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125 Cards in this Set
- Front
- Back
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What do hormones during pregnancy promote in terms of breastfeeding? |
They promote growth and branching of duct system & milk producing cells in preparation for lactation |
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What are the 2 key lactation hormones? |
Prolactin and Oxytocin |
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What is the main function of prolactin? |
milk production |
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What is the main function of oxytocin? |
Cause mammary glands to eject milk into ducts |
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Is breastfeeding an instinct or learned behavior? |
Learned |
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What are the difficulties of breastfeeding? |
-Not "natural" experience -Can take weeks to get adjusted -Can be initially painful |
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What are major factors that influence the success of breastfeeding? |
Your partner and adequate nutrition and rest. |
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Hormones contributing to breast development and lactation
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How does the development of the mammary glands progress? |
During puberty-system of ducts, lobes, alveoli develop Pregnancy- system remains inactive, proliferates with ductal branching and lobular-alveolar development proceeding at a spectacular rate, yet in an orderly fashion |
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Physiology of Breast Tissue |
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Breast Tissue & Duct System |
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What % of mothers begin breastfeeding? |
80% |
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True or False: At three months there is a significant drop of breastfeeding mothers. |
True |
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Where are the lobes of the breast tissue(adipose) located? |
in between the fatty tissue |
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Why does the areola get dark? |
When infant is born, has limited vision so they can see where to latch on better |
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What is the pathway of the milk? |
Hormone → Alveoli →Alveolus → cluster of cells → milk production in cells → middle duct → nipple |
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What is lactogenesis? |
milk production |
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What are the stages of Lactogenesis? |
I →(birth to 2-5 days) milk formation begins II→(begins 2-5 days after birth) increased blood flow to breast; milk "comes in" III→(begins at about 10 day after birth) milk composition is stable |
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Do babies need a lot of milk right away? |
NO about 1/2 oz maybe |
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What are the lactation hormones? |
Prolactin and Oxytocin |
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How does prolactin and oxytocin function in lactation? |
Prolactin- stimulates milk production, released in response to suckling, stress, sleep Oxytocin - stimulates letdown, tingling of the breast may occur corresponding to contractions in milk duct, cause uterus to contract, seal blood vessels, & shrink in size (prepping for another pregnancy) |
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True or False: Breastfeeding actually helps a woman return to normal much faster.
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True |
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Breastfeeding Cascade System and Hormones Involved |
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What is the cascade of breastfeeding to milk ejection? |
Suckling→Hypothalmus→Post Pit→Oxytocin→contraction of myoepithelial cells surrounding alveoli→milk ejection |
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What is the cascade of breastfeeding to milk secretion? |
Suckling→Hypothalmus→Anterior Pituataryuckling→Hypothalmus→Prolactinuckling→Hypothalmus→secreition by alveolar epithelial cells→milk secretion |
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Which pituitary glands go with what hormones? |
Ant Pit- Prolactin Post Pit - oxytocin *simultaneously work together for it to occur |
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What is the Let Down Reflex for Lactation? |
Suckling→Hypothalamus→prolactin and oxytocin released→Oxytocin promotes milk letdown→prolactin acts on the milk-producing glands to stimulate milk synthesis |
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Why is infant suckling important? |
It causes the nerve receptors in the nipple to send signals to the hypthalamus which triggers the release of prolactin and oxytocin |
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What influences the taste of the breastmilk? |
Whatever the flavor foods are in the mother's diet |
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When are the infants more interested in the breastmilk? |
If the mother's milk flavor is new |
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How can new breastmilk flavors benefit the child? |
Exposure to a variety of flavors may contribute to infant's interest and acceptance of new flavors in solid foods |
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What are some benefits of breastfeeding to the mom? |
Hormonal benefits- increased oxytocin stimulates uterus to return to prepregnancy status Physical benefits- Delay in monthly ovulation resulting in longer intervals between pregnancies(not reliable contraceptive measure) Psychological Benefits- Increase self-confidence and bonding with infant |
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What are health benefits of breastfeeding for mom? |
-Conserves iron stores(delay of menstruation) -May protect against ovarian and breast cancer, reduce risk of type 2 diabetes -Increases energy expenditure, contributing to weight loss (mom uses stored fat to make breast milk |
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What are benefits of Breastfeeding to the Infant? |
