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patient MCQ > Pharmacy infant feeding > Flashcards

Pharmacy infant feeding Flashcards

1
Q

what does WHO recommend for breastfeeding?

A

should be done for the first 6 months of life

and continue alongside solid foods for the first 2 years and beyond

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2
Q

UK rates of breast-feeding

A

<1%

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3
Q

TF theres benefits in health outcomes for mothers and babies who breastfeed

A

true

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4
Q

what is breast milk initially composed of? for how long and why?

A

colostrum- rich in antibodies and WBCs
yellow and thick to set up the IS
nutrients aren’t the priority at this point
for 3 days

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5
Q

when does breast milk reach its full volume

A

about 2-4 weeks

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6
Q

TF: content varies over time and over the feed

A

TRUE

time: to meet infants need, e.g. ratio of casein/ whey products
feed: initially water and protein as fat droplets take longer to move through the system

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7
Q

what does the flavour of the milk depend on?

A

maternal diet

fats have more flavour

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8
Q

how is cows milk modified to make breast milk substitutes (BMS)

A 
reducing fat and protein levels 
adding: sugars especially lactose
oils and proteins 
minerals like iron 
vitamines
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9
Q

TF: breast milk has the lowest protein levels of all mammals milk

A

true

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10
Q

why do you need alot of iron in BMS?

A

not well absorbed (about 10%)

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11
Q

why can BMS cause low grade inflammation of the infant bowel?

A

based on bovine proteins- recognised as a foreign product

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12
Q

does BMS contain living comonents?

A

no

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13
Q

how do you have to make milk up? why?

A

boiled water and allowed to cool but not to below 70 degrees

powder isnt sterile

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14
Q

why can you bottle breast milk and it not grow lots of bacteria?

A

contains WBC so bacteria would actually go down over time

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15
Q

benefits of breastfeeding?

A

optimises microbiome
benefits to maternal health
responsive parenting, good for babys brain development
best for the environment/ sustainability

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16
Q

BMS fed babies are at increased risk of?

A 
gastrointestinal infectsion 
respiratory, ear, urinar infections 
necrotising enterocolitis and late term sepsis 
type 1 and 2 diabetes 
obesity 
dental malocclusions 
sudden infant death
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17
Q

TF: children who are breastfed for longer periods have higher intelligency?

A

true

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18
Q

TF BMS supports a healthier microflora

A

false

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19
Q

how does breast feeding support bonding and attachment

A

frequent close contact
oxytocin and prolactin in mothers
helps mother be attuned and responsive to her babys need

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20
Q

what can decrease brain development in children in the first year and why?

A

lack of social contact
phenomenal brain
develop best with known caregiver who responds quickly, kindly and consistently

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21
Q

unmet needs in babies can cause? effect?

A

release of infant stress hormones

high cortisol levels inhibit brain growth and affect social and brain development

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22
Q

impact of breast feeding on women

A

prevent breast cancer
improve birth spacing
reduce risk of diabetes and ovarian cancer
post natal depression protection

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23
Q

how much could a moderate increase in breasting save the NHS. how

A

50 million

maternal BC, gastroenteritis (20mil), respiratory infection, middle ear infections, necrotising enterocolitis

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24
Q

what type of women tend to breast feed more?

A

well educated
older
professional
ethnic minority

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25
Q

what makes BF hard for women?

A

social attitudes are negative
learn best by seeing and copying but cant do that as not many people do it
anxious about it
restrictions, easier if BF

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26
Q

BMS is only legal for how long… so what did they do?

A

6 months

follow on milk

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27
Q

what is the code for the marketing of BMS

A

code to protect BF from commercial interests rather than prohibit it

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28
Q

what cant BMS companies do inline with the code of marketing?

A

no samples
no contact between companies and parents
no promotion in HC facilities
no gifts to HCP or mothers
no labels which idealise the use of infant formula
no implications that BMS is better than BF
information to HCPs to be factual and scientific only

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29
Q

BF effect on HR

A

stabilises

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30
Q

what reflexes does the baby have in relation to BF?

A 
instincts to find the nipple and latch 
headbobbing 
arm cycling
rooting 
cough and gag
placing reflec
31
Q

when should you feed the baby

A

when they show early feeding cues, dont wait till theyre distressed

32
Q

babies cues for being hungry. why is it best to feed before they’re distressed?

A

sucking fingers

cant draw on reflex behaviours when distressed

33
Q

what happens to the baby reflexes over time?

A

disappear or are inhibited by the frontal lobe as a child moves through normal development

34
Q

what is the birth cry?

A

cry after birth to inflate the lungs for the first time- triggers CV changes

35
Q

how soon after birth do babies make crawling movements?

A

approx 35 minutes after

36
Q

2 tissues which make up breast anatomy

A

glandual and connective

37
Q

arrangement and purpose of glandular tissue of the breast?

