water<\/p>\n\n\n\n
breastmilk is low in this nutrient but it’s very bioavailable
iron<\/p>\n\n\n\n
which nerves innervate the breasts
T3-T5<\/p>\n\n\n\n
Number one reason why moms stop bfing is due to
milk supply<\/p>\n\n\n\n
hormone that increases with nipple stimulation
prolactin<\/p>\n\n\n\n
hormone secreted by the placenta
progesterone<\/p>\n\n\n\n
what promotes the release of gastrin
touch<\/p>\n\n\n\n
leading cause of infant death
diarrhea<\/p>\n\n\n\n
three strategies needed for increasing BF initiation and duration
protection, promotion, support<\/p>\n\n\n\n
commonly cited reasons why mothers stop BF
work, pain, low supply, latching<\/p>\n\n\n\n
which timeframe are the moms most vulnerable to stop BF
first 3-7 days<\/p>\n\n\n\n
what do montgomery glands do
secrete protective lipid material during lactation<\/p>\n\n\n\n
what does prolactin do
milk production<\/p>\n\n\n\n
what does oxytocin do
Milk letdown and uterine contractions<\/p>\n\n\n\n
when does prolactin peak and when does it drop
drops: between nursing
peaks: right after nursing at its highest<\/p>\n\n\n\n
prolactin is released with
nipple stimulation<\/p>\n\n\n\n
oxytocin is released with
nipple stretching<\/p>\n\n\n\n
stages of making milk
lactogenesis 1, 2, 3<\/p>\n\n\n\n
lactogenesis 1
happens during pregnancy
placenta releases progesterone, which makes colostrum<\/p>\n\n\n\n
lactogenesis 2
birth of the placenta- triggers transition of milk from colostrum to mature milk<\/p>\n\n\n\n
lactogenesis 3
breastfeeding
needs frequent removal of milk to increase production<\/p>\n\n\n\n
foremilk
beginning of the feed<\/p>\n\n\n\n
hindmilk
end of the feed<\/p>\n\n\n\n
babies that exclusively BF have a more __<\/strong> gut what are secretory Iga (SIGA) how long after birth should the baby get back to its birth weight how many times should they be nursed\/day Formula fed babies secrete 50% MORE insulin than BF grade 1 nipple classification grade 2 nipple classification grade 3 nipple classification Sheehan’s syndrome What are green\/shiny stools a sign of?<\/a><\/p>\n\n\n\n -sign of overproduction leading to less fat in milk, faster digestion causing not enough time for lactase to digest the lactose in milk. An improved latch could allow for more fat flow<\/a><\/p>\n\n\n\n Signs of oversupply<\/a><\/p>\n\n\n\n Rapid weight gain in infant, unsettled baby after feeding, recurrent plugged ducts and mastitis, painful feedings, voluminous (huge volumes of) stools- often green & shiny<\/a><\/p>\n\n\n\n What causes nipple pain?<\/a><\/p>\n\n\n\n Improper latch–> need lactation support to help with proper latch on, good seal<\/a><\/p>\n\n\n\n True\/false: baby should be pulled into breast.<\/a><\/p>\n\n\n\n False! Do not pull baby into breast, let baby tilt head back for optimal latch. Hand on back of baby’s head can interfere baby’s interoral function by restricting the movement of the cranio-cervical spine–> causes nipple trauma. Make sure crook of arm in cradle position does not block baby from being able to fully tilt back.<\/p>\n\n\n\n Should a latch be symmetric or asymmetric?<\/a><\/p>\n\n\n\n Asymmetric! A baby should form a teat with breast tissue underneath the nipple as part of a latch<\/a><\/p>\n\n\n\n What is a symmetric latch<\/a><\/p>\n\n\n\n Not a good latch, causes nipple damage<\/a><\/p>\n\n\n\n Asymmetric latch<\/a><\/p>\n\n\n\n Optimal attachment to the breast, where the baby’s lips are not centered in relationship to the areolar, but rather vertically off-centered with the baby’s chin and lower lip closer to the edge of the areola than the baby’s upper lip. A baby should form a teat with breast tissue underneath the nipple as part of a latch<\/p>\n\n\n\n Do nipple creams work?<\/a><\/p>\n\n\n\n Continued questions of effectiveness, fear of ingestion by baby<\/a><\/p>\n\n\n\n Should a frenotomy be suggested for tongue tie?