Core Curriculum for Interdisciplinary Lactation Care Questions and Answers

Core Curriculum for Interdisciplinary Lactation Care Questions and Answers Which drug property results in MORE transfer into milk? High Lipid solubility Low pH High molecular weight High protein binding High lipid solubility aids transfer across the alveolar cell. The other factors inhibit transfer into milk What is the most important factor in ongoing milk production? Overall breast size Milk storage capacity Frequent stimulation of the breast Frequent emptying of the breast Frequent emptying of the breast Which protective component in milk is highest in the first few days after birth and decreases over time? White cells Lysozyme SIgA Lactoferrin SIgA: secretory immunoglobulin antibody plays an important role in the protection and homeostatic regulation of intestinal, respiratory, and urogenital mucosal epithelia separating the outside environment from the inside of the body Which essential nutrient may be deficient in mothers who consume no animal products? Iron Zinc B12 Vitamin A B12 is found in abundance in animal products. Mothers who avoid animal products should take a B12 supplement When should an exclusively breastfed baby begin to be offered family (complementary) foods? 6 months 12 months 4 months 8 months 6 months. "Food before one is just for fun." Which family planning method is MOST compatible with breastfeeding? An intrauterine device with estrogen Barrier methods LAM (Lactational Amenorrhea Method) Progestin-only pill LAM is highly effective in the first 6 months. Only 1.5% of unintended pregnancies occur Which form of maternity protection MOST supports breastfeeding? Pumping facilities On-site daycare Flexible scheduling Paid maternity leave Paid maternity leave is the most common and supportive form of maternity protection. Which complication of birth is MOST likely to impact milk production? Sheehan's syndrome Forceps use Epidural anesthesia Cesarean surgery Sheehan's syndrome, or postpartum hemorrhage, can profoundly affect milk PRODUCTION *Sheehan syndrome is also known as postpartum pituitary necrosis. Death of the cells causes prolactin deficiency If a baby is unable to breastfeed immediately after birth, how soon should the mother begin hand-expressing her milk? Within 12 hours Within 6 hours Within 1-2 hours Within 24 hours A normal baby would have moved the breast and begun nursing within 1-2 hours. If the baby cannot feed, the expression should be started within the same time frame Which feature of Kangaroo Mother Care is MOST important to the baby's well-being? Baby is soothed by mother's voice Stabilizes baby's cardiovascular function Reduces noise stimulus from equipment Pleasant for the mother Stabilization of cardiovascular function is most important. The other features provide benefits to the baby and mother as well. Which aspect of bonding with twins or triplets is likely to occur first? Mother struggles with bonding for many weeks Mother bonds with the first born Mother bonds with the unit Mother bonds with the last born Mothers of multiples are more likely to bond with "the unit" before any of the individual babies What is the global recommendation for the duration of any breastfeeding? 2 years or more 1 year or more 6 months no stated recommendation The WHO/UNICEF Global Strategy for Infant and Young Child Feeding recommends exclusive breastfeeding for 6 months followed by breastfeeding and complementary foods for two years or beyond Which factor is most important for supporting breastfeeding in a mother with a chronic illness? Provide written information Refer her to a support group Help her discontinue breastfeeding Individualized lactation support Individualized care that keeps the mother and baby together and breastfeeding is most important Which maternal mental health condition is HIGHER in women who do not breastfeed? Postpartum depression Anxiety Post-traumatic stress disorder Bipolar disorder Breastfeeding mothers are less likely to experience postpartum depression Which suggestion is most likely to succeed when a mother is attempting to relactate? Start as soon as possible Use a breast pump to stimulate Ask about hormone therapy Use a tube-feeding device Many mothers can relactate after they stopped for a period of time if they start as soon as possible. Which is the most common cause of early nipple pain? Fungal infection Tongue-tie Poor positioning and latch Inverted nipples A poor (shallow) latch is the most common cause of early nipple pain What is the recommended treatment for a newborn with documented hypoglycemia? Ready-to-feed formula Oral glucose water Intravenous glucose infusion Spoon-fed colostrum Spoon-fed colostrum should be administered first. If the values do not improve quickly, intravenous glucose is the next recommendation