Chapter 16: Breastfeeding

Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition

MULTIPLE CHOICE

1. The primary care pediatric nurse practitioner performs a well child assessment on a 6-month-
old infant whose mother reports having less breast milk because of stressors associated with
pumping and returning to work. The nurse practitioner will provide resources to promote
pumping and what other intervention?
a. Discussing adding other foods to the baby’s diet.
b. Encouraging the mother to increase her fluid intake.
c. Prescribing a multivitamin containing iron.
d. Suggesting offering only breast milk to the infant.
ANS: A
After 6 months, infants should continue to breastfeed while taking other nutrients, at least up
to 1 year of age. The mother should be encouraged to continue breastfeeding while adding
other nutrients. The mother has successfully breastfed up to this point and increasing fluids is
not the source of the problem.

2. The mother of a newborn asks the primary care pediatric nurse practitioner about the benefits
of breastfeeding. What will the nurse practitioner tell her?
a. Breastfeeding for 9 months or longer will reduce the incidence of food allergies.
b. Breast milk is an excellent source of vitamin D, iron, and other essential nutrients
for the baby.
c. Nursing her baby exclusively for at least 4 months will help her infant to resist
infections.
d. There is a decreased risk of atopic dermatitis in babies who nurse for 12 months or
longer.
ANS: C
There is evidence that infants who exclusively breastfeed for at least 4 months have less risk
for infection than infants breastfed for less time. However, infants who breastfeed exclusively
for 9 months or for longer than 12 months may have increased risks for food hypersensitivities
and atopic dermatitis. Breast milk is a poor source of vitamin D and iron.

3. The primary care pediatric nurse practitioner learns that the mother of a newborn infant is
being tested for tuberculosis after a positive TB skin test. What will the nurse practitioner tell
the mother who states a desire to breastfeed her baby?
a. Breast milk is contraindicated if the mother has tuberculosis.
b. She may continue to nurse her baby since the risk of transmission is low.
c. That she can express breast milk and feed that to her infant.
d. To give formula until results of tuberculosis testing are known.
ANS: C
A maternal diagnosis of active, untreated TB is a contraindication to nursing, but expressed
breast milk may be fed to the infant. The mother may feed expressed breast milk; the milk
itself is not contraindicated. Until active TB is ruled out, the mother should not breastfeed her
infant. It is not necessary to feed formula if the mother can provide expressed breast milk.
4. The primary care pediatric nurse practitioner sees a 3-day-old nursing infant whose newborn
metabolic screen is positive for galactosemia. The nurse practitioner refers the newborn to a
specialist for immediate evaluation and will tell the mother to do what?
a. Continue to breastfeed her infant.
b. Give the infant a cow’s milk formula.
c. Supplement breast milk with formula.
d. Stop breastfeeding immediately.
ANS: D
Infants with galactosemia cannot consume galactose, which is in both cow’s milk and breast
milk. Since there is a potential for a life-threatening response, the mother should be instructed
to stop nursing immediately.

5. The mother of a nursing infant expresses concern about whether high-cholesterol foods will
increase her infant’s risk of hyperlipidemia. What will the primary care pediatric nurse
practitioner tell her?
a. Breastfed infants have lower serum cholesterol levels than those who are not
breastfed.
b. Maternal cholesterol levels affect the cardiovascular risk of breastfed babies.
c. Maternal dietary cholesterol intake does not affect the infant’s serum cholesterol
values.
d. She should limit her dietary cholesterol to prevent hyperlipidemia in her infant.
ANS: C
Changes in the maternal diet do not produce changes in cholesterol values in infants.
Breastfed infants tend to have higher cholesterol levels than other infants, but cholesterol is
necessary for brain and retinal development.

6. The primary care pediatric nurse practitioner is counseling the mother of a newborn about
breastfeeding her infant. Which supplements will the nurse practitioner recommend?
a. Fat-soluble vitamins
b. Iron
c. Multivitamins with iron
d. Vitamin D
ANS: D
The level of vitamin D in breast milk may not be adequate for breastfed infants, so it should
be given as a supplement. Human milk has more than adequate amounts of other vitamins.
Iron is not present, but this is generally added at 6 months of age, when solid foods are added
to the diet.