<\/a><\/p>\n\n\n\n No study was able to report that frenotomy led to better long term breastfeeding<\/a><\/p>\n\n\n\n Tongue tied breastfeeder<\/a><\/p>\n\n\n\n -complete feeding assessment and suggest ways to optimize latch. What is a fissure straight down the nipple evidence of?<\/a><\/p>\n\n\n\n A symmetric latch. Top lip needs to have good seal, moist part of lip should be touching nipple, can roll out top lip, to reduce injury during BF<\/a><\/p>\n\n\n\n Is there a deep latch with nipple stretching?<\/a><\/p>\n\n\n\n If nipple not stretched deeply into mouth, less oxytocin flows, less fat is in mix. With less fat, milk digested quicker = not enough time for baby to make enough lactase to digest lactose in milk.<\/a><\/p>\n\n\n\n What to do for oversupply?<\/a><\/p>\n\n\n\n Decrease additional stimulation\/milk removal if possible How many mL considered oversupply?<\/a><\/p>\n\n\n\n normal milk production = 750-1000 mL\/day<\/a><\/p>\n\n\n\n Thrush during BF<\/a><\/p>\n\n\n\n painful for mother & baby. Treatment of candida on breast<\/a><\/p>\n\n\n\n -nystatin first line What to do if antifungal treatment for yeast doesn’t work?<\/a><\/p>\n\n\n\n Not candida infection!<\/a><\/p>\n\n\n\n Reynaud’s Phenomenon<\/a><\/p>\n\n\n\n -vasospasm of nipple, recognized by triple color sign: from white–> blue–> raspberry or bicolor sign white –> raspberry. treatment of reynauds<\/a><\/p>\n\n\n\n -prevent\/decrease cold exposure Nipple pain and poor milk transfer that is persistent despite optimal latch<\/a><\/p>\n\n\n\n -can use nipple shield as a test to see if baby exerting too much pressure? Clogs\/plugs<\/a><\/p>\n\n\n\n Palpable lumps of milk within the lumen or duct system, usually not visible. Solids dont get absorbed…could be too tight of a bra slowing flow of milk<\/a><\/p>\n\n\n\n what to do for clogs\/plugs<\/a><\/p>\n\n\n\n Encourage massage using side of hand and warm compresses. Do double nursing by doubling up on side of clog to push it out. point baby’s chin toward clog When to call PCP for clog\/plug<\/a><\/p>\n\n\n\n If plug hasn’t moved in 24-48 hrs or systemic signs of inflammation (flu like s\/s)<\/a><\/p>\n\n\n\n Causes of clogs\/plug<\/a><\/p>\n\n\n\n too tight nursing bra<\/a><\/p>\n\n\n\n what is a bleb<\/a><\/p>\n\n\n\n small white spots on the face of the nipple that look like milk-filled blisters. one duct opening is usually covered<\/a><\/p>\n\n\n\n what does a bleb feel like<\/a><\/p>\n\n\n\n painful stabbing pinpoint pain<\/a><\/p>\n\n\n\n how to get rid of blebs<\/a><\/p>\n\n\n\n Same as clog treatment. Sometimes need t be lanced by HCP<\/a><\/p>\n\n\n\n Common mastitis<\/a><\/p>\n\n\n\n -can be non-infective or infective causes of common mastitis<\/a><\/p>\n\n\n\n -tight bra (look for indentation of breast straps) s\/s common mastitis<\/a><\/p>\n\n\n\n systemic- fever, ill, malaise, redness, pain, one inflamed breast<\/a><\/p>\n\n\n\n What bacteria causes infective mastitis<\/a><\/p>\n\n\n\n Staphylococcus<\/a><\/p>\n\n\n\n tx common mastitis<\/a><\/p>\n\n\n\n NSAIDS first line but make sure diagnosed by PCP Abscess on breast<\/a><\/p>\n\n\n\n Localized areas of pus and necrotic tissue that can develop with a breast infection Antibiotics for mastitis?<\/a><\/p>\n\n\n\n Usually for double mastitis, not generally proscribed for one breast common mastitis. If treatment uneffective consider anemia, ductal or inflammatory breast cancer<\/a><\/p>\n\n\n\n Double mastitis<\/a><\/p>\n\n\n\n EMERGENT AND UNCOMMON- tissue of both breasts inflamed.<\/a><\/p>\n\n\n\n organism cause of double mastitis<\/a><\/p>\n\n\n\n strep -potentially fatal, whole body inflammation, sepsis signs of inflammatory breast cancer<\/a><\/p>\n\n\n\n – breast tissue is red, warm, has orange peel (peau d’orange), pitting appearance on skin surface True\/false: MRSA can look like mastitis when on breast<\/a><\/p>\n\n\n\n TRUE can masquerade as mastitis. might see peeling skin, pitting. can also cause lesions and abscess.<\/a><\/p>\n\n\n\n Abscess on breast is full of …<\/a><\/p>\n\n\n\n PUS not MILK. as many as 60% positive for MRSA.