IBCLC

Why shouldn't a parent put a crying baby to the breast?

- a crying baby places their tongue in the palate which is a defensive response that inhibits sucking & disturbs that rooting- tongue reflex system

Explain the supply-demand response

- a feedback control that regulates the production of milk to match the intake of the infant

What is Prolactin inhibiting factor?

- a hypothalamic substance ( I.e dopamine) that inhibits prolactin secretions - i.e Bromocriptine is a drug that suppresses lactation: dopamine agonist

What is cortisol?

- a main glucocorticoid - high cortisol = delayed lactogenesis

What is Involution?

- average of 40 days after last BF - high sodium levels - additions of regular supplements

11-12 month milestones

- drops objects deliberately - speaks a few words - shakes head for NO - acrobatic BF

What are prolactin receptor sites?

- located in the lactocytes; allow prolactin to be absorbed from the blood and enter into the alveoli to stimulate milk production

What is galactopoiesis?

- occurs day 9 to beginning of Involution - maintenance of established secretion - controlled via autocrine system

Right breast

- smaller - makes more

What is a lactocyte?

- specialized epithelial cell that lines the inside of the areola - absorbs nutrients, immunoglobulin, and hormones from the mothers bloodstream to compose milk

Eminences of the pars villosa

"Tiny swellings on the inner surfaces of the infant's lips that help the infant to retain a grasp on the breast during suckling." Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Low tone babies

"Wet noodle" appearance

Weight loss after pregnancy

"privileged countries" lose ~2 pounds/month "underprivileged countries" lose ~1 pound/month

Bisphenol A

(BPA) organic compound found in plastics. Linked to disease in infants. Now banned. (BPA) organic compound found in plastics. Linked to disease in infants. Now banned.

Lactogenesis II

(begins 2-5 days after birth) increased blood flow to breast; milk "comes in"

Lactogenesis III

(begins at ~10 days after birth) milk composition is stable

Lactogenesis I

(birth to 2-5 days) milk formation begins

*3* - main fats in human milk

*1) Cholesterol* - remains constant; mom's diet does not affect *2) Triglycerides* - 98-99% milk fats are triglycerides - maternal diet can affect - increased digestability - AHA, DHA (palmitic acid, Oleic acid) - *CYTOTOXIC* to parasites E. coli, G. lambia etc - *NEEDS lipases* (x4) to break down chains (bile-salt/lingual/gastric/pancreatic) *3) Phospolipids* - fat soluble vitamins

*4* - main protein components in human milk

*1) Whey (60%)* *- a-lactalbumin = HAMLET cells* *- Lactoferrin* - more in colostrum binds to the iron that bacteria need to thrive; kills candida *Lysosome* - enzymes attack E.Coli/salmonella and increases at around 6 months *Serum Albumin* *Immunoglobulins sIgA* - targeted protection *2) Casein (40%)* b-casein - forms soft curd, mainly nutritive *3) NPN * 19 amino acids, creatinine, urea, uric acid, peptides *4) Growth Factors* promote GI maturation *EGF* epidermal; higher in preterm milk *IGF* insulin-like; higher in postpartum period *TGF* transforming

Intraductal Papilloma

*BENIGN* spontaneous discharge from one nipple only

*2* - main carbohydrates in human milk

*Lactose* - dissacharide (galactose and glucose) - needs Lactase to digest - made in lactocytes/myoepithelial cells - calcium & iron absorption *HMO (Human milk olligosaccharides)* - Probiotic; lactobacillus bifidus factor - energy; brain development

Carbohydrates in human milk

*Most stable component* 40% calories in milk 7% total

Fats in human milk

*Most variable component* 50% calories in milk 4% total R/T degree of fullness in breast Low concentraion when breast is fullest and more when breast is drained

What homrone is responsible for *Functional Development*

*PROLACTIN* *ONLY* during pregnancy does complete functioning of mammary glands develop

SIDS

*Risk factors:* Sex (boys), Age (2-4 months), Race (non-white), Family history, SHS, prematurity, maternal drug/alcohol use, poor PN care, mom younger than 20 *Prevention/Harm reduction:* Back to sleep, breastfeeding, pacifier, immunizations, avoid SHS.

What does Human Placental Lactogen (HPL) do?

*ductal-lobular-alveolar tissues*

Nutrition in colostrum

*more nutrient dense* *immune function - high sIgA* *HIGH protein* (lactoferrin, growth factors, immune protection) *Whey:Casein = 90:10* *HIGH* sodium and chloride *low* fat, lactose and vit B1 5-10 mL day 1-2 15-24mL day 3-4

Mature milk is....

*nutritive function* 20 cals per oz end of second week (7-10 days) *Whey:Casein = 60:40* *Higher lactose* *780 mL/day average milk volume*

Preterm milk is....

*similar to colostrum* more nutirent dense and increased immune factors

16-20 month milestones

- 6 to 10 words - imitates parents - temper tantrums - leads mother to nursing chair

Lactogenesis Stage II AKA: secretory activation

- Day 3 to 8 PP - onset of copious milk secretion - milk volume increases rapidly from 38-98 PP then abruptly levels off - triggered by drop of serum progesterone - switch from endocrine to autocrine

Left breast

- Larger than right - makes less

What meds are commonly used to assist mothers with MER and increase milk production?

- Metoclopromide- "reglan" - Domperidone- " motilium " - oxytocin

Lactogenesis Stage I AKA: secretory differentiation

- Mid pregnancy to day 2 PP - Initiation of milk synthesis - differentiation of alveolar cells to secretory cells

Domperidone

--Galactagogue used in countries other than the US --research is mixed --may alter cardiac rhythms (QTc) especially in hypokalemic pts --don't consume grapefruit --interacts with fluconazole, erythromycin, clarithromycin

High acuity problem: 3 key actions

--feed the baby --protect the milk supply --preserve breast focus

Lymphatic system in the lactating breasts function as...?

--filtering bacteria that have entered ducts --provides local responses to infection --drains extracellular fluid from Breast tissue

Goldsmith's sign

--initial refusal to BF on 1 breast --may happen suddenly with older babies --R/O ear infection, teething, birth trauma, etc --breast cancer may be dx as late as 5 yrs after sign --breast cancer is possible & must be medically monitored

Lactoferrin has what functions?

--nutrition --anti-inflammatory agent --iron transport It is a major protein source, transports iron and reduces or prevents inflammation.

Some reasons for delayed lactogenesis II

--suboptimal breastfeeding behavior --primiparity --prolonged labor --instrument delivery --C/S delivery --retained placenta --obesity --excessive blood loss --use of non-breast milk fluids --HTN --Diabetes and maternal insulin resistance --hypo-androgenism

First line of treatment for HIV in pregnant mothers (3 meds) If CD4 cell count <=500 must have life long tx, or if testing of CD4 cell count not available

--tenofovir --emtricitabine --efavirenz

With what conditions is breastfeeding contraindicated?

-Active herpes lesions on the nipple -In some places, HIV -Varicella: pumped milk may be given -Tb: pumped milk may be given, but mother and infant may not be in contact with one another until mother treated. -Hep C and CMV: no contraindications

What is the effect of pitocin on BF?

-Anti-diuretic effect/ increased fluid or water -Lower mom's natural oxytocin levels will be

During the infant assessment and examination, what should you do?

-Assess the infant capacity to BF -Look for things out of the norm -Birth history (How did the birth go?)

What is the importance of skin-to-skin immediately after birth (first 60 minutes)?

-BF sooner -BF more effectively -Longer duration of BF -Had more confidence in parenting -Responded to infants needs sooner

What is the bottom line for skin-to-skin?

-Babies need close contact w/ caregivers -Touch and interaction make the difference -Holding baby increases BF success

What are signs of an effective feeding?

-Baby feeds w/ eyes open at beginning of feeding -Falls asleep toward end of feeding and stays asleep (may nap 10-20 minutes at breast)

Babies w/ dieresis

-Common in induction -Associated w/ high maternal fluid balance and excessive weight loss -Large # of wet diapers in 1st 24 hours w/ high levels of fluid

Raynaud's disease

-Decreased blood flow to nipple d/t vasospasm -Usually affects hand and feet too -White, red, and blue -Can be caused by emotional distress or cold

When should you use dancers hand position?

-Down syndrome -Preterm -Late term -Cleft lip

What does normal breastfeeding look like?

-Good first feed w/in 1st hour of life and then several lesser feeds -Skin-to-skin as much as possible -Watch for feeding cues -Feeds on second day should be much better -8-12 feedings usually -Wait until you see feeding cues

What are some key ideas to keep in mind when considering drug exposure in the infant?

-If a medication is safe in infants, it likely will be safe if transferred to the infant from the Mother's milk -Use medication with most information regarding it's usage -Try to schedule doses around breastfeeding, so infant is less exposed -Try not to use long acting medications -Always watch for symptoms and educate parents on them

What are some treatments of plugged ducts?

-Improve removal of milk -Warm compresses (won't fix it, but helps milk flow) -Gentle massage

What are risk of maternal obesity

-Infertility -PCOS -Pre-X -Thromboembolic disease - sleep apnea - gestational diabetes

Lipase and Amylase do what?

-Lipase: Breaks down fat to make it available for energy -Amylase: Breaks down carbohydrates (starch in particular) to make it available for energy

Amino acid composition of human milk compared to cow's milk

-Lower concentration of tyrosine and phenylalanine -Greater concentration of glutamate and taurine

Signs of good attachment/latch

-More areola seen above the mouth than below -Widely open mouth such that the lower lip of the infant is turned outward and infant's chin is resting on the breast

Late Preterm infant

-Observe BF -Encourage skin-to-skin -Hand expression or breast massage -Tend to fall asleep at the breast -Avoid positions that cause flexion of the neck and trunk

Types of tissue in mammary glands (2)

-Parenchyma = actual secretory tissues that make and move milk -Stroma = fatty tissue, blood and lymph vessels, fibrous tissue

Factors that increase risk for postpartum psychiatric disorder

-Previous episode of PPD or diagnosis of depression prior or during pregnancy -Concurrent stressful life evens -Inadequate social support -Partner relationship problems

In preterm milk, the levels of __________ increased

-Protein nitrogen -Long chain fatty acids -Medium chain fatty acids -Short chain fatty acids -NaCl -Magnesium -Iron -Growth Factors -Hormones -Anti inflammatory factors - Immunomodulators - Live infection fighting cells

Autoimmune disorders: MS

-Those with endometriosis, may also have concurrent fertility and lactation problems, in addition to autoimmune disorders -Does not directly impact breastfeeding, fatigue and pain likely affect mother MS: -sx d/t demyelinization, cause not understood. -sx exacerbated postpartum -Upper extremities commonly affected, difficulty latching baby on perhaps, help with positioning and support -may tend towards partial breastfeeding d/t stress and lack of sleep -check medications to see if safe with breastfeeding.

In preterm milk, the levels of _______ went unchanged

-Volume -Calories -Fat (?) -Lactose -Linoleic acid -Potassium -Calcium -Phosphorus -Copper -Vitamin B12 -Zinc

Falling asleep at the breast?

-Wake up q 2-3 hours, but don't go longer than 4 -Skin-to-skin until baby begins to show feeding cues -If baby is still asleep, pump and have partner feed using cup or spoon -Use hand massage to remove remaining milk -Increase pumping/feeding to whenever baby is awake or pump q 2-3 hours -LC to see again in 2-4 days

Phagocytes, including neutrophils and macrophages do what?

-attack and digest bacteria -kill microbes -mobilize immune system

One type of whey protein is alpha-lactalbumin, what does it do?

-bind pathogens -kill cancer cells -prevents infection

Secretory Immunoglobulin A does what?

-coats mucosal surfaces to prevent adherence and penetration by pathogens -main immunoglobulin -binds microorganisms -protects against pathogens -highest concentration found in colostrum

What does lactose do?

-essential for brain development -produces steady release of glucose -lactose is the primary carbohydrate, least variable, most consistent

What is important to know about iron content in breastmilk?

-full term infants are born with sufficient stores of iron in the liver, in hemoglobin, and in breastmilk to last at least 6 months. -iron concentration not influenced by maternal iron status or intake -lactose helps promote iron absorption -after 6 months, iron rich complementary foods should be added in addition to continued breastfeeding

Breast surgery

-inquire about surgery -observe location of scars -ask about nipple sensitivity -teach mother how to assess normal feeding -test weights -hand expression, observe pumping -counsel about supplementation -allow mother to verbalize emotions -support finding ways for closeness

Polycystic ovarian syndrome

-likely cause of infertility in women -sx: irregular menstrual cycles, ovarian cysts, excessive hair and infertility -not an absolute that woman will have milk supply issues, must be monitored for potential though

Infertility and affect on milk production

-likely to have insufficient milk production -associated with PCOS, thyroid disorders, hypoplasia

Breast cancer

-lumps that do not disappear within a couple of days -fixed -no clear margin -pink swollen breast without improvement from ibuprofen =visit MD safe to breastfeed after treatments as long as chemotherapy/hormonal therapy not being currently used -if radiated, may not make much milk on that breast, but one breast can supply enough milk for a baby

Migraine headaches

-medications often are okay for breastfeeding -store milk in freezer in case baby needs to be bottle fed during a migraine

Whey and casein ratios change throughout lactation, what would you expect in early lactation?

-more whey than casein in early lactation (90:10) -almost equal quantities of both by the time mature milk is created (60:40) -equal quantities by late lactation (50:50)

What to know about fat in breastmilk...

-most variable component, somewhat affected by maternal diet, but not as much as water soluble vitamins are -approx 50% calories and 50% energy -fat content directly related to fullness or emptiness of breast: as breast empties, fat increases. -fat levels vary from feeding to feeding, left to right breast, one day to the next -smoking decreases fat level

Cytomegalovirus

-one of the human herpes viruses -congenital or acquired CMV have a better prognosis if are breastfed to allow for antibody protection (if term infant can breastfed even while mother shedding virus in milk, be more cautious with giving to preterm infants)

Other cells in breastmilk include...

-phagocytes -leukocytes -lymphocytes -epithelial cells -granulocytes -chemical mediators -stem cells

Epidermal growth factor, does what?

-prevents inflammation -promotes growth and healing of gut

What purpose do carbohydrates serve in breastmilk?

-primary source of calories -provides 40% of energy needs -lactose is main carbohydrate

Augmentation mammoplasty

-reason for augmentation: possible woman had aplastic breasts before? -surgery should not interrupt ducts/blood/nerve supply if incision near chest wall and not periareolar

Which vitamins are water soluble?

-thiamin, riboflavin, niacin, folate, Vitamin B6 and B12, Vitamin C etc. -vary with stage of lactation, maternal intake, and if delivery is preterm or full term -must be derived from maternal diet, breast does not synthesize. May have to supplement.

What does the whey protein, lactoferrin do?

-transports iron and helps it become absorbed -competes with bacteria to bind iron -antibacterial -essential growth factor for lymphocytes -promotes growth of lactobacilli (good bacteria)

What is bifidus factor

-type of carbohydrate, several oligosacchardies together -helps to create an acidic environment where pathogen growth is deterred

Retained placenta

-uncharacteristic bleeding, painful uterus -may inhibit lactogenesis II -tx with D+C

How old is the infant that lifts their head while lying on their tummy?

1 month old

What is the relationship between an increase in a pregnant woman's BMI & the onset of lactogenesis II?

1 unit increase in BMI=1/2hr delay in onset of lactogenesis II

What 7 signs indicate an infant is having trouble feeding?

1 watery eyes 2 bradycardia 3 apnea 4 low 02 sats 5 poor weight gain 6 color change 7 worried look

On average, what percentage of a med given to a lactating mom passes to her baby?

1%

Human Milk Protein

1% of milk, Casein (solid) Whey (liquid)

Stages of *Lactogenesis*

1) Lactogenesis I - mid-pregnancy-2 days pp * Secratory differentiation - functional changes to breast tissue; HPL has greatest effect on breast growth in pregnancy *ENDOCRINE* 2) Lactogenesis II - day 3-day 8 * Secretory Activation - COPIUS milk *ENDOCRINE* 3) Lactogenesis III - Day 9 -maintenance *AUTOCRINE* 4) Involution - 40 days after weaning

Inflammatory Bowel Disease

1) Ulcerative colitis 2) Crohn's Disease Immune reaction to own intestinal tract - immune response triggered with cow's milk protein

What does *ESTROGEN* do to breasts?

1) increase growth and branching of ductal system 2) ducts grow and divide forming extensive networks

Tanner's Staging - breast development

1) no development 2) breast dveelopment/sparse pubic hair - areola widens/darkens/elevates - breast buds - *~11.5 yrs* 3) breast development/increase pubic hair - breast bud enlarges - montgomery buds form - further breast enelargemnt - *~12.5 yrs* 4) breast development - areola/nipple growth - increased pigmentation - *~13.1 yrs* 5) development of mature breast - increased size - first period - *~15.3 yrs*

Exclusively breastfeeding a 5 month old whose mom has not yet had her period, what are the chances of her becoming pregnant if sexually active?

1-2%

How old would you guess an infant is that can lift their head and support themselves on their forearms in their crib?

1-3 months

What are the main steps to getting a good latch?

1. Baby is reading to nurse/ is cueing 2. Hold bby so that they may find the nipple (can be baby led (best) or mom led 3. Wide mouth, baby will grasp nipple and surrounding tissue, bring it to his mouth, and begin to suckle *CHIN IS IN*

Anand (2001) describes 3 types of pain interventions for infants:

1. Environmental: reduce noise, light, group procedures 2. Behavioral: breastfeed, EBM, glucose, pacifiers 3. Pharmacological Anesthetics, analgesics per order

What are the effect of oxytocin on the brain?

1. Promotes attachment to baby 2. Eases stress 3. Solidifies relationships/ bonding 4. Reduces drug cravings 5. Triggers protective instincts 6. Calming, tranquil, loving- sleepy

What is the treatment for mastitis?

1. Refer to HCP 2. Take a history to determine possible causes 3. Teach effective milk removal and get plenty of rest 4. Therapeutic Breast massage

Name the 3 parts of the hindbrain and it's function

1. cerebellum 2. medulla oblongata 3. pons Controls the autonomic functions and equilibriums, i.e. breathing & body temperature

Malaria treatments 4 meds (both mom and baby need tx)

1. chloroquine--L2 (also used for rheumatoid arthritis) 2. doxycycline--L3 (a tetracycline ABX that yellows baby's teeth and retards bone growth) is okay if not taken for more than 3 weeks 3. mefloquine--L2 (similar to quinine) 4. primaquine--L3 (not to be given if has condition of G6PD)

What are the 5 extrinsic muscles of the tongue? And what do they do?

1. genioglossus 2. styloglossus 3. palatoglossus 4. hyoglossus 5. mylohyoid muscles They change the position of the tongue

2 muscles names from the Greek word for Wing-shaped

1. medial pterygoid 2. lateral pterygoid

List the 4 primary muscles of mastication.

1. temporalis 2. masseter 3. medial pterygoid 4. lateral pterygoid

What are the 4 intrinsic muscles of the tongue? And what do they do?

1. transverse muscle 2. superior longitudinal 3. inferior longitudinal 4. vertical muscles These 4 muscles change the shape of the tongue

What is step one of the 10-steps to successful breastfeeding?

1.a. Comply w/ International Code of breastmilk substitutes and relevant World Health Assembly resolutions 1.b. Have a written BF policy that is communicated to all health care staff members 1.c. Establish ongoing monitoring and data management systems

How old is the infant that has developed a "pincer grasp" using thumb and finger to pick items up?

10 months old

How old would you guess an infant is that is walking with assistance is?

10 months old on average (between 6-14 months of age this occurs)

Proteins in human milk

10% calories in milk 0.8-1% total

At what age do infant's recognize vocabulary much more readily?

10-12 months of age

How old would you guess that an infant is that is walking alone is?

11 1/2 months old on average (between 8-17 months of age this occurs)

How long can EBM be deep freezed for?

12 months

How old would you guess an infant is that is standing alone is?

12 months old on average (between 7-17 months of age this occurs)

How many weeks gestation would you expect to see the swallow reflex?

12-14 weeks

How many lobes are in a breast?

12-20

How many weeks would you expect to see the suck reflex?

15-18 weeks

Expected daily weight gain in the first 3 months

15-30 grams or 1/2 to 1 ounce a day. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 284.

Percentage risk of vertical transmission of HIV if untreated during pregnancy

15-45%

Lactating women should not consume less than ____ kcal, as they are not likely to maintain lactation.

1500

LBW in grams is?

1500-2500g

At what gestational age does the swallowing reflex first appear?

16 weeks

How many weeks would you expect to see the gag reflex?

18 weeks

When does a child feeding themselves improve in coordination and ease?

18-20 months

GI function returns to prepregnancy in __ days

2

At term of pregnancy, breasts have increased by about __ inches and __ pounds

2 inches, 3 pounds

Breast quadrants

2 upper quadrants 2 lower quadrants

How long does it take for marijuana to be cleared from the Breast feeding infant's urine?

2-3 weeks

How to determine appropriate intake for age...

2.5 x weight in pounds = ounces in a 24 hour period divide by number of feedings to determine approximate amount of intake per feeding

What is the half life of marijuana?

20 hours-13 days depending on infant and exposure

What is the approximate risk reduction for leukemia conferred by breastfeeding?

