breastfeeding

montgomery glands- olfactory stimulus for newborn appetite.

BM production Factors: PROLACTIN, OXYTOCIN, FEEDBACK INHIBITOR OF LACTATION
Prolactin Reflex - Secreted during and after fed to produce next feed
OXYTOCIN REFLEX - milk ejection reflex or let down, Works before or during a feed to make milk flow
FEEDBACK INHIBITOR OF LACTATION (FIL) - amount of milk depends on how much is removed
SIGNS OF GOOD ATTACHMENT
> NIPPLE AND AREOLA ARE STRETCHED OUT TO FORM A LONG TEAT.
> LARGE DUCTS ARE INSIDE THE BABY’S MOUTH.
> BABY’S TONGUE REACHES LOWER gum and under the areola
> TIP OF NIPPLE REACHES HARD PALATE.
Correct - The tongue is under the AREOLA, with the tip of the nipple touching THE HARD PALATE.
Rooting Reflex - When something touches lips, baby opens mouth, puts tongue down and forward
Sucking Reflex - When something touches palate, baby sucks
Swallowing Reflex - When mouth fills with milk, baby swallows
Cradle Hold - most popular way to hold baby
Feeding – 1-3 hrs/ day, 8-12 times in 24 hrs
Breast care – water only

Disease Prevention
Obesity -Exclusive breastfeeding for at least 6 mos
Allergies - Exclusive breastfeeding for at least 4 mos
Diabetes - Exclusive breastfeeding for at least 4 mos,dlay introduction of cow’s milk until 4 mos
Colostrum – high protein, low fat, ig components, high fat soluble vit
Transitional milk – 10 days – 2 weeks, more fat and lactose
Breast milk – water>cho>fat>protein
Oligosaccharides – immune booster – MAIN energy sourc of bifido and lactobacilli
Lactoferrin – iron absorption
Beta casein – calcium absorption
Anti infectivs – lysozime, lactoferrin, ig’s, IGA
Haptocorin – vit b12 binding

Complimentary feeding
6 months
600 kcal – 6-8 months
700 kcal – 9-11
900 kcal – 12-24
4-5 times per day plus 1-2 snacks
Gynecology

Vulvovaginitis – mc gyne problem

Gardnella – mc vulvovaginitis

Candida – diaper rash

Enterobiasis – perineal pruritus, GI symptoms – mebendazole

Giardiasis – discharge, diarrhea, malabsorption

Molluscum contagiosum – MC virus, vulvar lesions, nodules in umbilical, curdlike material, tx- curettage

Ptherus pubis – pruritus, excoriation, skyblue macules, lower abdomen, tx- lindane

Scabies – nocturnal pruritus, vescles, pustules, tx- lindane 1%

Shigellosis – fever, malaise, fecal contamination, cramps, tx: tetra, ampi

Staph,strep – vaginal discharge

Hpv – genital warts

Clitoral synechiae – pruritus, eryhtema, pain, tx- estrogen cream

Labial adhesions – topical estrogen cream, zinc oxide, mechanical

Foreignbody– bleeding, foul, MC- toilet paper

Genital trauma – hematoma, tx – ice packs, pressure

PCOS- infetility, type 2 DM, CV; criteria – oligomenorrhea,hyperandrogensm, multiple follicles

Teratoma- mc neoplasm in adult, adenoma – 2nd

Embryonal CA – highly malignant –HCG,AFP

Endodermal sinus tumor – most lethal, radiosensitive

Granulosa tumor – MC of sex-cord stromal tumors

Imperforate hymen – primary amenorrhea, normal 2ndry sexual char, tx – surgical

Mayer rokitansky kuster hauser syndrome – absenc of vagina, tx – delayed until ready to churva