FN 124 - Lactation Flashcards
makes the milk-secreting cells contract
oxytocin
“Bonding” hormone – strengthens the mother-child bond
from early on
oxytocin
makes them secrete milk
Prolactin
surrounded by fat tissue
Alveolar tissue
(Interplay of hormones) Diabetogenic or causes increase of
blood glucose levels in mother
Prolactin and hPL
Mark on which infants are signaled to latch
Areola
Fat is stored because of ______
estrogen
Releases a sort of oil/lubricant to improve flow of milk in baby
Montgomery’s glands
A physiologic process done by females
lactation
What happens during the 1st trimester?
Small ducts from the mammary ducts proliferate to create maximum number of surface cells for alveolar cell formation
Human lactation determined by:
o The anatomic structure of the mammary tissues and development of milk
o Initiation and maintenance of milk secretion
o Ejection of milk from the alveoli to the nipple
Lobules gradually appear becoming distinct ____________
12-18 months after 1st menstrual period
As the ovulation pattern becomes usual, the regular development of ____________________ in the ovaries promotes further development
progesterone-producing corpora lutea
What happens during the 3rd trimester?
Milk-producing cells dilate as final preparation step for lactation
What happens during the 2nd trimester?
Reduplicated small ductules group together to form large lobules
Additional proliferation of the lining cells takes place shortly ______________
before delivery or parturition
produced by the anterior pituitary gland that stimulates and maintains lactation in postpartum mammals
prolactin
The proliferation is in response to the increasing levels of the hormone __________
prolactin
2-3 days postpartum, secretion of small amount of
__________
colostrum
first 2-3 weeks is the period of _____________
lactation initiation
two stages of lactation
o Milk Secretion; and
o Milk ejection whereby the milk passes along the duct
system
Secretion involves the ____________ and _____________
milk production and passage of the
formed milk into the ducts
Recite the process of milk secretion
Flowchart A
Recite the process of let-down reflex
Flowchart B.1
The secretory process activated by the _______________
sucking stimulus of the
infant
Recite the process of let-down reflex
Flowchart B.2
Suckling infant -> ___________________
Stimulus to increase in milk production
FACTORS THAT AFFECT “LET-DOWN” REFLEX
Psychologic influences such as embarrassment or stress but easily set-off by the thought of the baby or sound of his/her cry
The composition varies from ?
human to human, period of lactation, during the day, stage of lactation, timing of withdrawal, individual differences (diet, age, parity, health, and social class)
Composition of Human Milk
o High CHON, Sodium, Vitamin A
o Low CHO, fat
o Calcium and phosphorus necessary in milk secretion
Signs of Successful “let-down” reflex
o Milk dripping from the breast even before baby starts
nursing
o Milk dripping from the breast opposite the one being
nursed
o Contractions of the uterus during breastfeeding which may
cause pain or discomfort
o Tingling sensation in the breast
Human milk consists of a solution of ?
protein, sugar, and salts in which a variety of fatty compounds are suspended
Nutrient content of mature milk that varies from mother to mother
fats, Vit A, D, E, K, B1, B2, B3, C
Mean milk volume
between 600-900 ml/day
Opaque, yellow fluid secreted in the 1st few days after delivery
Colostrum
Volume varies depending on the parity, usual amount 2-10ml for
the 1st 10 days
Colostrum
Nutrient content of colostrum
o Higher carotene, protein, ash, sodium, potassium, and chloride
o Less sugar, fat, and kcal that future milk produced
Content of colostrum only found in human milk
Considerable high levels of antibodies (IgA)
Type of milk between the 3rd and 6th day, at which the CHON content is still rather high
when does the CHON content falls but lactose and fat rise progressively
end of 1st month
when transitional milk —> mature milk
End of the 1st month
Why do we not boil milk?
Because casein complexes with pyridoxine, making it less bioavailable for the body
types of protein found in milk
casein and whey
phosphorus-containing proteins that occur only in
milk
casein
thin liquid milk remaining after the curd (casein) and cream have been removed
Whey protein
contains lactoferrin and lactalbumin
Whey protein
Amount of protein in milk
0.8 to 0.9g CHON per 100 ml of milk
excess protein -> excess glucose then cause:
o Increased adipocytes (adipocity)
o Increased glycogen stores (after conversion of
amino acids)
o Eventually, may increase probability towards
kidney and liver problems
amino acid that humans cannot synthesize
taurine
Excess protein leads to excess __________
glucose
What amino acids are low in human milk?
Met, Phe, Tyrosine
_____ of the fat is triglycerides with small amounts of phospholipids, cholesterol, mono- and diglycerides, glycolipids, sterol esters, and free fatty acids
~90%
What amino acids are high in human milk?