20-30%

What is the whey to casein ratio of cows milk

20:80

How old would you guess that a child who walks and runs well is?

24 months old

At what week gestation does a fetus display the suck reflex?

24 weeks gestation

Average infant's intake in ounces per day for the first 4-5 months after birth?

25-27 ounces or 750-800 mls

At what week gestation can a baby coordinate the suck/swallow/breath cycle at the breast ?

28 weeks

How many weeks would you expect to see the tongue protrusion or phasic bite reflexes?

28 weeks

May take up to ___ months to remove extra blood volume

3

Wessel's Rule of 3 (Colic)

3 hours per day 3 x per week for 3 weeks

How long can EBM stay in the freezer

3 months

How many ounces would you expect an 8 month old to gain each week?

3 to 5 ounces

PPD Postpartum Depression

3 types of disorders: Postpartum blues is a temporary depression lasting a few days. Postpartum depression is a mild to moderate depression lasting at least 2 weeks. Postpartum psychosis is the most severe form, beginning at 2-4 weeks postpartum. Mothers may have insomnia, irrational ideas, feelings of failure, depression, hallucinations, and self-accusatory thoughts. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 539.

A baby begins more social interacting at what age?

3-4 months

At what age is a child/baby most likely to self-wean?

3-4 years

At which ages/stages are babies MOST likely to self-wean?

3-4 years

How many days after delivery is the greatest risk for stopping BF?

3-7days

Infants should be put to breast within ________ of delivery

30 minutes

Newborn normal heart rate (birth to one year)

30-60 breaths per minute. Wikipedia. en.wikipedia.org/wiki/Respiratory_rate.

Newborn normal respiratory rate (birth to one year)

30-60 breaths per minute. Wikipedia. en.wikipedia.org/wiki/Respiratory_rate.

How many weeks gestation would you expect to see the rooting reflex?

32 weeks

Late preterm

34 0/7 - 36 0/7 wks

Early term

37 0/7 - 38 6/7

Full term

39 0/7 - 41 6/7

How much would you expect a 1 year old to weigh?

3x their birth weight (some sources say 2x their birth weight at 12 months)

Lysozymes

3xmore in human milk. Damages bacterial cell walls.

Women who are breast feeding should wait at least ____ hours after consuming one alcoholic beverage before breast feeding again.

4

How old is the infant that rolls over from tummy to back?

4 months old

Human Milk Fat

4% of milk. 50% of calories. 98% is form of triglycerides, MCT and LCT ASSOCIATED with DEVELOPMENT OF RETINAL AND NEURAL TISSUES

At what age do infants imitate sounds?

4-5 months of age

How long can EBM stay out in Room temperature

4-6 hrs

How long can EBM stay in the fridge before expiring

4-8 days

Human milk carbohydrates

45-50% of calories. Predominantly Lactose. Poly

Gastric half-emptying time breastmilk

48 minutes

How many ounces would you expect a 4 month old baby to gain each week?

5 to 7 ounces

What is the whey to casein ratio of late lactation

50:50

How old would you guess an infant that is sitting without support is?

6 1/2 months old on average (between 4-9 months of age this occurs)

At what age do infants babble/coo/squeal?

6 months

At what month should a newborn Breastfeed first then be offered ( puréed/mashed) foods?

6 months

At what developmental age is self-feeding MOST LIKELY to begin?

6-7 months

At what developmental age is self-feeding most likely to begin?

6-7 months

How old is an infant who has good head control?

6-8 weeks

What is the whey to casein ratio of mature milk

60:40

Holder Pasteurization for donor milk is at what temperature Celsius and for what length of time?

62.5C for 30"

When is "gymnastic" nursing most common?

7-12 months

At what month does a newborn drink from a cup & can tolerate soft, lumpy, minced foods?

7-8 months

How much milk do babies normally take in?

76% of total milk volume in breast -Increased frequency of emptying breast will increase milk production -Can choose to pump afterward to promote more milk production (don't have to do it every time, but sometimes helps)

Gastric half-emptying time formula

78 minutes

When does breast milk jaundice peak?

7th to 10th day, starting from about 3rd day of life

How old would you guess an infant that is standing with assistance is?

8 1/2 months old on average (between 5-12 months of age this occurs)

When is separation anxiety most common?

8-10 months

At what month does a newborn get foods FIRST then Breastfeed?

8-9 months

How old would you suspect a baby that expresses separation anxiety is?

8-9 months old

Water in Milk

87.5% Components are dissolved in water. Increased fluids doesn't increase milk supply, unless dehydrated

How old would you guess an infant that is on their hands and knees crawling is?

9 months old on average (between 5-13 months of age this occurs)

At what age would you expect teething to begin?

9 months on average (between 4-14 months this occurs)

At what month can newborns have soft cooked foods; foods cut in small bites; finger foods

9+ months

At how many months can a newborn use a spoon and girl?

9-15 months

What is the whey to casein ratio of early lactation ?

90:10

After 5 half-lives of a drug approximately what percentage has been eliminated?

98%

Botulism

<1 year - caused by a toxin produced by the bacterium Clostridium botulinum Constipation #1 sign; poor appetite/sucking, respiratory distress, lethargy, droopy eyelids, hypotonia

Preterm infant

<34 wks

Delayed lactogenesis II

>72 hours from birth to initiation of milk supply -similar causes to low milk supply -temporary problem, self resolving if managed well

What do you do if antibiotic tx within 2 days, if mastitis recurs, if it's nosocomial mastitis, or if severe or unusual?

A Breast milk culture and sensitivity testing should be done.

What is CCK?

A GI hormone that: -enhances digestion -causes sense of well-being and sedation *babies are designed to fall-asleep at the breast after nursing*

Colostrometer

A ______ measures IgG concentration by measuring specific gravity.

A pregnant woman with many allergies asks about infant feeding. Your BEST response is:

A baby is never allergic to its mothers' milk, but he may be sensitive to foods in the mother's diet.

IUD Intrauterine device

A birth control device inserted into the uterus. Non-hormonal types have been shown to have no effect on lactation. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 725-726.

Very low birth weight infant

A birth weight of less than 1500 grams. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 671.

Low birth weight infant

A birth weight of less than 2500 grams. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 671.

Mongolian spots

A bluish-black pigmented area on the newborn's buttocks or back. Seen in newborns with dark skin and typically fade over time. Can easily be confused for bruising. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 686.

Breastfeeding dyad

A breastfeeding mother and baby.

Back to sleep

A campaign that significantly reduced SIDS. Babies are less prone to SIDS when sleeping on their back. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 632.

Oligosaccharide

A carbohydrate consisting of monosaccharides found in breastmilk. Antibacterial properties. Promotes the growth of Lactobacillus bifidus. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

Exocytosis

A cell releases secretory vesicles as in production of protein and lactose in the alveoli. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/exocytosis.

Mammary bud

A cluster of embryonic epithelial cells that mark the beginning of milk ducts. Forms approximately 49 days after conception. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

Nucleotides

A compound that has a nitrogen base. Essential for energy metabolism, enzyme reactions, gastrointestinal tract development, and immune function. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 128.

Hyperbilirubinemia

A condition characterized by elevated levels of bilirubin and decreased elimination of bilirubin. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 367 & 370.

Osteoporosis

A condition of bone loss. Breastfeeding for 6 months or longer is the best protection against bone loss. Although calcium is lost during breastfeeding, more calcium is deposited after weaning. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 510.

Lauric and capric acid

A crystalline fatty acid found in fats and oils, also called dodecanoic acid. Active against viruses, bacteria and protozoa. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/lauric+acid?show=0&t=1296699750 and http://www.merriam-webster.com/medical/capric%20acid.

antibodies

A decrease in _____ causes a decrease in proteins of milk.

Lymphocyte

A developed leukocyte that is bactericidal. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

Lactose

A disaccharide that is the primary carbohydrate found in human milk. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869-870.

Polycystic ovarian (ovary) syndrome

A endocrine-metabolic disorder where multiple cysts interfere with ovarian function. Common symptoms are unusual breast development, amenorrhea, male pattern hair growth, obesity. Can effect milk supply. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 523.

Vitamin D

A fat soluble vitamin that prevent rickets. Produced in the skin from exposure to sunlight. Found in fatty fish, eggs and meat. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 128.

Vitamin D

A fat soluble vitamin that prevent rickets. Produced in the skin from exposure to sunlight. Found in fatty fish, eggs and meat. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 128. Hale, T., 2010. Medications and Mother's Milk, (14th Edition), page 1052.

TE Fistula Tracheoesophageal fistula

A fistula (passage way) between the trachea and esophagus. Oral feedings are withheld until the fistula is surgically repaired due to the risk of aspiration. Merck manuals Online Medical Library. www.merckmanuals.com/professional/sec19/ch289/ch289b.html?qt=tracheoesophageal fistula&alt=sh.

Galactogogue

A food, herb or drug that is thought to increase milk supply in lactating women. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

Chamomile

A herb, L3. Used for anti-inflammatory, calminative, antispasmodic, milk sedative, and antiseptic properties. No concerns reported via breastmilk. Hale, 2010. Medications and Mother's Milk (14th ed.), page 202.

Shatavari

A herbal galactagogue. Safety rating B. Humphrey, 2003. The Nursing Mother's Herbal, page 301.

Leptin

A hormone found in breastmilk that regulates appetite, metabolism, and food intake. Not present in formula. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 146.

Progesterone

A hormone high during pregnancy delaying lactogenesis II. Dramatically decreases after birth. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 88.

Pancreas

A large gland that secretes digestive enzymes which pass through the intestine and break-down proteins, fats, and carbohydrates. It also secretes insulin. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/pancreas.

Αlphalactalbumin

A major protein found in human milk whey. Assists in processing lactose. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863.

What is mammary duct ectasia?

A milk duct beneath the nipple widens and the duct walls thicken and fill with fluid. The milk duct may become blocked or clogged with a thick, sticky substance.

Galactocele

A milk filled lacteal cyst. Most frequent lump found in a lactating breast. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page311.

10-20

A moderate amount of colostrum is __-__ mg/mL.

Galactose

A monosaccharide derived from lactose. Helps with central nervous system development. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

Amenorrhea

A natural phase of infertility that takes place when a mother is exclusively breastfeeding. Menstruation has not returned. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 707 &865.

Flat nipple

A nipple that does not protrude out or retract in (it is neither everted or inverted). It may or may not have slight movement inward or outward when stimulated or compressed. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 205.

Holder pasteurization

A pasteurization process in which the milk is heated to 62.5o Celsius for 30 minutes, and then rapidly cooled in ice water. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 482.

Informed consent

A patient has been given full information and offered appropriate options. Wikipedia. en.wikipedia.org/wiki/Informed_consent.

Lyophilization

A process preformed to obtain human milk nutrients used to fortify human milk. The milk is rapidly frozen and dried in a high vacuum. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

Dopamine

A prolactin inhibiting factor. Decrease releases prolactin and milk production begins. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 88.

What is FIL?

A protein called feedback inhibitor of lactation that down-regulates the milk supply by accumulating in the Breast and interferes with the calibration of the milk supply

Noncasein protein

A protein found in the whey component of milk. Includes alphalactalbumin, serum albumin, lactoferrin, immunoglobulins, and lysozyme. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

Bolus

A quantity of medication given by IV, or a quantity of fluid (milk) given orally. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/bolus.

Choanal atresia

A rare congenital anomaly, blocked posterior nostrils on one or both sides. Feedings by mouth are either difficult or impossible. Surgery opens the airways. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 644.

Phasic bite

A reflex that is characterized by a rhythmic opening and closing of the jaw when the gums are stimulated. Appears around 28 weeks gestation. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 142.

Ethnography

A research method that attempts to understand the beliefs, practices, and behaviors of the culture of study from the perspective of those living within the culture. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Trachea

A semirigid tube that branches into the primary bronchi leading to each lung

Eczema

A skin inflammation or rash. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Lobule

A structure composed of branching ductules that end in alveolar clusters. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 54.

Allergen

A substance that causes an allergic response, such as foods, drugs, inhalants. Cow's milk is common source for infants. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863.

Periareolar incision

A technique used in breast augmentation where the incision is made around the areola. It is associated with loss of nipple sensation. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 360.

Esophagus

A thin muscular tube that extends into the stomach and distended as good is propelled through it by peristaltic motion

Ankyglossia

A tongue tie. Characterized by a thick, short, or tight frenulum under the tongue. Can cause breastfeeding issues, such as a painful latch or inefficient milk transfer.

Phototherapy

A treatment for jaundice involving blue spectrum light. The light is absorbed by bilirubin and changes the structure, allowing it to be excreted from the body more easily. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 374.

Low-dose birth control pills

A type of hormonal birth control that includes both estrogen and progestin in lower doses. May reduce milk supply but less likely than estrogen based pills. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 728.

Chicken pox

A virus infection, mothers can continue to breastfeed. Antibodies from her breastmilk provides immunity for the baby. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 202-203.

Wet nurses

A woman who breastfeeds a infant that is not her own. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 875.

Malfeasance

A wrongful act

CN VI

Abducens; moves eye away from center of body

Cultural competency

Ability to understand, communicate, and interact effectively with people from different cultures. Four components: Awareness of one's own cultural worldview; attitude towards cultural differences; knowledge of different cultural practices and worldviews; cross-cultural skills. Wikipedia. en.wikipedia.org/wiki/Cultural_Competency.

Rickets

Abnormal calcification of the bones and changes in growth plates that lead to soft or weak bones due to lack of Vitamin D. AAP advises that full-term breastfed infants receive vitamin D supplement beginning at 2 months of age." Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

What is hypertrophy?

Abnormally large breast

Tachypnea

Abnormally rapid rate of breathing. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

Amazia

Absence of breast tissue

Amastia

Absence of breast, nipple and areola

When selecting a drug to be given to a breastfeeding woman, which of the following drug properties is MOST IMPORTANT to consider?

Absorption from the GI tract

Hypermastia or polymastia

Accessory mammary tissue. Different accessory tissue from the tail of Spence that drains into the central distal system. Accessory mammary tissue has a separate system. Must be treated like tx engorgement.

Cultural relativism

Acknowledging the variation in beliefs and actions given to the behaviors of different cultures. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

TORCH diseases

Acronym for organisms that can damage the fetus: toxoplasmosis, rubella, cytomegalovirus, herpes simplex. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 204 & 875.

3 Levels of Lactation Acuity (Developed by Oklahoma University MC, 2010)

Acuity level 1: requires basic education & routine management (example: by RNs & CLCs) Acuity level 2: complicated mom & baby characteristics, i.e. C/S delivery, delayed BF, NB birth trauma or suboptimal milk transfer leading to medical decision to PC. Refer to IBCLC with early F/U after discharge. Acuity level 3: in depth & ongoing care needed. Includes pathological engorgement, mastitis, breast abscess, induced lactation, maternal breast complications, i.e. Breast sx & anomalies, maternal illness or other sx. Baby cases include NICU care, late premies, SGA, multiple births, jaundice, hypoglycemia, congenital defects, oral/motor dysfunction (tongue-tied, hyper or hypotonia), excessive wt loss (>7% before discharge)

Hepatitis A

Acute viral infection of the liver usually transmitted through food and water-borne routes. The newborn can be infected by vertical transmission from the mother. Baby and mother should be given gamma globulin. Breastfeeding can proceed as normal. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 697.

Hepatitis B

Acute viral infection of the liver. It is safe for baby to breastfeed from infected mother, if baby receives a hepatitis vaccine with 12 hours after birth. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 205.

Why is iron-rich food not recommended to infants under 6 months of age?

Adding additional sources of dietary iron overwhelms the lactoferrin, leaving the iron available to pathogenic bacteria for growth.

International code of Marketing of Breast milk substitutes

Addresses improper marketing practices. It prohibits the distribution of free formula ( including discharge packages)

Innocenti Declaration

Adopted August 1, 1990 in Florence Italy contains specific national action steps to promote and support BF. Adopted by many countries and modified and reconfirmed in 2005

What type of food consistency is best for a 12 month old?

Adult foods

Which type of bacteria are MOST dangerous for the newborn?

Aerobic bacteria on the mucous membranes

What is the mineral content of breastmilk like?

Affected strongly by pregnancy/involution/mastitis, during these times the alveolar junctions are open and milk has higher concentrations of sodium and chloride and lower concentrations of lactose and potassium

What percentage of available milk is pumped after one MER and after the second MER?

After 1st MER: 45% obtained After 2nd: 76% obtained after pumping

What to do if there is delayed lactogenesis II?

After 72 hours it is delayed -increase stimulation of breast

Post-

After, later than. Merriam Webster Medical Dictionary. www.merriam-webster.com/medical/post-.

Alcohol and breastfeeding

Alcohol can decrease milk supply. Breastfeeding must be interrupted for 1 hour per drink, or until mother is sober. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 171 & 188.

Herpes

All herpes are viruses and are highly contagious -exposure to active lesions can be fatal to neonate -breastfeeding acceptable if no active lesions in contact with infant -all lesions should be covered and none should be on nipple, if they are, then mother should pump and dump until scabbed over -wash hands, avoid kissing/nuzzling with cold sores

What is nipple inversion?

All part of the nipple is drawn inward within the folds of the areola - two types: simple ( nipple moves out with manual pressure) and complete ( nipple does not respond to manual pressure) - at 15-25 gestation the mammary pit becomes elevated forming the nipple and areola: an inverted nipple results when the pit fails to elevate

IgE mediated allergy

Allergic reaction to food causing immediate, systemic reaction; can sometimes be severe. Wikipedia. Available online: http://en.wikipedia.org/wiki/Food_allergy.

Cooper's ligaments

Also know as the "suspensory ligaments." Attaches the skin of the breast to the chest wall. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 82.

Spoon feeding

Alternative feeding method. Feed infant via small spoon. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 226-227.

Beta lactoglobulin

Amino acid not naturally occuring in human milk, but is in cow's milk. Linked to allergies & diabetes

Amino Acid-Based Formulas (e.g. Neocate® or EleCare®)

Amino acid-based formulas offer complete nutrition for infants. These formulas are for infants who are unable to tolerate extensively-hydrolyzed formulas. Amino acid-based formulas are also known as "elemental" formulas

What is supernumerary nipples ( aka: polymastia)

An accessory nipple - can occur anywhere along the milk line from the groin to axilla

Misfeasance

An act that is legal but is performed improperly

Finger feeding

An alternative feeding method that involves a feeding tube running along side the finger during a feed. It is believed to help coordinate suck, swallow, and breath and allows baby to pace themselves. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 232-233.

Function of lysozyme

An enzyme that is abundant in colostrum and breast milk that breaks down bacterial cell walls

Lactocyte

An epithelial cell that lines the alveoli. Secretory cell. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 165.

Goat's Rue

An herbal galactagogue. Chemically similar to metformin. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 592.

Blessed thistle

An herbal galactagogue. L3. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 592. Hale, T., 2010. Medications and Mother's Milk, (14th Edition), page 123.

Marshmallow root

An herbal galactagogue. Safety rating A. Humphrey, 2003. The Nursing Mother's Herbal, page 294.

Comfrey

An herbal poultice, L5. Is not considered safe due to alkaloids found in breastmilk after use. Hale, 2010. Medications and Mother's Milk (14th ed.), page 259.

Late preterm infant (weeks of gestation)

An infant born between 34 0/7 and 37 6/7 weeks gestation. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

Lactoferrin

An iron binding protein that prevents gastrointestinal diseases. Found only in human milk, not bovine milk. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 144.

Storing energy for growth

Anabolism

Epidural

Analgesia for childbirth. Anesthesia is placed in the epidural space just outside of the dura mater. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 217.

Foods containing Vit B12

Animal products, such as fish, meat, poultry, eggs, milk and milk products. For vegetarians, fortified cereals or nutritional yeast. National Institutes of Health. Office of Dietary Supplement. //ods.od.nih.gov/factsheets/vitaminb12/.

Some characteristics of abnormal tongues:

Ankyloglossia, short, bunched, retracted, flat tongue. Tongue protrusion may be from low tone or chromosomal disorders

Interluken 10

Anti-inflammatory, helps prevent GI disease, arthritis

Isoniazid

Anti-tuberculosis agent, L3. No concerns reported via milk but infant should be monitored for toxicity. Hale, 2010. Medications and Mother's Milk (14th ed.), page 551.

Ampicillin

Antibiotic, L1. Observe for change in intestinal flora, compatible. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 177. Hale, T., 2010. Medications and Mother's Milk, (14th Edition), page 68.

Amoxicillin

Antibiotic, L1. Observe for change in intestinal flora, compatible. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 177. Hale, T., 2010. Medications and Mother's Milk, (14th Edition), page 65.

Cephalexin/Keflex

Antibiotic, L1. Observe for change in intestinal flora; compatible. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 178.

Metronidazole/Flagyl

Antibiotic, L2. Milk levels moderately high, but significantly less than pediatric therapeutic dose (15 mg/kg/d). Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 179.

Fluconazole/Diflucan

Antibiotic, L2. Safe; no untoward effects have been reported. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 179.

Ciprofloxacin (Cipro)

Antibiotic, L3. Recently approved by AAP. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 178. Hale, 2010, Medications in Mothers' Milk. p. 224.

Zoloft/Sertraline

Antidepressant, L2. A serotonin re-uptake inhibitor with a short half-life. No concerns reported via breastmilk, probably safe for breastfeeding. Hale, 2010. Medications and Mother's Milk (14th ed.), page 930.

