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Repro and Sexual Health > Breastfeeding and formula feeding module > Flashcards

Breastfeeding and formula feeding module Flashcards

1
Q

What are the treatment benefits for breast fed infants?

A

Reduced risk of resp, GI and ear infections
Higher IQ scores
Reduced malabsorption and reduced risk of infant death
Effects on obesity

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2
Q

What are the treatment benefits for women who breast feed?

A

Reduced risk of breast cancer and better birth spacing
Reduced risk of ovarian cancer
Reduced risk of T2DM

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3
Q

Are vitamin D supplements recommended for breast feeding women?

A

Yes;
All pregnant and breastfeeding women should take 10 micrograms a day
All babies under 1 year should have a daily supplement from 8.5 to 10 micrograms a day from birth

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4
Q

Are women with HIV recommended to breast feed?

A

Currently no to reduce any potential risk of transmission of HIV to the baby

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5
Q

How can vertical HIV transmission be reduced?

A

HAART for mother and baby
Birth by c/s
Avoidance of breastfeeding

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6
Q

What advice should be given if a women with HIV chooses to breastfeed?

A

Advised to breastfeed exclusively and stay on medication to keep viral load undetectable

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7
Q

When will babies tend to feed most?

A

Evening

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8
Q

Is feeding regular in the first 48 hours?

A

No; feeding is infrequent, but around the 3rd day as milk supply increases and changes from colostrum to more mature milk, frequency increases

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9
Q

What is the range of feeding in infants?

A

From 6 to 15 feeds in 24 hours

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10
Q

Does breast size determine the quantity of breast milk produced?

A

No; during pregnancy the glandular tissue will proliferate and produce colostrum from mid pregnancy

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11
Q

What is present in breast milk?

A 
Protein
Carbohydrates
Water
Fat 
First milk; protein rich
End of milk; fat rich
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12
Q

When is colostrum produced?

A

Mid-pregnancy and through first few days of birth

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13
Q

What is present in colostrum?

A

High levels of immune proteins

Laxative effect to help infants pass meconium and prevent jaundice

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14
Q

Do babies require lots of colostrum in the first 48-72 hours of life?

A

No; as their immature kidneys adjust from excreting large amounts of fluid as blood volume reduces by 25% and colostrum is a concentrated form of milk

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15
Q

Does mature milk have the same overall daily intake of immune proteins as colostrum?

A

Yes

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16
Q

Why is breast milk bluish with a thin cream layer on standing?

A

Contains little casein which are the milk solids that reflect light

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17
Q

Describe how breast milk changes from the start to end of a feed

A

The milk at the beginning of a feed can be high in water, sugars and protein but low in calories and fat
As oxytocin triggers milk release, it has a higher fat content

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18
Q

What change of hormones post birth give rise to the mlik?

A

Decreasing progesterone and oestrogen

Increasing prolactin

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19
Q

Describe the suckling reflex?

A

Production of breast milk is stimulated by prolactin which is released in response to baby suckling
In the early days, when lactation is being established, frequent feeding or expression is important for stimulation and continuation of milk production

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20
Q

Describe the “let down/ ejection reflex”?

A

Milk is ejected from the breast in response to a combination of suckling-stimulated oxytocin release and the baby’s feeding action
Oxytocin levels are highest when mother and baby are in contact

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21
Q

Describe the action of feedback inhibitor of lactation (FIL)

A

In any area of the breast not being drained, the level FIL rises and signals to the breast tissue to slow production
Milk is produced all the time, but is fasted when there is least milk in the breast
THUS milk removal is key to milk production

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22
Q

What is attachment?

A

Refers to how the infant takes the breast into his mouth for breastfeeding

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23
Q

What is good attachment vital for?

A

Essential for effective, pain free breastfeeding

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24
Q

What can poor attachment lead to?

A

Painful nipples
Engorgement
Low milk supply
Infant; unsettles, very frequent feeding and failure to gain weight

