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ALPP CLC Exam questions and well detailed
answers.
breast feeding: a public health priority - ANSWERhas been recognized as a public health priority in tropical climates since the 1930's, but not until the 1990's in the US costs to prevent needless deaths - ANSWERless than $6 billion/year worldwide suboptimal breastfeeding - ANSWERaccounts for more than 3,340 maternal and child deaths a year, 80% are maternal nursing a baby for a year or more - ANSWERdecreases by 10-15% the risk of developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease women who do not breastfeed - ANSWERare at greater risk for myocardial infarction and aspects of metabolic syndrome; are at a greater risk of breast, endometrial, and ovarian cancer WHO and UNICEF three strategies - ANSWERfor increased breastfeeding initiation and duration in every country: promotion, protection, and support breastfeeding promotion - ANSWERfocuses on advantages of breastfeeding on a personal, community, country, or global level
breastfeeding protection - ANSWERfocuses on government, manufacturer, and social responsibility to assure breastfeeding's ability to compete with commercial interests; includes addressing improper marketing practices; the AAP advices not to provide formula, company gift bags, and industry- authored handouts; in the US, state and local breastfeeding legislation addresses breastfeeding in public, employment issues, jury duty, family law, mothers in prison, etc. breastfeeding support - ANSWERfocuses on the interaction of "helpers" with family as well as program development and implementation community expertise - ANSWERvariety of community expertise is needed to promote, protect, and support breastfeeding International models - ANSWERfor integrating breastfeeding promotion, protection, and support as well as balancing technical information, programs, and protocols CLC - ANSWERnationally recognized designation awarded by the ALPP to those who are exam eligible and pass the exam; have competenct verified CLCs and IBCLCs - ANSWERhealth professionals who provide lactation support why is breastfeeding so difficult? - ANSWER1. unrealistic expectations
- lack of timely interventions unrealistic expectations - ANSWERlack of preparation for what the newborn period would look like
the strategy - ANSWERis intended as a guide for action
- it identifies interventions with a proven positive impact
- it emphasizes providing mothers and families the support they need to carry out their crucial roles
- it explicitly defines the obligations and responsibilities in this regard of governments, international organizations, and other concerned parties the world breastfeeding trends initiative - ANSWERintended to track, assess, and monitor the implementation of the "global strategy" at the country and sub-country level what contributes to low rates of ebf globally? - ANSWER- caregiver and societal beliefs favoring mixed feeding
- hospital and healthcare practices and policies that are not supportive of BF
- lack of adequate skills and support
- aggressive promotion of infant formula and other breastmilk substitutes
- inadequate maternity/paternity leave legislation
- workplace policies
- lack of knowledge about dangers of not exclusively BF and proper BF techniques how to support ebf - ANSWERincrease hospital and health system capacity regarding baby friendly hospital initiative
- provide community based strategies including campaigns tailored to local context
- strengthen monitoring and enforcement of the code
- enact at least 6 months paid maternity leave
- invest in training and capacity building in protection, promotion, support disparity of US breastfeeding trends - ANSWERaccording to the CDC, "black mothers are less likely than white to breast-feed their babies, and here's one possible reason why: hospitals in neighborhoods with many black residents do less to promote nursing than those in areas with more white residents" anatomy of milk cells - ANSWERmyoepithelial cells, connective tissue, capillaries, anteriole, venule, alveolar cells anatomy of human breast - ANSWERglandular tissue made up of clusters of alveoli and small ducts, fat amongst the glandular tissue, milk ducts, areola, nipple with several duct openings making milk - ANSWERmessages from the breast travel through the nervous system to the brain, then hormones travel to the breast through the blood system hormone pathways - ANSWERtwo separate hormone pathways, pituitary gland is important to both prolactin levels - ANSWERgo down in between nursing and rise during nursing infrequent nursing - ANSWERleads to lower levels and less rise even with the same amount of nipple contact
