FN 124 - Lactation Flashcards
1
Q
makes the milk-secreting cells contract
A
oxytocin
2
Q
“Bonding” hormone – strengthens the mother-child bond
from early on
A
oxytocin
3
Q
makes them secrete milk
A
Prolactin
4
Q
surrounded by fat tissue
A
Alveolar tissue
4
Q
(Interplay of hormones) Diabetogenic or causes increase of
blood glucose levels in mother
A
Prolactin and hPL
5
Q
Mark on which infants are signaled to latch
A
Areola
5
Q
Fat is stored because of ______
A
estrogen
6
Q
Releases a sort of oil/lubricant to improve flow of milk in baby
A
Montgomery’s glands
7
Q
A physiologic process done by females
A
lactation
8
Q
What happens during the 1st trimester?
A
Small ducts from the mammary ducts proliferate to create maximum number of surface cells for alveolar cell formation
8
Q
Human lactation determined by:
A
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
9
Q
Lobules gradually appear becoming distinct ____________
A
12-18 months after 1st menstrual period
9
Q
As the ovulation pattern becomes usual, the regular development of ____________________ in the ovaries promotes further development
A
progesterone-producing corpora lutea
10
Q
What happens during the 3rd trimester?
A
Milk-producing cells dilate as final preparation step for lactation
11
Q
What happens during the 2nd trimester?
A
Reduplicated small ductules group together to form large lobules
12
Q
Additional proliferation of the lining cells takes place shortly ______________
A
before delivery or parturition
13
Q
produced by the anterior pituitary gland that stimulates and maintains lactation in postpartum mammals
A
prolactin
13
Q
The proliferation is in response to the increasing levels of the hormone __________
A
prolactin
14
Q
2-3 days postpartum, secretion of small amount of
__________
A
colostrum
15
Q
first 2-3 weeks is the period of _____________
A
lactation initiation
15
Q
two stages of lactation
A
o Milk Secretion; and
o Milk ejection whereby the milk passes along the duct
system
16
Q
Secretion involves the ____________ and _____________
A
milk production and passage of the
formed milk into the ducts
17
Q
Recite the process of milk secretion
A
Flowchart A
17
Q
Recite the process of let-down reflex
A
Flowchart B.1
18
The secretory process activated by the _______________
sucking stimulus of the
infant
19
Recite the process of let-down reflex
Flowchart B.2
20
Suckling infant -> ___________________
Stimulus to increase in milk production
21
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
22
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)
23
Composition of Human Milk
o High CHON, Sodium, Vitamin A
o Low CHO, fat
o Calcium and phosphorus necessary in milk secretion
23
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
23
Human milk consists of a solution of ?
protein, sugar, and salts in which a variety of fatty compounds are suspended
24
Nutrient content of mature milk that varies from mother to mother
fats, Vit A, D, E, K, B1, B2, B3, C
25
Mean milk volume
between 600-900 ml/day
26
Opaque, yellow fluid secreted in the 1st few days after delivery
Colostrum
26
Volume varies depending on the parity, usual amount 2-10ml for
the 1st 10 days
Colostrum
27
Nutrient content of colostrum
o Higher carotene, protein, ash, sodium, potassium, and chloride
o Less sugar, fat, and kcal that future milk produced
28
Content of colostrum only found in human milk
Considerable high levels of antibodies (IgA)
29
Type of milk between the 3rd and 6th day, at which the CHON content is still rather high
30
when does the CHON content falls but lactose and fat rise progressively
end of 1st month
30
when transitional milk ---> mature milk
End of the 1st month
31
Why do we not boil milk?
Because casein complexes with pyridoxine, making it less bioavailable for the body
32
types of protein found in milk
casein and whey
32
phosphorus-containing proteins that occur only in
milk
casein
33
thin liquid milk remaining after the curd (casein) and cream have been removed
Whey protein
34
contains lactoferrin and lactalbumin
Whey protein
35
Amount of protein in milk
0.8 to 0.9g CHON per 100 ml of milk
36
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
36
amino acid that humans cannot synthesize
taurine
37
Excess protein leads to excess __________
glucose
38
What amino acids are low in human milk?
Met, Phe, Tyrosine
39
_____ of the fat is triglycerides with small amounts of phospholipids, cholesterol, mono- and diglycerides, glycolipids, sterol esters, and free fatty acids
~90%
39
What amino acids are high in human milk?
