ALPP CLC EXAM NEWEST 2025 ACTUAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+

ALPP CLC EXAM NEWEST 2025 ACTUAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ “has been recognized as a public health priority in tropical climates since the 1930's, but not until the 1990's in the US - CORRECT ANSWER breast feeding: a public health priority" "less than $6 billion/year worldwide - CORRECT ANSWER costs to prevent needless deaths" "myoepithelial cells, connective tissue, capillaries, anteriole, venule, alveolar cells - CORRECT ANSWER anatomy of milk cells" "glandular tissue made up of clusters of alveoli and small ducts, fat amongst the glandular tissue, milk ducts, areola, nipple with several duct openings - CORRECT ANSWER anatomy of human breast" "messages from the breast travel through the nervous system to the brain, then hormones travel to the breast through the blood system - CORRECT ANSWER making milk" "two separate hormone pathways, pituitary gland is important to both - CORRECT ANSWER hormone pathways" "go down in between nursing and rise during nursing - CORRECT ANSWER prolactin levels" "leads to lower levels and less rise even with the same amount of nipple contact - CORRECT ANSWER infrequent nursing" "positively associated with suckling within the first 2 hours after birth - CORRECT ANSWER ongoing milk production" "initiation of milk expression before one hour resulted in significantly more milk when measured on days 7 and 42 - CORRECT ANSWER initiation for mothers of preemies" "such 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 - CORRECT ANSWER diarrhea mechanisms 5 - antibodies" "kill microbes directly or mobilize other defenses - CORRECT ANSWER diarrhea mechanisms 6 - white blood cells" "kill microbes by destroying the cell walls, these include fatty acids and lysozymes - CORRECT ANSWER diarrhea mechanisms 7 - cell wall disrupters" "reduces the amount of B12 in the intestines available to microbes - CORRECT ANSWER diarrhea mechanisms 8 - B12 binding factor" "stress + male hormones = fight or flight stress + oxytocin + female hormones = tend and befriend - CORRECT ANSWER stress & hormones" "up to 9% of PP women met the DSM-5 criteria for PTSD after childbirth - CORRECT ANSWER postpartum post traumatic stress disorder (PP-PTSD)" "- depressive symptom scores - total number of physical symptoms experienced since birth - CORRECT ANSWER two conditions that increase odds of PP-PTSD" "humans 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 - CORRECT ANSWER MYTH - its about the types or amounts of foods eaten during laction" "inverted nipples had lower prolactin levels and less milk - CORRECT ANSWER uncorrected grade 3" "- ask if and when nipple evert - look over the shoulder just after feeding for nipple eversion and compare to pre-feeding nipple - if not seen, intensive follow up - consider expression - assure adequate nutrition of infant - CORRECT ANSWER counseling implications with alternative nipples" "shells, everters, shields and pumps have not been studies in prospective experimental controlled trials - check that tools are FDA approved and have safety and efficacy studies - CORRECT ANSWER PP eversion techniques" "- iron deficiency - hemorrhage, anemia, sheehan's syndrome - hormone imbalance - CORRECT ANSWER suboptimal or altered physiology" "has been associated with milk supply problems may be: - physiologic (poor oxygen to milk making cells) - due to exhaustion or depression altering parent's coping behavior - combination of the above - more than 20% of PP US women have iron deficiency anemia - CORRECT ANSWER iron deficiency anemia" "- pumping along with the lack of breast/mouth contact independently influences the milk microbiota - should be appropriate for mother's intended usage - must be used according to manufacturers' Instructions - get training from the rep, see cleaning guidelines on CDC website - if multi-use, must be used with the kits specified by the manufacturer unless the manufacturer says so - 2/3s of pump users reported problems with their pump and 15% reported an injury attributed to the pump - care providers and consumers can report damage/injury from pumps to FDA - there is not one pump that is right for every situation - getting a pump is associated with decreased odds of any BF around 10 weeks - CORRECT ANSWER pumps" "- distribution of free pumps (to predominately black WIC eligible mothers) was not associated with increased rates of EBF at 1.5-3.5 months PP - 15/25 studies in Cochrane review acknowledges being funded by pump companies - lower cost pumps and hand expression may be as effective, or more effective than large electric pumps for some outcomes - common intention to use a pump early after delivery with an ID'd BF problem indicated need for increased lactation support to reduce concerns about insufficient milk supply - no one flange shape is going to be best for all women, some may be too small - CORRECT ANSWER distribution of pumps" "- cleanest way to collect milk - simple process, hand washing and clean container is all that is needed - CORRECT ANSWER milk expression by hand" "- milk storage information for home use for full-term infants (ABM Protocol #8) - milk is a raw food and should be handled with care - heat little (or not at all) to preserve Immune properties and nutrients - CORRECT ANSWER milk storage and handling" "is.. - preventative - reduces long term morbidity - reduces mortality, matter or life or death for some infants - decreases NEC - cost-effective in many cases - sage - CORRECT ANSWER banked donor milk" "-donor screening (by history, by serology) - bacteriology on milk - heat treatment/pasteurization (does not destroy all beneficial components (milk from HMBANA milk bank retains an average of 90% of active properties) - CORRECT ANSWER donor milk safety guaranteed" "can be personalized with the addition of a small amount of mother's own milk - CORRECT ANSWER donor milk personalization" "not the same as informal sharing - informal milk sharing cannot be condoned in the US - "as donors need screening, we discourage the use of any milk from an anonymous donor) - US and Canadian health authorities have raised concerns about: - wet nursing or cross nursing (except where culturally appropriate) - borrowing or buying milk not from a HMBANA-member or licensed milk bank (from a friend or over the internet) - human milk purchased via the internet exhibited overall bacterial growth and frequent contamination with pathogenic bacteria - many contained cow's milk or formula - donors to "peer to peer" systems knew they would not qualify for milk bank - all donors may be criminally liable if they know they are ineligible as milk bank donors, and sell or distribute their milk anyway - CORRECT ANSWER donor milk banking" "a majority of US babies receive infant formula in the first 6 months of life - CORRECT ANSWER safer use of infant formula" "- inadequate and unpaid maternity leave, unequal pay, maternal mortality and morbidity, lack of universal counseling for breastfeeding, health care inequities - CORRECT ANSWER what issues in our society make formula use happen?" "- frequently recalled - can be contaminated in the collection, or manufacturing process, and/or in the home - powder Is particularly susceptible to contamination - should be alerted regularly with powdered infant formula is not a sterile product - CORRECT ANSWER formula" "- water