nest or cache - ANSWERmammal species with high fat/protein and low water content = infrequent feeds nest = bunnies cache = deer carry, follow, or hibernate - ANSWERmammal species with hither water content milk have more frequent feeds carry = koala follow = elephants hibernate = bears our culture - ANSWERwants us to be nesters when it comes to feeding, but our milk composition indicates that we should be carriers the brain - ANSWERmost rapidly developing organ in human newborns; human milk is the ideal fuel for brain growth nursing pattern - ANSWERshould be frequent to accommodate human milk composition stages of making human milk - ANSWERlactogenesis I, lactogenesis II, lactogenesis III lactogenesis I - ANSWERsecretory differentiation, placental hormones, colostrum
lactogenesis II - ANSWERsecretory activation, after complete delivery of placenta, rapid drop in progesterone, transitional milk lactogenesis III - ANSWERlactation, galactopoesis, prolactin from frequent nipple stimulation, frequent removal of milk, mature milk breastmilk composition - ANSWERhuman milk changes continually, makes it impossible to obtain a single representative sample of milk preterm milk - ANSWERappears to have a different composition for the first 5 - 7 weeks after delivery independent of gestational age at delivery
- appears to be higher in protein, fat, and electrolytes than term milk
- if baby is SGA, LGA, or AGA, does not make a difference in milk composition after 1 year of lactation - ANSWERhas significantly increased fat and energy contents fore vs hind milk - ANSWERforemilk is milk at the beginning of a feed, hindmilk is at the end of a feed
- used to think that hindmilk contained more fat content but it is more complex than originally described
- foremilk does not mean "low fat" and hindmilk is not always highest in fat
- sometimes foremilk and hindmilk have equal amounts of fat and we should not give mothers tules based on the ideas of fore and hindmilk breastmilk composition changes - ANSWER- over the course of lactation
- within the day
- presence of hormones
- antibodies such as SIgA
- white blood cells
- cell wall disrupters
- B12 binding factor
- lactoferrin
- antimicrobial activity boosters
- mucosal wall protectors
- microbes
- absence of exposure to contaminants
- antibodies
- synergistic effect diarrhea mechanisms 1 - ph of the gut - ANSWERbreastfed babies' gut is more acidic while formula-fed babies' guts are more neutral/basic gut bacterial colonies (the microbiome) of mixed fed babies are similar to exclusively formula fed babies diarrhea mechanisms 2 - low iron in the gut - ANSWERrelatively low iron content in human milk diarrhea mechanisms 3 - presence of bifidus factor - ANSWERpromotes intestinal presence of lactobacillus bifidus that maintain the low pH and crowd out pathogenic organisms
diarrhea mechanisms 4 - presence of hormones - ANSWERhormone like factors and growth factors that stimulate growth and development of the GI tract and GI motility, such as:
- GI hormones
- prolactin
- EGF (epidermal growth factor)
- prostaglandins diarrhea mechanisms 5 - antibodies - ANSWERsuch as SIgA bind to microbes in the baby's intestinal tract and prevent them from being absorbed into the rest of the body. mother's IgA has been found to protect against the development of NEC in preterm infants. maternal IgA shapes the host- microbiota relationship of pretern neonates that IgA in maternal milk is critical and necessary factor for the prevention of NEC diarrhea mechanisms 6 - white blood cells - ANSWERkill microbes directly or mobilize other defenses diarrhea mechanisms 7 - cell wall disrupters - ANSWERkill microbes by destroying the cell walls, these include fatty acids and lysozymes diarrhea mechanisms 8 - B12 binding factor - ANSWERreduces the amount of B12 in the intestines available to microbes diarrhea mechanisms 9 - lactoferrin - ANSWERdeprives bacteria of iron, disrupts the integrity of the outer membrane of bacteria, assists in intestinal maturation and in the recovery of the intestine from injury and other mechanisms
what increases gastrin and decreases somatostatin in babies? - ANSWER- sucking babies have cutaneous (touch) receptors in their mouths that respond to sucking starting at 27 weeks gestation
- species own milk
- decreased stress
- touch
