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Lactation > Chapter 1 > Flashcards

Chapter 1 Flashcards

1
Q

Malocclusion

A

Misalignment of upper and lower teeth, irregular bite, cross bite, cam affect speech and eating

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2
Q

Meta analysis

A

Quantitative stat analysis of several separate but similar studies to test pooled data for stat significance.

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3
Q

Necrotizing enterocolitis (NEC)

A

2nd to 3rd week in preterm formula fed infant leads to damage of intestinal system with increased mortality. 50%

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4
Q

Peer support

A

Lactation support by individual with same life experience

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5
Q

Sudden infant death syndrome (SIDS)

A

Sudden and unexplained death in infancy may be explained or not

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6
Q

Systemic review

A

Detailed and strategic search involving summarizing results of quantitative studies - high level of evidence on the effectiveness of healthcare interventions

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7
Q

Technology mediated support

A

Technology used by LC to deliver education, care and support via social media, mobile apps, videoconferencing and telehealth

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8
Q

Lactation support provider

A

Trained, certified or licensed BF education, care, and support according to specific scope.

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9
Q

Exclusive breastfeeding

A

No other food or drink for 6 months. Oral rehydration solutions, and medicines or vitamins in liquid form are not considered food or drink.

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10
Q

Benefits breastfeeding for infants and children

A

Protect respiratory illness, reduced risk of asthma, protective against GI infections and diarrhea (may be dose related), reduces risk of otitis media, lowers risk of cavities, lowers risk of malocclusion, lowers risk of NEC in preterm infants, lowers risk for SIDS (strongest with exclusive), lowers risk of childhood leukemia, may lower risk of obesity, may reduce risk of diabetes , may be associated with higher performance on intelligence tests

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11
Q

Benefits for lactating parents

A

Lowers risk of breast cancer and ovarian cancer, associated with lactational amenorrhea (if 6 months or longer), may decrease risk for Type 2 diabetes, may lower risk of cardiovascular disease

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12
Q

Global impact

A

Economic benefits in reduction of illness, in black population in US worse with increased NEC and other illness including GI, >1500 maternal deaths could be averted by optimal breastfeeding

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13
Q

Evidence based practice (EBP)

A

Integration of best available clinical evidence, clinician and provider expertise and patient needs and preferences into comprehensive plan of care and support

Has become expectation and evidence based medicine are now expected in health care

John’s Hopkins EBP - identify clinical practice problem or question, find and evaluate the research, translate research into clinical practice

Highest level of evidence is RCT

*** Finding and evaluating evidence **

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14
Q

Evidence informed practice (EIP)

A

Process by which a clinician uses knowledge and expertise to evaluate all forms of clinical evidence patient needs and preferences and the specific clinical presentation and circumstances to create an individualized plan of care and support
Need to elevate clinical expertise over pure RCTs, clinical intuition is important
Patients have complex needs, need to value their experiences and values
Consider all forms of research - fit the method to the problem
Consider the community values and culture
Balance all 3 pillars: Clinical expertise, patient needs and patient values

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15
Q

Knowledge translation, Knowledge to Action (KTA)

A

The syntheses, exchange and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health
Can take a long time to implement new findings
Knowledge to Action (KTA) - identify problem, modify and review knowledge, adapt knowledge to local situation, assess barriers, select and tailor interventions, monitor knowledge of use. This process is cyclical

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16
Q

Qualitative research

A

Scientific inquiry that seeks to interpret the meaning of life experiences, cultures and social processes from personal perspective, predominately through interviews and observations

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17
Q

Quantitative research

A

Scientific inquiry that uses precise objective measurement and statistical analysis to describe, compare or determine causation of interventions and effects

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18
Q

Systemic review

A

A process of evaluating multiple studies of one focus area or intervention and synthesizing the results to determined the best or most evidence supported course of action for patient care

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19
Q

RCTs as part of EBP

A

Overemphasis is problematic
Costly, complicated
Randomization to no treatment group can be unethical
Interventions not tested in RCT are considered not evidence based
May be undervaluing clinical expertise and patient needs
Statistical findings may not be clinically relevant

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20
Q

PICOT Method

A 
P = patient, problem, population
I= intervention, prognostic factor, exposure
C= comparison (what is alternative)
O=Outcome of interest
T = time involved to demonstrate outcome
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21
Q

Good research databases

A

CINAHI
PubMed
PsycINFO
Cochran Collaboration: systematic reviews

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22
Q

BF Peer reviewed journals

A

Journal of human lactation
Breastfeeding medicine
Clinical lactation
International Breastfeeding Journal

