Human milk and decisions to breast feed- FINAL EXAM! Flashcards
Human Milk: Basic content highly \_\_\_\_. Volume depends on \_\_\_\_. \_\_\_\_ first affects quantity Composition affected by \_\_\_\_ \_\_\_\_. Type and amount of milk depends on \_\_\_ since \_\_\_. Mean volume \_\_\_ mls/d (Range 3-1000 ml)
variable demand Malnutrition severe malnutrition time, birth 750
Human Milk potential hazards: \_\_\_\_\_reduces milk volume Alcohol reduces infant’s \_\_\_ and \_\_\_\_ development Only \_\_\_\_ approved drugs \_\_\_ can be transmitted by milk
Smoking
intake, psychomotor
physician
HIV
Composition of Human Milk:
Solution of ___, ____ and ____ with suspended ___.
More than ___ recognized constituents
Composition varies, depending on:
Period of _____
___ of the day
___ __ of the infant
protein, sugar and salts, fat 100 lactation time Gestational age
Types on mammary secretions: \_\_\_\_\_- Opaque fluid secreted for a few days after birth \_\_\_\_\_ milk – day _-_ \_\_ \_\_\_ milk \_\_\_ or \_\_\_\_ milk
Colostrum
Transitional 3-6
Pre term
Term or mature
Volume and Composition of Colostrum:
__-__ mls per feeding depending on ____ (the number of times a female has given birth)
2-10
parity
Colostrum: Compared to mature milk, it has: More \_\_\_ – \_\_\_\_ Less \_\_\_\_ Less \_\_\_ Less \_\_\_\_ (kcals) More \_\_, \_\_, \_\_\_
protein, immunoglobulins sugar fat energy Na, K, Cl
Colostrum has more secretory ___ and ____.
IgA and lactoferrin
Composition of Transitional Milk:
____ levels fall
____ and ____ increase
Major changes completed by day ___
At one month:
____ firmly established
No significant changes in _____
protein lactose and fat 10 lactation compostition
Composition of Pre-Term Milk: compared to term milk
Higher in __ and __ ___ _
Higher in __, ___, ___, ___, ___, and ____.
Higher in ____
Higher in ___, ___ and long chain ____
Lower in ____
protein and non protein N Ca, Na, K, Cl, P, Mg IgA fat, MCT and long chain PUFA lactose
What happens if the baby is premature?
The breast milk composition changes
Premature and LBW infants should be on:
Pre term milk + a special supplement and Pre term commercial formula
Premature = < __ weeks
37
Low Birth Weight (LBW)=<____ g
2500
Very Low Birth Weight (VLBW)=<____ g
1500
Extremely Low Birth Weight (ELBW)=<____ g (cut off is 400 g which is less than 1 pound!)
1000
Micropremies = <___-___g
750-800
Premature:
Caloric needs based on kcal/kg are ___ in premature.
May not be able to breast feed but can be fed ___ ____.
May require __ or ____ (fewer kcals needed) feeding
higher
expressed milk
enteral or parenteral
Enteral is ___ because it supports ___ _____ maturation
better
gi tract
_____- delivering nutrients directly into the circulatory system: IV feeding
Parenteral
____- delivering food via tube: tube-feeding. “nil by mouth”: naso enteral
Enteral
Protein Composition of Mature Human Milk:
Approximately ___ %(cow’s milk >4%)
___ ____ synthesizes
(Casein, Lactalbumen, Lactoferrin)
The following are obtained from ___ ____:
Albumen, Immunoglobulins, Peptide hormones
About ___% Nitrogen is non protein N
_____ are present
1% Mammary gland maternal blood 25 enzymes
Maternal diet has little influence on __ ____of milk.
protein content
Low maternal protein intake has ___ ___.
Chronic protein deficit will have an ___
__ __ ___ of breast milk is ideal for human infant
little effect
effect
Amino acid content
Lipid Composition of Mature Human Milk: \_\_\_% triglycerides Compared to cow’s milk, higher levels of: \_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_
90%
Cholesterol
N-6 PUFA
N-3 PUFA
Maternal diet affects type of ___.
fat
Type of fat in maternal diet milk affects ___ ___.
lipid composition
Maternal ___ ____ affects milk lipid content
energy restriction
____ levels higher than cow’s milk
Carnitine
Lipases in breast milk aid ___ ____.
fat digestion
Carbohydrate in Mature Human Milk:
Lactose stimulates beneficial microorganisms in ___ ____
Lactose improves ___ ___
e.g. Calcium
Other ____ present in small amounts
infant gut
mineral absorption
sugars
Maternal diet and carbohydrate:
Doesn’t influence _____
Lactose intolerant mothers have lactose in their ___.