-optimal nutrition -balanced nutrients -isosmotic human milk -meets protein needs without overloading kidneys -contains soft, easily digestible curd -provides generous amounts of the right lipids(long chain polyunsaturated fatty acids are present) -enhanced availability of minerals |
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What are some health benefits of breastfeeding for an infant? |
-Immunological benefits and lower infant mortality (infection protection) -Fewer acute illnesses and reductions in chronic illnesses (reduce risk of celiac, IBS, leukemia, allergies and asthmatic disease) |
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What is a weight benefit of breastfeeding to the infant? |
Typically breastfed infants are leaner at one year. With breastfeeding the child feeds at will. Formula sometimes child is overfed, maybe deters internal cures of self regulating appetite. |
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What are cognitive benefits of breastfeeding? |
Increased cognitive ability, some studies suggest higher IQ among bf babies, better neurological development. |
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What are analgesic effects to bf baby? |
Reduction of infant pain, also decreased need for medical care and lower medical costs |
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When does a babies need to learn to regulate their own intake begin? |
Starts at breastfeeding |
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True or false: Formula can give antibodies like mother's milk |
False, only breastmilk will have antibodies |
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What factors is milk synthesis related to? |
-How vigorously an infant nurses -How much time infant is at breast -How many times per day infant nurses(10-12x a day when first born) |
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Can women make enough milk? |
As long as nothing is wrong with breast tissue/alveoli/function |
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Does the size of the breast limit a woman's ability to nurse her infant? |
No |
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What is a baby friendly hospital? |
Give babies to mom right away, can bond and breastfeed. Encourage breastfeeding. |
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Is feeding frequency related to the amount of milk a woman makes? |
Rate of milk synthesis is variable between breasts and between feedings |
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Can women breastfeed after breast reduction or augmentation? |
Depends: Usually as long as duct system is intact and functional. |
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Does silicone from breast implants leach into the milk? |
No evidence of direct toxicity to the infant |
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What is the best alternative to breastfeeding? |
Pumping breast milk, milk has to be frozen right away |
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Can women pump or express enough milk? |
Stimulating adequate milk may require 8-12 expressions a day |
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What are the different types of pumps that can be used? |
-manual -hand pumps -commercial electric pumps -hospital grade electric pumps-best |
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What are the benefits of an electric pump versus a hand or manual pump? |
They are faster, can pump both breast simultaneously |
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True or False: In CA, by law, employers have to supply a place and time to pump breastmilk. |
True |
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What does AAP reccommend in regards to breastfeeding? |
AAP (American Academy of Pediatrics) recommends exclusive bf for the first 6 months after birth, and bf in combo with solid foods until at least age 1 |
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Why is breastmilk ideal? |
-Breastmilk contains the right balance of nutrients for baby and boosts baby's immune system -considered gold standard for infant nutrition |
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When should you give solid food? |
When they can sit up and have good muscle control(in neck especially) |
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What is the colostrum? |
The first milk secreted during the first few days postpartum, slightly yellow when milk comes in "dirty"(betacarotene-Vit A makes milk yellow) |
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What is unique about the colostrum? |
It is very high in proteins such as secretory IgA & lactoferirin. Mild milk-highly protective against disease |
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Water in breastmilk |
-major component in human milk -isotonic with maternal plasma |
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Energy in breastmilk |
-about 0.65 kcal/mL -calories may vary with fat, protein and CHO composition -Lower in calories than infant formula |
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Why is breastmilk high in fat? |
Need fat in milenation of nerves, brain development |
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Why is cow's milk bad for baby? |
20% protein, hurts infant's gut, too heavy protein level, infant can't support it. |
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Lipids in Human Milk |
-provide 1/2 the calories of human milk(more fat in bm than infant formula, 55% vs. 49%) |
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What is the effect of maternal diet on fat composition? |
-fatty acid profile reflects dietary intake of mother -Very low fat diet w/ adequate CHO & protein, milk is high in medium-chain fatty acids |
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DHA(docosahexaenoic)-found in breastmilk |
-Essential fatty acid -For retinal development(eyes) -associated with higher IQ scores -Can be found in fatty fish, walnuts |
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Cholesterol in Human milk |
-Higher in human milk than infant formula -early consumption of cholesterol through breast milk appears to be related to lower blood cholesterol levels later in life(weight control, better ability to maintain appetite) |