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23
Q

Type 1 error

A

Study concludes there is a significant effect when there is not (pvalue gives that amount accepting by test)

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24
Q

Type 2 error

A

Study concludes there is a difference when there is not

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25
Q

Power

A

How likely you are to find a real difference if one exists (best if at least 80%)

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26
Q

Statistical vs clinical significance

A

Large sample get stat sig but not clinically relevant

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27
Q 
Stat terms 
Inferential stats
Dependent and independent
Null hypothesis and alternative
Pvalue
Type 1 error
Type 2 error
A

Just review

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28
Q

Power of a study

Stat sig vs clinical sig

A

Know it

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29
Q

Relative risk

A

Risk or odds of disease for groups that exposed or unexposed

Compares prob of getting the disease or condition in exposed vs unexposed

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30
Q

Tests t-test, paired t-test, ANOVA, chi-square, correlation, multiple regression, logistic regression

A

Know this

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31
Q

Odds ratio

A

Odds of getting a disease in exposed vs unexposed. More complex than RR and doesn’t translate like RR hard to interpret if not rare events

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32
Q

NNT, RD, Attributable Risk, Population Attributable Risk

A

Number needed to treat = 1/ RD

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33
Q

Qualitative Methods Evaluation

A

Multiple constructed realities, subject-object interaction, simultaneous mutual shaping, , value bound inquiry
Have philosophies that govern
Usually natural settings, purposive sampling, inductive analysis,

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34
Q

Qualitative design phases

A 
Identify the problem
Conduct literature review
Address ethical issues
Gaining entry
Focused exploration, confirmation and closure , dissemination
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35
Q

Sampling in qualitative

A

Purposive, convenience, max variation sampling, snowball sampling (people refer each other), theoretical (select participants to ensure accuracy of emerging groups)

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36
Q

Ankyloglossia

A

Condition involving an atypically short, thic, or tight frenulum that tethers the bottom of the tongue to the floor of the mouth, restricting the range of motion

37
Q

Cleft lip

A 
Anormal fissure or opening sesulting from failure of fusion during embyonic development (cleft lip or palate)
In uppper lip and can extend into nose
Congenital midline defect 
2nd most common birth defect
Can still nurse
38
Q

Dysphagia

A

Swallowing disorder characterized by difficulties swallowing foods or liquids

39
Q

Dysrhythmic

A

Haing an irregular rhythm

40
Q

Frenectomy

A

Resectin of the lingual frenulum to improve tongue movement

41
Q

Frenulum

A

A small fold of tissue that helps secure or restrict the movement of a semimobile body part. Freula can be found throughht the body but in the oral cavity are under tongue and between upper lip and gums

42
Q

Hypertonia

A

Condition of muscle rigidity or too much (increased) muscle tone

43
Q

Hypotonia

A

A condition of muscle flaccidity or dereased muscle tone

44
Q

Macroglossia

A

Abnormally large tongue

45
Q

Micrognathia

A

Smaller than normal tongue

46
Q

Pierre Robin Sequence

A

Sequence of abnormalities beginning in utero, romarily consisting of a small lower jaw (micrognathia), a retracted or displaced tongue (glossoptosis) and airway obstruction. Usually als cleft palate

47
Q

Peristaltic

A

Wavelike motion of tongue which assists in removving milk from the nipple and facilitates swallowing

48
Q

Retrognathia

A

Having a recession of one or both of the jaws (mandible and maxilla) but more common in lower (mandible)

49
Q

Oral Assessment

A
  1. Observation of infant’s oraofacial anatomy
  2. Identification of deviations in oral anatomy and how may contribute to dysfunctional or poor feeding behavors
  3. Observation of the infant’s feeding reflexes and indentification of abnormal presentations
  4. Observation of the effectiveneess of feeding - suck-swallow-breathe coordination
  5. Observation of the fit between infant’s mouth and nipple
50
Q

Lips

A

Lips assist tongue in drawing in the nipple and stablilizing in mouth
Lips in neutral position while nursing
If hypotonia can’t maintain seal - more work and fatigue
Hypertonic lips may be compensatory due to weakenss in cheeks, jaws or tone
Tethered maxillary frenulum (upper lip or superior labial frenulum) - may lead to poor suck and later gap in teeth, monor congenital defect, can lead to lip curling, poor transfeer and pain in nipples

51
Q

Assessing Lip

A

Look for blanching of frenulum when lift lip (too tight)
Observe entire feed, breaks in seal? Lip retraction?, tremors?, leaking milk
Sucking blisters can mean tight lip or tongue tie or hypertonia

