ch. 25 newborn nutrition and feeding

Question 1

healthy people 2030

Answer 1

1) increase # women who take 400mg folic acid
2) increase # breastfed babies
3) increase # babies who are ever breastfed (81.9%)
4) increase # babies breastfed at 6 months (60.6%)
5) increase # of babies breastfed at 1 year (34.1%)
6) increase # employers with lactation support programs

Question 2

recommended infant nutrition

Answer 2

1) human milk provides the best nutrition for infants

2) GOLD STANDARD: human milk

3) AAP/WHO: recommended exclusive breastfeeding of human milk for first 6 months of life
- CONTINUE breastfeeding as complementary foods are introduced at about 6 months
- continuing breastfeeding as long as mutually desired by the mother/child (until child is 2 years)

4) dietary guidelines: infants are fed human milk exclusively for the first 6 months; continue to receive human milk for at least the first year and longer as desired

Question 3

breastfeeding rates

Answer 3

despite increases in national breastfeeding rates, ongoing disparities exist

1) lowest breastfeeding rates among:
- non-hispanic blank infants
- lower income families
- families living in rural areas
- ex: lack role models, education, support, access to breast pump, income

Question 4

benefits of breastfeeding

Answer 4

1) extensive evidence exists concerning the health benefits of breastfeeding and human milk for infants, with some of the benefits extending into adulthood

2) reduced risk:
- variety of cancers for mothers (breast cancer, cervical, thyroid cancer)
- SIDs, infant/child mortality, variety of childhood diseases
- enhanced bonding and attachment
- convenience
- economic benefits
- environmental benefits (waste reduction)

Question 5

infant feeding decision making

Answer 5

1) the decision making about breastfeeding
- demographics (age, ethnicity, socioeconomic status, education)
- cultural beliefs and practices
- awareness of benefits of breastfeeding/human milk
- support of father and family
- variety of personal, economic, and other factors

2) obstacles to breastfeeding
- employment and the need to return to work after bith
- access to breast pumps, pumping facilities, and time for pumping
- awareness of the availability of breastfeeding resources
- widespread marketing by infant formula companies
- lack of prenatal breastfeeding education
- insufficient training and education of health care professionals about breastfeeding

Question 6

contraindications to breastfeeding

Answer 6

1) newborns with galactosemia (glucose + galactose)
2) mothers who are positive for human T cell lymphotropic virus types 1/2
3) mothers with untreated brucellosis
4) mothers with active tb
5) mothers with active herpes simplex lesions on the breasts
6) mothers with HIV infection
- considered contraindicated in the US
- in developing countries where HIV is prevalent, the benefits of breastfeeding for infants outweigh the risk of contracting HIV from infected mothers

Question 7

cultural influences on infant feeding

Answer 7

1) breastfeeding beliefs and practices vary across cultures; this requires that nurses are knowledgeable and sensitive to the cultural factors influencing infant feeding practices (cultural humility)
- islam and breastfeeding
- beliefs about colostrum on various cultures
- hispanic practices las dos cosas
- other specific beliefs and practices

Question 8

nutritional needs of the infant

Answer 8

1) fluids:
- day 1/2: 60-80 mL/kg/day
- day 10: 10 mL/kg/day
- infants should be monitored closely for fluid intake and water loss (breast milk is 8-% water, infants have low ability to regulate water)

2) energy:
- fluctuates

3) carbohydrates:
- first 6 months of life is 60g/DAY
- second 6 months of life is 95 g/DAY

4) fats:
- major energy source for infants, supplying as much as 50% of the calories in human milk and formula

6) protein:
- 9.1g/DAY

7) vitamins:
- with the exception of vitamin D (400mg)
- human milk contains all the vitamins required for infant nutrition
- vitamin K (SHOT -> produced in the intestines)

8) minerals:
- no sub. for formula/milk
- Ca/Phos (2:1): used for bone growth ( NOT present in milk)

Question 9

AP of lactation: anatomy of lactating breast

Answer 9

• 15-20 segments (lobes)
• alveoli: milk producing cells within lobes
• myoepithelial cells: contract to send milk to ductules
• complex, intertwining network of milk duct that transports milk from alveoli to nipple
• the size and shape of the breast are NOT accurate indictors of its ability to produce milk