used to dilute formula - additives such as melamine - bottles - improper cleaning, BPA and other chemicals of concern In plastic bottles - bottle nipples - CORRECT ANSWER other routes for formula contamination" "- 77% of formula feeding mothers do not receive instruction on formula prep - 73% did not receive storage instruction from a health professional - no consistent pattern of maternal characteristics (age, education, income, etc.) was associated with unsafe practices - CORRECT ANSWER FDA has found that" "- WHO and CDC: mix PIF with water heated to temp of at least 70 degrees C, 158 degrees F to kill Enterobacter sakazakii - formula made with hot water needs to be cooled quickly to body temp if it is being fed to the baby immediately - if formula is not being fed immediately, refrigerate it right away and keep cold until feeding - CORRECT ANSWER recommendations for preparing powdered infant formula (PIF)" "watering down can have negative consequences for the infants both immediate and long term - CORRECT ANSWER formula stretching" "- reflux - colic - CORRECT ANSWER other feeding issues" "may be associated with cow's milk allergy in infants less than one year of age - CORRECT ANSWER reflux" "- review of literature of management of infantile colic = "an easily ID'd childhood problem that has no clearly ID'd treatment guidelines) - colic does not seem to be associated with GERD - new microbiota framework for colic? colicky babies had more than double the abundance of proteobacteria, wheras bifidobacteria and lactobacilli were increased in control infants - anaphylaxis is also possible - related to cow's milk or cow's milk based formula is rate but important event - CORRECT ANSWER colic" ""..should not be recommended for the prevention of allergy or food intolerance in infants at high risk of allergy or food intolerance" - feeding with cow milk formula may also provoke allergy in those at risk - even in little doses - CORRECT ANSWER feeding with soy formula" "researchers report that although published estimates of intolerance range from 2-15% and 33-50% of infants undergo formula change during first 6 months of life - raises concerns that formula switching can have detrimental effects on the parent/child dynamic - instead of switching formulas when there is no medical indication, focus on helping families build skills in coping with uncomfortable babies - CORRECT ANSWER formula intolerance" "help parents be aware of the gap - infant formula industry is adept at making marketing claims that appear to imply that formula Is just as good or even better than human milk - FDA announced that it is finalizing rule that sets standards for manufacturers of infant formula - under the final rule, standards include: current good manufacturing practices specifically designed for infant formula, including required testing for harmful pathogens salmonella and cronobacter - requirement that manufacturers demonstrate that the infant formulas they produce support normal physical growth, that formulas be tested for nutrient content in final product stage, before entering market, and at the end of the products' shelf life - CORRECT ANSWER gap between marketing claims and health claims" "homemade formulas, animal milks, or plant milks are not appropriate for human babies - babies fed these substitutes may suffer from: electrolyte imbalances, metabolic acidosis, folate deficiency, and specific and non-specific antigenicity "scurvy is a new and severe complication of improper use of almond drinks in the first year of life" - CORRECT ANSWER homemade formulas" "expectation is 750-1000 mls per day, but a mother of twins made 2355ml/24 hrs and more recently 4170ml/24h - CORRECT ANSWER how much milk do we make?" "- until fall 2000, NCHS growth charts on babies weight gain patterns were based on growth of babies from without reference to how they were fed - newer NCHS data included some BF infants - WHO study released in 2006 makes EBF babies the growth standard - in 2010, CHC recommended WHO growth standards be used for all children under 24 months - 2012 AAP statement agrees - CORRECT ANSWER growth in BF baby" "mothers frequently report that the size and shape of their breasts have changes after childbirth, but these changes do not seem to be associated with BF - CORRECT ANSWER study of breast changes" "BF is: - normal - achievable - desirable - protection from specific diseases (give list) - natural: breasts were made for breastfeeding - CORRECT ANSWER we must address for fathers" "is not: - one-size fits all approach - talking to a friend - a teacher talking to a student - mechanical fixing of "what's wrong" - giving advice that would work for you - one-size fits all info (as found on the internet) - imposition of the counselor's agenda on the family - CORRECT ANSWER good counseling" "- family concerns are heard and valued - baby feels heard and valued - counselor elicits "the whole story" before offering feedback or intervention - adults, baby, and counselor are fully involved in problem solving - safety is always the primary focus (even over breastfeeding) - technology andd gadgets are used very carefully - avoid loaded and judging words - CORRECT ANSWER BF counseling goals" ""counseling emphasizes interactions with individual parents to support their decision-making, which means that the content and style of the intervention inevitably varies for different people at different time" - CORRECT ANSWER what is lactation counseling?" "four key principals: - partnership, acceptance, compassion, evocation rests in communication that is: - open, respectful, and compassionate - CORRECT ANSWER motivational interviewing" "- open ended questions - affirmation - reflective listening - summarize and teach back - CORRECT ANSWER OARS: steps to motivational interviewing" "show interest in what is on the client's mind today - ask questions that can't be answered with a single word - start questions with: how, who, what, when, where, etc. - why can be perceived as confrontational, try "tell me about" - CORRECT ANSWER OARS: open ended questions" "builds empathy and connection between client and counselor - listen for and call attention to examples of good actions/decisions to affirm - strive for genuine and specific recognistion, not a generic response - CORRECT ANSWER OARS: affirmation" "- listen for deeper understanding of situation, hearing not only the words, but open to possible underlying meanings and beliefs - rephrase or paraphrase statements, or reflect on meaning of what you heard to assure understanding - CORRECT ANSWER OARS: reflective listening" "- summarize strengths shared by client and action steps planned teach back: - ask client to demonstrate back a skill or learning - CORRECT ANSWER OARS: summarize and teach back" "- first time parents - mothers of late preterm infants born at 34-37 weeks gestation - women with family or financial problems - women experiencing postpartum adjustment disorder (PPAD) - 85% of women experience mood changes associated with hormonal changes, lack of support and many life changes - CORRECT ANSWER greater support is needed for" "- not related to feeding choice - women with history of PMS and prior dysphoric disorder have higher risk of PPD - CORRECT ANSWER PPADs" "postpartum post traumatic stress disorder - up to 9% of PP women met the DSM-IV criteria for PTSD after childbirth - CORRECT ANSWER PP-PTSD" "- depressive