52
Q

How to imporve when problem with lip

A

Firm pressue (tapping) on lips prior to feeding
Put finger in mouth and pull back so infant grabs - resistance training
If distressed stop doing
Show parent how to flip back
Provide referrral for tight labial frenulum
May need to pump or hand express to keep up supply
Refer to OT or Speech language pathologist who specializes in infant feeding

53
Q

Deal with Cleft lip

A

Use finger or shape breast to seal cleft
Prefers one breast - teach slide over to other
Work with team, safe and effective to breastfeed after surgery

54
Q

Buccal pads, subcutaneous fat in checks - structural support or oral activity

A

Low birth wt or prematurity can have low facial tone or pooly developed pads
Hypotonia and thin cheeks - hard to maintain pressure - get exhausted
Asses with gloved finger inside and push with thumb - should not be able to almost touch
Deep creases under eyes - mean thin cheeks
Look for collapsing - dimples when feeds
Use Dancer HOLD - team to parents
Provide supplementary food (breast best) until develop

55
Q

Jaw - provides stability for movement of tingue lips and cheeks
How evaluate?

A

Premature can have jaw instability due to underdeveloped muscles
To assess: observe for asymmetry, micrognathia or retrognathis, while feeding look for jaw grading, clenching or tremors
Glowed pinkie finger - in corner count reflexive bites, is it weak

56
Q

Micrognathia and Retrognathia

A

Micro - abnormally small lower jaw, if severe can push tongue back and obstruct airway
Retrognathia - abnormally receding lower job - both can be familial, can lead to nipple pain, can try tipping head back to bring jaw to correct position

57
Q

Wide jaw

A

Can cause breaks in seal, loss of suction, and increased work

58
Q

Jaw clenching

A

Can be to manage rapid flow OR hyppertonia or weakness in another area

59
Q

HOw to help when jaw weak or injured

A

Hold finger under bony part of jaw
Make sure body is positioned correctly
Exercise jaw by eliciting bites - don’t stress - several times a day
Refer for PT or chiropractic body work or speech therapist or OT if swallowing issue

60
Q

Tongue - helps draw with lips the nipple into mouth

A

Shapes structure of palate
Must elevate and put pressure on nipple to work
If can;t move properly will tire and ineffective transfer
Anterior tongue ties - heart shape - easy to diagnose
Posterior tongue ties - harder to diagnosis

61
Q

Tongue tie incidence, treatment

A

Incidence - 0.02 to 10.7, more common in males

Fenotomy (release) or frenectomy (resectin)

62
Q

Bunched or retracted tongue

A

Traumatic birth process, torticollis, ankyloglossia, hypertonia, or early bottle

63
Q

Tongue protrusion

A

Abnormal tongue development (macroglossia) or hypotony (Downs)

64
Q

Tongue tip elevation

A

Adaptive compensatry behaviour make hard to latch, preemies, traumatic birth, hypotonia ankyloglossia or resporatory problems

65
Q

Tongue problems assessment

A

Poor head position can neg influence tongue position
Pull breast away and should see tongue cupping
Clicking, smacking, milk dripping
Press down should get resistance back
While crying does tongue elevate
Tap on lip or end of tongue - does it stick out beyond gums

66
Q

How to assist with problem tongue

A 
Exercises
Short frequent feeds
Postition with head in extension so lower jaw close to breast
Refer to specialist 
Supplement if needed
67
Q

Hard palate evaluate

A

Should be intact, moderate slope and smooth, arc of tongue

Epstein pearls may be observed no big deal

68
Q

Soft palate function

A

Elevates during swallowing

Should have intact uvula

69
Q

Clefts of hard and soft palates

A

Unilateral or bilatera, partial or incomplete or complete
Any type can make breastfeeding difficult or impossible
Submucosal clefts are hard to diagnosis

70
Q

Weak or dysfunctional soft palate feeding challenges

A

Generalized hypotonia from prematurity, structural differnces n eurologic involvement or a syndromic condition

71
Q

Velopharyngeal dysfunction

A

Cant close nasal cavity from oral cavity impact swallowing

72
Q

Assess hard and soft palate

A

Family history of cleft
Visual assessment of palate - including intact uvula
Gloved finger feel hard palate for ridges etc
See whole feeding and make sure no nasal regurgitation

