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Breastfeeding Support and Promotion

Message from the Secretary, U.S. Department of Health and Human Services

1. ____ percent of all newborns in America now begin their lives breastfeeding, and breastfeeding has regained its rightful place in our nation as the norm.

A. 55

B. 65

C. 75

D. 85


2. An Agency for Healthcare Research and Quality (AHRQ) report shows the health risks associated with formula feeding and early weaning from breastfeeding include all of the following EXCEPT:

A. Diarrhea

B. Ear infections

C. Leukemia

D. Diaper rash


3. The risk of hospitalization for lower respiratory tract disease in the first year of life is more than 250 percent higher among babies who are formula fed than in those who are exclusively breastfed for at least four months.

A. True

B. False


Environmental Effects

4. Although breastfeeding requires mothers to consume a small amount of additional calories, it generally requires no containers, no paper, no fuel to prepare, and no transportation to deliver, and it reduces the carbon footprint by saving precious global resources and energy.

A. True

B. False


Endorsement of Breastfeeding as the Best Nutrition for Infants

5. Which of the following is NOT one of the organizations that has recommended breastfeeding:

A. American Academy of Pediatrics (AAP)

B. American Academy of Family Physicians

C. American Association of Breastfeeding Advocates

D. American Dietetic Association


Rates of Breastfeeding

6. National objectives for Healthy People 2010 called for 75 percent of mothers to initiate breastfeeding, 50 percent to continue breastfeeding for three months and 25 percent to continue breastfeeding for six months.

A. True

B. False


Disparities in Breastfeeding Practices

7. Breastfeeding rates for black infants are about ___ percent lower than those for white infants at birth, age six months, and age 12 months, even when controlling for the family's income or educational level.

A. 50

B. 25

C. 40

D. 35


8. Many people, including health professionals, are under the incorrect assumption that because commercially prepared formula has been enhanced in recent years, infant formula is equivalent to breast milk in terms of its health benefits.

A. True

B. False


Lactation Problems

9. Frequently cited problems with breastfeeding include all of the following EXCEPT:

A. Sore Nipples

B. Fatigue

C. Engorged breasts

D. Pain


Employment and Child Care

10. Which of the following is NOT a significant barrier to breastfeeding for the working mom?

A. Inflexibility in work hours and locations

B. Lack of privacy for breastfeeding or expressing milk

C. Lack of maternity leave

D. Insecurity about overexposure in the workplace


11. In a survey of 712 mothers, participants reported that each week of maternity leave increased the duration of breastfeeding by at least one week.

A. True

B. False


12. Separating mothers from their babies during their hospital stay has a negative impact on the initiation and duration of breastfeeding, and yet one study reported that only ___ percent of U.S. hospitals and birth centers allowed newborns to stay in the same room as their mothers.

A. 54

B. 57

C. 61

D. 64


13. Cesarean delivery is associated with delayed skin-to-skin contact between mother and baby, increased supplemental feeding, and separation of mother and baby, all of which lead to suboptimal breastfeeding practices.

A. True

B. False


Breastfeeding from the Public Health Perspective: Mothers and Their Families

14. In 2009, half of all mothers with children under the age of one year were employed, which could impact breastfeeding rates.

A. True

B. False


15. The American Medical Association (AMA) uses a social marketing approach to encourage and support breastfeeding that began with the campaign Loving Support Makes Breastfeeding Work.

A. True

B. False


16. Peer counselors may be effective in breastfeeding success in part because they are seen as role models and also because they often provide:

A. Coaching during childbirth

B. Counseling for mothers having emotional issues

C. Assistance through phone calls or home visits

D. None of the above


17. The WHO International Code of Marketing of Breast-milk Substitutes declares that substitutes for breast milk should not be marketed in ways that can interfere with breastfeeding.

A. True

B. False


18. The promotion and support for breastfeeding is highly recommended throughout the encounters women have with health professionals during prenatal and postpartum care, and as a result most clinicians are adequately prepared to support mothers who wish to breastfeed.

A. True

B. False


19. All of the following are examples of barriers to breastfeeding newborns EXCEPT:

A. Non-private hospital rooms

B. Placement of stable, healthy full-term newborn on infant warmer immediately upon delivery

C. Provision of infant formula or water without medical indication

D. Removal of newborn from mother's room at night


20. The Baby-Friendly Hospital Initiative, established by WHO and UNICEF, includes a set of maternity care practices known as the Twelve Steps to Successful Breastfeeding, that, when implemented together, result in better breastfeeding outcomes.

