Week 5 - Module - Infant feeding Part 1 - Breastfeeding

Question 1

Breast-fed infants are shown to have better heath outcomes in certain conditions compared to formula-fed infants. Name some of the benefits for breast infants?

Answer 1

Better outcomes in * Acute otitis media * Gastroenteritis * Obesity * Childhood leukamia * Atopic dermatitis Reduced likelihood of developing type 1 and 2 diabetes Higher IQ Lower cholesterol

Question 2

What is the condition that develops when the tissue in the inner lining of the small or large intestine becomes damaged and begins to die. This causes the intestine to become inflamed? Usually seen in forumala fed babies over breast fed babies

Answer 2

This is necrotizing enterocolitis

Question 3

The exact cause of necrotizing enterocolitis is unknown What is the proposed cause of the condition however? Name 2 risk factors associated with the condition?

Answer 3

The exact cause of NEC isn’t known. However, it’s believed that a lack of oxygen during a difficult delivery may be a contributing factor. When there’s reduced oxygen or blood flow to the intestine, it can become weak. A weakened state makes it easier for bacteria from the food entering the intestine to cause damage to the intestinal tissues. This can lead to the development of an infection or NEC. Preterm (premature) births and formula fed babies

Question 4

Breast feeding mothers are shown to have better health outcomes in certain conditions compared to those who have never breast fed Name at least 4 better outcomes?

Answer 4

Less likely to suffer from Type II diabetes Ovarian cancer Breast cancer Post-natal depression Early return of fertility (remains as a natural contraceptive)

Question 5

True or false 1. All infants should be breast fed exclusively for a max of 3 months? 2. Breast-fed babies should be given cooled down, boiled water, to quench thirst especially in the summer months? 3. Solid foods should be introduced after 3 months? State why

Answer 5

1. False - It is recommended that infants should be exclusively breast fed for the first 6 months of pregnancy 2. False - Unless medically indicated, no other food or drink should be given to babies in the 1st 6 months of pregnnacy 3. False - Recommened age of solid foods introduction is 6 months

Question 6

True or flase 1. Mothers should stop breastfeeding after solid foods have been introduced? 2. Solid foods should be introduced at the same time for formula and breast fed babies?

Answer 6

1. False - Mothers should continue with breastfeeding as long as the baby and mother wish 2. True - Currently it is recommended that solids are introduced at the same time for formula and breast fed babies

Question 7

One in 4 women of childbearing age in the UK have low vitamin D levels. Department of health recommends daily supplements for all mothers and infants What is the daily supplement for each for: Pregnant and breastfeeding women? All infants from 6 months?

Answer 7

All pregnanct and breastfeeding women - 10micrograms/day All infants from 6 months- 7micrograms / day

Question 8

Transmission of HIV from mother to infant can occur during pregnancy, labour and breastfeeding (only if there is an active viral load of HIV) What is done to reduce the risk of MTCT (mother to child transmission)?

Answer 8

Anti-retroviral treatment during pregnancy Vaginal delivery if undetectable viral load but caesaren if detectable - follow up with post exposure prophylaxis for the child Exclusive forumla feeding for the baby

Question 9

What are the three different types of breast milk produced by the mother? (one is in the first few days, the other days are at the early and late of a feed)

Answer 9

Colostrum Foremilk Hindmilk

Question 10

Why is colostrum good? When is it produced?

Answer 10

Colostrum is produced from mid-pregnancy and the first few days of after birth It contains the contains a high level of immune proteins and therefore helps colonise the baby with normal bacteria that is not a risk of infection - rich in nutrients and antibodies

Question 11

What effect does colostrum have which helps the baby to pass meconium?

Answer 11

The colostrum has a laxative effect to help the baby pass meconium

Question 12

Do infants require a large amount of colostrum with each feed? What colour is the colostrum? What immmunoglobulin is passed in the breatst milk?