A

milk producing cells arranged in clusters with ducts to carry milk to the nipple

38
Q

what makes up connective tissue of the breast?

A

skin, fat, ligaments for support

blood vessles, lymph vessels and nerves

39
Q

what happens to myo-epithelial cells in the breasts during feeding?

A

contract in response to oxytocin. compress alveoli to drive milk to the nipple

40
Q

what types of cells secrete milk

A

lactocytes or acini cells

41
Q

role of prolactin

A

causes the lactocyte to make milk

42
Q

role of oxytocin

A

causes myo-epi cells to contract

43
Q

explain lactogenesis stage 1? time frame? what happens?

A

16 weeks pregnancy to day 3 PN

breast development in pregnancy, clostrum secretion

44
Q

in the first feed what is it composed of??

A

1-5 mls colostrum- infection not nutrients is the aim

45
Q

how many feeds are most common in the first 24 hours?

A

3-8 feeds, can be less

46
Q

explain lactogenesis stage 2, time frame?

A

36-96 hours
copious milk production
mature milk transition

47
Q

which factors can delay and increase copious milk production (lactogenesis 2)? by how long?

A

obesity, C-section
only by about a day
increased if have had previous pregnancy

48
Q

by one month how much milk is being produced?

A

700-800 mls/ day

49
Q

what happens in stage 3 of lactogenesis?

A

gradual switch from endocrine control to local autocrine control through feedback inhibitor of lactation
i.e removal of milk from the breast is the trigger for further production via feedback inhibitor of lactation

50
Q

what does feedback inhibitor of lactation do?

A

down regulates amount of milk

51
Q

process of prolactin when the baby suckles on the breast?

A

sensory impulses pass from the nipple to the brain= prolactin release from AP, travels to the tissue
prolactin stimulates lactocytes to make milk

52
Q

when do prolactin levels peak and why?

A

after the feed- to produce more milk ready for the next feed

53
Q

how quickly does prolactin rise and fall?

A

slowly

54
Q

what time of day is the prolactin response greatest? what does this mean regarding skipping feeds?

A

in the night
try not to skip night feeds early on before establishment or the milk supply can drop off as dont have prolacting stimulation on lactocytes

55
Q

explain the ‘let down’ reflex when the baby suckles?

A

sensory impulses pass to the brain
oxytocin released from the pituitary
myo-epi cells contract to propel milk collected in the alveoli towards the nipple
muscle cells in the ducts cause the ducts to open

56
Q

what is feedback inhibitor of lactation? what happens if it builds up in the alveoli?

A

protein formed by the lactocytes as part of the milk

if it builds up it acts as a local hormone to slow milk production

57
Q

what can you do to stop the impacts of FIL?

A

empty breasts even if she cant feed- to keep up milk supply

frequent sucking and emptying of the breast maintains production

58
Q

TF a woman must feed from both breasts to stop one becoming engorged?

A

NO

59
Q

effect of poor positioning and attachment to the breast?

A

nipple pain, poor weight gain

60
Q

when should solid foods be introduced?

A

exclusive BF in the first 6 months and then nutrient rich complementary foods thereafter with continued BF for 2 years

61
Q

what is a sign babies arent ready for solid foods?

A

tounge out when put the food in

62
Q

effects of making up the wrong concentration bottle feed?

A

too much: too much sodium- bad for kidneys

too little: lack of nutrients

63
Q

way to make up a bottle?

A

1 level scoop to 30ml water - WATER first due to displacement
use water which has been boiled and cooled to no less than 70 degrees

64
Q

what to do with remaining bottle milk?

A

discard after an hour

65
Q

can a baby stay on ‘first milks’

A

no reason for a baby to be moved off this

66
Q

what are second milks?

A

more casein based protein- longer to digest so kept full

can cause constipation

67
Q

when is cows milk suitable for babies?

A

after 1 year

68
Q

can follow on milks be used before the 6 months

A

no doesnt contain enough nutrients

69
Q

should we recommend probiotics in infant feeds?

A

no evidence to suggest it is beneficial

70
Q

should we recommend prebiotics to the feed?

A

also insufficient evidence but most formulas contain it

71
Q

how much a bottle be made?

A

must meet the UK standard
food grade plastic
smooth interiors and easy to clean- must be sterilised
accurate, easy to see measures

72
Q

what size do you want the bottle hole?

A

size so milk drips out if upturned at the rate of one drop per second

73
Q

what happens if the milk flow is too fast or slow?

A

fast: gagging and choking
slow: work to hard for the milk

will alter feeding success

74
Q

things in place to protect BF from commercial interests?

A

not advertising to parents of babies up to 1 year old
no free samples
no contact between reps and parents
no promotion at health care facilities
no gifts to mothers or health care workers
no idealisation of formula with labels or pictures
contain warning labels
no implication formula is better than feeding
factual and scientific information only to HCPs

patient MCQ (22 decks)

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