7. The primary care pediatric nurse practitioner is examining a newborn who is breastfeeding
and notes the presence of an ankyloglossia. What will the nurse practitioner do next?
a. Ask the mother if the infant has any feeding difficulties.
b. Refer the infant for a possible frenulectomy.
c. Schedule an appointment with a lactation consultant.
d. Suggest that the mother feed breast milk by bottle.
ANS: A
 Infants with ankyloglossia may have difficulty feeding if the tongue does not extend well. The
PNP should first assess feeding difficulties and then may refer for a lactation consultant or
consider a frenulectomy.

8. The primary care pediatric nurse practitioner performs an initial well baby exam on a 1-week-
old infant who is breastfeeding and who is at birth weight. The mother tells the nurse
practitioner that her baby is already sleeping 5 or 6 hours at night. What will the nurse
practitioner recommend?
a. Consultation with a lactation specialist to assess intake
b. Pumping her breast during the night to maintain milk supply
c. Supplementing the last feeding of the day with formula
d. Waking the infant up at least every 3 hours to nurse
ANS: D
Newborn infants should nurse every 2 to 3 hours in order to establish a routine and stimulate
milk supply. The infant has regained birth weight, which is expected by age 2 weeks, so
weight is not a concern and a lactation consultation is not warranted. The infant should
continue to nurse during the night, so there is no need for the mother to pump her breasts or to
supplement with formula. Using formula from a bottle also causes nipple confusion and
should be avoided.

9. The mother of a newborn infant asks the primary care pediatric nurse practitioner about
pumping her breasts when she returns to work in 2 months. What will the nurse practitioner
include in teaching this mother?
a. Frozen breast milk may be stored up to 3 months in a 0° F freezer.
b. Once she begins pumping the infant should drink only pumped breast milk.
c. Pumped breast milk must be discarded after 3 days when stored in the refrigerator.
d. Unused defrosted breast milk may be stored in the refrigerator for 48 hours.
ANS: A
Frozen breast milk may be stored up to 3 months in a well-regulated freezer. It is not
necessary to use only pumped breast milk once this begins. Refrigerated breast milk may be
stored up to 8 days. Once frozen breast milk is thawed it should be used within 24 hours.

10. The mother of a 2-month-old infant tells the primary care pediatric nurse practitioner that she
is afraid her breast milk is “drying up” because her baby never seems satisfied and wants to
nurse all the time. Which action is correct?
a. Recommend pumping her breasts after feedings.
b. Refer the mother to a lactation consultant.
c. Suggest supplementation with formula.
d. Weigh the infant to assess for a growth spurt.
ANS: D
Infants have growth spurts about every 3 to 4 weeks that increase their breast milk needs.
Until the mother’s milk supply catches up, the infant will act hungry and want to nurse more
frequently. The PNP should evaluate for this growth spurt and then instruct the mother to feed
her baby more often to increase her milk supply. Since the infant is hungry, the infant should
nurse. It is not necessary to refer for a lactation consultation or to supplement with formula.
11. The mother of a 15-month-old infant tells the primary care pediatric nurse practitioner that she
wishes to continue nursing her child for another year, if possible. What will the nurse
practitioner recommend?
a. Breastfeed only at bedtime to establish meal patterns.
b. Clean the toddler’s teeth after each breastfeeding.
c. Offer the breast just prior to meals to maintain milk supply.
d. The toddler should continue to be breastfed “on demand.”
ANS: B
One drawback to breastfeeding toddlers is the effect of prolonged contact with lactose on the
teeth. Mothers should be cautioned to consult with a dentist and to clean the toddler’s teeth.
The mother may choose when and how often to breastfeed but should not allow “on demand”
feedings. The breast should be offered after meals.

12. The primary care pediatric nurse practitioner is performing an assessment on a 1-week-old
newborn with a slightly elevated bilirubin who is breastfeeding well and who has gained 30
grams in the past 24 hours. The infant is stooling and voiding well. The nurse practitioner
suspects breast milk jaundice. Which action is correct?
a. Order home phototherapy and closely monitor bilirubin levels.
b. Reassure the mother that the bilirubin level will drop in a few days.
c. Recheck the serum bilirubin and infant’s weight in 24 hours.
d. Recommend that the mother pump her breast milk for a couple of days.
ANS: C
Infants with breast milk jaundice who are gaining weight and thriving should continue to
breastfeed and be monitored for the development of pathologic jaundice. It is not necessary to
order phototherapy or discontinue breastfeeding unless pathologic jaundice is present. The
bilirubin may remain elevated up to 3 months.