Question 10

AP of lactation: lactogenesis

Answer 10

1) prolactin:
- anterior pituitary gland
- prepares the breasts during pregnancy to secrete milk and during lactation to synthesize and secrete milk
- supple meets demand system
- baby sucks on breast to stimulate brain to release prolactin

2) oxytocin:
- posterior pituitary gland
- milk ejection reflex (MER): let down reflex
- same hormone that stimulates uterine contractions during labor (to bring cervix back down to normal size - review)
- mothers who breastfeed are at decreased risk for postpartum hemorrhage

3) nipple erection reflex
- baby suckles -> help to push milk -> nipple

Question 11

protein

Answer 11

1) human milk composition
- casein and whey proteins (increased iron absorption)

2) whey predominant protein in human milk
- 60:40 whey/casein ratio
- easily digested
- more frequently feedings (Q3H)

3) casein predominant in cow milk
- 20:80 whey/casein ratio (60:40 human)
- less easily digested, forms curds

4) cow’s milk based formulas modified
- 48:52 whey/casein ratio

Question 12

AP lactation: uniqueness of human milk

Answer 12

1) human milk is the ideal food for human infant

2) contains many immunologically active, protective components:
- main immunoglobulins: IgA, IgG, IgM, IgD

3) colostrum: more concentrated than mature milk and extremely rich in immunoglobulins
- higher concentrations of protein and minerals but less fat than mature milk

4) breast milk promotes colonization and maturation of the infant’s intestinal microbiome, which is essential to development of the immune systen

TIP:
- MADE Good

Question 13

AP lactation: human milk

Answer 13

1) uniqueness of human milk

2) composition of mature milk changes during each feeding
- lactogenesis stage 1: begins 16-18 weeks of gestation
- lactogenesis stage 2: begins with delivery of placenta (colostrum for first 2-3 days, important in establishing normal lactobacillus bifidus flora in the infant’s digestive tract
- lactogenesis stage 3: mature milk is established, approximately 10 days after birth

Question 14

AP lactation: uniqueness of human milk

Answer 14

1) the composition of human milk changes over time as the infant grows and develops
- fat: MOST variable component of human milk

2) during each feeding, the concentration of fat gradually increases from the LOWER FAT foremilk -> HINDmilk (higher fat milk)

3) milk production gradually increases as the baby grows

4) fairly predictable growth spurts (at about 10 days, 3 weeks, 6 weeks, 3 months, and 6 months)

Question 15

care mgmt: supporting breastfeeding mothers, infants, and families (supporting breastfeeding mothers and infants)

Answer 15

• care providers w/ knowledge, skills, and attitudes to promote and support breastfeeding
• birthing environment in which breastfeeding is promoted and supported
• baby friendly hospital initiative (BFHI)
• nursing mothers support groups, such as La Leche League (mom support moms)

Question 16

care mgmt: supporting breastfeeding mothers, infants, and families (breastfeeding initiation)

Answer 16

1) infants exhibit feeding-readiness cues
- hand to mouth OR hand to hand movements
- sucking or mouthing motions
- rooting reflex: infant moves towards whatever touches the area around the mouth and attempts to suck

2) the ideal time to begin breastfeeding is within the first HOUR after birth
- schedule + cues (can’t wait until cry)

Question 17

care mgmt: supporting breastfeeding mothers, infants, and families (main components)

Answer 17

• positioning
• latch
• milk ejection or let down
• frequency of feedings
• duration of feedings
• indicators of effective breastfeeding

Question 18

nursing education: breast feeding

Answer 18

1) frequency: on demand 1 1/2 - 3 hours (Q3H, duration 30-40min)

2) positioning:
- modified cradle
- cradle
- football hold
- side lying position

3) latching on
- position for optimal attachment
- infant needs to attach lips to areola
- sore nipples
- elicit rooting reflex: infant opens mouth wide, mother draws baby toward her (BABY must find breast)

Question 19

care mgmt: supporting breastfeeding mothers, infants, and families (assessment of effective breastfeeding)

Answer 19

1) the nurse should observe at least one breastfeeding session every 8-12 hours to assess feeding effectiveness

