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NURS 4500: Final Material > Class 10: Infant Feeding > Flashcards

Class 10: Infant Feeding Flashcards

1
Q

what is the recommended route for infant nutrition for the 1st 6 months of life?

A
  • exclusive breast/human milk
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2
Q

what supplementations are recommended for infants who are breats/human milk fed

A
  • vitamin D supplementation of 400 IU daily
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3
Q

how can the birther give the infant vitamin D supplementation

A
  • comes in drop form –> put drop on nipple
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4
Q

if infants are weaned off human/breast milk before age 12 months, what should they receive?

A
  • should receive iron-fortified infant formula
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5
Q

what % of people initiate breast/chest feeding? what % continue exclusively for 6 months?

A
  • 90.9% initiate
  • 34.4% continue exclusively for 6 months
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6
Q

what factors are associated w breast/chest feeding (3)

A
  • social & economic factors
  • marital status
  • age of birther
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7
Q

what are examples of social & economic factors that are associated w breast feeding (3)

A
  • food insecurity
  • lower income
  • lower education
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8
Q

what impact does marital status have on breast feeding?

A
  • single birthers were more likely to stop
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9
Q

what impact does age of the birther have on breast feeding? (2)

A
  • older age = higher chance of breastfeeding for 6 months
  • adolescent birthers more likely to stop
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10
Q

what are reasons for stopping breast feeding before 6 months (2)

A
  • inadequate amt of breast milk (rare, assess)
  • difficulty w technique
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11
Q

describe the absorption and amt of nutrients in human milk (2)

A
  • nutrients in human milk are more easily absorbed than those informula
  • human milk is designed for human infants –> nutritionally superior to any alternative
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12
Q

human milk is considered… why?

A
  • living tissue
  • bc it contains almost as many live cells as blood
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13
Q

describe the bacteria in human milk

A
  • bacteriologically safe
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14
Q

due to the differences in absorption of nutrients in human milk, what impact does this have on stools?

A
  • stools will be different on formula
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15
Q

what are benefits of human milk to the newborn? (5)

A
  • immunity
  • on demand, safe & fresh w easily absorbed nutrients
  • analgesic of NBs
  • enhances brain development
  • decreases risk of various health conditions
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16
Q

what does human milk reduce the risk of in newborns? (15)

A
  • gastroenteritis
  • necrotizing enterocolitis (preterms)
  • childhood obesity
  • IBD
  • celiac
  • RSV
  • OM
  • pneumonia
  • UTIs
  • bacteremia
  • bacterial meningitis
  • allergies
  • SIDs
  • childhood lymphoma
  • DM1 and 2
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17
Q

the analgesic benefit of human milk is used for?

A
  • minimally invasive procedures such as venipuncture
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18
Q

what are benefits of chest feeding to the birth (4)

A
  • decreased risk of various health conditions
  • helps decrease weight after pregnancy
  • help w bonding w infant
  • convenient and free
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19
Q

what does human milk reduce the risk of in the birther? (8)

A
  • PPH (helps uterine involution)
  • ovarian, uterine, and breast cancers
  • RA
  • T2DM
  • HTN
  • hypercholesterolemia
  • CVS
  • PPD
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20
Q

what should be considered when choosing an infant feeding method (4)

A
  • provide factual info about nutrition & immunological needs met by human milk
  • provide info to parents in non-judgmental manner & respect their decision
  • consider cultural influences on infant feeding
  • provide affirming & respectful care to individuals who are part of sexual and/or gender minority populations
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21
Q

describe the presence of fluids in breast milk

A
  • breastmilk = 87% water
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22
Q

describe supplementation of water for the infant

A
  • never give baby plain water within 1st 6 months of life
  • no supplementation w water is recommended
    = breastmilk or formula only
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23
Q

what should be monitored closely in the early PP time? how can this be done?

A
  • fluid intake & weight loss shoudl be monitored closely
  • document voids, stools, daily weights, feeding times/amts
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24
Q

breastmilk provides the calories, nutrients, vitamins, and minerals required for infants with the exception of:

A
  • vitamin D
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25
Q

due to the lack of vitamin D in breast milk, what is done

A
  • vitamin D supp, 400 IU daily
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26
Q

describe vitamin K after birth

A
  • we provide vitamin K injection after birth, then the infant will start making their own
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27
Q

B12 sufficiency with breast feeding depends on?

