Chapter 22: Infant Feeding Flashcards
1
Q
how many calories does a full term newborn need?
A
- breast fed: 39-45 calories/per pound of body weight
- bottle fed: 45-50 cal/lb of body weight
2
Q
how many calories are in each ounce of breast milk and formula?
A
20 calories/oz
3
Q
how much weight can an infant lose? why does this happen?
when is the infant evaluated for weight loss?
A
- during early days, infants may lose up to 10% of birth weight.
- result of normal excretion of extracellular water and meconium and newborns consuming fewer calories than needed
- infants should be evaluated for feeding problems if weight loss exceeds 7%, if weight loss continues beyond 3 days of age, or if birth weight is not regained w/in 10 days
4
Q
why are complex carbs and fats not well digested by the newborn?
A
- because they are lacking pancreatic amylase and lipase
5
Q
water needs of a newborn
A
- newborn needs larger amounts of fluid in relation to size than an adult, b/c they lose more water thru the skin, kidneys, and intestines
- they need approx 27-45 mL/lb during first 3-5 days
- then gradually inc to 68-80 mL/lb a day
- breast milk and formula supply the infant’s water needs
6
Q
composition of breast milk
A
-
lactogenesis: is the production of milk
- lactogenesis I: starts during pregnancy and continues to early days after giving birth
- breasts secrete colostrum
- lactogensis II: begins 2-3 days after birth
- transitional milk comes in
- amount of milk inc as milk “comes in”
- lactogenesis III: mature milk replaces traditional milk
- breast milk is bluish and thin
- lactogenesis I: starts during pregnancy and continues to early days after giving birth
7
Q
Colostrum
A
- made during lactogenesis I
- higher in protein and some vitamins and minerals than mature milk
- lower in carbs, fat, lactose
- rich in IgA (good for GI infection protection)
- helps establish normal flora of intestines
- has a laxative effect to help pass meconium
8
Q
Transitional Milk
A
- made during lactogenesis II
- appears over about 10 days
- inc in amount as the milk comes in
- immunoglobulins and proteins decrease
- lactose, fat, and calories increase
- vitamin content is the same as colostrum
9
Q
mature milk
A
- present during lactogenesis III
- appears during 2nd week of lactation
- bluish and thin
- easily digestible
- species specific
- contains approx 20 kcal/oz and nutrients sufficient to meet the infant’s needs
- provides immunoglobulins
- low in iron and vitamin D, but absorbed well
10
Q
protein in breast milk
A
- breast milk is high in taurine which is important for bile conjugation and the brain
- tyrosine and phenylalanine are low to correspond to low level of enzymes to digest them
- casein and whey are proteins in milk
- breast milk is easily digestible b/c made mostly of whey which does not form the insoluble curd like casein does
- antigens in foods the mother has eaten may pass int obreast milk and may cause an allergy (including cow’s milk, milk products, chocolate, cola, corn, citrus, wheat, peanuts_
11
Q
how to protect against food allergies in the infant
A
- infant should be exclusively breast fed for at least 4 months and allergic foods should be avoided by the mother if her infant under 6 weeks of age has colic
12
Q
carbs in breast milk
A
- lactose is the major carb
- improves absorption of calcium and provides energy for brain growth
- other carbs inc intestinal acidity and impede growth of pathogens
13
Q
fat in breast milk
A
- provides 50% of calories in breast milk
-
hindmilk: milk produced at the end of the feeding
- produces satiety and helps the infant gain weight
- triglycerides form the majority of fat content
- cholesterol and long chain DHA and arachidonic acid are present to help with vision and growth of brain and nervous system
14
Q
vitamins in breast milk
A
- vitamin A, E, and C are in high levels
- vitamin D is low
- may need daily supplementation during first few days of life of 400 IU
- breastfeeding infants who are not exposed to sun or have dark skin may need supplement
- formula fed infants who drink less than 1 qt of vit D fortified milk per day should supplement
15
Q
minerals in breast milk
A
- iron is in low levels, but it absorbs well so infant’s that are breast fed are not usually deficient
- if breastfed exclusively, the infant will maintain iron stores for the first 6 mos of life until they start eating solids
- preterm and formula fed infants need iron supplementation
- Na, Ca, and phosphorus are higher in cow’s milk than human milk, so if formula not diluted properly this could place a high solute load on immature kidneys
16
Q
what components of breast milk help prevent infection?
A
- bifidus factor: promotes the growth of lactobacilllus bifidus which is important to intestinal flora
- leukocytes
- macrochages: secrete
- lysozyme: protects against gram + and enteric bacteria
- lactoferrin: which binds iron in iron dependent bacteria to prevent their growth
- immunoglobulins
17
Q
does a mother’s diet effect breast milk composition?