St John's Wort

Antidepressant, L2. No concerns reported via breastmilk, probably safe for breastfeeding. Hale, 2010. Medications and Mother's Milk (14th ed.), page 950.

Enteromammary system

Antigens enter maternal gut, pass to the lymph system where IgA specific antibodies are produced, then enter breastmilk. Hale and Hartman, 2007. Textbook of Human Lactation, page 200, 206

Aldomet/Methyldopa

Antihypertensive, L2. Frequently used to treat hypertension during pregnancy. No concerns reported via breastmilk. Hale, 2010. Medications and Mother's Milk (14th ed.), page 667.

Acyclovir/Zovirax

Antiviral used to treat herpes infections, L2. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 177. Hale, T., 2010. Medications and Mother's Milk, (14th Edition), page 84.

What is the effect of stress/fear/anxiety on oxytocin?

Anxiety interferes w/ oxytocin and can shut down the let-down reflex

You are working on a policy-development team as your hospital is implementing the WHO/UNICEF Baby-Friendly Hospital Initiative. How should your facility address infant formula in its policy guidance?

Any formula and bottles must be purchased through regular supply channels.

T cells

Any of several kinds of thymic lymphoid cells or lymphocytes that help to regulate cellular immune response. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

Acinus

Any of the small sacs or alveoli that terminate the ducts and are lined with secretory cells. Merriam-Webster Medical Dictionary. Available online: http://www.merriam-webster.com/medical/acinus?show=0&t=1296699192

Virtue ethics

Approach to ethics that emphasizes the character of the moral agent, rather than rules or consequences, as the key element of ethical thinking. Wikipedia. en.wikipedia.org/wiki/Virtue_ethics.

Deontology

Approach to ethics that judges the morality of an action based on the action's adherence to rules. Described as duty or obligation, because rules 'binds you to your duty'. Wikipedia. Available online: http://en.wikipedia.org/wiki/Deontology.

AGA

Appropriate for Gestational Age. Having a birth weight between the 10th and 90th percentile on intrauterine growth charts. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 671.

% of breastmilk that is protein

Approximately .8 - 1 % Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 272.

Nonprotein nitrogen

Approximately 1/4 of nitrogen found in breastmilk. Contains essential amino acids for infant. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

% of calories in breastmilk from protein

Approximately 10% Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 272.

% of breastmilk that is fat

Approximately 4% Hale and Hartman, 2007. Textbook of Human Lactation, page 50.

% of calories in breastmilk from carbohydrates

Approximately 40% Hale and Hartman, 2007. Textbook of Human Lactation, page 69.

% of calories in breastmilk from fat

Approximately 50% Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 124.

% of breastmilk that is carbohydrates

Approximately 7% Wikipedia. en.wikipedia.org/wiki/Breast_milk.

Lesion

Area of injured or diseased skin. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

Per-

Around

casein

Around the 4th milking, protein is in the form of ____.

Ethnocentrism

Assessing other cultures based on how one's own culture defines appropriate behavior. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Faster milk maturation

Associated w/lower bilirubin levels and greater weight gain. Milk maturation happens faster with more frequent feedings in newborn period.

How many stools is expected?

At least 3 scoopable poops every 24 hours by the end of day 4

Where is the BEST placement for the examiner's fingers when testing a nipple-areola complex for inversion?

At the edge of the areola

Phagocytes and lymphocytes

Attack and digest bacteria

Variable

Attributes, properties, and/or characteristics of persons, events, or objects that are examined in a study. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 875.

Potty training is an example of what stage?

Autonomy vs shame & doubt

Caloric density of breastmilk

Average, 20 cal/ounce

6 month milestones

Aware of caregiver vs strangers

What type of cell in human milk gives rise to antibody targeted against specific microbes?

B-lymphocytes

Which type of cell in human milk gives rise to antibodies targeted against specific microbes?

B-lymphocytes produce targeted antibodies that quickly appear in milk

What is the result of pasteurizing donor human milk? A. reduction in lactose B. no change in secretory IgA C. concentration of lipids D. destruction of lactoferrin

B. secretory IgA is stable to heat tx and freezing

Most commonly lacking vitamins

B6, thiamin, folic acid

Hirschsprung disease

BF infant may have milder symptoms and delayed onset of disease -lack of nerves to some portion of the intestines

Post-exposure prophylaxis for infants, BF vs bottle

BF: 6 weeks of nevirapine Bottle: 4-6 weeks of nevirapine or zidovudine Note: if mom didn't get treated before labor then the baby's treatment should be longer

Key milestones 4 months

Babbles, laughs, imitates sounds. Rolls over, sits with support, holds rattle. WebMD. Is Your Baby on Track? www.webmd.com/parenting/guide/is-your-baby-on-track.

Ten Steps

Baby Friendly Hospital Initiative uses the Ten Steps as outlined by UNICEF/WHO. Baby Friendly Hospital Initiative USA. www.babyfriendlyusa.org/eng/10steps.html.

Congenial Heart Disease

Baby at the breast won't use as much energy as formula-fed babies -May need to do insurance pumping -May need to supplement w/ EBM, especially hind milk, to increase caloric consumption w/o volume increase

What is pain-free weight gain?

Baby is gaining weight and mom's nipples don't hurt

Switch nursing

Baby is switched back and forth between the two breasts during a feeding to help stimulate multiple letdowns and increase milk intake. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

Aerobic bacteria

Bacteria requiring air for metabolic processes. The breast is colonized with this type of bacteria. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863.

2 microbes that can be either harmful or helpful in NBs gut

Bacteroides, entero-bacteriaceae

Old breast feeding method: Schedule

Based solely on maternal comfort and not infant need

Matrescence

Becoming a mother. http://findarticles.com/p/articles/mi_qa3783/is_200101/ai_n8945635/

Lactogenesis I

Beginning milk production; mid-pregnancy to day 2 postpartum. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 85 & 86.

What is foremilk?

Beginning of feed; high in lactose; " bluish cast"; + brain growth

Infra-

Below

Flexion

Bending movement around a joint in a limb that decreases the angle between the bones of the limb at the joint. Opposite of extension. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/flexion?show=0&t=1296702486.

When should complementary foods be a part of a child's diet?

Between 6-24 months of age

Hospital grade breast pump

Bilateral electric breast pump. Used in hospitals, available for rent in community. Achieves more effective suction levels and frequency. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 526.

Personal use breast pump

Bilateral electric breast pump. Used primarily by working mothers. Achieves good suction and frequency. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 524.

Kernicterus

Bilirubin encephalopathy, a form of brain damage resulting from unconjugated bilirubin entering the brain. Characterized by lethargy, poor feeding, vomiting, irregular respiration, perhaps death. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 370.

Prolactin receptor sites

Binding sites on the walls of the lactocytes that receive prolactin. Frequent breastfeeding early in lactation creates more receptor sites resulting in increased milk production. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 89.

Neonatal period

Birth through the first 26 days of life. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

Metoclopramide

Black box warning from FDA, side effects can be depression or development of tardive dyskinesia

Tx of hypergalactia

Block feeding on one Breast for intervals up to several hours, relieving the other Breast slightly by manual or pump expression. After the one breast is softened block feed on the other breast. If not working can take estrogen for 4-7 days.

Cephalohematoma

Blood collection between the bones of the head and periosteum - likely delivery related - increased risk of jaundice *weeks to recover*

Cord blood

Blood remaining in the umbilical cord after birth. May be saved for later stem cell transplantation. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Cyanotic/Cyanosis

Bluish coloring due to low oxygen levels. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 296-296.

Acrocyanosis

Bluish discoloration of the hands and feet in the newborn; peripheral cyanosis. Should not persist beyond 24 hours after birth. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863.

PKU (phenylketonuria)

Body does not produce enzyme to break-down amino acid phenylalanine and this builds-ups in blood; need low phe formula and CAN breastfeed

Maple Syrup Disease

Body is unable to break-down certain proteins/amino acids (leucine); sweet smelling urine. Need low protein diet/special formula i.e. Ketonex-1. *BF CONTRAINDICATED*

Premature infant

Born at less 37 weeks gestation. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 671.

Thrush

Both mom and baby may need antibiotic/medication -may be gassy and fussy -white curdled looking tongue

UNICEF United Nations Children's Fund

Branch of the United Nations that advocates for children's rights. Developed the International Code of Marketing of Breastmilk Substitutes in conjunction with the WHO. UNICEF. www.unicef.org/.

Mastitis Milk fever

Breast infection usually caused by S aureus. Localized breast tenderness and flu-like symptoms, hot, reddened spot on the breast. Stress, cracked nipples, plugged ducts, large milk supply, and engorgement/milk statis are risk factors. Treated with dicloxacillin, amoxycillin-clavulinic acid, cephalexin, erythromycin, clindamycin, ciprofloxacin or nafcillin. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 294-295.

How can you raise oxytocin levels?

Breast massage/stimulation

Breastmilk Jaundice

Breast milk jaundice can last for 3-12 weeks after birth, but as long as the baby is feeding well and bilirubin levels are monitored, it rarely leads to serious complications.

What's not covered by the WHO International Code of Marketing of Breast Milk Substitutes

Breast pumps

Inferior pedicle technique

Breast reduction surgical technique. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 654.

Central pedicle technique

Breast reduction surgical technique. Intended to keep ducts intact. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 654.

Eample of promotion

Breastfeeding cost less

PKU

Breastfeeding is possible along w/ phenylalanine-free formula simultaneously

Biological nurturing

Breastfeeding on the chest, laid back positioning

Weaning milk

Breastmilk during the end of lactation (whether intentional or unintentional). This milk is higher in sodium and immunoglobins. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 676.

Transitional milk

Breastmilk produced between colostrum and mature milk, during the first 4-10 days postpartum. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 875.

Milk stasis

Breastmilk retention causing uncomfortable breast fullness. Results in slower milk production. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page264.

What drug is used to suppress lactation?

Bromocriptine (Parlodel, Bromolactin, Kripton, Bromohexal)

BALT/GALT/MALT

Bronchus/gut/mammary-associated immunocompetent lymphoid tissue. Intermammary pathway. IgA antibodies are transferred through breastmilk to the infant. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864.

Describe roux-en-Y gastric bypass WEight loss surgery

Bypass the distal end of the stomach, the duodenum, and jejunum limiting nutrient absorption

What Cranial Nerves are required for swallowing ( hint: 5)

CN V: trigeminal CN VII: facial CN IX: glossopharyngeal CN X: vagus CN XII: hypoglossal

If a drug is not protein bound would you be concerned or not, about the drug passing into the Mother's milk?

CONCERNED

Hyperthyroidism

Can breastfeed -nervousness may interfere w/ ability to cope -Some are given radioactive iodine, if this happens stop BF

Breast reduction

Can breastfeed, but rare to have full milk supply

Lactose use in body

Carbohydrate. CNS development, brain growth, energy.

Oligosaccharides

Carbohydrate. Promotes lactobacilus bifidus, Lowers gut pH, prevents pathogens from attaching to mucosal epithelium by PROVIDING BINDING SITES FOR BACTERIA

Epiglottis

Cartilaginous structure of the larynx, just below the soft palate. When the infant swallows it closes the larynx maintaining passage of milk to the esophagus. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

When revising or creating policies relating to breastfeeding, which of the following provides the strongest evidence for the policy?

Case reports

What does cholecystokinin do for a baby?

Causes satiety & relaxation

Mitosis

Cell division in which each daughter cell contains the same DNA as the parent cell. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

Which of the following maternal perinatal factors is MOST LIKELY to interfere with initiation of breastfeeding?

Cesarean surgery

Which of the following maternal perinatal factors is MOST LIKELY to interfere with initiation of breastfeeding?

Cesarean surgery

Preeclampsia

Characterized by increased blood pressure during pregnancy, after 20 weeks gestation. Treatment often includes preterm delivery. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 610.

Dioxin

Chemical contaminant in the environment. As dioxin levels increase, the EPA has still determined it safe for mothers to breastfeed in the United States. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 369.

Nicotine

Chemical in cigarette smoke, L2. Hale, 2010. Medications in Mother's Milk, page 745.

What essential mineral was omitted from infant formula that lead to brain damage and learning disabilities in the 1980's

Chloride

Hepatitis C

Chronic viral infection of the liver. Breastfeeding is allowed if mother's titers are not high. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 205-206.

Foods containing Vit C

Citrus fruits, peppers, broccoli, and strawberries. National Institutes of Health. Office of Dietary Supplement. //ods.od.nih.gov/factsheets/VitaminC-Consumer/.

Cord clamping procedures

Clamping the cord once pulsation has ceased (3 minutes) can increase # of rbcs

SSRIs Selective serotonin reuptake inhibitor

Class of antidepressants (as fluoxetine or sertraline) that inhibit the inactivation of serotonin by blocking its reuptake by nerve cell endings. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/ssri.

Serum

Clear fluid portion of blood that remains after coagulation. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

Cleft lip/palate

Cleft lip (orbicularis oris muscle interrupted) Cleft palate (Unilateral or bilateral) Creates one large naso-oro cavity - tongue sits upward and backward in mouth *Difficulty creating negative pressure - uncontrolled tongue movements, recurrent ear infections *SSC right after birth, Mom can use thmb or breast tissue to occlude lip* *May need more than BF - top-up d/t not being able to create enough vacuum @ breast - 1/3 will not grow on BM alone*

Proximal

Closer to the point of attachment. Opposite of distal. Wiktionary. en.wiktionary.org/wiki/proximal.

A microbe that's always pathogenic in the NBs gut

Clostridia

Lobe

Clusters of several alveoli with their ducts. Each breast contains 15-20 of these structures. Included in each one is 10-100 alveoli. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 80.

Polyamines

Coats the gut. Maturation of the gut, gut closure, protects against allergies and illness

Cephalhematoma

Collection of blood beneath the periosteum due to birth trauma; contrasted with caput succedaneum, where the effusion overlies the periosteum and consists of serum. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864.

What fx does lactobacilus bifidus play in colostrum?

Colonizes newborn GI tract with gram positive bacteria to crowd out gram negative bacteria

20%

Colostrum may contain over ___ (percentage) IgG.

Witch's milk

Colostrum, formed under the influence of maternal hormones, which may be temporarily present in newborn's breasts. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 875.

20-24 months

Combines 2-3 words - helps with simple tasks - stands up while nursing

Group B Strep

Common streptococcus bacteria in lower intestines. Harmless in adults, serious infection in neonates. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 526.

H1N1

Commonly called the Swine Flu. Mother may breastfeed. Antibodies are passed through breastmilk. http://www.usbreastfeeding.org/NewsInformation/NewsRoom/200905BreastfeedingandSwineFlu/tabid/144/Default.aspx

What anti inflammatory property is poorly represented in human milk?

Complement

Disaccharide

Complex sugar consisting of two monosaccharides. Forms the principle sugar in breastmilk, known as lactose. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Pinch test

Compressing the areola to see wither the nipple protrudes or retracts. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 63.

Torticollis

Condition of the neck in which the cervical muscles are contracted, producing twisting of the neck and an unnatural position of the head. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

Micrognathia

Condition where jaw is undersized; common but can interfere with feeding and breathing

Chylothorax

Congenital anomaly, obstruction of the lymphatic system. Chyle (lymphatic fluid) collects in the chest cavity and is drained via chest tubes. Managed by diet and medication. Fat free breastmilk has been used successfully. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 648-649.

Gastroschisis

Congenital malformation characterized by herniation of abdominal contents through a fusion defect. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

You recently read a published article by an IBCLC that sounds very much like something you wrote several years ago. Comparing the two documents confirms that you were correct. What is your NEXT course of action?

Contact the publisher of the magazine to voice your concerns and request the material be properly cited in print.

TB Tuberculosis

Contagious bacterial infection usually involves lungs. Mothers may breastfeed after treatment is begun. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 525.

Cystic Fibrosis

Continue breastfeeding and offer pancreatic enzymes

A mother asks about sources of vitamin D for her 16-month-old breastfeeding child. Your FIRST recommendation should be:

Continue breastfeeding, and ask your doctors to test you both for vitamin D levels

gastroenteritis

Continue breastfeeding, no cessation is necessary -nausea and vomiting may decrease desire to BF

A mother asks about sources of vitamin D for her 16-month-old breastfeeding child. Your FIRST recommendation should be:

Continue breastfeeding; you and he should get direct sunlight about 30 minutes a week.

Myoepithelial cells

Contractile cells that surround the milk secreting alveoli creating the milk letdown. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

Connective tissue of the breast

Cooper's ligaments or Suspensory ligaments (made up of fibrous protein) and connects the back-side of the breast skin to the pectoral muscles

Common sitting positions/holds

Cradle Football

Trigeminal nerve

Cranial nerve V. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 92.

Vacuum

Creates negative pressure

Which feeding device is MOST APPROPRIATE if a preterm baby cannot yet breastfeed but can tolerate oral feeds?

Cup: most researched

Golgi apparatus

Cytoplasmic organelle that is active in production and transport of breastmilk proteins—called also Golgi complex. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/golgi%20apparatus.

Hypoglycemia

DOES NOT occur in healthy full-term infants *at 8 hrs after birth, whether fed or not, a normal full-term infant will have a normal blood sugar level* Routine blood glucose testing IS NOT recommended S&S = jittery, lethary, high-pitch cry, exaggerated MORO, hypotonia, inadequate sucking reflex S&S + <45mg/dL - clinical intervention needed Risks but no S&S + <36 mg/dL - close surveillance +++SSC, early, frequent BFing

Fat content goes up as the volume goes ___

DOWN. Weaning milk has higher fat content.

Cerebral Palsy

Damage to motor area of brain -possible upper extremity functioning, affecting positioning

Pseudoephedrine/Sudafed

Decongestant, L3. Usually compatible with breastfeeding, but can effect maternal milk supply. Hale, 2010. Medications and Mother's Milk (14th ed.), page 867.

Hypotonia

Decreased muscle tone; "floppy" difficulty coordinating suck-swallow-breathe poor gape and mouth control poor search and tongue extension loss of suction long/slow feeds *Dancer Hold for BFing w/ upright positioing; tube at breast prn - switch nursing & compressions*

Reliability

Degree to which collected data are accurate, consistent, precise, and stable over time. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Validity

Degree to which collected data are true and represent reality; the extent to which a measuring instrument reflects what it is intended to measure. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 875.

What is the pros of delaying the first bath?

Delaying the first bath 8-24 hours can help keep baby warm and helps them regulate their blood sugar

What is the most likely side effect of metoclopramide?

Depression

Metaclopramide (Reglan) side effects

Depression, tardive dyskinesia If no receptor sites, med just elevates prolactin in blood stream

Exogenous

Derived from outside the body - such as iron supplements. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Intent to treat research--describe

Design allocates research participants to groups according to a planned intervention

Bactericidal

Destroys bacteria. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/bactericidal.

Epidermal growth factor (EGF)

Develops lining of the infant's gut to improve nutrient absorption

Transcutaneous bilimeter

Device that estimates bilirubin concentrations in the blood by measuring the intensity of yellowish skin coloration. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

SIDS Sudden Infant Death Syndrome

Diagnosis when all other possible causes of death were ruled out. Major risk factors are maternal smoking, prone position, and formula feeding. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 282 & 874.

DRGs

Diagnostic Related Groups, used by insurance companies for reimbursement. Diagnostic Related Groups, used by insurance companies for reimbursement. Wikipedia. en.wikipedia.org/wiki/Diagnosis-related_group.

What is the most likely effect for baby if mom is treated with amoxicillin for an infection?

Diarrhea and loose stool

Name a commonly used drug for tx mastitis and what organism is it effective against?

Diclixacillin is generally effective against Staph aureus

Caput succedaneum

Diffuse swelling or collection of serum under the scalp of the newborn from birth trauma. Differentiated from cephalhematoma by unrestriction by the sutures of the skull. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864.

-ectasis

Dilation of or stretch

Galactosemia

Disorder of the metabolism of galactose, a milk sugar. Baby must be on galactose-free formula. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 650 & 652.

Dysphagia

Disruption in the swallowing process

Cigarette smoking decreases milk volume. How?

Disrupts hormonal control of lactation by oxytocin and prolactin

Water soluble vitamin

Dissolve in water and not stored in the body. Vitamin C, nicotinic acid, B12, riboflavin, and B6. B12 can be deficient in women who eat a vegan diet. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 129.

Meaning of nonmaleficence?

Do no harm

DHA & ARA

Docosahexanoic acid and Arachidonic acid. Essential fatty acids known for improving visual acuity and cognitive ability. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 125-126.

Contemporaneous

Documenting in a timely fashion

A breastfeeding mother is also pregnant. She asks the lactation consultant if she needs special dietary considerations to "eat for three" while she's pregnant. Which suggestion is irrelevant?

Double your protein intake.

What level of alertness should you feed baby?

Drowsy or quiet alert

Seizure disorders

Drugs can make baby sleepy and depress sucking, pump after feeds if this occurs -encourage breastfeeding otherwise

L 1

Drugs that have been taken by a large number of breastfeeding mothers with no observed adverse effects in infants. Controlled studies have not shown any risk or harm to infant or the drug is not orally bioavailable in the infant. These drugs are considered "safest" to use when breastfeeding. Hale, 2010. Medications and Mother's Milk (14th ed.), page 15.

