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OB/PEDS: Midterm > INFANT FEEDING: > Flashcards

INFANT FEEDING: Flashcards

1
Q

Benefits of Breastfeeding:
for Baby

A
  • Immunity
  • Gastrointestinal
  • Brain development
  • Bonding
  • Better health (*prevents respiratory illness)
  • Lowered infection rates
  • Happier baby
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2
Q

Benefits of Breastfeeding
Benefits for Baby
Immunity:

A
  • starting with colostrum
  • Breast milk helps develop immunity, starting with the colostrum, which is a distillation of the mothers lifetime immunity
  • Breastmilk is easier to digest, and will empty faster from the baby stomach. It coats and seals the intestine, making the intestines less permeable to bacteria and viruses
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3
Q

Benefits of Breastfeeding
Benefits for Baby:
Gastrointestinal

A
  • easier to digest
  • Breast-fed babies have less colic, constipation, and diarrhea
  • Breast milk, actually engulfs and digests rotavirus, a Common Pediatric form of gastroenteritis
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4
Q

Benefits of Breastfeeding
Benefits for Baby:
Brain development:

A
  • higher IQ scores
  • Breastmilk, enhances, optimal brain development, with IQ scores 5-10 points higher in breast-fed infants
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5
Q

Benefits of Breastfeeding
Benefits for Baby
Lowered infection rates

A
  • Breast Milk protects the baby from respiratory illnesses, such as RSV and pneumonia
  • Hospitalization rates and infection are much lower for breast-fed babies
  • Lower lifetime risk of diabetes type two, multiple sclerosis, obesity, and childhood cancers
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6
Q

Benefits of Breastfeeding
Mom

A
  • Healthier baby
  • Lower cancer risks
  • Delayed return of period/less bleeding
  • Weight loss
  • Time savings
  • Bonding
  • Relaxation
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7
Q

AAP Recommendations

A

The American Academy of Pediatrics:
- recommends exclusive breastfeeding for 6 months, with the introduction of complementary foods and vitamins at 4-6 months-
- with breastfeeding for a full year and beyond that as long as mutually desired by mother and child.
.
- If a mother weans before a year of age, the baby will need to be on formula until one year of age, when cows milk may be introduced
- Many mothers plan to nurse their babies for a full year, but may wean prematurely, due to going back to work or low milk supply

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8
Q

Hormones of Breastfeeding

A

prolactin and oxytocin
- are the two hormones that make milk

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9
Q

Prolactin

A
  • *if mom is not producing prolactin, check for leftover placental fragments)
  • Produced by the anterior pituitary gland, early in pregnancy in response to estrogen and progesterone.
  • Prolactin receptors in the breasts, are blocked by high levels of estrogen and progesterone, which inhibit milk, production until birth
  • Prolactin causes the alveoli of the breast to enlarge in preparation for making milk; *causes milk cells to produce milk
  • Upon delivery of the placenta, estrogen and progesterone levels, decrease rapidly, while prolactin levels will peak
  • Prolactin levels peek at 45 minutes after a feeding and then returning to baseline in about three hours
  • *If the placenta is not completely removed, then fragments of it can keep the progesterone levels too high to stimulate milk production
  • If a mother’s milk has not come in by the 4th to 5th postpartum day, and she is bleeding heavily, then she may have a retained placenta, and may need a D&C.
  • A piece of placenta as small as a thumbnail can keep a mothers milk from coming in
  • Stimulates breast development
  • Causes milk cells to produce milk
  • Released in response to suckling/breast emptying
  • Incomplete removal of placenta blocks milk production
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10
Q

Oxytocin

A
  • *Causes uterine contractions (like pitocin)
  • Released from posterior pituitary
  • *Causes milk ejection
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11
Q

Infant Stomach Size

A
  • 1st day of life: 5-7 ml marble size
  • 3rd day of life: 22-27 ml Ping-pong ball size
  • 10th day: 60-81 ml Extra large chicken egg size
  • 30 ml = 1 ounce
  • Stomach size increases with age: Most 6 week olds eat 2-3 ounces per feeding
    .
    .
  • Notes:
  • babies who are breast-feeding well and having a Adequate output really do not need anything but Mom’s colostrum the 1st 3 days of life
  • Explaining to mothers, the size of a newborn stomach, and help them to believe that they are claustrum, which comes in spoonfuls, not ounces, is the perfect food for the baby
  • By the time, the baby is 6 weeks old, they will eat approximately 2-3 ounces per feeding
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12
Q

