CLS- Certified lactation specialist Questions and Answers

CLS- Certified lactation specialist Questions and Answers What is chestfeeding? term used by many transmasculine and non-binary parents to describe how they feed and nurture their children from their bodies. What is body feeding? term that may be used by anyone, but anyone, but mostly commonly by a transmasculine or non-binary parent. What did original formula consist of? When, and who created it? wheat flour, sugar, and cow's milk. Henri Nestle, early 1800's-19th cent Where are hypoplastic breasts located? What significant features do they have? 3-5th rib asymmetrical looks like stopped growing somewhere in puberty When does milk start to produce for mom and baby (breast buds)? 16-20 weeks What is the function of montgomery glands/tubercles? Lubricates/ protects nipples/areola pH-lowering fatty acids- lethal for Invading micro-organisms Scent glands- guide infant to nipple Pregnancy- glands hypertrophy= more prominent Approximately how many pores are there in the nipple? Average? 4-18 9 T/F: the nipple contains smooth muscle fibers that allows the nipple to become erect and graspable. True What is the act of moving an anatomical part forward? protraction What are some tricks and tools for inverted nipples? avent nipplette supple cups breast shells latch assist nipplesuckers inverted syringe best tool- laid back position What is the breast composition? 2/3 glandular 1/3 adipose What is the tail of spence? breast tissue that extends axilla What structure fills the alveolus? What do they do? lactocytes cells that actually synthesize the milk What is it called when a lactating mother delivers her baby and the breasts grow by 1500 cc or more? gestational gigantomastia What are the roles of colostrum? protection- primary nutrition- secondary T/F: What the clock not the baby. What the baby not the clock. When does mature milk come in? 10-14 days How long does rusty pipe syndrome last? 24-72 hours What percentage of water is human milk? 87.5% How many living cells does colostrum have? 5 mil per ml How many living cells does mature milk have? decreased 10 fold What are the two main types of WBCs in human milk? macrophages lymphocytes What does the A-secretory IgA do for the baby? antibody-main key protection in early days 15-40 times higher in1st 24 hours coats infants gut and seals off entry points for potential dangerous pathogens What does the Proteins- S IgA do for the baby? protection binds with bacterial cells- clumping/destroys coats intestines anit-inflammatory more than any other bodily fluid Which flora is normal for human milk? bifidus flora- crowd out growth of more dangerous bacteria How do HMOs work? prebiotic decoy receptors- pathogens instead bind to HMOs work with good bacteria to produce sialic acid What is the function of protein in human milk? amino acids for growth PROTECT AGAINST INFECTION carriers for hormones and vitamins Enzymatic activity other biological activities What is the whey to casein ratio in colostrum, mature milk, cow's milk, and most formula? C (90:10) MM (60:40) Cow (20:80) F (60:40) What are the whey components to human milk? A-lactalbumin serum albumin lactoferrin immunoglobulins lysozyme What are the big three proteins for human milk? Lactoferrin secretory IgA lysozyme When is the fat content of human milk the highest? Day What is the first milk the baby receives during MER? Foremilk What is the milk the baby receives later in the feeding? Hindmilk What hormone is involved with making the baby "Milk drunk"? CCK Cholecystokinin What is the hormone that signals baby is full and to stop? Leptin If the breast milk has a metallic, soapy smell/taste once defrosted what are some interventions we can do? What causes this? Scaling the milk prior to freezing Lipase- baby might refuse What enzyme helps the baby to digest starch? When does the baby start producing? Amylase- 6 months old How much Vit D is recommended for baby and mom when breastfeeding? B- 400 IU 6400 IU What is the goal for first BF? 60-90 mins after birth What is the goal for feedings for infants? 8 or more in 24 What is the LC's role for feedings? Support parents feeding goal listen to concerns and validate observe and assess feeding reassure parents and teach "normal" meet the needs of parents and baby encourage and instill self-efficacy When does mature milk come in? Between 10-14 days What is the ABM's recommendations for baby intake per feed in the first 24 hours, 24-48 hours, 48-72 hours, and 72-96 hours, 10 days, 1-6 months? 2-10 ml 5-15 ml 15-30 ml 30-60 ml 60-90 ml 90-150 ml How do we know if breastfeeding is working? Pain-free weight gain What GA is preterm? Born before 34 weeks regardless of weight What GA is late preterm? 