L 3

Drugs that have no controlled studies on breastfeeding women or the adverse effect shown by controlled studies is only minimal. These drugs should only be given if the benefit justifies the potential risk to the infant. These drugs are considered "moderately safe" for breastfeeding moms to use. Hale, 2010. Medications and Mother's Milk (14th ed.), page 15.

L 2

Drugs that have not been widely studied in breastfeeding women, but have not been shown to have an adverse effect on the infant or the risk of adverse effect is unlikely. These drugs are considered "safe" for breastfeeding moms to use. Hale, 2010. Medications and Mother's Milk (14th ed.), page 15.

L 4

Drugs with positive evidence of risk to breastfeed infant or to breastmilk production. However, the benefits for the breastfeeding mother may justify the risk to the infant. These types of drugs are considered "possibly hazardous" for breastfeeding women to use. Hale, 2010. Medications and Mother's Milk (14th ed.), page 15.

Down Syndrome

Duplication of the 21st chromosome. Characterized by epicanthal folds, a flat nasal bridge, broad hands and short fingers, a single crease in the upper palm (simian crease), a flattened forehead, small mouth, large tongue (macroglossia), and hypotonia. Some have congenital heart disease. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 636.

Explain " tight junction"

During full lactation the passage of substances between alveolar cells is stopped by this gasket like structure - occurs during lactogenesis stage II

When are the levels of secretory IgA (sIgA) highest in human milk?

During the first 24 hours after birth

Explain what the D-MER is

Dysphoric milk ejection reflex- The abrupt emotional drop can cause a funny feeling in pit of stomach, longing, or nausea

IDDM (Type 1 Diabetes)

Early exposure to cow's milk protein increases risk Intro to solids <3 months Environmental factors provide the trigger

Whey:Casein ratio Early lactation Mature Late

Early lactation: 90:10 Mature milk: 60:40 Late lactation: 50:50 Cow's Milk: 20:80

Iron in breast milk

Easily used, 2/2 lactose and vitamin C. Iron absorption 48% vs 19% in bovine milk

Kappa-casein

Efficiency of digestion. Inhipits gastric pathogen (H-Pylori), Prevention of allergy to proteins

What are the 2 muscles that move the mandible up and down?

Elevator and depressor muscles

What is hindmilk?

End of feeding ; high in fat; essential for weight gain

Function of phagocytes

Engulf and absorb pathogens; release IgA

Function of lactose

Enhances calcium absorption

What is the function of lactose?

Enhances calcium absorption; metabolizes galactase and glucose why supplies energy to infants growing brain

Lactase

Enzyme needed by the infant to breakdown lactose in breastmilk to simple sugars. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869.

Lipase

Enzyme that digests the fat in breastmilk. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870 & 146.

Taurine

Essential Amino Acid, brain & retina development, heart rate regulation, cell membrane stability, prevents brain cell over-activity. Added to formula.

Tyrosine

Essential amino acid. Transmits brain and nerve impulses. Thyroid, pituitary, and adrenal gland function

Parenchyma

Essential and distinctive tissue of an organ as distinguished from its supportive framework. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/parenchyma.

Fourth intercostal nerve

Essential for inervation of the nipple. Enters the areola at 5 o'clock position on the left breast and the 7 o'clock position on the right breast. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 56.

Ethical altruism

Ethical doctrine that holds that individuals have a moral obligation to help, serve, or benefit others, if necessary at the sacrifice of self interest. Wikipedia. en.wikipedia.org/wiki/Ethical_altruism.

Ethical egoism

Ethical position that moral agents ought to do what is in their own self-interest. Wikipedia. en.wikipedia.org/wiki/Ethical_egoism.

Signs of disorganized suck

Excessively long feedings, perhaps 30-45" each side with eyes closed

Independent variable

Experimental (treatment) variable that is manipulated by the investigator to influence the dependent (outcome) variable. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 868.

Operational definition

Explicit description of a concept or variable of interest in measurable terms. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

EMM/EBM

Expressed Mother's Milk/Expressed Breastmilk. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 163.

Hydrolysate formula

Extensively-hydrolyzed formulas are hypoallergenic; offer nutrition for infants who cannot digest intact cow's milk protein these formulas break casein into smaller pieces that can be absorbed without allergic reaction.

Internal validity

Extent to which manipulation of the independent variable makes a significant difference on the dependent variable, or the extent to which the independent variable, rather than extraneous variables, has caused the change in the dependent variables. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869.

External validity

Extent to which study findings can be generalized to samples and settings different from those studied. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

True or false: Medications safe in breastfeeding are safe in pregnancy?

FALSE! With breastfeeding the infant is metabolizing the drug. In pregnancy the placenta is metabolizing the drug.

CN VII

Facial; muscles of facial expression

Of the following options for mothers returning to work, which is the LEAST protective of the breastfeeding relationship?

Facilities for collecting and storing milk THESE ARE PROTECTIVE Onsite child care b. Extended paid maternity leave c. Flexible working hours

Which of the following is the MOST IMPORTANT indication of baby's readiness for solid (family or complementary) foods?

Fading of tongue-extrusion reflex

What is the main cause of plugged ducts?

Failure to remove milk effectively, tight clothing/trauma to the breast

Pseudofedrine affects the MER? True or false?

False

True or false: cup feeding can prevent nipple confusion

False, though not always the case

Which statement is MOST accurate about the variation in composition of human milk?

Fat levels vary within a feed.

Buccal pads

Fat pads on the masseter muscles in an infant's cheeks giving them a plump cheeked appearance. Provide stability for the tongue during suckling. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864.

Vitamin K

Fat soluble vitamin necessary for blood clotting. Insufficient amounts of this vitamin can cause hemorrhagic disease. Injections of this vitamin are routinely given postpartum to infants. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 129.

Which nutrient is most difficult for premature babies to digest?

Fats

12-15 month milestones

Fears unfamiliar - will leave mothers side to explore familiar surroundings - speaks several words - code word to feed

Better method: demand feeding

Feed infant when she/he exhibits signs of hunger Infant breast feeds every 2-3 hours, around the clock, for first 6 weeks

Exclusive Breastfeeding

Feeding with only breastmilk, no supplements of water, glucose water, artificial breastmilk, or foods. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 296-297.

Which of the following is the MOST effective at increasing gastrin and CCK and decreasing somatostain in the baby?

Feeding with species-specific milk.

Lactic acid bacteria

Feeds of lactose, promotes healthy gut.

Common symptoms of bacterial Breast infection

Fever, chills and deep aching Breast pain

What type of food consistency is best for an 8 month old?

Finger foods

How many days after hospital discharge is the fastest drop off from breastfeeding?

First 10 days

Primary infection

First incidence of the illness after exposure to a pathogen. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Colostrum

First milk created during late pregnancy and early postpartum period. Has higher concentrations of immunoglobins, fat soluble vitamins and some minerals. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Primiparous

First pregnancy. Having carried one pregnancy to viability. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

How many stages are described in Tanner's phases of breast development?

Five

Tanner stages

Five stages of sexual development in adolescence evaluating pubic hair, genitals and breast development Merck manuals Online Medical Library. www.merckmanuals.com/professional/sec18/ch243/ch243a.html?qt=tanner stages&alt=sh.

Promotion of BF

Focuses on advantages of BF on a personal, community, state or global level

Protection of breastfeeding

Focuses on governmental, manufacturer, and social responsibility to assure breastfeeding's ability to compete with commercial interests

Protection

Focuses on governmental. manufacturer, and social commercial interest such as Nestle company(formula maker).

Support of BF

Focuses on interaction of helpers with family as well as program development and implementation

Support

Focuses on the interaction of helpers with family as well as program development and implementation.

1 month milestone

Follows objects with eyes; long sleep

Not necessarily lower in fat content

Foremilk

WABA World Alliance for Breastfeeding Action

Formed in 1991, this global organization's goal is to protect, promote, and support breastfeeding. World Alliance for Breastfeeding Action. www.waba.org.my/aboutus.htm.

Does breastmilk or formula contain more zinc?

Formula, but breastmilk contains prostaglandin E which increases absorption of zinc - Breastmilk is essential for babies w/ zinc deficiency

Harmful bacteria have difficulty growing in the breastfed infant's gut because the composition of breastmilk:

Fosters the growth of good bacteria that crowd out other organisms.

Human Growth Hormone

Found in human milk, it provides growth promoting and protective effects on cells. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 147.

Lysozyme

Found in the whey component of breastmilk, this enzyme creates a bactericidal and anti-inflammatory response. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 146.

Lactogenesis III requires which of the following to succeed?

Frequent milk removal and nipple stimulation

Paracellular milk synthesis/Paracellular pathway

From mothers blood stream between lactocytes & into alveoli, passage between epithelial cells "Leak" between cells, pregnancy Mastitis Involution Full lactation, gaps close Medications tx more easily to milk during these times

Candidiasis

Fungal infection caused by Candida albicans; also called "thrush." Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864.

Cholecystokinin

GI hormone that causes fullness/ sedation

Can a mom safely BF if she has been exposed to CMV?

Generally, yes unless the infant is very premature or of low birth weight. Then options could be to pasteurize and/or freeze the EBM.

______________ is the greatest predictor of body composition during lactation.

Gestational weight gain

Fibroadenoma

Glandular structure (such as breast) with a large amount of fibrous tissue (benign tissue). Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/fibroadenoma and http://www.merriam-webster.com/medical/adenoma.

The long, slender stylopharyngeal muscle is innervated by what nerve?

Glosso-pharyngeal nerve

What cranial nerve is responsible for the gag response and if triggered may inhibit the baby's deep latch?

Glossopharyngeal (C IX)

CN IX

Glossopharyngeal; taste; sensation in pharynx; important for swallowing

What carbohydrates are found in human milk?

Gluconjugates, lactose, oligosaccharides

Which herbal galactogogue is similar to metformin and may cause low blood sugar

Goats rue

Universal precautions

Guidelines for infection control, based on the assumption that every person receiving health care carries an infection that can be transmitted by blood, body fluids, or genital secretions. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 875.

HELLP syndrome

H (intravascular hemolysis), EL (elevated liver enzymes; LP (low platelets). Develops as a result of pre-eclampsia in about 0.1% of women. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 610-611.

What resources are always available to access if you have a question about transfer of medications into Mother's milk?

Hale or Lawrence

Manual breast pump

Hand operated pump, generally used for short term or occasional pumping. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 524.

Flange

Hard plastic shields used to collect milk while pumping. Sometimes a soft plastic or silicone. The nipple opening is often available in a variety of diameter sizes to accommodate differing nipple sizes. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 396 & 398.

High tone babies

Hard to take off clothes -caused by smoking moms or mom's who used SSRIs

Harlequin sign

Harmless color change in a newborn in which the dependent side of the body is a deep color while the other side is pale. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

A thriving, exclusively breastfed 3-monthold baby suddenly begins nursing much more frequently, around the clock. Her mother calls you, worried that something has happened to her milk. Your BEST response to her is:

Has the baby been exposed to illness lately?

SGA Small for Gestational Age

Having a birth weight that is below the 10th percentile on intrauterine growth charts. There is a concern for malnutrition and hypoglycemia. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 671-672.

Multiparous

Having carried two or more pregnancies to viability. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

Polymastia

Having more than 2 breasts. Additional breasts occur along the milk line and typically have little glandular tissue. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Hyperthelia

Having supernumerary nipples (extra nipples). Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/hyperthelia.

Raynauds syndrome treatment:

Heat and/ or medically with nifedipine therapy.

Pasteurization

Heating milk to destroy pathogens. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

Theoretical frameworks do what?

Help establish a systematic point of view and a starting or reference point for professional activities

HBV

Hepatitis B Virus. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 205.

HBIG

Hepatitis B specific immunoglobulin. Infants who are born to mothers with hepatitis B should receive this immunization at birth. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 698.

Dong quai

Herb contraindicated in lactation. Used to quell uterine cramps. Humphrey, 2003. The Nursing Mother's Herbal, page 239.

Echinacea

Herbal immunostimulant, L3. Known for stimulating immune system and wound healing. No concerns reported via breastmilk. Hale, 2010. Medications and Mother's Milk (14th ed.), page 348.

Type II Diabetes

High blood sugar levels due to lack of insulin production in the pancreas. A noninsulin dependent disease known as adult onset diabetes. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 681.

Type I Diabetes

High blood sugar levels due to lack of insulin prodution in he pancreas. An insulin dependent disease. Can delay lactogenesis II. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 652-653. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 267 & 681.

Hindmilk high in

High in fat - weight gain, up to 5x higher in fat than foremilk

Foremilk high in

High in lactose - brain growth

Which drug property is MOST LIKELY to permit high passage into milk?

High lipid solubility

Hypertonia

High, rigid muscle tone; rigid tight jaw, clamping down on breast restricted tongue movement *Finger feeding in prone position over the arm of an adult before BFing - use prone (tummy down) position; increased SSC, swing in blanket, colic hold*

Composition of preterm milk (<32 weeks)

Higher in Iron, Protein, Fat, IGA, up to 35-40cal/ounce

Phenylalanine

Higher in breastmilk. Of concern if PKU

Mature milk composition

Higher in calories, fat, and lactose. Lower in Protein.

Premie milk is high in what components for the 1st 30 days?

Higher in protein, fat, and electrolytes than mature milk

Construct

Higher order theoretical or empirical idea or phenomenon that has abstract meaning and requires multiple concepts to represent it more concretely. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Hyperprolactinemia

Higher-than-normal prolactin levels, which may result in spontaneous breastmilk production and amenorrhea. Causes include pituitary tumors and some pharmaceuticals. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 868.

You are working with a late preterm infant (born at 34 to 36 weeks gestation) who had been in the hospital NICU since birth 10 days ago. The baby falls readily asleep at breast each time you assist mom to latch. Her milk supply is plentiful because of pumping. What is the MOST LIKELY cause for this infant to be unable to sustain his latch at breast?

His suck has low intraoral pressure (vacuum) due to gestational age.

Key milestones 5 months

Holds head steady, reaches for objects and gets them, places objects in mouth. Wikipedia. en.wikipedia.org/wiki/Child_development_stages.

Progestin only birth control pills

Hormonal birth control that does not contain estrogen. Called the "mini-pill." Not likely to decrease milk production. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 728.

Prolactin

Hormone essential for initiating and maintaining milk production. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 88.

Oxytocin

Hormone responsible for the milk-ejection-reflex. Causes contraction of uterus after delivery and creates a sense of calmness and relaxation. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 91.

Insulin/humulin

Hormone that regulates carbohydrate and fats. L1, no concerns reported breastmilk. Insulin is too large a molecule to be secreted into breastmilk. Hale, 2010. Medications and Mother's Milk (14th ed.), page 537.

Cholecystokinine

Hormone that signals sedation and feeling of fullness/well-being during sucking; CCK release in mom and baby produces sleepy feeling

HTLV 1

Human Lymphotropic Virus. Causes T-cell leukemia and lymphoma. Breastfeeding is not recommended. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 206.

Donor milk

Human milk voluntarily given to a milk bank. Donor is screened, milk is pasteurized. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Anaphylaxis

Hypersensitivity (as to foreign proteins or drugs) resulting from sensitization following prior contact with the causative agent. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/anaphylaxis.

CN XII

Hypoglossal; muscles of the tongue

Conservative tx of mastitis:

Ibuprofen, cold therapy and mechanical flushing, whether it be by the baby nursing or pumping, plus resting for two days, drinking extra fluids and eating healthy

Pyloric Stenosis

If surgery occurs, can go back to the breast w/in 6-8 hours -more likely to occur in bottle fed infants

RER

IgA and IgM are produced in what organelle in mammary cells?

Functions of: --IgA --IgM & IgG --IgE

IgA: binds to microbes and blocks IgM & IgG: neutralize toxins but trigger an anti inflammatory response IgE: increased in allergic reactions

7-8 months

Imitates actions and noises; responds to name; - Says no - enjoys peek a boo - BF anytime anywhere

What is the MOST IMPORTANT reason for continuing to breastfeed into the second year of life and beyond?

Immune protection tailored to the child's environment

What is the MOST IMPORTANT reason for continuing to breastfeed into the second year of life and beyond?

Immune protection tailored to the child's environment

Active immunity

Immunity conferred by the production of antibodies by one's own immune system. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 868.

Passive immunity

Immunity passed to infant by antibodies manufactured passed to the infant transplacentally or in breastmilk. Passive immunity is temporary. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 868.

Antibody

Immunoglobulin formed in response to an antigen, including bacteria and viruses. Antibodies attack those bacteria or viruses helping the body resist infection. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863.

Secretory IgA

Immunoglobulin that forms antibodies in body and is critical in mucosal immunity. The most common immunoglobulin in breastmilk. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 142.

What are the formulas for calculating BMI in Imperial and metric units?

Imperial: weight in pounds X 703/height in inches squared Metric: weight in kilograms/height in meters squared

What is the half life of caffeine?

In a newborn (6 weeks of age) approx. 100 hrs In a baby (6 months of age) approx 6 hours

How is the composition of milk at the end of a feeding different from the beginning?

In general protein and fat contents are highest at the end of a feeding

Sow

In the ___, colostrum is absorbed for 36-48 hours.

intestinal wall

In the cow, large compounds such as IgG are absorbed through the ____ ___.

When do breastfed babies grow the quickest?

In the first 2-3 months, slowing at 6 months of age.

When is sIgA the highest in Breast milk?

In the first 25 hours, up to 15 times higher

Lactose deficiency/intolerance

Inability of the intestines to digest lactose; the principal carbohydrate in human milk. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

What is artrogriposis?

Inability to grip with the hand. May be challenging to BF.

Lactose Overload

Increase in lactose due to large volume of low-fat milk and not enough Lactase to break it down; frequent watery, green, frothy stools, diapers soaked with clear urine, ++ gas and colic behvaiour Often seen with OMER - block feeding, drain one breast, strategies for OMER

What changes to the components in breastmilk occur over time?

Increase: water, fat, energy, casein, serotonin, lysozyme Decrease: protein (casein increases), zinc, calcium, LC-PUFAs (specifically between 6-12 months)

A mother with epilepsy wants to breastfeed her third baby, after formula-feeding her first two. Which aspect of breastfeeding should you spend MOST time discussing with her?

Increased infant alertness Breastfed infants are more alert and responsive compared to formula-fed babies

Mucus in stool

Increased let down, lactose overload, food allergy -look for 4 poops by the 4th day the size of O in Okay hand

Apgar score

Index to evaluate the condition of a newborn infant based on a rating of 0, 1, or 2 for color, heart rate, reflex response, muscle tone, and respiration with 10 being a perfect score. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/apgar%20score.

Alpha Lactalbumin

Induces cell death in abnormal cells (i.e. cancer cells). Mucosal immunity in GI tract. Protective against lymphoma. "HAMLET" lethal to tumor cells

Plagiocephaly

Infant flattened head; often from prolonged lying in one spot

IDM

Infant of Diabetic Mother Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 227-241.

Rooting reflex

Infant turns his head towards touch and opens mouth. Appears at 28 weeks gestation and disappears around 4 months. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 698.

What formula can help a LC determine a baby's BM needs

Infant weight x 2.5= 24 hr intake THEN divide by the # of feeds

Normal Birth Weight

Infant with BW 2500 - 4200g

Extremely Low Birth Weight (ELBW)

Infant with BW <1000g

Very Low Birth Weight (VLBW)

Infant with BW <1500g

Low Birth Weight (LBW)

Infant with BW <2500g

Gestational age

Infant's age since conception, usually specified in weeks and partial weeks. Counted from the first day of the last normal menstrual period. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

Mastitis

Infected blocked duct (bacteria from the skin can get into the milk ducts) Symptoms: blocked duct and fever and generally feeling poor Treatment: continue to nurse and take antibiotics

Congenital infection

Infection existing at birth that was acquired via placenta. Includes HIV and TORCH organisms. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Nosocomial

Infections resulting from hospital treatment. Can be prevented by hand washing, hand sanitizer gels, disposable gloves, and disinfection of baby equipment. Wikipedia. en.wikipedia.org/wiki/Nosocomial_infection. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 527.

Anthrax

Infectious disease caused by a spore-forming bacterium (Bacillus anthrax), characterized by external ulcerating nodules or by lesions in the lungs. Merriam Webster Medical Dictionary. www.merriam-webster.com/medical/anthrax.

Necrotizing enterocolitis

Inflammation of the intestinal tract that may cause tissue to die. Premature infants not receiving human milk are at markedly greater risk for this serious complication. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

Conjunctivitis

Inflammation of the mucous membrane that lines the eyelid. Sometimes treated with fresh breastmilk. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Gastroenteritis

Inflammation of the stomach and intestines resulting from bacterial or viral invasion. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

Cross-nursing

Informal, short term wet nursing. Typically seen in the context of child care. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Atopic eczema

Inherited allergic tendency to skin rashes or inflammation. Exclusively breastfed infants are less likely to develop as cow's milk protein is a common allergen. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863.

Cystic fibrosis

Inherited disease of the exocrine system, causing normal secretions to become thick and sticky breastfeeding recommended

What does prolactin do in pregnancy?

Initiates *functional* activity of the breast formation of colostrum

BFHI Baby Friendly Hospital Initiative

Initiative by UNICEF and WHO (1991) to support breastfeeding in hospitals and maternity centers. "The 10 Steps". Unicef. Baby-Friendly Hospital Initiative. Available online: http://www.unicef.org/programme/breastfeeding/baby.htm.