Initiation of Breastfeeding

A
  • Initial feeding as soon as possible after delivery (30-60 minutes) once mom and baby are stable
    — A baby, in respiratory distress should be observed in the nursery until stable
    — First breast-feeding in the golden hour if possible
  • May feed 10-40 minutes a breast
  • Let drain one breast, then burp and offer a second breast.
  • Baby may take only one breast.
  • Babies are most alert in the first hour after delivery (golden hour). Babies then go into a deep sleep cycle for 4-6 hours, during which it will be harder to feed them
  • Baby should be placed skin to skin with the mother
    — She will need to remove her bra and unbuttoned her down to make this easier.
    — Babies are proven to latch and suck better wind skin to skin.
    — Make sure that the mother is comfortable, with pillows to support under her arms
  • Ensure mom’s privacy by having visitors leave the room
    — Milk, let down is less likely to occur with the stress of visitors
  • Mother may try to express a drop or two of colostrum for the baby to smell, as this will help guide the baby to the nipple
    — She may also need to gently roll the nipple to evert it
    — Guide the babies nose toward the nipple and let it latch on and suck until it falls off content
    —- This may take 10 to 40 minutes. If mom is getting sore or ready to switch, then she can gently put a finger at the side of the babies mouth and move the child to the other side.
  • Don’t be surprised if the baby does not burp.
    — This is not unusual, since there is no air in the breast. If the baby latches as well, it does not take in any air while breast-feeding.
    — Some babies will only take one breast in feeding, especially in multiparas mothers and moms with ample colostrum
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13
Q

Initiation of Breastfeeding:
C-section

A

May take longer with C-sections
- C-section babies may have more amniotic fluid in their lungs and need oxygen and observation, but can easily be fed in the recovery room once stable

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14
Q

Feeding Cues:

A
  • Babies feed best when they are hungry. Teach new moms to watch babies for signs of hunger:
    — *Chewing hands, sucking their fingers, lips, or fists
    — *Smacking lips
    — *Tongue motions
    — *Fussing, Crying
    —- By the time the baby is crying, it is a late sign of hunger, and the baby maybe inconsolable
  • Increased Movement
  • rapid eye movements in sleep
  • Rooting

Notes: just read
- Rooming in encourages breast-feeding, because the baby is near the mother as soon as it shows cues
- Pacifier and formula use is discouraged in breast-fed babies, especially as they are still learning to latch, and be satisfied at the breast. It is harder to notice feeding cues in a baby that is sucking a pacifier.
- Frequency of feeds varies the first few days of life. Most babies are very tired the first few days and may only feed every 3-5 hours. Once they start waking up, they may feed every hour or more. This is a dramatic transformation for the mother to understand: going from a baby that “won’t wake up” to a baby that “ won’t quit eating” but very normal in terms of newborn behavior.
- Ultimately, babies should feed 8-12 times in 24 hours to bring milk in well and maintain a supply, but this is more likely to happen after the sleepy first 24 hours of life.

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15
Q

Proper Positioning

A
  • Make mom comfortable
  • *Position baby with support for the back of his neck
  • *Tilt baby’s chin into breast
  • *Support baby’s buttocks
  • *Assure airway
  • *C-hold on breast
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16
Q

Proper Positioning:
Make mom comfortable

A
  • Introduce yourself and explain what you were going to do. If you just come in and grab a mom’s breast, then she may view you as pushy or rude. Admire her baby and start asking basic assessment questions.
  • Next, make sure that Mom is well positioned in a chair or in the bed, with plenty of pillows, a Boppy, or whatever she needs to feel physically comfortable.
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17
Q

Proper Positioning:
Position baby with support for the back of his neck

A
  • As she brings the baby in tummy to tummy, she should support the back of the baby’s neck and his buttocks. This makes the baby feel secure, because babies have a strong, startle reflex that makes them scared of falling.
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18
Q

Proper Positioning:
Tilt baby’s chin into breast

A
  • She should bring the baby toward her and not lean into the baby
  • As the baby’s chin tilts into the breast, it stimulates sucking.
  • Many mothers strain their backs, and necks with poor baby mechanics
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19
Q

Proper Positioning:
Assure airway

A

A larger breasted Mom may need to modify her, hold on the breast and gently pull breast tissue away from the babies nose
- Babies are obligate nose breathers, and will not suck when their airways are occluded.
- Mothers may also pull their babies legs closer into them, curling them around their opposite side, which angles the baby away from the breast.
- Many mothers inadvertently, get sore nipples by pulling the baby back too far from the breast to get a wide latch and a full mouthful of breast

