Nutrition During Lactation - Conditions and Interventions

Question 1

How can nipple pain and soreness be prevented?

Answer 1

proper positioning of the baby, nipple needs to be drawn deep into the mouth, good latch

Question 2

What type of nipple pain and when isn’t normal?

Answer 2

severe pain, cracks or fissures, pain that persists through feeding
if it doesn’t improve by the end of the first week

Question 3

What are the common causes of nipple pain?

Answer 3

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

Question 4

How can nipple pain be managed?

Answer 4

let breasts air dry after nursing, rub milk or ointment on nipples, use warm compresses

Question 5

What can cause letdown failure?

Answer 5

inhibited oxytocin secretion

could be from stress, alcohol or distractions

Question 6

What is hyperactive letdown?

Answer 6

milk streaming quickly as feeding begins

can cause infant to choke and cough or gulp and take in a lot of air (gas, fussiness)

Question 7

What are signs of hyper lactation in the mother?

Answer 7

hyperactive letdown, breasts not drained completely, chronic plugged ducts, leaking in between feedings, pain with letdown or deep in breast

Question 8

What are signs from the baby of hyper lactation?

Answer 8

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

Question 9

Why does engorgement occur?

Answer 9

supply-demand process not established, infrequent and ineffective removal of milk (mother-infant separation, sleepy baby, sore nipples, improper technique)

Question 10

When is the peak time for engorgement?

Answer 10

day 2-14

most common on day 2 or 3

Question 11

What problems does engorgement cause?

Answer 11

discomfort, difficulty establishing flow, difficulty with latch
severe - inhibit milk flow from compressed ducts

Question 12

How can engorgement be managed?

Answer 12

express milk before latching (softens breast)
analgesics to reduce pain
warm shower or compresses and massage before feeding
cold compresses between feedings

Question 13

What is a plugged duct?

Answer 13

localized obstruction from milk remaining in the duct

Question 14

What is mastitis?

Answer 14

inflammation of the breast

can be infective or non-infective

Question 15

What can cause mastitis?

Answer 15

plugged ducts, cracked or sore nipples, engorgement, restrictive clothing

Question 16

What are the symptoms of mastitis?

Answer 16

sudden onset, usually one breast
localized, hot, red, swollen area on breast
intense, localized pain
fever and flu-like symptoms

Question 17

How can mastitis be managed?

Answer 17

continue nursing to remove milk, rest, fluids, adequate nutrition, antibiotics if not resolved within 24 hours

Question 18

What are causes of low milk supply?

Answer 18

usually - mother not feeding or pumping enough or inefficient emptying
stress
inadequate diet and fluid intake
estrogen can inhibit

Question 19

How can low milk supply be addressed?

Answer 19

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

Question 20

What is the most common medical issue facing breastfeeding patients?

Answer 20

medication use

medication is excreted in breast milk

Question 21

What questions should be asked to assess risk of exposure to medication excreted in breast milk?

Answer 21

How much of the drug is excreted?

What is the risk of adverse effects at that level?

Question 22

What variables should be considered to address risk from medication exposure in milk?

Answer 22

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

Question 23

What is milk to plasma drug concentration ratio?

Answer 23

ratio of the concentration of drug in milk to the concentration of drug in maternal plasma
should be time-averaged

Question 24

What is the exposure index?

Answer 24

indicates amount of drug in breast milk that the infant ingests

Question 25

Which medications are contraindicated?

Answer 25

drugs of abuse, radioactive isotopes, drugs that suppress lactation, antineoplastic agents

Question 26

How can you minimize the effect of maternal medication?

Answer 26

avoid long-acting forms, schedule doses carefully, evaluate the infant, chose the drug that produces the least amount in the milk

Question 27

What common herbs are not recommended to consume during lactation?

Answer 27

echinacea, ginseng root

Question 28

What causes jaundice?

Answer 28

too much bilirubin in the blood (hyperbilirubinemia)

Question 29

What are risk factors for severe hyperbilirubinemia?

Answer 29

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

Question 30

What is bilirubin?

Answer 30

a byproduct of normal hemoglobin degradation

Question 31

What can severe hyperbilirubinemia lead to?

Answer 31

permanent neurological damage - bilirubin deposits destroy brain cells (can’t be regenerated)
bilirubin encephalophathy/kernicterus - end result of very high untreated bilirubin levels

Question 32

What are the effects of kernicterus?

Answer 32

50% mortality rate

cerebral palsy, hearing loss, paralysis of upward gaze, intellectual and other handicaps

Question 33

What are mild effects of bilirubin on the brain?

Answer 33

incoordination, excessive contractions of muscles, mental retardation, perhaps learning disabilities

Question 34

How can breastfeeding impact jaundice risk?

Answer 34

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

Question 35

What areas of support do mothers of multiples need to breastfeed successfully?

Answer 35

organization, feeding, individualization, stress management

Question 36

What challenges do mothers of multiples face with breastfeeding?

Answer 36

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

Question 37

What influences the development of infant food allergies?

Answer 37

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

Question 38

What are common pediatric food allergens?

Answer 38

cow’s milk, wheat, eggs, peanuts, soybeans, tree nuts

Question 39

Why might breastfeeding have allergy preventive effects?

Answer 39

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

Question 40

When should a mother consider avoiding certain foods?

Answer 40

when there is a family history of allergies

when the baby shows allergic symptoms

Question 41

What is the difference between a food allergy and a food intolerance?

Answer 41

allergic reaction involves the immune system

intolerant reaction involves digestion or metabolism

Question 42

What challenges do late preterm infants have that might make breastfeeding challenging?

Answer 42

poor suck-swallow coordination –> poor latch-on and milk transfer
less stamina
less alert, awake periods

Question 43

What is the late-preterm breastfeeding cascade?

Answer 43

challenges result in insufficient milk transfer and breast stimulation to empty completely –> insufficient supply –> hypoglycemia, jaundice, poor weight gain –> readmission, supplementation, separation from mother

Question 44

Why is breastfeeding especially beneficial to preterm infants?

Answer 44

ease of protein digestion, fat absorption
improved lactose digestion
health and development benefits
*milk composition is different

Question 45

What are medical contraindications to breastfeeding?

Answer 45

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

Question 46

What are the recommendations for breastfeeding with HIV?

Answer 46

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

Question 47

What factors contribute to tranmission rates of HIV during breastfeeding?

Answer 47

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