Cystine and taurine
Needed for bile acid conjugation and may also be a
neurotransmitter or neuromodulator in the retina
taurine
composition of human milk that Vary according to individual, parity, sampling method, season of the year, health status of the mother, and maternal diet composition
lipids
main CHO in human milk;
lactose
Recite the omega-6 and omega-3 FAs
table
Benefits of higher cholesterol level compared to milk
o Cholesterol – structural development (phospholipid bilayer)
o Myelin synthesis and development of enzymes needed for
cholesterol degradation
stimulates the growth of microorganisms producing organic acids and synthesizing vitamin B complex
lactose
exerts 60-70% of the total osmotic pressure of milk;
lactose
not influenced by the maternal diet
lactose (CHO)
The _______ created by lactose helps in the absorption of Ca, P, Mg, and other minerals
acidic milieu
_______ promote the growth of lactobacilli, the dominant acid-producing bacteria in the gut
N2-containing sugars
Enters human milk and can cause _____ poisoning
of the breastfed infant
Nicotine
________ also present, an alternative pathway for digestion of glucose polymers when pancreatic amylase is low
Amylase
trace amounts in human milk
Fe, Cu, and Mn
major minerals in human milk
K, Ca, P, Cl, and Na
their packaging that makes them more bioavailable
Mg, Ca, Fe, Zn
Iron in human milk is ___ available compared to ___
available from cow’s milk
49% ; 10%
________ more responsive to maternal dietary changes
than fat-soluble
Water-soluble
Level of the vitamin ___ is substantially greater and
absorbed faster than that of cow’s milk
Vit E
Recite the anti-infectious factors in human milk
Table (8)
Only vitamin that cannot be found in sufficient amounts in human milk
Vit K
Necessary that protein is adequate to ensure proper
absorption of vitamins
Proteolytic enzymes
Too much ___ = increases bacterial growth that may cause
diseases
Fe
Lactoferrin – ___ is a food source for bacteria
Fe
Passes from the maternal blood to the breastmilk
Caffeine
____ of caffeine passed on to the human milk may
accumulate over time
~1%
______ of caffeine-containing beverage intake of a
mother may give an infant “coffee nerves”
6-8 cups
may exhibit a __________ if human milk contains ethanol or delayed psychomotor development at 1 year old (Alcohol)
pseudo-Cushing’s syndrome
- Similar symptoms to PCOS, hence often misdiagnosed
- Distinguishing factor
Pseudo-Cushing’s Syndrome
- ____ is transmitted through bodily fluids
- Hence, although not confirmed by study,
there’s a high chance of passing the virus onto the infant
HIV
Energy during Prenatal Stage
During pregnancy, most women store _____ of body fat, which may be used for additional energy during lactation
~2-4kg
Stored fat will provide ______ during lactation for 3 months but added energy must come from the diet
200-300 kcal/day
- Studies conclude that the energy needed for daily
milk production is _____ - The production efficiency of human milk is ______
~560 kcal; ~90%
Along with a recommended energy increase, ______ increment in daily CHON intake is advised
15-20g
Other foods advised
- Citrus fruits
- Vegetable oils
- leafy green vegetables
Foods allowed to meet increased kcal and CHON
- 3-4 cups of milk//day
- 2-3 cups of rice
The extra CHON is believed to cover the requirement
for milk production with an allowance of ______ of CHON utilization
70% efficiency
Nutrient profile of breastmilk changes as the months go by - _______
decreases
Decreases after 6th month due to development
of teeth in infants, which means they can begin
complementary feeding
Milk volume
Process of feeding baby human milk either directly
from the breast or in the expressed form
breastfeeding
Exclusive breastfeeding should only be limited to ______ because breastmilk can no longer fully support infant’s health on its own
first 6 months
Infant has been breastfed on at least one occasion
Ever breastfed
Infant has only ever been fed with breast milk. No other liquids or solids have been introduced, with the exception of vitamin and mineral supplements
Exclusive breastfeeding
Infant has mainly been breastfed but may have
consumed water, fruit juices, teas, or oral
rehydration fluids
Predominant breastfeeding
Includes both exclusive and predominant breastfeeding behavior
Full breastfeeding
Process of feeding baby liquid or semi-solid foods via
a bottle with a teat. Generally, this refers to feeding a
cow’s milk-derived substitute to human milk
Bottle-feeding
Process through which an infant is nourished through a combination of breastfeeding and solid or semi- solid food
Mixed feeding
The infant is nourished through a combination of
breastfeeding and solid or semi-solid foods
Complementary feeding
Steps for proper latch on
Recite
Steps for latching positions
Recite
- Diagnosed by pressing the areola between the thumb and forefinger
- A flat or normal nipple will protrude, an inverted nipple will retract
Inverted Nipples
RELIABLE SIGNS THAT A BABY IS NOT GETTING ENOUGH MILK
- Poor weight gain - less than 500g
- Small amount of concentrated urine - less than 6 times/day
- Accompanied by tenderness and redness of the areola
- More common in women with fair skin
- Treated immediately because it may lead to cracks and fissures
and then infections may occur
Nipple Soreness
- Engorged breasts are hot, heavy, hard with milk
Breast engorgement
- Experienced during the first few weeks of breastfeeding * Caused by fullness of the breast
- May occur during nursing on the opposite breast
- Sometimes caused by psychologic conditioning
Milk leaking
Manual expression of milk
Marmet technique
Electrically-wired and battery operated, mimicks suckling action of child
Breast pump
Freshly expressed milk is bacteriologically safe for __ hours under room temperature
6
Freezing stores up to _ month, refrigeration is not enough
1
The genetic disease _______ is a contraindication to breastfeeding
phenylketonuria (PKU)
inborn error of metabolism where there is a decreased metabolism of the amino acid phenylalanine
PKU
_____ can be transmitted through bodily fluids such as breast milk
AIDS
Successful breastfeeding usually happens after the effect of anesthesia has worn
o Anesthesia → mom feels nothing, so suckling may not
trigger expression of milk
Caesarian birth
____ and ____ are known separately to decrease milk output since ____ inhibits oxytocin release
Anxiety and stress; adrenalin
_______ levels also effect let-down function
Cortisol
The presence of ____________________ such as influenza is usually no reason to discontinue lactation.
colds or other milk viral infections
Caused by incomplete emptying of one or more milk ducts – unequal drawing on all milk sinuses during feeding, causing stasis
Clogged milk ducts
________ accumulate within a duct and form a blockage. Milk then builds up behind the plug. Tenderness may develop around the area and a lump may be felt
Milk or cast-off cells
A mother with ______ may be advised to halt breastfeeding so that immediate treatment may be given to the mother
cancer
Recite the diagnostic flowchart: Failure to thrive
Flowchart