A
  • depends on diet of individual feeding the infant
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28
Q

those with what type of diet need to supplement vitamin B12? why is this important?

A
  • vegan diet –> should take supplements or it will be low in breast milk
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29
Q

describe iron in breastmilk

A
  • iron is not high in any milk, but iron in human milk is well absorbed by infants –> no need to provide sources until 6 months of age
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30
Q

how many stages of lactogenesis are there?

A
  • 3 stages
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31
Q

describe stage 1 of lactogenesis: when does it begin? end?

A
  • begins in pregnancy
  • ends with the beginning of increased milk production after delivery (start of stage II)
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32
Q

describe stage 2 of lactogenesis: when does it start?

A
  • starts w the increase in milk production
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33
Q

describe stage 3 of lactogenesis: what happens and when?

A
  • when mature milk is produced
  • usually around day 10-14 after birth
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34
Q

the female breast is composed of?

A
  • composed of 15-20 segments (lobes) embedded in fat & connective tissues
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35
Q

the female breast is well supplied with.. (3)

A
  • blood vessels
  • lymphatic vessels
  • nerves
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36
Q

within each lobe of the female breast, what is present? what are these?

A
  • alveoli = the milk-producing cells
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37
Q

what are the alveoli of the female breast surrounded by? what do these do?

A
  • surrounded by myoepithelial cells that contract to send milk forward into the ductules
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38
Q

what occurs after the milk is sent forward into the ductules during lactogenesis?

A
  • ductules enlarge into lactiferous ducts & sinuses, where milk collects behind the nippled
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39
Q

each nipple has? what function do these have?

A
  • each nipple has pores through which milk is transferred to the ducking infant
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40
Q

after birth, the drop in estrogen & progesterone levels triggers?

A
  • release of prolactin from the anterior pituiatry gland
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41
Q

what is the function of prolactin

A

= milk production

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42
Q

when are prolactin lvls highest

A
  • during first 10 days after birth
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43
Q

describe the declination of prolactin

A
  • gradually decline but remain above baseline lvls for the duration of lactation
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44
Q

prolactin is produced in response to.. (2)

A
  • infant suckling
  • “emptying” of breasts”
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45
Q

describe the “emptying” of breasts

A
  • lactating breasts never completely empty
  • suckling triggers positive feedback loop tp produce milk = milk is constantly produced as the infant feeds
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46
Q

what function does oxytocin have in lactogenesis

A
  • stimulates milk-ejection reflex or let-down reflex
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47
Q

describe the production of oxytocing for lactogenesis

A
  • as the nipple is stimulated by suckling infant, posterior pituitary prompted by hypothalamus produced oxytocing
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48
Q

describe the production of oxytocing for lactogenesis

A
  • as the nipple is stimulated by suckling infant, posterior pituitary prompted by hypothalamus produced oxytocin
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49
Q

what is integral to lactation

A
  • the nipple-erection reflex
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50
Q

what role does human milk play in the immune system?

A
  • contains immunologically active components
    = provides some protection against broad spectrum bacterial, viral, and protozoal infections
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51
Q

what is the major immune globulin in huamn milk

A
  • secretory immunoglobulin A
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52
Q

what is a colostrum?

A
  • first form of breastmilk that is released by the mammary glands
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53
Q

what does colostrum look like?

A
  • clear, yellowish fluid
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54
Q

when is colostrum present?

A
  • at birth
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55
Q

describe the concentration of colostrum (3)

A
  • more concentrated than mature milk
  • high conc of protein, fat soluble vitamins, and minerals
  • extremely rich in immune globulins
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56
Q

describe the fat concentration of colostrum

A
  • less fat than transitional or mature milk
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57
Q

what is transitional milk

A
  • increase in amt of milk compared with 1st few days
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58
Q

what composition changes occur w transitional milk (5)

A
  • immunoglobulins decrease
  • proteins decrease
  • lactose increases
  • fat increases
  • total calories increase
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59
Q

describe the composition of mature milk (3)

A
  • fat content increases
  • lactose increases
  • protein decreases

compared w colostrum & transitional milk

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60
Q

describe milk composition with each feeding

A
  • changes during each feeding
61
Q

initially, foremilk is released that is part.. (2)

A
  • is part skim milk, about 60% of volume
  • is part whole milk, about 35% of volume
62
Q

initially, foremilk is released that provides primarily (3)…

A
  • lactose
  • protein
  • water-soluble vitamins
63
Q

when is hindmilk usually let down?

