IBCLC Final Study Questions and Answers

IBCLC Final Study Questions and Answers % of breastmilk that is protein Approximately .8 - 1 % Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 272. % of calories in breastmilk from carbohydrates Approximately 40% Hale and Hartman, 2007. Textbook of Human Lactation, page 69. % of calories in breastmilk from fat Approximately 50% Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 124. % of calories in breastmilk from protein Approximately 10% Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 272. Αlphalactalbumin A major protein found in human milk whey. Assists in processing lactose. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 863. Aspirin Salicylate analgesic, L3. Use associated with Reye's Syndrome in infants. Hale, 2010. Medications and Mother's Milk (14th ed.), page 87. β lactaglobin Major protein in bovine milk. Hale & Hartman, 2007. Textbook of Human Lactation, page 40. Bactrim/Septra Sulfonamide antibiotic, L3. The mixture of trimethoprim and sulfamethoxazole. No concerns reported via breastmilk in term healthy infants. Use with caution in preterm or jaundiced infants. Hale, 2010. Medications and Mother's Milk (14th ed.), page 249. Central pedicle technique Breast reduction surgical technique. Intended to keep ducts intact. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 654. CMV Cytomegalovirus -Type of herpes virus found in human milk, genital tract, urine, and pharynx. Transmitted by close contact. Avoid pumping or breastfeeding in premature infants if mom has acute infection. - Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 204. Comfrey An herbal poultice, L5. Is not considered safe due to alkaloids found in breastmilk after use. Hale, 2010. Medications and Mother's Milk (14th ed.), page 259. Dependent variable -Outcome -Affected by the independent variable; response the researcher wishes to explain Examples: comfort, change in attitudes Independent variable Experimental (treatment) variable that is manipulated by the investigator to influence the dependent (outcome) variable. Examples: Tongue tie clipping, Breastfeeding educational program Dong quai Herb contraindicated in lactation. Used to quell uterine cramps. Humphrey, 2003. The Nursing Mother's Herbal, page 239. Dopamine A prolactin inhibiting factor. Decrease releases prolactin and milk production begins. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 88. Estrogen (after delivery) This hormone dramatically drops after birth allowing milk production to begin. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 88. Expected daily weight gain in the first 3 months 15-30 grams or 1/2 to 1 ounce a day. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 284. Fourth intercostal nerve Essential for inervation of the nipple. Enters the areola at 5 o'clock position on the left breast and the 7 o'clock position on the right breast. Walker, 2009. Breastfeeding Management for the Clinician: Using the Evidence (2nd ed.), page 56. Galactocele A milk filled lacteal cyst. Most frequent lump found in a lactating breast. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page311. Galactose A monosaccharide derived from lactose. Helps with central nervous system development. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 867. Low birth weight infant A birth weight of less than 2500 grams. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 671. Lysozyme -Found in the whey component of breastmilk, this enzyme creates a bactericidal and anti-inflammatory response. -Increases starting at 6 months after delivery. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 146. Median Middle number in a series of numbers; the number on either side of which exist an equal amount of numbers. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871. 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. Heroine Narcotic analgesic, L5. Not recommended for breastfeeding. Infant should be observed for sedation, tremors, vomiting, restlessness, and poor feeding. Hale, 2010. Medications and Mother's Milk (14th ed.), page 500. Holder pasteurization A pasteurization process in which the milk is heated to 62.5o Celsius for 30 minutes, and then rapidly cooled in ice water. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 482. Mode The value that occurs most frequently in a data set. For example, if the data set is 1, 3, 3, 3, 5, 7, 8, 8, the mode is 3. Wikipedia. IgE mediated allergy Allergic reaction to food causing immediate, systemic reaction; can sometimes be severe. Wikipedia. Available online: Key milestones 1 month Watches faces intently, follows objects, reacts to noise. WebMD. Is Your Baby on Track? Key milestones 2 months Smiles at sound of voices. Lifts head and chest while on stomach. WebMD. Is Your Baby on Track? Key milestones 3 months Raises head and chest while on stomach, holds head up for periods of time, grasps objects, smiles at people, makes vowel noises. WebMD. Is Your Baby on Track? Key milestones 4 months Babbles, laughs, imitates sounds. Rolls over, sits with support, holds rattle. WebMD. Is Your Baby on Track? Key milestones 5 months Holds head steady, reaches for objects and gets them, places objects in mouth. Wikipedia. Key milestones 6 months Rolls over, moves objects from hand to hand, pulls self up to sit, makes double syllable sounds like "dada". WebMD. Is Your Baby on Track? Key milestones 9 months Responds to name, finds partially hidden objects, sits without support, crawls, picks up objects with pincer grasp. WebMD. Is Your Baby on Track? Key milestones 12 months Walks with or without support, beginning to say words, imitates people. WebMD. Is Your Baby on Track? Key milestones 18 months Walks independently, drinks from a cup, says at least 15 words. WebMD. Is Your Baby on Track? Lactase Enzyme needed by the infant to breakdown lactose in breastmilk to simple sugars. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869. Lactobacillus bifidus Main bacteria in the intestine of a breastfed infant. Called the bifidus factor, promotes the growth of beneficial bacteria. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 144. Lactoferrin -An iron binding protein that prevents gastrointestinal diseases. Found only in human milk, not bovine milk. -Declines over lactation Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 144. Lactose -Primary carbohydrate found in human milk; supplies energy to the infant's rapidly growing brain -Present in the newborn's gut at birth -Constant amount throughout lactation (although more concentrated the more frequent the feeds) -Enhances calcium absorption Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 869-870. Leptin A hormone found in breastmilk that regulates appetite, metabolism, and food intake. Not present in formula. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 146. Lipase Enzyme that digests the fat in breastmilk. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 870 & 146. Whey protein Includes alphalactalbumin, serum albumin, lactoferrin, immunoglobulins, and lysozyme. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 871. Oligosaccharide A carbohydrate consisting of monosaccharides found in breastmilk. Antibacterial properties. Promotes the growth of Lactobacillus bifidus. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872. Orbicularis oris Muscle that encircles the mouth and controls most movements of the lips (as compressing, closing, or pursing movements). Merriam-Webster Medical Dictionary. Palate, hard The hard portion of the roof of the mouth. During breastfeeding the infant compresses the breast tissue against this area with his tongue. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872. Paget's disease Type of breast cancer, 1-3% of all breast cancers. Occurs unilateral with demarcated, red, scaly plaque on the nipple and/or areola. Blood tinged discharge, pain, crusting, itching, burning, skin thickening, redness, ulceration, or nipple retraction. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 652. Palate, soft The soft portion of the roof of the mouth, located between the hard palate and the throat. This area rises when the infant swallows to close the nasal passages. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 872. Physiologic engorgement Physiologic engorgement is normal increase in milk production of lactogenesis II. Pathologic engorgement Pathologic engorgement is excessive fullness due to restrictive feeding practices or ineffective milk removal. Prolactin inhibiting factor Stimulates dopamine releases and thus inhibits prolactin. Nipple stimulation and milk removal suppresses PIF and dopamine, causing prolactin levels to rise and the breast to produce milk. From the hypothalamus. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 90. Prolactin receptor sites Binding sites on the walls of the lactocytes that receive prolactin. Frequent breastfeeding early in lactation creates more receptor sites resulting in increased milk production. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 89. Rugae The ridges behind the gum line on the hard palate. This structure helps the infant to maintain grasp of the breast during suckling. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 873. Secretory IgA Immunoglobulin that forms antibodies in body and is critical in mucosal immunity. The most common immunoglobulin in breastmilk. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 142. Shatavari A herbal galactagogue. Safety rating B. Humphrey, 2003. The Nursing Mother's Herbal, page 301. Tuberculosis Contagious bacterial infection usually involves lungs. Mothers may breastfeed after treatment is begun. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 525. TE Fistula Tracheoesophageal fistula A fistula (passage way) between the trachea and esophagus. Oral feedings are withheld until the fistula is surgically repaired due to the risk of aspiration. Merck manuals Online Medical Library. Very low birth weight infant A birth weight of less than 1500 grams. Riordan & Wambach, 2010. Breastfeeding and Human Lactation (4th ed.), page 671. Weaning milk Breastmilk during the end of lactation (whether intentional or unintentional). This milk is higher in sodium and immunoglobins. Mannel, Martens & Walker, 2008. Core Curriculum for Lactation Consultant Practice (2nd ed.), page 676. Preterm milk Higher levels of protein, nitrogen, fatty acid, some vitamins/minerals, immune factors and anti-inflammatory elements, lactoferrin 11 weeks gestation swallows amniotic fluid 16 weeks gestation swallow reflex 24 weeks gestation suck reflex 26 weeks gestation immature suck pattern 34 weeks gestation suck-swallow reflex 37 weeks gestation synchronized coordination of sucking and swallowing with breathing is achieved consistently Infant's mouth -Vertically short -When closed, the tongue is in lateral contact with the gums and roof of the mouth Infant's jaw Lower jaw is small and somewhat receded Infant's cheeks Fat pads assist with sucking stability (no sucking pads in preterm infants which is one of the reasons preterm infants have difficulty breastfeeding) Infant's tongue Anterior tongue moves as a "stiff body" along with the jaw while the Posterior tongue undulates in a peristaltic wave Infant's lips seal around the areola and create an airtight closure around the breast Serum Prolactin (during pregnancy) promotes nipple growth and increased breast mass Serum Prolactin (after delivery) -Remains elevated throughout the first six months PP in women who breastfeed regularly and can remain elevated after 6 months in response to suckling -Follows a circadian rhythm, being higher during the night (while sleeping) than during the day -Declines slowly during the course of lactation Progesterone (during pregnancy) Promotes increase in the size of the breast lobes, lobules and alveoli Progesterone (after delivery) Lactogenesis II is triggered by a rapid drop in progesterone after delivery of the placenta Placental Lactogen Promotes areolar growth during pregnancy Estrogen (during pregnancy) Proliferation & Differentiation of the ductal system ACTH & Growth Hormone (during pregnancy) together they promote mammary growth Relative Risk (RR) -Refers to the likelihood of something happening in a population exposed to a substance or event compared to the risk of what it would be for an unexposed population -If the RR is "1" then each group has equal risk. RR of "2 or more" means that the exposure group has a higher chance of getting whatever is being studied (i.e. sore or damaged nipples) Example: RR of a woman developing sore or damaged nipples from using a breast pump to remove milk versus the risk of only using a baby to remove milk. Odds Ratio Represents the odds that the outcome will occur given in a particular exposure compared to the odds of the outcome occurring in the absence of that particular exposure. Example: What are the odds that a group of woman will get mastitis if they have cracks in their nipples versus the odds of a group of women developing mastitis who have no nipple cracks. Confidence interval Should be 95% Example: Bhutani curve is an example of confidence interval (represents all babies and has accurate results) Trigeminal Nerve-5th Facial sensation Mastication