<\/a><\/p>\n\n\n\n can you nurse on same side as abscess<\/a><\/p>\n\n\n\n No should nurse on other breast. must be aware of possible contamination on flanges, pump parts, can not track infection from one side to other.<\/a><\/p>\n\n\n\n abscess surgical intervention<\/a><\/p>\n\n\n\n can cut through nerves and ducts. try to avoid surgical intervention<\/a><\/p>\n\n\n\n treatment of abscess<\/a><\/p>\n\n\n\n drainage through ultrasound-guided technique is first choice (needle aspiration often has to be repeated)<\/a><\/p>\n\n\n\n Report any suspicious area of the breast to a qualified provider because it could be…<\/a><\/p>\n\n\n\n MRSA or herpes- fatal for babies<\/a><\/p>\n\n\n\n Goldsmith’s sign<\/a><\/p>\n\n\n\n The association of a baby’s persistent refusal of one breast with possible breast cancer in the mother Neonatal hypoglycemia<\/a><\/p>\n\n\n\n -symptomatic infants = glucose of 40 requires per APP Signs of neonatal hypoglycemia<\/a><\/p>\n\n\n\n \u2022 Jitteriness, tremors Do healthy term newborns need glucose checks<\/a><\/p>\n\n\n\n No<\/a><\/p>\n\n\n\n Jaundice is caused by<\/a><\/p>\n\n\n\n Unconjugated bilirubin that accumulates in blood stream of newborn because fetal-type blood cells are broken down and live and intestines too immature to excrete at fast pace.<\/a><\/p>\n\n\n\n Pathologic jaundice<\/a><\/p>\n\n\n\n Result of an underlying disease appearing before 24 hours (or persistent after day 7) Bhutani curve<\/a><\/p>\n\n\n\n Chart that can be used to determine when bilirubin levels require treatment<\/a><\/p>\n\n\n\n Early onset jaundice<\/a><\/p>\n\n\n\n “Physiological” or “starvation” jaundice Late onset jaundice<\/a><\/p>\n\n\n\n develops second week of life Kernicterus<\/a><\/p>\n\n\n\n Bilirubin encephalopathy, a form of brain damage resulting from unconjugated bilirubin entering the brain. Characterized by lethargy, poor feeding, vomiting, irregular respiration, perhaps death warning signs of kernicterus<\/a><\/p>\n\n\n\n extreme jaundice (advancing from upper body to lower body), lethargy, fussiness, feeding difficulties, muscle rigidity, high pitched cry can skin to skin help a latch?<\/a><\/p>\n\n\n\n yes- influences state organization and motor system modulation, can help with difficulty latching and sustaining a feed<\/a><\/p>\n\n\n\n skin to skin with twins- each breast…<\/a><\/p>\n\n\n\n warms up depending on the temperature of each baby closest to breast<\/a><\/p>\n\n\n\n preemies\/skin to skin<\/a><\/p>\n\n\n\n decreased time of nicu stay, improved weight gain, more mature sleep patterns, improved cerebral blood flow, warmer\/more stable, better breastfeeding<\/a><\/p>\n\n\n\n Negative influences on milk production<\/a><\/p>\n\n\n\n Long spaced between feedings Why does pressure occur in breast?<\/a><\/p>\n\n\n\n Vascular, lymphatic, and third-spacing forces, especially early on Normal fullness vs engorgement<\/a><\/p>\n\n\n\n Normal fullness= breast soft, body temp normal, mother feels well, breast may be hot, baby can grasp nipple When do engorgment symptoms most commonly occur?<\/a><\/p>\n\n\n\n In days 3-5 What can decrease risk of engorgement early on?<\/a><\/p>\n\n\n\n More time spent BF in the first 48 hours<\/a><\/p>\n\n\n\n How does engorgement work<\/a><\/p>\n\n\n\n Pressure builds up inside of the breast- as pressure increases, milk production decreases, nature’s early lactation dry up mechanism What causes pressure to build up in breast<\/a><\/p>\n\n\n\n
acidic<\/p>\n\n\n\n
bind to microbes to prevent them from being absorbed. baby gets it from colostrum- not naturally in their body<\/p>\n\n\n\n
2 weeks<\/p>\n\n\n\n
10-12 times\/day<\/p>\n\n\n\n
true<\/p>\n\n\n\n
easily pulled out<\/p>\n\n\n\n
can be pulled out but dont maintain after stimulation stops<\/p>\n\n\n\n
difficult or impossible to pull out<\/p>\n\n\n\n
death of an area in the pituitary gland<\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/j0XrbTCx.SnT1pjPa8iwxQ.jpg\")
<\/figure>\n\n\n\n