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20
Q

Proper Positioning:
C-hold on breast

A
  • The C hold supports the breast while breast-feeding. The woman should cup her breast in her hand between the index finger and thumb.
  • Many smaller, breasted moms do not even need to hold the breast to the babies, mouth, but larger breasted women find this essential
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21
Q

Positions:

A

Cradle Hold:
Cross Cradle Hold:
Football hold:
Side lying:

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22
Q

Establishing Latch

A
  • Nose to nipple
  • Open wide
  • Chin first and bring top lip up and over the nipple
  • Flanged lips
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23
Q

Latch Score:

A

Score of 7 or less indicates mother needs further assistance with breastfeeding

Measures:
- Latch
- Audible Swallowing
- Type of Nipple
- Comfort
- Hold

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24
Q

Assessing Supply

A

Moms are often concerned that they are not making enough milk. Some good ways to assess actual supply include:
- Pre-post weights
- Breast changes during feeding: becomes softer
- *6-8 wet and 2-3 dirty diapers in 24 hours
- Audible gulping
- Satisfied after feeds
- Leaking milk or letdown

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25
Q

Assessing Supply: Pre-post weights

A
  • With the baby before, and after a breast-feeding and measure the weight in grams
  • 30 g equals 1 ounce. The baby should get 1 - 4 ounces (30 - 120 grams) in an average breast-feeding, depending on the age of the baby. This is not always terribly accurate (low volumes of claustrum don’t show up well in this method), it can give a good general idea how much of the baby is getting
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26
Q

Assessing Supply:
Breast changes during feeding: becomes softer

A

The breast should feel full at the beginning of the feeding and softer at the end

27
Q

Assessing Supply:
6-8 wet and 2-3 dirty diapers in 24 hours

A

The baby should have 6 - 8 wet diapers per day, with non-concentrated urine, and 2-3 soft yellow stools per day

28
Q

Assessing Supply:
Audible gulping

A

The baby should be swallowing or gulping at the breast, taking pause type sucks at intervals

29
Q

Assessing Supply:
Satisfied after feeds

A
  • Baby should seem satisfied after feedings. Some babies fall off the breast looking drunk.
  • An average feed last 10-20 minutes. It is not unusual for a baby to nurse up to 30 minutes per breast with claustrum, but once milk comes in, the baby generally is content after 10-20 minutes, on average
  • A baby that is on each breast for 30-40 minutes per breast, never seeming satisfied, warrants investigation of Mom’s milk supply
30
Q

Assessing Supply:
Leaking milk or letdown

A

Mom should have some milk leak from the breast or feel a let down. Note that not all first time mom’s feel let down occurring.

31
Q

7-10 days without BF=

A

dried up milk
.
- Many moms feel that they are drying up when babies go into a growth spurt at 2 or 6 weeks. Normal breast fullness, which accompanies engorgement persists the first few weeks after delivery and then goes down, but it does not mean that milk has dried up. When babies get older and more efficient at nursing, they empty the breast more quickly and efficiently, which can also lead to this perception.

32
Q

Increasing Milk Supply:

A
  • Increase breast stimulation (nursing/pumping):
  • Fluid intake:
  • Rest
  • Medication Therapy
33
Q

Increasing Milk Supply:
Increase breast stimulation (nursing/pumping):

A

The first thing to do after assessing supply is to increase stimulation to the breast, with more frequent breast-feeding, or with adding breast pumping right after mom, feeds or an hour after feeding. If the baby latches or feeds poorly, this may well help the milk supply.

34
Q

Increasing Milk Supply:
Fluid intake:

A

Have mom’s increase their fluid and food intake. Some new moms are so busy feeding their babies that they forget to feed themselves.

35
Q

Increasing Milk Supply:
Rest

A

Tired moms have difficulty making enough milk. Encourage them to rest when the baby naps and to get help from friends or family with household tasks.

36
Q

Increasing Milk Supply:
Medication therapy

A

If your mom has recently started an estrogen, containing birth control pill, this may be drying her up. Other causes: prolonged use of pseudoephedrine, containing medication for a cold, lower thyroid levels or pregnancy (which may be difficult to accept when she may not have even resumed normal menses).

