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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
what makes BF hard for women?
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
26
BMS is only legal for how long... so what did they do?
6 months | follow on milk
27
what is the code for the marketing of BMS
code to protect BF from commercial interests rather than prohibit it
28
what cant BMS companies do inline with the code of marketing?
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
29
BF effect on HR
stabilises
30
what reflexes does the baby have in relation to BF?
``` instincts to find the nipple and latch headbobbing arm cycling rooting cough and gag placing reflec ```
31
when should you feed the baby
when they show early feeding cues, dont wait till theyre distressed
32
babies cues for being hungry. why is it best to feed before they're distressed?
sucking fingers | cant draw on reflex behaviours when distressed
33
what happens to the baby reflexes over time?
disappear or are inhibited by the frontal lobe as a child moves through normal development
34
what is the birth cry?
cry after birth to inflate the lungs for the first time- triggers CV changes
35
how soon after birth do babies make crawling movements?
approx 35 minutes after
36
2 tissues which make up breast anatomy
glandual and connective
37
arrangement and purpose of glandular tissue of the breast?
milk producing cells arranged in clusters with ducts to carry milk to the nipple
38
what makes up connective tissue of the breast?
skin, fat, ligaments for support | blood vessles, lymph vessels and nerves
39
what happens to myo-epithelial cells in the breasts during feeding?
contract in response to oxytocin. compress alveoli to drive milk to the nipple
40
what types of cells secrete milk
lactocytes or acini cells
41
role of prolactin
causes the lactocyte to make milk
42
role of oxytocin
causes myo-epi cells to contract
43
explain lactogenesis stage 1? time frame? what happens?
16 weeks pregnancy to day 3 PN | breast development in pregnancy, clostrum secretion
44
in the first feed what is it composed of??
1-5 mls colostrum- infection not nutrients is the aim
45
how many feeds are most common in the first 24 hours?
3-8 feeds, can be less
46
explain lactogenesis stage 2, time frame?
36-96 hours copious milk production mature milk transition
47
which factors can delay and increase copious milk production (lactogenesis 2)? by how long?
obesity, C-section only by about a day increased if have had previous pregnancy
48
by one month how much milk is being produced?
700-800 mls/ day
49
what happens in stage 3 of lactogenesis?
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
what does feedback inhibitor of lactation do?
down regulates amount of milk
51
process of prolactin when the baby suckles on the breast?
sensory impulses pass from the nipple to the brain= prolactin release from AP, travels to the tissue prolactin stimulates lactocytes to make milk
52
when do prolactin levels peak and why?
after the feed- to produce more milk ready for the next feed
53
how quickly does prolactin rise and fall?
slowly
54
what time of day is the prolactin response greatest? what does this mean regarding skipping feeds?
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
explain the 'let down' reflex when the baby suckles?
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
what is feedback inhibitor of lactation? what happens if it builds up in the alveoli?
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
what can you do to stop the impacts of FIL?
empty breasts even if she cant feed- to keep up milk supply | frequent sucking and emptying of the breast maintains production
58
TF a woman must feed from both breasts to stop one becoming engorged?
NO
59
effect of poor positioning and attachment to the breast?
nipple pain, poor weight gain
60
when should solid foods be introduced?
exclusive BF in the first 6 months and then nutrient rich complementary foods thereafter with continued BF for 2 years
61
what is a sign babies arent ready for solid foods?
tounge out when put the food in
62
effects of making up the wrong concentration bottle feed?
too much: too much sodium- bad for kidneys | too little: lack of nutrients
63
way to make up a bottle?
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
what to do with remaining bottle milk?
discard after an hour
65
can a baby stay on 'first milks'
no reason for a baby to be moved off this
66
what are second milks?
more casein based protein- longer to digest so kept full | can cause constipation
67
when is cows milk suitable for babies?
after 1 year
68
can follow on milks be used before the 6 months
no doesnt contain enough nutrients
69
should we recommend probiotics in infant feeds?
no evidence to suggest it is beneficial
70
should we recommend prebiotics to the feed?
also insufficient evidence but most formulas contain it
71
how much a bottle be made?
must meet the UK standard food grade plastic smooth interiors and easy to clean- must be sterilised accurate, easy to see measures
72
what size do you want the bottle hole?
size so milk drips out if upturned at the rate of one drop per second
73
what happens if the milk flow is too fast or slow?
fast: gagging and choking slow: work to hard for the milk will alter feeding success
74
things in place to protect BF from commercial interests?
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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