IBCLC Exam questions and answers 2024 already graded A+

Innocenti Declaration Developed by WHO/UNICEF. International call for governments to support breastfeeding. Encourages governments to develop national breastfeeding policies and set goals. Code for Marketing breast milk substitutes Provides a model of marketing practices that permits the availability of manufactured baby milk but forbids its advertising of free distribution directly to consumers Baby Friendly Hospital Initiative Developed 10 Steps to successful breastfeeding practices Mammary ridge Primitive milk streaks develop from axilla to groin on trunk of embryo by 5th week embryonic life Nerve supply of the breast 2nd to 6th intercostal nerve Conditions that can cause a delay in lactogenesis C-section, type 1 diabetes, labor analgesia, obesity, PCOS, gestational ovarian theca Lutien cysts, retained placenta, stress, Pp hemorrhage-Sheehan's syndrome GALT Gut associated lymphoid tissue BALT Bronchus associated lymphoid tissue water soluble vitamins Vitamin C and B complex vitamins Fat soluble vitamins Vitamin A,D,E and K taurine Second most abundant amino acid in human milk. Lactation risk categories medications L1-safest, L-2 safer, L-3 moderately safe, L-4 possibly hazardous, L-5 contraindicated Medications whose molecular weight exceeds 1000 daltons Insulin, heparin, interferon. The transfer of drugs into human milk Usually facilitated by passive diffusion. From areas of high concentration to low Most influential factors to medication transfer to human milk Maternal plasma levels, molecular weight, oral bioavailability, protein binding Drugs to avoid in lactation Amphetamines, Demerol, dostinex, eegotamine, estrogens, fluoxetine, iodine, lithium, parlodel, pseudoephedrine, sulfonamides, chemo, albuterol, ace inhibitors Breast feeding recommendations for HIV + mom. Can be done if mother is on antiretroviral medications. Hepatitis B May breast feed. Should receive Hbig within 12 hours of birth and HBV Alternative feeding methods Cup feeding, finger feeding, syringe feeding, SNS, nipple shields, paladai Physiologic Jaundice of the Newborn unconjugated hyperbilirubinemia; begins on day three, generally resolves within the first week of life Lactogenesis I Mammogenesis. Begins in pregnancy. Colostrum is created Lactogenesis II Lactogenesis secretion on copius milk follow hormonal shift triggered by delivery of the placenta Lactogenesis III Galactopoesis -Milk supply is maintained by autocrine control. Around day 10 post partum until weaning Lactogenesis IV Breast involution. Average 40 days after last breastfeeding Sensorimotor Birth-2 years. Piaget Preoperational stage 2-7 years. Piaget Freud's sexual stages Oral, anal, phalic, latency, genital Trust vs. Mistrust 0-1 1/2 yrs. Erikson. Hope Autonomy vs. Shame and Doubt Erikson's stage in which a toddler learns to exercise will and to do things independently; failure to do so causes shame and doubt Initiative vs. Guilt Erikson's third stage in which the child finds independence in planning, playing and other activities Ainsworth's 3 attachment styles type a - avoidant type b - securely attached type c - ambivalent Preterm milk Higher in protein , sodium , chloride, calories, lipids than mature milk - lower lactose than mature milk colostrum higher in Fat, protein, Vitamin A & E, antibodies, sodium, chloride, magnesium colostrum lower in Carbohydrates, lactose, pottasium, calcium pre-term milk lacks Calcium and phosphorus Volume distribution Drugs with increased volume distribution generally require longer to clear from the body Milk plasma ratio Quantity of a drug in human milk in relation to maternal plasma. If the M/P ratio > 1.00, the drug is found in greater quantities in milk than in plasma. M/P ratio < 1.00, the drug is found in lesser quantities in milk than plasma. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871. Hale, Medicaitons in Mother's Milk 2010, p 18. pKa ph at which a drug is equally ionic and non-ionic. Choose drugs with low pKa in lactation Drugs in lactation Key points Choose drugs with: short half-life, high protein binding, low oral bioavailability, high molecular weight. Drugs that transfer into human milk low molecular weight, low protein binding, pass easily into the CNS/brain, attain high concentrations in maternal plasma How do drugs enter into breast milk Passive diffusion Gaps between alveolar cells during the first 3 days of life Large. Permits enhanced access into the milk for most drugs.