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Download ALPP CLC Exam 2025 Certified Lactation Counselor REAL/Authentic Proctored Exam Complete Qu and more Exams Nursing in PDF only on Docsity!
Breast feeding: a public health priority - Correct Answer has 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 - Correct Answer less than $6 billion/year worldwide Suboptimal breastfeeding - Correct Answer accounts for more than 3,340 maternal and child deaths a year, 80% are maternal Nursing a baby for a year or more - Correct Answer decreases by 10-15% the tisk of developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease Women who do not breastfeed - Correct Answer are 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 - Correct Answer for increased breastfeeding initiation and duration in every country: promotion, protection, and support Breastfeeding promotion - Correct Answer focuses on advantages of breastfeeding on a personal, community, country, or global level Breastfeeding protection - Correct Answer focuses 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 - Correct Answer focuses on the interaction of "helpers" with family as well as program development and implementation Community expertise - Correct Answer variety of community expertise is needed to promote, protect, and support breastfeeding International code of matketing of breastmilk substitutes (the code) - Correct Answer an international health policy framework to regulate the marketing of breastmilk substitutes in order to protect breastfeeding - published by the WHO in 1981 - internationally agreed voluntary code of practice - written in response to the marketing activities of the infant feeding indurstry which were promoting formula feeding over breastfeeding, which in turn was leading to dramatic increases in maternal and infant morbidity and mortality - subsequent clarifying and extending resolutions have been passed by the world health assembly The code - Correct Answer regulates the marketing of breastmilk substitutes which includes infant formulas, follow-on formulas, and any other food or drink, together with feeding bottles and teats, intended for babies and young children; sets standards for the labeling and quality of products and for how the law should be implemented and monitored within countries Restricting marketing - Correct Answer does not mean that the products cannot be made available, neither does it restrict parents choice; it simply aims to make sure that their choices are made based on full, impartial information, rather than misleading, inaccurate, or biased marketing claims The strategy - Correct Answer is 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 - Correct Answer intended 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? - Correct 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 Making milk - Correct Answer messages from the breast travel through the nervous system to the brain, then hormones travel to the breast through the blood system Hormone pathways - Correct Answer two separate hormone pathways, pituitary gland is important to both Prolactin levels - Correct Answer go down in between nursing and rise during nursing Infrequent nursing - Correct Answer leads to lower levels and less rise even with the same amount of nipple contact Ongoing milk production - Correct Answer positively associated with suckling within the first 2 hours after birth Initiation for mothers of preemies - Correct Answer initiation of milk expression before one hour resulted in significantly more milk when measured on days 7 and 42 Triggering oxytocin mechanism #1 - Correct Answer conditioned response - conditioned milk ejection (let down) reflex - was probably given too much importance in the years we didn't understand the other mechanisms - conditioned over time and lasts a lifetime - is faster for women who already have one from previous breastfeeding - to condition response.. Smell, touch, hear the stimulus Triggering oxytocin mechanism #2 - Correct Answer nipple stretching, happens with a proper latch Triggering oxytocin mechanism #3 - Correct Answer baby hand massage, each hand movement releases oxytocin Hormones of lactation - Correct Answer have an emotional/behavioral function as well as making and moving milk; aggression, protection, bonding & trust Milk composition - Correct Answer is complex - each species of mammal milk is different - milk is "species specific" Nest or cache - Correct Answer mammal species with high fat/protein and low water content = infrequent feeds Nest = bunnies Lactogenesis I] - Correct Answer secretory activation, after complete delivery of placenta, rapid drop in progesterone, transitional milk Lactogenesis III - Correct Answer lactation, galactopoesis, prolactin from frequent nipple stimulation, frequent removal of milk, mature milk Breastmilk composition - Correct Answer human milk changes continually, makes it impossible to obtain a single representative sample of milk Preterm milk - Correct Answer appears 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 - Correct Answer has significantly increased fat and energy contents Fore vs hind milk - Correct Answer foremilk 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 - Correct Answer - over the course of lactation - within the day - within a feeding - between feedings Is also changes by the way it is taken Babyled feeding - Correct Answer "the breast-fed baby can regulate his fat intake quickly and thus mothers should be encouraged to practice baby-led feeding” Maximum fat levels - Correct Answer obtained 30 mins post-feed - mothers of male infants seem to produce milk that has 25% greater energy content than mothers of female infants Milk composition, milk action - Correct Answer milk composition is complex, milk action is redundant - milk is more than nutrition, bioavailability of nutrients is higher in human milk than in other foods or supplements Diarrhea mechanisms 1 - ph of the gut - Correct Answer breastfed 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 - Correct Answer relatively low iron content in human milk Diarrhea mechanisms 3 - presence of bifidus factor - Correct Answer promotes intestinal presence of lactobacillus bifidus that maintain the low ph and crowd out pathogenic organisms Diarrhea mechanisms 4 - presence of hormones - Correct Answer hormone 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 - Correct Answer 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 Diarrhea mechanisms 6 - white blood cells - Correct Answer kill microbes directly or mobilize other defenses Diarrhea mechanisms 7 - cell wall disrupters - Correct Answer kill microbes by destroying the cell walls, these include fatty acids and lysozymes Diarrhea mechanisms 8 - B12 binding factor - Correct Answer reduces the amount of B12 in the intestines available to microbes Diarrhea mechanisms 9 - lactoferrin - Correct Answer deprives 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 Diarrhea mechanisms 10 - antimicrobial activity boosters - Correct Answer such as fibronectin and gamma interferon Gastrointestinal hormones - somatastin - Correct Answer inhibits GI secretion, inhibits motility in the GI tract and the release of most GI hormones. Inhibits the secretion of HGH from the pituitary and inhibits cellular growth and proliferation In the gut What increases gastrin and decreases somatostatin in babies? - Correct 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 - Correct Answer also 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 - Correct Answer pregnancy 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 - Correct Answer in first date after birth, most babies lose weight, some from normal diureses AAP weight loss stance in 2005 - Correct 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 - Correct Answer added "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: - Correct Answer the baby should regained to its birth weight Infants lose more weight in the first postpartum days... - Correct 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 Breastfeeding associated hypernatremia - Correct Answer hypernatremia is a common complication of inadequate milk transfer during breastfeeding - completely preventable complication that seems to be relatively common Hypernatremia weight loss difference - Correct Answer 1.6% in healthy infants vs. 16.2% in hypernatremic addmited infants Hypernatremia frequency of feeds difference - Correct Answer 10.2 for healthy infants vs. 7.6 in the NHD admitted infants How has the AAP responded to hypernatremia? - Correct Answer - ensure formal evaluation and documentation of breastfeeding by trained caregivers (including position, latch, milk transfer, examination) at least for each nursing shift - all breastfeeding newborn infants should be seen by a pediatrician at 3-5 days of age, which is within 48-72 hours after discharge from hospital - evaluate: hydration (elimination patterns), body weight gain (body weight loss no more than 7% from birth and no further weight loss by day 5), discuss maternal/infant issues - observe feeding MYTH - size of the breast relates to the amount of milk - Correct Answer the 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 - Correct Answer there 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 - Correct Answer maternal 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 - Correct Answer "fatigue" may be tiredness, but also may be a symptom of an underlying medical problem that could affect milk supply. MYTH? Worry/stress?? - Correct Answer increased worry/stress does not seem to directly diminish milk supply in humans, however... - worry/stress may alter behavior, which may alter supply 
