Breastfeeding Quiz Study Guide Summer 2021
Breastfeeding Advantages:
For the infant: Most complete form of nutrition for
babies.
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Protects them from wide array of infectious and noninfectious
diseases. (immune support)
Higher test scores in cognitive and motor development
Higher IQ
Improved visual acuity
Improved neuromotor skills in neurologically impaired children
Associated with lower rate of SIDS
More rapid growth and weight gain
Hormones for maturation of organs
For the mother:
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Reduces postpartum bleeding and risk of breast/ovarian cancer.
Less menstrual blood loss during early postpartum months
Earlier return to pre-pregnant weight
Delayed resumption of ovulation, leading to increased child
spacing
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Improved bone remineralization
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Reduction in hip fractures post menopause
Social/economic benefits:
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Reduced healthcare costs
Reduced employee absenteeism for care of sick infant
Reduced direct cost compared to formula feeding Other
advantages:
Mitigated intellectual deficits in congenital cretinism
higher test scores of cognitive and motor developments
ten point IQ advantage for preterm infants who were tube-fed human milk and did not go to
the breast
improved visual acuity
improved neuromotor skills in neurologically impaired children
Decrease postpartum bleeding and more rapid uterine involution
Last menstrual blood loss during early postpartum months
earlier returned to pre pregnant weight
delayed resumption of ovulation, leading to increased child spacing
improved bone remineralization postpartum
reduction in hip fracture in the postmenopausal period
reduce risk of ovarian cancer
reduced risk of breast cancer
Social & Economic Benefits of Increase Breastfeeding
reduce health care cost
reduced employee absenteeism for care of sick infants
reduced direct costs of breastfeeding in comparison to formula purchase
Separating mothers and babies consequences
Separation during the first hour interrupts the infant’s predictable behavior patterns and delays
the beginning of effective suckling.
Role of oxytocin on breastfeeding

Responsible for releasing milk (the let-down reflex). it causes the myoepithelial cells
surrounding the alveoli to contract and push milk out through the ducts
Oxytocin is released by the posterior pituitary in response to several types of stimulus
Stimuli include:
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nipple stretching by correct suckling of infant
massage-like motions of infant’s hands on the breast
seeing, touching, smelling, or hearing her infant, resulting in a conditioned
response
response is transient & intermittent
women may experience several let-downs during a feeding. Extreme pain or stress my
temporarily inhibit oxytocin release
Recommendation for effectively latched on and breastfed a newborn
1.
Baby’s body position
Ventral surface of infant to ventral surface of mother
Baby’s lower arm around mother’s trunk or hugging the breasts
Baby’s head shouldn’t be turned away from the breast, but looking at the breast
Never push the baby toward the breast
2.
Baby’s Mouth position
Mouth wide open w/ lips about 1 – 1.5 in onto breast beyond base of nipple (asymmetric latch)
Tongue under areola
Lips not folded in
Oral searching reflex stimulating by touching baby’s lip w/ nipple
Gape elicited when baby drawn back from breast
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Essential prior to moving baby onto the breast to feed
Motion of baby’s masseter muscle should be observed
Sounds of swallowing should be audible
There shouldn’t be in-drawing or dimpling of cheeks during feeding
3.
Mother’s Position
Should be comfortable w/o tension or discomfort
Hand position (if any) at breast shouldn’t interfere w/ placement of baby’s mouth, nor compress
the ducts of the breast
Mother should experience no breast or nipple pain
Signs of good attachment:
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Chin touching breast (or nearly)
Nose touching breast (or nearly)
Mouth wide open o Lower lip turned
outward
Areola: more visible above than below the
mouth
Signs of effective suckling:
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Slow, deep sucks and swallowing sounds
Cheeks full and not drawn in
Baby feeds calmly
Baby finishes by themselves and is
satisfied
Mother feels no pain
Nipple should not move in and out of
mouth during suckling
Cause for nipples cracked and bleeding
correct positioning and latch-on is critical to nipple comfort
nipple sucking is associated with sore, cracked nipples – ex. of incorrect latch-on
an infant with a tight labial or lingual frenulum may cause nipple pain or soreness
nipple irritants may include creams and ointments, plastic-backed breast pads, nipple shields, etc
stabbing pain in nipple and breast may be due to a bacterial or other infection, and may be
multifactorial
Recommendations for a mother with Sore nipples
first, identify and correct the cause(s) of sore and cracked nipples
Individual assessment leads to an appropriate treatment plan, which includes correcting latch-on
and:
o changing the latch or nursing position
o healing pain
o nursing on the unaffected breast first
consider pain relief medications if necessary (ASA, Tylenol). use short-acting preparations taken
just before nursing
Warm or cold packs
Non-verbal communication to build mother confidence
Sit at the same level and close to the mother
Remove physical barrier such as desk or papers
Pay attention and show you are listening
Take your time and don’t look at your watch
Appropriate touch (hand/arm)
Factors that decreased supply of breast milk in a postpartum mother
Pain medication/ analgesia can have an effect on milk supply
Inadequate breast emptying from incorrect latch-on
Separation of mothers and babies
Mismanagement of feeding routines- short, infrequent feeds
Stress, lack of confidence
Not understanding infant feeding and fullness cues- e.g. crying is a late feeding cue
If the milk is not removed, less milk is made
Maternal malnutrition unrelated
Possible contributors:
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Maternal infection, anemia
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Thyroid disease
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Poor release of milk (let-down reflex)
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Anatomical anamolies of mother or baby
Incomplete delivery of placenta (drop in progesterone, initiates lactogenesis)
Sign of inadequate supply: weight loss of 10% from birth weight
How to support a mother in the workplace
Space: dedicated private, accessible space with sink, outlets, comfortable chair, lighting, possibly
hospital grade pump and small refrigerator
Time: mothers of <4months need two or three 20-30 minute breaks per 8 hour day. Less pumping
is required as baby grows older
Support: Lactation consultant services, human resources/supervisor support for pumping, mother
to-mother support groups, phone support, etc.