A
- fatty acid content and levels of water soluble vitamins are influenced by the mother’s diet
- total fat, protein, carbs, and most minerals are not effected
18
Q
cow’s milk
A
- unmodified: not recommended for infants under 12 mos
- it contains too much protein, potassium, chloride, and sodium
- it lacks fatty acids, vit E, iron, zinc
- modified: is the source of most commercial formulas
- formulate it for infants by reducing protein content to dec renal solute load
- saturated fat is removed and replaced with vegetable fats
- vitamins are added
19
Q
soy formula
A
- can be used for infants with galactosemia or lactase deficiency and for those whose families are vegetarians
- but many infants are also allergic to this
20
Q
what are the best formulas for infants with allergies?
A
- protein hydrolysate formula
- protein is treated to make it less allergenic
- can also be used if infant has a malabsorption disorder
21
Q
breastfeeding recommendations
A
- AAP recommends infants only receive breast milk for first 6 mos after birth
- then, breastfeeding should continue until infant is 12 mos old with the addition of foods
22
Q
benefits of breastfeeding for the infant
A
- less allergies
- immunologic properties to prevent infection
- dec incidence of respiratory tract, ear, urinary tract, and GI tract infections
- lower incidence of diabetes, asthma, obesity, SIDS, cancers
- composition meets infant’s needs
- easily digested
- unlikely to be contaminated
- less likely to result in overfeeding or constipation
23
Q
benefits of breastfeeding for the mother
A
- oxytocin release enhances uterine involution
- less blood loss b/c of delayed return of menses
- delayed resumption of ovulation
- reduction in cancer risk
- increases attachment
- convenient and always available
- economical
- infant less likely to be ill
- easier to travel
24
Q
why would a mother choose to feed the baby formula?
A
- some women are embarrassed
- lack of social support
- anxiety about not being able to tell how much milk the baby gets with BF
- partner not supportive
- taking medications that may harm the baby
- lack of understanding or education
25
Q
factors influencing how women choose to feed their babies
A
- support from others
- father feeling “left out” if choose BF
- culture
- most likely to BF if Asian, Pacific Islander, or Hispanic
- least likely to BF if non-hispanic black
- many times, colostrum is not valued in certain cultures, so they wait to breast feed until after going home
- employment:
- returning to work is often a reason women choose to stop breastfeeding
- staff knowledge
- past experience
- feelings on modesty
- time intensive
26
Q
breast changes during pregnancy
A
- changes start early in pregnancy
- ducts, lobules, and alveoli develop in response to estrogen, progesterone, hCS, an dprolactin
- prolactin is high but estrogen and progesterone prevent milk production
- colostrum present at 16 weeks gestation
- women should see an increase in breast size during gestation
27
Q
milk production
A
- produced by the alveoli of the breasts
- milk is ejected from the secretory cells of the alveoli into the lumen by contraction of the myoepithelial cells
- then, it travels thru the lactiferous ducts to the nipple
- infant compresses the areola to move a stream of milk thru pores in the nipple
28
Q
hormonal changes at birth in relation to lactation
A
- at birth, loss of placental hormones results in inc prolactin which activates milk production
- suckling and the removal of colostrum cause continued inc levels of prolactin
- prolactin secreted in highest levels with suckling and at night
- suckling and the removal of colostrum cause continued inc levels of prolactin
- oxytocin inc in response to nipple stimulation and causes the milk ejection/let down reflex–>the release of milk from the alveoli into the ducts
- this reflex can occur any time oxytocin is released which occurs when a mom sees, hears, or thinks about her baby
29
Q
continued milk production
A
- amount of milk produced depende on adequate stimulation of the breast and removal of the milk by suckling/breast pump which causes production of prolactin
- “supply and demand” effect
- early and frequent suckling causes prolactin to be released which makes more milk
- if milk is not removed from the breast, this causes a feedback to decrease prolactin and dec milk production
30
Q
preparation of breasts for breastfeeding
A
- do not apply soap to the nipples b/c it removes protective oils
- inverted or flat nipples make it harder for an infant to latch
31
Q
hunger cues in infants
A
- licking or sucking movements
- lip smacking
- rooting
- hand to mouth movements
- sucking on hands
- increased activity
- crying (late sign)
32
Q
initial feeding
A
- should occur within 1 hour after birth as long as mom/baby are stable
- baby should be placed skin to skin as soon as its born, b/c infant’s are in the first period of reactivity so they are alert and ready to nurse
- early BF
- assoc with a higher BF rate at 2-4 weeks and 2-4 mos postpartum
- provides stimulation for milk production
- improves suckling
- inc bonding
- helps infant to excrete meconium
- helps stabilize infant’s blood sugar and temp
33
Q
how often to breast feed
A
- should feed baby 8-12 times/24 hours
- so about every 2-3 hours
34
Q
what occurs during the second period of reactivity
A
- cluster feeding: 5-10 feedings are done over about a 2-3 hour period
35
Q
position of mother and infant with breastfeeding
A
- most common positions:
- cradle
- football or clutch
- cross cradle
- side lying
- help increase mom’s comfort by getting her pain meds, prop her up with pillows, and make sure her shoulders are relaxed.
