Nutrition During Lactation - Conditions and Interventions Flashcards
How can nipple pain and soreness be prevented?
proper positioning of the baby, nipple needs to be drawn deep into the mouth, good latch
What type of nipple pain and when isn’t normal?
severe pain, cracks or fissures, pain that persists through feeding
if it doesn’t improve by the end of the first week
What are the common causes of nipple pain?
poor positions, poor latch, improper release of suction, infection, pumping with too much suction, pumping with incorrect breast flange size, disorganized/dysfunctional suck, dermatological abnormalities
How can nipple pain be managed?
let breasts air dry after nursing, rub milk or ointment on nipples, use warm compresses
What can cause letdown failure?
inhibited oxytocin secretion
could be from stress, alcohol or distractions
What is hyperactive letdown?
milk streaming quickly as feeding begins
can cause infant to choke and cough or gulp and take in a lot of air (gas, fussiness)
What are signs of hyper lactation in the mother?
hyperactive letdown, breasts not drained completely, chronic plugged ducts, leaking in between feedings, pain with letdown or deep in breast
What are signs from the baby of hyper lactation?
milk leaking for the sucked breast, spitting up, pour weight gain due to high volume of low-fat milk, good initial gain followed by poor weight gain, difficulty maintaining latch, arching back off breast, excessive gas, green frothy explosive stools
Why does engorgement occur?
supply-demand process not established, infrequent and ineffective removal of milk (mother-infant separation, sleepy baby, sore nipples, improper technique)
When is the peak time for engorgement?
day 2-14
most common on day 2 or 3
What problems does engorgement cause?
discomfort, difficulty establishing flow, difficulty with latch
severe - inhibit milk flow from compressed ducts
How can engorgement be managed?
express milk before latching (softens breast)
analgesics to reduce pain
warm shower or compresses and massage before feeding
cold compresses between feedings
What is a plugged duct?
localized obstruction from milk remaining in the duct
What is mastitis?
inflammation of the breast
can be infective or non-infective
What can cause mastitis?
plugged ducts, cracked or sore nipples, engorgement, restrictive clothing
What are the symptoms of mastitis?
sudden onset, usually one breast
localized, hot, red, swollen area on breast
intense, localized pain
fever and flu-like symptoms
How can mastitis be managed?
continue nursing to remove milk, rest, fluids, adequate nutrition, antibiotics if not resolved within 24 hours
What are causes of low milk supply?
usually - mother not feeding or pumping enough or inefficient emptying
stress
inadequate diet and fluid intake
estrogen can inhibit
How can low milk supply be addressed?
more frequent feeding, check for proper latch and pump use, pump if baby isn’t feeding efficiently, rest and relaxation, use progesterone only birth control, medication
What is the most common medical issue facing breastfeeding patients?
medication use
medication is excreted in breast milk
What questions should be asked to assess risk of exposure to medication excreted in breast milk?
How much of the drug is excreted?
What is the risk of adverse effects at that level?
What variables should be considered to address risk from medication exposure in milk?
pharmacokinetic properties of the drug
drug exposure index
time-averaged breast milk/plasma ration
dose, strength, and duration of dosing
infant’s ability to absorb, detoxify and excrete the agent
infant’s age, feeding pattern, total diet, and health
What is milk to plasma drug concentration ratio?
ratio of the concentration of drug in milk to the concentration of drug in maternal plasma
should be time-averaged
What is the exposure index?
indicates amount of drug in breast milk that the infant ingests
Which medications are contraindicated?
drugs of abuse, radioactive isotopes, drugs that suppress lactation, antineoplastic agents
How can you minimize the effect of maternal medication?
avoid long-acting forms, schedule doses carefully, evaluate the infant, chose the drug that produces the least amount in the milk
What common herbs are not recommended to consume during lactation?
echinacea, ginseng root
What causes jaundice?
too much bilirubin in the blood (hyperbilirubinemia)
What are risk factors for severe hyperbilirubinemia?
levels in the high risk zone pre-discharge
jaundice within first 24 hours
gestational age of 35-36 weeks
east Asian race
siblings with it
exclusive breastfeeding (especially if it isn’t going well)
significant bruising
What is bilirubin?
a byproduct of normal hemoglobin degradation
What can severe hyperbilirubinemia lead to?
permanent neurological damage - bilirubin deposits destroy brain cells (can’t be regenerated)
bilirubin encephalophathy/kernicterus - end result of very high untreated bilirubin levels
What are the effects of kernicterus?
50% mortality rate
cerebral palsy, hearing loss, paralysis of upward gaze, intellectual and other handicaps
What are mild effects of bilirubin on the brain?
incoordination, excessive contractions of muscles, mental retardation, perhaps learning disabilities
How can breastfeeding impact jaundice risk?
early onset may be from poor intake/suboptimal late onset (5+ days) not from poor intake, something to do with the milk but what exactly is disputed
What areas of support do mothers of multiples need to breastfeed successfully?
organization, feeding, individualization, stress management
What challenges do mothers of multiples face with breastfeeding?
supply usually isn’t an issue - it’s totally possible
fatigue is a major challenge (sleep deprivation)
many multiples are premature and have medical complications, breastfeeding might need to be established in the NICU
had more physically demanding pregnancy and birth
What influences the development of infant food allergies?
genetic risk, duration of breastfeeding, time for introduction to other foods, smoking during pregnancy, parents smoking around children, air pollution, infectious disease exposure, maternal diet and immune systems
What are common pediatric food allergens?
cow’s milk, wheat, eggs, peanuts, soybeans, tree nuts
Why might breastfeeding have allergy preventive effects?
low content of allergens transfer of maternal immunity regulation of infant immunity influence on gut microbial flora long-chain fatty acids and IGA presence protects against inflammation and infections
When should a mother consider avoiding certain foods?
when there is a family history of allergies
when the baby shows allergic symptoms
What is the difference between a food allergy and a food intolerance?
allergic reaction involves the immune system
intolerant reaction involves digestion or metabolism
What challenges do late preterm infants have that might make breastfeeding challenging?
poor suck-swallow coordination –> poor latch-on and milk transfer
less stamina
less alert, awake periods
What is the late-preterm breastfeeding cascade?
challenges result in insufficient milk transfer and breast stimulation to empty completely –> insufficient supply –> hypoglycemia, jaundice, poor weight gain –> readmission, supplementation, separation from mother
Why is breastfeeding especially beneficial to preterm infants?
ease of protein digestion, fat absorption
improved lactose digestion
health and development benefits
*milk composition is different
What are medical contraindications to breastfeeding?
few are absolute contraindications - very few risks that outweigh potential benefits
HIV
inborn errors of metabolism - galactosemia, PKU
mother receiving chemo or radioactive treatment
abusing drugs or alcohol
maternal active TB
certain maternal drugs
herpes - only if there is active lesions
What are the recommendations for breastfeeding with HIV?
developed countries with safe substitutes - strongly counsel not to breastfeed
developing countries - subs. not affordable, sanitation concerns, need fuel to boil water, recommendations less clear and depends on infant mortality rate in the area
What factors contribute to tranmission rates of HIV during breastfeeding?
strain of HIV, maternal illness, immune status and viral load, duration of breastfeeding, primary infection, exclusive vs. mixed feeding, mastitis, maternal vitamin deficiencies, availability of antiretroviral therapy