for documented hypoglycemia. Breastfeeding should continue. Which is the most likely cause of low milk production? Pituitary abnormality Pacifier use Small breasts Infrequent breastfeeding Infrequent breastfeeding is the most common and likely cause of low milk production Which infant condition is a contraindication for breastfeeding and breastmilk? Galactosemia PKU (phenylketonuria) Down Syndrome Cystic Fibrosis Babies with galactosemia cannot metabolize lactose, the primary carbohydrate in human milk. If a baby cannot breastfeed directly, which device should be the FIRST to be used? Bottle teat Syringe Dropper Open cup Open cups should be the first strategy used when a baby cannot feed from the breast Which fetal structure may remain open or be re-opened by excessive infant crying? Ductus venosus Foramen ovale Portal sinus Ductus arteriosus The foramen ovale may remain open or be re-opened by excessive infant crying, which produces a Valsalva effect and increases thoracic pressure. This can have significant negative long-term consequences for the person later in life Which statement regarding the timing of Lactogenesis II is MOST accurate? Begins 30-40 hours after delivery of the placenta May be delayed 36-48 hours if mother has diabetes Timing is dependent on breast stimulation by the baby Lactogenesis II is triggered by the delivery of the placenta and the drop in progesterone. It is not dependent on breast stimulation by the baby and may be initially unnoticed by the mother. If the mother has diabetes, it may be delayed by ~24 hours. What statement BEST describes the role of the thymus gland in the infant's immune system? A large thymus gland may be related to increased risk of SIDS Breastfed infants have smaller thymus glands than formula-fed children The larger the thymus gland, the lower the infant mortality rate A small thymus gland at birth is related to prematurity and prenatal nutrition The larger the thymus gland, the lower the infant mortality rate. A fully breastfed baby's thymus gland is twice the size of a formula-fed baby. A small thymus at birth is related to low birth weight, malnutrition, and higher infant mortality. An old and false myth alleged that SIDS was due to a large thymus. Prenatal infections are a common cause of fetal death and are associated with smaller thymus glands. A pregnant woman has heard that letting epidural anesthesia wear off prior to delivery will avoid anesthesia-related breastfeeding problems. Which of the following is the MOST IMPORTANT information to provide to her? Drugs can take much longer to clear the baby's system, so there is still a possible breastfeeding risk with this approach. The combination of drugs used in epidural anesthesia makes it difficult to determine which medications cause breastfeeding problems. Epidural anesthesia has minimal or no effect on the baby regardless of how long before delivery it is administered. Epidural anesthesia increases the likelihood of other birth interventions that can affect breastfeeding. Drugs can take much longer to clear the baby's system The pediatric half-life of labor pain relief drugs is often much longer than the maternal half-life, which is the most important factor to consider. Choices B and D are important and accurate, as all labor drugs cross the placenta, including those administered in the epidural space. The effect on the baby's ability to breastfeed is dose-related What percentage of a drug administered to a lactating woman reaches a breastfeeding baby via milk? 0.01% 0.1% 1.0% 10% About 1% of most medications administered to a lactating woman actually reach her breastfed baby. There are exceptions, based on drug properties, dosage, age of the baby, and other factors. A mother calls in a panic on day 3. She has been crying all morning, her breasts hurt, and her baby is having a hard time feeding. Your FIRST response to her should be: How many times did your baby stool today? Things sure are overwhelming for you today! Have you been pumping your breasts? You'll be fine. Many mothers have problems on day 3. Things sure are overwhelming for you today! Beginning your interaction with an empathetic response such as B helps validate the mother's emotions, helps her integrate her experience, and moves her into problem-solving. Which of the following family planning methods is MOST effective and compatible with breastfeeding? Condoms Implanted progestin Combined oral contraceptives Lactation Amenorrhea Method Lactation Amenorrhea Method (LAM) is the most effective and compatible with breastfeeding. Condoms are also compatible but less reliable. Progestin-only methods are second choices, and methods containing estrogen are the least compatible On day 2, an obese mother is worried about her baby's breastfeeding. Which indicator would be the MOST REASSURING indicator