symptom scores - total number of physical symptoms experienced since birth - CORRECT ANSWER two conditions significantly increased odds of PP-PTSD" "- babies born during the night and early morning (10pm-9am) had double the odds of supplementation compared to babies born during the day - at one month, frequency of EBF as well as behaviors that promote BF was significantly higher in the group that received a doula - intrapartum synthetic oxytocin (pitocin)? - oxytocin (pitocin) infusion during labor decreased the amount of oxytocin released from suckling on day 2 dose dependently - and is an independent risk factor for APGAR scores of fewer than 7 at 5 minutes and unexpected admission to NICU lasting more than 24 hours for full-term infants - higher relative risk of mother receiving documented depressive or anxiety disorder diagnosis or antidepressant/anxiolytic prescription within the 1st year PP than women without synthetic oxytocin exposure - CORRECT ANSWER optimal start" "- mixed results from studies = its complicated - mothers who have had labor meds need extra BF support - may have a delayed onset of "milk coming in" (DOL) - CORRECT ANSWER pain medications during labor" "- avoid longer durations, delay administration of epidurals - conservative use of IV fluids - close follow-up and good BF support - continuous support in labor (doula) - reduce need for pharmacologic pain management through Lamaze or other childbirth education, breathing and relaxation, hypnosis, acupuncture, acupressure, etc. - CORRECT ANSWER research re: pain medications during labor" "- use hands-off technique of helping - implement 10 steps to successful BF - CORRECT ANSWER what else can we do to support EBF during hospital stay?" "- bags containing BF supplies or no bag at all were positively associated with EBF at 10 weeks and 6 months - weaning risk is greater when hospital practices do not support BF - positive relationship was found between mPINC score and in-hosp BF, any BF, and EBF at 8 weeks - use quality improvement measures to ID and change unhelpful practices - CORRECT ANSWER successful BF" "TJC created in 2010, measure set includes: - decrease elective delivery - decreased cesarean section - increase antenatal steroids - decrease health-care associated bloodstream infections in newborns - increased EBM feeding - CORRECT ANSWER perinatal care core measure set" "anticipates that hospitals will implement a strict definition of acceptable criteria for supplementation and work toward 100% EBM feeding - CORRECT ANSWER perinatal care core quality measure" "skin-to-skin in 1st hour, encouraging early feeding - one of the most powerful steps in influencing BF outcomes - s2s is a good starting point in changing practices - windstrom found all babies transition through the same 9 states - CORRECT ANSWER step 4/10 steps to successful BF" "is a barrier to BF - perhaps due to later initiation of BF, or more separation or more supplementation or greater weight loss. better post-op pain control improves BF outcomes - baby's gut microbiome is affected by antibiotic use, mode, and place of birth - s2s after cesarean may increase BF initiation, reduce formula supplementation in hospital, and maintain infant temp - if mother is separated from the baby, the partner can do s2s - CORRECT ANSWER cesarean birth" ""the infants in the s2s group were comforted, that is, they stopped crying, became calmer, and reached a drowsy state earlier than the infants in the cont. group" - CORRECT ANSWER father s2s" "can affect whether the baby suckles in the first hr or not - when a mother has had labor pain meds, her baby needs at least 2 hrs of s2s contact for the baby to self-attach - CORRECT ANSWER common labor meds" "important early developed sense for most newborns to attract the baby to breast - exposure to mother's odor may facilitate the infant's adaptation to the early postnatal environment - mother's areolae and milk odor appear to be sufficient to attract and guide neonates to the odor source, especially after the infant has been exposed to contractions of labor - maternal BM odor calms newborns during painful procedures - women are rewarded when they smell babies! body odors of. unfamiliar 2-day-old babies elicits activation in reward-related cerebral areas of women regardless of their maternal status - CORRECT ANSWER smell" "- decreased rate of primary PP hemorrhage - faster expulsion of the placenta - correct suckling - less crying - s2s babies are warmer - CORRECT ANSWER s2s promotes" "and opportunity to touch nipple, placed their babies in the nursery for fewer minutes - CORRECT ANSWER mothers with early s2s" "- families can observe for feeding cues - baby can be held s2s - babies can smell the milk - babies can be fed at their best time - learning happens together - CORRECT ANSWER when babies are in close proximity" "slept slightly longer and reported higher quality of sleep than mothers whose babies were in the nursery - CORRECT ANSWER mothers whose babies roomed in" "compared to mothers with no early s2s contact, EBF was higher in mothers who experienced longer s2s contact - CORRECT ANSWER s2s promotes BF" "- if they did not accomplish the first BF session within 2 hours after birth - had almost 4-fold increase in NOT EBF at 6 weeks PP - counseling implication: women reporting depressive symptoms during pregnancy seem to be more vulnerable to the effects of postponed first BF on EBF. women who have experienced depressive symptoms may benefit from targeted BF support during the first hours after birth - CORRECT ANSWER women who had reported depressive symptoms in pregnancy (EPDS>/= 13)" "- decreased prolactin receptors activated - decreased oxytocin/uterine contractions - decreased milk volume - decreased opportunities to practice with colostrum - decreased confidence - increased risk of supplementation - CORRECT ANSWER risks of delayed BF in hours after birth - mother" "- increased risk of jaundice, sleepiness, lethargy - increased risk of hypoglycemia - decreased opportunities to practice with colostrum - increased risk of supplmentation - increased pH and opportunistic microorganisms in gut - CORRECT ANSWER risk of delayed BF in hours after birth - baby" "- deep sleep (don't attempt feeding) - light sleep state (REM, happens about every 27-30 mins during sleep) - quiet alert (still body, fixed eye focus) IDEAL time to start feeding - growing restlessness with hand to mouth activities - open-eyed with rooting - crying (change in state is needed before attempting feeding) - CORRECT ANSWER infant states in the first hour" "- all babies had a least a one-hour wake time after birth - after the first hour, wakefulness varies - CORRECT ANSWER sleep wake cycles in the first hour" "a study of 24-48 hr old babies indicated that rooting was the most common first behavior followed by hand-to-mouth movement - CORRECT ANSWER most common feeding cues" "- when they are close to the source of the milk - when cues are missed or state is not optimal infants fret or sleep at the breast - solution - s2s and re-teach feeding cues - when baby is in optimal state for learning and feeding, the baby will have long periods of concentration, usually during REM and quiet alert - CORRECT ANSWER babies show more cues" "tummy to mummy nose to nips flex the hips to open the lips - CORRECT ANSWER snuggle poem" "indicated no difference in BF outcomes, however, greater