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Breastfeeding

Pediatrics

QuestionAnswer
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