Answer 12

Infants only a require a few mls of colostrum with each food. It is produced in sufficient quantities to meet the infants nutritional needs and provide immunity to infection- infant only needs litttle milk during the first 48-72 hours The colostrum is a yellowish colour IgA is passed in the breast milk

Question 13

What are the five antibodies? Are they monomers, dimers, tetramers or pentamer? Which crosses over the placenta to provide immunity during pregnancy and shortly after birth? What is the most common immunoglobulin? What is the first to appear in response to an antigen?

Answer 13

IgA, IgD, IgE, IgG, IgM

Monomer - IgD, IgE, IgG

Dimer - IgA

Pentamer - IgM

• IgG is the most common antibody and crosses over the placenta to provide immunity
• IgM is the first antibody in response to infection (M for iMMediate)

Question 14

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Answer 14

A - True (mature milk has the same overall daily intake of immune proteins as colostrum) B - True C - True - milk volume increases ater 24-48hours D - True E - False

Question 15

Why is breast milk slightly blue and translucent with the cream layer on top? What is milk at the beginning of the feed known as? What ingredients is it high and low in?

Answer 15

Breast milk does not contain casein - this is the milk solid that reflects light - therefore is slightly translucent Milk at the beginning of the feed is known as the foremilk - it is low in fat and calories but high in sugar and water and proteins The hindmilk is the ilk at the end of the feed high in fat and calories - this is why it is important to drain the milk from one breast before moving to the other

Question 16

Production of breast milk is stimulated by hormones which are produced by the baby suckling or other methods of expressing breast milk * What hormone produces breast milk and what hormone causes its ejection? * How does the baby suckling cause their production / release? (where does this happen) * What kind of feedback control is breast milk release and production under?

Answer 16

When the baby suckles, sensory impulses are sent from the nipple to brain Prolactin is produced in the anterior pituitary gland in response to the babies suckling and this causes the production of breast milk Oxytocin is released from the posterior pituitary gland in response to suckling and the babies feeding to cause milk ejection from the nipple Positive feedback - milk removal helps milk production

Question 17

Many consider that the most important aspects of breast feeding are positioning and attachment of the baby. Good attachment is essential for effective, pain free breast feeding What can poor attachment lead to?

Answer 17

Poor attachmnet can lead to Sore nipples Engorgement Mastitis - engorgement increases this likelihood Unsettled baby, very frequent baby and failure to thrive as not good milk supply

Question 18

Attachment refers to how the infant takes the breast into the mouth for breastfeeding Positioning refers to how the mother positions the baby to enable feeding What are the important principles of positioning? (ie babies head position,)

Answer 18

The mother is comfortable and well supported The babies head is close to the mother and turned towards the mother’s body Babies head neck and back are in a striaght line with head slighlty tilted Babies nose should be in alignment with the nipple and the head should not be flexed

Question 19

Where should the nipple insert into the mouth when feeding?

Answer 19

The nipple should be at the junction of the hard and soft palate when feeding

Question 20

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Answer 20

A - True B - false - Vit D supplements of 10microgram should be taken daily by all pregnant and breastfeeding women C - True D - True E - False - Breast feeding should be done when requried (usually around 6-15) but doesnt have to be timetabled

Question 21

What is the recommended vitamin D intake for infants?

Answer 21

Recommended intake is 7micrograms per day for all breastfed infants after six months of age

Question 22

When is it promoted that mothers begin breastfeeding the children? When should mother breast feed their children during development? (ie what is on demand feeding)

Answer 22

Promoted to try begin breast feeding within the 1st hour of birth Breast feeding should be frequent and baby led (on demand) feeding

Question 23

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Answer 23

A - feeding on demand - do not abandon is it is important for breastfeeding B - Unlimited mother-baby contact - good - do not abandon C - Supplemental feeds without medical reasons - infants should be exclusively breast fed for the first six months of life unless medical reasons - therefore abandon D & F - abaondon promoting infant formula

Question 24

There are several reasons why a mother may need to express breast milk What are some of these reasons?

Answer 24

Breasts feel full and uncomfortable prior to breast feeding The infant is too small or sick to breastfeed Mother is unable to come into contact with baby ie hospitalisation

Question 25

What are ways to encourage the flow of breast milk?