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Total proteins in human milk
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-lower than in whole cow's milk(.32 vs. .96 g/fl oz) -Have antiviral & antimicrobial effects |
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Casein in human milk. |
-Main protein in mature human milk -facilitates calcium absorption |
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True or False: Infancy to 11 months the protein composition of the milk changes |
True |
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Whey in Human Milk |
-Soluble protein that precipitates by acid or enzyme -some minerals, hormones & vitamin binding proteins are part of whey -includes lactoferrin, an iron carrier |
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Non-protein in nitrogen in Human milk |
-about 20-25% nitrogen in human milk -used to make non-essential amino acids |
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Lactose in human milk |
-dominant CHO -enhances calcium absorption |
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Oligosaccharides
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-medium-length CHO(carbohydrate) -Prevent binding pathogenic microorganisms to gut, which prevents infection & diarrhea |
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Fat Soluble Vitamins in Human Milk |
Vitamin A - content in colostrum is double that of mature milk. Yellow color from beta-carotene Vitamin D - Exclusively bf infants need supplements at 2 months, content reflective of mother's exposure to sun Vitamin K - about 5% bf infants at risk for deficiency based on clotting factors, those who didn't get an injection at birth may be deficient |
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What is VKDB? |
Vitamin K deficiency bleeding. |
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Why is a Vit. K shot important at birth? |
Can be fatal, no blood clotting |
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What are some water soluble vitamins? |
B6 & B12, content reflective of mother's diet or supplements. Vitamin most likely to be deficient is B6 |
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Vitamin B12 and folate |
-Bound to whey proteins -Low B12 seen in women who: Have hypothyroidism or pernicious anemia Vegans or malnourished Had gastric bypass |
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What deficiency can a B12 deficiency lead to? |
Folate deficiency |
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Minerals contribute to osmolality |
-Content related to growth of infant -concentration decreases over first 4 months, except for magnesium |
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What is the bioavailability of minerals? |
-Most have high bioavailability -exclusively bf infants have very low risk of anemia despite low iron content of human milk |
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How can you prep the breast for breastfeeding? |
Gentle massage, helps begin flow |
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IS positioning important in breastfeeding? |
yes |
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How should the breast be presented to the suckling infant? |
Women can use their hand to shape and position the breast so the infant can easily latch |
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What are the 3 positions for breastfeeding? |
Lay back hold, football hold, cross cuddle hold |
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Positioning during breastfeeding |
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What are the different infant reflexes? |
Gag reflex - prevents infant from taking food and fluids into lungs Oral search reflex - infant opens mouth wide when close to breast & thrusting tongue forward Rooting reflex - infant turns to side when stimulated on that side(could be a sign baby is hungry) |
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What's a sign it is too late and a baby is VERY hungry? |
crying |
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What is hunger signaled by? |
Infant bringing hands to mouth, sucking on them & moving head from side to side |
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What is the hindmilk? |
Last bit of milk in breast, has high fat content that provides satiety, reason you should allow infant to nurse on one breast as long as they want |
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Feeding frequency: |
-10-12 feedings/day are normal for newborns(small stomach) -stomach emptying occurs in about 1 and 1/2 hours -infant stomach capacity is small -isosmatic formula is best for easy digestion |
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What is normal weight loss for newborns? |
-about 7% of birthweight in 1st week -weight loss of 10% needs evaluation by lactatin consultant |
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What are symptoms of malnourished infants? |
-sleepy -nonresponsive -weak cry -wet few diapers |
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What is the diaper expectations for newborn for first week? |
By day 5-7, infants should have 6 wet diapers & 3-4 soiled diapers= about 10-12 diapers/day |
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Maternal Diet:Energy and Nutrient Needs for Lactation |
-MyPlate Food guide, 1/2 plate veggies -Energy needs vary by activity level -Additional 500 kcal/day for 1st 6 months & +400kcal/day afterward (If woman overweight prior to pregnancy may be cut back) -recommendation does vary for individual variation in energy needs |
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If mom isn't breastfeeding, does she need extra calories? |
No, they already have fat stores from pregnancy |
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Protein-calorie Malnutrition results in what? |
reduction in milk volume but NOT quality |
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Weight loss during breastfeeding: |
-Caloric DRI assume a loss of 0.8 kg/month -most women do not reach pre-pregnancy weight by 1 year after birth -Modest or short term energy reductions do not decrease milk production |