37
Q

Maternal Problems

A
  • Sore Nipples
  • Engorgement
  • Breast Infections
  • Oversupply
38
Q

Maternal Problems
Sore Nipples: Cause/ Treatment

A
  • Poor latch
  • Poor baby position
  • Strong suction
  • Anatomical problems: Tongue tie/ bubble shaped/ high palette
    .
    Treatments
  • Latch/positioning
  • Lanolin cream
  • Air drying with EBM
  • Keeping the area dry, either through keeping the bra flap down or frequent changing of breast pads works well also
39
Q

Maternal Problems:
Engorgement: occurs when?
Treatment

A
  • Occurs on day 3-5
  • Heat
  • Emptying breast
  • Maintain latch
  • Pumping
  • Cold treatment (cold stops milk production)
  • Cabbage
  • Medications (like Benadryl to dry up the milk)
40
Q

Maternal Problems: Breast Infections:

A
  • mom may still breast-feed the baby
  • Mothers with breast infections should contact their OB/GYN *as soon as possible
  • Putting it off, could lead to a breast infection, so severe that it abscesses
  • Not taking the entire course of antibiotics can be detrimental, as partially treated mastitis can occur
  • Mastitis
41
Q

Mastitis: S/S

A
  • An infection of the breast tissue
  • It is usually unilateral and sudden in origin
  • It is seen more often in women using nipple shells or shields, with cracked nipples, poorly fitting underwire bras, and with a rundown physical condition.
  • The milk becomes sour in taste
  • The DNA in breast-feeding, polymerizes, forming a sticky goo in the infected area, so the milk will be thicker and harder to extract

-S/S:
— high fever
— bodyaches
— flu symptoms
— breast redness
— severe pain

42
Q

Mastitis:
Treatment

A
  • antibiotics (preferably dicloxacillin, Augmentin, or Keflex)
  • Anti-inflammatories/antipyretics
  • Breast drainage through breast-feeding, and pumping
    — It is important not to stop breast-feeding during mastitis, as the breast needs to be drained to avoid abscess
43
Q

Thrush
Mother s/s:
Treatment:

A
  • A yeast infection of the nipple tissue, not the milk ducts.
  • If the baby is diagnosed with thrush, the baby is likely to pass it along to mother
  • The mother may have:
    — sharp stabbing pain in the nipples
    — redness, or pinkness of Areola
    — nipple cracking
    — possibly even a red or white rash around the area.
    — It is more common in women with a history of yeast infection or antibiotic treatment.
    Treatment: Both baby and mother need treatment
  • Dr. Newman’s APNO
  • topical antifungal.
44
Q

Topical Staph infections:
- Treatment

A

May be an unrecognized cause of ongoing nipple soreness
Treatment:
- Mupirocin (bactroban) rapidly improve symptoms of soreness
- Easily treated and rarely recognized
- Mom’s may also use Polysporin ointment

45
Q

MRSA:

A

Methicillin Resistant Staph Aureus
- Can cause long-term colonization in severe accessing and needs complete antibiotic treatment
- Mothers with MRSA may continue to breast-feed, as antibiotics in the breast milk will protect the baby who has already been exposed
- *Mom may still breastfeed baby

46
Q

Maternal Problems:
Oversupply
- issue/ treatment

A
  • Baby may choke and sputter
  • Do one sided feeds
    — Some others, with an abundance of milk, will try feeding one breast at a time, which can down regulate her supply
    — Other mothers opt to pump and store some of the excess, denoting it to a milk bank, or storing it for later
    — Lots of breast pads, an upright, feeding position for the baby, and a good sense of humor will help this mother
47
Q

Shields or shells may be used especially for what kind of nipples

A

inverted or flat nipples

48
Q

Nipple shield:

A
  • Silicone nipples with holes in the end. They fit over the mothers nipple and part of the areola. They allow the baby to latch and suck when they are having difficulty due to the shape or size of the nipple.
  • They come in sizes from 16mm, 20mm, 24mm to cover a variety of nipple sizes
  • They can be used repeatedly and washed between usages.
  • They should be seen as a temporary aid, due to a potential for poor weight gain. With a shield, the baby is not putting their mouth directly on the breast and may not get as much Ariola as they would otherwise.
  • With a plan to monitor output and weight gain, the shield is a very useful tool, indeed
  • Note: no milk or colostrum transfer is seen, this would be a case in which to consider supplementation until the milk comes in or milk flow is seen.
49
Q

Nipple shells:

A
  • Hard plastic device that can be used to help evert flat or everted nipples, or to provide airflow by keeping clothing off of sore nipples
  • They are not in favor by most LCs, because they can cause pressure and bruising on an edematous Ariola (when the milk comes in). They also cause more milk, leakage, and most LCs would prefer to use a nipple shield to assist latch.
  • Mini mom’s report giving up breast-feeding while using nipple shells because they made it so much more complicated
  • However, some mom swear by their usefulness
  • Some OB doctors recommend that Mom’s wear them prenatally to help evert flat or inverted nipples
50
Q

Pacifier may cause

A

nipple confusion

51
Q

Types of nipples

A

Everted: out
Flat: flat
Inverted: in

52
Q

What is Safe for the Breastfeeding Mom to Take ?

