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NuFS 106A > Lactation Ch 6 FULL > Flashcards

Lactation Ch 6 FULL Flashcards

1
Q

What are the time spans with respect to breastfeeding?

A

6mo - Exclusively breastfeed
>6mo: breastfeed + complements
12mo: can stop or continue
can continue breastfeeding ‘til 2years

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2
Q

What are the benefits for breastmilk?

A

*immunity (can’t get w/ HMS)

infant bond w/ mother strengthened

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3
Q

What are the factors in the changing composition of milk?

A
  1. age of infant
  2. infection in the breast
  3. w/ menses
  4. maternal nutrition status
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4
Q

What are the functions of human milk (HM)?

A

nurtures and protects infants from infectious diseases

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5
Q

how often does the composition of HM change?

A

over a single feeding and/or over a day

milk matures overtime (not the same @ beginning&end)

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6
Q

what are the hormones asso w/ lactation? (2)

A
  1. prolactin: stimulates milk production
    - released when suckling, stress, sleep
    - ↓ ovulation & likelihood of getting prego again
  2. oxytocin: stimulates the letdown (release of milk fm the breast)
    - helps uterus to get back to norm (uterus contracts/shrink)
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7
Q

what is colostrum?

A

:1st milk secreted during the 1st few days postpartum (3-5 days)

  • mature milk day 15
  • transition milk: 5-15 days
  • immunity: high in proteins (IgA&lactoferrin)
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8
Q

what does too much lactose cause?

Na?

A

diarrhea

Na: fluid hydration

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9
Q

what is human milk composed of?

A
  1. water
    -major component
    -isotonic (same osmolality) w. maternal plasma
    -helps w/ hydration; easier absorption
    (water in GI=>diarrhea)
  2. energy
    1oz of BM = 20 kcal
    cals vary w/ fat, protein, & CHO
    formula feed = ↑ energy intake (intake > amount)
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10
Q

lipids in HM (2)

A

-lipids provide 1/2 cals in HM (45-55% of all cals)
-maternal diet affect fat composition
recommendation of fat 20-35%
DHA: helps w/ cognition
medium-chain fatty acids

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11
Q

what is foremilk?

what is hindmilk?

A
  1. FOREMILK:
    - 1st milk baby starts getting
    - > watery (helps w/ hydration)
    - ↓ lipid content
    - some CHO (esp lactose)
  2. hindmilk (2nd half of milk; end of feeding)
    - rich in lipids (for energy)
    - > CHO (oligosaccharides)
    * empty 1 breast before the other to get fore&hindmilk
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12
Q

what fats are in HM? (3)

A
  1. DHA: Docosahexaenoic acid (omega-3 fatty acid)
    -essential for retinal dev
    -asso w/ ↑ IQ scores / cognitive abilities
    (few formulas have DHA)
  2. trans fatty acids
    -present in HM fm maternal diet
  3. cholesterol
    -↑ in HM than HMS
    -early intake fm BM related to ↓ blood cholesterol levels later in life
    (won’t restrict as much as cholesterol)
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13
Q

What are general info about proteins in HM?

A

total protein: BM ↓ than whole cow’s milk
-can overload infant’s kidney w/ cow’s milk (early in life)
-HM has antiviral & antimicrobial effects *
-protective immunity
non-protein N
- ~20-25% in HM
-used to make non-essential AAs & other proteins (hormones, ect)

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14
Q

What are the proteins in HM?

A
  1. CASEIN: solid product fm the coagulation of milk+acidic/enzyme
    -main protein in mature HM
    -rich in Ca binds to protein; > absorption
  2. WHEY: liquid product fm the coagulation of acidic/enzyme
    -remains soluble in water
    -some minerals, hormones,&vita binding proteins
    lactoferrin (carrier for iron)
    -most immunity function
    -protein that remains
    -enzymes present aid in digestion & protection against bacteria
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15
Q

what CHOs are in HM?

A
  1. lactose
    - main CHO in HM
    - helps/enhances w/ Ca absorption
  2. oligosaccharides: medium-length CHO
    - prevent binding of pathogenic m/o to gut, which prevents infection&diarrhea
    • works as prebiotic (fosters growth of healthy bacteria)
    • <diarrhea & help gut fm bacteria/infection
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16
Q

vitamins in HM

A

content of vitas in HM reflect mom’s diet
HM not rich in iron, but iron is bioavail
lack Vita B12 (vegan/malnourished) & folate
-vegans, malnourished, gastric bypass
missing fat soluble vitas (ADEK)
(infants may have vita k bleeding ∴ shot right after birth)
(iron rich foods should be the 1st foods introduced to bbs)

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17
Q

minerals in HM

A

Minerals contribute to osmolality
-most have ↑ bioavailability
easier to absorb & metabolize the minerals
-↓ risk of anemia despite ↓ iron content of HM
easier on kidneys

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18
Q

taste of HM

A

flavor of foods in mom’s diet influences taste of BM
-change in mom’s diet = change in flavor of BM
-infant > interested bc flavor varies from mom’s diet
- > exposure to variety = < picky in life
bc they accept new flavored

19
Q

what are the benefits of BF for women?

