Chapter 7: Nutrition During Lactation Conditions and Intervention

The composition of milk in mothers who deliver preterm infants is higher in _____ and slightly lower in _____ content compared with milk of mothers who deliver full-term infants.

protein and energy; lactose

Large doses of St. John's wort decrease prolactin levels in women. This could potentially _____.

reduce breast milk supply

Treatment for plugged ducts would least likely include _____.

stopping breastfeeding until consulting a health care provider

The recommendation by R.A. Lawrence for use of herbal teas by nursing women is to choose _____.

teas using only herbs for essence

Which factor is least likely to be considered a cause for the scarcity of human milk banks in North America?

the availability of wet nurses as an alternative to banked milk

Approximately _____% of healthy full-term infants will become visibly jaundiced with their serum bilirubin levels exceeding 5 to 7 mg/dL.

​40

The energy content of breast milk in women who deliver pre-term infants is _____ kcal/100 mL.

​58-70

A new mother goes to the mall with her friends. She is gone longer than planned and is not able to nurse her baby until she returns 6 hours later. Which problem is she most likely to experience?

​engorgement

If a 110-lb nursing woman (50 kg) wants to drink alcohol, how many cans of beer (15 g alcohol/12 oz.) can this woman drink and stay within the Institute of Medicine's alcohol recommendations?

1

It will take approximately _____ hour(s) to eliminate the alcohol in one glass of wine from a 120-pound nursing woman.

2 to 3

A full milk supply is considered _____ ounces per day.

25-35

Infants born between _____ weeks are considered late-preterm.

34-37

If nursing mothers want to store expressed milk in a refrigerator, the temperature setting should be _____ degrees.

39

As many as _____ of women who experience nipple pain and trauma switch to bottle feeding with the first 6-8 weeks postpartum.

one-third

550

450

In most cases, the symptoms of an infant's adverse reaction to an offending food will improve after the food has been removed from the mother's diet for _____.

5 to 7 days

To achieve production goals, mothers should begin pumping _____ post-delivery.

6 hours

Freshly expressed breast milk left at room temperature can be considered safe for a baby for up to _____ hours.

6-8

Galactogogue

A medicine or herbal substance taken with the belief to increase milk supply

Breast abscess

A tender lump in the breast resulting from unresolved mastitis

Hyperactive letdown

A tender lump in the breast resulting from unresolved mastitis

The brain and brain cells, if destroyed by bilirubin deposits, will _____.

not regenerate

Which food item is least likely to be considered a common pediatric food allergen?

oats

Mothers of multiples should _____.

obtain their nutrients from a well-balanced diet to ensure their milk can adequately nourish all of their infants

Plugged ducts

Blockage of milk, which may be caused by milk stasis

List at least four possible ways in which breastfeeding may prevent allergies.

Breastmilk contains a low amount of allergens. Breastfeeding transfers maternal immunity to the infant. Long-chain fatty acids and IGA in breast milk protect against inflammation and infections. Breastfeeding can help regulate infant immunity. Breastfeeding has an influence on the gut microbial flora.

A food allergy is an immunologic response, typically immunoglobulin _____ mediated, to a specific food protein.

E

Hyperbilirubinemia

Elevated levels of bilirubin

What would be the best response if you suspected your breastfed baby was responding adversely to milk in your diet?

Eliminate milk from your diet and monitor the baby for changes.

Describe the factors that influence the rate of transmission of HIV from mother to child through breastfeeding.

Factors that contribute to the rate of transmission of HIV through breastfeeding include strain of HIV, maternal illness, immune status and viral load, duration of breastfeeding (timing of transmission), primary infection of the mother during the breastfeeding period, exclusive breastfeeding versus mixed feeding, mastitis, maternal vitamin deficiencies (A, C, E, or B vitamins), and the availability of antiretroviral therapy.

A nursing mom should avoid cauliflower because it has the potential to cause gas in her baby.

False

Alcohol has been found to be a "galactologue" that facilitates milk letdown.

False

Drinking one cup of coffee results in hyperactivity in all infants.

False

Medicinal herbs have been shown to be a safe alternative to drugs during lactation.

False

Physicians typically are well trained to counsel women on breastfeeding.

False

The vast majority of women experience significant problems with breastfeeding.

False

Women should discontinue all medications while breastfeeding.

False

Which statement correctly describes food allergy or food intolerance?

Food allergy is an exaggerated immunologic response.

Mastitis

Inflammation of the breast

The best way to prevent sore nipples is to _____.

make sure the baby is positioned properly

The symptoms of mastitis and plugged ducts are similar; however, _____ is/are accompanied by _____.

mastitis; fever and flu-like symptoms

The ultimate test of drug safety is the _____ and any side effects on the infant.

measurement of the infant's plasma drug concentration

​A woman experiencing letdown failure may be prescribed _____ nasal spray.

oxytocin

A woman with low milk supply visits her physician, believing that she needs to switch from breastfeeding to feeding her infant with human milk supplement. What should the doctor explain to her about the causes of low milk supply and what should be recommended to increase the woman's milk supply?

Low milk supply is usually caused by the mother not breastfeeding or pumping often enough or inefficient emptying of the breast caused by a poor latch or incorrect flange size while pumping. Stress may also contribute to low milk supply. The mother should be advised to nurse or pump using a hospital-grade electric breast pump every 2-3 hours during the day and once at night. If the baby is not nursing effectively, the mother may need to pump after breastfeeding to improve her supply. She should also make sure her diet is adequate and her fluid intake is appropriate. Additionally, she should be encouraged to adopt resting and relaxation techniques.

List at least four major program components of the Rush Mothers' Milk Club.