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25
Where should the baby's face be positioned for adequate attachment?
Nose opposite to nipple Head tipped back to allow top lip to brush nipple When mouth is wide open; quickly move them towards the breast with head tilted back and chin leading
26
What can a tongue tie lead to?
Issues attaching to breast Issues drawing enough breast tissue into mouth Issues achieving coordinated sucking
27
What is a tongue tie?
Congenital condition whereby there is tightness in the infant's lingual frenulum restricting tongue motility
28
What is positioning?
Refers to how the mother holds the infant to enable breastfeeding
29
What are the key factors that support breastfeeding?
Provide all women with antenatal information on how breastfeeding works Early (preferably within 1st hour) and frequent responsive feeding Mother and infant in close proximity as much as possible, including skin to skin Inform mothers on lactation, positioning and how to maintain lactation Avoid giving breastfed infants any food or drink other than breast milk
30
What are reasons why women express breastmilk?
Breasts feel full and uncomfortable prior to attachment Infant too small or sick to breastfeed Hospitalization of mother where not possible to keep mother and infant together Mother away from infant for more than a few hours Mother returning to work with no facilities to breastfeed
31
What has been shown as an effective intervention for breastfeeding in neonatal units?
Kangaroo skin to skin
32
How can milk flow be encouraged for expressing?
Being in a comfortable place, where it is relaxed and quiet Close contact with infant Warm bath or shower or applying warm flannels to breast Gently massaging or stroking breast towards nipple for a few mins Changing breasts every few mins
33
What are the different methods of expressing?
Hand expression | Hand and electric pumps
34
What is important for expressing irrespective of the method chosen?
Mother washes hands | All containers and bottles and pump are washed in cold, then hot soapy water and then sterilised
35
How long can expressed breast milk be stored?
5 days in the coldest part of the fridge 2 weeks in freezer compartment of fridge 6 months in a domestic freezer; as minus 18 or lower
36
How should frozen breast milk be used?
Defrosted and then used within 24 hours Should NOT be refrozen once is thaws A microwave should not be used to warm of defrost breast milk
37
What are the most common problems associated with breastfeeding?
Painful nipples; poor attachment Engorgement; painful swelling of breasts Mastitis; red, inflamed breasts Concerns about not enough milk
38
Is there evidence to support the application of topical preparations to prevent/ treat painful nipples in absence of nipple infection?
No
39
For what condition is topical preparations used to treat in terms of painful nipples?
Thrus and/or staphylococcus
40
What tends to relieve the symptoms of mastitis?
Frequent feeding | Expressing between feeding
41
What are positive signs that the mother is producing enough milk?
Appropriate assessment of weight Several (6 or more) wet nappies in 24 hours At least 3 dirty nappies per 24 hours
42
Can babies lose weight when first born?
Yes; it is not uncommon for breastfed infants to lose up to 10% of birth weight in the first few days
43
What are good signs of attachment?
Baby has large mouthful of breast | Babies chin indenting breast
44
What does the UK department of health recommend in terms of how long to breast feed for?
Breast fed exclusively for first 6 months, with breastfeeding continuing thereafter along appropriate types and amounts of solids
45
Why is formula inferior to breast milk?
Powdered instant formula is not sterile and so can be contaminated with pathogenic microorganisms Formula fed babies do not receive immunological benefits of breastmilk Growth pattern of formula fed infants is different to that of breastfed babies; lose less weight in first few days and gain weight quickly from around 4-6 months which may increase risk of CV and non-communicable diseases in future Infant formula is made to standard recipes and the constituents do not vary with the differing needs to infants over time as breast milk does
46
Should you prepare formula feeds in advance?
No; should prepare one bottle at a time
47
Should eye contact be made whilst formula feeding?
Yes; eye contact and cuddling will help to release oxytocin in baby and carer
48
Should you force a baby to finish the formula feeds?
No; can lead to over-feeding Mouthing, rooting and fussing are cues that babies are hungry Babies take natural pauses in a feed and may need to be lifted to release any swallowed air before continuing
49
Is a gulping baby a hungry baby?
No; trying to cope with fast flow | Holding the bottle close to horizontal will enable the baby to take milk at a more comfortable rate and to take pauses
50
When should leftover formula milk be discarded?
Within 2 hours
51
How much formula should babies be taking based on weight?
Average formula intake from around day 4 to 5-6 months is 150 ml/kg weight in a 24 hour period
52
How much formula should babies be taking based on energy requirements?
170 ml/kg/day in first 3 months | 130 ml/kg/day at 4-6 months
53
What are cues that babies are hungry?
Mouthing Rooting Fussing Let baby open mouth, never force a teat into mouth Allow infant to stop feeding when finished Allow infants to pause and sit up to release swallowed air
54
In hot weather, should formula fed babies be given water?
Yes; offered plain, cooled, boiled water | Different for breastfed babies as breastmilk will change in response to babies needs for fluid even in very hot weather
55
With what temperature water should formula be mixed with?
No less than 70 degrees
56
What can formula milk be based from?
Cow's milk Goat's milk Soya protein
57
What are the different cows' milk based formulas?
``` Whey dominant (60:40) Casein dominant Modified formulas for minor digestive problems ```
58
What are casein dominant formulas labelled for?
Hungry babies Whey:casein ratio of 20:80, similar to cows' milk Protein content higher
59
Are follow on formula's recommended for babies under 6 months?
No
60
What will modified formula's contain?
Partially hydrolysed protein, with altered carbohydrate source and thickeners
61
At what age can you give babies soya based formula?
Over 6 months | High content of phyto-oestrogen
62
What are the 2 formats of infant formulas?
``` Dried powder (not sterile) Sterile UHT treated ready to feed liquid that is more expensive ```
63
What are the most dangerous organisms that can be present in dried powder formula?
Salmonella - gram negative bacillus | Cronobacter - gram negative, facultatively anaerobic bacillus
64
What infants are most at risk for severe illness from contaminated formula?
Young infants up to 4 weeks Low birthweight infants Infants with compromised immunity Preterm infants
65
What can over concentration of feeds lead to?
Constipation Hypernatraemia Vomiting Excessive weight gain
66
What can under concentration of feeds lead to?
Inadequate calories for growth and development
67
What are the recommendations if formula feeds are required to be prepared in advance?
Keep them constantly at 5 degrees or below Use within 24 hours Use a cool box if needed to be transported
68
How should formula feeds be warmed?
Stand in jug of hot water for a few mins
69
Why is microwaving not recommended?
Ongoing heating; milk will continue to heat after removal | Hot spots; milk heats unevenly and hot milk in centre may scald infant
70
What are the recommended methods of sterilisation?
Chemical Steam Microwave; with a special steamer Boiling water; immersed for 10 mins

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