Diabetic moms

Insulin needs may decrease -high pro or carb snack before or during nursing can help -may have a delay of lactogenesis II -susceptible to yeast infections

What two structures supply blood to the breast

Internal mammary (60%) Lateral thoracic (30%)

International agencies that have official position papers or programs supporting breastfeeding include all of the following EXCEPT:

International Monetary Fund

Necrotizing Enterocolitis

Intestines inflamed and infection - portion of bowel dies - common in preemies (7%) with typical onset first 4 weeks. BM can treat - ALL Preterms should receives human milk Significantly higher in AF infants

Symbiosis

Intimate association of two different kinds of organisms. An example is the breastfeeding dyad.

IUGR

Intrauterine Growth Restriction. An infant with slower than expected intrauterine growth. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 671.

Mothers of twins are LEAST likely to experience which of the following circumstances?

Intrauterine growth retardation

Placenta

Intrauterine organ that transfers nutrients from the mother to the fetus. After the delivery the drop in estrogen and progesterone levels allows milk secretion to begin. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Hyperalimentation

Intravenous feeding of an infant, commonly a very premature infant, with a solution of amino acids, glucose, electrolytes, and vitamins. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 868.

Parenteral

Introduction of fluids, nutrients, or drugs into the body by an avenue other than the digestive tract (intravenous, intramuscular). Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

Smooth muscle

Involuntary muscle fiber that responds to hormones. Ex., muscle around alveoli contracts in response to oxytocin. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 54.

Peristalsis

Involuntary, rhythmic, wavelike action. To strip milk from the breast, and infant's tongue uses a peristaltic motion that begins at the tip of the tongue and progresses toward the back of the mouth. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

Breastmilk is low in this nutrient________________.

Iron

Which mineral is particularly difficult for the premature (preterm) infant to absorb?

Iron

At what age would you consider Iron, Vitamin A, and Vitamin D supplementation?

Iron: 6 months of age; Vitamin A: 12 months of age; Vitamin D: during pregnancy via mother

What effect does breastfeeding at least 7 months have on UTIs?

It reduces the risk up to 2 years because of sIgA and lactoferrin in milk and human milk's anti-inflammatory and anti-infective properties.

What position is best for jaw asymmetry ("tilted jaw") or mandibular asymmetry?

Kangaroo or little cowboy -could also use Dancer's hand position?

You are counseling the mother of baby born at 36 weeks gestation who says her infant is quite sleepy. She calls her infant a snacker, which she describes as her infant waking up to feed approximately every 1-2 hours and promptly falling asleep at the breast. What should be your NEXT suggestion for this mother

Keep the baby skin-to-skin, without swaddling blankets, to maintain his temperature during feeds. Late preterm infants may fall asleep if they are slightly chilled, due to inherent thermal instability. Skin-to-skin contact is the best way to maintain thermal stability and maintain alertness.

Which organization fostered and financially supported the development of the lactation consultant profession?

La Leche League International

Example of support

La Leche League Leader

Why do breastfeeding women supplement with formula without medical reason or request in the early postpartum?

Lack of preparation for what the newborn period would be like .

2 microbes in the NBs gut that are acidic and beneficial

Lactobacilli and bifido bacteria

Lactogenesis I vs lactogenesis II

Lactogenesis I: mid-pregnancy maturation of gland. Lactogenesis II: occurs 30-40 hours postpartum of milk "coming in." Delayed lactogenesis II: when copious lactation hasn't occurred by 72 hours.

Making human milk stage: rapid drop in progesterone. Transitional milk produced.

Lactogenesis II complete delivery of placenta

Making human milk stage: Prolactin from frequent nipple stimulation, frequent removal of milk. Mature milk produced.

Lactogenesis III Glalactopoesis

Human milk has the highest content of _______ of all mammals

Lactose

What component is the first to diminish in weaning?

Lactose

LGA

Large for Gestational Age. Having a birth weight greater than the 90th percentile on intrauterine growth charts. There is a concern for hypoglycemia. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 671-672.

Hirschsprung Disease

Large intestine - prevents bowel movements - missing nerve in colon - heredity and more common in females - surgery

Pro-

Latin word meaning "for." Wikipedia. en.wikipedia.org/wiki/PRO.

De-

Latin word meaning "of" or "from." Wikipedia. Available online: http://en.wikipedia.org/wiki/De.

Foods containing folic acid

Leafy green vegetables, citrus fruits, dried beans and peas. National Institutes of Health. Office of Dietary Supplement. //ods.od.nih.gov/factsheets/Folate-HealthProfessional/.

Half-life

Length of time for half of a drug dosage to be eliminated. Five half-lives from time of original dosage usually clears the drug. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

a hospital nurse told her "if he nurses longer than that, he's only using you as a pacifier and you'll get sore." Your FIRST statement to her should be:

Let's see what he can do with nursing at breast at his own pace.

If a mother is taking medication for her depression during pregnancy, should you tell her to stop postpartum, because it will hurt her baby?

Likely no. Depends. Untreated mental illness is dangerous, more so than not breastfeeding. If you change a depression medication, it can put a person at risk for suicide before the other drug has time to become effective

If a mother was on methadone during her pregnancy and will be taking it postpartum, should you recommend that she breastfeed?

Likely yes. If mother is stable on therapy and dose is 100 mg or less, it should be safe. Withdrawal from the drug by infants is more gentle if infant is breastfed.

Describe the adjustable gastric band WLS

Limits the amount of food that can be Ingested; reduces emptying rate of stomach; noted to be a restrictive surgery

Hypothalamus

Links the nervous system to the endocrine system via the pituitary gland. Secrets the prolactin-inhibiting factor (dopamine). Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 225. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 88.

Which drug property results in MORE transfer of the drug into mother's milk?

Lipid solubility

Leukocytes

Living cells found in breastmilk that fight infection. Includes macrophages and lymphocytes. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

When does an abscess occur?

Localized infection that may require surgical drainage -can continue BF if comfortable -Maybe a reduce in supply

Claritin/Loratadine

Long-acting antihistamine, L1. Observe for sedation, dry mouth, and tachycardia. Hale, 2010. Medications and Mother's Milk (14th ed.), page 617.

A 5-month-old exclusively breastfed baby is recovering from hernia surgery. Which is the MOST LIKELY breastfeeding pattern for this child?

Longer nursing sessions for the comforting of slow milk flow

Hypoglycemia

Low blood glucose levels. Breastfed infants tend to have lower glucose levels than formula fed infants. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 233.

Hypoxia

Low blood oxygen causing tachycardia, hypertension, peripheral, vasoconstriction, dizziness, and mental confusion. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 868.

Colostrum composition

Lower in calories, fat, and lactose. Higher in protein.

Influence of smoking on milk composition/quanity

Lower in fat, Lower quantity

In comparison to mature milk, colostrum is:

Lower in: -lactose -fat -water -water soluble vitamins Higher in Immunoglobulins and proteins, specifically... -IgA -vitamins A+E -carotenoids -protein -sodium -zinc -chloride -potassium

Human milk has lower __________ and higher _________ and _________

Lower protein Higher fat Higher carbs

What are the effects of epidurals on BF?

Lowers oxytocin levels which may impact BF by impairing suckling in the early postpartum period

Prone

Lying facing down. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Supine

Lying on one's back. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

B Cell

Lymphocyte produced in bone marrow and peripheral lymphoid tissue; found in breastmilk. Attacks antigens. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864.

Which immunological component of breastmilk continues to increase beyond 6 months of breastfeeding?

Lysozyme

mother kept her 4-year-old daughter and 7-month-old baby alive while snowbound in their car 9 days. Which component of breastmilk at this stage was HIGHER than at previous stages of lactation?

Lysozyme Lysozyme increases over the early months of lactation and is higher at 3 months than 1 month.

Which component of human milk is LEAST important in preventing neonatal septicemia?

Lysozyme in colostrum ARE PREVENTATIVE: Secretory IgA antibodies c. Oligosaccaride receptor analogues d. Lactoferrin protein

If a drug is lipid soluble instead of fat soluble, would you be more or less concerned about the likelihood for passage into Mother's milk?

MORE

Where is prolactin made and stored?

Made in hypothalamus and stored in anterior pituitary gland -levels rise to get ready to make milk

Transcellular milk synthesis

Made in lactocyte, transferred through lactocyte -Exocytosis -Milk fat secretion -Secretion of ions and water -Immunoglobin secretion

What is the importance of oxytocin?

Made in the hypothalamus and stored in the posterior pituitary -Breasts may need several minutes of stimulation to achieve high enough levels to produce a let-down -Oxytocin required to produce a let-down of milk

Lactobacillus bifidus

Main bacteria in the intestine of a breastfed infant. Called the bifidus factor, promotes the growth of beneficial bacteria. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 144.

What signs and symptoms are seen in subclinical mastitis?

Mainly low milk supply and low grade Breast pain.

Galactopoiesis

Maintaining lactation once lactogenesis has been established. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

Lactogenesis III

Maintenance stage of milk production. Controlled by the autocrine system (supply and demand). Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 86.

β lactaglobin

Major protein in bovine milk. Hale & Hartman, 2007. Textbook of Human Lactation, page 40.

What is step 3 of the 10-steps to successful breastfeeding?

Make breastfeeding easier for babies, mothers, and their families

What is step 2 of the 10-steps to successful breastfeeding?

Make sure all staff members are educated on BF

Tracheomalacia

Malformation of the trachea cartilage causing collapse and wheezing sound during respiration. Mannel, et al. Core Curriculum, 2008, p. 633.

Hyperadenia

Mammary tissue without a nipple present (sometimes seen in axilla). Creasy, Resnik, Iams, 2004. Maternal-Fetal Medicine: Principles and Practice (5th ed.), page 139.

Down Syndrome

Marked hypotonia; decreased suck-swallow-breathe coordination, large tongue with poor control, poor gape and mouth control - *Dancer Hold for BFing*

What type of food consistency is best for a 6 month old?

Mashed or pureed

Gigantomastia

Massive enlargement of breasts during pregnancy can result in tissue necrosis, ulceration, and infection. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 307.

Water soluble vitamins

Maternal diet *DOES* affect B12 main one that can affect supply Vitamin B and C

What can cause color change to breastmilk? Should this be of concern?

Maternal diet/medications can alter color of breastmilk No need for concern unless frank blood is found, this will not harm infant, but should be followed up

Obesity affect on breastfeeding

Maternal obesity is linked to hypertension, type 2 diabetes, and a greater risk of birth interventions. Delays lactogenesis, lower milk supply and earlier weaning. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 255. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 107.

Stem Cells

Maturation, development.

Prolactin hormone takes over after pregnancy and takes up the receptor sites to produces ____________.

Mature milk

Calories in breastmilk

Mature milk has approximately 20 cal/oz. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 227.

Hypo-

Meaning "deficient." Wiktionary. en.wiktionary.org/wiki/hypo-.

Hyper-

Meaning "excessive." Wiktionary. en.wiktionary.org/wiki/hyper-.

Foods containing B6

Meat, fish, poultry, beans, and many fruits and vegetables, such as bananas and spinach. National Institutes of Health. Office of Dietary Supplement. //ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/.

Foods containing iron

Meat, fish, poultry, lentils, and beans. National Institutes of Health. Office of Dietary Supplement. //ods.od.nih.gov/factsheets/Iron-HealthProfessional/.

Bellagio Consensus Conference

Meeting to develop protocol for the Lactational Amenorrhea Method of birth control. 1988. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 714-715.

Frenulum

Membrane on the underside of the tongue that anchors it to the floor of the mouth. If short or tight it may restrict tongue extension and cause breastfeeding problems. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

Mucous membranes

Membranes that line body passages or cavities that communicate directly or indirectly with the exterior (such as respiratory tract). Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/mucous%20membrane.

To aid milk production in PCOS

Metformin May not be effective if there were no Breast changes during pregnancy

High Temperature Short Time Pasteurization

Method of pasteurization of breastmilk to preserve nutrients. www.britannica.com/EBchecked/topic/265421/high-temperature-short-time-method

Median

Middle number in a series of numbers; the number on either side of which exist an equal amount of numbers. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

four

Milk can legally be sold at ___ days.

Lactahedrin

Milk fat globules, protects against rotavirus.

When does engorgement occur?

Milk not effectively removed or completely removed and there is an increase in pressure to the alveoli on the lactocytes -Sometimes it just happens

CH Cancers

Milk protein a-Lactalbumin has HAMLET cells which kill tumour cells DNA is damaged in the absence of human milk

Drip milk

Milk that leaks from the opposite breast during a feeding. This milk is low in fat. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Foods containing calcium

Milk, milk products, broccoli, kale, and most grains. National Institutes of Health. Office of Dietary Supplement. //ods.od.nih.gov/factsheets/Calcium-Consumer/.

Milk-Based Formulas (e.g. Similac® Advance® or Enfamil® Lipil®)

Milk-based formulas offer complete nutrition. But, babies sometimes develop an allergy or intolerance to the cow's milk protein in these formulas.

Which components of human milk are MOST STABLE to pasteurization and freezing?

Minerals

140 degrees

Minimum angle of mouth corners

Exercise and breastfeeding

Moderate exercise is fine. Exercise to exhaustion can increase lactic acid levels in milk and baby may refuse to breastfeed. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 501.

Congenital dermal melanocytosis

Mongolian spots

What should you do for babies w/ brick dust urine?

Monitor hydration and stooling along with weight gain

Periodontal disease

More likely to have a preterm infant

Blocked ducts

More milk made than used can clog the duct Symptoms: Hard lump tender to the touch, may be reddened Treatment: Nurse more frequently to completely remove milk from the ducts

Birth control and lactation

Most birth control and/or oral contraceptives can cause decrease in milk production - If exclusively BF, lactational amenorrhea can be most effective form of BC

Hyperbilirubinemia (Jaundice)

Most common in first week (physiologic jaundice) accumulation of unconjugated bilirubin Caused by inadequate intake in first days of life; prolonged intestinal transit and delay in passing meconium - weight loss of >7% *BFing management, SSC - increase feeding*

Post partum hemmorage

Most common type of complication -transfusion may be necessary

Fenugreek

Most commonly used herb to stimulate milk production. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 175.

Treatment for PPD

Most efficacious = pharmacotherapy Moderate efficacy = interpersonal therapy (i.e. counseling) Mixed efficacy = exercise; essential fatty acid supplementation; hormone supplementation

Dermatitis

Most skin conditions on mother's breasts are considered dermatitis -for eczema use topical corticosteriods

You are working with a team developing policies for a postpartum (postnatal) unit that support exclusive breastfeeding, assure safety for all mothers and babies, and facilitate sleep for mothers at risk of postpartum depression. Which practice is MOST LIKELY to facilitate all three factors?

Mother and baby share the same bed unless specific risk factors are present.

Phenylketonuria

Mother would need special PKU diet breastfeeding recommended if mother has PKU, if infant has PKU is possible that infant may not be able to breastfeed exclusively as breastmilk has phenylalenine in it

Duct ectasia

Multi-coloured sticky discharge

Topical prescription med to treat cracked nipples?

Mupirocin (Bactroban) has antibiotic and anti fungal properties

Orbicularis oris

Muscle made up of several layers of fibers passing in different directions that encircles the mouth and controls most movements of the lips (as compressing, closing, or pursing movements). Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/orbicularis+oris.

Pharynx

Muscular tube at the rear of the mouth, through which air travels to the larynx and food from the mouth travels to the esophagus. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

Muscle cells around the alveolus

Myoepithelial cells

Heroine

Narcotic analgesic, L5. Not recommended for breastfeeding. Infant should be observed for sedation, tremors, vomiting, restlessness, and poor feeding. Hale, 2010. Medications and Mother's Milk (14th ed.), page 500.

What is common behavior with breastfeeding of a 10 month old?

Negotiable about location and timing, more flexible with BF than within the first 6 months. Often breastfeed to go to sleep, enjoy family foods, and may be cautious or frightened with approaching strangers.

NICU

Neonatal Intensive Care Unit

Lymphatic system of the breast

Network of lymph nodes and lymph ducts that help fight infection --Lymph nodes are under the arm pit, above the collar bone, behind the breast bone and other places of the body. --They trap harmful substances and fluid that maybe in the lymphatic system and safely drain them from the body

Port wine stain

Nevus flammeus. Reddish or flat pink lesion that does not blanch with pressure, caused by dilated capillaries below the epidermal skin. This lesion usually remains constant in size and does not fade with time. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 686.

Whey-casein ratio on human milk

Newborn period: 90:10 6 months: 60:40

Inverted nipple

Nipple below the skin line. Umbilicated nipple can be pulled out or everted, while an invaginated nipple cannot be everted. Occurs in 3 percent of women.

What is nipple protraction?

Nipple moves forward; a normal function response

What is nipple retraction?

Nipple moves inward - range from minimal to moderate severe

Which of the following mechanisms cause oxytocin to be released?

Nipple stretching with appropriate latch-on

What is hyperthelia?

Nipple without accompanying mammary tissue

Nitrates & nitrites

Nitric oxide produced, supports GI tract. Especially rich in colostrum

If a drug has a pH of 6 would you be concerned about ion trapping and about a medication transferring into a Mother's milk?

No

Breast implants

No decrease in BF initiation rate in women w/ implants

If the drug has a large molecular weight (>500) would you be worried about passage into Mother's milk?

No! I would not.

NGO

Nongovernmental organization. Organizations that operate independently of any government. Wikipedia. en.wikipedia.org/wiki/Non-governmental_organization.

Intrauterine growth rate

Normal rate of weight gain of a fetus. It is considered by many to be the ideal growth rate for premature infants. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869.

Manufacturers of artificial feeding products have attempted to increase the protective properties in their products by adding which of the following nonprotein nitrogen compounds found in human milk?

Nucleotides

What non protein nitrogen compounds are formula companies adding to artificial milk?

Nucleotides, but fall short of what's in breast milk

Mortality

Number of deaths in a specific population. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

Morbidity

Number of ill persons or instances of disease in a specific population. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

What are the most important complementary foods for a BF baby between 6-12 months?

Nutrient-dense and iron-rich foods, such as cooked pork. Fruits and vegetables are still important in the diet.

Human milk fortifiers

Nutrients derived from human milk or cow's milk and added to human milk to enhance the growth of very low birth weight infants. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 868.

Foods containing Vit E

Nuts, seeds, vegetable oils, and green leafy vegetables. National Institutes of Health. Office of Dietary Supplement. //ods.od.nih.gov/factsheets/vitamine/.

Due diligence

Obligation to adhere to a standard of reasonable care while performing any acts that could foreseeably harm others

Meaning of beneficence?

Obligation to do good

Helping mother to learn about correctly latching on involves

Observation for pre-feeding and readiness behaviors

Hawthorn effect

Observing a population for a specific behavior change that often produces the desired change, independent of the intervention being studied.

You are about to assess a breastfeeding mother-baby dyad. What should you do FIRST?

Obtain written consent from the mother.

Intracellular

Occurring within cells. For example, viruses live within cells as part of their reproductive period. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869.

When does mastitis usually occur?

Occurs with an infection -fever occurs -flu-like symptoms -aching -malaise

CN III

Oculomotor; responsible for several eye movements

What is the most common breastfeeding behavior in a child older than 1 year?

Often play and explore mom's body during breastfeeding sessions

Toxoplasmosis and chicken pox

Ok to pump and feed to baby

CN I

Olfactory; smell

Which of the following is NOT an example of breastfeeding promotion?

Opening a private lactation consultant practice

Fentanyl/Sublimaze

Opiate analgesic, L2. A narcotic analgesic used during labor and delivery. Controversy about effect on breastfeeding. Hale, 2010. Medications and Mother's Milk (14th ed.), page 405.

CN II

Optic; sight

Metformin/Glucophage

Oral hypoglycemic agent for diabetes, L1. Can also be used to treat Polycystic Ovary Syndrome. No side effects reported. Hale, 2010. Medications and Mother's Milk (14th ed.), page 662.

Human milk bank

Organization that collects, screens, processes and distributes donor milk. The milk is dispensed on prescription for infants and adults in need. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 868.

Abnormally high testosterone levels and delayed lactogenesis II can be caused by what condition?

Ovarian theca lutein cyst

Macromastia (hyperplasia)

Over development of breast * abnormally large breasts * starts in puberty * >400 * mastia: condition of having (such or so many) breasts or mammary glands* May be a reason to seek reduction mammoplasty

What is hyperplasia?

Overdevelopment of the breast; hyper plastic breast

Which hormone is produced in the posterior pituitary gland and is stimulated with hand massage and nipple stretching to allow milk to be let down?

Oxytocin

Let-down reflex Milk Ejection Reflex

Oxytocin causes the myoepithelial cells surrounding the alveoli to contract and remove milk from the breast. Stimulated by the suckling infant and causes the suckling pattern to change from non-nutritive sucking to nutritive sucking as the milk flow increases. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 91. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 296-237.

"let down" reflex

Oxytocin levels increase within one minute of any breast stimulation or in response to a baby crying or smelling a baby. Result is a contraction of the smooth muscle and milk ejection.

Adrenaline caused by stress affects what lactation hormone?

Oxytocin release temporarily

baby hand massage

Oxytocin releasing mechanism

A research study concludes that an event happened purely by chance. Which probability value is MOST LIKELY to show an effect by chance?