Major program components include: (1) providing information for mothers to make an informed decision, (2) providing access to a hospital-grade electric breast pump, (3) providing skin-to-skin care and suckling at the empty breast as practice for the newborn, (4) babies feeding at the breast as soon as they are able to suck and swallow effectively, and (5) nursery staff helping the mother prepare for breastfeeding after discharge.

Fenugreek

May act as galactogogue

Cabbage leaves

May help reduce discomfort and swelling in breasts

Letdown failure

Milk is not ejected from breasts

A mother of a late-preterm infant visits her physician because she is concerned she does not have adequate milk supply. How does her infant affect her milk supply, and what should the physician recommend to help increase her supply of milk?

Milk production relies on adequate suckling stimulation. Late-preterm infants may not be able to stimulate the breast enough to produce an adequate milk supply. If an infant is not sucking vigorously or the suckling ability is weak, mothers of late-preterm infants should pump after each feeding attempt, or at least every 3 hours, to build the milk supply. A specific feeding plan, including the plan to wake a sleepy infant every 2-4 hours, is recommended to avoid the late-preterm breastfeeding cascade. Mothers and their late-preterm infants should have a feeding assessment by a trained lactation professional who can provide intervention for positioning, potential suck problems, and other breastfeeding issues. Weighing an infant before and after feedings may be useful to determine milk transfer.

A breastfeeding mother asks you if alcohol can be eliminated from her breast milk by pumping immediately after drinking a few glasses of wine. What would you tell her?

No; the alcohol will still be in the breast milk and will clear from the milk as soon as it clears from the blood stream: roughly 2 to 3 hours per drink for a 120-pound woman.

Breastfeeding women should avoid swordfish, shark, and tuna because they have high _____ levels.

mercury

Your best friend had a baby 3 months ago and is anxious to go "out on the town" with her friends. She is still breastfeeding, but would like to be able to have some drinks. What advice would you give her?

Pump milk before going out and use that until the alcohol has been cleared from your system.

The American Academy of Pediatrics classifies _____ as a substance that is contraindicated during lactation.

THC

Which foods do the National Institute of Allergy and Infectious Diseases recommend that nursing mothers avoid?

The institute does not recommend avoidance of food allergens during lactation.

Your friend is considering feeding her preterm infant formula rather than breastfeeding because she is a working mom and believes it would be more convenient and supply sufficient nutrients. What would you tell her about the nutritional, health, and developmental benefits of breastfeeding preterm infants to persuade her to consider breastfeeding as better option?

The nutritional benefits include ease of protein digestion, fat absorption, and improved lactose digestion. The known health and developmental benefits include better visual acuity, greater motor and mental development at 1.5 years of age, greater verbal intelligence quotient at 7-8 years of age, and a lower incidence of serious infectious disease, including necrotizing enterocolitis and sepsis, even among infants who also receive some human milk substitutes. Nosocomial infection rates may also be decreased by as much as 50 percent in premature infants who receive at least 50 percent of their daily feedings from mother's milk.

Which statement correctly describes HIV transmission and breastfeeding?

The rate of HIV transmission with prolonged breastfeeding is 35-40%.

"Anyone can be a milk bank donor." Is this statement true? Describe the purpose of a milk bank and how they select women to provide milk.

The statement "Anyone can be a milk bank donor" is not true. Human milk banks provide human milk to infants who cannot be breastfed by their mother. Premature and sick infants are most likely to receive banked milk. A woman can donate milk once or on a continuing basis if her supply exceeds the demands of her infant. Human milk donors are chosen by their health profile. Women are carefully screened before they can donate extra milk to milk banks. Milk banks that belong to the Milk Banking Association of North America require telephone screening, a written health and lifestyle history, and verification of the health of the mother and baby by the health care provider of each. Blood samples are tested for hepatitis B, hepatitis C, HIV, HTLV, and syphilis by the milk bank. Women are not accepted if they are acutely ill, have had a blood transfusion or an organ transplant within a year, drink more than 2 ounces of liquor daily, regularly use medications or megavitamins, smoke, or use street drugs. Additionally, women who eat no animal products must take vitamin supplements with B12 to be eligible to donate.

A woman with mastitis should continue to nurse her baby.

True

Alcohol is transferred through breast milk.

True

HIV can be transmitted from mother to infant through breastfeeding.

True

Infants with galactosemia should not be breastfed.

True

The BPPOP strongly promotes training for breastfeeding support and management beginning in medical schools and during residencies.

True

The highest calorie portion of milk is usually produced during the last 10 minutes of pumping.

True

Echinacea

Used to enhance immune system

Engorgement

When the breasts become overfilled​

Which types of drug are usually compatible with breastfeeding?

antihistamines

What is typically the main obstacle in nursing multiples?

both time and fatigue

Which food is least likely to cause colic in breastfed infants?

chocolate

Which contraceptive method does the World Health Organization advise women to avoid in the first six weeks postpartum?

combined oral contraceptives

One effective treatment for a plugged duct is to _____.

completely empty the breast

Alcohol _____ milk letdown by _____ levels.

decreases; decreasing oxytocin

Management of early jaundice is best achieved by _____.

early and frequent breastfeeding

Which herb is the most commonly used herbal galactogogue?

fenugreek

Breastfeeding is unadvisable if the mother _____.

has HIV

The condition characterized by milk streaming from the breast as feeding begins is called _____.

hyperactive letdown

The most frequent cause of hospital readmission for the first two weeks of life is _____.

hyperbilirubinemia

Suboptimal breastfeeding can lead to jaundice because it can _____.

increase intestinal absorption of bilirubin

Among the causes of low milk supply is _____.

inefficient emptying of the breast caused by a poor latch

​Some women have flat or _____ nipples, which do not extend very far into the infant's mouth.

inverted

Milk banks store donated milk in plastic containers because it _____.

keeps white blood cells found in breast milk intact