satisfaction with comfort, ease of positioning, BF for longer periods in side-lying group compared with laid-back group - CORRECT ANSWER sidelying vs. laid-back foe post c-section moms" "1. line up the nose to nipple, then move baby back an inch or two 2. baby should gape, repeat as needed 3. as baby is moved toward the breast, the head tilts back (hand should not be on back of the head in order to allow for the head to tilt) 4. bottom lip and chin reach breast first 5. nipple will then align with upper half of mouth. when baby is latched optimally, there is more of the lower part of the breast drawn in 6. nose and chin should be close to the breast 7. angle at the corner of the mouth should be at least 140 degrees. the tongue takes up half of the mouth, so a wide angle is needed for room for the nipple to stretch in the TOP HALF of the mouth 8. both lips should optimally seal 9. cheek line should optimally be rounded 10. not a broken cheek line, not a dimpled cheek 11. bursts of 1:1 or 2:1 in an irregular pattern indicate a nutritive suck - CORRECT ANSWER latch" "baby looks "off center", more of lower portion of breast goes in baby's mouth - CORRECT ANSWER asymmetric latch" "rocker motion is optimal, piston motion is not optimal baby should end feeding with hands relaxed - CORRECT ANSWER feeding, ending feed" "- commercial preparations have same improvements as without, however, group without healed faster and had less need for f/u - individualized assessment of feeding in addition to education and corrective interventions was effective in reducing nipple pain and healing fissures in more than 90% of participants with sore nipples - pain was associated with every aspect of poor latch - CORRECT ANSWER BF shouldn't hurt" "assess for proper latch on, good seal, baby's tongue, swallowing sounds - and reteach as needed - early stages of the infant's breast seeking and latching behaviors should be observed as well as the actual feeding - CORRECT ANSWER assessing for pain" "pre-feeding behaviors (state and cue) and more optimal latching process behaviors of the baby (rooting, gaping, sealing, and sucking) were related to less pain with sore nipples - CORRECT ANSWER less pain with sore nipples" "- heal best with antibiotics (systemic or topical) - lanolin users had a 62% infection rate, non-lanolin users 18% - CORRECT ANSWER nipple infections" "hand on back of baby's head and shaping the breast - appear to interfere with baby's inter-oral function by restricting the movement of the cranio-cervical spine and nuchal alignment and is related to nipple trauma - CORRECT ANSWER two practices that interfere with babies function" "can also cause damage - bottom or top lip turned in or tongue ties - CORRECT ANSWER anatomical problems" "a visible lingual frenulum is not the same as a TOT - researched examined 200 healthy infants and found only 1 infant with no observable or palpable lingual frenulum - "a lingual frenulum is a normal anatomic finding.. that is not correlated with BF difficulties. we suggest that the term lingual frenulum should be used for anatomic descriptions and that the term "tongue tie" be reserved for a lingual frenulum associated with BF difficulties in newborns) - out of more than 500 articles about TOTs, only 8 are RCTs, 5 are related to short-term BF outcomes and 3 are about procedure itself - CORRECT ANSWER tongue tie" "concludes that a small body of evidence suggests that frenectomy may be associated with mother-reported improvements in BF, and potentially in nipple pain; but with small short-term studies with inconsistent methodology, strength of evidence is low to insufficient - CORRECT ANSWER systematic TOT research review" "- complete feeding assessment and suggest ways to optimize latch - refer onward for diagnosis - provide ongoing support - pacifier and feeding bottles in the hospital were both associated with sore nipples at discharge - CORRECT ANSWER role of CLC provider regarding TOTs" "significantly less likely to leave the hospital EBF - CORRECT ANSWER mothers with sore nipples" "- continuing question of effectiveness - fears of ingestion by baby - CORRECT ANSWER creams for nipple soreness?" "oversupply baby trying to hold back flow by clamping on nipple - CORRECT ANSWER other reasons for nipple soreness?" "usually see: - rapid weight gain - unsettled baby, especially after feeding - recurrent plugged ducts and mastitis - painful feedings - voluminous (huge volume of) stools - often green and shiny - CORRECT ANSWER oversupply" "indicated need for feeding evaluation - CORRECT ANSWER green shiny stools" "- if the nipple is not stretched deeply, less oxytocin flows, and therefore, less fat in the mix - with less fat, milk is digested more quickly, perhaps leading to not enough time for lactase to digest the lactose - with improved latch, more fat flows and slows down digestion, allowing time for lactase to be digested - CORRECT ANSWER is there deep latch with nipple stretching?" "if there is a lot of milk at once, the production of lactase may not keep up with the amount of lactose - decrease additional stimulation/milk removal as possible - consider block feeding (nurse on one side only per feeding) - try australian posture - watch for mastitis - consider donating to a milk bank - if lactation management solutions are ineffective, consultation with HCP for medical diagnosis - CORRECT ANSWER is there either overactive letdown and/or over production of milk?" "- is thought to cause pain for mother and/or baby - may be visible or not - mother will usually have itchy, flaky/shiny skin - CORRECT ANSWER candida albicans/yeast/thrush" "- simultaneous pharmacologic treatment (in recurrent cases, possibly other family members as well) - nystatin ointment is typically the first round - fluconazole (diflucan) oral capsules may be used - cleaning or replacing yeast vectors - toys, pacifiers, pump parts, etc. - if treatment doesn't work, may not be yeast - antihistamines were found to relieve symptoms when there was persistent pain thought to be yeast - CORRECT ANSWER treatment of candida" "often treated inappropriately of organisms such as candida albicans - is not the same as blanching due to poor attachment during feeding - involves vasospasm of the nipple, recognized by: triple color sign, bi color sign - pain is extreme and spasmodic (not continuous) - CORRECT ANSWER raynaud's phenomenon of the nipple" "triple: white -> blue -> raspberry bi-color: white -> raspberry - CORRECT ANSWER raynauds color signs" "- preventing or decreasing cold exposure - avoiding vasoconstrictive drugs (including some hypertensive drugs) and caffeine and nicotine - pharmacological methods, especially nifedipine (procardia), a calcium channel blocker - CORRECT ANSWER treatment of raynaud's" "in rare cases, babies have strong sucking vacuum as measured by a pressure transducer or nipple shield - CORRECT ANSWER what if, despite optimal latch, there is persistent nipple pain during feeding (suck and pause) with poor milk transfer?" "palpable lumps of milk within the lumen or duct system, usually not visible - CORRECT ANSWER clogs, plugs, or cakes" "1. figure out cause, especially if recurring (I.e., bra) 2. massage, warmth, double nursing may help (point chin toward clog?) 3. see HCP if systemic symptoms appear or if clog does not move in 24-48 hrs - CORRECT ANSWER for clogs" "may appear at a nipple tip as a "bleb" - small