12: Burns Chapter 11 & Thureen Chapter 8 Flashcards
What are the breastfeeding recommendations
Exclusive breastfeeding for 6 mo, then combined with other nutrients for at least the first year.
Healthy people 2020 initiative: increase education and support
What is Hospital-Based Support?
The baby-friendly hospital initiative:
10 criteria every facility must meet to be baby-friendly.
Educate all staff on breastfeeding
What are the benefits of breastfeeding?
As the infant grows and develops the properties of the breastmilk changes to fit the needs of the infant
Provides the best nutrition possible for infants
Lowers risk of gastroenteritis, necrotizing enterocolitis, acute OM, severe lower respiratory tract infections, asthma, atopic dermatitis, DM Type 1 & 2, obesity, SIDS, and childhood leukemia, allergic diseases
Reduces fever after immunization
Lowers rates of atopic disease - asthma
Lower cholesterol in adult
Need to add complementary foods by 6 months to reduce risk of allergens
Enhances bonding
Enhances cognitive development
Contraindications to breastfeeding
Herpetic lesions on the mother’s nipples, areolas, or breast
Maternal diagnosis and treatment of cancer
Maternal HIV
Infant with Galactosemia
Significant maternal or infant illness affecting the ability to feed
Maternal illness, such as TB, chickenpox, or Hep B
Invasive breast surgery
Documented hx of milk supple problems
Colostrum: When does production begin? Composition? Benefits?
Production begins at 20 weeks gestation - Pregnancy woman may notice small amount of yellow discharge
Thick, rich, and yellow has fewer calories than mature milk
Immunoglobulins (IgA) and other antibodies
Higher in: Na, Cl, protein, fat-soluble vitamins, and cholesterol
Facilitates passage of meconium
Often referred to as the infants “first immunization”
Transitional Milk: When does production begin? Composition?
Appears several days after delivery
Has more lactose, calories, and fat and less total protein than colostrum
Mature milk: When does production begin?
Composition?
Replaces transition milk by week 2
Water
Lipids-fat content is higher at the end of feedings (hindmilk) than at the beginning (foremilk)
Various lipids
Cholesterol
Fatty acids (DHA) - may play a role in brain and retinal growth, beneficial effect on neurobehavior functioning
Protein
Carbohydrates - Primary carb is Lactoase
Vitamins and Minerals - except Vitamin D - must supplement about 400 IU/day or sun exposure
Anatomy and Physiology of Milk Production
By 20 weeks OB mammary glands are capable for milk production
Breast Milk production is signaled by the fall of progesterone. Suckling stimulates the hypothalamus to decrease prolactin-INHibiting factors to permit prolactin by the anterior pituitary which leads to a rise in the level of prolactin. Suckling by the infant is essential to establish and maintain lactation by increasing prolactin levels. The hypothalamus also stimulates the synthesis and release of oxytocin by the posterior pituitary to cause “letdown reflex”.
Amount of milk production depends on stimulation of the breast - “supply and demand”
Assessment of the Breastfeeding Dyad
Maternal History - breast feeding hx, culture, expectations, drug use
Infant History - Health status, congenital conditions, trauma, complications, medications, gestational age, how is feeding going?
Maternal Examinations -Type of nipples, Presence of surgical scars, nipple bruising or bleeding
Infant Examination - oral motor skills
Maternal History
Overall health previous breastfeeding experience cultural expectations, routine use of medications/etoh/drugs/ect, surgical interventions nutritional status family and community support pregnancy history L & D history
Infant History
Overall health Congenital conditions Trauma or complications during delivery medications received during labor activities or procedures (circumcision, bili lights, tube feedings) gestational age early responses to feeding attempts
Maternal Examinations
Types of nipples
Presence of surgical scars on the breast or thoracic area
Any nipple bruising or bleeding
Infant Examination
Evaluate oral-motor skills and structures
Principle of correct positioning
good body position
Audible “glug” or swallow from the infant
Positions for breastfeeding
Cradle position
Side-lying position
Football hold
How long should an infant breast feed on each nipple?
Encourage infant to go to each breast for 10-15 minutes up to 20-30 min
After the first 24 hours how often should the mother breastfeed
8-12 times or every 2-3 hours a day
*Be aware of the infant that goes 4 hours between feedings and falls asleep in 5 minutes at the breast, these infants need to be woken up to feed
Urine output Guidelines
In first 24 hours infant may only urinate 1-3 times
By day 3: 4 wet diapers
By day 4: 4-6 wet diapers
Eventually: 6-8 wet diapers
Stool Output Guidelines
First 24 hours: one meconium followed by another the second day.
Day 3: transition stools - loose, yellow, seedy
How often should a mother pump?
Pump 6-8 times in 24 hours for 15 min on a double pump, or 10 min per breast on a single pump set up
What are collection and storage of breastmilk?
Clean pump parts after each use
Milk defrosted, but not used within 24 hours needs to be thrown away
Pump milk can be stored in the fridge for 8 days or a “blue ice” cooler for 24 hours
Refrigerator freezer - 3 months
Deep Freeze - 12 months
Infant Weight Gain:
What is an acceptable percentage weight loss in first few days?
Normal to lose 5-8% of BW in first few days
How much weight should an infant gain per day?
0.5-1 oz per day, or 4-7 oz per week
When should the infant’s weight be back to birth weight?
2 weeks
When is an infant considered Failure to Thrive?
3 Week
What should an infant’s weight be by 6 months and 1 year?
The infant’s weight should be double the infants birth weight by 6 months and triple the infant’s body weight by 1 year
What are the characteristics of a healthy breastfed infant:
active and alert state
Developmentally appropriate progress
Age appropriate height and head circumference
Good skin turgor and color
Sufficient output of at least 6 wet diapers a day
Content and satisfied behavior after feeding