Infants born to lactose intolerant mother’s are not ___ ____.
lactose
milk
lactose intolerant
Minerals in Mature Human Milk:
It’s all about ______. This is why formula has to have higher ____ content.
bioavailability
mineral
Cow’s milk higher in some ____.
macrominerals (Na, Ca, and P)
Breast milk contains _____.
Zinc and iron and others
(aka: trace elements)
Micromineral content ____, but bioavailability is ____.
microminerals
low
high
Iron:
___ bioavailable in breast milk than from cow’s milk
Breast fed infants require supplement at ___ months (AND)
more
5
Calcium:
___ compared to cow’s milk
Level ____ by maternal diet
__ ___in mother if mother’s diet is inadequate
Her bone will be ____ after weaning
____ aid to maintain bone health in lactation
low unaffected Bone loss renewed Hormones
Fat Soluble Vitamins are affected by ___ ___ and ____.
maternal intake and stores
Vitamin D: Levels in breast milk \_\_\_ Milk content affected by: \_\_\_\_\_ diet Maternal \_\_\_ \_\_\_
low
maternal
sun exposure
Vitamin A: Levels affected by \_\_\_ \_\_\_. Good sources for mother \_\_\_\_ Fruits and vegetables high in \_\_\_ \_\_\_.
maternal diet
milk
beta carotene
Vitamin E:
Breast milk Levels ____ than in cow’s milk
Vitamin E in formula now ____ breast milk
higher
matches
Vitamin K:
Levels ___ compared to cow’s milk
Infant gut ____ so no synthesis by microbes
Most get an intramuscular ___ at birth
low
sterile
dose
Water Soluble Vitamins:
Values increase with ___ ___ and ___.
maternal intake and plateau
Water soluble Vitamins:
Vitamin B6
Levels in breast milk may be __ ___ to meet the AI for infants
too low
Water soluble Vitamins:
Vitamin B12
Not significantly affected by __ ___.
Milk of strict ___ (___) )may be deficient
maternal diet
vegetarians (vegans
Resistance Factors in breast milk:
Favor the growth of beneficial ____.
Antiviral activity Immune factors reduced with ___ ___.
_____transferred to infant
bacteria
maternal malnutrition
Antibodies
Anti infectious Factors in Human Milk:
__ ___ – antagonist to pathogenic bacteria. Lactose and calcium are involved.
Secretory IgA, IgM, IgE, IgD, and IgG – ____.
____ ___ – specific for staph infection
Bifidus factor
same
Antistaphylococcus factor
Anti infectious Factors in Human Milk:
____– a protein that binds iron and therefore inhibits bacterial growth (some bacteria need iron)
_____ – this enzyme kills streptococci and enteric bacteria.
_____– promotes phagocytosis of bacteria
Lactoferrin
Lactoperoxidase
Complement
Anti infectious Factors in Human Milk:
_____ – inhibits viral replication
_____ – lyses bacteria
__ ___ ____ - B12 not available to bacteria
Interferon
Lysozyme
B12 binding protein
Anti infectious Factors in Human Milk:
_____ - synthesize IgA
_____ – synthesize complement, lactoferrin, lysozyme, carry out phagocytosis and probably other things
Lymphocytes
Macrophages
Human Milk:
It also contains “___” ____ to protect functional proteins from digestion
“anti” proteases
___ ___ ___ (___) and ___ ___ protects the infant against a wide range of infectious and other diseases.
Human Breast Milk (HBM)
beast feeding
Advantages of Breast Feeding:
___ ___ designed for ____ ___
____ normal for mammals
Breast feeding has advantages for ____ and ___.
