3.2 Nutrition - breastfeeding part 5

Question 1

What is nipple preference

aka nipple confusion

Answer 1

occurs when an infant is accustomed to nursing from a bottle and is introduced
to the breast but have trouble because of the different sucking pattern needed

Different oral-motor skills are used in breastfeeding

and bottle feeding, and infants who have been given a bottle or pac-
ifier sometimes attempt to breastfeed using the same sucking pat-
tern as with a bottle. This can make it difficult to obtain adequate

nourishment and may contribute to maternal sore nipples.

Question 2

What are other reasons an infant may have difficulty feeding

3

Answer 2

• thrush
• colic
• reflux

Question 3

How can you prevent nipple preference

Answer 3

• avoid all rubber bottle nipples and pacificers for first 4-6 weeks until breastfeeding well

The following are complications of ongoing nipple preference: failure to thrive, hyperbilirubinemia, colic and crying, prolonged feedings, sore and cracked nipples, plugged ducts, mastitis, and frustration.

Question 4

What is breast milk jaundice

Answer 4

physiologic jaundice caused by elevated indirect bilirubin concentration

Question 5

When does serum indirect bilirubin concentration peak when breastfeeding

Answer 5

after first week of life

The exact cause of breast milk
jaundice is unknown; however, it is believed that an enzyme may be
present in some mothers’ milk that inhibits the action of glucuronyl

transferase in the newborn, an enzyme which causes intestinal reab-
sorption of bilirubin.

Question 6

What is breast milk jaundice vs breastfeeding jaundice

Answer 6

breast milk- occurs in infants with adequate breastmilk intake

breast feeding jaundice- occurs at day 2-7 of life- associated with low intake of breast milk

Question 7

What does an infant present looking with with breast milk jaundice

Answer 7

• healthy, thriving
• adequate output
• good weight gain
• yellow green hue to skin

can persist into first few months of life

Question 8

What inital screening can be done to detect breast milk jaundice

Answer 8

transcutaneous bilirubin measurement

Question 9

What is the differential for breast milk jaundice

Answer 9

pathologic jaundice

Question 10

Should infants with breast milk jaundice stop breastfeeding

Answer 10

no- keep feeding

Question 11

FYI

Factors for poor weight gain in infants:

Answer 11

Ineffective latch-on or sucking
* Short time at the breast (the infant is removed before nursing
is finished, thus reducing access to lipid dense milk and total consumption)
* Infant kept on a preset schedule despite cues for more feeding
* Infant given water between feedings to “get through” to the next feeding
* Infant encouraged or allowed to sleep through the night before 8 to 12 weeks old
* Fewer than eight feedings in 24 hours
* Infant fed in a distracting environment
* Infant in a day care setting that does not facilitate breastfeeding
Maternal Factors
* Does not initially respond to infant’s cues for feeding or does not recognize that waking is needed to establish feeding
* Hectic schedule with limited time for breastfeeding
* Recent illness or significant weight loss
* Uses oral contraceptives or other hormones that decrease production of breast milk.

Women wishing to use hormonal contraceptives that contain estrogen should wait until 6 months after birth when breast milk supply is well established and the infant is beginning to consume solids.

management:

• Be alert for any infant who has lost too much weight and is unable to feed with vigor at the breast; such infants require an immediate infusion of calories for energy
• Use a supplemental system at the breast if supplementation with expressed breast milk or formula is required