white spots on the face of the nipple that look like milk-filled blisters - one duct opening is usually covered - women describe stabbing pinpoint pain - blebs may exit when treated as clogs - sometimes blebs may need to be lanced by HCP - CORRECT ANSWER clog appearance" "breast inflammation, can be non-infective or infective - CORRECT ANSWER common mastitis" "- blocked ducts, e.g., from engorgement, hurried feedings, use of nipple shield - attachment difficulties - tight bra - use of breast shell - nipple pain - anemia in the mother - TOTs - CORRECT ANSWER factors commonly assosicated with mastitis" "fever, ill feeling, redness, pain, one inflamed breast - CORRECT ANSWER systemic mastitis" "most probably staph - problem is generally not in the milk but in the tissue of breast - CORRECT ANSWER if mastitis infective" "NSAID are usually the first step - antiobiotics for mastitis? Cochrane: little evidence for effectiveness of antibiotics for one breast "common" mastitis) - keep milk flowing and breasts soft and comfortable to avoid abscess development - nursing with common mastitis is NOT controversial - CORRECT ANSWER medical intervention is needed - mastitis" "consider anemia, ductal or inflammatory breast cancer - CORRECT ANSWER mastitis tx ineffective" "the tissue of both breasts are inflamed - strep is probable organism - a potentially fatal, whole-body inflammation, sepsis - not a problem with milk - CORRECT ANSWER uncommon and EMERGENT mastitis" "can look like mastitis when it's on the breast - newly recognized issue - can also cause lesions and abscess - CORRECT ANSWER methicillin-resistant staphyloccus aureus (MRSA)" "- pus, not milk - as many as 60% may be positive for MRSA - nursing on the other breast is possible - no clear clinical consensus about nursing on breast with abscess before of after "drainage" - surgery may cut through ducts - instead, drainage of breast abscess with ultra-sound technique has been shown to be efficient and should be the first choice - CORRECT ANSWER abscess" "of breast, nipple, areola should be referred at once to a qualified provider - could be MRSA or herpes, deadly for babies, so no BF or BM - CORRECT ANSWER any suspicious area or appearance" "needed when baby slips off breast, tires easily, repeated latches and sucks only a few times before letting go of the breast - CORRECT ANSWER careful assessment" "needs evaluation/referral - CORRECT ANSWER any recurrent feeding problem" "baby won't latch onto one breast - CORRECT ANSWER Goldsmith's sign" "one breast refusal may also happen suddenly with older babies - rule out common problems such as ear infection, teething, birth trauma (tort) - breast cancer is also a possibility that must be medically monitored - cancer may be dx as late as 5 years after Goldsmith's sign - CORRECT ANSWER persistent newborn refusal to nurse on one breast is of concern" "is vital and will enable early dx and improved prognosis if breast cancer - CORRECT ANSWER recognition of goldsmith's sign" "low blood sugar - healthy term newborns who are breastfed on demand and are asymptomatic do not need blood glucose routinely checked - AAP guidance current evidence does not support a specific concentration of glucose that separated normal from abnormal - "reasonable, although arbitrary, cutoff for treating symptomatic infants is 40 mg/dL" - CORRECT ANSWER neonatal hyoglycemia" "- jitteriness - cyanosis (blue coloring) - apnea (stopping breathing) - hypothermia (low body temp) - poor body tone - poor feeding/lethargy - seizures - CORRECT ANSWER hypoglycemia symptoms" "most commonly in infants who are SGA, LGA, born to mothers who have diabetes and late-preterm infants - greatest attention should be paid to neurologic signs in these babies - healthy term newborns who are breastfed on demand and are symptomatic do not need blood glucose routinely checked - s2s and BF should be initiated immediately after birth for best outcomes - implementation of quality-improvement intervention promoting s2s and early feeding in at-risk Infants was associated with a decreased risk of transfer to the NICU from 17% to 3% for hypoglycemia - CORRECT ANSWER NH occurs" "hyperbilirubinemia - yellow coloring of the skin and sclera - yellow coloration is caused by unconjugated bilirubin (UCB) - advancing jaundice requires clinical evaluation - CORRECT ANSWER jaundice" "kernicterus - UCB is fat soluble and crosses the blood-brain barrier - if amount of UCB is too high, has potential to cause damage to the brain, spinal cord, and nerve cells - CORRECT ANSWER why are we concerned about jaundice?" "- jaundice advancing from upper body to lower body - fussiness - lethargy - feeding difficulties - fewer than 4 wet/dirty diapers in 24 hours any jaundiced baby has the potential for kernicterus and should be closely monitored - CORRECT ANSWER jaundice warning signs" "pathologic, early onset, late onset - CORRECT ANSWER types of jaundice" "occurs before 24 hours of age, usually due to sepsis, blood incompatibility - CORRECT ANSWER pathologic jaundice" "peaks between 72-96 hours, often called "physiological" or "starvation" or "lack of BF jaundice" - frequently related to underfeeding - CORRECT ANSWER early onset jaundice" "should not prevent mothers from BF are sleepy, lethargic, and have difficulty sustaining the feeding - CORRECT ANSWER tx for jaundice" "often called "BM jaundice", may actually be related to metabolic or other issues with the infant (e.g., G6PD, Gilbert syndrome, UTI) - benign, prolonged UCB associated with BF - presents in 2nd week and can persist for 12 weeks - current research does not support the discontinuation of BF.. instead, need thoughtful investigation, monitor until total falls below recommended level for phototherapy - CORRECT ANSWER late onset jaundice" "state organization and motor system modulation of newborn - can help with difficulty latching and sustaining a feed, not just for right after birth - CORRECT ANSWER s2s influences" "KMC - special kind of s2s holding for premature and fragile babies that has been shown to decrease mortality by 36% as well as sepsis, hypoglycemia, hypothermia, and hospital admission - adult stays in upright position - may last for hours, even 24 - CORRECT ANSWER kangaroo mother care" "- have better longterm physiologic organization and cognitive control - have improved cerebral blood flow - have improved weight gain - may have nostrils decolonized that have been colonized by MRSA/MRSE organisms - have sleep patterns that are more mature - are warmer and more physiologically stable - may have better BF outcomes - CORRECT ANSWER preemies who have KMS or s2s" "under 1500 gm at birth - have longer BF duration if they have been cared for s2s - significantly warmer in mother's arms - burned fewer calories while being held than in the incubator - CORRECT ANSWER VLBW" "found that each breast increases temp separately for the closest baby - CORRECT ANSWER s2s twin studies" "- may struggle with breastfeeding - need many opportunities at the breast to develop the skill of. latching and transferring milk - CORRECT ANSWER premature, late preterm, early term" "34-36 6/7weeks - CORRECT ANSWER late preterm" "37-38 6/7 weeks - CORRECT ANSWER early term" "do better on human milk - better cardiac performance - predominant BM feeding in the first 28 days was associated with greater nuclear gray matter volume at term equivalent age - 28-32 week