of effective feeding? Baby stays attached at least 10 minutes. Rooting and swallowing are observed. Baby's ear, shoulder and hips are aligned. The mother reports gentle tugging on her breast. Rooting and observed swallowing are reliable indicators that the baby is effectively breastfeeding during the first 4 days. Length of feeds can vary and still be effective. Alignment can vary. The mother's sensation is not a reliable indicator of a good feed. The mother's obesity is irrelevant A mother wants to continue breastfeeding her 18-month-old child during a subsequent pregnancy. She was advised to wean the child to avoid triggering premature labor. Your BEST response is: Suggest she immediately wean the older baby. Reassure her breastfeeding during a normal pregnancy is not harmful to either child. Suggest she use lanolin during the pregnancy to prevent nipple pain. Recommend that she discontinue sexual relations so that uterine contractions do not jeopardize the pregnancy. Reassuring her breastfeeding during a normal pregnancy is not harmful to either child. Unless her pregnancy is high-risk, there is no documented harm to either the fetus or older baby by continuing to breastfeed. Nipple pain during a subsequent pregnancy is hormonally based and may be unavoidable. What is the MOST IMPORTANT reason that a mother with influenza should continue breastfeeding her child? Antibodies to the specific illness will appear in milk within hours The milk is easier to digest if her baby gets sick She will recover more quickly from the illness It would be too tiring for her to change to artificial feeds now Antibodies to the specific illness will appear in milk within hours Targeted antibodies specific to that infection quickly appear in milk and protect the baby. Other immune factors in milk also protect the baby. B is less important because the baby may not even get sick After the baby releases the breast after a 20-minute feed, there is a crease across the nipple tip and the nipple appears flattened. The MOST LIKELY cause of this is: Normal suck Shallow latch (attachment) Baby's head is turned away Torticollis in the baby Shallow latch (attachment) is the most likely reason that the mother's nipple is flattened after a feed with a crease across the nipple tip. Position of the baby and torticollis are possible explanations to explore after the depth of attachment is corrected. Normal suck should not crease, flatten, or damage the mother's nipple Which of the following citations is an example of a primary reference or source? Anderson GC. Current knowledge about skin-to-skin (Kangaroo) care for preterm infants: Review of the literature. Journal of Perinatology 1991; XI: 216-226. Als H, Lester BM, Tronick E, Brazelton B. Manual for the assessment of preterm infants' behavior (AFPB). In Fitzgerald JE, Lester BM, Jogman MW, eds. Theory and Research in Behavioral Pediatrics, Vol. 1, New York: Plenum, 1982, 64-133. Ludington-Hoe SM, Golant SK. Kangaroo Care: the Best You Can Do to Help Your Preterm Infant. New York: Bantam Books, 1993. Ludington-Hoe SM, Hadeed AJ, Anderson GC. Physiologic responses to skin-to-skin contact in hospitalized premature infants. Journal of Perinatology 1991, Vol XI, no. 1, p. 19-24. Ludington-Hoe SM, Hadeed AJ, Anderson GC. Physiologic responses to skin-to-skin contact in hospitalized premature infants. Journal of Perinatology 1991, Vol XI, no. 1, p. 19-24. A research article published in a peer-reviewed professional journal is a primary reference. A is a review article, which is a secondary reference. B is a chapter in a book, which is a secondary or tertiary source. C is a book for parents, interpreting other sources in its recommendations A pregnant woman has gestational diabetes. What length of breastfeeding is MOST likely to reduce her risk of developing Type 2 diabetes? At least three months More than six months Over twelve months Breastfeeding does not change the risk At least three months For pregnant women with gestational diabetes, breastfeeding at least three months reduces the risk of developing Type 2 diabetes Which of these suggestions is MOST LIKELY to improve the feeding behaviors of a premature baby? Wake the baby after 2 hours of sleep because longer sleep periods can compromise nutritional status. Offer the baby a pacifier to help extend sleep periods because a pacifier is calming and soothing. Expect the baby to feed for 10-30 minutes every 1-3 hours in a pattern similar to that of term newborns. Keep the baby in prolonged skin-to-skin contact (Kangaroo Mother Care) as close to continuously as possible. Prolonged skin-to-skin contact between baby and mother (Kangaroo Mother Care) is the most important strategy for safe and effective care of preterm babies. The other choices are inappropriate. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #44. [44. Engage in a conversation with a mother of a preterm, late preterm, or low-birth-weight infant not sucking effectively at the breast, including at least 5 points.] A first-time mother at home calls you on day 5 for help with her painfully engorged breasts. Which strategy is MOST LIKELY to have prevented or avoided this situation? She should have worn a supportive bra starting on the first day after delivery. The hospital could have provided her with cold compresses to reduce swelling. She should have been given a breast pump to relieve overproduction. The baby should have been allowed to move to the breast in the first hour after birth and helped to feed effectively. The baby should have been allowed to move to the breast in the first hour after birth and helped to feed effectively. Immediate breastfeeding in the first hour followed by at least 8-12 effective feeds per day is the most effective strategy to ensure normal lactogenesis and prevention of engorgement after birth. A supportive bra may be comfortable but not relevant to engorgement. If edema does occur, cool compresses may be comforting and helpful. Pumps are appropriate only if the baby is not feeding well and mother cannot hand-express for comfort. The mother of a hospitalized baby born at 30 weeks gestation. She says her milk supply is low and she cannot keep up with the feeding demands of her infant. She is using a hand--operated single flange type of breast pump. What is the NEXT suggestion you should make? Your pump is adequate, so you are probably making all the milk you are able to make. Put your baby to the breast even more, instead of pumping. Ask for a hospital-grade electric pump. Your current pump is inadequate, so begin taking a galactagogue. Hospital-grade electric pumps are currently the best devices for compensating for a preterm infant's ineffective suck in supporting milk production. Galactogogues alone won't increase the milk supply. Adequate removal of breastmilk from the breast is key to maintaining or increasing lactation. Putting a preterm infant with a weak suck to breast more often will not extract more milk from the breast The MOST LIKELY reason a mother's nipples are cracked and bleeding on the second postpartum day is: Baby has ankyloglossia Baby is latching only onto the nipple Mother has fragile nipple skin Mother is nursing too often Baby is latching only onto the nipple Most early cracked nipples are caused by a shallow latch or latching only onto the nipple. The length and/or frequency of breastfeeds are far less important causes of nipple damage than maternal skin conditions or the baby's ability to suck correctly. Ankyloglossia (tongue-tie) is less common. Which of these is a MATERNAL risk factor associated with delayed onset of lactogenesis II (milk "coming in")? Small breasts Diabetes Teenage (20 years old) Malnourished Diabetes (gestational, Type 1 or Type 2) is a risk factor for delayed onset of lactation. Copious milk secretion may be delayed until 50-60 hours after birth instead of the typical 30- to 40-hour onset. The other choices are not accurate Why is powdered infant formula made from cow's milk especially risky for premature infants? Immune properties of lipids are neutralized during production. The powder is difficult to dissolve in clean water. Premature babies cannot digest bovine protein. Powdered formula is never sterile and cannot be made sterile. Powdered formula is not sterile and cannot be made sterile because of manufacturing processes. Infection is a significant risk. A new mother asks when her baby will likely wean from breastfeeding. Your BEST response is: You should wean at 12 months to prevent dental decay Continue to at least 24 months and as long as you and your baby desire Your baby will begin weaning at 6 months and complete weaning by one year Your baby will probably want to continue exclusive breastfeeding until 12 months, then begin weaning Continue to at least 24 months and as long as you and your baby desire There is no age beyond which breastfeeding is inappropriate. Complementary foods should begin in the second six months of life. Breastfeeding for two years or longer is globally recommended. A breastfeeding mother fractured her pelvis and right leg in a car accident, is in traction and taking pain medications. Her exclusively breastfed 3-month-old baby has never taken a bottle. The MOST helpful action to support this mother and baby is to: Get her an electric breast pump so she does not become engorged. Encourage a family member to teach the baby to take milk from a spoon or cup. Help her position the baby for nursing in a way that does not disturb her injuries. Obtain a prescription for birth control pills to dry up her milk. Help her position the baby for nursing in a way that does not disturb her injuries. The