A

Anesthetics
Birth control
OTC meds
Sudafed
Pediatric meds

53
Q

What is Safe for the Breastfeeding Mom to Take ?
Anesthetics:

A

Most anesthesia clears the system rather quickly, and once a mother is awake and alert, she should be able to feed her baby. With general anesthesia, the baby may have received a fair amount, trans-placentally, and so the infant may be quite groggy and have poor sucking initially.

54
Q

What is Safe for the Breastfeeding Mom to Take ?
Birth control :

A
  • Estrogen containing birth control pills can completely dry up milk supply, often irretrievably
  • Mother should take a progesterone based pill, such as Micronor, or Mirena IUD, or use a barrier method
  • Reminding mothers of this at discharge teaching
  • Depo-Provera, given in the immediate few days after delivery is contraindicated, as it can block, milk production dramatically
55
Q

What is Safe for the Breastfeeding Mom to Take ?
OTC meds

A
  • as long as they come in pediatric dose)
  • Can be looked up as needed
  • Imodium= diarrhea
  • Tylenol/Advil= headaches
  • Maalox= upset stomach
  • Reglan= reflex
  • Vitamins
  • And most nasal sprays for allergies
56
Q

What is Safe for the Breastfeeding Mom to Take ?
Sudafed:

A
  • for Nasal congestion
  • Sudafed (pseudoephedrine) is an L-3, found in many cold and allergy preparation, and has been shown to decrease milk supply by as much as 24% and some others
  • And a mother with low milk supply, or an older baby, it could definitely cause a big drop in Supply
  • Council lactating mothers to find an alternative decongestant
  • Benadryl (diphenhydramine) is an L-2 and may cause sedation. Not recommended for Mothers with babies under 4 months
57
Q

What is Safe for the Breastfeeding Mom to Take ?
Pediatric meds:

A

Generally all medication that is given to a child is safe for a mother to take herself

58
Q

When Breastfeeding is Contraindicated

A
  • An infant diagnosed with galactosemia, a rare genetic metabolic disorder
    The infant whose mother:
  • Has been infected with the human immunodeficiency virus (HIV)
  • Is taking antiretroviral medications
  • Has untreated, active tuberculosis
  • Is infected with human T-cell lymphotropic virus type I or type II
  • Is using or is dependent upon an illicit drug
  • Has herpes simplex lesions on the breast
  • Is taking prescribed cancer chemotherapy agents, such as antimetabolites that interfere with DNA replication and cell division
  • Is undergoing radiation therapies; however, such nuclear medicine therapies require only a temporary interruption in breastfeeding
    All medications mother is taking must be double checked with MD and in the drug book for contraindications.
59
Q

Storage and Handling
Of breast milk

A
  • Remember that breast milk is a body fluid so gloves must be worn while handling.
  • Milk must never be given to the wrong child.
  • Be especially careful to label breast milk with the correct child’s hospital sticker or name, date/time
  • *Breast milk should never be warmed in a microwave
60
Q

Breast Milk Storage Guidelines
Freshly expressed breast milk:
- Room temp
- Refrigerator temp
- Freezer temp

A

Room temp: 4 hours at 66° - 72°
Refrigerator: 3-8 days at 32°-39° F (0-4 C)
Freezer: 6-12 months at 0° F (-19 C)

61
Q

Breast Milk Storage Guidelines
Thawed breastmilk (previously frozen):
- Room temp
- Refrigerator temp
- Freezer temp

A
  • Room temp: do not store; Once breastmilk is thawed, it should be used right away
  • Refrigerator: 24 hours
  • Freezer: never refreeze thawed milk
62
Q

Formula:
When to give it:

A

The point that preserving and supporting breast-feeding is vital and supplementation is usually a temporary option is an important thing to remind the mother
- Weight loss above 10% or FTT
- Severe jaundice
- Hypoglycemia
- Prematurity
- Refusal to feed
- Low milk supply
- Provider order
- Personal Preference

63
Q

Breast feeding:
Counseling Techniques

A
  • In reality not all mothers will make enough milk
  • Not all mothers want to breastfeed
  • Many mothers may have a decrease in supply from stress
  • Not all mothers will succeed
  • Avoid guilt & shame
  • Be supportive
  • Be sensitive
  • See what mom really wants
  • Be flexible
  • Be a cheerleader/ praise her mothering, and her bonding
  • Reassure

OB/PEDS: Midterm (21 decks)

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