A
  1. hormonal benefits
    - ↑ oxytocin stimulates uterus to return to pre-prego
  2. physical benefits
    - prolactin: delay on monthly ovulation ∴longer intervals between pregnancies
  3. psychological benefits
    - ↑ self-confidence & bonding w/ infant
20
Q

what are the nutritional benefits of BF for infants?

A
  1. widely recognized
  2. HMS use HM as a standard
  3. nutrients are balanced
  4. HM is isosmotic = help w/ hydration
  5. meet infant’s protein needs w/o overloading kidney
  6. > digestible
    -has soft, easily digestible curd
  7. provides generous amounts of the right lipids
    - >energy dense
  8. minerals are > bioavail
    (formula mimiks HM)
21
Q

what are the benefits of breastfeeding for infants? pt 1

A
  1. IMMUNOLOGICAL benefits
    -↓ infant mortality in developing countries (sanitation)
    - reduce acute illnesses
  2. REDUCTIONS IN CHRONIC ILLNESSES
    - reduce risk of celiac disease, IBS (irritable bond syndrome), leukemia
    - reduce risk of allergies and asthmatic disease
    • peanut allergies during prego/breastfeeding
      = ↓ risk of allergies
  3. BREASTFEEDIDNG & CHILDHOOD OVERWT
    - typically breastfed infants are leaner @ 1 yr of age
22
Q

what are the benefits of breastfeeding for infants? pt 2

A
  1. COGNITIVE BENEFITS
    -Studies: ↑ in cognitive ability even after
    adjusting for family environment
    -edu & socioeconomic status (related to presence of DHA-cognitive ability)
  2. ANALGESIC EFFECTS of BM
    - Reduction of infant pain when BF
  3. Socioeconomic benefits
    - ↓ illness = ↓ need for medical care
    • < likely of kid being ill = ↓ days missed at work
      -formula is expensive, affect cost of families
23
Q

BM supply & demand: what is milk synthesis is related to?

A

Main worry: worry not providing BM to infant

  1. How vigorously an infant nurses
  2. How much time the infant is at the breast
  3. How many times per day infant nurses
    * demand of how much milk is being removed from the breast = > milk will be produced
    - *important to empty one breast before the other
    * demand is going to ↑ the production
24
Q

what is the main concern of BF mothers?

A

worry not providing enough milk to infant

25
Q

BM supply & demand: does breast size limit a woman’s ability to nurse?

A

NO, the size of the breast does NOT limit a woman’s ability to nurse

  • adipose storage is the difference
  • smaller breast may hold < milk, BUT milk production is the SAME
26
Q

BM supply & demand: Is feeding frequency related to the amount of milk a woman makes?

A

Rate of milk synthesis is variable between breasts & between feedings
-smaller breast may have to feed > frequently bc can store less in breast

27
Q

BM supply & demand: what are the different methods of pumping or expressing milk?

A
  1. Manually
  2. Hand pumps
  3. Commercial electric pumps
  4. Hospital grade electric pumps
    bc babies can’t latch on or mouth is small (small surgeries)

↑ frequency esp @ beginning bc will stimulate adequate milk may require 8-12 expressions per day
-comparable to how much mom will be breastfeeding in 1st wks of life of the infant

28
Q

The Breastfeeding Infant: what are the reflexes babies have?

A
  1. Gag reflex—prevents infant from taking food and fluids
    into lungs
  2. Oral search reflex—infant opens mouth wide when close to breast & thrusting tongue forward
    -swallowing & sucking; following finger when close to mouth
    -be attached to nipple&areola *position is key
    -appropriate positioning = adequate letdown & milk production
  3. Rooting reflex—infant turns to side when lip stimulated on that side.
    -sign of hunger when babies act like they are getting milk from inanimate object
29
Q

The Breastfeeding Infant: how to identify hunger & satiety?

A

HUNGER is signaled by infant:

  1. Bringing hands to mouth, sucking on fingers, & moving head from side to side
  2. Crying is late sign of hunger

Allow infant to nurse on 1 breast as long as they want to ensure they get foremilk & hindmilk w/ its ↑ fat content that provides satiety

*Note: High lactose content of foremilk may cause diarrhea

30
Q

The Breastfeeding Infant: what is the feeding frequency for babies?