- wellness adult GI hormones - ANSWERalso impacted by suckling when mother suckles her gastrin and cholecystokinin go up. this increases the efficacy of insulin and increases the storage of ingested nutrients pregnancy & breastfeeding in re: to T2DM - ANSWERpregnancy itself may bring an increased risk for Type 2 diabetes in the mother, which breastfeeding can negate. compared with women who have not had children, childbearing women who do not breastfeed have a 50% increased risk of T2DM in later life weight loss in the BF neonate - ANSWERin first date after birth, most babies lose weight, some from normal diureses AAP weight loss stance in 2005 - ANSWER"weight loss in the infant of greater than 7% from birth weight indicates possible breastfeeding problems and requires more intensive evaluation of breastfeeding and possible intervention to correct problems and improve milk production and transfer" AAP weight loss stance in 2012 - ANSWERadded "evaluate body weight gain - body weight loss no more than 7% from birth and no further weight loss by day five: assess feeding and consider more frequent follow-up"
by two weeks at the latest: - ANSWERthe baby should regained to its birth weight infants lose more weight in the first postpartum days... - ANSWER- when labor meds are used... but perhaps not at a baby-friendly hospital
- when more intrapartum fluids have been given
- when there was no labor prior to cesarean however, supplementation rates for weight loss decreased with routine use of 24 hr weight and did not increase untoward effects during the hospital stay what do we know about breastfed babies who become dangerously undernourished? - ANSWERreport by cooper & colleagues identified a significant increase in the incidence of malnutrition and hypernatremia in breastfed infants
- 5 sentinel cases in ohio began a chart review of the prior 4 years
- chart review babes were 23% below birth weight on average on readmission and showed clinical signs of dehydration and hypernatremia
- babies were: not d/c early, nursing q 3-4 or 4-6 hrs, scheduled, both breasts, 5 - 10. min a side, SLEEPY
- researchers found: the class was inadequate, inadequate follow up in the community post-partum how do you know about breastfeeding adequacy? - ANSWERfewer than 4 soiled diapers on day 4 when used in conjunction with delayed onset of lactation may indicate breastfeeding inadequacy
- four on four... and each day after
MYTH - size of the breast relates to the amount of milk - ANSWERthe proportion of glandular and fat tissue and the number and size of the ducts are not related to milk production. for health providers, perceptions of who will have difficulty with breastfeeding may be related to breast size. MYTH - not getting enough fluids impacts volume of milk - ANSWERthere is not enough evidence to support increasing fluid intake beyond with breastfeeding mothers are likely to require to meet their physiologic needs MYTH - exercising or working too hard impacts supply - ANSWERmaternal exercise when breastfeeding was not related to changes in macronutrients or volume or infant weight gain or growth. rest is not associated with increased milk production. MYTH - not getting enough rest - ANSWER"fatigue" may be tiredness, but also may be a symptom of an underlying medical problem that could affect milk supply. MYTH? worry/stress?? - ANSWERincreased worry/stress does not seem to directly diminish milk supply in humans, however...
- worry/stress may alter behavior, which may alter supply maternal stress - ANSWERbreastfeeding mothers may perceive less stress compared to formula fed mothers, breastfeeding mothers:
- had more positive moods
- reported more positive events
- perceived less stress
stress & hormones - ANSWERstress + male hormones = fight or flight stress + oxytocin + female hormones = tend and befriend postpartum post traumatic stress disorder (PP-PTSD) - ANSWERup to 9% of PP women met the DSM-5 criteria for PTSD after childbirth two conditions that increase odds of PP-PTSD - ANSWER- depressive symptom scores
- total number of physical symptoms experienced since birth MYTH - its about the types or amounts of foods eaten during laction - ANSWERhumans have breastfed and are breastfeeding under conditions we can't even imagine. this is possible because:
- lactation has a lower energy cost for humans compared to other mammals
- number of kcal/day for lactation is much less than previously believed
- the body adapts with physiological mechanisms in favor of lactation in humans when the infant suckles from the breast... - ANSWERthere is an outpouring of 19 different GI hormones in both the mother and the infant, including cholecystokinin, which cycles to the kidneys, and gastrin, which stimulates growth of the baby and mother's villi, increasing surface area and absorption of calories with each feeding how is it possible for humans to make milk with such a small amount of energy expenditure? - ANSWER- maternal plasma prolactin concentration generally increases under conditions of negative energy balance, which may serve to protect lactation
