Lecture 5.2 - Nutrition Flashcards

1
Q

What is the main principle of the Baby Friendly Initiative?

A

Healthcare providers have to provide parents with all information about breastfeeding/alternatives so that parents can make an informed decision

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2
Q

How long is exclusive breastfeeding recommended? How long should breastfeeding continue once complementary foods are added to the diet?

A

First 6 months exclusively
+ Cont breastfeeding with complementary food for up to 2 years

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3
Q

What kinds of foods should be initially introduced to babies?

A

Iron rich foods - brain development
–> Soft meats, fortified cereals, fatty fish, eggs, beans, oats

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4
Q

Until 1 year of age babies should receive which supplement?

A

Vit D
–> 400 IU/day
Bone health, prevent rickets

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5
Q

Why is 6 months the age that complementary food is introduced?

A

Additional options needed for nutrition

Developmental milestones at this age:
–> Gut closure, mature
–> Ability to sit up independently
–> Tongue protrusion reflex has subsided

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6
Q

What is recommended if a baby is weaned from breastmilk before a year?

A

Iron rich formula recommended
–> Supplemental d/t high incidences of bacteria that use iron

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7
Q

What is mixed feeding?

A

Partial breastfeeding + formula

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8
Q

What unique properties of breastmilk make it ideal?

A

Composition changes with development of infant

Enhances maturation of GI tract + microbiome

Nutrients easier to absorb

Immunologically active components
–> IgA highest amount
–> T + B lymphocytes, epidermal growth factor, cytokines, interleukins, bifidus factor, lactoferrin

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9
Q

What immunoglobulin is most abundant in breastmilk?

A

IgA
–> Acts locally in GI tract

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10
Q

What kinds or protection does breastmilk provide?

A

Some protection against a broad spectrum of bacteria, protozoan infections

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11
Q

What is the composition of breastmilk?

A

87-88% - water
7% - carbs
1% - protein
3.8% - fat

Variations occurs with GA of infant, timing of feeds, maternal health

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12
Q

What is necrotizing enterocolitis? What is a risk factor for it?

A

Inflammation of intestines leads to Injury + death of cells
–> Perforations

Related to NBs having immature GI system –> Breastfeeding can decrease risk

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13
Q

What are some advantages of BF for maternal health?

A

Weight loss

Decreased risk of breast/ovarian cancers, rheumatoid arthritis, HTN, hypercholesterolemia, cardiovascular disease, DMII, osteoporosis.

+psychosocial benefits

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14
Q

When is BF contraindicated d/t maternal reasons?

A

Maternal HIV
–> In high income countries

Active maternal TB that is not in treatment, HSV on breast, Human T-cell leukemia virus type 1

Cancer therapy

Consider maternal substance use
–> Unregulated substances are most concerning

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15
Q

When is breastfeeding contraindicated for infant factors?

A

Galactosemia
–> Inability to process galactose

Will cause build up of bilirubin, jaundice

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16
Q

What maternal infections are not contraindicated to breastfeeding?

A

CMV, Hep ABC

Maternal HIV in low-income countries

Fever

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17
Q

What is the main reason why BF is stopped early?

A

Perceived insufficient supply and overall lack of BF and social support, which can lead to low self-efficacy
–> Practical knowledge and relevant information must be provided by HC providers

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18
Q

What are the functional units of the breast?

A

Alveoli - produce milk

Lobules - Contain many alveoli

Ducts - Carry breastmilk to the nipple (15-25 lactiferous ducts)

Montgomery glands/tubercles - small raised bumps on the areola that lubricate nearby tissue

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19
Q

What are Montgomery glands?

A

Small raised bumps on the areola that lubricate nearby tissue and secrete anti-infective substance

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20
Q

What are the stages of milk production?

A

Rapid Mammogenesis

Lactogenesis I

Lactogenesis II

Lactogenesis III

Stage IV: Involution

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21
Q

How much colostrum is produced by birth?

A

2-20ml/feed

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22
Q

What is rapid mammogenesis?

A

First half of pregnancy
–> Rapid growth of ducts and lobules, increased epithelial cells (response to progesterone and estrogen)

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23
Q

What is Lactogenesis II?

A

Secretory activation that occurs 48-72 hours PP to 8 days
–> Triggered by drop of P/E after delivery of placenta, stimulates alveoli to produce and secrete milk
–> Junctions between alveolar cells close and increased development of alveoli and ducts
–> Rapid increase in milk volume that levels off –> engorgement

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24
Q

What is lactogenesis I?

