ICL 10.1: Lactation

Question 1

what is gynecomastia?

Answer 1

abnormal development of breast tissue in males

it’s benign enlargement of BREAST tissue, not fatty tissue

Question 2

why does gynecomastia occur?

Answer 2

imbalance of androgen and estrogen levels

Question 3

when can gynecomastia occur commonly?

Answer 3

1. neonatal
2. puberty
3. late adulthood

Question 4

what are the signs that gynecomastia is benign?

Answer 4

1. no lactation
2. no erythema
3. mobile, rubbery (NOT firm)
4. may be tender but not painful

should resolve in 12-15 months; due to increased peripheral conversion of testosterone to estrogen by aromatase and androgen/estrogen imbalance before testosterone kicks in

Question 5

what are the pathologic causes of gynecomastia?

Answer 5

1. cirrhosis
2. hyperthyroidism
3. alchol
4. XXY
5. spironolactone
6. ketoconazole
7. fenesteride

Question 6

what ia galactorrhea?

Answer 6

abnormal milk production outside of childbirth

Question 7

how does lactation start in a postpartum woman?

Answer 7

estrogen and progesterone levels from pregnancy need to fall to stop inhibiting prolactin production

this is why women don’t lactate throughout pregnancy! the high levels of estrogen are inhibitory to prolactin and milk production – this takes 3-5 days so it takes some time to breast feed immediately after birth

Question 8

when does galactorrhea in a new born happen?

Answer 8

once the estrogen levels from the placenta have worn out so around week 1-4

Question 9

A 28 year old G1P1 brings her newborn male for a 2 week well child check. He was born at full term by normal spontaneous vaginal delivery and went home at 48 hours of age. She consistently took prenatal vitamins and completed all necessary pre-natal screenings/visits on schedule and without complication. At birth, his length was 21” and weight was 6# 5 ounces.

1 month later mom returns for her 6-week post-partum checkup. She has been breastfeeding well, and was pumping 2-3 times per day and storing milk for later use when she returns to work, but, it seems as though her breast milk supply has been decreasing and she is producing less milk than she did a couple of weeks ago.

what could be impacting her milk supply?

Answer 9

this is due to an adjustment to breastfeed

all infants lose weight in the first couple weeks! there’s a low point in 3-5 days after birth but then they start to regain weight

they should regain their birthweight by 10-14 days and that’s for bottle fed vs breastfed, respectively

5-6 diapers is fine but maybe some more is better

wanting to feed at night is because breast milk changes in consistency – in the morning it’s more watery and then at night the baby cluster feeds so maybe they will sleep for longer so cluster feeding is normal

ask her if she’s well hydrated, maternal nutrition, is she pumping/constant nipple stimulation, OCP

make sure the mom isn’t on contraceptives because increased estrogen can prevent milk production!

make sure she’s not taking any anti-histamines that could dry up the milk production

Question 10

how often should you bottle feed vs breast feed?

Answer 10

every 2-3 hours for bottles

8-12 times a day for breast feeding

Question 11

how does breast milk change during feeding?

Answer 11

milk in the beginning is more watery so that the baby can quench their thirst

and then after a couple minutes the milk becomes more nutrient rich so it’s important that the babies feed for more than a few minutes on each side

Question 12

how do you know if the baby is getting enough milk?

Answer 12

1. milk let-down
2. hear swallowing
3. content infant
4. regain birth weight by 10-14 day s

Question 13

what is milk letdown?

Answer 13

prolactin surge with nipple stimulation goes away with milk-lets down which happens a couple minutes into breast feeding

Question 14

when do you supplement breast milk?

Answer 14

milk production follows demand!

so negative feedback to milk production is a full breast so if you supplement then you’re going to reduce your breast milk production so you need to always be emptying and pumping to make sure you make more and more milk

also make sure the mom is well hydrated

Question 15

at the 2 week well child check, how many times should a neonate between 5-28 days of age be breast feeding?

Answer 15

8-12 times in 24 hrs

so like every 2-3 hours but the number of times is more important than the time spacing

Question 16

at the 2 week well child check, how long should a neonate be noosing for during each feeding?

Answer 16

the baby can nurse until he releases the nipple

feeding 10-25 minutes on a single breast is typical

he may nurse less or not at all on the secondary breast

Question 17

at the 2 week well child check, how many wet diapers should a baby have each day? how many BM should they have each day?

Answer 17

6+ wet diapers per day with pale, yellow urine

2-3 bowel movements with loose, seedy stool but may be less because breast milk is really efficient and babies will use up all the nutrients – it’s just important that the consistency is soft but it could be days between poops

Question 18

what findings should you asses on PE of a 2 week old baby?

Answer 18

oral cavity examination

note whether the lingual frenulum is short or the genioglossus muscle is highly attached resulting in restricted tongue movements

ankyloglossia is infant tongue-tie and can interfere with a neonates ability to extract milk

fungal infections of the neonatal mouth can lead to the areolar health deteriorating