P 1.0

What happens if there is not good attachment/latch?

Pain or damage to the nipple may occur The infant can not adequately remove milk from the breast Mother and infant get frustrated

Elevated prolactin levels close it

Paracellular pathways

1st days after birth the cells have space between them producing what kind of transport and content of milk?

Paracellular transport produces milk high is sodium and protein

Partially Hydrolyzed Formulas (e.g. Carnation Good Start®)

Partially hydrolyzed formulas take a cow's milk protein whey, and break it into large pieces. Unfortunately, most babies allergic to cow's milk will react to these large pieces of milk protein. So, these formulas are not used for infants allergic to cow's milk.

Active transport

Passage of drug into breastmilk assisted by components in breastmilk. Hale & Hartman, 2007. Textbook of Human Lactation, page 470.

Passive transport

Passage of drug into breastmilk by diffusion, molecular weight and relative amount of drug circulating in maternal serum. Hale & Hartman, 2007. Textbook of Human Lactation, page 467.

Most drugs are absorbed by what process?

Passive diffusion

Breastfeeding provides this type of immunity:

Passive immunity

PDA

Patent ductus arteriosis. Abnormal blood flow between the aorta and pulmonary artery. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 24.

When doing a review of the literature for a research study, which sources are MOST IMPORTANT to include?

Peer-reviewed journal report of research, written by the researcher

Which aspect of lipid composition varies MOST in human milk?

Percent of fat in a given feed

Protein binding

Percentage of a drug bound to maternal plasma. High PB means less in breastmilk. Hale, 2010. Medications in Mother's Milk, p. 18.

Incubation period

Period between exposure to infectious pathogens and the first signs of illness. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 868.

Interbout interval

Period when baby is not at breast

pKa

Ph of a drug when equally ionic and nonionic. Drugs with pKa higher than 7.2 may be sequestered in breastmilk. Hale, 2010. Medications in Mother's Milk, p. 19.

Physiologic engorgement vs. Pathologic engorgement

Physiologic engorgement is normal increase in milk production of lactogenesis II. Pathologic engorgement is excessive fullness due to restrictive feeding practices or ineffective milk removal. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 637-638.

Gland that secretes lactation hormones.

Pituitary gland

A first-time mother and her 5-day-old infant called you for help. The baby is neither voiding nor stooling regularly and appears yellow. While the mother's breasts were engorged, all attempts at latching the baby onto the breast failed. She expressed 2 oz of milk total (60 ml). What is the NEXT action she should take?

Place the baby skin-to-skin on her chest, and see if he will self-attach.

What hormones trigger secretory differentiation, ie lactogenesis I?

Placental hormones produce colostrum

Name 5 different types of breast milk storage containers

Polypropylene Polycarbonate Polyethylene Clear glass Brown glass

Target population

Population that is of interest to the investigator and about which generalizations of study results are intended. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

If a drug has a high milk/plasma ratio would you be concerned about the drug in a mother's milk?

Possibly...not always a concern. I would be more concerned than with an alternative drug that has a low milk/plasma ratio.

What is the choanae

Posterior nasal apertures; paired passages from the nasal cavity to nasopharynx - BF widens the choanae unless tongue tie is present

Healthy People 2020 BF Targets:

Postpartum 82% Six months 61% Twelve mos 34% Exclusive to 3mo: 46% Exclusive to 6mo: 25.5%

PIH Pregnancy Induced Hypertension

Preeclampsia or toxemia. Characterized by increased blood pressure during pregnancy, after 20 weeks gestation. Treatment often includes preterm delivery. Can progress to HELLP syndrome. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 470 & 610.

Sepsis

Presence of bacteria in fluid or tissue. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Sialic Acid

Present at end of oligosacchride. High in brain tissue, colostrum, preterm milk

How are the components or concentration there of in preterm milk different?

Preterm milk is similar to colostrum. Higher in: -Protein -Sodium -Chloride (as well as IgA, Lactoferrin, Lysozyme, LC-PUFAs) Lower in: -Lactose Fatty acids parallel to intrauterine levels and profiles

Contraception

Preventing conception. Hormonal pill, barrier methods, intrauterine device. Breastfeeding can provide contraceptive protection. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Bacteriostatic

Prevents the growth of bacteria. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864.

Pre-

Prior to, before, earlier than. Merriam Webster Medical Dictionary. www.merriam-webster.com/medical/pre-.

Power

Probability that a statistical test will reject a null hypothesis when it should be rejected, or, in other words, detect a significant difference that does not exist. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Sampling

Procedure of selecting the sample from the population of interest. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Diffusion

Process by which the molecules of one substance (e.g., a drug) are spread uniformly throughout blood or plasma. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Deductive reasoning

Process of reasoning from a general premise to the concrete and specific. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Inductive reasoning

Process of reasoning from specific observations or abstractions to a general premise. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869.

Malpractice

Professional negligence by act or omission. Deviation from accepted standards of practice that causes injury or death to the patient, with most cases involving medical error. Wikipedia. en.wikipedia.org/wiki/Medical_malpractice.

Liability

Professional responsibility for an occurrence or omission. Being the cause. Wikipedia. en.wikipedia.org/wiki/Liability.

Which receptor cites produce colostrum and plugs up receptor site during pregnacy?

Progesterone

Why is there not copius milk during pregnancy....

Progesterone holds milk in check until delivery of placental and progesterone levels drop

Apoptosis

Programmed normal cell death. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863.

What lactation hormone is not affected by psychological stress?

Prolactin

Which hormone is produced in the anterior pituitary gland and stimulated by sucking to produce milk?

Prolactin

Which of the following statements about prolactin is TRUE?

Prolactin causes milk to be made

Lactation, ie lactogenesis III or galactopoesis is affected by what?

Prolactin from frequent nipple stim & frequent removal of milk produces mature milk

Describe how lactose is made

Prolactin triggers production of lactose in the lactocytes

Bifidus Factor

Promotes gram +lactobacillus, competes w/gram- (EColi)

Thyroid stimulating hormone

Promotes mammary growth and lactation through a permissive rather than a regulatory role. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 90.

What is thyroid stimulating hormone?

Promotes mammary growth and lactation through permissive rather than regulatory role

A staff member is fond of telling mothers how expensive it is to formula feed infants and how inexpensive it is to breastfeed. What is she doing when she talks to mothers on this topic?

Promoting Breastfeeding

What hormone in milk has anti-inflammatory activity?

Prostaglandins

What hormone is most responsible for any-inflammatory activity?

Prostaglandins. Protect all tissues and especially baby's gut

Cytoprotective

Protection from inflammation and death for cells. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 854.

Myelination

Protective fatty sheath around nerve fibers. Long-chain polyunsaturated fats that are important to myelination are abundant in human milk. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

What is one of the major benefits of colostrum, other than nutrient value?

Protective: -coats gut to prevent adherence of pathogens -promotes gut closure Protein dense

Function of lymphocytes

Protects infants by destroying cell walls of viruses through cell mediated immunity

Protein fat lactose percentage in breast milk

Protein 0.9% Fat 3.5-4.5% Lactose 7%

What nutritional problems do people encounter that undergo Roux en y

Protein calorie malnutrition , Vit b12 and D, calcium, folate, iron, zinc

Serum albumin

Protein in serum (blood). Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

immunoglobulins

Protein is greatly increased in colostrum because of the presence of _____.

Cow's Milk Protein Allergy

Proteins from mother's diet can pass into breastmilk and cause an allergy *2-5% of infants* Avoidance or restriction of causal food may be needed Full allergy - may need hydrolyzed formula IF BFing not possible

Immunoglobulin

Proteins produced by plasma cells to respond to a immunogen. The 5 different types include: IgG, IgA, IgM, IgE, and IgD. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 142.

Fluoxetine/Prozac

Psychotropic drug. L2 in older infants, L3 in neonates. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 182. Hale, T., 2010. Medications and Mother's Milk, (14th Edition), page 430.

What is the preterm pumping protocol?

Pump 8 times w/in 24 hours -following pumping, use hand expression to remove remaining milk -KEEP RECORDS!

Gentian violet

Purple dye with antifungal properties used to treat candida. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 303-304.

You are helping a mother 3 days after a surgical procedure to drain a breast abscess. Her breast is firm and milk is leaking from the incision, which is on the lateral side of the breast near her chest wall. What is the FIRST action she should take?

Put the baby to breast on the affected side to relieve milk stasis.

Milk-plasma ratio

Quantity of a drug in human milk in relation to maternal plasma. If the M/P ratio > 1.00, the drug is found in greater quantities in milk than in plasma. M/P ratio < 1.00, the drug is found in lesser quantities in milk than plasma. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871. Hale, Medicaitons in Mother's Milk 2010, p 18.

Flash heating

Quick, high temperature pasteurization. You Tube. www.youtube.com/watch?v=NNw1odieIoI

An optimal state for breastfeeding is when the baby is _____________.

REM sleep

Key milestones 3 months

Raises head and chest while on stomach, holds head up for periods of time, grasps objects, smiles at people, makes vowel noises. WebMD. Is Your Baby on Track? www.webmd.com/parenting/guide/is-your-baby-on-track; Wikipedia. //en.wikipedia.org/wiki/Child_development_stages.

What research study design is considered the most rigorous?

Randomized controlled trial

What leads to secretory activation, ie lactogenesis II?

Rapid drop of progesterone after delivery of the placenta produces transitional milk

Lactogenesis II

Rapid increase in volume increases due to rapid drop in progesterone. Milk production switches from endocrine to autocrine control. Day 3 and 8 postpartum. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 86.

Whey:Casein ratio

Ratio changes throughout lactation. Early milk the ratio is 90:10, mature milk is 60:40, weaning milk is 50:50. The ratio in formula is 20:80. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 26.

Retrognathia

Receding chin

AAP recommendation on duration of breast feeding

Recommends exclusive breast feeding for the first six months of an infant's life and continued until at least 12 months of age (WHO recommends until age 2)

Common symptoms of nipple thrush infection

Reddened areola and nipple with burning, stinging and itching

Pepcid/Famotidine

Reduces gastric acid secretion, L1. No concerns reported via breastmilk. Hale, 2010. Medications and Mother's Milk (14th ed.), page 398.

Which breast surgery is more destructive to milk supply?

Reduction surgeries tend to be more destructive as they affect nerve sensation needed for let-down and hormonal pathways (4th intercostal nerve). The 4th intercostal nerve runs at 4:00 o'clock on left breast and 8:00 o'clock on right. * horizontal incisions are more damaging (anchor) * assess location of scars, nipple sensitivity

Flow rate

Refers to the milk flow during milk ejection. Can also refer to the flow of a bottle nipple. When the milk flow is high the baby sucks slower and when the milk flow is low the baby sucks faster. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 445 & 450. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 523.

Gag reflex

Reflex that protects the airway by causing a contraction in the back of the throat. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 229 & 585.

Tachycardia

Relatively rapid heart rate whether physiological (as after exercise) or pathological. Opposite of bradycardia. Merriam Webster Medical Dictionary. www.merriam-webster.com/medical/tachycardia.

Frenotomy

Release of tongue tie by clipping the lingual frenulum. Often preformed without anesthesia with few complications. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 389.

What is reverse pressure softening ( RPS )??

Relieves areola edema by temporarily redistributing accumulated fluid

Distal

Remote from the point of attachment or origin. Opposite of proximal. Wikitionary. Available online: http://en.wiktionary.org/wiki/distal.

Kidneys

Removal of extra blood volume Removal of extra protein from the catabolism of uterine tissue

What is the " Patient Protection and Affordable Care Act " & " the reconciliation act of 2010"

Requires an employer to provide reasonable break time to pump; if the employer has > 50 workers a place other than the bathroom must be provided

Applied research

Research that focuses on solving or finding an answer to a clinical or practical problem. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863.

Basic research

Research that generates knowledge for the sake of knowledge. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864.

RSV

Respiratory syncytial virus. Viral respiratory illness; can be severe in infants. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Key milestones 9 months

Responds to name, finds partially hidden objects, sits without support, crawls, picks up objects with pincer grasp. WebMD. Is Your Baby on Track? www.webmd.com/parenting/guide/is-your-baby-on-track; Wikipedia. en.wikipedia.org/wiki/Child_development_stages.

International code of marketing

Restricts formula marketing practices

Dehydration

Results from inadequate intake decreased output, weak cry, lethargy, dry MM, sunken fontanelles >14% weight loss Require IV fluids and BF management

Uterine involution

Return of the uterus to its approximate size and location prior to pregnancy Occurs by actual loss of cells Takes ~6 weeks following delivery for complete involution to occur and for the site of the placenta to heal

Nutritive sucking

Rhythmic sucking at the breast with milk flow. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

Meds used to treat TB while breastfeeding

Rifampin Isoniazide Pyrazinamide

The baby's chin digs into the mothers breast in the back and forth motion.

Rocker

Key milestones 6 months

Rolls over, moves objects from hand to hand, pulls self up to sit, makes double syllable sounds like "dada". WebMD. Is Your Baby on Track? www.webmd.com/parenting/guide/is-your-baby-on-track; Wikipedia. en.wikipedia.org/wiki/Child_development_stages.

A staff nurse called the LC to help assess an obese mother breastfeeding her baby on day 2. Which indicator would be the MOST reassuring indicator of effective feeding?

Rooting and swallowing are observed.

Which infants are at most risk for effects of medications in their Mother's milk?

SGA, preterm, those born from a high risk pregnancy, or who are jaundiced

Aspirin

Salicylate analgesic, L3. Use associated with Reye's Syndrome in infants. Hale, 2010. Medications and Mother's Milk (14th ed.), page 87.

Cholecystokinin (CCK) helps babies feel as sense of ______________ (full & Sleepy)

Satiety

Likert scale

Scale that primarily measures attitudes by asking respondents their degree of agreement or disagreement to a number of statements. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

Warning signs of poor intake:

Scant/dark/concentrated urine No urine <4 stools/day after day 3 Stools not transitioned after day 6

Alveolus, alveoli

Secrete and store milk for let down. Surrounded by myoepithelial cells, contractile cells and connective tissue. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 80.

Montgomery glands

Secretes lubricating fluids on areola

Galactorrhea

Secretion of breastmilk in non-lactation women. Common among women who have previously been pregnant or breastfed. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 93.

Making human milk stage: colostrum is produced.

Secretory differentiation Lactogenesis I

Prader Willi syndrome

Seen with low muscle tone. For BF: upright straddle position and jaw support.

Seroconvert

Serum shows the presence of a factor that previously was absent. Ex., when cytomegalovirus antibodies become present in blood due to CMV disease the person is said to have seroconverted. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873-874.

Seropositive/Seronegative

Serum that demonstrates (positive) or does not demonstrate (negative) the presence of a factor. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

Which of the following foods is the BEST source of calcium for a partly breastfeeding 16-month-old who cannot tolerate dairy products?

Sesame seed paste

How long does it take for a baby's intestinal microflora to return to normal after being treated with an antibiotic?

Several weeks are necessary for the breastfed child's microflora to return to normal.

Gigantomastia

Severe over development of breasts *mastia: condition of having (such or so many) breasts or mammary glands* May be a reason to seek reduction mammoplasty

Human Immunodeficiency Virus Acquired Immunodeficiency Syndrome HIV/AIDS

Sexually transmitted disease. Antiretroviral drugs are helpful in prevention of it's spread to infant during pregnancy. In the U.S. it is recommended that women do not breastfeed. In developing countries exclusive breastfeeding is recommended. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 198-199.

HSV Herpes Simplex Virus

Sexually transmitted disease. Type 1 is infection of the genitalia. Type 2 occurs in the mouth region. However, lesions can occur on any place of the body including the breasts. Infants should not come in contact with active lesions. Good hand washing should be encouraged. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 201-202.

Bed-sharing

Sharing adult bed with baby. Questioned safety in reduction of SIDS. Safe bed sharing has been shown to extend the duration of breastfeeding. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 282-283.

Which of these sets of symptoms is MOST LIKELY to culture positive for mammary candidosis?

Shiny, flaking skin with breast pain

Infant position for breast feeding

Should allow the infant to appropriately latch and not impede swallowing

What is the general consensus on pacifiers?

Should be avoided until supply well established, if baby will take it. Some babies wont

STS

Skin to skin or Kangaroo Care. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

If you need to wake up the baby to feed, what should you do first?

Skin-to-skin or grandma rocking until the baby shows feeding cues - If baby doesn't, pump and then have partner supplement w/ spoon or cup

Ligand

Small molecule that binds specifically to a larger molecule (e.g., the binding of an antigen to an antibody, or of a hormone to a receptor). Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

4-5 month milestones

Smiles at mirror image

Key milestones 2 months

Smiles at sound of voices. Lifts head and chest while on stomach. WebMD. Is Your Baby on Track? www.webmd.com/parenting/guide/is-your-baby-on-track.

2 month milestones

Smiles; vocalizes in response to interactions - pacified by frequent BF

Paracellular transport: milk is higher in ___________ and _________.

Sodium & protein

What type of bottle/nipple is recommended for a BF baby

Soft-walled bottles; more physiologically like BF

What is the treatment for a nipple bleb?

Soften plugged area in warm water then massage or express duct opening.

Soy Formulas (e.g. Isomil®, Prosobee® or Nestlé Good Start Soy®)

Soy formulas are no less allergenic than cow's milk-based formulas. Eight to 14 percent of infants with cow's milk allergy will react to soy. Some infants will develop proctocolitis or enterocolitis. The term enterocolitis refers to the inflammation of the GI tract, which includes both the small and large intestine (colon). *soy formulas are not recommended in the treatment of cow's milk allergy.*

CN XI

Spinal accessory; muscles of the neck and shoulder

Ideopathic means?

Spontaneous or of unknown origin

What is galactorrhea?

Spontaneous secretion of milk from the breast under non physiological circumstances

Transitional milk (lactogenesis II)

Stage between colostrum and mature milk, lasting between 5 days and 2 weeks after delivery

When latching the baby to the breast.

Start with the baby's nose at the level of the nipple

Example of protection

State law on breastfeeding in public

Correlation coefficient

Statistic that indicates the degree of relationship between two variables. The range in value is +1.00 to -1.00; 0.0 indicates no relationship, +1.00 is a perfect positive relationship, and -1.00 is a perfect inverse relationship. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Chi-square

Statistical procedure that uses nominal level data and determines significant differences between observed frequencies in relation to data and expected frequencies. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864.

Parametric statistics

Statistical procedures used when a sample is randomly selected, represents a normal distribution of the target population, and is considered sufficiently large in size, and interval level data are collected. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

Nonparametric statistics

Statistical procedures used when required assumptions for using parametric procedures are not met, especially assumptions regarding a normal probability distribution. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

Univariate

Statistics derived from the analysis of a single variable (e.g., frequencies). Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 875.

Bivariate

Statistics derived from the analysis of the relationship between two variables. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864.

Stem cells

Stem cells can differentiate into all of the specialized cells types. Have been found in breastmilk. Cregan, Fan, Appelbee, Brown, et al. (2007). Identification of nestin-positive putative mammary stem cells in human breastmilk. Cell and Tissue Research, 329(1), 129-136. Available online: http://www.springerlink.com/content/k28h687mg3n433mj/

Prednisone

Steroid, L2. No concerns reported via breastmilk. Safe for short term use.

Prolactin inhibiting factor

Stimulates dopamine releases and thus inhibits prolactin. Nipple stimulation and milk removal suppresses PIF and dopamine, causing prolactin levels to rise and the breast to produce milk. From the hypothalamus. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 90.

Erythropoietin

Stimulates new RBCs. Abundant in breastmilk, primary source is kidney. Immunologic role.

Delayed Lactogenesis II can be delayed by what kind of labor?

Stressful labor with long second stage, i.e. from when the cervix is fully dilated to when the baby is delivered

Which of the following is the MOST APPROPRIATE complementary food for a 10-month-old breastfed baby?

Strips of lightly cooked pork Nutrient-dense and iron-rich foods are the most important complementary foods for the breastfed child between 6 and 12 months.

Conceptual framework

Structure of interrelated concepts that may be generated inductively by qualitative research to provide a base for quantitative study. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Epidemiology

Study of the frequency and distribution of disease and the factors causing that frequency and distribution. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Paced bottle feeding

Style of bottle feeding that helps avoid overly fast flow, especially in less mature infants. This technique includes: positioning infant upright in the caregiver's arms, positioning bottle horizontally with just enough angel to keep milk in the tip of the nipple, and pacing the feeding to approximately the same time as a breastfeeding would take. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 243. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 559.

Sample

Subset of the population selected for study. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Pathogen

Substance or organism capable of producing illness. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Antigen

Substance that stimulates antibody production. May be dust, food, or bacteria. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863.

Non-nutritive sucking

Sucking not on the breast, such as a pacifier, or sucking at the breast with brief sucks and long rest periods with minimal milk flow. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

What suction and frequency on a breast pump mimics Breastfeeding?

Suction: 150-250 mg Hg Frequency: 40-60+ suck- release cycles per minute

Tx TB

Sulfa drugs not used. --12 week tx of isoniazid (INH) & rifapentine (RPT) or --9 month tx of isoniazid (INH) or if resistant strain: --4 months of rifampin

Bactrim/Septra

Sulfonamide antibiotic, L3. The mixture of trimethoprim and sulfamethoxazole. No concerns reported via breastmilk in term healthy infants. Use with caution in preterm or jaundiced infants. Hale, 2010. Medications and Mother's Milk (14th ed.), page 249.

