Lactation

Question 1

What are the three stages of breast milk?

Answer 1

Colostrum, transitional, and mature milk

Question 2

What are typical breast milk production volumes?

Answer 2

Birth: 22 ounces per day
Six months: 30 ounces per day
Twelve months: 25 ounces per day

Question 3

What is colostrum?

Answer 3

It is the initial milk that a woman produces. It is yellow in color and high in IgA and lactoferrin –important for immune protection.

High in protein and lower in fat.

Question 4

Describe transitional milk.

Answer 4

Produced after the colostrum, from about day 2 to day 14, transitional milk has a higher fat content and a lower IG content.

Question 5

In mature milk, about half of the calories are _________.

Answer 5

lipids; the other half are proteins –primarily whey

Question 6

What carbohydrates are in mature milk?

Answer 6

Glucose and galactose

Question 7

There are trace elements of ____________ in mature milk.

Answer 7

iron (lower than the total amount in formula but more bioavailable) and zinc

Question 8

What are foremilk and hindmilk?

Answer 8

Foremilk is the first milk that comes out and hindmilk comes out later. Hindmilk is higher in fat.

Question 9

In general, malnourished mothers have ____________.

Answer 9

the same concentrations of fat, protein, and carbohydrates, but they produce less overall

Question 10

Research has shown that infants who breastfeed have better responses to ____________.

Answer 10

vaccinations

Question 11

Breastfed infants have been shown to have lower incidence of _____________.

Answer 11

Infections: OM, gastroenteritis, and URIs

Allergies: Eczema

SIDS

Diabetes

Death (in fact, breastfeeding has been shown to be the best way to decrease mortality in children younger than 5 years)

Question 12

What are the immediate effects of breastfeeding on mothers?

Answer 12

Oxytocin leads to decreased risk of hemorrhage

Amenorrhea leads to decreased iron loss

More rapid return to prepartum weight

Question 13

What are some medical contraindications to breastfeeding?

Answer 13

Maternal HIV infection
Drugs
Galactosemia

Question 14

The baby-friendly hospital initiative has been shown to ____________.

Answer 14

increase the rate of breastfeeding even up to 1 year of age

Question 15

The AAP recommends that children breastfeed for _____________.

Answer 15

at least 6 months exclusively and up to one year with food supplementation

Question 16

What is the “golden hour”?

Answer 16

The first hour after birth, during which the AAP and WHO recommend starting to breastfeed (primarily because infants are awake during the first hour and then fall asleep).

Question 17

Infants are designed to survive on _____________ for the first couple days.

Answer 17

the colostrum

They have fat stores to last for a couple days while the mom’s milk comes in.

Question 18

Infants typically lose weight during the first ________ days of life.

Answer 18

5 (while they survive on their fat and the colostrum)

Question 19

What are typical problems that arise during the first couple weeks of breastfeeding?

Answer 19

Mother positioning
Difficulty attaching
Mother not recognizing the baby’s signals

Question 20

Why do infants get jaundice with difficulty feeding?

Answer 20

They need to dispose of bilirubin by stooling, and they won’t stool if they don’t eat.

Question 21

Primary lactation failure (i.e., not making milk) is _______________.

Answer 21

very rare; most reports of deficient milk production are due to inadequate milk removal

Question 22

Protein content is higher in _____________.

Answer 22

infant formula

Question 23

Some evidence suggests that formula increases the risk of obesity because ______________.

Answer 23

bottles are designed to be extremely easy for infants to get milk from; as such, it’s hypothesized that bottles take away a step of self-regulation

Question 24

How does infant growth compare between formula and breastmilk?

Answer 24

Same for the first three months and the formula-fed infants get heavier

Question 25

Breastmilk banks are typically used in __________.

Answer 25

NICUs

Question 26

Breastmilk is low in ____________. It’s thought that this is because infants’ kidneys are not as functional.

Answer 26

sodium

Question 27

The are omega-______ in breastmilk.

Answer 27

3s

Question 28

Breast-fed infants have more ___________ in their GI tracts.

Answer 28

commensal (“good”)

Note: this is thought to occur from the “bifidus factor” that supports non-pathogenic Lactobacillus.

Question 29

How many calories does it cost the mother to produce breastmilk?

Answer 29

500 calories per day

Question 30

What is the relationship between maternal diet and the contents of the breastmilk?

Answer 30

Electrolyte and mineral content is independent of maternal intake (with the exceptions of iodide and selenium), while vitamin content depends on maternal intake.

Question 31

The AAP recommends continuing breastfeeding through _________ and the WHO recommends it through __________.

Answer 31

the first year of life; the second year of life

One reason the WHO’s is longer is that water is less safe for young children worldwide.

Question 32

The largest constituent of breast milk is ____________.

Answer 32

water

Question 33

What’s the typical timeline for neonatal metabolism?

Answer 33

• Glycogen stores last for the first twelve hours.

* Glucagon rises and releases triglycerides and stimulates gluconeogenesis.

Question 34

what does lactoferrin do

Answer 34

inhibits growth of Fe dependent bacteria in the GI tract

Question 35

what percent of birth weight do infants typically lose?

Answer 35

5-7% in the first 5 days

Question 36

when do infants typically regain birth weight?

Answer 36

7-14 days

Question 37

how many g/day do infants typically gain

Answer 37

15-30g

Question 38

what is insufficient milk syndrome?

Answer 38

the most common cause of lactation problems
there is inadequate milk removal which then causes inadequate milk production
factors: maternal and fetal

Question 39

what are the two main differences between human milk and infant formula?

Answer 39

more protein and CHO in infant formula

Question 40

what does pasteurization of breastmilk do

Answer 40

decreases lactoferrin, otherwise milk remains relatively unchanged