Breastfeeding promotion
Efforts focus on the advantages of breastfeeding to the individual baby and mother.
Includes dissemination of advantages in regard to global ecology.
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Decreased waste from bottles
Diminished environmental costs of feeding dairy
cattle
State/local initiatives to protect breastfeeding in the work place and the public.
Ten steps to successful breastfeeding (no need to learn them in chronological
order)
1.
Have a written breastfeeding policy that is routinely communicated to all healthcare staff
2.
Train all health care staff in skills necessary to implement this policy
3.
inform all pregnant women about the benefits and management of breastfeeding
4.
Help mothers initiate breastfeeding within one hour of birth
WHO/UNICEF: now interpreted as – place the baby skin to skin with its mother
immediately after birth. Skin to skin should be continuous and uninterrupted until the
completion of the first breast feeding. Applies to all births, regardless of feeding
intention.
5.
Show mothers how to breastfeed and how to maintain lactation even if they are separated
from their infants
6.
Give newborn infants no food or drink other than breast milk, unless medically indicated
7.
Practicing rooming-in, allowing mothers and infants to remain together 24 hours a day
8.
Encourage breast feeding on demand
9.
Give no pacifiers or artificial nipples to breastfeeding infants
10. Foster the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital
International Code on Marketing of Breast Milk Substitutes (prohibitions)
adopted by the World Health Assembly (WHA) in 1981
calls for all government to regulate marketing practices that promote artificial feeding (formula
and other breastmilk substitutes) as well as feeding devices such as. bottles and nipples
to date, no legal action has been taken to implement this Code, in the US
Hospitals should not advertise brand logos or give samples/gifts. (although most do)
However, the baby-friendly Hospital Initiative standards include Code compliance in Baby-Friendly
designated facilities
Aim of code:
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protect, promote, and support BF
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ensure the breastmilk substitutes (BMS) are used properly when they are
necessary
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provide adequate info about infant feeding
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prohibit the advertisement or any other form of promotion of BMS
Dangers of formula
Illnesses and diseases associated:
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Crohn’s, IBS, Celiac
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Respiratory illness
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Otitis media
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Bacteremia and
meningitis
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Juvenile diabetes
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Childhood obesity
Disorders associated:
Malignant
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lymphomas
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Breast cancer
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Multiple sclerosis
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Allergies
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Chronic respiratory
disease
Coronary artery
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disease
Ischemic heart
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disease
During emergencies (ex. Earthquake in Indonesia)
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Lack of consistent availability
High risk of contamination through
water
Errors in preparation
No means of sterilizing bottles
No refrigeration
Advice on whether to use one or both breast for each feeding
Frequency of feedings – Module 3 Session 9
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Early, frequent feeding- unlimited by the clock
24-hour rooming benefits
facilitates mothers and babies learning each other’s cues and skills of breastfeeding together
separation is stressful for both mother and baby, physiologically and emotionally and deprives
couplet of learning opportunities
facilitates bonding of mother and baby
fewer incidences of maternal child abuse and higher maternal attachments scores were seen in a
Swedish study of rooming in
rate of newborn abandonment in the hospital reduced from 1.8/1000 live births to 0.1/1000 live
births in just 2 years of instituting practice
promotes successful BF
higher rates of full or exclusive BF and longer durations of BF. Babies were less likely to require
supplementation in hospital
improvement may be due to earlier establishment of milk supply and larger amounts of milk due
to
BF more frequently and on cue
babies have lower rates of jaundice and separation for treatment
Type of milk at 7-10 days postpartum- it called transitional milk that emerges as the breast
gradually shift from production of colostrum to production of mature milk
Characteristics of the breast one day postpartum
Engorgement due to increased vascularity and milk production
Disease incompatible with breastfeeding
if infant has been diagnose with galactosemia
special formula is required
if BF mother has:
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HIV/AIDS
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is taking antiretroviral medications o has active untreated TB
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Group B Beta-streptococcus & Group A stept
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infected with HTLV-1 or -2 o Hepatitis
Hep A – mother must receive gamma globulin first
Hep B – immunoglobulin must be administered to infant
Hep C
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is using/dependent on illicit drugs
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is taking prescribed anti-cancer agents that interfere with cell replication
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is undergoing radiation therapy
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there are many misconceptions about contraindications