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PCE Certified Breastfeeding Counselor Exam Study
Guide
Questions and Answers
1. What is the normal weight loss for the infant during the first few days
ANS 5-7% in the first 24hrs and below 10% in the first week
- How many calories does a lactating mom need
ANS : Moms need approximately 500 extra calories/day when breastfeeding. Range is 1,800-2,700 with most monsconsuming around 2,
3. What type of supplement do most lactating vegans / bariatric patients take
ANS supplement Vitamin B
- How much vitamin D does a baby need? When do they need to be supple- mented
ANS Babies need 400 IU of Vitamin D per day. They should be supplementedif moms are deficient ; there is vitamin D in formula , so if they are being formula - fed they do NOT require additional vitamin D supplementation.
- What types of foods ( or diet ) should lactating moms consume
ANS Moms should consume a diet of normal foods - they should eat when they're hungry anddrink when they're thirsty. The MyPlate is a good example - 50 % carbs , 15 % protein , 20-30 % healthy fats
- When would a Habermen feeder be indicated
ANS with Down's Syndrome or aCleft Lip / Palate
- What medications are contraindicated in breastfeeding mothers
ANS An- timetabolite drugs or chemotherapy , radioisotopes ( not IV contrast dye ) and illicitdrugs
ANS The baby's stomach is only the size of a marble , button or grape at birth. It can only hold 1 - 7 mL or 1 - 2 teaspoons at this time.
- Standards of of practice for CBC
ANS Help families define and achieve goals -Problem solving : Assessment , plan , implementation , evaluation -Education and counseling -Professionalism -Legal considerations
- Where is the milk produced
ANS ANSWER- In the alveoli
- How long after cessation of breast feeding does milk production ( involu- tion ) stop
ANS Approximately 40 days
- What are the common signs of milk " let down "
ANS Tingling , warmth , fullness , dripping and contractions
- How is preterm milk different than term milk ANS It is higher in protein andimmune factors ( because the body KNOWS this is what the preemie needs! )
- What component of breast milk is the most variable ANS Lipids
- What component of human milk is destroyed by freezing ANS Macrophages
- International code of marketing substitutes: -No advertising -No free sample
- Scientific info Not law but should be use
- Baby friendly 10 steps: -- Written policy -Proper training -Proper education -Initiation w in 1 hr -Maintain lactation even if separated -Breastmilk only unless medically required -Rooming in -Cue feeding , 8-12x -No artificial teats - Supportgroups
- Where is milk produced ANS Alveoli
- How is milk ejected into ducts from alveoli? aka let down: Myoepitheal cells encase the aveoli , contract in response to oxytocin. In response to sucking oxytocin increases
- Different stages of breast development: embryogenesis : Mammary gland while embryo
- Mammogenesis : @ puberty , estrogen influences growth of ducts and buds -Lactogensesis 1 : Fullness and tenderness while pregnant. Ducts stimulated.
Lactogenesis 2 : Secretory activation when placenta out. D / t increase of prolactin when progestrone decreases. Lactogenesis 3 : Milk removal =production. Infant sucking- oxytocin = let down.
32. How long after cessation of breast feeding does milk production stop?
ANS 40 days
33. What happens to estrogen and progesterone during pregnancy and birth
ANS Increase during pregnancy , decreases after birth Helps development of lobes .
- Signs of letdown ANS Tingling , warmth , fullness , dripping , contractions
- Accessory tissue : Where are they found ANS Diagonal line from axilla to groinarea. Can lactate and undergo malignant change. 36. Flat / inverted nipples : possible issues and solutions? What is short shank
ANS Difficulty w / latch. Nipple shield may help. Short shank- retraction w / stimulation
- Hypoplasia , what is it ANS Underdevelopment , insufficient glandular tissue. Nochanges during pregnancy , insufficient milk.
- What is breast milk composed of ANS Fats : higher in mature milk and evenings
- What is considered failure to thrive ANS -- < 1 month Loses wt after 10 days doesn't regain birth wt by 3 wks. below 10 % at 1 month >> 1 month : Below 30 % ,drop in growth of length and head. Evidence of malnutrition and dehydration. Badfeeds , no milestones.
- What is the normal wt loss in the first 3-4 days: 5-7 %
- How many calories should a lactating mom intake ANS 1800 2700. 500 for milkproduction. 53. What type of supplementation should vegans and bariatric patients use
ANS supplementation bl
- Cause for sore nipples , how to fix: Improper latch , correct position. Open wide mouth , body in straight line , nipple in between two palates. Feed on less tender side , warm compresses.
- 3 causes of engorgement: Congestion / vascularity , accumulation of milk , edema
- How to treat engorgement ANS Alt which breast offered first completely emptybreast , reverse pressure softening , compress areola for latch. No pumping. Supportive bra , gentle massage , green cabbage. RICE : rest , ice , ocmpression( bra ) , elevate
- Plugged duct : what is it , how to treat: Incomplete drainage. Must empty side . Massage , moist heat. Lecithin supplement
- What is mastitis , s / s , how to treat: Infx of plugged duct. Flu , fever , pain. Cold pack after feeding , abx.
- Breast abscess : what is it , treatment ANS Collection of puss d / t mastitis .Surgically drained. Abx , frequent feeds and warm compress.
- Candidiasis / thrush : what is it? symptoms ANS Overgrowth of fungus in mouth . Infant : No symptoms , red rash at anus , refusal to nurse Mom : Burning , itching
- How to treat hypotonic infant ANS Skin to skin early feed. Flex positions w /jaw support- dancer. Cup or spoon.
- How to induce lactation ANS Estrogen and progesterone w / dopamine antag-onist. Nipple stimulation for 2 months.
- What's the deal with galactagogues ANS Herbal supplement that increases milksupply. Safety questionable
- When is a larger flange needed ANS If the nipple rubs or sticks. Doesn't moveand mom in pain
- What's a breast shell for ANS Evert nipple , collect leaking milk , engorgement , tender nips
- What's a nipple shield for ANS Latch , overactive let down , cleft palate , preterm .
- Who uses a habermen feeder: Downs , cleft
- What to monitor in baby who's mom is on meds ANS Behavioral changes gichanges , rash
- Estrogen ANS ^ during pregnancy ; stim growth in ductile system
- Progesterone: ^ during pregnancy ; stim alveoli and lobes
- Prolactin: frm ant pituitary gland ; lands on prolactin receptor start milk prod -from
- Oxytocin: from post pituitary gland ; cause LETDOWN
- TSH: ^ responsiveness of mammary cells
- Flat nipples: remains flat after stimulation or retract with compression ( shortshank ) -- > diff w / latch
- Pseudo inverted nipple: seems inverted but erect upon stimulation
- Retracted nipple: retracts upon stimulation
- Inverted nipple: retracted at rest & s stimulation
- Impact of breast surgery on lactation Implants: Implants compress milk ducts -- > impede milk flow -- > compromise reaching max milk vol
- Impact of breast surgery on lactation - hyaluronic acid injections: - no riskof being absorbed in baby's GI tract
- Impact of breast surgery on lactation Reduction: - BF might not be possible after - BF early + stim bm early ins
- Normal urine output: > 1 diaper per day of life ( e.g : 2 day old infant min of 2 wet diapers )
- Relactation: induced lactation in mother who previously breastfeed or has never breasted following invultion ( reverse weaning )
- Relactation: can take estrogen , progesterone , and GALACTAGOGUES
- Weaning: avg age -- > 3-4 y.os