only limiting factor to breastfeeding is the mother's injuries. Compatible pain medications are available. She and her baby still need each other while she recovers. Which drug property results in MORE transfer of a drug into mother's milk? Milk-plasma ratio 1.0 Molecular weight 300 High protein binding Lipid solubility Lipid solubility facilitates transfer of drugs into mother's milk. The other factors inhibit drug transfer to milk. Which technique for helping a mother breastfeed has been found to be offensive to mothers? Placing the baby skin to skin and allowing the baby to self-latch Grasping the mother's breast and guiding it into the baby's mouth Showing the mother how to support her breast from underneath Showing a movie or video of several positions for breastfeeding Grasping the mother's breast and guiding it into the baby's mouth Mother do not like for staff members to grab their breasts or push the baby onto their breasts and may be too intimidated to express their displeasure. Demonstrating with a doll or with a video may be more helpful. Option A, self-attachment, is usually very helpful and effective. Supporting the breast from underneath with her hand may compress some surface milk ducts Which immune factor in human milk is at its highest level at postpartum day one? SIgA Cytokines Lysozyme Complement Secretory IgA in milk /colostrum is ten times higher on the first postpartum day than at any other time during lactation A breastfeeding mother is being treated for a fungal (candida) infection on her nipples. Your BEST recommendation to help resolve this infection is: Boil all baby's teething objects including this toothbrush Wash hands before and after contact with baby's mouth or diaper area Wash bras in hot water with a small amount of bleach Make sure your baby's mouth is being treated at the same time. Nipple thrush (Candida) is a contagious infection shared by skin surfaces. This baby's mouth should be treated simultaneously with the mother's nipples by a qualified provider A mother says she is enjoying breastfeeding. Your FIRST response should be: Your baby looks a bit jaundiced. Has he been to the doctor? How many times has your baby nursed in the past 24 hours? How many wet diapers have you changed so far today? Wonderful! You were ambivalent, and now you look so confident. Reinforcing the mother is the first strategy to support her decision and build confidence. After rapport is established, attending to the baby's possible jaundice and breastfeeding management questions is appropriate. A baby can't latch deeply nor continue feeding more than a few minutes. What is the FIRST action you should take to help the mother and baby? Teach her to hand-express and cup-feed her milk Give her a nipple shield. Refer the baby to a dentist to evaluate the oral structures. Carefully observe an entire feed. Always carefully observe and evaluate an entire feed before suggesting any interventions. This baby's short, tight lingual frenulum might be the cause of the inability to deeply latch or sustain a feed. The baby of a mother using a nipple shield has been feeding well for 4 days. What should you NEXT action be? Remind the mother to express or pump milk while this device is necessary. Begin cutting away the nipple shield, so the baby doesn't become dependent on it. Sterilize the nipple shield by boiling it once a day. Suggest that the baby might need the shield for a long time. When a nipple shield is being used correctly as pictured, the mother often needs to express or pump milk to support milk production. Cutting back the nipple shield can leave sharp edges and is therefore not recommended. The shield needs to be cleaned; boiling is usually not needed. The duration of use cannot be predicted Your goal is to build confidence and give support to the mother of this baby. Which statement is MOST likely to build confidence? He looks so happy when he's at your breast! At this age, your baby will soon be grasping for objects. What a good baby! You're doing a great job with him. In another month, your baby will be ready for family (solid) foods. Recognizing and affirming what is going well for the dyad is the most likely way to build confidence and support. Factual statements are less likely to build confidence. Vague or judgmental words (good baby, great job) are not supportive A woman is planning to become pregnant and concerned that her nipple size will cause difficulty with breastfeeding. Your BEST response to her is: Yes, your small nipple may be a problem. Nipples vary in size, and your nipple appears normal. Be sure to pull and roll your nipples daily Wear breast shells during your pregnancy Small nipples work just fine for breastfeeding. This woman's breast is entirely normal A mother complains of a sudden-onset raw sensation on this nipple Her infant