Human milk
human infants
lactation
mother and infant
Advantages for the Infant: Designed exclusively for \_\_\_\_. \_\_\_\_\_\_ superior \_\_\_\_\_ safe Provides \_\_\_\_ Stimulates \_\_\_\_ \_\_\_\_\_ system Decreases risk of \_\_\_\_ \_\_\_\_ Prevents or reduces \_\_\_\_ of \_\_\_\_ Promotes proper \_\_\_ \_\_\_ Decreases risk of \_\_\_\_ \_\_\_\_ Promotes \_\_\_-\_\_\_attachment
humans nutritionally bacteriologically immunity infant immune infectious diseases risk allergy facial development childhood obesity maternal-infant
Advantages for the Mother:
Promotes recovery from _____.
- Promotes uterine involution
- Decreases bleeding
- Increases period of anovulation (no ovulation…birth control, in a way)
Promotes attachment to the \_\_\_\_ Increases \_\_\_ \_\_\_\_ Allows for daily \_\_\_ \_\_\_\_ Eliminates work involved with \_\_\_ \_\_\_ Decreases risk of \_\_\_\_ and \_\_\_ \_\_\_\_ Promotes \_\_\_\_ \_\_\_\_ More \_\_\_\_
pregnancy infant self esteem rest periods formula feeding breast ovarian cancer weight loss economical
The incidence of breast feeding was at an all time low in ____.
1970
Incidence varies by \_\_\_\_\_: \_\_\_\_ \_\_\_\_ \_\_\_\_ level \_\_\_\_ status
mother race income educational marital
Incidence of breast feeding:
___ ___ are also a factor
Regional differences
Incidence increasing due to changes in ___ ___ and ___.
medical opinion and attitude
AAP (___ ___ of ____) actively recommends breast feeding
American Academy of Pediatrics
The decision to breast feed: Usually made early in \_\_\_\_. Complex \_\_\_\_. involved Concerns of \_\_\_\_ should be addressed Techniques that work include Emphasizing benefits Prenatal preparation Education Choosing a baby friendly hospital
pregnancy
factors
mother
Decision to breast feed: Lactation should be supported by: \_\_\_ \_\_\_ professionals \_\_\_\_ \_\_\_, especially the father \_\_\_\_ influences
Health care
Family members
Outside
Deciding to breastfeed: Techniques that work include Emphasizing \_\_\_\_ \_\_\_\_\_ preparation \_\_\_\_ Choosing a \_\_\_ \_\_\_ hospital
benefits
Prenatal
education
baby friendly
Breast-Feeding in the Post-Partum Period: Mother should be \_\_\_\_\_ Mother and infant taught \_\_\_\_ (Position for \_\_\_) (Importance of \_\_\_ \_\_\_)
comfortable
correct
feeding
latching on
Breastfeeding in post partum period: Breast feeding abandoned due to: Lack of \_\_\_\_\_\_ \_\_\_ hospital stays Outdated \_\_\_ Delays between \_\_\_\_ and\_\_\_\_ Time \_\_\_\_ \_\_\_ \_\_\_\_availability
knowledge Short policies birth and initiation limitations Commercial formula
____ access to breast important
Frequent
Frequent Feeding will build up ____ ___.
milk supply
Feeding on schedule _____.
detrimental
Newborns need to nurse ___-___times/day for adequate nutrition
10-12
Frequent and prolonged feeding will increase: \_\_\_ output \_\_\_\_ weight gain \_\_\_ of breast feeding \_\_\_ between feeding
milk
infant
duration
time
Supplementing with formula will ___milk supply
decrease
Lactogenesis 1: During \_\_\_\_\_ \_\_ weeks before delivery \_\_\_\_ produced but not yet secreted Progesterone inhibits \_\_\_ For our application we will say it ends when \_\_\_, \_\_\_ and \_\_\_ drops
pregnancy 12 Colostrum secretion progesterone, estrogen and hPL
Lactogenesis II and III:
Begins when __ ends
Lots of __ in this liquid as well as other important factors
Change in ___ and ___ over these two stages
II is result of rapid drop in ___, ___ and ___.
At the very initiation of II, ___ which contains white blood cells and antibodies, especially Immunoglobulin A (IgA)
Over the first ___ weeks after the birth, colostrum production slowly gives way to mature breast milk.
I fat composition and quantity estrogen, progesterone and hPL colostrum two
Iron supplements may interfere with the ___ ___-___ ___.
lactoferrin anti-infective properties