A

1st stage of milk production
–> Colostrum begins at 16 weeks
–> Prolactin is inhibited be progesterone/estrogen, dopamine (PIF)

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25
Q

What is lactogenesis III?

A

Maintenance stage (9+ days PP to weaning/involution)
–> Shift from endocrine to autocrine (supply driven demand)

Milk production regulated by feedback inhibitor of lactation that builds when alveoli are full, prevents prolactin uptake.
–> Prolactin cannot be taken up when alveoli are full d/t change in receptor shape

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26
Q

At what time of day does prolactin peak?

A

At night

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27
Q

How is milk production autoregulated during lactogenesis III?

A

Supply + Demand
–> Milk production regulated by Feedback Inhibitor of Lactation that builds when alveoli are full, prevents prolactin uptake.
–> Prolactin cannot be taken up when alveoli are full d/t change in receptor shape

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28
Q

What is essential for lactation maintenance?

A

Frequent milk removal

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29
Q

How much milk is being produced by two weeks after birth?

A

750ml/24 hours

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30
Q

How long does it take to establish a stable milk supply?

A

Can be up to 6 weeks

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31
Q

How often should baby eat?

A

8-12 feeds/day
–> or q2-4 hours + cluster feeds

Responsive feeding is best.

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32
Q

What are the periods of growth spurts for infants?

A

Day 6, 3 weeks, 6 weeks 3 months, 6 months
–> Associated with increased cluster feeding

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33
Q

What is Stage IV of BF?

A

Involution
–> Apoptosis of milk producing cells when weaning begins

Take around 40 days for involution to finish following last breastfeed

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34
Q

What are some unique aspects of colostrum?

A

Establishes microbiome + immunity
–> Higher concentration of immune cells
–> Rich in proteins d/t Igs, fat soluble vitamins, minerals. Cholesterol for myelination.
–> Natural laxative

Less fat and lactose than mature breastmilk

35
Q

What is the volume of a NB stomach?

36
Q

Transitional milk differs from colostrum in which ways?

A

Richer in fat, lactose, and calories.

The concentration of Igs gradually decreases as it transitions to mature milk.

37
Q

What are the two kinds of mature milk?

A

Foremilk
–> Higher in protein, lactose, water

Hindmilk
–> Higher concentration of fats

38
Q

What is some important teaching with breastfeeding d/t foremilk and hindmilk?

A

Encourage mother to let baby drain first breast before offering second

Start feeding on the breast they finished last

39
Q

Where is prolactin released from? When do levels rise?

A

Anterior Pituitary
–> Inhibited by P/E/PIF (dopamine)
–> Prolactin levels increase after delivery of placenta d/t hormone drop and after 4 days d/t stimulation + effective drainage

40
Q

What is the purpose of oxytocin in breastfeeding? Where is it released from?

A

Posterior Pituitary
–> Hormone of milk ejection reflex

41
Q

What is the relationship between stress and oxytocin?

A

Oxytocin decreases cortisol and therefore stress

But high stress can inhibit oxytocin secretion.

42
Q

How many MERs occur during a feed?

A

2-3x
–> Lasting 45 second to 3.5 minutes

43
Q

What BF support can be done in the first few hours?

A

Skin-to-Skin ASAP
–> Allow dyad to get to know each other

Teach response to hunger cues and attempts to assess breastfeeding. Remember BF is a learned skill between two people.

44
Q

When can hand-expression be helpful?

A

Increases self-efficacy/confidence
–> Softens tissue to make latch more comfortable for both
–> Stimulates MER for a sleepy baby

45
Q

What are some early hunger cues for baby?

A

Quiet Alert state
–> Hand to mouth
–> Sucking/mouth movements
–> Strong rooting
–> Hunger posturing

46
Q

What are late hunger cues for baby?

A

Crying

Irritable, frustrated, fall asleep

47
Q

What are infant satiation cues?

A

Slowed/decreased sucking

Release of nipple or turning/arching away

Relaxed body (extension)

48
Q

What is a sign that an early feed might be effective?

A

Good latch + sucking
–> Early feeds can take a long time, that okay

49
Q

When and where is oxytocin released?

A

From Posterior Pituitary
–> Labour, skin-skin, orgasm, when thinking about baby

50
Q

How does colostrum prevent jaundice?

A

Natural laxative which promotes excretion of meconium, which has high bile concentration (and therefore promotes excretion of bili)

51
Q

What are the general principles of breastfeeding position?