2) use scoring tool such as the LATCH tool:
- Latch
- Audible swallowing
- Type of nipple
- Comfort level of the mother
- Hold (positioning)
- Other scoring tools: IBFAT and MBA

Question 20

signs of newborn dehydration

Answer 20

1) depressed fontanelles
2) rapid, weak pulse
3) elevated low grade temperature
4) dark, concentrated urine
5) dry, hard stools
6) dry skin with little turgor
7) elevated specific gravity

TIP:
- assess skin turgor -> abdomen, sternum

Question 21

care mgmt: supporting breastfeeding mothers, infants, and families (supplements and special considerations)

Answer 21

1) supplements, bottles, pacifiers

2) special considerations:
- sleepy baby
- fussy baby
- slow weight gain
- jaundice
- preterm infants (slow, lethargic)
- late preterm, early term infants
- breastfeeding multiple infants (energy, weight gain)
- weight loss or slow weight gain

Question 22

care mgmt: supporting breastfeeding mothers, infants, and families (expressing and storing breast milk)

Answer 22

1) hand expression

2) mechanical milk expression (pumping)
- types of pumps

3) storage of breast milk

4) maternal employment

5) weaning

6) milk banking
- cannot be breastfed BUT cannot survive except on human milk, pasteurized human donor milk (PHDM) from a milk bank is critically important
- human milk banking association of north america has established annually reviewed guidelines for the operation of not for profit donor human milk banks
- demand for human milk exceeds the supply

Question 23

care mgmt: supporting breastfeeding mothers, infants, and families (milk sharing, care of mother)

Answer 23

1) milk sharing:
- informal milk sharing is becoming increasingly more common
- there is often a lack of screening of milk donor in terms of diseases, medications, or illicit substances
- the USFDA warns against milk sharing

2) care of the mother:
- nutrition
- rest
- breast care

Question 24

care mgmt: supporting breastfeeding mothers, infants, and families

Answer 24

1) care of the mother
- breastfeeding and contraception
- breastfeeding during pregnancy
- breastfeeding after breast surgery
- breastfeeding, nipple piercing, and tattoos
- breastfeeding and obesity
- medications, herbal preparations, and substance use

Question 25

care mgmt: supporting breastfeeding mothers, infants, and families (care of mother, f/u discharge)

Answer 25

1) care of the mother: common concerns of the breastfeeding mother
- engorgement (big inflamed breast)
- nipple discomfort (breakdown, breastmilk helps heal nonadhesive dressing)
- insufficient milk supply
- plugged milk ducts
- mastitis
- breastfeeding and maternal illness
- TIP: cabbage leaves, massage, head/cold

2) follow up after discharge
- f/u care of the breastfeeding mother and infants is interprofessional
- breastfeeding infants should be seen by a pediatric health care provider within 48-72H after discharge or at 3-5 days of age
- majority of breastfeeding issues occur between 4-7 days after birth

TIP:
- babies lose 3-5% weight with breastfeeding

Question 26

formula feeding: patient education

Answer 26

1) readiness for feeding
- feeding patterns
- feeding technique: infants should be held for all feedings, paced bottle feeding (45 degree nipple, slow flow nipple, pace baby)
- common concerns: spitting up, burping (stop 1/2 way to help with burp/projectile vomiting)
- bottles and nipples

2) infant formulas (commercial formulas):
- cow’s milk based formulas (all made equal)
- protein hydrolysate formulas (hard to digest)
- soy protein based formulas, recommended for infants with galactosemia and congenital lactase deficiency

3) alternate milk sources such as goat’s milk, skin or low fat milk, condensed milk, or raw unpasteurized milk from any animal source should NOT be fed to infants

4) formula preparation:
- powdered formula: least expensive follow directions
- concentrated formula
- read to feed: most expensive but easiest to use

5) vitamin and mineral supplements (no need for formula)

6) weaning

7) complementary feeding: introduced solid foods
- the AAP recommends introducing SOLID foods at approx. 6 months of age
- cultural beliefs and traditions affect complementary feeding practices
- nurses and other health care professionals educate parents regarding complementary feedings

TIP:
Q$ d/t digestable but not recommended

Question 27

benefits of the mother associated with breastfeeding include all except which of the following:

Answer 27

it is an effective method of birth control