34 0/7- 36 6/7 What GA is early term? 37 -38 6/7 What GA is term? 39- 41 6/7 What are the best interventions for both over arousal and under arousal? Vestibular- upright rocking skin to skin What types of babies have low muscle tone? Down syndrome preterm late preterm full term lga What position is best for low tone babies? Dancer hand position What can high tone in a baby indicate? Neuro developmental probs increased metabolic needs- slower weight gain smoker decreased oxytocin levels What can mucus in stool mean? Oalr lactose overload food allergy What are the 3 important things needed for motivational counseling? Baby needs fed protect supply protect bf/cf parents mental space What are the three steps to counseling strategies developed for bf? Ask open ended questions affirm feelings educate What are the primary factors of marasco's milk supply equation? Sufficient glandular tissue intact nerve pathways and ducts adequate hormones and hormone receptors What are the secondary marascos milk supply equation? Adequate lactation critical hormones frequent effective milk removal and Brest stim no other lactation inhibitors When does Lactogenesis 1 occur? Pregnancy When does lactogenesis 2 occur? Postpartum Where is prolactin manufactured and stored? M- hypothalamus s: anterior pituitary gland Where is oxytocin manufactured and stored? M- hypothalamus s: posterior pituitary gland what makes oxytocin more than the mer? Promotes attachment eases stress solidifies relationships reduces drug cravings triggers protective instincts calming, tranquil, loving- and sleepy generosity What can sabotage bf? Supplementing encourging mothers to sleep at night pacifiers to postpone feeding parent programs that encourage adult control instead of cue feedings What are the 5 components of encouraging father or partner participation with bf? Joint bf goal shared bf responsibilities proactive bf support father/partner parental child interactions productive communication And problem solving How long can meds adm through epidural be found in babies system? 10 minutes How long is bupivicaine found in neonatal blood? 3 days What type of pain relief is s better option rather then epidural analgesia/ anesthesia? Nitrous oxide- breathe peak of contraction min effect on baby elim quickly once baby starts breathing on own What are the effects of pitocin? Antidiuretic neonatal jaundice lower apgar 7 at 5 mins unexpected adm to nicu more than 24 hours for full term infants impaired first hour feeding inhibit the expression of several primitive neonatal reflexes associated with bf How long should the first bath be delayed? 8-24 hours What is the first official step to successful bf? Policy What is the second official step to successful bf? Staff education What is the third official step to successful bf? Prenatal education What is the fourth official step to successful bf? Skin to skin What is our goal as lactation specialists? Make bf easier for babies, parents, and staff What is the fifth official step to successful bf? Hand expression/ manage good position and attachment What is the sixth official step to successful bf? Bf exclusively What is the seventh official step to successful bf? Rooming in What is the eighth official step to successful bf? Responsive feeding What is the ninth official step to successful bf? No bottles teats or pacifiers What is the tenth official step to successful bf? Support after d/c How long can eye ointment wait? After first feed How long can vit k wait? 4-6 hours after first feed What does the preterm and full term infant need on for skin to skin? Pre- diaper, socks, and hat full- diaper What is the position for the infant when doing skin to skin? 35-80 degree angle head and shoulders elevated head tilted back, and mother able to see infants face What are the 9 instinctive stages at birth lead to the breast? Birth cry relaxation awaking active resting familiarization suckling sleeping What are some neonatal responses once infant is born that encourages laid back breast feeding? Hand to mouth mouth gape tongue dart hand/finger flex and grasp arm/leg cycle head lift head bob suck and swallow What is our goal for parents with bf? Independence- we don't want them to need us to be able to feed the baby. Support and guidance to be able to feed their own What is another term for biological nurturing? Laid back bf What is the primary stage of emotional and neuro behavioral development in which the infant recognizes its mother through oral tactile memory for continuing evolutionary survival? Latchment What are our latch goals? Pain free weight gain= effective latch What are the five strategies of gestalt bf? Parent semi-reclined with infant chest and abdomen flat against body and breasts. infants bare hands move freely firm pressure of infant chin and lower lip infant in alignment with maternal body support infant's core What should we do if the pt is having sore nipples? Deep the latch look for different cause (sucking, jaw, short frenulum, candidiasis/ bacterial infection, dermatological condition (darmangeat) What is AFLOW mean for feeding assessments? A- ask F-feeding and feel L- latching O- output W- weight What are the 4 P's of bf? Patience perseverance practice plan to protect the baby and milk supply while learning What type of pain is normal for bf? Initial latch pain that fades as feeding progresses tugging or pulling sensation