week 6 breastfeeding

Question 1

what to do if infants are weaned off breastmilk before 12 months?

Answer 1

should receive iron- fortified infant formula

Question 2

benefits of breastfeeding infant/child

Answer 2

-Reduced infant and child mortality
-Enhanced maturation of the gastrointestinal tract and immune factors
-↓ risk for gastroenteritis, celiac disease, Crohn disease, necrotizing enterocolitis in preterm infants, obesity
-Helps protect against otitis media, respiratory illnesses, bacteremia, and bacterial meningitis
-Lower incidence of certain allergies among breastfed infants, particularly for families at high risk
-Less likely to die from SIDS
-Protective effect against childhood lymphoma and type 1 and type 2 diabetes mellitus
-Decreased risk of dental malocclusions
-Enhance cognitive developmental for term and preterm infants
-Pain relief for newborns undergoing painful procedure
-baby is less likely to get sick overall even in the beginning weeks of life

Question 3

Benefits of Breastfeeding - mother

Answer 3

-↓ postpartum bleeding and more rapid uterine involution
-↓ risk of ovarian cancer, breast cancer, rheumatoid arthritis, hypertension, hypercholesterolemia, cardiovascular disease, and type 2 diabetes
-Helps in rapid postpartum weight loss
-May provide protection against development of osteoporosis
-Delayed return of menses
-Unique bonding experience
-↑ maternal role attainment
-May provide protection against perinatal mood disorders when breastfeeding difficulties addressed

Question 4

Conditions that are NOT considered contraindications to breastfeeding are as follows

Answer 4

• Maternal infection with Hepatitis A or C
• Hepatitis B surface antigen (HBsAg)–positive status
  (newborn receives immunoglobulin and vaccine) * Mothers who are cytomegalovirus (CMV) positive
• Maternal herpes simplex lesion on a breast (Mothers can continue to breastfeed on the unaffected breast. Avoiding contact with the lesion is important.)
  -moms on methadone

Question 5

Contraindications to Breastfeeding

Answer 5

• Maternal cancer therapy, diagnostic and therapeutic radioactive isotopes or radioactive iodine
• Active tuberculosis not under treatment in the mother * Human immunodeficiency virus (HIV) infection in the
  mother, in high-income countries
• Galactosemia (classic) in the infant
• Maternal substance use (e.g., cocaine, methamphetamines, marijuana).
• Maternal human T-cell leukemia virus type 1 or II (HTLV) * Some medications (although rare) that may exert an
  untoward effect on the breastfeeding infant;

Question 6

when is an ideal time to begin breastfeeding post delivery?

Answer 6

should be 1 hour after birth -baby is quiet and alert at state

Question 7

what is rooming-in?

Answer 7

Rooming-in ensures that the newborn stays in the room with the mother- helps with breastfeeding

Question 8

what are the cues of feeding in babies

Answer 8

-hand to mouth- or hadn’t to hand movements
-sucking motions
-rooting reflex- infants move towards whatever touches the area around the mouth and attempts to suck
-mouthing
-flexed arms and legs with clenched fits, held over chest and tummy- called hunger posture

Question 9

how to prevent trauma to the nipple when removing baby from breast?

Answer 9

-to prevent nipple trauma as the newborn is taken off the breast, the breastfeeding patient is instructed to break the suction by inserting their finger in the side of the infant’s mouth between the gums and keep it there until the nipple is completely out of the newborns mouth

Question 10

latch on position

Answer 10

-mom feels a firm tugging sensation on the breast, but should feel no pinching or pain
-baby sucks with cheeks rounded and not dimpled
-baby’s jaw glides smoothly w/ sucking
-swallowing is usually audible and sounds like a “ca” sound
- the baby cannot be easily removed from the breast
- mother’s nipple is not distorted when the baby release from the breast

Question 11

how many times should you breastfeed per/day?

Answer 11

8x per day or every 1-3 hours

Question 12

Newborn Urine and Stool Output on Day 1

Answer 12

1 or more wet, clear, pale, yellow pee
1 or more meconium

Question 13

Newborn Urine and Stool Output on Day 2-3

Answer 13

2-3 wets, clear, pale yellow
1 more meconium or greenish brown color

Question 14

Newborn Urine and Stool Output on Day 3-5

Answer 14

3-5 wets, clear, pale yellow
3-4 transitional stools changing to loose and yellow

Question 15

Newborn Urine and Stool Output on Day 5-7

Answer 15

4-6 wet, clear, pale and yellow
3-6 yellow or golden -usually loose stool

Question 16

Newborn Urine and Stool Output on Day 7-38

Answer 16

frequent -clear, pale, yellow (at least 6)
BM: should be 5-10 yellow

Question 17

sore nipples

Answer 17

-usually d/t a poor latch/ineffective suck
-break suction, and reposition baby again
-rub breast milk on the nipple after feed
-encourage air dying of nipples after feed and change nursing pads
-don’t wear a tight bra

Question 18

engorgement

Answer 18

-often happens 2-6 days postpartum when there’s an increase in milk production
-breasts are hard, throbbing, nipples are flat
-feed frequently
-soften breasts w/ warm compress, shower, hand expressing before feed
-may cause a plugged duct

Question 19

plugged ducts

Answer 19

-massage the breast before and during feed
-feed on unaffected side first and ensure emptying
-may be d/t engorgement

Question 20

Mastitis:

Answer 20

-infection that commonly occurs 2-3 weeks postpartum
S/S
-fever, tachycardia, chills, malaise, headache, enlarged axillary nodes
-breastfeed every 2-3 hours
-use warm compress and massage the breast
- antibiotics and antipyretics
-this affects mom not baby, so yes you can continue to breastfeed

Question 21

formula feeding

Answer 21

-feeding child solely on formula as a supplement to human milk

Question 22

how can we tell is the infant is in stress during feedings?