A
  • 10-20 min into feeding
64
Q

describe calorie composition of hindmilk

A
  • denser calories from fat
65
Q

the changing composition of human milk during each feeding requires…

A
  • breastfeeding long enough to supply balanced feeding
66
Q

watch SickKids video on breastfeeding position and latch

A

know
- details about latching
- assessing latch
- how to set up position

67
Q

describe breast feeding positioning (3)

A
  • mother semi-reclines
  • skin-to-skin
  • tummy-to-tummy
68
Q

why is skin to skin contact imp when breastfeeding

A
  • promotes alertness in infant during feeding
69
Q

define: latch

A
  • infant’s mouth over nipple, areola and breast, making a seal between the mouth & breast to create adequate suction for milk removal
70
Q

milk ejection or let down is stimulated by?

A
  • infant suckling
71
Q

describe the freq of feedings

A
  • cue based
  • 8-12 feedings / 24 hrs
72
Q

describe the duration of feedings

A
  • avg, 20 min per breast
73
Q

what are indications of effective breast feeding (4)

A
  • urine
  • stools
  • weight
  • infant satisfied & relaxed
74
Q

what should be established prior to introducing bottle?

A
  • until BF established
75
Q

what is the concern w introducing bottles too early to infants?

A
  • can make breastfeeding harder since it’s easier to latch to a bottle
76
Q

what should happen after a feed?

A
  • pumping, unless the birther has heavy milk letdowns (in which case done before feed)
77
Q

describe holding of the newborn during breastfeeding

A
  • do not hold the back of the baby’s head during latching –> support the neck & bring beast to baby
78
Q

during breastfeeding, the nipple should align with?? chin should contact?? tongue should be ??

A
  • nipple should align with infant nose
  • chin should contact breast before mouth to promote good latch
  • tongue should be down
79
Q

since the tongue should be down when breastfeeding, the baby should be …. before latching

A
  • soothe baby before latching –> if baby is crying tongue will be touching the roof of its mouth
80
Q

describe the newborn nose during breastfeeding

A
  • ensure nose is not compressed in the breath
81
Q

describe void & stools during day 1

A
  • 1 void
  • 1 meconium stool
82
Q

describe void & stools during day 2

A
  • 2 voids
  • 1-2 stools
83
Q

if meconium is still present on days 3-4, what should be done

A
  • reassess breastfeeding
84
Q

know voids & stools expected in first 5 days of life

85
Q

how often are latch assessments done

86
Q

what is included in infant assessments for breast feeding?

87
Q

what is included in mother assessments for breast feeding? (2)

A
  • assess breasts
  • assess nipples for erythema and cracks
88
Q

what amt of weight loss in the baby is normal? when should this be regained?

A
  • 5-10% weight loss over days 3-5 can be normal
  • should regain this weight within 7-10 days of life
89
Q

what is the formula for net weight gain/loss

A

current weight - previous weight = net weight gain or loss

90
Q

what is the formula for % weight gain or loss

A

(net weight gain or loss / previous weight) x 100

91
Q

what is assessed r/t general feeding (5)

A
  • type (breast/chest or formula)
  • LATCH-R assessment q8h
  • if using other supplemental feeding (formula) along w breast feeding document type & volume
  • note and document skin-to-skin
  • voids, BMs, weight, skin turgor, lethargy, jaundice
92
Q

what are early feeding cues of the NB (5)

A
  • hand to mouth
  • sucking motions
  • rooting reflex
  • mouthing
  • flexed arms & legs w clenched fists
93
Q

what is a late sign of hunger

94
Q

on day 1, how many wet diapers should there be?

