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Breastfeeding
Pediatrics
| Question | Answer |
|---|---|
| Human milk decreases incidence of: | diarrhea, resp illnesses, OM, bacteremia, bacterial meningitis, necrotizing enterocolitis; poss less allergic sx/eczema |
| Breastfeeding confers which antibodies? | IgA |
| BF advantages to mother: decreased risk of: | postpartum hemorrhage, ovarian/ premenopausal BrCa; possibly osteoporosis |
| Breastfeeding results in a longer interval of: | amenorrhea |
| Primary lactation failure is: | rare |
| Breast milk composition | highly bioavailable protein; essential FA; LC unsat FA; relatively low Na; low but highly bioavailable Ca, Fe, Zn |
| Adequate milk intake is assessed by: | infant's voiding/ stooling patterns; well-hydrated infant voids 6-8 / day |
| By 5 to 7 days, loose yellow stools should be passed how often: | at least 4 times/day |
| Bilirubin: BF vs formula | higher bili in BF infants; bili level inversely related to feeding frequency |
| Condition in infants w/ insufficient milk intake & poor wt gain => increase in unconjugated bili 2/2 exaggerated enteropathic circulation of bilirubin: | Breastfeeding jaundice |
| Condition in older breastfed infant in which prolonged elevated serum bili is 2/2 unknown factor in milk that enhances intestinal absorption of bilirubin: | Breast milk jaundice; dx of exclusion |
| In exclusively breastfed infants, supplement diet with: | Vitamin D (200 IU/day, start at 2 months) |
| Mom with fever, chills, and malaise = | mastitis (usually due to S aureus) |
| Mastitis tx | Dicloxicillan; Oxacillin; 1G ceph; erythromycin; Fungal: Diflucan |
| Chronic illness: effect on BF | HIV: CI for BF; TB, syph, VZV: poss restart after tx |
| Breastfeeding is contraindicated for: | HIV. Active TB. Mom on meds: radioactive iodine, antimetabolites, lithium, tetracycline, antithyroid drugs, recreational drugs |
| Drugs that are allowed when breastfeeding | Methadone. Antidepressants: Zoloft preferred, Prozac okay |
| Decision to breastfeed is usually made when? | Before delivery; often when mom feels quickening |
| Function of Estrogen: | stimulates ductal system to grow; levels drop at delivery |
| Function of Progesterone: | Increase in pregnancy; growth and size of alveoli/lobes; drop at delivery/triggers milk |
| Function of Human Placental Lactogen: | instrumental in breast/ nipple/ areolar growth; before birth |
| Function of Prolactin: | Increase contributes to accelerated growth of alveoli |
| Function of Oxytocin: | contracts smooth mx layer of cells surrounding the alveoli to squeeze milk into ductal system |
| breast milk volume | Colostrum (precursor; pro & Ab rich): 5-10 mL/ feeding; milk: 750ml–1000 ml/24 hrs by 10-14 days pp |
| Lactation: timing | Baby to breast within 1-2 hrs postpartum. Encourage feeding 8-12 times/24 hrs; average feeding 20-40 min active sucking/ swallowing (15-20 min each breast) |
| Frequent feedings stimulate the body to transition: | colostrum to milk by day 3-4 |
| Foremilk & hindmilk | Foremilk: high vol, low fat; fat content rises as feeding progresses; Hindmilk: low vol, high fat |
| Easiest positions in the early post-partum period | Football or crosslap holds |
| 4 breastfeeding positions: | cradle, crosslap, football (clutch)(good for C/S), reclining |
| Breast milk for premature infant | Initiate pumping within 6-8 hrs pp; pump q3 hr around the clock while establishing supply;at 2 wks, goal = 20-25 oz/ 24 hr |
| Engorgement sx | Gradual onset, immediately pp; bilateral; general heat, swelling, pain; mom temp <38.4; |
| Engorgement tx | Heat prior to feeding; ice after; cabbage leaves? |
| Mastitis sx | gradual or sudden onset (after 10 days); local edema, heat, erythema, pain; unilateral; temp >38.4; flulike sx |
| Pinkish-red appearance with shiny nipples/areola; white plaques on nipples; persistently sore; think: | yeast |
| Gradual onset, unilateral; no heat, swelling may shift; mild local pain; temp <38.4; think: | Plugged duct; tx: heat/ massage/ nurse; infant's chin pointed toward plugged duct; lecithin? |
| If breast augmentation, lactation success depends on: | surgical technique used; potential for nerve disruption/ pressure from implant; f/u & observe for engorgement |
Created by:
Abarnard
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