Breastfeeding Final Flashcards
What are the benefits of breastfeeding for the baby?
Breastfeeding of infants under 2 years has the greatest potential impact on child survival.
Breastfeeding within the first hour saves 22% of the neonates lifeFew ear infections
Fewer hospitalizations for pneumonia
Reduces the prevalence and morbidity of respiratory illness in infancy
Less risk of dehydration from diarrhea
Lower incidence of enterovirus infection, SIDS
Substantial effective on attentiveness and in reaction
More likely to crawl and walk earlier
Attainment of gross motor milestones
Improved cognitive development
Neural Maturation
Enhances vaccine response
Reduces graft verses host disease in organ transplant
Lower blood pressure
Lower cholesterol
What do formula fed babies have a higher incidence of?
Type 1 and 2 diabetes Celiac disease, ulcerative colitis, Crohn's disease Obesity childhood cancer allergies/asthma Heart disease Obesity
What are the benefits in breastfeeding for mothers?
Reduced cancer risk Lower risk of Type II diabetes Decreased Stress Emotional Health Less postpartum bleeding Lower blood pressure during feeds Weight loss Cheaper child spacing
Describe the skin of the breast?
Thin and flexible
Contains hair, sweat, and oil glands
Describe the areola
Varies in size and color, circular in shape
Color changes during pregnancy, never goes back to pre-pregnant color
What is the purpose of the nerves in the breast?
Proper latch stimulates these nerves to produce milk
What are the Montgomery glands?
Sebaceous glands located around the areola that are pimply in appearance.
Secrete an oily substance that serves as a lubricant and protective agent.
What are the mammary ducts?
The nipple pores. They are the openings of the breast into the nipples. Approximately 4-18 with 0 the average number of openings
How is nipple erection achieved?
Tactile, sensory, or autonomic stimulation
Describe the nipple?
Contain smooth muscle fibers that function as a closing mechanism for the milk ducts. Nipples should protract with stimulation.
Poor protraction is common in first time mothers
28-35% of mothers have poor protraction
Protraction improves with pregnancy and subsequent pregnancies.
What are Cooper ligaments?
Connective tissue that gives breast its shape
What does subcutaneous fatty tissue do?
Gives breast its shape. Size of breast does not affect milk production
Describe the Alveoli/Aveolus
Glands in which milk production takes place that consist of epithelial cells
Capillaries surround the alveoli which bring nutrient-rich blood from which the milk is produced.
They are the milk producing tissue.
Capillaries receive the oxytocin and prolactin and signal alveoli to produce and release milk.
Contract when exposed to oxytocin, resulting in a squeezing effect on the lobule, forcing milk down the ducts.
The alveoli are grouped together, called lobules, and can be compared to grapes, 7-10 per breast.
Describe the ductules
Branches that extend from the alveoli
Sprout and branch during puberty
Transport milk out of the breast through the nipple pores.
What are the three stages of lactation?
Initiation of milk synthesis
Copious milk production
Galactopoisis, establishment of mature milk
What is Stage 1 of lactogenesis?
Initiation of milk synthesis.
Starts at the beginning of the third trimester.
Substances needed for milk synthesis are drawn from the maternal blood stream
What is stage II?
Second day to fifth day postpartum
“Milk comes in”
Colostral phase ends and transitional milk is produced
Blood flow within the breast is increased and milk secretion begins.
What is Stage III?
Stages 3 begins 8-10 days postpartum
Galactopoisis marks the establishment and maintenance of mature milk
You start to see more of a leveling out of supply and demand at that point.
What is involution?
Period after lactogenesis
Decreased size of the breast
Takes about 3 months when accompanied by slow and gradual weaning.
What maternal conditions can delay or impair lactation?
Cesearean Diabetes Labor analgesia Obesity Polycystic ovarian syndrome Theca Lutein cysts Placental retention Stress
What hormones affect lactation?
Estrogen
Progesterone
Prolactin
Oxytocin
How does estrogen impact lactation?
Produced in the ovaries, adrenal glands, and placenta
Growth of mammary ducts and connective tissue between ducts
How does progesterone impact lactation?