A
  • at least 1 wet
95
Q

on day 2, how many wet diapers should there be?

A
  • at least 2 wet
96
Q

on day 3, how many wet diapers should there be?

A
  • at least 3 wet
97
Q

on day 4, how many wet diapers should there be?

A
  • at least 4 wet
98
Q

from day 5-3 weeks, how many wet diapers should there be? what should the color be? how heavy?

A
  • at least 6 heavy wet
  • with pale yellow or clear urine
99
Q

on days 1-2, how many soiled diapers should there be? color?

A
  • at least 1-2
  • black or dark green
100
Q

on days 3-4, how many soiled diapers should there be? color?

A
  • at least 3
  • brown, green, or yellow
101
Q

from day 5-3 weeks, how many soiled diapers should there be? consistency? color?

A
  • at least 3 large
  • soft, seedy
  • yellow
102
Q

describe the process of latching on

A
  • when mouth is open, draw baby close
  • nipple should be centered upward in infant’s mouth
  • as baby latches on, draw infant closer to breast & chin should be tucked in close to breast
  • baby should be allowed to nurse until he or she stops swallowing
103
Q

see figure 27-07 on correct attachment (latch-on) of infant at breast

104
Q

what should be encouraged for the lactating individual

A
  • good nutrition
  • hydration
  • exercise
  • rest
105
Q

what is included in care of the nipples & breasts with breastfeeding (5)

A
  • bathe normally
  • avoid soap on nipples
  • avoid creams (will be ingested by infant)
  • supportive bras or no bra is okay –> avoid underwire
  • breast pads okay –> avoid plastic lined
106
Q

what cream is okay with breast feeding

107
Q

why is it imp to avoid underwire when breast feeding

A
  • can cause mastitis
108
Q

why is it imp to avoid plastic lined breast pads when breast feeding

A
  • hold in moisture & cause breakdown of nipple
109
Q

some individuals may feel more comfortable with feeding infants which way?

A
  • expressing milk & bottle feeding as well
110
Q

what is the benefit of both breast and bottle feeding ?

A
  • infants will still get the benefits of the nutrition and immune support that is provided by breast milk
111
Q

with bottle feeding, what can still be provided?

A
  • skin to skin contact
112
Q

what are special considerations with breast feeding (4)

A
  • jaundice
  • preterm infants, late perterm infants
  • cleft lip/palate
  • tongue-tie/ankyloglossia
113
Q

how can preterm infants have issues w breastfeeding? (2)

A
  • less of a suck swallow breathe reflex
  • very premature infants will not be able to feed, expressed breast milk will be admin thru device
114
Q

how can cleft palate contribute to issues w breast feeding?

A
  • reduces latch suction
  • may squeeze lip together to create a seal
  • if palate is involved, direct breastfeeding is not usually possible
115
Q

if there are issues with latch due to tongue ties, what may be done? what is a sign a tongue tie may cause problems?

A
  • may but cut if there are issues w latch
  • if can’t put 1 finger under tongue = may cause problems
116
Q

what effect does breastfeeding have on menstruation?

A
  • typically will not ovulate for 6 months
117
Q

describe contraceptive use when breast feeding (2)

A
  • may need backup contraception like condoms just in case
  • combined contraceptives not ideal
118
Q

what types of contraceptives are preferred if using combined contraceptives (2)? when should this be initiated?

A
  • progesterone only pills
  • IUDs
  • should not initiate until breastfeeding is well established
119
Q

what impact does diabetes have on the person breastfeeding

A
  • lower’s birthers blood sugar
  • benefits infant??
120
Q

how long until alcohol hits peak lvl in breast milk

121
Q

how long between smoking & feeding infant is recommended

122
Q

describe the ingestion of caffeine & breastfeeding

A
  • caffeine only problematic in very high doses
123
Q

meds, illicit drugs & breast feeding

A
  • ? relisten
124
Q

engorgement of the breasts occurs when? how long does it last?