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Why can't moms exercise at same level as prior to pregnancy? |
-Baby to take care of -Sleep deprived -Body hasn't healed |
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What may help women lose weight & body fat? |
Modest energy restriction combined with increased activity |
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Why must women be careful in exercising after pregnancy? |
Joints loosen during pregnancy |
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Why is exercise beneficial to breastfeeding? |
It promotes neurotransmitters, less risk of postpartum depression |
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Are vitamin and mineral supplements needed in well-nourished women? |
no, if they are eating healthy balanced meal |
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How much fluids should you drink with bf? |
Drink to thirst, need more liq. At least 10-12 eight oz cups |
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What is infant colic? |
crying for more than 3 hr/day, no medical cause |
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Components of maternal diet may be related to infant colic: |
Cow's milk, onions, cabbage, broccoli, & chocolate (science not clear) |
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MUST KNOW FOR TEST |
American Academy of Pediatrics(AAP) and Academy of Nutrition & Dietetics(AND) recommend bf continue for at least 12 months, and thereafter as long as mom and baby desire. |
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MUST KNOW FOR TEST |
US Surgeon General: Exclusively for 6 months, best to bf for 12 months |
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MUST KNOW FOR TEST |
World Health Organization(WHO) recommends continued breastfeeding up to 2 years of age or beyond. |
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Breastfeeding Goals vs. Actual |
Proportion ever bf(79.2-82%) Exclusive bf at 6 months(18.8-25.5%) Breastfeeding at 1 year(26.7%-34.1%) (From year 2011ACTUAL, to our Healthy People 2020 GOALS) |
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Barriers to breastfeeding initiation |
-embarrassment -time & social constraints -lack of support from family & friends -lack of confidence (self efficacy ability to think you can do it) -concerns about diet & health -fear of pain (engorgement and mastitis) |
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Lactation support in hospitals and birthing centers: |
-Hospital practices can influence bf -distribution of free formula samples is discouraged -Baby Friendly Hospital Initiative in 1992 -UNICEF and WHO - Global Strategy for Infant and Young Child Feeding 2002 |
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When should a pediatrician, nurse or other knowledgeable health care practitioner see all breastfed infants? |
At 2-4 days of age |
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What is the Le Leche League? |
Founded in 1956, international organization that provides education, info, support and encouragement to women who want to bf. Oldest non-profit lactation organization |
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What are some barriers of bf support at work? |
-Lack of on-site day care -insufficiently paid maternity leave -rigid work schedules -lack of understanding/knowledge by employers -legislation support bf or pumping in workplace |
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What are some bf support barriers in the community? |
-Lack of access to reliable & culturally appropriate sources of info and social support -cultural perceptions of bottle feeding as norm -aggressive marketing by formula companies -laws that prohibit bf in public |
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What is the nestle infant formula scandal about? |
Went into African community, low income. Problem: no clean water, many babies died. Internation code of Marketing was put out by WHO. |
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What is WIC? |
Special Supplemental Nutrition Program for Women, Infants, and Children. |
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What does WIC do? |
-Serves 53% of all infant births in US -Federally funded USDA nutrition program -provides nutritious supplemental food package, education and breastfeeding support to low-income pregnant and postpartum women, infants and children up to age 5 -improvement in program makes huge impact -provides supplemental package-very restricted, specialized -covers:pregnant, bf mom, mom w/ child up to age of 5 -package tailored to meet needs iron level tests -nutrition education -breastfeeding support, can get a free pump |
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Is WIC a nationwide program? |
YES |
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Does WIC work? |
-Improved birth outcomes containing health care costs. Every $1 spent on prenatal WIC resulted in: -longer pregnancies ( less lbw babies, less medical care required) -greater likelihood of receiving prenatal care -fewer premature births and infant deaths(connection hub) -lower incidence of moderately low and very low birth weight infants - less babies in NICU |
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What are the savings in health care for WIC? |
$1.77-$3.13 within first 60 days after birth |
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What is the impact of WIC around US? |
-Higher mean intakes of Fe, Vit C, thiamin, niacin, and vit B6, without an increase in food energy intake, indicating an increase in the nutrient density of diet -pos effects on intakes of ten nutrients without an adverse effect on fat or cholesterol -decline in rate of iron deficiency anemia |
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What is a package like for no/some breastfeeding? |
Some food for mom first 6 months then none 6-12 months. baby gets food 1-12 months. |
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What is a package for mostly breastfeeding? |
Mom gets good food supply and baby get same amount of rice cereal and formula. |
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What does the fully breastfeeding package get? |
Mom gets ton of food, baby gets a ton of food starting at 6 months. |