-refer onward for diagnosis (have PCP diagnose TT)
-provide support<\/a><\/p>\n\n\n\n
Consider block feeding (only nursing on one side only per feeding)
Watch for mastitis
Try australian posture (mother down under, baby on top)
Consider donating to milk bank
Consult with HCP for medical dx<\/a><\/p>\n\n\n\n
may be visible or may not (whiteness that can’t be wiped off)
-mother will have itchy, flaky, shiny skin
-candida not found inside the ducts or milk<\/a><\/p>\n\n\n\n
-flucanizole second line
-throw out all yeast vectors (pacifiers sterilize breast pumps)
-flucanazole oral capsules may be used to clean yeast vectors due to the biofilm created on pacifiers by candida<\/a><\/p>\n\n\n\n
pain is extreme and spasmodic (not continuous)
-this happens after feeding once baby’s mouth comes off nipple has vasospasm, feels like frostbite<\/a><\/p>\n\n\n\n
-avoid vasoconstrictive drugs such as caffeine and hypertensive drugs, nicotine
-can use nifedipine or calcium channel blocker<\/a><\/p>\n\n\n\n
-OT involvement
-in rare cases baby have a strong sucking vacuum as measured by a pressure transducer or nipple shield<\/a><\/p>\n\n\n\n
See PCP if clog hasnt moved in 24-48 hours or systemic symptoms of inflammation (flu like s\/s)<\/a><\/p>\n\n\n\n
-blocked ducts from engorgment, hurried feedings, nipple shield (pressure will build until milk sneaks out of space, body reacts to this like invader)<\/a><\/p>\n\n\n\n
-use of breast shell or nipple shell
-attachment difficulties
-anemia in the mother
-tongue tie in baby (ineffective milk emptying)<\/a><\/p>\n\n\n\n
-must keep pumping\/breastfeeding to keep milk flowing. keeps breasts soft\/comfortable to avoid abscess development<\/a><\/p>\n\n\n\n
\u2022Can develop in the subcutaneous, intramammary, retromammarylayers
\u2022Symptoms include pain, swelling, redness, fever, increased WBC count, palpable mass
-pocket of pus forms in the breast
-from untreated mastitis<\/a><\/p>\n\n\n\n
-not a problem with milk<\/a><\/p>\n\n\n\n
– breast mass may or may not be present<\/a><\/p>\n\n\n\n
-can also happen suddenly with older babies
-rule out common problems such as ear infection, teething, birth trauma
-CA may be diagnosed as late as 5 yrs after this sign<\/a><\/p>\n\n\n\n
-dextrose & BF = first line tx
-SGA, LGA, diabetic moms, late preterm infants at gretest risk<\/a><\/p>\n\n\n\n
\u2022 Poor muscle tone
\u2022 Diaphoresis (sweating)
\u2022 Poor suck, failing to sustain latch
\u2022 Tachypnea
\u2022 Tachycardia
\u2022 Dyspnea
\u2022 Grunting
\u2022 Cyanosis
\u2022 Apnea
\u2022 Low temperature
\u2022 High-pitched cry
\u2022 Irritability
\u2022 Lethargy & poor feeding
\u2022 Seizures, coma
\u2022 No signs (some infants may be asymptomatic)<\/a><\/p>\n\n\n\n
-due to sepsis, blood incompatibility<\/a><\/p>\n\n\n\n
Peaks 72-96h after delivery
Frequently related to underfeeding
“lack of breastfeeding” jaundice<\/a><\/p>\n\n\n\n
infant thriving, gaining wt, stooling
pathologic causes ruled out
factor in human milk increases the intestinal absorption of bilirubin
-often called breastmilk jaundice actually related to metabolic issues with infant
-do not discontinue breastfeeding, can persist for 12 weeks<\/p>\n\n\n\n
-can damage brain, spinal cord and nerve cells.<\/a><\/p>\n\n\n\n
-fewer than 4 wet or dirty diapers\/24 hrs<\/a><\/p>\n\n\n\n
Long, slow feedings-can effect prolactin production
Excessive pressure in breast
Breast surgery\/injury
Suboptimal breast anatomy<\/a><\/p>\n\n\n\n
Sensory activation- lactogenesis II<\/a><\/p>\n\n\n\n
Engorgment = hard breast, temp normal or higher, feels discomfort, breast hot & shiny, nipple difficult to grasp, baby can’t latch<\/a><\/p>\n\n\n\n
Mothers who have had IV fluids in labor have higher levels of swelling up to day 9
C-section moms experience peak engorgement 24-48 hours later than those who deliver vaginally<\/a><\/p>\n\n\n\n
-failure to resolve symptomatic engorgement may have negative impact on continued adequate milk supply<\/a><\/p>\n\n\n\n