A. True

B. False


21. Which of the following is NOT one of the practices of the Baby-Friendly Hospital Initiative?

A. Have a written breastfeeding policy that is routinely communicated to all health care staff

B. Inform all pregnant women about the benefits and management of breastfeeding

C. Help mothers initiate breastfeeding within two hours of birth

D. Give newborn infants no food or drink other than breastmillk, unless medically indicated


22. Baby-Friendly hospitals do not allow pacifiers or artificial nipples for breastfeeding infants.

A. True

B. False


23. In 2006, an estimated ____ percent of all U.S. births were preterm (less than 37 completed weeks of gestation), and ____ percent of infants had a low birth weight (less than 2,500 grams).

A. 9; 9.2

B. 7; 10.1

C. 5; 7.2

D. 12.8; 8.3


24. Which of the following is NOT an accurate statement about NEC (necrotizing enterocolitis)?

A. Formula feeding is a risk factor

B. About 20% of preterm infants weighing less than 2500 grams will suffer from NEC infection

C. Hospitalization for all surgical NEC averages 62 days and $300,000 per patient

D. NEC treatment accounts for 19% of all newborn health care costs


25. Breast milk is a means of viral transmission, and thus it is essential that donors are screened for significant viral diseases, such as:

A. HIV

B. Human T-cell leukemia virus

C. Hepatitis C

D. All of the above


26. Although heat treatment can destroy most infectious pathogens in milk, excessive heat will destroy some of the nutritional components of the milk as well.

A. True

B. False


27. The skin-to-skin closeness that occurs during breastfeeding promotes bonding and attachment between mother and infant, increases the efficiency of breastfeeding, and enhances the neurological and _________ development of the infant.

A. Physical

B. Interpersonal

C. Psychosocial

D. Behavioral


28. Currently, among 173 countries, only four are without a national policy requiring paid maternity leave. These countries include all of the following EXCEPT:

A. Swaziland

B. Russia

C. Papua New Guinea

D. United States


29. The 2010 Affordable Care Act included a provision requiring employers to a provide reasonable, though unpaid, break time for a mother to express milk and a place, other than a restroom, that is private and clean where she can express her milk.

A. True

B. False


30. The 2005-2007 Infant Feeding Practices Study II found that among mothers who worked and breastfed, 28 percent kept the infant at work and breastfed during the workday, 17 percent went to the infant to breastfeed, and 5 percent had the baby brought to them at the work site in order to breastfeed.

A. True

B. False


31. Because of ethical considerations, research on the health outcomes of different modes of infant feeding is limited to randomized controlled studies, the results of which can only provide inferences on the association between feeding type and outcomes.

A. True

B. False


32. The USDA operates the WIC program, which serves more than ____ of the infants born in the United States.

A. 30%

B. 40%

C. 50%

D. 60%


33. Forty-seven states have now formed breastfeeding coalitions, and there are many local, tribal, and territorial coalitions as well.

A. True

B. False


Action 4: Use Community-Based Organizations to Promote and Support Breastfeeding

34. Difficulties with breastfeeding can occur at any time of the day or night, so mothers are encouraged to use _________ to provide needed assistance.

A. Telephone triage

B. Hotlines

C. Online networks

D. All of the above


Action 5: Create a National Campaign to Promote Breastfeeding

35. Social marketing, which engages members of the community with each other, is a promising way of ensuring that new generations understand the value of breastfeeding and can make well-informed decisions about infant feeding.

A. True

B. False


Action 7: Ensure that Maternity Care Practices Throughout the United States are Fully Supportive of Breastfeeding

36. Maternity care practices often reflect clinicians' personal experiences with breastfeeding and may be based on misinformation that interferes with successful breastfeeding.

A. True

B. False


Action 10. Include Basic Support for Breastfeeding as a Standard of Care

37. International Board Certified Lactation Consultants carry certification by the International Board of Lactation Consultant Examiners (IBLCE) and are the only health care professionals certified in lactation management.

A. True

B. False


Action 13: Work Toward Establishing Paid Maternity Leave for all Employed Mothers

38. The International Labor Organization, an arm of the United Nations, recommends a paid maternity leave of 12 weeks and also recommends that employers not be solely responsible for funding maternity leave, as this could create a disincentive to hire women.

A. True

B. False


Action 15: Expand the Use of Programs in the Workplace

39. Providing reasonable break times during the workday is the most effective strategy of combining employment and breastfeeding because it allows for the increased duration and intensity of breastfeeding.

A. True

B. False


Action 19: Develop a National Monitoring System to Improve the Tracking of Breastfeeding Rates

40. Although the Centers for Disease Control and Prevention (CDC) tracks breastfeeding rates, few systems exist to track changes in breastfeeding behavior and attitudes.

A. True

B. False


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