Breastfeeding Flashcards
What initiative exists to encourage mothers to breastfeed?
Baby-Friendly Hospital Initiative (BFHI) - WHO and UNICEF launched this
What is the BFHI document that helps women to breastfeed?
10 steps to successful breast-feeding in ‘Protecting, Promoting and Support Breast-Feeding: a Joint WHO/UNICEF Statement’
What is colostrum?
produced from about 20 weeks gestation, is the early form of milk supply. starts to mature to breast milk after around 2 weeks until around 4 weeks
What is the appearance of colostrum?
thick yellow fluid
What key nutrients are present in colostrum?
- high concentration of secretory IgA
- rich in proteins that are important for gut maturation and immunity
What volumes of colostrum are produced for the baby?
small quantities
What happens to the volume of milk that is produced following birth?
the amount of milk rapidly increases to about 500ml at 5 days post-partum
How many calories does breast milk contain and how does this compare to formula milk?
- 57-65kcal/dL (2/4-2.7 mJ/L)
- more energy efficient than formula milk
What should happen immediately following the birth and the baby?
skin-to-skin contact - asap, provided as ‘Kangaroo care’: holding baby to chest
What is the benefit of early skin-to-skin contact after birth?
increases breast feeding if occurs within first 2h birth, and increased duration of breast-feeding, when compared with delay of 4 hours of more
What should determine frequency of breast-feeding and why?
demand feeding: benefits of less weight loss in immediate post-partum period and increased duration of breast feeding subsequently; helps prevent engorgement, and breast-feeding is established more easily
What positive effect can frequent feeding in the early neonatal period have?
associated with less hyperbilirubinaemia
What is the median number of times in a day that exclusively breast-fed term infants feed?
8 times a day (6 during day and twice at night)
How frequent are feeds typically in the first 24-48 hours?
tend to be infrequent, could be as few as 3 feeds in first 24h (should not cause concern if baby otherwise well)
What happens to frequency of breast feeding as time passes after birth?
gradually increases, reaches peak around 5th day of life
How long does WHO recommend exclusive breast feeding for?
4-6 months
What are 10 benefits of breast feeding for the infant?
Reduced risk of:
- Gastrointestinal illness
- UTIs
- Respiratory infection
- Atopic illness
- Leukaemias, acute lymphoblastic leukaemia, Hodgkin’s disease, neuroblastoma
- Giardiasis
And:
- Intelligence (maybe improved)
- Improved bonding
- Contains omega 3 fatty acids - visual development in small infants
- Effects of colostrum on immunity
What are 5 benefits of breast feeding for the mother?
- Uterine involution + reduces risk of PPH
- Lactational amenorhoea (amenorrhoea helpful for anaemia in developing countries)
- Protects against premenopausal breast cancer
- Protects against premenopausal ovarians cancer
- Protects against osteoporosis
How can breast feeding produce lactational amenorrhhoea and how effective is this as contraception?
full or nearly full breast feeding for up to 6 months - nearly 99% effective
drops to 97% at 12 months
What are 5 problems associated with breast feeding?
- Inadequate milk supply
- Breast engorgment
- Mastitis
- Breast Abscess
- Sore or cracked nipples
What proportion of women are physiologically incapable of producing an adequate milk supply?
<1%
What are 6 options for treatment of insufficient milk in the mother?
- Adequate fluids
- Nutrition
- Secure and private environment
- Dopamine antagonists
- Thyrotropin-releasing hormone
- Oxytocin
What are 2 problems that can cause breast engorgement, mastitis and breast abscess?
- Limitations on feeding frequency and duration
- Problems with positioning the baby at the breast
What is the most effective method of treating problems with milk flow - breast engorgment/ mastitis/ breast abscess?
allowing baby unrestricted access to the breast
What causes non-infective mastitis?
obstruction of milk drainage from one section of the breast - may be due to restriction of feeding, badly positioned baby, blocked ducts, compression from fingers holding the breast or from wearing too small a bra
What are 4 factors which can cause non-infective mastitis due to contributing to obstruction of milk drainage?
- Restriction of feeding
- Badly positioned baby
- Blocked ducts
- Compression from fingers holding breast or wearing too small a bra
What are 4 symptoms of mastitis?
- Swollen, red and painful area on breast
- Tachycardia
- Pyrexia
- Aching, flu-like feeling, often accompanied by shivers and rigors
What causes non-infective mastitis to resolve?
relieving the obstruction by continuing to breast-feed with correct positioning of the baby
What can non-infective mastitis lead to if not managed properly?
may become infected and lead to infective mastitis
What is the commonest organ involved in infective mastitis?
staphylococcus aureus
What is the management of infective mastitis?