- use blankets/pillows to elevate infant to the level of the nipple
- infant’s head and body should directly face the bresat w/ the infant’s nose, cheeks, and chin lightly touching
- neck should be flexed b/c hyperextension makes swallowing difficult
- mother makes C shape with hand to hold her breast by placing her thumb on the top and fingers under her breast
36
Q
eliciting latch on
A
- baby should always be awake and hungry
- position the infant to face the breast and instruct the mother to hold her nipple so it brushes against the infant’s lips
- do not insert the breast until the mouth is widely opened
37
Q
position of infant’s mouth while breast feeding
A
- the infant’s lip should be positioned on the areola about 1-1.5 in form the base of the nipple to allow the nipple to be drawn toward the back of the mouth
- this prevents the nipple from sucking only on the nipples whic hcan cause sore nipples
- the infant’s tongue should be forward, cupped under the breast, and over the top of the lower gums
- the lips should be flared outward
38
Q
removal of infant from breast
A
- teach mother to remove infant from breast when sucking becomes non-nutritive
- avoid trauma to the breast by inserting her little finger into the corner of the infant’s mouth b/w the gums to break the suction
- then remove breast quickly
39
Q
suckling pattern
A
- during nutritive suckling (sucking), the infant sucks with smooth, continuous movement with occasional pauses to rest
- infant may swallow after each suck or may suck several times before swallowing
- during non-nutritive suckling, little or no milk flow is obtained, and often occurs when infant is falling asleep
- the infant’s jaw is moving in a fluttery, choppy motion and is not accompanied by swallowing
40
Q
length of feedings
A
- it may take as long as 5 min for milk ejection reflex to ccur during early days after birth, so often it is a good idea to allow the infant to set the length of feeding
- when non-nutritive sucking occurs, remove infant, burp, and try on other breast
- feeding should start at about 10-15 min in length
- if you switch back and forth on the breasts during a feeding, this will inc amount of foremilk an infant gets but dec amount of hindmilk
41
Q
foremilk vs. hindmilk
A
- foremilk: watery first milk that quenches the infant’s thirst
- hindmilk: comes at the end of a feeding
- richer in fat, more satisfying, leads to weight gain
- if feeding is too short, the infant will not get this milk and will lose weight
- richer in fat, more satisfying, leads to weight gain
42
Q
signs of letdown
A
- cramping
- increased lochia
- milk leaking from other breast
- tingling feeling in breast
- feeling of relaxation
- pressure, pain, anxiety will inhibit letdown
43
Q
how to assess the position and the latch
A
- is the baby tummy to tummy with mom?
- do the nose and chin touch the breast?
- do the lips both flare out?
- is the neck straight?
- head slightly higher?
- wide mouth open?
44
Q
signs of milk transfer to baby
A
- audible swallowing
- absence of clicking noises or cheeks pulling inward
- milk in baby’s mouth
- breasts soft after feeding
- milk leaking from opposite breast
- infant’s stools are yellow and seedy
- infant is urinating at least 6-10 times per day at 1 week old
45
Q
insufficient milk supply
A
- one of the major reasons for early weaning to formula
- teach the parents how to assess swallowing and nutritive sucking
- suggest mom count the wet/dirty diapers
- commonly caused by:
- ineffective suckling
- infrequent or short feedings
- maternal fatigue
- low maternal thyroid function
- preterm/late preterm infants
- some meds like oral contraceptives
46
Q
how much weight should an infant gain per day
A
- gain on average 0.7-1 oz each day during the early months
47
Q
signs an infant is having trouble breastfeeding
A
- falling asleep after feeding for 5 min or less
- refusal to BF
- tongue thrusting
- smacking or clicking sounds
- dimpling of cheeks
- failure to open mouth widely
- lower lip turned in
- short, choppy motions of jaw
- no audible swallowing
- use of formula
48
Q
jaundice and breastfeeding
A
- an infant can normally be removed from phototherapy lights for feedings, but the concern is with adequate intake
- insensible water loss is increased thru the skin due to lights/heat so worried about dehydration
- need to have frequent feedings to keep hydrated and inc stools to get rid of bilirubin
49
Q
prematurity and breastfeeding
A
- if baby can’t breastfeed after birth immediately, teach mom to use a breast pump to establish her supply
- late preterm infants may also have difficult breastfeeding b/c they are immature
- may have problems with coordination of sucking, swallowing, and breathing and they are sleepier than full term infants
50
Q
engorgement of the breasts
A