Produces in the ovaries and placenta
Aids in the development of milk secreting cells
Inhibits prolactin’s effects during pregnancy
How does prolactin impact lactation?
Levels in blood increase soon after initiation of the sucking stimuli
Deliver of placenta allows for the release of prolactin
Signals the breast to speed up milk synthesis
Serves as a natural tranquilizer and stimulates feelings of restlessness
Sets mother up to interact positively with her baby
Keep levels high by offering unlimited access to breast and breastfeeding at night.
Stimulates milk production
How does oxytocin impact lactation?
Produced in hypothalamus
Travels through nerves fibbers
Infants suckling stimulates nerve endings in the nipple that signal the pituitary to release oxytocin
the blood stream carries oxytocin to the breast where it causes smooth muscle cells to contract
Oxytocin produces cell contract during letdown, called milk ejection reflex
What causes prolactin to increase?
Delivery of placenta and sharp drop of estrogen and progesterone.
What is the process of milk production?
- Estrogen stimulates the growth of mammary ducts and the connective tissue between the ducts
- Progesterone aids in the development of milk secreting cells and inhibits prolactin’s effects during pregnancy
- The alveoli begin producing colostrum in the 4th month of pregnancy. As pregnancy advances colostrum production continues to fill the alveoli
- The high levels of prolactin combined with decreased levels of estrogen and progesterone after the delivery of the placenta signals the alveoli to start producing milk.
- Prolactin levels increase in the blood after the initiation of the sucking stimulus. This signals the breast to speed up milk synthesis.
- The release of oxytocin is triggered by the infants suckling. Milk producing tissue receives the oxytocin and prolactin and signals the alveoli to produce and release milk.
- Oxytocin causes smooth muscle cells to contract which causes the milk ejection reflex, or letdown.
- Ductules trasport milk out of the breast through the mammary ducts, or nipple pores, that open into the nipple.
- Prolactin receptors are laid down when there is a surge of prolactin that is caused by effective breast stimulation.
- Every time a baby nurses, prolactin surges, which establishes prolactin receptores in the alveoli. The more receptors, the more milk that can be put out.
- Receptors are developed in the early days after birth and remain constant thereafter.
- Frequent feeding in the beginning increases sensitivity to prolactin. After this point, control of milk production moves from endocrine to autocrine control.
- Oxytocin causes smooth muscle cells to contract which causes the milk ejection reflex, or letdown.
What signals the alveoli to start producing milk?
The high levels or prolactin combined with decreased levels of estrogen and progesterone
How is colostrum produced?
the alveoli begin producing colostrum in the fourth month of pregnancy.
How much does prolactin increase near term?
20 times the normal value
What causes a surge of prolactin?
effective breast stimulation
What do prolactin surges establish?
Prolactin receptors in the alveoli
What increases sensitivity to prolactin in the beginning?
Frequent feeding
What acts to inhibit the production of more milk when control moves from endocrine to autocrine?
milk that remains in the breast
What is the prolactin inhibitory factor?
It prevents the release of prolactin at times when the baby is not nursing
What are signs of the milk ejection reflex?
Swallowing patterns change other breast leaking tingling or tightening Increase thirst or sleepiness Uterine contractions
What can inhibit letdown?
fatigue, anxiety, fear, and pain
Ineffective stimulation of the nipple
Is the quality of milk dependent on maternal diet?
No
What contains antibodies produced by the body?
Colostrum
Describe colostrum
Clear to golden yellow, see it 1-5 days post birth
high density, thick, and gel-like
promotes gut closure
Has a laxative effective to clear out meconium
Has higher levels of: sodium, potassium, chloride, protein, fat-soluble vitamins and minerals
Lower levels of: fat, lactic
Rich in immunoglobins (IgA)
Establishes the bifidus flora
Contains appropriate essential fatty acids for the newborn
Describe Transitional milk
milk between colostrum and mature milk
Days 2 or 3-8 post birth
Color beginning to change to white
What are the nutritional values of human milk?
Fat Carbohydrates Protein Vitamins Micronutrients Minerals Immunoglobins
How does the composition of human milk vary?