A

newborn: 10-12 feedings/day are normal for newborns
-Feeding ↓s overtime
Stomach is small
- ∴ stomach emptying occurs every ~1.5-2 hours
-feeding & diaper changes are often

(1st few days bbs drink 1 tbsp/feeding)

31
Q

Identifying Breastfeeding Malnutrition: generalization facts

A

Normal weight loss for newborns

  • ~7% of birthweight in 1st week / 1st 5days
  • Weight loss of 10% or > needs evaluation by lactation consultant
    • not enough nutrients
32
Q

Identifying Breastfeeding Malnutrition: signs of malnutrition (4)

A

Malnourished infants become sleepy, non-responsive, have a weak cry, & wet few diapers
-By day 5 to 7, infants should have 6 wet diapers & 3-4 solid diapers per day -towards end of 1st wk (start happening around day 5)

amount of wet diapers will give you an idea of how much milk they’re intaking

33
Q

Tooth Decay (3)

A

Cavities can occur in children who are breastfed
Risk factor is frequent nursing at night after 1 yr
All children should be seen 6 months after 1st tooth erupts or @1 yr of age
(water after 6mo bc BM is exclusive in 6months)

34
Q

how to evaluate infant malnutrition?

A

Evaluate at mom & infant - what is the cause?
MATERNAL CAUSES:
1. Poor production of milk:
Mom have poor energy intake? <1500 cals?/day
-illness?
Poor letdown
-smoking? latching? stimulation from bb?

infant causes:
POOR INTAKE
-sucking inefficiencies or mouth
-excess times between feedings
ILLNESS: vomiting, diarrhea, infection
↑ ENERGY NEEDS: baby may need additional supply besides BM
35
Q

Benefits of HM: tooth decay

A

HM has antimicrobial components (not in HMS)

  • HM helps prevent cavities in 1st yr of life
  • helpful, but does not mean infant will not develop cavities
36
Q

Vitamin Supplements: what are the vitamin supplements for breastfeeding infants?

A

Bbs exclusively breastfed don’t usually develop deficiencies
Vitamin K (bleeding): all U.S. infants receive vitaK injections at birth
-5% births in US
-but parents can opt out
Vitamin D: exclusively breastfed infants need supplements @ 2 months
No recommendations for fluoride or iron

Ricketts: childhood bone disorder where bones soften & become prone to fractures and deformity. ( ) legs

37
Q

Maternal Diet: What are the dietary guidelines for prego & breastfeeding women?

A

MyPlate Food Guide has been adapted for prego & breastfeeding women
DIETARY GUIDELINES
-Moderate wt reduction can be achieved w/o
compromising the wt gain of the infant
Diets formed around a MyPlate food plan for prego & breastfeeding women provide
-Healthy assortment of nutrients at specified calorie levels for each stage of breastfeeding

38
Q

Energy and Nutrient Needs for Lactation (3)

A
  1. Energy needs vary by activity level
  2. DRI is +500 kcal/day for the 1st 6 months & +400 kcal/
    day afterward
  3. A single recommendation for energy needs could never address all of the individual variation in energy needs
39
Q

Maternal Energy Balance and Milk Composition

A
  1. Protein-calorie malnutrition (meet min cals to produce milk)
    - Results in reduction in milk volume but not quality
    • quantity > quality
  2. Wt loss during breastfeeding
    - caloric DRI assume a loss of 0.8 kg/month
    - Most women do not reach prepregnancy wt by 1 yr after birth
    - Modest or short-term energy reductions do not ↓ milk production (~500 kcal, but not <1500 kcal/d)
    • ie: 2300+500-500, if want to lose wt
40
Q

Exercising and Breastfeeding (2)

A

Modest energy restriction combined w/ ↑ activity may help women lose wt & body fat
Exercise does not inhibit milk production or infant growth

41
Q

Other Factors of Maternal Diet

A

Fluids (milk is 87% water)
-Women should drink to thirst
-check if urine is pale yellow
Infant Colic
-Defined as crying for >3 hrs a day – no medical
cause
-Components of maternal diet may be related to infant colic
-More likely with cow’s milk, onions, cabbage, broccoli, & chocolate

*tip: drink water while BFing/pumping
10mins/breast; feeding & pumping

42
Q

Breastfeeding Goals for the United States:

A
  • Healthy People 2020 breas4eeding objectives:
  • ↑ proportion of infants breastfed
  • ↑ duration of breastfeeding
  • ↑ worksite lactation programs
  • ↓ formula supplementation in first 2 days of life
  • ↑ births in facilities providing recommended care for breastfeeding mothers
43
Q

Discuss barriers to breastfeeding initiation.

A
  1. Embarrassment
    - mom can train body for < frequency, but > volume
  2. Time & social constraints
  3. Lack of support from family & friends
  4. Lack of confidence
  5. Concerns about diet & health
  6. Fear of pain: not done properly & pain (esp in 1st wk)
44
Q

Discuss barriers to breastfeeding at the workplace.

Breastfeeding Promotion, Facilitation, and Support

A
  1. Barriers exist such as lack of on-site day care
  2. Insufficiently paid maternity leave
  3. Rigid work schedules
  4. Lack of understanding/knowledge by employers
  5. Legislation is in progress to support breastfeeding or pumping in the workplace

NuFS 106A (15 decks)

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