______ in both day and night
- skin to skin
- Rooming in
Skin to Skin
- We _____ for the first feeding…
- You can delay what until they first feed?
- You can even do (3) while their skin to skin
- wait
- Bathing, weighing, exams, meds, diapering
- APGAR, Heel sticks, med admin
Skin to Skin
What does it do?
Decreases risk of (2)
Acts as an ______ to the newborn
Avoids separation, Diminishes newborn stress
Hypothermia, Hyperglycemia
Analgesic
Mother Baby Dyad
What should you not do?
No separation of mother and baby
Transport infant and mother to recovery room together!
Colostrum
- _____ amounts
- _____ the gut for mature milk
- Higher amounts of (2)
- Coats GI tract with beneficial _____ and anti-____ properties
- Lower’s gut __ (5.1 -5.4) dominated by bifidobacteria
- What raises the pH of gut and changes the flora?
- small
- Primes
- protein – immunoglobulins
- Lowers pH
- Formula
Normal Breastfeeding Patterns
- Many babies want to BF often and f_____ until milk is more plentiful
- Some babies nurse _____ for several ____ and repeat this pattern
- Some babes BF for ___ min every 30-40min around the clock
- Newborns are most wakeful during the ______
- Some babies are unintterested in ____ and very ____ for first few days
- frequently
- continuously for hours
- 10 min at a time
- night
- nursing, very sleepy
Intrapartum Care
- Avoid ____ the mother and/or infant and _____ the infant from the mother’s presence in order to obtain routine weights and VS
- Whenever possible, these should be done in the ___-___ room
- Time assessments so both can be assessed _____
- waking, removing infant
- mother-infant
- together
Third to Fifth Day
- ____ comes in
- _____ milk
- _____ mixes in with milk for 2 wks
- ____ milk at end of 2 wks
- Stomach the size of a?
- Milk
- Transitional
- Colostrum
- Mature
- ping pong ball
A Newborn’s Stomach Sizes
How many oz?
- Day 1 =
- Day 3 =
- 1 week =
- 1 month =
- Cherry, 1-1.4 tsp
- Walnut, 0.75-1 oz
- Apricot, 1.5-2 oz
- Large egg, 2.5-5 oz
Milk vs. Early Milk
What does it look like?
Satisfied Baby
What do their hands look like?
Hand open or on head
Hand closed = still hungry
AAP Nutritional Guidelines
- Normal weight loss
- Average __%
- Not to exceed __% in term newborns
- Normal timing to regain birth weight - day __-__
- Expected feeding volumes in first 2 days for term infants
- Per feed?
- Per day?
- Indicators of adequate hydration and nutrition?
- Weight loss
- 7%
- 10%
- 10-14 days
- Feeding volumes in first 2 days
- 1-2 tsp (5-10ml) per feed
- 1-2 oz/day
- Bright yellow bowel movements by 4-5
AAP After Discharge
- ______ visit at 48-72 h post discharge
- Evaluate hy____ ( using ______ patterns)
- Evaluate _____ loss
- No further weight loss after day __
- Discuss maternal/infant iss____
- Observe f______
- Mother and infant should ____ in proximity to each other to facilitate BF
- ______ use no earlier that 3-4wks of age and after BF has been established
- Place infant ____-sleep position
- Pediatrician
- hydration (elimination)
- weight
- 5
- issues
- feeding
- sleep in proximity
- Pacifier
- Back
*
Infant Indications for Supplementation
- ___glycemia
- Clinical and lab evidence of de____
- ____ loss
- Delayed ____ movements or continued ____ stools by day 5
- Isufficient ____ despite an adequate milk supply (poor milk transfer)
- Hyperb_____
- Delayed lacto____ and inadequate intake by infant
- Breast p_____ or prior s_____ with poor milk production
- Intolerable ____ during feedings unrelieved by interventions
- Hypoglycemia
- dehydration
- Weight
- bowel, meconium
- intake
- Hyperbilirubinemia
- lactogenesis
- pathology, surgery
- pain
Sore Nipples
Causes
- Improper _____
- ____ angled mouth
- _____ lips
- Baby sucks on what instead of?
- Tx (2)
- latch
- small
- pursed
- sucks on tip not on areola
- Bactroban and Triamcinolone ointment 0.1%
Good Latch
- Baby _____ for the breast rather than ____ on the nipple
- Large part of _____ on mouth
- ____ open mouth with baby brought to the breast
- Mom supported with ______
- Baby has ____ angled mouth with ____ lips
- roots, not sucks
- Areola
- Wide
- pillows
- wide angle, flanged (everted)
How to Establish a Good Milk Supply
- Nurse within how long of birth?
- 24 hour _____ in
- Nurse __-__ times in 24hr - Q2h
- No b_____ or s______ (unless medically indicated)
- No p______ - all sucking at the breast
- Nurse on _______
- 60min
- Rooming in
- 10-12
- bottles, supplements
- pacifiers
- Demand
Breasts Filling and Engorgement
- Breasts Filling
- Fast or Slow? Over a period of ____
- Engorgement
- ___ at once, Breasts feel?
- Slowly, period of days
- All, Feel hard, full, painful
Engorgement
Management
- Before a feeding you can give?
- After a feeding you can give?
- What can you do during a feeding?