is teething, has recently started solid foods, and is taking an antibiotic for strep throat. The MOST LIKELY cause of this sensation is: An allergic reaction to a food the baby consumed An allergic reaction to the medication being given to her infant Psoriasis that was exacerbated by the infant's saliva A bacterial infection in the crevices of the nipple tip Bacterial infection. She was diagnosed a bacterial infection of the nipple crevices, most likely streptococci transferred from the baby's mouth. Sudden-onset pain is often due to infection. Her nipple developed this configuration during pregnancy and posed no problem during breastfeeding. A and B are possibly correct, but less likely. This woman is in her third trimester of pregnancy. What is the MOST IMPORTANT action you could take to help her prepare to breastfeed? Teach her good positioning and latch-on technique, using a doll as a mode Teach her Hoffman's techniques to prepare her nipples Provide her with breast shells to wear several hours a day Instruct her to rub her nipples with a towel several times a day. Teaching her how to position her baby for breastfeeding is the most important action. Her nipples are not retracted, so B and C are incorrect. Rubbing the skin with rough fabric is inappropriate and can damage areolar structures A mother reports that her baby's doctor recommended that she give artificial baby milk after each breastfeeding to her slow-gaining nine-week-old infant. What should be your FIRST response? Discuss what formula products she might prefer. Suggest she ask what other options might be possible. Give information on how to provide supplements without compromising breastfeeding. Refer her to a breastfeeding support group When a mother is advised to follow a practice that isn't her goal, her first response should be to request other options. The lactation consultant is expected to support the mother's decisions, help her communicate her goals to the professionals, and provide relevant information to the primary care provider(s). Referring her to a support group might be useful after the immediate crisis is resolved Which reason to separate a mother and baby is justified because of the mother's condition? Mother needs to rest/sleep. Mother is obese Easier for the staff to assess mother's well-being Mother is unconscious or medically unstable Mother is unconscious or medically unstable. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #36. Name a reason to separate the baby from the mother because of the baby's condition. Baby is being treated with photo therapy. Easier for staff to examine the baby. Baby sleeps better alone Baby needs respiratory support. Baby needs respiratory support. A baby being supported by a ventilator needs professional supervision. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #36. Medical treatments are generally not a reason to separate. What is the key point to discuss with a mother before she breastfeeds her preterm infant? There is no such thing as a shallow latch for a preterm baby. A preterm baby can latch properly only after reaching a certain gestational age. A stable preterm infant demonstrates the same behaviors as a term baby. Preterm, late preterm, or some weaker infants may not initially open their mouths wide enough to latch. Preterm, late preterm or weak infants may be unable to open their mouth enough for a deep, effective latch. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #43. If a preterm, late preterm, or low-birth-weight infant is not sucking effectively at the breast, a conversation with the mother should include: Encouragement to let the baby sleep as along as the baby wants and avoid waking for feeds. A late preterm reacts exactly the same as a term infant. Encouragement to use frequent hand expression and compression of the breast. A caution that prolonged skin-to-skin contact can stress the baby Encouragement to use frequent hand expression and compression of the breast. Preterm, late preterm or low-birth-weight babies may not be able to effectively obtain milk at breast. Encourage the mother to hand-express her milk and use breast compression during feeds to assist milk transfer. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #44. Why does a mother need to be with her sick or preterm infant in the Intensive Care unit? Baby is too fragile. Reduces workload for the direct care providers. Mother brings in bacteria. Helps her baby heal and grow, and the mother can breastfeed or provide her milk Sick and preterm babies need their mothers' presence, milk, and touch even more than healthy babies. Mothers should be enabled to visit the intensive care unit as often and for as long as they want. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #45. What is unique about responsive feeding for preterm infants? Responsive feeding for preterm infants is possible only when the baby is over 36 weeks gestational age. Preterm infants do not show feeding cues so they have to be awakened at frequent intervals. Breastfeeding should be scheduled more frequently because the preterm babies have very small stomachs. Breastfeeding at the breast is guided by the infant's competence and stability rather than a certain gestational/postnatal/post menstrual age or weight. Breastfeeding at the breast is guided by the preterm infant's competence and stability rather than a certain gestational/postnatal/post menstrual age or weight. And mother has to learn discrete signs of readiness to feed. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #46. After a skilled assessment and management of breastfeeding, which of the following condition is a medical indication for supplementing the breastfed newborn? The mother feels tired because her 4-day-old baby could not sleep longer than 4 hours at night. A three-day-old baby did not have any stool for two days. His mother had bilateral nipple surgery for inverted nipples in adolescence. A mother with eczema over right breast which itches during breastfeeding. Her 7-day-old baby is gaining weight. A five-day-old baby with body weight same as birth weight, 5 heavy wet diapers per day, 4 yellow brownish stool per day. Mother has diabetes mellitus. A three-day-old baby did not have any stool for two days. His mother had bilateral nipple surgery for inverted nipples in adolescence. The baby did not have adequate intake. Mother's previous nipple surgery may damage the nerve supply and influence the milk production. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #48. Bilateral nipple surgery may have reduced milk production capacity. Which statements about giving a breastfed newborn any food or fluids other than breast milk, in the absence of medical indication is CORRECT? Formula does not change the microbiota of the baby. Giving any food or fluids other than breastmilk may interfere with the establishment of breast-milk production. It can prevent infants' dehydration, jaundice or hypoglycemia. Formula offers complete nutrition, same as breastmilk. It does no harm. Giving any food or fluids other than breastmilk may interfere with the establishment of breast-milk production. When there is no medical indication, adding any food or fluid other than breastmilk profoundly and permanently alters the baby's gut and microbiota. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #49. Fundamental principle, and BFHI Step 6. When a 2-day-old breastfed baby with cleft palate needs supplementation following poor suckling at breast even after skillful help, which of the following is the BEST CHOICE? Standard infant formula. Mother's own expressed milk. Oral glucose water. Hydrolysate infant formula. Expressed breast milk from the infant's mother is the first choice for extra feeding for the breastfed infant. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #50. Always the first choice if baby can't breastfeed directly. A breastfeeding mother is concerned about her 2-day old baby's frequent crying. She asks to get a bottle of formula so that she and her baby can have a good sleep. What is your best action after you have listened to her concerns? Explain to her the risks of introducing formula. Give her a pacifier to calm the baby. Reassure her that it's common for a baby to cry at the second night and give her a bottle so that they both can sleep for a while. Assess a breastfeed to evaluate the presence of medical indications for supplementation. First, health workers need to evaluate the breastfeeding and other relevant condition to explore the reason of baby's crying. Only after then, they can give the right timely help. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #51. What is an important element of safe cup feeding? Baby is asleep. Cup is rocked quickly back and forth to maximize baby's intake. Baby is lying supine on a flat surface. Baby should be held securely upright During safe cup feeding, the baby should be held securely upright, awake and alert, and the feed should progress at a pace comfortable for the baby. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #53. What is an UNSAFE action during cup feeding? Hold baby fairly upright for feeds. When the baby closes his/her mouth and will not take any more, stop cup feeding. Pour the milk in the baby's mouth. Ensure the baby is fully awake, alert and interested in feeding. Pouring milk into the baby's mouth may cause aspiration and does not actively involve the baby in feeding. The WHO-UNICEF Baby-Friendly Hospital Initiative Competency Verification Toolkit includes this question to verify knowledge of Performance Indicator #53. Pouring the milk into the baby's mouth can cause choking or aspiration