Answer 22

-turning the head
-arching the back
-chocking- sputtering
-changing color
-moving the arms, and tensing fists
-infants swallow air from a bottle and need a chance to burp several times during a feeding
-pace feeding, risks overfeeding baby

Question 23

formula feeding over-dilution and under-dilution

Answer 23

over-dilution- baby is not getting the required nutritions and calories needed to function
-under- dilution - can lead to hypernatremia- straining the newborns kidney’s

Question 24

formula considerations

Answer 24

formula should never be microwaved!!!
-should be a room temp, warm, cold even but not hot
-Bottle fed infants do not need supplemental vitamin D for first 6 months
-Any formula left in the bottle after the feeding should be discarded because the infant’s saliva has mixed with it
-during feed, keep nipple full of milk, air bubbles may cause gas
-cleaning bottles, you can use soap and water, no need to sterilize anymore.

Question 25

complementary feeding - introducing solids

Answer 25

-foods or liquids given to the infant in addition to breast milk or formula
-after 6 months of age
-iron-fortified cereal, meat, meat alternatives, are recommended to be the FIRST solids introduced
-start fruits and vegetables at 8 MONTHS

Question 26

attachement

Answer 26

is an emotional bond between baby and its parent that results from the satisfying interaction between parent and infant.
Attachment and bonding are used interchangeable

Question 27

postpartum blues

Answer 27

-Episodes of tearfulness, agitation, mood swings, anxiety, sleep and appetite disturbances, and feelings of being overwhelmed
-happens 1-5 days postpartum
-can be challenging to breastfeed
-associated with hormonal changes
-resolves after 2 weeks and does not disrupt the postpartum pt ability to care for themselves or there babies

Question 28

s/s of postpartum blues

Answer 28

-mood swings, crying spells, feeling low, fatigue, frustrating, anxiety, emotional, confused or muddled thinking

nurse should validate, reassure, and educate

Question 29

perinatal mood disorder

Answer 29

-triggered by hormonal changes, physical changes, emotional and social changes
-very stressful
-disrupts family life, and can negatively affect the couples relationship
-indigenous, black people, and adolescent have a higher chance of developing postpartum depression (SDH, colonization, racism, marginalization, poverty, + lack of culturally safe care)

Question 30

risk factors for PMD
strongest risk factors:

Answer 30

-strongest risk factors would be a hx of psychiatric illness (depression/anxiety at any given time)
-prenatal symptoms of anxiety
-onset of depression during pregnancy or postpartum

Question 31

risk factors for PMD
moderate risk factors:

Answer 31

-stressful life (divorce, losing a job)
-refugee or immigrant status
-low social support
-unfavourable obstetrical outcomes
-low -self esteem
-hx of physical or sexual abuse during life
-domestic violence
-hx of reproductive trauma. like infertility
-grief r/t miscarriage, stillbirth or infant loss
-substance abuse

Question 32

weak risk factors of PMD -postpartum depression

Answer 32

• low socioeconomic status
  -lack of a partner
  -pregnancy-unplanned or unwanted
  -breastfeeding challenges

Question 33

complications of having PMD

Answer 33

-Mother–infant attachment issues
-Depression in the partner
-Long-term emotional behavioural and cognitive issues in the child
-Relationship issues and family breakdown
-Social, financial, and occupational complications
-Self-harm and suicide
Infant and sibling neglect and occasionally infanticide

Question 34

Perinatal Anxiety

Answer 34

a feeling of constant worrying
-constant anxiety
provide medication relief

-selective serotonin reuptake inhibitors (SSRIs) and antianxiety medications
Benzodiazepines provided for short-term relief
-encourage to put usual chores on hold and ask for help

Question 35

what is PDM

Answer 35

-perinatal depression
-intense and pervasive sadness w/ severe and labile mood swings that last longer than 2 weeks
-irritability
-feelings of detachment
-guilt and shame
-obsessive thought about harming the infant
-reluctant to share and seek assistance

Question 36

Postpartum Psychosis

Answer 36

this is RARE
-episodes of abnormally high energy levels, cognition and mood swings (mania)
-characterized by depression
-hallucinations
-delusions
-thoughts of harming either infant or self - hight risk for suicide or infanticide

benzodiazepine is the treatment of choice - want to give antipsychotic medications, and mood stabilizers
-can also do electroshock therapy (ECT)

Question 37

PMD screening

Answer 37

-Screening for anxiety or depression during pregnancy and the postpartum period aids in prevention and early intervention for PMD.
-Screening-Edinburgh Postnatal Depression Scale (EPDS)
-Postpartum Depression Screening Scale (PDSS)
-A maximum score on the EPDS is 30; patients with scores of 10 or higher may possibly have depression and need further assessment

Question 38

4 stages of grief -phases can overlap

Answer 38

phase 1-shock and numbness - sense of unreality, loss of innocence and powerless, feeling like having a bad dream, denial, disbelief
-person can feel sad, devastated, emotional, cannot concentrate or make decisions
-may also express lack of effect, euphoria and calmness, numbness, denial
phase 2- searching and yearning
-feeling lonely, empty and yearning- guilt may occur, helplessness, anger, resentment, bitterness, and irritability
-phase 3- disorientation- deep sadness and depression, insomnia, social w/drawl, and lack of energy
-phase 4- reorganization and resolution
-self esteem and confidence, can cope with new challenges, and have placed the loss in perspective, kind of like accepting the loss