Breastfeeding and Lactation

Question 1

Who among these mothers can breastfeed?
A. A 19-year-old mother with hepatitis B infection
B. A 32-year-old mother with active tuberculosis who has
been treated for 1 week
C. A 29-year-old mother currently on therapeutic doses
of chemotherapy
D. A 21-year-old mother with a history of cocaine use
with a positive urine screen for cocaine and marijuana

Answer 1

A
Viral Hepatitis is not an absolute contraindication. If the mother is HBSAg(+), treat the baby with HBIg within 12-25 hours + give immunization. Regardless, breastfeeding must continue even without HBIg and vaccine

Question 2

2. Which of the following is/are contraindication/s to
   breastfeeding?
   A. Known maternal cytomegalovirus infection
   B. Herpes simplex viral lesions on the breast
   C. Latent TB infection
   D. AOTA

Answer 2

B

Question 3

The policy implementing health reforms in essential
newborn care is otherwise known as:
A. RA 9709
B. EO 51
C. RA 7600
D. AO 2009-25

Answer 3

D
Unang Yakap: Immediate & thorough drying, Early skin-to-skin
contact, Properly-timed cord clamping, Non-separation of newborn
from mother for early breastfeeding

Question 4

. Which of the following drugs is absolutely contraindicated
in breastfeeding
A. Warfarin
B. Dilantin
C. Amiodarone
D. Methimazole

Answer 4

D
Does not affect thyroid function or intellectual development in
breastfed infants with doses up to 20mg daily. Some experts
recommend it as the antithyroid DOC in nursing mothers

Question 5

Which of the following infectious agents is NOT detected
in breastmilk
A. Syphilis
B. Toxoplasma
C. Cytomegalovirus
D. Human Immunodeficiency Virus

Answer 5

A

Question 6

A term infant is seen by her pediatrician at two weeks of
age. The infant’s mother has mastitis and is being treated with Dicloxacillin. Which of the following
recommendations is appropriate for the mother in this
vignette
A. Temporarily stop breastfeeding, use a breast pump
and disregard pumped milk until antibiotic course is
finished
B. Continue breastfeeding and/or use a breast pump
C. Temporarily stop breastfeeding and provide pumped
breastmilk
D. Temporarily stop breastfeeding and avoid use of a
breast pump

Answer 6

B
Mastitis is an acute bacterial infection of the breast caused by
Staphylococcus, E. coli, and Streptococci
● Continue to breastfeed on both breasts starting with
unaffected side
● Ensure bed rest
● Select antibiotics that are effective and safe for the infant
(min. 10-14 days of treatment)
● Local treatment

Question 7

Which Republic Act promotes setting up of lactation
stations and providing rotation periods for the
breastfeeding employees in private and government
offices?
A. 10152
B. 7600
C. 9709
D. 10028

Answer 7

D
Expanded Exclusive Breastfeeding in the Workplace: Mandates that all workplaces in BOTH private & government offices need to set up lactation stations & provide lactation periods. lactation periods: >
40 mins for every 8hr work period OR 2-3 breastmilk expression lasting 15-30 mins w/i a workday

Question 8

According to the World Health Organization, which of the
following hospital-based newborn interventions is
associated with increased newborn breastfeeding rates
A. A strict breastfeeding schedule of feeding every 3
hours
B. Initiation of breastfeeding for all babies within the first
hour after birth
C. AOTA
D. Separation of babies and mothers from other siblings

Answer 8

B
WHO UNICEF recommend that breastfeeding should be initiated within
the first hour of life and children should be exclusively breastfed for the
first 6 months of life
→ No other food or liquids provided including water
→ Nearly 2 out of 3 infants are not exclusively breastfed for the
recommended 6 months
→ Has not improved in the past two decades

Question 9

Which of the following statements regarding
immunoglobulins in human milk is TRUE
A. The concentration of IgA in human milk decreases
over time
B. There is no IgM in human milk
C. IgA represents 90% of all immunoglobulins in human
milk
D. Colostrum contains a lower concentration of
immunoglobulins

Answer 9

C
Colostrum has high protein and Ig content. IgA represents

Question 10

Which among the following practices is NOT
recommended to encourage successful breastfeeding
A. Practicing timed feedings
B. Expressing hind milk
C. Keeping mommy and baby together
D. Inclusion of father in breastfeeding education

Answer 10

A
Encourage breastfeeding on demand

Question 11

The factors leading to inadequate breastmilk production
in mothers of preterm infants include all of the following
EXCEPT
A. Altered colostrum composition after premature
delivery precluding its use
B. Lack of appreciation of volume and frequency of
pumping needed to be established in the first 2
weeks after delivery
C. Delayed lactogenesis
D. Lack of hospital grade electric pumps

Answer 11

A
Colostrum has no direct effect on breastmilk production

Question 12

A breastfeeding mother complains of breast pain.
The following factors are associated with candidal
infections of the nipple EXCEPT:
A. Maternal fever
B. Mother is sleeping with milk-soaked breast pads
C. Recent antibiotic use by the mother
D. History of diabetes

Answer 12

A
Fever is not a necessary prerequisite to Candida infection

Question 13

Compared to cow’s milk formula, human milk
contains:
A. Less carnitine
B. Less cholesterol
C. More amino-acids
D. More long-chain polyunsaturated fatty acids

Answer 13

D

Question 14

Compared to cow’s milk formula, human milk
contains:
A. Less carnitine
B. Less cholesterol
C. More amino-acids
D. More long-chain polyunsaturated fatty acids