It varies among women
changes throughout lactation and during a given day or feeding
High weight gain in pregnancy is associated with increased milk fat
Fat stores are laid down in pregnancy
Fat
Provides up to 50% of energy needs
Main source of vitamins and fatty acids needed for growth
Dependent on maternal body fat stores that are laid down in pregnancy
Varies in concentration over feed, between breast, over time, and between women.
The shorter time between feeds, the higher the fat content
Fatty acids
Around 200 have been identified that are vital for neural and visual development
DHA and AA
Supplementation doesn’t work well
Carbohydrates
Lactose makes up 40-50% of the infants energy needs
Remains constant throughout the day regardless of mother’s diet
2 unique functions: enhance calcium absorption, supply energy to infant’s brain and development of CNS
Lactose
Digest slowly for a steady release of glucose
Oligosaccharides
type of carb, richest of all milks
protects from pathogens by preventing them from binding to receptor sides in the gut
promotes the growth of bifidus factor
protection through digestive system
Protein
Whey
Casein
Lactoferrin
Lysozyme
Three times higher in colostrum than mature milk
Content remains the same regardless of maternal diet
Formula can’t mimic, lacks Lactoferrin
Lactoferrin
iron binding protein in whey
Antiviral, antifungal, antimicrobial, antitumo, promotes growth of GI tracts
Protects infants from salmonella, E. coli
Lysozyme
Antimicrobial
Part of the “big three” with lactoferrin and sIgA to produce bacteriostatis and bactericidal properties of human milk
Increase at 6 months of age
Vitamins
All vitamins are available i sufficient quantities in breast milk
Excessive B6 can lower milk production
Vegetarians can be deficient in B12
Vitamin D
Sunlight
Controversy of sufficiency in infants
AAP recommends supplements
Deficiency: rickets, muscle pain, weakness
Fat soluble vitamins
Vitamin E, K, and D
Not as ‘fragile” as water soluble vitamins
Water soluble vitamins
Vitamin C and B-Complex Group
Needed replaced every day
Mineral
ratio more favorable in human milk thank owe
formula fed are more at risk for hypcalcemia
Calcium, phosphorus, and magnesium: increase in maternal diet will not increase levels in milk
Trace minerals
Iron, copper, and Zinc are not influenced by maternal dietary intake
Aluminum
100xs more in cows milk
2000x more in soy formula
Iron
Final 6-8 weeks of pregnancy mother lays down iron stores
blood from umbilical cord provides iron the infant stores in the liver
present in small quantities
sufficient for newborn until around 6 months
Immunoglobins
IgA: high levels in coo strum, protection of intestinal and respiratory tract
Epidermal growth factor
promotes growth and healing of gut mucosa
helps preterm gut mature more efficiently
Cholecystokinin
Digestive hormone triggered by baby’s suckling
Sleepiness in mother and babies
Foremilk
first milk obtained during a feed, gradually increases in fat
Hindmilk
empire the breast, the higher the fat
At the end of a feeding may be four to give times higher than at the beginning
Baby friendly hospital initiative 10 steps
- Have a written breastfeeding policy that is routinely communicated to all healthcare staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within one half-hour of birth.
- Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
- Give newborn infants no food or drink other than breast milk, unless medically indicated.
- Practice rooming in.
- Encourage breastfeeding on demand.
- Give no artificial teats or pacifiers
- Foster the establishment or breastfeeding support groups and refer mother to them on discharge from the hospital or clinic.
What is the baby friendly hospitals initiative?
The Baby Friendly Hospital Initiative, launched in 1991, is a global effort to implement practices that protect, promote, and support breastfeeding.
A facility can be described as “baby friendly” when it does not accept free or low cost breast milk substitutes, feeding bottles or teats, and has implemented the 10 specific steps to support successful breastfeeding.
How can you get baby off to a good start?
Breastfeeding on demand
No other food or drink than breast milk
Rooming in
No pacifiers or bottles
What are basic breast-feeding norms?