- many women experience a temporary swelling/fullness to the breasts which peaks at 72-96 hours after birth when production of milk begins to increase
- normal temporary engorgement occurs due to congestion, inc vascularity, accumulation of milk, and edema–>does not interfere with BF
- may be a problem if feedings are delayed, too short, infrequent
- breasts may become edematous and hard and making feedings painful
- may lead to nipple trauma, mastitis, or d/c BF
- prevent by feeding early and often, BF at night, do not use formula
- treat by feeding frequently, hot showers, and massage
51
Q
nipple pain w/ BF
A
- common during early breastfeeding, esp during first week
- peaks at 3-6 days, and resolves after
- but nipple trauma can sustain pain
- the nipples appear red, cracked, blistered, or bleeding
- redness, purulent drainage, and fever indicate mastitis and requires and abx
- caused by improper positioning or latch, exposure to soap/prolonged moisture/creams may cause sore nipples
52
Q
maternal signs of breastfeeding problems
A
- hard, tender breasts
- painful, red, cracked, blistered, bleeding nipples
- flat or inverted nipples
- localized edema or pain in breasts
- fever, generalized aching, malaise (mastitis)
53
Q
breastfeeding contraindications
A
- mother:
- breast cancer
- HIV positive
- cytomegalovirus (CMV)
- untreated gonorrhea or syphilis
- active TB
- active drug dependency
- some meds (chemo)
- infant:
- metabolic disorders (ie. galactosemia)
54
Q
milk storage
A
- room temp: 4-6 hours at 66-78 deg F
- cooler with 3 frozen ice packs: 24 hours at 59 deg F
- refridgerator: 3-8 days at 39 deg F or lower
- freezer: 6-12 mos at 0-4 deg F
- thawed breast milk: use within 24 hours
55
Q
using a breast pump
A
- can use electric, battery, or manual pumps
- these can be rented or purchased
- electric are more efficient and are indicated when mother plans to pump for a long time
- double pump: allows mother to pump both breasts at once, saving time and inc milk production
- should start using ASAP if cannot breastfeed infant
- should pump at least 8 times per day for 15-20 min each
- breast massage and application of heat help initiate flow of milk
- relaxation during pumping increases volume
56
Q
teaching with breastfeeding
A
- avoid dieting: eat as you did in pregnancy to lose weight
- should have 8 glasses of non-caffeinated beverages daily
- avoid smoking, drugs, alcohol and undue stress
- 10 min on first side and finish until satisfied on 2nd side
57
Q
nipple confusion
A
- may occur when an infant who has been fed by a bottle confuses the tongue movements necessary for bottle feeding with the suckling of breastfeeding
- some infants may refuse to BF or push the breast out of the mouth
- discourage use of formula in BF infants b/c it reduces breastfeeding time, which dec prolactin secretion, and, therefore, milk production
- formula takes longer to digest (about 4 hours) so infant not hungry again for a while and may lead to inc times b/w feedings, so breasts may become engorged.
- also should limit pacifiers, b/c it may be associated with suckling problems if used to early
58
Q
types of formulas
A
- infants should receive iron fortified formulas
- can be purchased in 3 preparations:
-
ready to use formula: should not be diluted
- shake container and pour into bottle
- good for traveling
- refridgeration is not necessary unless open, and then use in 48 hours
-
concentrated liquid formula: use equal parts concentrated formula and water and pour into bottle
- store in fridge and use in 48 hours
-
powdered formula: use 1 level scoop and add to 2 oz of water
- not sterile, so not recommended for preterm or immunocompromised infants
- refridgerate for no more than 48 hours if prepared
- can use a can of the powdered formula for 4 weeks once opened
-
ready to use formula: should not be diluted
59
Q
formula preparation
A
- need to have proper dilution of formula to provide proper nutrition to infant
- if water supply is safe, sterilization of milk and equipment is not necessary
- however, all water mixed with formula should be boiled for 1 min
- use hot, sudsy water and a brush to clean, rinse, and air dry
- can also use dishwasher, but nipples are weakened in dishwasher
- cleanliness is important
- no honey
- can prepare 1 bottle at a time or prep a 24 hour supply
60
Q
teaching with formula feeding
A
- hold in semi recumbent position (cradle hold)
- check nipple hole to make sure it is a drip not a stream
- make sure bottle is held so nipple is full of formula at all times
- point nipple directly into mouth
- burp at middle and end of feeding
- feed infant every 3-4 hours
- do not overfeed–>regurgitation is common
- never microwave bottles of formula
- do not prop the bottle b/c it inc likelihood of regurgitation and eliminates holding/cuddling that should accompany feeding
- small risk of allergic reaction