Answer 14

D

Question 15

A 2-week-old male newborn is brought to the
office by his mother for routine well-child examination.
The patient is breast-fed, and his mother follows a vegan
diet. The mother says she plans to breast-feed until the
patient reaches six months of age, and then she will
introduce him to solid foods that conform to her vegan
diet. On the basis of this information, the patient is at
greatest risk for which vitamin deficiency
A. B1
B. B12
C. B6

Answer 15

B
The question stem implies that the infant will not be given enough protein since his mother will make him conform to her vegan diet. Cobalamin is almost exclusively found in animal products. Thus,
cobalamin deficiency is the best answer

Question 16

A 10-day-old full-term infant came in for a routine
follow-up visit. He was born with a birthweight of 3.02kg
and discharged at 2 days of age with a discharge weight
of 2.85kg. At 4 days of age, his weight reached a nadir of
2.79kg. He is now 3.03kg. Parents report that stools
transitioned from meconium to yellow/mustard-colored by 3 days of age. He also has several wet diapers per day, He is breastfeeding, All of the following are signs of the adequacy of breastfeeding EXCEPT:
A. None of the choices are correct
B. Transition to mustard-colored stools by 5 days of age
C. Regaining birth weight by 10 days of age
D. Presence of several wet diapers per day

Answer 16

A
All are signs of good and adequate breastfeeding. The initial weight loss may be attributed to the mother’s learning curve and physiologic start in breastfeeding.

Question 17

Which of the following statements about fat
content of human milk is INCORRECT
A. Human milk contains lipases to aid in fat digestion and
absorption
B. Triglycerides are the most variable component of
breastmilk, depending on gestational age and
maternal diet
C. Cholesterol is a negligible component of breastmilk
and varies by maternal diet
D. Fat is responsible for 50% of the caloric content of
breastmilk

Answer 17

C
Various lipids in breastmilk can modulate the functions of the GIT, lipoprotein metabolism, structure and function of cell membranes, as well as many signal pathways in the infant’s organism

Question 18

Compared to foremilk, hindmilk contains:
A. More protein
B. Less fat
C. Equal amount of protein
D. More lactose

Answer 18

C

Question 19

You are counseling the mother of a newborn about
breast-feeding. Which recommendations will help
increase prolactin and breast milk production
A. Emptying the breast of milk with each feed
B. Establishment of a breastfeeding routine
C. The touch, sight, or smell of an infant
D. AOTA

Answer 19

D
Enhancing Factors:
● Early initiation of breastfeeding
● Good attachment and effective suckling
● Frequent feeds including night feeds
● Emptying of breast

Question 20

The mother of a 4-month-old boy was recently
diagnosed with shingles on her lower abdomen. The boy
was born term and has been growing and developing
normally with no intercurrent illnesses. His mother is
wondering if she can continue to breastfeed. Which
of the following is the BEST course of action
A. Continue breastfeeding after vaccinating the infant
against varicella
B. Pump and discard her milk until the lesions heal
C. Continue breastfeeding without interruption
D. Stop breastfeeding immediately

Answer 20

C
Only active lesions from varicella infection are a contraindication to breastfeeding. Thus, mothers should continue breastfeeding without interruption.

Question 21

A 3-day-old infant presents after discharge for
routine follow-up. The mother has been breastfeeding,
but complains of breast tenderness. Since discharge, the
infant has been slowly establishing a routine feeding
every 3 hours. Both breasts are warm and throbbing. She denies fever, chills, or aches. There is no specific area of tenderness. The areola and nipple appear normal with no shiny or flaky skin. What do you recommend to the mother
A. Miconazole or nystatin cream applied to the mother’s
nipples
B. A 10- to 14-day course of antibiotics to cover
Staphylococcus aureus for mastitis
C. Increase feedings to 10 to 12 times per day; hand
expression and application of cold compresses for
engorgement
D. Discontinuation of breastfeeding temporarily

Answer 21

C
When the breasts are too hard or engorged, hand expression may help relieve pressure from the mother’s breast. There is also a possibility that there may still be leftover milk from the baby’s last feed that is why the breasts feel warm, tender, and throbbing. Hand
expression may be done to empty the remaining milk

Question 22

Which micronutrient is relatively low which in
breastmilk compared to cow’s milk?
A. Vitamin K
B. Iron
C. Vitamin D
D. Zinc

Answer 22

B
Breastmilk is a poor source of Vitamin D (hence why some infants are exposed to the morning sun)

Question 23

This act provides incentives to all government and
private health institutions in the Philippines that support
rooming in and breastfeeding
A. RA 9288
B. RA 8750
C. RA 7600
D. RA 7610

Answer 23

C
Rooming in and Breastfeeding Act
Tip: the “00” in “7600” are the “oo’s” in “boobies and roomies”.
RA 10028 (also with “00” is the promotes breastfeeding in the workplace and August (“8”) as the breastfeeding month.

Question 24

Which of the following amino acids are NOT found
in breastmilk?
A. Essential Amino Acids
B. Conditionally Amino Acids
C. None of the choices because breastmilk contains ALL
types of amino acids
D. Non-essential Amino AcidS

Answer 24

D
Human milk contains both essential and conditionally essential amino acids, and it is the best protein source for infants. [Nelsons, 21st Ed]
Even though non-essential AAs are made from essential AAs, doc said to “choose the best answer” based on the lecture and reading materials

Question 25

Hello

Answer 25

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