gestation - "infants fed BM have faster brainstem maturation compared to infants fed premie formulas) - CORRECT ANSWER preemies" "<1500 g baby - for every 10ml/kg/day increase in BM ingested, there was an increase in the Bayley Mental Development Index, the Bayley Psychomotor Dev. Index, and the Behavioral Rating Scale - 6% decrease in re-hospitalization - CORRECT ANSWER BM and VLBW baby" "for every increase in HM of 10 ml/kg/day, the odds of sepsis decreased by 19% - for a 2lb baby (0.9 kg), that translates to 9ml or 1.8tsp of HM/day - for a 4lb baby (1.8 kg), that translates to 18 ml or 3.6 tsp of HM/day - in US, cost savings of $117,239 per infant! - CORRECT ANSWER NICU - can BM improve outcomes and save money?" "EBF associated with more rapid maturation in function - extremely premature infants who received exclusive HM diet had significantly lower incidence of NEC and mortality - CORRECT ANSWER intestinal barrier function" "NEC rate of 1.3% - CORRECT ANSWER HM diet of more than 98% NEC rate" "NEC rate of 11.1% - CORRECT ANSWER pre-term formula NEC rate" "NEC rate 8.2% - CORRECT ANSWER mixed feeding NEC rate" "two main choices - fortifier made with cow's milk or fortifier made with human donor milk - preterm formula should be the last choice according to most expert groups - "the available evidence points to an increase in adverse outcomes with the cows milk fortifier, including NEC and severe morbidity comprising NEC surgery or death" - CORRECT ANSWER mother's own milk (MOM) fortifiers and donor milk - preterm" "should be based on cardiorespiratory stability, irrespective of current maturity, age, or weight - birthweight and length of stay are not associated with BF behaviors - preterm babies at the breast have better SSB coordination and oxygenation including REE (resting energy expenditure) after feeding than when bottle feeding - CORRECT ANSWER initiation of BF guidelines" "- rooting - areolar grasp - latched-on - sucking - longest-sucking burst - swallowing - CORRECT ANSWER PIBBS individual aspects" "often struggling with skill of BF - low tone - cues - depressed reflexes (hard to latch on) - gape - hypotonic perioral muscles, weak suck (enough to decrease mother's milk supply) - piston, ratio, sustian - deficiency in smooth tongue movement - skeletal abnormalities of the mouth and skull will decrease volume of the oral cavity - significant improved development in the suckling behavior over time is possible - CORRECT ANSWER babies with DS" "- individualize positions - hold baby to maximize a feed - provide sensory input to the mouth and muscle toning exercises if appropriate - individualize hand hold to connect the baby and the breast - CORRECT ANSWER helpful corrective interventions for positioning babies with difficulty sustaining feed" "longer duration of feeding with BM lowers indicence of OM in babies with clefts - for babies with clefts in the lip and palate, making a seal, creating a vacuum and sustain the feed is the challenge - CORRECT ANSWER clefts, OM, and feeding" "1. remove milk to make milk 2. infant requires nourishment to remove milk ABOVE ALL, infant cannot be compromised - CORRECT ANSWER guiding principals" "- expression within 1 hour of birth for the highest milk volume, has the most milk through week 8 - hand expressed milk was highest in calories compared to pumped milk - early hand expression with later addition of pump expression yielded milk that exceeded norms for fat and energy - CORRECT ANSWER remove milk to make milk" "- ongoing support person and professional oversight - express in proximity to the infant (particularly during KMC) for higher milk volume - double stimulation - collecting milk on one breast when nursing on the other is an effective strategy - guided imagery has been shown to increase the amount collected via pump - "power pumping" for a day or two may also help to increase volume - adequate frequency of stimulation plus try 5 minutes pause 4 minutes, repeat - CORRECT ANSWER using a pump or hand expression to build milk supply" "substances believed to increase milk production - "some providers may inappropriately recommend galactogogues before emphasizing the primary means of increasing milk synthesis.. or evaluating other medical factors that may potentially be involved" - prescribing drugs or herbal remedies is not within the scope of practice for any LCPs unless they are legally prescribers - CORRECT ANSWER what about galactogogues?" "herbs can have pharmacological properties and significant side effects - recommending herbs is prescribing - lawrence & lawrence gives a list of herbs that are considered safe for tea drinking - CORRECT ANSWER herbal remedies and drugs" "may cause reduced absorption of all medications used concurrently - worsening asthma, diarrhea, maple smelling urine and perspiration - cross reaction is possible if there is an allergy to chickpeas, peanuts, and other legumes - concerns about a decrease in blood coagulation and decreased serum glucose - after 21 days of taking fenugreek or placebo, there was no statistical difference in prolactin levels or milk volume - CORRECT ANSWER fenugreek" ""given the insufficiency of evidence from these trials, no recommendation is made for the use of herbs as galactogogues" - CORRECT ANSWER systematic review of efficacy of herbal galactogogues" "research shows that reglan did not improve BM volume or duration of BF in mothers pumping for premies - CORRECT ANSWER reglan (metoclopramide)" "Cochrane: did not show improvement in longer-term outcomes of BF - improvement of BF practices seems to be more effective and safer than the use of an off-label domperidone treatment - "domperidone is not currently a legally marketed drug or approved for sale in the US" - CORRECT ANSWER domperidone" "- some do increase serum prolactin levels - however, no direct correlation has been demo'd between artificially increasing baseline serum prolactin levels and long-term BF success conclusion: "if mothers are provided education and practice techniques that support lactation physiology, galactogogues appear to have little or no added benefit" - CORRECT ANSWER galactogogues and prolactin levels" "- relactation follows pregnancy (not necessarily BF) - it's not easy - interview revealed feelings of rejection, anger, stress, and failure - good strategy for emergencies - CORRECT ANSWER is relactation possible?" "- ability to produce milk - baby's willingness to nurse - length of time it will take to produce milk - CORRECT ANSWER relactation variables" "when there has not been a prior pregnancy - if possible, including for trans women - requires a lot of time and effort - almost never results in a full milk supply - works best when the focus is on the experience and the relationship rather than on the amount of milk from the mother in the baby's diet - CORRECT ANSWER induced lactation" "we should assess: - all aspects of the comprehensive risk assessment tool - how often the baby is being fed, and what is being fed - whether there is milk expression - how effective feeding/expressing is - how much milk is being transferred at breast (observe at least one feeding with pre- and post-weight checks) - need for comprehensive pediatric and maternal medical evaluation - CORRECT ANSWER rather than looking for a "magic bullet" to increase milk" "considering other supplemental devices - CORRECT ANSWER infant requires nourishment in order to