Infant Feeding

Question 1

Ingredients only in breastmilk

Answer 1

Growth factors
Stem cells (repair)
Lactoferrin (iron absorption)
Oilgosaccharides (prevent bacteria sticking to gut wall)
White cells - lymphocytes and leukocytes
Bifidus factor (acidic, discourage bacterial growth)
Antibody IgA
Milk lipids
Enzymes

Question 2

What is first milk called

Answer 2

Colostrum

Question 3

Purpose of colostrum

Answer 3

Prime baby’s immune system and has laxative effect to aid pass of meconium

Question 4

How many stages of lactogenesis

Answer 4

3

Question 5

Stage 1 lactogenesis
What and when?

Answer 5

Pregnancy
Epithelial cells to lactocytes from prolactin
Breast growth - tender
Hormones - oestrogen, progesterone, human placental lactogen

Question 6

When colostrum produced

Answer 6

From 16 weeks

Question 7

Other pregnancy changes (3)

Answer 7

Areola and nipple darken
Montgomery tubercles secrete antiseptic sebum (lubricate and scent)
Blood supply increase (shinier and veins)

Question 8

When lactogenesis 2

Answer 8

At birth
Onset milk production 32-92 hr

Question 9

What happens for lactogenesis 2 to happen?

Answer 9

Drop in oestrogen and progesterone due to birth of placenta triggers milk production
Prolactin and oxytocin rise in response skin to skin, smell, sight touch

Question 10

What stimulates prolactin

Answer 10

Sucking

Question 11

What causes let down/milk ejection

Answer 11

Oxytocin

Question 12

When does prolactin peak? (2)

Answer 12

45 min after start of feed (so enough milk for next)
At night

Question 13

Oxytocin reflex

Answer 13

See, hear, smell, touch

Question 14

Other oxytocin effect

Answer 14

Uterine contractions to return uterus to ‘before’

Question 15

What can inhibit oxytocin production

Answer 15

Cortisol and adrenaline

Question 16

Lactogenesis 3

Answer 16

Long term milk production
Feedback inhibitor of lactation (FIL)

Question 17

What is FIL produced by?
How does it work?

Answer 17

Produced by breast alveoli
If milk not removed, FIL builds up and signals lactocytes to stop producing milk
Regulates supply and demands and helps when comes to time of weaning

Question 18

Significance of prolactin receptors

Answer 18

If all busy, alveoli open more receptors, so more ability to produce more milk as ‘switched on’

Question 19

Off to a good start ‘factors’ (5)

Answer 19

First golden hour
Skin to skin
Early frequent and effective feeds
Responsive feeding
Avoid unnecessary supplements

Question 20

Benefits of skin to skin

Answer 20

Stimulates birth of placenta
Reduces post partum bleeding - contraction of uterus
Increase milk ejection reflex - oxytocin release
Lower stress levels
Initiates bonding
Keeps baby warm
Regulates heart rate and breathing
Encourages feeding behaviours
Biome
Familiar with scent - find nipple for feeding

Question 21

Responsive feeding (4)

Answer 21

In response to feeding cues
In need of comfort (mother baby)
Convenience
When breasts full

Question 22

Position for breastfeeding

Answer 22

C held CLose to mother
H able to tilt Head back
I head and body in straight line
N nose to nipple

Question 23

Good attachment (4)

Answer 23

Wide open mouth
Chin leads
Bottom lip touches breast well away from base nipple
Nipple towards rear of roof of baby mouth

Question 24

Signs of effective attachment

Answer 24

Pain free
Mouth wide open
Chin indents breast and nose away
Cheeks full and round
If areola visible more above top lip
Baby content and stays on breast

Question 25

Effective milk transfer

Answer 25

Short rapid sucks to Active feeding - long, slow, rhythmic suck and swallow with pauses Flutter sucking with occasional swallows

Question 26

What indicates poor milk transfer

Answer 26

Suck ratio more than 2:1

Question 27

Signs effective feeding

Answer 27

Wet nappies/ dirty nappies/active alert no jaundice/no bottles/dummy/8-10 feeds 5-30 min/nipple shape same or slightly elongated/all signs effective attachment

Question 28

Why hand expression?

Answer 28

Colostrum for sleepy baby Soften full breast with baby struggling to attach Clear blocked duct In case of separation from baby

Question 29

Responsive bottle feeding

Answer 29

Cues Close and eye contact Limit number of people Pace feed- baby control milk flow Do not force to finish

Question 30

How to pace bottle feed

Answer 30

Semi-upright Place teat gently Bottle horizontal or slightly tipped to cover end with milk Follow cues

Question 31

Safe formula prep

Answer 31

Clean hot soapy water Sterilise Boil tap water Cool Add powder at 70 Do not overfill Check temp Cool under tap Bin leftovers Make feed as needed

Question 32

9 instinctive phases in first hour

Answer 32

Cry Relaxation Level of activity Larger movement Rest times Crawling Lick/taste/touch (can last 20 min) Self attach initiate feed Sleep

Question 33

Getting breastfeeding off to best start (6)

Answer 33

Talk through any concerns Skin to skin Feeding cues Position Feeding regularly- FIL Attachment- CHIN

Question 34

Why is separation detrimental to breastfeeding

Answer 34

Miss of cues FIL No stimulation for milk production/ prolactin No skin to skin - oxytocin release/ milk ejection reflex

Question 35

How to help expressing colostrum/milk

Answer 35

In front of baby Photo of baby Scent of baby Oxytocin releasing conditions

Question 36

How to express

Answer 36

Encourage milk flow massage and nipple to stimulate hormones to release milk C shape of thumb and finger 2-3 cm from nipple Gentle press and release until milk flows Move round breast as required When no more move to other breast

Question 37

Breastfeeding benefits for mothers

Answer 37

Decrease postpartum depression Reduction ovarian and breast cancers

Question 38

Benefits for babies

Answer 38

Decrease obesity Reduction SIDS Everything they need, What's in it