2
Breastfeeding
Residency Curriculum
American Academy of Pediatrics
4) When positioning a newborn to breastfeed, all of the following are correct EXCEPT:
a) After a cesarean section delivery, the side-lying or football hold (clutch) positions are most comfortable for
mother.
b) When using the cradle hold, the infant should be placed in a supine position across the mother’s lap, with the
infant’s neck extended and rotated to latch on to the nipple.
c) The mother needs to be sitting or lying in a comfortable position without excessive strain on her shoulders,
arms, or back.
d) The cross-cradle, or transitional, hold usually works well for most breastfeeding infant and mother when
learning to breastfeed.
e) Alternating or rotating 2 or more breastfeeding positions may help to prevent nipple discomfort in the early
days after delivery.
ANSWER: b. In any hold or position the infant’s head, shoulders, and hips should be in alignment with the infant
chest-to-chest or tummy-to-tummy facing the mother. If the head is turned, the infant will not be able to swallow, and
will be pulling at the mother’s breast and nipple to pull it into alignment, causing poor milk transfer and sore nipples.
5) The mother of a breastfed infant is going to have surgery (not involving the breast) requiring general anaesthesia
and an overnight hospital stay. How soon after surgery can she resume breastfeeding?
a) 6 hours
b) 12–24 hours
c) 48 hours
d) 1 week
e) When she is fully awake and able to care for herself
ANSWER: e. General anesthetics are relatively short acting, and the mother can usually resume breastfeeding as soon
as she is fully awake and able to care for herself. Many anaesthesiologists conservatively recommend pumping and
dumping for 12–24 hours, but this is not strictly necessary.
6) Although some older studies found a correlation between breastfeeding and higher intelligence, more recent
studies, which controlled or adjusted for maternal education, socio-economic status, and related factors have:
a) Found no correlation between IQ and breastfeeding duration in full-term infants
b) Found no correlation between IQ and breast milk intake in preterm infants
c) Found a small, but statistically significant, increase in IQ and academic performance in breastfed or breast milk-
fed infants
d) Found breastfed infants have a 13–15 IQ point advantage over artificially fed infants
ANSWER: c. Although controlling for confounding factors in families is extremely difficult, recent studies and a meta-
analysis have concluded that breastfed infants have a small, but statistically significant improvement in intellectual
function, with preterm infants benefiting the most.
7) The primary hormone responsible for milk synthesis is:
a) Estrogen
b) Prolactin
c) Progesterone
d) Oxytocin
ANSWER: b. Prolactin is secreted by the anterior pituitary and travels via the bloodstream to stimulate the mammary
alveolar cells to produce milk.