Good first feed immediately after birth; second day feeds improve in frequency and direction
Stools: Meconium first 2-3 days, Transitional days 3-4, Yellow seedy by day 5
Voids: 1 wet diaper per day up to, 5 to 6 heavy wet diapers a day after milk is “in”
Number of feeds; 6-8 on days 1 and 2, 8 to 12 from four on
Baby determines intervals between feeds and length of feeds
How can you identify good feeding?
Feeds begin with a short sucking then long, drawing sucks, rhythmic suckling, several sucks/pause several sucks/pause
What are signs of effective milk transfer?
move from short rapid sucks to slow deep sucks
Signs of Milk Ejection reflex
No dimpling or puckering of baby’s chess
Breast tissue does not slide in and out of baby’s mouth
No smacking or clicking sounds
Maintains latch throughout feeding
Mother’s breasts soften
How can you identify good latch?
Infant chin touching breast
assymetrical
tongue down
What are different breastfeeding positions?
Cradle hold Cross-cradle hold Football Laying down Laid back
Sore/cracked nipples
Signs and symptoms: intense pain at any time, burning sensation in nipples, soreness does not improve even after working on fixing the cause
Soreness can last around 1-2 weeks
If the nipple looks pinched or like lipstick
Treatment: Find cause (most commonly latch issue)
Hand express initial let down then put the baby to breast
Pain medicine
expressing milk onto nipples after feeds and let it air dry
Saline rinses
Lanolin
Hydrogels
What are some causes of sore/cracked nipples?
poor latch, position, engorgement, baby’s suck, nipple confusion, baby’s palate
Thrush, teething, chapped nipples, skin problem, pregnancy
Engorgement
Skin is really tight, main thing to do is get the milk out to avoid mastitis
Best way to do this is frequent nursing. You only want to pump until the breast is soft of they will keep producing too much milk
Allow baby to finish the breast instead of swapping back and fourth
Can normally begin around the 3rd to 5th day and subsides within 12-48 hours
Areola: tight, skin might be shiny, looks stretched to its maximum, might have a low grade fever
Grade 4: even if they are pumping, no milk is coming out
Ice, heat just minute before nursing
Before nursing, massage the breast to get the milk down toward the nipple, use a warm compress for a few minutes before nursing, use ice, 20 minutes on, 20 minutes off
Reverse pressure softening because often the nipple will flatten out
Hand express or pump to relieve it if it still isn’t softening when baby nurses
Anti-inflammatories and motrin can help
Plugged Duct
Anywhere in the breast where the pore is restricted
Nipple blisters can cause this or the way your clothes are fitting.
Mom has a hard lump in her breast that may be hot, red, and swollen
Most painful when breast is full, low fever may be present
Engorgement or inadequate milk flow can cause
Fluids, rest, good nutrition, emptying the breast.
Heat, massage, rest, and empty breast
Dangle feed: hanging breast over baby so that gravity helps pull that milk out
Raw garlic can help
Mastitis
Inflammation in the breast that can be caused by clogging or infection
Pain, heat, and swelling
Fever higher than 101, chills, aching, tired, etc.
Stress and fatigue can increase the changes
Engorgement or inadequate milk flow due to latching issues, skipping feedings, cracked nipples that allow infection to enter your breast
Fluids, good nutrition, rest, emptying the breast, heat, massage, rest, and emptying the breast
If symptoms are not improving within 24 hours you need antibiotic
Raw garlic
Tennessee Breastfeeding Laws
A mother has the right to breastfeed her child in any location, public or private, where the mother and child are otherwise authorized to be present.
The act of breastfeeding shall not be considered public indecency, nudity, obscene, or sexual conduct. A unit of local government shall not prohibit breastfeeding in public by local ordinance.
An employer shall provide reasonable unpaid break time each day to an employee who needs to express breast milk for an infant child.
Thrush protocol
APNO
Add gentian violet if not getting better use once a day for 4-7 days
GSE dilute in water and apply with a cotton ball, use until pain is gone and wean down slowly
Coconut oil, cutting sugar from mom’s diet, probiotics
What is thrush?
White chalky that you can’t brush off.
Treat mom and baby for it
Can give probiotics to baby or mom