A

Tummy-to-tummy

Baby to breast, not breast to baby

Both well supported and comfortable

Eye-contact

52
Q

What is mother-led latching?

A

Mother controls and adjusts breast and baby’s head to facilitate latch

53
Q

What is baby-led latching?

A

Allows baby to move towards latch, baby will reach up with chin and latch

54
Q

What BF position can be comfortable for someone recovering from c/s?

A

Side-lying
–> Takes pressure of incision

55
Q

What BF positions can be more comfortable for someone with larger breasts?

A

Football or side-lying might be more comfortable

56
Q

What are some signs of effective breast milk transfer to infant?

A

Baby sucks more quickly and shallowly at first, then moved to slower deeper pattern

Swallowing - chin drop w audible swallow

May see milk around mouth

Satiation position through feed

57
Q

What is involved in a latch assessment?

A

L - Characteristics of latch itself
A - Degree of audible swallow
T - Type of nipple
C - Comfort (maternal)
H - Holding skills

Assess and work with mother.

58
Q

When can uric acid crystals be normal for an infant?

A

Day 1-4 might be normal finding
–> Concentrated urine

59
Q

What % weight loss for a baby is normal in the first 3 days?

A

up to 7% is normal
–> Cannot dc if greater than 10% weight loss

60
Q

When do babies start gaining weight? Why?

A

Day 4+ - 20-35 g/day
–> Milk let down

61
Q

When is birth weight regained?

62
Q

When is supplementation of BF indicated?

A

Greater than 10% weight loss/inadequate weight gain

Hypoglycemia

Still passing meconium at day 3-4, or no stooling for first 24 hours

Signs of dehydration/decreased urine output

Maternal contraindications to BF

63
Q

What must be kept in mind if we are supplementing BFing?

A

Implement action to protect the mother’s milk supply
–> Pumping, hand expression

64
Q

What is the first choice for breastfeeding supplementation?

65
Q

How often and for how long should someone pump?

A

Minimum 6x a day (Q4) over 15-20 minutes until MER stops.

66
Q

When is pumping indicated?

A

Premature bbs, severe tongue tie, separation from mother

67
Q

If a person is exclusively pumping, why is it essential to pump at night?

A

Prolactin increases at night
–> Facilitates full milk supply or complications d/t milk stasis

68
Q

How can EMB be stored?

A

3-4 hours room temperature - maybe up to 4-8

Fridge - 3-8 days
Freezer - 3-6 months

69
Q

What are some alternatives to bottle feeding if the person is also BFing?

A

Cup, spoon, dropper

70
Q

How many extra calories are needed while BFing?

A

500 cals/day

71
Q

When does engorgement occur most often? How long does it usually last?

A

Often occurs day 3-5 and lasts 24 hours
–> Related to milk stasis

72
Q

How can breast engorgement be managed?

A

Effective drainage
Warm compresses, massage to soften breast before feeding
Hand expression to make latch easier
Cool compresses between feeds for comfort
Tylenol + Advil

73
Q

What is the most common cause of nipple pain with BFing?

A

Poor positioning, latch issues, infection, improper suck
–> Can also be thrush, vasospasm, Reynaud’s

74
Q

What is the first intervention to treat nipple pain?

A

Correct the latch

75
Q

When can expressing some milk onto nipple before feed be helpful?

A

For mild pain - soothes and prevents growth of thrush

75
Q

What topical application can help sore nipples?

A

EBM, lanolin, nipple cream, hydrogel dressing

76
Q

What is a blocked milk duct? What causes it?

A

Swollen, tender, leads to narrowing of duct with afebrile mother
–> result of inadequate emptying

76
Q

What should we assess when there is pain with breastfeeding?

A

Thrush, tongue tie, poor latch

77
Q

How can a blocked milk duct be managed?

A

Warm compress or massage to encourage drainage

Frequent feeding

Changing BF position - point chin to affected area can massage area

78
Q

What is mastitis?

A

Inflammatory or infective
–> Localized pain and tenderness, red, warm

Infective will also present with sudden onset flu-like symptoms

79
Q

How is mastitis managed?

A

Rest, care - fluids, nutrition

Effective drainage but no extra drainage to prevent overproduction

Cool compress between feedings
–> Warm can worsen inflammation

Antibiotics for infection

80
Q

When is soy-based infant formula recommended?

A

Only when recommended by health care provider

81
Q

Patients should be taught to have how much ready to feed formula available?

A

72 hours worth
–> In case of loss of safe water source or loss of power