Answer 25

The mother should be in a comfortable and relaxed environment and in close contact with infant - preferably skin to skin A warm bath r shower or applying warm flannels to the breast

Question 26

After expressing into a sterilised container, the container should be covered with a tight fitting lid and labelled with the date. Expressed milk can be stored for how long? A - Up to seven days in the coldest part of a fridge - 4degrees or lower B - Up to four weeks in the freezer compartment of the fridge C - Up to six months in a domestic freezer, at minus 18 degrees or lower

Answer 26

C - Expressed milk can be stored for up to six months in a domestic freezer at minus 18 degrees or lower

Question 27

How long can expressed milk be stored in a fridge? How long can expressed milk be stored in the freezer compartment of the fridge?

Answer 27

Expressed milk can be stored for up to 5 days in the fridge - 4degrees or lower It can be stored in the freezer compartment of the fridge for up to 2 weeks Expressed milk can be stored in a domestic freezer for up to six months - minus 18 degrees or less

Question 28

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Answer 28

A - False - leaflets alone are not good enough B - True C - True D - safe to store in coldest part of fridge for 5 days (2weeks in freezer compartment of fridge, 6months in domestic freezer (minus 18 or below) E - Do not defrost breast milk in the microwave

Question 29

How should breast milk be defrosted?

Answer 29

Breast milk should be defrosted in the fridge and used within 24 hours of defrosting

Question 30

Women who experience problems with feeding will be anxious and can experience severe pain It is therefore important they recieve accurate, consistent and timely help. Four main problems with women and breast feeding are Painful nipples, engorgememnt, mastitis and concerns about not having enough breast milk What causes painful nipples? What is engorgement and mastitis?

Answer 30

Painful nipples is caused by poor attachment of baby to nipple (nipple should be at junction of hard and soft palate) Engorgement is painful swelling of the breasts Mastitis is red inflamed breasts

Question 31

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Answer 31

A - False B - True C - True D - False E - False

Question 32

Expressing a little milk before feeds may help with attachment for the infant Expressing a little milk between feeds is likely to relieve the symptoms of engorgement and mastitis Feeding more frequently is also likely to relieve the symptoms Why should aspirin not be given to relieve the pain? What can be given instead?

Answer 32

Aspirin should not be given in children as it is thought to be linked to a disease known as Reye’s syndrome Instead of giving aspiring to children, ibuprofen or paracetamol should be given

Question 33

* In Reye’s syndrome, it’s thought that tiny structures within the cells called mitochondria become damaged. * Mitochondria provide cells with energy and are vital for the healthy functioning of the liver. * If the liver loses its energy supply, it begins to fail. This can cause a dangerous build-up of toxic chemicals in the blood, which can damage the entire body and can cause the brain to swell. What substance containing nitrogen is in high levels?

Answer 33

Ammonia levels rise in the blood in reyes syndrome - hyperammonaemia - toxic to brain

Question 34

If a mother is worried about not producing enough breast milk for the infant, there are positive signs that can be explored * Appropriate assessment of weight * Several (six or more) wet nappies in 24 hours * At least three dirty nappies in 24 hours It is normal for breast fed infants to lost how much weight in the first few days after birth? What chart is used to assess the growth of a child?

Answer 34

It is normal for breast fed infants to lose up to 10% of their weight in the first few days after birth The UK-WHO gorwth chart is used to assess the growth of the child

Question 35

Should the babies nose or chin be indenting into the breast during feeding? Should more areola be visible above the top lip or below the bottom lip? Should the babies cheeks be pulled in or rounded?

Answer 35

The babies chin (NOT THE NOSE) should be indenting into the breast during feeding More areola should be visible above the top lip than below the bottom lip The babies cheeks should be rounded

Question 36

Mother comes in with red inflames breasts What is this?

Answer 36

This is mastitis

Question 37

What is the most important initial management of mastitis in a mother?

Answer 37

Advice the mother to feed frequently and to express milk between feeds

Question 38

When should antibiotics be considered in mastitis?

Answer 38

If the symptoms of mastitis have not improved after 12-24 hours - consider giving flucloxacillin