remove milk" "consider: - cost and availability of device - ease of use and cleaning of device - stress to the infant of feeding method - whether milk volume can be fed in 20-30 mins - whether anticipated use of the plan is short or long-term - family preference - expertise of the healthcare staff to teach/supervise plan - whether the method enhances development of BF skills - safety and efficacy of device used - consideration of parents' ability to use device safely - CORRECT ANSWER when thinking about supplemental feeding device" "- healthy babies fed at the breast only are the most likely to be BF at 6 months - BF support should be offered in the NICU BEFORE using bottles - babies who are bottle fed (with either formula or expressed milk) are 2x more likely to empty the cup or bottle in late infancy than those. who are fed only directly at the breast - bottle feeding may alter self-regulation of intake, contributing to later obesity, higher weight gain velocity, and BMI - bottle size may be a modifiable risk factor - CORRECT ANSWER issues to consider when/if using bottles" "results in: - less increase in HR - better oxygenation - ability for infants to pace own feeding -premies randomized to cup feeds (vs. bottle) were significantly more likely to be fully breastfed on d/c home (two cochrane review agree) - cup feeding is the preferred supplementation method of WHO/UNICEF - inexpensive to implement - CORRECT ANSWER cup feeding for premies" "regardless of method, had a detrimental effect on BF duration - number of supplements makes a difference - more supplements = less duration - CORRECT ANSWER supplementation" "how to support: - get tuned into reality for this family - reexamine our individual POV - focus on helping with BF in the first week after d/c - assure support 2-3 weeks before return to work/school and continuing through adjustment (Tips from Office on Women's Health) - make support for parents available in the workplace/school - CORRECT ANSWER separation due to work/school" "- expecting to work in the first year after baby's birth does not significantly impact whether or not BF is initiated - planning to go to work may negatively influence the intention to EBF - timing of return to work and ending BF are closely linked - "returning to work FT before 3 months may reduce a mother's ability to meet her intention to BF by at least 3 months" - CORRECT ANSWER working plans" "2010 Health Care Reform (ACA) - amendment to Section 7 of Fair Labor Standards Act, requires employers: - to provide "reasonable break time for an (hourly) employee to express BM for her nursing child for 1 year after the child's birth each time such employee has the need to express milk" - space must be private place other than a bathroom and "is shielded from view and free from intrusion by coworkers and the public" - over 40% of employed women with infants had access to both break time and a private space to express BM - CORRECT ANSWER workplace BF law" "- break time for nursing mothers from US Dept of Labor - business care for breastfeeding from : for employers and employees - investing in workplace BF programs and policies - company sponsored lactation programs - can enable parents to provide BM for their infants for as long as they work, even those who are least likely to choose BF - CORRECT ANSWER resources for making BF friendly workplaces" "- 35% of pregnant women said their workplace was very supportive of BF... but... - 52% of PP women said their workplace was very supportive - only about half of women in US are covered by the Family Medical Leave Act - CORRECT ANSWER according to IFPS II" "- paid maternity leave could improve EBF rates at 6 months - fewer than 10% of Americans surveyed disagreed that the US should have paid maternity leave - CORRECT ANSWER what about staying home with the new baby?" "WHO recommends: - after a live birth, the recommended interval before attempting the next pregnancy is at least 24 months in order to reduce the risk of adverse maternal, perinatal, and infant outcomes - CORRECT ANSWER achieving a healthy inter-pregnancy interval" ""contraceptive counseling during BF extends beyond issues of efficacy, because the selected method must be appropriate for a woman's BF expectations" - CORRECT ANSWER which child-spacing methods are appropriate for BF?" "asks 3 questions: - is the baby younger than 6 months? - is there food or suckling except at the breast? - has menses returned? - CORRECT ANSWER lactation amenorrhea method" "- difficulty to predict timing - ovulation first? - decreased supply? - CORRECT ANSWER return of menstruation" "- women using combined oral contraceptives (verses progestin only) were least likely to continue BF for 4 months - women using contraceptive hormones were slightly more likely to report concerns about milk supply especially around the time of starting them - "barrier" and natural family planning methods are all considered okay - IUDs (some have hormones) can be placed in the postpartum without affecting BF outcomes - pills (oral contraceptives) - CORRECT ANSWER what about other forms of BC?" "most modifiable risk factors for child allergy are: - maternal smoking - type of infant feeding - cesarean birth - may even be that consumption of "allergenic foods" in pregnancy reduces allergy and asthma in children - CORRECT ANSWER altering diet to prevent allergies" "- cow's milk whey is the only substance consistently shown to bother some babies with "colic" symptoms - not all babies show symptoms and those that are botheres do so on very different amounts of liquid cow's milk from 4mls (5mls is 1 tsp) to 400 mls (1.7 cups) - proctocolitis (rectal bleeding) may occur even in EBF infants - CORRECT ANSWER other foods eaten when BF" "may play a role in the pathogenesis in many of the cases of proctocolitis - sometimes sensitization is through "hidden bottle" practices - CORRECT ANSWER cow's milk protein allergy" "- exclusion of the offending protein from the mother's diet, - usually cow's milk, although soy, corn, egg, and chocolate have also been implicated - many (50%) have a multiple positivity - resolution of visible rectal bleeding took place within 72-96 hrs in most babies, although can take up to a week - CORRECT ANSWER standard treatment for proctocolitis" "- women on milk-free diets should be referred for dietetic counseling - dairy products have nutrient value other than calcium (protein, vitamin D, etc.) - pregnancy and lactation are not the same - fetal calcium demand is met by increased intestinal absorption during pregnancy - regardless of amount of calcium in diet, BM calcium is met by renal calcium conservation and loss of bone (which is recovered post-lactation) - there is a 3-9% decrease in bone density during lactation - breastfeeders (even on high calcium diets) lost 3.9% of BMD in lumbar spine but gained 5.5% after weaning - pregnancy with BF in adolescence did not negatively affect BMD at later age - estrogen levels increase during weaning - the way bone mineralization increases in adolescent girls as estrogen levels increase - this is another example of the body adapting physiologically and positively to lactation - CORRECT ANSWER supporting calcium needs" "- many anthropologists believe that the flavors of the culture are conveyed to the child through milk while lactating - children are acculturated to the taste of their native foods through BM - longer