Cystine and taurine
40
Needed for bile acid conjugation and may also be a
neurotransmitter or neuromodulator in the retina
taurine
41
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
42
main CHO in human milk;
lactose
42
Recite the omega-6 and omega-3 FAs
table
43
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
44
stimulates the growth of microorganisms producing organic acids and synthesizing vitamin B complex
lactose
45
exerts 60-70% of the total osmotic pressure of milk;
lactose
46
not influenced by the maternal diet
lactose (CHO)
47
The _______ created by lactose helps in the absorption of Ca, P, Mg, and other minerals
acidic milieu
48
_______ promote the growth of lactobacilli, the dominant acid-producing bacteria in the gut
N2-containing sugars
48
Enters human milk and can cause _____ poisoning
of the breastfed infant
Nicotine
49
________ also present, an alternative pathway for digestion of glucose polymers when pancreatic amylase is low
Amylase
50
trace amounts in human milk
Fe, Cu, and Mn
50
major minerals in human milk
K, Ca, P, Cl, and Na
50
their packaging that makes them more bioavailable
Mg, Ca, Fe, Zn
51
Iron in human milk is ___ available compared to ___
available from cow’s milk
49% ; 10%
51
________ more responsive to maternal dietary changes
than fat-soluble
Water-soluble
52
Level of the vitamin ___ is substantially greater and
absorbed faster than that of cow’s milk
Vit E
53
Recite the anti-infectious factors in human milk
Table (8)
53
Only vitamin that cannot be found in sufficient amounts in human milk
Vit K
54
Necessary that protein is adequate to ensure proper
absorption of vitamins
Proteolytic enzymes
55
Too much ___ = increases bacterial growth that may cause
diseases
Fe
56
Lactoferrin – ___ is a food source for bacteria
Fe
57
Passes from the maternal blood to the breastmilk
Caffeine
58
____ of caffeine passed on to the human milk may
accumulate over time
~1%
59
______ of caffeine-containing beverage intake of a
mother may give an infant “coffee nerves”
6-8 cups
60
may exhibit a __________ if human milk contains ethanol or delayed psychomotor development at 1 year old (Alcohol)
pseudo-Cushing’s syndrome
61
* Similar symptoms to PCOS, hence often misdiagnosed
* Distinguishing factor
Pseudo-Cushing’s Syndrome
62
* ____ is transmitted through bodily fluids
* Hence, although not confirmed by study,
there’s a high chance of passing the virus onto the infant
HIV
63
Energy during Prenatal Stage
During pregnancy, most women store _____ of body fat, which may be used for additional energy during lactation
~2-4kg
64
Stored fat will provide ______ during lactation for 3 months but added energy must come from the diet
200-300 kcal/day
65
* Studies conclude that the energy needed for daily
milk production is _____
* The production efficiency of human milk is ______
~560 kcal; ~90%
66
Along with a recommended energy increase, ______ increment in daily CHON intake is advised
15-20g
67
Other foods advised
- Citrus fruits
- Vegetable oils
- leafy green vegetables
67
Foods allowed to meet increased kcal and CHON
- 3-4 cups of milk//day
- 2-3 cups of rice
68
The extra CHON is believed to cover the requirement
for milk production with an allowance of ______ of CHON utilization
70% efficiency
68
Nutrient profile of breastmilk changes as the months go by - _______
decreases
69
Decreases after 6th month due to development
of teeth in infants, which means they can begin
complementary feeding
Milk volume
70
Process of feeding baby human milk either directly
from the breast or in the expressed form
breastfeeding
70
Exclusive breastfeeding should only be limited to ______ because breastmilk can no longer fully support infant’s health on its own
first 6 months
71
Infant has been breastfed on at least one occasion
Ever breastfed
71
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
72
Infant has mainly been breastfed but may have
consumed water, fruit juices, teas, or oral
rehydration fluids
Predominant breastfeeding
73
Includes both exclusive and predominant breastfeeding behavior
Full breastfeeding
74
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
74
Process through which an infant is nourished through a combination of breastfeeding and solid or semi- solid food
Mixed feeding
75
The infant is nourished through a combination of
breastfeeding and solid or semi-solid foods
Complementary feeding
76
Steps for proper latch on
Recite
77
Steps for latching positions
Recite
78
* Diagnosed by pressing the areola between the thumb and forefinger
* A flat or normal nipple will protrude, an inverted nipple will retract
Inverted Nipples
79
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
80
* 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
81
* Engorged breasts are hot, heavy, hard with milk
Breast engorgement
82
* 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
83
Manual expression of milk
Marmet technique
84
Electrically-wired and battery operated, mimicks suckling action of child
Breast pump
85
Freshly expressed milk is bacteriologically safe for __ hours under room temperature
6
86
Freezing stores up to _ month, refrigeration is not enough
1
87
The genetic disease _______ is a contraindication to breastfeeding
phenylketonuria (PKU)
88
inborn error of metabolism where there is a decreased metabolism of the amino acid phenylalanine
PKU
89
_____ can be transmitted through bodily fluids such as breast milk
AIDS
90
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
91
____ and ____ are known separately to decrease milk output since ____ inhibits oxytocin release
Anxiety and stress; adrenalin
92
_______ levels also effect let-down function
Cortisol
93
The presence of ____________________ such as influenza is usually no reason to discontinue lactation.
colds or other milk viral infections
94
Caused by incomplete emptying of one or more milk ducts – unequal drawing on all milk sinuses during feeding, causing stasis
Clogged milk ducts
95
________ 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
96
A mother with ______ may be advised to halt breastfeeding so that immediate treatment may be given to the mother
cancer
97
Recite the diagnostic flowchart: Failure to thrive
Flowchart