A
  • days 2-5
  • lasts ~24 hrs
125
Q

describe the characteristics of the breasts during engorgement (7)

A
  • should be bilateral (otherwise consider mastitis)
  • firm
  • tender
  • swollen
  • hot
  • aerolae can become firm
  • nipple flattens
126
Q

what can cause sore nipples? (2)

A
  • latch issues
  • monilial infections
127
Q

what are monilial infections? how are they treated?

A
  • yeast infections
  • treated w topical antifungals
128
Q

what is assessed to determine if any insufficient milk supply

A
  • assess for infant weight gain –> if gaining good weight, unlikely there is insufficient milk supply
129
Q

describe vitamin D supplementation in infants who receive formula w vitamin D added

A
  • would not require additional vitamin D supplementation unless they are at high risk for deficiency (individual considerations)
130
Q

what is assessed in follow-up after hospital discharge (3)

A
  • infant feeding patterns
  • jaundice
  • breast discomfort
131
Q

what is included in general follow up after discharge r/t breastfeeding (3)

A
  • community resources –> breastfeeding groups in each community in Winnipeg area
  • PHN visit offered for everyone
  • referral can be made to lactation consultant if needed
132
Q

what should the birther be educated on if they choose formula feeding (3)

A
  • choose a formula approved by Health Canada
  • cow’s milk based w iron
  • always check expiry date
133
Q

formula feeding amt should be based on?

A
  • infant hunger cues
134
Q

what is the general guidance on amt of formula feeding for 1st 24 hrs of life? 24-48 hrs?

A
  • first 24 hrs = ~5-10 mLs per feed q2-3 hrs
  • 24-48 hrs = ~10-15 mLs per feed q2-3 hrs
135
Q

what is included in parent education r/t formula feeding (6)

A
  • readiness for feeding
  • feeding patterns
  • feeding techniques
  • common concerns
  • bottles & nipples
  • formula preparation
136
Q

describe infant position when formula feeding

A
  • position infant so they have to suck, not just receive passive gravity flow
137
Q

what may occur and we should try to reduce as much as possible with formula feeding?

A
  • some ingestion of air
138
Q

what is critical with formula feeding prep

A
  • sterile enviro
    = sterilize water, bottles, etc.
139
Q

is sterile liquid or powder recommended for preterm, immunocompromised infants

A
  • sterile liquid
140
Q

define: complementary feeding

A
  • foods or liquid given to the infant in addition to breast milk or formula
141
Q

when is complementary feeding offerred

A
  • after 6 months of age
142
Q

what are recommended to be the first solid foods introduced (3)

A
  • iron fortified cereal
  • meat
  • meat alternatives
143
Q

during pregnancy, perform an assessment r/t breastfeeding that includes: (6)

A
  • intent to breastfeed
  • breastfeeding history
  • access to breastfeeding support
  • breast examination
  • medication use history
  • develop prenatal care plan to prep the pt for lactation
144
Q

after birth, what should the nurse do r/t skin-to-skin and breastfeeding (8)

A
  • ensure uninterrupted skin-to-skin contact immediately after birth and until the newborn completes 1st feeding
  • promote nonseparation of newborn and birther
  • teach responsive feeding to help parents identify early feeding cues
  • encourage breastfeeding early & often –> 8-12 x/day without supplementation
  • help birther recognize when baby is feeding well
  • encourage breastfeeding, esp for preterm and low-birth weight
  • reinforce recommendation for exclusive breastfeeding for first 6 months, w intro of complementary foods at 6 months, and continued breastfeeding up to 2 years and beyond
  • ensure community follow up
145
Q

how often should the birther breastfeed?

A
  • at least 8 foods per day (q1-3 hrs)
146
Q

when breastfeeding, the baby should be sucking.. (4)

A
  • strongly
  • slowly
  • steadily
  • and swallowing often
147
Q

in the first 3 days after birth, the baby loses how much weight on average?

A

7% of their birth weight

148
Q

from day 4 onward, the baby should gain how much weight?

A
  • 20-35g per day
  • and regain their birth weight by 10-14 days
149
Q

in addition to voids, stools, and weight gain, what are other signs that the baby is getting enough to eat? (4)

A

baby should:
- have a strong cry
- move actively
- wake easily

  • breasts feel softer and less full after breastfeeding

NURS 4500: Final Material (16 decks)

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