73
Q

How help when cleft palate

A

Usually not fixed until 10 months
Palatial obturator - prosthetic but not routinely used in West
Sit baby upright, demonstrate chin support , teach rhythmic compressions
Keep track of weight gain, use weighted feeds
Supplement with donor milk if needed
Protect milk supply - pumping
Try alternative feeding methods - make sure don’t develop aversion
GI tube may be neccessary

74
Q

Abnormal nasal passages also how assess

A

Are nose breathers but can’t be mouth
Deviated septum can impact breathing while feeding
Choanal atresia - one or both nasal passages blocked (rare)
To assess: visually assess if breathing is congested or infant struggles when feedng, were any instruments used in delivery
Can use baby strength saline drops, bulb syringes can make swelling worse, refer to primary care

75
Q

Adaptive reflexes

A

Rooting reflex - touch lips or cheek, head turns and gape response (begins at 32 weks), integrates at 4-6 months
Sucking reflex light touch of nipple or finger to lips or tongue. At 15-18 weeks, integrates at 6-12 months
Nutritive sucking: sucing burses and pauses in response to liquid, Slower, and only when there is liquid
Non nutritive: fast shallow suck 6-8 per swallow, stimulates MER, helps self-soothe, increases peristalsis of GI tract, manage pain (wait to use pacifiers until BF established)

76
Q

Absent or Weak suck what does it mean

A

Absent - CNS immaturity, trisomy, premature, drugs during labor or congenital issues
Weak - CNS issues, abnormalities of muscles, sick, doesnt provide adequate stimulation leading to reduction in milk supply

77
Q

Disorganized suck

A

Immature pattern of 3-5 sucks with pause, dysrhythmic and uncoordinated

78
Q

Swallow reflux

A

Elicit by bolus of fluid touching soft palate tongue and back of mouth
9-14 weeks gestational, continues to adulthood

79
Q

Tongue thrust reflex

A

Tongue moves down and foward to drawn in and grasp breast
Appears at 28 weeks gestation
Integrates by 6 months

80
Q

Gag reflex

A

Elicit by touching mid to posteriour tongue - first line of defense to choking
18 weeks gestation and have as adults
Can by hyperactive (immaturity) - stimulate too often and can develop food aversion

81
Q

Cough reflex

A

No evidence of lung damage by aspiration of breast mik

Normal at begin of feeds when milk comes fast

82
Q
  1. Stepping reflex
  2. Palmar grasp
  3. Moro response
A
  1. Crawl to breast
    2, Integrated by 5-6 months
  2. Startle reflext - integrate by 3-6 months
    Also predictable hand movements to stimulate, move and shape breast
83
Q

Suckling cycle

A
  1. Downward movement of posterio tongue leads to increased negative intraoral pressure (increases vacuum)
  2. Persistalic movement of tongue
  3. Draws nipple in mouth by vaccuum, nipple in ideal place
  4. Lips and cheeks make seal - negative pressure, jaw provides stable base for rest to move
  5. Tongue drawn down and with milk ejection brings milk to oral cavity
  6. Various movement moves bolus of milk back and then swallow reflex, soft palate elevates and prevents milk flowing to nose
84
Q

Coordination of Suck Swallow Breathe

A

Often not coordinated at first at birth
Very variable as adapt to milk flow
Anatomy different in babies - structures close which allow to develop suck-swallow-breath
Matures in infants so pattern changes so decreased number of swallows during prolonged respiratory pauses
See nonnutritive at beginning at end of feeds

85
Q

Suck Phase

A

Number varies based on flow - milk ejection vs slowing down

86
Q

Swallowing - 3 Phases

A
  1. ORal - remove milk and bolus goes to back
  2. Pharyngeal - complex and protective mechanisms, anatomy very different from adults believe to help learn to coordinate. Breathing ceases for 0.5 seconds while bolus goes toward esophagus away from airway
  3. Esophageal - goes down to stomach
87
Q

Drooling at less than 3 months

A

Weak swallow control

88
Q

Observations for Poor Feeding quality

A
  1. Respiratry noises - stridor (raspy) - narrowing or floppy obstructed airway
    Wheezing - high pitched noise during exalation - some constriction
    Apnea: prolonged periodic breath holding while trying to manage swallowing
    Fatigue: fall asleep due to stress or other causes
    Poor intake: follow by weighted feeds
    Poor growth: weight loss of 10% by the fifth day and failure to properly recover our markers for some optimal infant feeding (careful about fluids during labor)
    Feeding aversions; can result from aspiration respiratory compromise choking or other sensory-based factors or medical procedures
89
Q

Chapters 4-7

A

Lactation (9 decks)

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