Polythelia

Supernumerary nipples, of associated with renal anomalies or other organs.

Down syndrome

Support infant head w/ dancer's hand position -move in the upright position -insurance pumping -Supplementation as needed

What is step 5 of the 10-steps to successful breastfeeding?

Support moms in maintaining breastfeeding and manage common difficulties such as positioning, preventing engorgement, and sore nipples

Low thyroid level can lead to what symptoms?

Suppressed milk synthesis, fatigue & chills

Frenulectomy/frenuloplasty

Surgical procedure to release a tongue tie. Used for more extensive tongue tie. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 389.

Anchor scar

Surgical technique for breast reduction, slang.

Black dots in stool

Swallowed blood

Apocrine gland

Sweat glands located on the areola that secrete a scent. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 197-198.

Caput succedaneum

Swelling of the infant scalp; disappears withon hours/days (1 week)

Engorgement

Symptoms: swollen, hard, painful to the touch breasts resulting in stretching of the nipple, low grade fever Treatment: feed more often

Colic

Syndrome in early infancy characterized by episodic loud crying, apparent abdominal pain (legs drawn up and rigid abdomen) and irritability. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864-865.

Pierre Robin Syndrome

Syndrome of oral facial abnormalities, micrognathia (a small jaw) and glossoptosis (tongue often blocks airway). Cleft palates are common. Difficulty maintaining the airway frequently causes feeding problems. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 643-644..

Supplementing at breast

System for supplementing the baby while feeding at the breast. Reservoir holding milk with a tube attached that is secured to the breast. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 414.

Trail factor

TNF-Related Aptosis Inducin Ligand. Reduces canncer risk

What are steps 6 + 8 of the 10-steps to successful breastfeeding?

Teach moms to not rely on the clock, but recognize cues in the baby and also not to give any other foods any other foods/fluids other than breastmilk unless clinically indicated

Reverse pressure softening

Technique to allow feeding on an engorged breast: apply steady pressure with fingers around the areola, pressing back towards chest wall. Moves edema towards lymphatic drainage system, triggers milk ejection reflex by stimulating nerves near the areola. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page241.

Inframammary incision

Technique used in breast augmentation where the incision is made in the fold under the breast and the implant is placed under the breast tissue. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 309.

Raynaud's phenomena

Temporary vascular condition; intense pain and pallor of the skin (usually of the fingers or toes, but in breastfeeding woman the nipples), cause by vasospasm. Can include white, red and blue phases. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Gut closure

Termination of absorption is known as ____ ____.

What does role fidelity mean?

That individuals caring for pts should practice within the scope of practice for which they are qualified

Vertical axis

The "X" axis in a graph The X-axis and Y-axis remembered. www.gradeamathhelp.com/x-axis-and-y-axis.html

Horizontal axis

The "Y" axis in a graph The X-axis and Y-asix remembered. www.gradeamathhelp.com/x-axis-and-y-axis.html

You are helping a breastfeeding mother of a preterm infant with positioning to optimize her infant's ability to latch and sustain feeding at breast. Which of the following is MOST LIKELY to result in effective breastfeeding for this mother and infant?

The "football" or cross-cradle hold with the mother's hand behind the baby's shoulders

Lactiferous ducts

The 15-24 milk ducts that collect milk from ductules and carry it to the nipple. If the alveoli are the "grapes" these structures would be the "stems". Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869.

Suck, suckle

The action of baby milking the breast. Related more to tongue movement than suction. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

10

The amount of IgG in colostrum that provides a sufficient amount of protection for the baby is ___mg/mL.

Bioavailable

The amount of a nutrient that is actually absorbed by the body. Nutrients found in breastmilk are easily absorbed by the infant's body. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864.

Creamotcrit

The amount of cream in a milk sample. The amount of cream (fat) varies from mother to mother, feeding to feeding, and throughout the course of lactation. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Teleology

The belief that all events are directed toward some ultimate purpose. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 874.

Mature milk

The breastmilk after colostrum and transitional milk, typically beginning 2 weeks postpartum. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

Autonomy

The capacity of a rational individual to make an informed, un-coerced decision. Wikipedia. en.wikipedia.org/wiki/Autonomy#Medicine.

As prolactin levels increase & cells plump up what happens to the paracellular pathway?

The cell spaces close up and become transcellular pathway for substances to go thru the milk cells and enter milk

Molecular weight

The chemical size of a molecule of a drug. The smaller the molecular weight of the medication (9300 Daltons or lower) the greater the diffusion across cell membranes. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 167.

WHO Code International Code of Marketing of Breast-milk substitutes

The code protects and promotes breastfeeding by ensuring the proper use of breastmilk substitutes. The code applies to the marketing of formula, milk products, beverages, complimentary foods used for the replacement of breastmilk. The code covers the marketing of feeding bottles and nipples (teats). World Health Organization, 1981. International Code of Marketing of Breast-milk Substitutes, page 8. www.who.int/nutrition/publications/code_english.pdf.

increases

The concentration of antibodies in colostrum _____ with age and lactation.

What happens to the content of breast milk after 1 year of lactation?

The creamatocrit levels are up to 28% higher and lysozyme is higher

Areola

The darker pigmented skin that surrounds the nipple. Contains sebaceous glands (Montgomery Glands) Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863.

Quasi-experimental studies are more likely to show that the explanation really did cause the outcome. What level of validity do they have?

The designs have the highest internal validity

Mammogenesis

The development of mammary glands and related breast structures. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

Beneficence

The duty to do good. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 31.

Nonmaleficence

The duty to do no harm. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 31.

When is lysozyme highest?

The early months of lactation, higher at 3 months than 1 month, for example

Whey component is greatest during what weeks in lactation?

The first few weeks

How long to most babies continue to wake at night for feedings?

The first year, though 2/3rd of babies wake during the night the 1st 6 months. Babies may get up to 1/3rd their calories at night.

Palate, hard

The hard portion of the roof of the mouth. During breastfeeding the infant compresses the breast tissue against this area with his tongue. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

Utilitarianism

The idea that the moral worth of an action is determined solely by its usefulness in maximizing utility and minimizing negative utility. Wikipedia. en.wikipedia.org/wiki/Utilitarianism.

During the colostral stage of BF, meds can more easily pass to breast milk due to what physiological reason?

The intracellular spaces between lactocytes are wide (Lactocytes are the mammary secretory epithelial cells)

Hindmilk

The last part of feeding

Whey

The liquid portion of milk that is left after curds separate. Primarily consists of proteins alphalactalbumin and lactoferrin. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 875.

What essential fatty acids are found in breast milk and in what portion of the milk?

The long-chain fatty acids are found in fatty portion of milk 1. Omega-3: Linolenic acid & docosahexacnoic acid (DHA) (although DHA is not technically an essential fatty acid because in opportune circumstances the body can make it) 2. Omega-6: Linoleic acid & arachidonic acid (AHA) (AHA isn't technically an essential fatty acid) 3. Omega-9: Oleic acid & palmitic acid (these are essentially non-essential fatty acids, though)

Recessed jaw

The lower gum ridge is posterior to the upper gym ridge

Mandible

The lower jaw, which causes the compressions during breastfeeding helping to milk the breast. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

Casein

The main protein in breastmilk. Creates the curd when digested in the infant stomach. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 864. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 26.

Hand expression

The manual removal of milk. Mothers push hands back towards chest wall and then roll fingers towards the nipple. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 241.

Foremilk

The milk at the beginning of a breastfeeding. This milk has low fat content. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

Hind-milk

The milk at the end of a breastfeeding. This milk has a higher fat content. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

With subclinical mastitis what does the milk become and what happens to the infant gut?

The milk becomes more like colostrum and the infant gut becomes more permeable.

Lateral and medial pterygoid

The muscle that controls certain movements of the jaw (medial) and acts as an antagonist of other facial muscles (lateral). It works in conjunction with the masseter and temporalis muscles. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/pterygoid+muscle.

Sternocleido-mastoid muscle

The muscle that is deviated in torticollis

Vasospasm

The nipple blanches sometimes turning blue or red temporarily due to vasoconstriction. Also occurs in other extremities, such as fingers and toes. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 306.

Lactogenesis

The onset of milk production. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869.

Autocrine control

The point in lactation when milk supply is controlled by milk removal. Local control in the breast. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 92.

Endocrine control

The point in lactation when milk supply is hormone driven. Milk will come in whether or not a mother is breastfeeding. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 92.

pinocytosis

The process by which colostrum is absorbed is known as _____.

Fortification of breastmilk

The process of adding extra nutrients to breastmilk for premature infants. These nutrients can be derived from human milk or cow's milk base. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 46-47.

Lactoengineering

The process of adding nutrients to human milk that are derived from human milk. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869.

Induced lactation

The process of stimulating milk production in a woman who has not been pregnant for the current child. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869.

Philtrum

The region between the nose and lips. The midline area should be grooved and defined. In fetal alcohol syndrome the area is flat. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

Rugae

The ridges behind the gum line on the hard palate. This structure helps the infant to maintain grasp of the breast during suckling. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Alveolar ridge

The ridges on the upper and lower jaw where infant's teeth will grow. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863.

Right brained thinking

The side of the brain characterized by logic, order, analysis, sequential. Wikipedia. en.wikipedia.org/wiki/Lateralization_of_brain_function

Left brained thinking

The side of the brain characterized by vision and hearing, art, pleasure, feeling, subjectivity. Wikipedia. en.wikipedia.org/wiki/Lateralization_of_brain_function

Ductules

The small ducts in the mammary gland that transfer the milk from the alveoli to the lactiferous ducts. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Velum

The soft palate. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 95.

Palate, soft

The soft portion of the roof of the mouth, located between the hard palate and the throat. This area rises when the infant swallows to close the nasal passages. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872.

The fat content of milk suckled by the baby is determined by:

The speed/ efficiency with which the baby removes milk.

Foramen ovale

The structure that is part of fetal circulation but closes about 3 days after birth

Stroma

The supporting tissues of an organ, ie, the breast. MedicineNet. com www.medterms.com/ script/main/art.asp?articlekey=12709

Difference between analgesic and anesthesia

The type of neurons affected

Mode

The value that occurs most frequently in a data set. For example, if the data set is 1, 3, 3, 3, 5, 7, 8, 8, the mode is 3. Wikipedia. en.wikipedia.org/wiki/Mode_(statistics).

Culture

The values, beliefs, norms, and practices shared by a group of people that guide the thoughts and behaviors of that group. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

passive immunity

The way that a cow requires antibodies through colostrum is known as ____ ____.

Jaundice

The yellow discoloration of skin, caused by high bilirubin levels. Physiologic jaundice usually resolves within the first weeks of life. Breastmilk jaundice is prolonged physiologic jaundice. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 375-376.

Studies on childhood obesity demonstrate that:

There is an inverse relationship between breastfeeding duration and obesity prevalence in a large population.

L 5

These drugs are considered "contraindicated" for breastfeeding mothers to use. Studies or human experience have shown that there is a significant risk to infant. The risk of using these drugs in breastfeeding women clearly outweighs the benefit of breastfeeding. Hale, 2010. Medications and Mother's Milk (14th ed.), page 15.

What is different in the appearance of a breastfed baby vs. a formula fed baby at 12 months of age?

They are leaner. Weighing less but having more body fat

What do alcohol, nicotine, sudafed, and birth control all have in common?

They decrease milk supply

What is thought to be the primary function of Montgomery glands?

They produce oil to lubricate the nipple and areolar skin

Colostrum

Thick yellow fluid made in the mammary secretory cells beginning about 16 weeks of gestation Released over the first 1-3 days following delivery Low volume (~1 tablespoon)

Posterior pituitary

This gland releases oxytocin into the blood effecting milk ejection. It is susceptible to stress. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 91.

Anterior pituitary

This gland releases prolactin into the blood effecting milk production and ejection. It is susceptible to stress. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 91.

Estrogen

This hormone dramatically drops after birth allowing milk production to begin. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 88.

Separation Anxiety

Three stages: Protest stage a child attempts to recover the mother/caregiver by crying, kicking, screaming for a few hours to days. Despair stage a child grieves or mourns as they accept their new environment. May show regressive behavior, such as sucking the thumb. Denial or detachment a child begins to interact and approach others. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 595.

Dia-

Through or complete

Which statement regarding the timing of lactogenesis II is FALSE?

Timing is dependent on breast stimulation by the baby. TRUE STATEMENTS: Begins 30-40 hours after delivery of the placenta b. May initially go unnoticed by mother c. May be delayed 10-20 hours if mother has diabetes

Nipple Bleb

Tiny white plug on the end of the nipple -inflammatory response to nipple trauma -very painful

Histio- or histo-

Tissue

What is the reason that professions develop theoretical frameworks?

To establish a systematic point of view

Population

Total set of individuals that meet the study criteria from which the sample is drawn and about whom findings can be generalized. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Eclampsia

Toxemia, end stage preeclampsia -hospitalized and watched for convulsions/seizures while on Magnesium -Magnesium may effect infant postpartum (hypotonia, urine retention) -may breastfeed, may use skin to skin and/or expression if going to breast is not possible at this time -blood pressure medications could lower prolactin levels

What is step 2 of BFHI?

Training all staff on the BFHI steps and BF management including feeding on cue

Transplacental

Transferred from mother to fetus through the placenta. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 875.

Demerol

Transfers to milk more readily than fentanyl or morphine

What is preterm milk?

Transition milk (milk in between colostrum and mature milk)

Vertical transmission

Transmission of infection from mother to child transplacentally or through breastmilk. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 875.

Horizontal transmission

Transmission of pathogens through direct contact. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

CN V

Trigeminal; muscles of mastication

What is the most predominant lipid in breast milk?

Triglycerides

What is the predominant lipid in human milk?

Triglycerides

What are predominant lipids in Breast milk?

Triglycerides & cholesterol

CN IV

Trochlear; innervates muscle that moves eye up and down

Demerol passes into great amounts, true or false

True

True or false: 8 month old breastfed twins are best friends and copy each other's BF behaviors, though they sometimes compete with each other for the breast and at the breast.

True

True or false: Distractibility is common behavior in 4-6 month olds while breastfeeding?

True

True or false: prolactin levels are unaffected by thin silicon nipple shields

True

True or false: whether the new mother with MS is breastfeeding or not she is likely to experience an increase in acute episodes during the postpartum period

True

Caffeine passes through to breast milk.

True, but in limited amounts

True or false: most mothers produce more milk than their baby needs in the first two weeks

True. Milk production adjusts over the first six weeks or so.

Meaning of Veracity?

Truthfulness and allowing informed consent

How much would you expect a 5 month old to weigh?

Twice their birth weight

Paget's disease

Type of breast cancer, 1-3% of all breast cancers. Occurs unilateral with demarcated, red, scaly plaque on the nipple and/or areola. Blood tinged discharge, pain, crusting, itching, burning, skin thickening, redness, ulceration, or nipple retraction. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 652.

CMV Cytomegalovirus

Type of herpes virus found in human milk, genital tract, urine, and pharynx. Transmitted by close contact. Avoid pumping or breastfeeding in premature infants if mom has acute infection. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 204.

Macrophage

Type of white blood cell that ingests foreign material. Destroys bacteria, protozoa, and tumor cells; in addition to stimulating cells in the immune system. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

Macrophage

Type of white blood cells, dominant type of phagocytes. They engulf and absorb pathogens, and also produce lactoferrin and lysozyme. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 141.

Extension

Unbending movement around a joint in a limb that increases the angle between the bones. Opposite of Flexion. Merriam-Webster Medical Dictionary. www.merriam-webster.com/medical/extension.

Preterm infant (weeks of gestation)

Under 37 weeks gestation. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 671.

Hypoplasia

Under development of breasts * Affect milk supply and milk production d/t decreased functional breast tissue * Plasia=formation, growth, development * May be a reason to seek augmentation

Axilla

Underarm. Breast tissue (the axillary tail) can sometimes extend into axilla. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863-864.

What is hypoplasia?

Underdeveloped breast tissue; lack of breast tissue

Hypoplastia

Underdeveloped breasts

Micrognathia

Underdevelopment of the jaw, especially the mandible. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871.

What is Polands Syndrom?

Unilateral hypoplasia of the breast combined with hypoplasia of the thorax and pectoral muscles

Rancid, soapy smell in milk

Unstable fats in milk. Active lipase, decomposes fats in milk when stored. Flash pasteurize to deactivate lipase.

Kernicterus

Untreated jandice - bilirubin moves from bloodstream into brain tissue - brain damage or death.

Laryngomalacia

Unusual flaccidity of laryngeal structures, a benign congenital condition that accounts for 70 percent of persistent stridor in infants. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

Spontaneous lactation

Unusual milk production in a non-breastfeeding woman. Also known as galactorrhea. Merck manuals Online Medical Library. www.merckmanuals.com/professional/sec12/ch151/ch151g.html.

Piston

Up & down chewing motion

Larynx

Upper end of the trachea (windpipe) through which the voice is produced. In the infant, the larynx lies close to the base of the tongue; during swallowing, it rises and is closed off by the epiglottis. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870.

Maxilla

Upper jaw

What is brick dust urine?

Urate/ uric acid crystals expelled in urine -Found usually in newborn diapers

An 18-hour-old baby has not yet successfully breastfed. He cues to feed, but cannot stay on breast. To help him suck better, which would be the LEAST effective strategy?

Use a supplementer at breast so his suck increases milk volume.

Within how many hours should a mom use her thawed EBM

Use within 24 hours

Cranial nerves used for sucking

V--trigeminal (sensory/motor) Mastication & facial sensation VII--facial (sensory/motor) Taste with anterior 2/3rds of the tongue, innervates the salivary glands, facial muscles and stylohyoid muscle (thin muscle among the triangle of the neck) IX--glossopharyngeal (sensory/motor) Taste with 1/3rd posterior of the tongue, innervates the salivary glands (parotid), motor innervates the stylopharyngeus muscle, and works with the vagus nerve for the gag reflex X--vagus (sensory/motor) Includes innervating the soft palate and triggering the gag reflex XII--hypoglossal (mainly motor) Innervates the glossal muscles. Important for swallowing (bolus formation) and speech articulation

Esophagus is innervated by what cranial nerve?

Vagus nerve

CN X

Vagus; larynx; pharynx

Dependent variable

Variable the investigator measures in response to the independent or treatment variable; the outcome variable that is affected by the independent variable. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 865.

Extraneous variable

Variables that can affect the relationship of the independent and dependent variables (i.e., interfere with the effect of treatment. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

Deficiencies of vitamins/minerals in vegan, post-bariatric surgery, or multipara

Vegan: deficiency in B12, possible deficiency in zinc post-bariatric: B12 Multipara: possible zinc deficiency

Erythema Toxicum Neonatorum

Very common, benign newborn rash Comes and goes

Acrocyanosis

Very common; bluish discoloration of hands and feet for first 24 hours after birth

CN VIII

Vestibulocochlear; hearing and equilibrium

West Nile Virus

Viral disease spread by mosquitos. Breastfeeding is permitted. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 206.

Rotavirus

Viral illness causing severe diarrhea. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873.

Hepatitis G

Viral infection of the liver is associated with blood transfusions and has not been proven to transmit through breastmilk. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 698.

Hepatitis E

Viral infection of the liver that is self-limited and is not chronic. It is typically association with water contamination. Breastfeeding is considered safe. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 698.

Hepatitis D

Viral infection of the liver, usually a co-infection with Hepatitis B. Once immunization has begun breastfeeding can begin. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 698.

What happens to the viral load of a HIV positive breastfeeding mom who has subclinical mastitis?

Viral load increases and there is more risk of vertical transmission. Also, sodium and potassium are higher in the breast milk. Even after resolution of mastitis there is a risk of transmission because antibiotics don't target HIV

Enveloped virus

Virus that cannot infect other cells without a coat (envelope). If the envelope is destroyed (e.g., by heat or soap and water) it is unable to produce infection. Ex. Cytomegalovirus and the human immunodeficiency virus. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 866.

Which vitamins are fat soluble?

Vitamins A, C, E, D, K

What vitamins vary the most in breast milk?

Vitamins B12 and D

Fat soluble vitamins

Vitamins including A, D, E, K. These vitamins are not affected by recent maternal diet, as they can be stored in the body. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 128.

3 month milestones

Voluntarily grasps objects; turns eyes and heads to moving objects

Hematemesis

Vomiting of blood. The bleeding may be from the infant's upper gastrointestinal (GI) tract or a crack in the mother's nipple. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867.

HIV

WHO recommends breastfeeding AAP does not -Depends on if there are greater risks associated with artificial feeding

Why did BF go up in the 1990s?

WIC programs were created

9-10 month milestones

Waives bye bye - distressed by new situations - interrupts dressing frequently

Key milestones 18 months

Walks independently, drinks from a cup, says at least 15 words. WebMD. Is Your Baby on Track? www.webmd.com/parenting/guide/is-your-baby-on-track?

Key milestones 12 months

Walks with or without support, beginning to say words, imitates people. WebMD. Is Your Baby on Track? www.webmd.com/parenting/guide/is-your-baby-on-track.

Key milestones 1 month

Watches faces intently, follows objects, reacts to noise. WebMD. Is Your Baby on Track? www.webmd.com/parenting/guide/is-your-baby-on-track.

