Lecture 4 - Part II Flashcards
What does the total milk volume vary with?
With infant age
Not with moms fluid intake
How much water should you drink while breast feeding?
3.8L/day
And while baby nurses
In hot temperatures what will baby do?
Adjust schedule in hot temps
How much milk is produced/day?
3/4L/day
-requires 400-650cals extra/day which is pulled from additional food and fat stores
What decreases milk production?
Severe energy restriction
-doesn’t impact composition
What is the additional EER cals for the first 6 months post partum and the second 6 moths?
First: 330kcals/day
Second: 400kcals
Does the amount of carbs fluctuate in milk?
Mother diets has no effect on carb content of milk
-70g lactose/L
What is the recommendations for carbs when breastfeeding?
210g/day RDA
Does the amount of protein fluctuate in milk?
Mother diets has no effect on protein content of milk
What are the protein recommendations during lactation?
71g/day
Does the amount of fat fluctuate in milk?
Moms diet hs an effect on breast milk fatty acid composition
- increase PUFA and DHA content of milk from increase in diet of mom
- NOT on total fat and cholesterol content
Does HMS contain cholesterol?
no
Does the amount of vitamins and minerals fluctuate in milk?
Generally nutrition inadequacies decrease in quantity not quality of milk
- even if supplies are limited milk is adequate in carb protein fat and most minerals
- quality maintained at the expense of maternal stores
Which vitamins if deficient in mom will be deficient in baby?
B6 and B12
-milk will be deficient in these
Which vitamins change in milk based on moms diet?
Vitamin ADK
-not all infant givent vitamin K shot
Do minerals in moms diet have an effect on milk?
Does not influence their concentration in milk
-mineral content on human milk is less than cows
IS supplementation recommended during lactation?
only recommended for specific nutrient/needs
-veg diets
Can you do physical activity while breast feeding?
Yes
-but compensation for cals is important
What are the benefits of physical activity during lactation?
Support healthy weight
Improve mental health post partum
Social Aspect/break from routine
Fresh air
Why might break feeding help with weight loss?
May help by facilitating mobilization of fat stores
-does not promote rapid easy weight loss
How much should you lose in the first 4-6months?
1-2lbs/month
DRI: 0.8kg/month for first 6 months
When do you normally see sore nipples?
4-5days post birth, then should get better
-if not most people switch to bottles
How do you alleviate pain during breast feeding?
Ensure proper positioning
Wash with warm water only
Let air dry
Proper pumping equipment
What is engorgement and what is the cause?
Breasts overfill with milk
Cause: infrequent or ineffective removal of milk
What is the solution to engorgement?
Warmth, pressure, express milk before feed until breast is not hard, BF often, pump less, anti inflammatory for let down, cold compress between feeds
What are plugged milk ducts and what are the signs and solutions?
Milk remains in duct and causes bloackage
Painful knot in breast
Warmth, pressure, complete emptying, supplements for let down
-can lead to mastitis
What is mastitis and what causes it?
Inflammation of the breast
Missing one or more feeds, tight bra, unresolved rengorgement or plugged duct
What are the signs and solutions of mastitis?
Signs: simulate to plugged duct with addition of fever/flu-like symptoms
Solution: continue BF, empty at each feed, ibuprofen, rest, hydration, nutrition, antibiotics may be needed
What are letdown issues?
Inadequate: stress, alcohol, distractions may inhibit oxytocin, which then decreases let down reflex
Hyperactive: milk sprays on its owne
What is hyper lactation and what are the signs and symptoms?
Overproduction of milk
Signs: spitting up, green frothy stool, chronic plugged ducts, leaking between feed, poor infant wt gain
Soplutions: only one side per feed, express some milk before starting feed cold compress before feed
What happens if mom has a cold when breast feeding?
Dont take meds, can dry up milk supply
Hydrate well
Can communicable disease appear in breastmilk?
Communicable disease
HIV/AIDS can be transmitted but low risk
What is post partum amenorrhea?
Lactational an ovulation (prolactin)
- favours birth spacing
- can take up to 1yr to replenish moms nutrient reserves
Its not always protective
Length depends on exclusive breastfeeding or not
Uterus returns to normal size in 6wks.
What is weaning?
Parent or baby led weaning
End of lactation
How can you end lactation?
Without suckling stimulation
Inhection of estrogen
Bromocriptine (Med)
Large dose of B6
What are the issues with premies breastfeeding?
Heart/breathing instability
Poor temp control
Fewer glycogen and fat stores=increase risk for hypoglycaemia
Immature immune system
Immature suck/swallow coordination
Tire easily, hard to get a full feed every time
Whats it like breastfeeding babies born before 34wks?
Tube fed for at least a while
Can be given fortified pumped breast milk
Soother to help learn suck/swallow
What is it like breastfeeding babies born 34-37wks?
3/4 of all singleton preterm births Shout not be treated as Tull term Insufficient milk intake Jaundice Hypoglycemia Poor wt gain
What are the preterm infant breastfeeding goals?
- Build and maintain milk supply
- feed and pump after - Feed infant adequately
- Wake infant 2-4 hours
- weight infant pre and post feeding
- appropriate d/c planning
What are the benefit of breastmilk for premies?
Easier to digest and absorb than formula
Better Brian and eye development
Reduced risk of infectious disease
What are the drawbacks of of breastmilk for premies?
May gains wt/length slower
May have poorer bone mineralizationi
What is the key to breastfeeding multiples?
Frequent feeds and or pumps (supply and demand)
Time management
Feed both at once if possible
What are the possible road blocks with breastfeeding multiples?
Prematurity
Lack of sleep or adequate nutrition/hydration
Stress
Lack fo education
Can babies have short-term allergies/intolerances while breastfeeding?
Some foods in moms diet may cause colic or irritability
Record keeping to help determine which foods causing discomfort
Reaction is 4-24hr post ingestion
Will see relief after 5-7 days without food in diet
What influences longterm allergies and intolerances while breastfeeding?
Genetics Duration of breastfeeding Introduction of foods Smoking during pregnancy Air pollution Exposure to infectious disease Maternal diet Maternal immunity
What is jaundice?
Too much bilirubin in the blood
Affect 80% premies, 40% FT
Can lead to permanent neurological damage if not addressed and corrected
2 types: breastfeeding and non breastfeeding jaundice
What practices are incompatible with breastfeeding?
Smoking Alcohol Medicinal Drugs Illicit drugs Environmental contaminants Excess caffeine Herbal remedies
What does successful lactation require?
Proper latching of baby on breast
Adequate nutrition and rest
Help and support: certified lactation consultant
What are the factors that need to be considered for the care of lactating women?
giving birth is exhausting -type of birth -meds used First kids Nursing on. request If mom has priorities to feed and care for herself
What is milk baking?
Breastmilk is good for infants even if not from its mom
-can pasteurize donor milk
Some women produce more than needed and can store for later
What are Canadas recommendations for alternate breastmilk?
Cow milk based, Fe fortified formulas until 9-12 months
Pasturized wholesaled cow milk at 9months
What are considerations that we need to be aware of when using infant formulas?
Safety and sanitary conditions:
- Reliable/pure water supply
- Boiling water
- Clean and sterilize bottles and nipples
- Prepare according to instructions