- antibiotics: penicillinase-resistant penicillins e.g. cloxacillin, flucloxacillin, co-amoxiclav or cephalosporins e.g. cefelexin, cefadrine, cefaclor
- breast feeding should be continued
What can cause a breast abscess when breastfeeding?
possible complication of inappropriately managed infective mastitis
What is the management of breast abscess?
- may need surgical drainage under anaesthetic
- in severe cases, breast-feeding may have to cease on the affected side
What may cause sore or cracked nipples when breastfeeding?
could be because of incorrect attachment of baby to breast
What may be the necessary management of sore or cracked nipples?
may be necessary to rest breast and express breast milk naturally until the crack has healed
What happens to lactation following breast cancer?
- will be little or no enlargement of the treated breast during pregnancy
- ability to lactate and breast feed from untreated breast remains normal
- tamoxifen inhibits milk production
What are 7 drugs that may reduce milk production?
- Progestins
- Oestrogens
- Ethanol
- Bromocriptine
- Ergotamine
- Cabergoline
- Pseudoephedrine
What are 4 things which affect the effect of a drug passed in breastmilk?
- Degree of passage into milk (almost all drugs pass in breastmilk to some extent)
- Amount of milk ingested by infant
- Absorption of drug
- Whether drug affects infant
What makes it harder to know what medicines in breast milk are safe for the baby?
limited human studies exist to advise on which drugs are contraindicated in pregnancy
What are 5 tips for prescribing in a breastfeeding woman?
- Prescribe medication only when absolutely indicated
- Choose medications with shorter half-lives
- Choose meds with less toxicity
- Choose those commonly used in infants
- Choose meds with reduced bioavailability
What are 6 examples of medicatios with poor bioavailability and therefore which are low risk in breastfeeding?
- Heparin
- Insulin
- Aminoglycoside antibiotics (gentamicin)
- Third generation cephalosprins
- Omeprazole and lansoprazole
- Inhaled steroids and beta agonists
What are 11 examples of drugs which are generally contraindicated in breastfeeding mothers?
- Amiodarone
- Antineoplastic
- Chloramphenicol
- Ergotamine
- Cabergoline
- Ergot alkaloids
- Iodides
- Methotrexate
- Lithium
- Tetracycline
- Pseudoephedrine
What are 2 types of viruses that, if present in the mother, mean she is advised not to breast feed?
- HIV
- Human T-cell lymphotropic virus (HTLV-1)
What are 3 risk factors for the transmission of HIV through breastmilk?
- Maternal viral load
- Duration of breast feeding
- Oral lesions in infant and maternal breast lesions
What is likely to happen if a mother with human lymphotropic virus (HTLV-1) breast feeds?
baby likely to become infected, especially with prolonged breastfeeding
When should breastfeeding in an HIV positive mother be avoided?
usually avoided in developed countries
What is the advice for mothers with HTLV-1 and breastfeeding?
advised not to breast feed if HTLV-1 seropositive
What is the rule regarding hepatitis B positive mothers and breast feeding? What are 2 further aspects of their management?
- infants may be breast fed - already exposed to maternal blood, amniotic fluid, vaginal secretions during delivery
- babies of all mothers positive for HBV surface antigen should be immunised at birth
- babies of mothers positive for HBVe antigen also given immunoglobulins
What effect does breast feeding have on transmission of hepatitis B virus?
does not appear to increase rate of infection among infants
Is breast feeding recommended in herpes simplex virus in mother?
if no breast lesions, breast-feeding encouraged
What should be done if the mother has chickenpox/varicella and is breastfeeding?
should continue to breast feed because antibodies in milk confer immunity against chickenpox to baby; passive immunisation may spare baby from symptoms of chickenpox
What is recommended if a breastfeeding mother is infected with cytomegalovirus?
no serious illness or clinical symptoms in neonates secondary to breast feeding has been reported - should continue
What happens if a mother is infected with rubella and is breast feeding?
can be passed on to infant if mother has active infection; however infant does not become ill as transmission of maternal antibodies serves as natural vaccine
What will happen if a breastfeeding mother is immunised to rubella postpartum?
breast-feeding infant will not show symptoms
What are 9 drugs to avoid in breast-feeding mothers?
- Acebutolol
- ACEIs (except captopril)
- Alcohol
- Caffeine
- Cocaine
- Marijuana
- Fluoxetine
- Iodine
- Sulphonamides