- Warm compresses (towels, warm shower, bowl of warm salt water)
- Cold compresses
- Massage hard areas, electric massage
Cabbage compresses can be warm or cold
Plugged Ducts
How do you clear the pathway?
Massage distal to proximal, US therapy
Orient baby’s chin to plug
Mastitis
- Caused by?
- Is it infectious?
- Symptoms =
- Plugged ducts
- Can be infectious or non-infectious
- Pain, Swelling, Warmth, Redness, Fever and flu like symptoms (for infectious)
Doxycycline Drug of Choice
After 1 Month
- How is the mother’s milk supply?
- Baby _____ well
- Can “tweak” the system
- Continue what?
- What is OK to do?
- Judicious use of?
- Full milk supply
- Gaining
- “tweak”
- Exclusive breastfeeding
- OK for bottles or breast milk
- pacifiers
Working Mothers
- Use how many and what type of breast pump?
- Pump how often?
- When to breastfeed?
- 2 electric pumps
- Q3h
- When arrive home, at night, on days off
Weaning
- Exclusive breast feeding for how long?
- When to introduce solids?
- Continue to breast feed or offer breast milk for how long?
- First 6 months
- At 6 months
- 1 yr and beyond (AAP), Two years (WHO/UNICEF), 2.5-6 yrs average worldwide
Medications
Can you take Medications while breastfeeding?
Yes many meds are compatible with breastfeeding
(Depends on bioavailability, dose, frequency, half-life, molecular weight, protein binding)
Alcohol
Can you drink Alcohol while breastfeeding?
No more than ___g/kg body weight
- 60kg mother (132lb)
- __ oz liquor
- __ oz wine
- __ beers
- Wait __ hours before breastfeeding
Yes, one or fewer drinks per day
0.5g/kg
- 2
- 8
- 2 beers
- 2 hours
Caffeine
Can the mother drink caffeine while breastfeeding?
Takes __ cups of coffee for caffeine to accumulate in baby’s system (includes all sources: coffee, tea, otc meds)
Yes, very little passes into mother’s milk, can drink in moderation
5 cups to accumulate
Smoking
Risk of not breastfeeding ___ Risk of smoking
Associated w increased incidence of (2)*
- Linked to earlier w_____
- F____ness
- _____ prolactin levels
- Interference with milk let-____
>
SIDS, respiratory allergies
- weaning
- fussiness
- suppressed
- down
Smoking Harm Reduction
- Half life of nicotine is __ min
- Encourage mother to _____ number of cigs/day
- Smoke before or after nursing?
- Smoke where?
- 95min
- decrease
- after nursing baby
- in a diff room
Phenylketonuria
Can a mother breastfeed when the baby has Phenylketonuria?
NO
Alternate BF with special protein-free or modified fomulas
Monitor baby’s blood
Contraindications
What conditions are contraindicated for mother to breastfeed?
Galactosemia
Maple Syrup Urine Disease
HIV 1 and 2
HTLV 1 and 2
Antimetabolite drugs
Radioactive pharmaceuticals (wait 12 hr)
Drugs of abuse
Caution Indicated
How to manage when nother has?
- Infectious TB?
- Herpes simplex?
- Hep A?
- Hep B?
- Chicken Pox?
- Lyme disease?
- CMV?
- can pump until treated x 2 wks and no longer infectious
- Safe if no lesions on breast
- Safe after dose of gamma globulin
- Safe after baby receives dose of Hep B immune globulin (HBIG)
- Safe as soon as mother is non-infective
- Safe as soon as mother starts treatment
- No contraindication if full term infant is seropositive
- caution if low birth weight < 1500gm
- Value of human milk outweighs risk
- No long term neurodevelopmental abnormalities reported
COVID+
What should mothers do if Covid+?
Wash hands well
Wear mask within 6 ft of newborn, and keep aways as much as possible
Discuss with HCP about using physicaal barrier (ie incubator while inpatient)
COVID+ and breastfeeding
What should the COVID+ mother do to breastfeed safely?
Use a dedicated breast pump and wear a mask during expression
Wash hands before touchig any pump, bottles, and expressing
Follow proper cleaning recs
Have someone without COVID to feed the expressed breast milk, and whoever feeds should wear a mask
Adopted Babies
AAP provides counsel and there are protocols to induce?
Lactation
(they take hormones)
Lactation Support
Some Resources include
Hospitals
La Leche League
Breastfeeding Support Groups
Baby Cafes
Private Lactation Consultants
Breast Milk, Please!
Can every woman breastfeed?
Every baby _____ breast milk
No
Deserve
AAP Policy Statement 2012 Premature Infants
“If mother’s own milk is unavailable despite significant lactation support, what should be used instead?”
Pasteurized donor milk
Bridge Program for Term Infant
- Donor milk as supplement when baby has?
- Does donor milk count as EBF?
- Hypoglycemia
- Neonatal Jaundice
- Excessive weight loss
- Dehydration
- Delayed Lactogenesis (of mother)
- YES! and raises EBF rate! HMBANA Human Milk Banking Association of North America
Do not Mix Human Milk and Formula
- If Mother’s own milk is insufficient?
- Feed human milk ____ from formula because if it’s mixed it can lead to
- Reduced _____ absorption
- Decreased L_____ activity
- Decreased anti-____ properties
- Collect milk to make one exclusive human feeding and use donor milk or formula at other feedings
- Separate
- minerals
- lysosomes
- anti-infective