A mother complains of incision pain following her cesarean birth and requests pain relief medication, but she is worried about the effect on her baby. Your FIRST response to her should be:

We will monitor you and your baby closely after you have received pain medication

SGA (Small gestational age)

Weight, length or head circumference <10th %tile at birth

LGA (Large Gestational Age)

Weight, length or head circumference >90th %tile at birth

American National standards institute (ANSI)

Well recognized within the industry as enforcing the highest standards in personnel certification accreditation.

Ca; P; Mg; Cl

What 4 minerals are increased in colostrum vs. normal milk?

Jersey

What breed of cow has the highest amount of IgG in their colostrum?

Holstein

What breed of cow has the lowest amount of IgG in their colostrum?

IgG

What immunoglobulin is highest in colostrum of the pig and cow?

IgA

What immunoglobulin is highest in the colostrum of a human?

What must you always consider when it comes to breastfeeding and medications?

What the risk of the medication is versus the risk of not breastfeeding, and in each situation, which one poses a greater threat.

IgA; IgM

What two immunoglobulins are synthesized in the udder?

Involution

When breasts return to a non-lactating state. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869.

Is it true that you need to wait until your breasts are "full" before you pump/nurse?

When prolactin receptors are "full", they will distort the receptor sites and alert the body not to make anymore milk -must remove milk to make more milk -frequent emptying of breasts

False negative (type II) error in research

When there's a real difference but the research falsely finds no difference

Functions of whey proteins and some components

Whey proteins aide digestion and promote critical immunological functions Some of which include 401 different enzymes, lactoferrin (which promotes growth of protective gut bacteria such as lactobacilli), Secretory immunoglobulin A (SIgA), which coats mucosal surfaces, preventing penetration by pathogens.

dilution

Why is there a greater milk yield during the first milking?

According to ultrasound studies, where does 70% of the glandular tissue lie in the Breast?

Within 30mm radius of the nipple

Where is MOST of the glandular tissue of the breast located?

Within a 30 mm radius of the nipple base

Intrauterine

Within the uterus; in utero. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869.

Torticollis

Wry neck May see breast preference, jaw clenching, jaw asymmetry, inability to form seal Cranio-sacral therapy helpful

If the drug had a long half life and a small molecular weight (<200), would you be concerned about passage into Mother's milk?

Yes!

Should women w/ preterm babies still feed w/in the first hour?

Yes! Pump w/in the first hour to prime body for good supply

Are high lead levels transferred through breastmilk?

Yes, and they are dangerous!

Can a mom safely BF if she has been exposed to toxoplasmosis?

Yes, unless theoretically she has been freshly exposed and has cracked, bleeding nipples, or has breast inflammation.

Humans

____ receive immunity from transfer across placenta.

IgG is the major

_____ immunoglobulin found in colostrum that is transported to the udder form blood. It is found at 10mg/mL in blood.

Postpartum thyroiditis

abnormal levels of TSH, fluctuates between hypo and hyperthyroidism -postpartum thyroiditis resolves 1 year postpartum

Hypoplasia/ Amastia

abnormally shaped breasts with insufficient glandular tissue -widely spaced -asymmetric -pt may have had breast augmentation to correct appearance -few breast changes during pregnancy -no engorgement postpartum -possible connection to thyroid disease -low supply likely -monitor infant growth -counseling necessary -may improve with subsequent pregnancies -utilize pumping/galactogogues

Dysphoric milk ejection reflex

abrupt negative emotions before and during milk release -medications that increase dopamine may help -in extreme cases: mother can decrease supply in order to make her let downs less frequent

Secretory IgA in mother's milk has all of the following functions EXCEPT:

active destruction of bacteria. IT DOES: bind of microbes in baby's gut. anti-inflammatory action. d. stimulate the infant's immune system

Abscess

advanced/untreated mastitis, local collection of pus without an opening for drainage -same sx and indications as mastitis -tx by lancing it and draining it -fluid cultured to determine antibiotic therapy -may still breastfeed

Lactose in human milk has all of the following properties EXCEPT:

aids absorption of phosphorus and manganese. IT DOES: supplies 40% of infant's energy needs. protects the gastrointestinal tract from pathogens. d. supports the central nervous system and cognitive development.

Milk blister

also called bleb, caused by a blocked nipple pore, painful -soak nipple in warm water and express -sterile needle extraction

Should be 140 degrees or more.

angle

A mother is 3 days postbirth and is worried that her milk is not flowing out, even though her breasts feel very full. She pumps 5 cc from one breast and 10 cc from the other. Your FIRST action should be:

apply cold packs to her breasts.

A mother birthed by cesarean surgery after a 36-hour labor with pitocin and intravenous fluid support. At the 6-day visit, the baby is still losing weight. The baby is urinating adequately, stooling adequately. The pediatrician asks that the baby be supplemented. The LC's FIRST action is to:

ask about medications and IV fluids during labor.

Hyperinsulinemia

associated with obesity in formula- fed infants

a___________ latch allows room for the nipple to stretch.

asymmetric

How long does fentanyl last in the mother's body?

at least 6wks

When should discussions about breast feeding begin?

at the first prenatal visit

Self _____________ promotes correct suckling

attachment

A cluster if milk making cells.

avelous

Spirochetes

avoid lesions -common example: syphillus

Tuberculosis

bacterial disease, attacking the lungs, spread through air -Dx before birth: treatment begins during pregnancy and infant prophylaxis begins at birth -Dx after birth: separate mother and infant while mother treated, express milk and give

A colleague asks you what education she should pursue to enter the lactation consultant profession. Your BEST response includes all of the following EXCEPT:

become a registered nurse, then begin practicing as a lactation consultant.

Galatocele

benign cyst containing milk, found in ducts of breast. Smooth, movable lump -continue to feed -dx with ultrasound -tx possible aspiration and surgery

Venous Thrombosis

blood clot inside vein -likely after bed rest -protect milk supply

Mastoplasty

breast-lift that elevates the parechymal tissue (breast mass), cuts and re-sizes the skin envelop and transposes the nipple-areola complex higher upon the breast hemisphere

What muscle means "trumpeter" because it's essential for blowing?

buccinator

Which is the LEAST significant risk of using a nipple shield?

c. Significant blockage of milk flow HIGHER RISK: Easy to misplace b. Changes in baby's oralmotor response Shortened duration of breastfeeding

Pooling or collection of fluid between the skin and cranial bones of the infant's head is called:

caput succedaneum.

What is the largest component of milk?

carbohydrate

What is the primary protein found in human milk?

casein

receptor cites

cellular "lock" for chemical "key"

Varicella

chicken pox -varicella vaccine given to infant if mother recently infected -birth deadly during this period of time -should encourage breastfeeding because infant has been exposed

The ease with which human milk fat is digested by the infant is explained by all of the following EXCEPT:

cholesterol is the predominant lipid in human milk.

Alveolus

cluster of milk-producing epithelial cells surrounded by a thin layer of smooth muscle

Newborn milk

colostrum

Respiratory Syncytial Virus

continue to breastfeed -good hand washing, avoid coughing on baby

You are employed by a community rescue squad and are establishing a large shelter for victims of a devastating hurricane. To BEST prepare for a sudden influx of young families, your MOST IMPORTANT action should be to:

create private areas for pregnant and breastfeeding mothers.

Chronic impaired lactation

d/t nipple anomalies, breast anatomy, mammary development, hormones, illness, nutrition, prolactin resistance -manage similarly to low milk supply

Oxytocin aids with uterine contraction and helps ___________ bleeding.

decrease

A cesarean birth is more likely to affect breastfeeding in all of the following ways EXCEPT:

delayed lactogenesis II.? It WILL cause: increased maternal pain. b. a need for maternal medications, more separation of mother and infant

Some women who have experienced childhood sexual abuse (CSA) by family members do choose to breastfeed their babies. Research shows that, compared to breastfeeding mothers who have not experienced such abuse, CSA survivors are more likely to experience all of the following while breastfeeding EXCEPT:

difficulty establishing an emotional bond with her baby.

All of the following components are found in the whey portion of milk EXCEPT:

docosahexanoic acid.

You are working to implement the Baby-Friendly Hospital Initiative in your facility, where scheduled feeds are often recommended for outdated and incorrect reasons. Your FIRST strategy should be to:

during Step 2 training, explore and correct all the reasons that are given for scheduling feeds.

Whey to casein ratio in early lactation vs late lactation

early lactation: 90:10 (whey to casein) late lactation: 50:50 (whey to casein)

Bile Salt-Stimulating Lipase (BSSL)

enzymes that are inactive until they come in contact with bile salts in the infant's gut

What covers the trachea during swallowing?

epiglottis

When lactation is established, these two hormones remain suppressed providing natural contraception:

estrogen and progesterone

Soluble components of human milk that have immunologic significance include all of the following EXCEPT:

estrogen.

Oversupply (hyperlactation)

excessive milk volume -baby may choke, pull away, feed frequently, act colicky, explosive watery bowel movements. Foremilk can cause digestive/respiratory disorders -may be mistaken for food allergies or GERD -at risk for plugged ducts, mastitis, abscesses -dx with test weights -tx with block feedings, pumping some milk off first, pharmacologic management

Pitting edema

excessive swelling -d/t breast abscess, cancer, malignant condition: peau d'orange, trauma to breast, inflammation of breast, obstruction of milk ducts/glands, benign breast lump/cyst

Innervates the forehead, nose, upper maxilla and mandible muscles/ Buccinator and orbicularis oris muscles

facial

Chemical mediators, another type of cell in breastmilk, do what?

facilitate healing and prevent infection

True or False: Galactagogues will assist with increasing milk production when prolactin levels are within normal range

false

What is the second largest component of human milk?

fat

Cholesterol

fat. Present in breast milk, not in formula. Improves cholesterol readings later in life

DHA and ARA

fat. building blocks for brain tissue

Lauric and capric acid -Protect against__ -How to increase levels -Sources

fat. protection against viruses (HIV, herpes), Bacteria (chlamydia and heliobacter), protozoa (giardia) Levels can increase from 3-4% to 21-26%by increasing levels in mom's diet (coconut)

Real hematocrit and hemoglobin return to prepregnancy levels within ...

first few days

A wide open mouth as the baby approaches the breast

gape

Within the first minute or two of beginning a breastfeed, a 2-week-old infant gulps, coughs and chokes, then releases the breast. This incident most likely describes:

gastroesophageal reflux. Babies can usually handle strong ejection at 2 wks

Diabetes

gestational vs type 1/type 2 preexisting metabolic disorder caused by body's inability to make enough insulin or to use the insulin that is available Infants likely to be macrosomic, have shoulder dystocia, c/section delivery. In utero elevated maternal glucose+elevated fetal glucose and insulin=macrosomia. Postpartum: elevated infant fetal insulin=hypoglycemia=supplementation. mother at risk for thyroiditis -lactogenesis likely delayed: mother's body and breasts compete for available insulin. less milk volume and less likely to fully breastfeed. -frequent feeding -insulin safe for use during lactation -mother needs calories, carbs, protein during lactation -mother more likely to have infections: yeast, mastitis, etc -gradual weaning to help balance blood sugars

The styloglossus muscle is innervated by what nerve?

glosso-pharyngeal nerve

How is the palate divided?

hard palate: 2/3rds of the anterior mouth soft palate: 1/3rd of the posterior mouth

All of the following developmental processes are interrupted by premature birth EXCEPT:

hearing and taste. ARE INTERRUPTED: bone mineralization. b. gut maturation. c. deposition of fat.

Where are prolactin and oxytocin produced?

hypothalamus

Thyroid disease

hypothyroidism: deficiency in thyroid hyperthyroidism: overactive thyroid -hypothyroidism has association with low milk supply if not corrected

Insufficient milk production

inadequate milk synthesis, less than 800 ml/24 hours in first 1-6 months of life -may be perceived -get a careful history: consider supplements, interrupted breastfeeding, unrelieved engorgement, separation -teach proper positioning, feeding cues, feeding frequencies, cluster feeding, breast massage, test weights -plan depends on cause: hand express milk, increase feedings/pumpings, massage breast, skin to skin, supplement if necessary, switch nursing, herbal supplements, relaxation -distinguish between maternal management and true low milk supply: education, "doing both," support, pain, pacifiers, etc

Postpartum hemorrhage

increased risk for separation of mother and baby, increased risk for supplementation, common obstetric emergency -delayed contact between mother/baby, may effect mother's ability to establish and maintain lactation, skin to skin, frequent feeds, Sheehan's possible.

Spinal cord injury

irreversible damage to spinal cord d/t trauma or tumor -spinal cord injury above T6 may affect milk production -may be affected by decreased sympathetic nervous system feedback to pituitary resulting in decreased prolactin secretion -may need assistance positioning, latching, and holding baby at breast

Symptoms of galactosemia and contraindication to breastfeeding

jaundice, hypoglycemia, vomiting, failure to thrive, suscepibility to E coli sepsis that may manifest as UTI. Baby must have specialty formula, not breastfeed.

What are the upper and lower lips joined to the gums by?

labial frenulum

What component of colostrum and milk increases over the first four days of lactation?

lactose

What is the primary carbohydrate found in milk?

lactose

Fresh human milk can be instilled in the eye to treat infections. Components in milk that are beneficial for this use include all of the following EXCEPT:

lactose.

All of the following are necessary components of the Lactational Amenorrhea Method of contraception EXCEPT:

limited pacifier use is allowed.

What joins the tongue to the floor of the mouth?

lingual frenulum

Human milk contains __________ to assist with fat digestion and absorption

lipases

Asthma

lung function affected by AF - immune response is triggered

A lactating mother noticed two raised bumps on her areola that drip milk when her baby is nursing on the other breast. These bumps are MOST LIKELY:

milk duct pores.

Lactation can continue as long as...

milk is produced and removed from the breast

Human milk contains (more/less) long chain fatty acids than cow's milk.

more

Breast reduction mammoplasty

more destructive than augmentation -need nerve sensation for let down -encourage to breastfeed but monitor and protect infant's growth

Colostrum contains more _________________ and less ____________________.

more protein, minerals, fat-soluble vitamins less lactose, fat, water-soluble vitamins

Bacterial infections

most bacteria blocked by milk components -treat and continue breastfeeding (special considerations for tB, brucellosis, and some staph)

Fungal infections

most common: thrush, can be in human milk , anti-fungal components in milk can be overwhelmed and lead to infection -likely treat mother and infant together

2 functions of the cranial nerves

motor and sensory

Not enough water and too much stress or exercise reducing milk supply are _____________.

myths

Nausea r/t milk ejection reflex

nausea with let down -disappears on own -increase fluid intake, snack often

Nipple trauma/soreness

normal for first week postpartum -may be d/t oral anomalies in infant, improper use of equipment, no buccal fat pads in infant -tx with positioning and attachment assistance, evaluate; nipple shape, flanges, vacumn on pump. Apply colostrum, anti-bacterial ointment on nipples, cold cloths, start feedings with less sore breast -if no improvement: 1-2 days nipple rest with expression used to preserve breastfeeding, skin to skin.

What are the most common reasons why mothers stop breast feeding?

not enough milk, baby won's latch, breast pain/ soreness, and work/ school.

What is the name of the muscle surrounding the mouth?

obicularis oris

Women learn a lot about breastfeeding by _____________ other mothers.

observing

Rusty pipe syndrome

old dark blood. Usually one breast. Large amount of blood may cause vomiting. Okay to keep BFing.

All of these statements accurately describe the protective role of breastfeeding EXCEPT:

once lactation and breastfeeding cease, the mother and infant are just as vulnerable to disease as anyone

Rheumatoid arthritis/ Lupus

painful autoimmune diseases, affecting joints -women with lupus are at risk for preeclampsia and premature deliveries -elevated prolactin levels, higher risk for raynaulds -support and rest, partial breastfeeding, mindful of medications

Fibrocystic breasts

palpable irregularities in breast tissue -respond to menstrual cycle -continue to breastfeed

Water, electrolytes, and some minerals travel by ...

passive diffusion

Puerperium

period following delivery where a woman's body recovers from pregnancy and adapts to lactation. Lasts 6-8 weeks.

Sheehan's syndrome

pituitary thrombotic infarction and necrosis d/t severe postpartum hemorrhage -sx: weight gain and then loss, loss of pubic and axillary hair, intolerance to cold, low blood pressure, vaginal and breast tissue atrophy -failed lactogenesis likely d/t insufficient prolactin from pituitary, may try prolactin stimulating drugs -may just need to pump to stimulate the number and sensitivity of breast prolactin receptors

Hyperadenia (polymastia/hypermastia) *extra breast tissue*

presence of additional breast tissue (with or without nipples); most common in axilla * can become engorged during initiation

Polythelia *(extra nipples)*

presence of nipples without breast tissue; seen along the milk line

Lymphocytes act similarly to phagocytes, except they also...

produce antibodies against microbes

Which hormones stimulate the uterus to return to its normal shape and size?

prolactin and oxytocin

Which two hormones stimulate uterine smooth muscle to contract and shed the highly vascularized endometrium after pregnancy?

prolactin and oxytocin

Feedback inhibitor of lactation (FIL)

protein found in secreted milk Accumulates in the ducts, decreases the secretion of milk components (i.e. protein, CHO, and fat) More milk accumulation = more FIL = less milk components made

Inadequate nutrition during lactation results in a decreased _________ of milk produced

quantity (not quality)

Viral infections

rare to pass through breastmilk. -avoid lesions (special considerations for hepatitis, herpes, varicella)

A mother has begun breastfeeding successfully and is leaving the hospital with her 3-day-old son today. Your BEST action is to:

refer her to a local mother support group such as La Leche League.

Cesarean Delivery

risk for separation, delayed lactogenesis II, increased fluid load for mother/baby, lethargic baby d/t meds, increased risk for suctioning in infant d/t mucus -skin to skin, pain control/comfort, have mother express her emotions regarding surgery, rest and quiet encouraged

Postpartum infection

separation and interrupted breastfeeding -help with milk expression

A mother and her breastfeeding toddler twins are likely to experience all of the following EXCEPT:

sibling rivalry for the breast. DOES have higher risk of milk stasis due to higher milk volume

The bone that is wedge-shaped

sphenoid

What are the upper and lower rings of the esophagus called

sphincters

Vasospasm/Raynaud's

stinging, tingling, burning with triphasic color changes: white/blue/red -triggered by emotional stress, cold; infants who clench, chew, bite the nipple -initiate let down before putting baby to breast -feed on less tender side first, ensure good positioning -avoid cold, apply heat, cover nipples, avoid caffeine, nicotine -use ibuprofen, nifedipine, compress end of nipple -more common with: scleroderma, lupus, rheumatoid arthritis, arteriosclerosis, pulmonary hypertension

What muscle elevates in the throat during gagging or swallowing?

styloglossus muscles

Episiotomy

surgical incision to aid in the delivery of the baby -painful: can interfere with milk ejection if extreme -cold packs and pain meds, repositioning

Which amino acid is important in order for the infant to begin making their own bile and to myelinate the CNS?

taurine

The muscle that is fan-shaped

temporalis muscle

Plugged duct

tender sot or lump on breast from duct blocked by milk, localized pain, low grade fever, and flu like sx -d/t missed feedings, restrictive clothing, pressure on breasts -frequent feedings, hand massage, positioning baby's mouth in direction of duct, warmth, ibuprofen, decreasing saturated fat intake -can become mastitis

Incidence

the relative frequency of occurrence of something Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 868.

A woman who received intravenous magnesium sulfate during labor to control her blood pressure is having trouble initiating breastfeeding The MOST LIKELY explanation for this is:

this medication can cause maternal lethargy, confusion, and muscle relaxation

what promotes the release of gastrin?

touch

transcellular transport

transport of materials through the milk cell; requires interaction with the cytoplasm and may require transport proteins.

Parasites

treat and continue to breastfeed

Muscles used in suckling are innervated by what 2 nerves?

trigeminal and facial nerves

Innervates the obital, maxilla and mandible muscles 4 primary muscles of mastication that are innervated by the 3rd mandibular branch of what?

trigeminal nerve

Assisted vaginal birth

vacumn/forceps, etc -risk for face/head trauma -increased risk for increased bilirubin levels, poor feedings, nerve damage, etc

What 3 main cranial nerves are needed for swallowing?

vagus, glosso-pharyngeal, hypoglossal

Carbohydrates travel by ...

vessicles

Hepatitis

viral infections of liver -hep A: gamma globulin to baby and mom, not transmitted through breastmilk, good hygeine -hep B: immunoglobulin given to baby, then breastfeeding may begin. infant may breastfeed but avoid maternal blood coming in contact with infant -hep C: no risk documented with breastfeeding, be careful if there is a co-infection with HIV -hep D, E, G: give immunoglobulin and then breastfeed

Human milk is composed of 88% ____________.

water

Candidiasis (thrush)

yeast infection, likely candida -d/t nipple trauma, mastitis, antibiotic use, vaginal yeast infection, contraceptives, steriods -passed between mom and baby: treat both -thrush can cause gassy/fussy baby -mother c/o nipple/areolar pain, burning and radiating through breast -areola appears shiny pink -use good cleaning techniques -don't stop breastfeeding -tx with nystatin/diflucan -keep nipples dry, use clean breast pads, expose breasts to sunlight, decease sugar and dairy