duration of BF is associated with higher food variety at 3 years - foods that do not taste familiar are more likely to be refused - CORRECT ANSWER "you shouldn't eat spicy foods when BF"" "- caffeine habit does not relate directly to amount of caffeine in milk - caffeine may accumulate in premature and very newborn infants - caffeine consumption during pregnancy and while nursing has no consequence on infant sleep - coffee consumption is not associated with duration of EBF - CORRECT ANSWER caffeine when BF" "- studies show after drinking 0.4g/kg dose of alcohol in OJ, oxytocin levels significantly decreased but prolactin levels increased - in another study, alcohol completely blocked the release of oxytocin - babies may not like the taste - alcohol is water soluble, it passes in and out of the milk as her blood alcohol increases, then decreases - it is NOT trapped in milk (pumping and dumping will not remove the alcohol) - another counseling issue is about the safety of the baby if the parent(s) are inebriated or incapacitated - CORRECT ANSWER alcohol when BF" ""if alcohol is used, advise the lactating woman to limit her intake to no more than 0.5g of alcohol per kg of maternal body weight per day" - for a 60 kg (132 lb woman), 0.5 g of alcohol per kg of bodyweight corresponds to approximately 2 to 2.5 oz of liquor, 8 oz of table wine, or 2 cans of beer - CORRECT ANSWER institute of medicine re: BF mothers" "- low level drinking during BF is not linked with shorter BF duration or adverse outcomes up to 12 months of age - questions remain about the effect on the infant when mother combines smoking and drinking, especially binge drinking - consuming alcohol in excess of two standard drinks per day during lactation was found to be independently associated with shorter BF duration, even after consideration of previously identified predictors of BF duration - CORRECT ANSWER alcohol impacts on BF" "BM is often studies to understand population to environmental contaminants exposure because it is easily accessible and rich in fats - scary headlines arise from reports of new findings - may be specific populations at risk (generally agricultural or occupational) - toxic exposure to the infant occurs largely in utero and minimally through milk - BF should be universally encouraged and the environment should be cleaned up! - CORRECT ANSWER BM environmental contaminants exposure" "families should learn about the importance of EBF should also learn about: - PP community resources - frequent feedings and having enough milk - BF management such as responsive feeding, rooming-In and s2s - CORRECT ANSWER during pregnancy" "- while BF reduces disease risk in the population, it does not provide 100% protection from illness for an individual - many factors contribute to disease risk, including nutrition, infant feeding choices, genetic factors, and environmental influences - CORRECT ANSWER risk reduction does not equal prevention" "we need: - "interventions to be delivered in a combination fo settings by involving health systems, home and family and the community environment concurrently" - systematic review indicates that programs that support mothers in the PP period, in their homes, and extend over a relatively long period are the most successful in increasing EBF rates - skilled assessment and comprehensive intervention when BF is not working well - available, affordable, culturally competent lactation care and services for all families - CORRECT ANSWER to support EBF in the community" "if only formula introduction were eliminated, the black/white gap in BF duration could be reduced by 20% of overall difference - black women not only have lower rates of BF compared to white women, but they are also disproportionally affected by triple-negative breast cancer, an aggressive subtype - reducing BF disparities could decrease incidence of aggressive breast cancers among black women - CORRECT ANSWER hospital formula introduction" "- community ownership of the need for support throughout BF experience.. task forces and coalitions! - to remember that trying to support BF by telling the family prenatally about problems, could decrease desire to try - focus on ongoing support.. crucial to BF duration and exclusivity - CORRECT ANSWER to support EBF, we also need:" "when we reach out to families rather than waiting for them to contact us - anticipatory guidance - timely (proactive) interventions to help mothers tune into baby ages and stages - reactive support - if families are expected to initiate the contact, is unlikely to be effective - face to face support strategies are more likely to succeed - mothers rate social support as much more important than health care system support of BF - CORRECT ANSWER BF support works best when" "- no apparent schedule to their life - night feeding - frequency days may be noted if mothers have gotten off to a difficulty or scheduled start or baby needs to catch up. these are not growth spurts - CORRECT ANSWER common newborn attributes" "- 10-12 feedings per 24hr time period - several bowel movements each day from day 2 through first 6 weeks (and beyond for most babies) 4 on 4 - several wet diapers daily - urinations do not mean wet diapers - CORRECT ANSWER normal newborn expectations" "according to UNICEF, the US BF committee, and other national/international orgs, EBF should continue until about 6 months of age - "although infants should be managed individually, no apparent risks in recommending as a general policy EBF for the first 6 months in both developing and developed country settings" - vitamin K should be given shortly after birth - no supplementary flouride during first 6 months - CORRECT ANSWER exclusive breast feeding" "- rich in iron and zinc starting at about 6 months of age - supplementation of oral iron drops before 6 months may be needed to support iron stores - premature infants should receive both a multivitamin preparation and an oral iron supplement until they are ingesting a completely mixed diet and their growth and hematologic status are normalized - CORRECT ANSWER complimentary foods" "- all BF infants routinely should receive an oral supplement of Vitamin D, 400 IUs per day, beginning at hospital d/c - in the US 36% of mothers and 58% of babies are deficient - 28% of pregnant women with lower serum vit D had a c-section compared to 14% of women levels of 37.5 or greater - lower vit D levels may be associated with GDM - CORRECT ANSWER vitamin D supplementation" "- only 5-13% of EBF infants - only 9-14% of mixed fed infants - only 20-37% of exclusively formula fed infants - CORRECT ANSWER how many babies were getting recommended amount of Vit D?" "- vit D is stored, passed to the fetus and if the stores are adequate, then to the baby via BF - sun is main source of vit D for humans - reproductive women need to have enough vit D from conception to delivery for the best change that their neonates will enter infancy with sufficient vit D - supplementation during pregnancy and lactation may improve vit D status of both mother and nursling - CORRECT ANSWER vit D during pregnancy" "distractible - may need to move to quieter place - regular naps? - separation anxiety - night feedings? - teething - CORRECT ANSWER 4-6 months" "- sore nipples can happen when baby's saliva changes and gets new enzymes around the same age as teething - babies may nurse much more or much less - offer cold "te