Infant Nutrition & Breastfeeding (pg 523-531) Flashcards
Lactation
Secretion of milk via breasts
Thought to be initiated by the interaction of progesterone, estrogen, prolactin, & oxytocin
Breast milk typically appears 4-5 days after childbirth
Maternal Lactation Needs
Increased water intake
Variety of nutrient dense foods
Increase ~500kcal/day
Breastfeeding
A dynamic process, which requires coupling between periodic motions of the infant’s jaws, undulation of the tongue, and breast milk ejection reflex
Newborn Nutrition Needs
100-110 kcal/kg/day
Feed on demand: ~ Every 2-3hr
Weight loss for the first 3-4 days
- Then weight gain about 10g/kg/day
American Academy of Pediatrics recommends exclusive breastfeeding for 6mo, and continued BF for 1yr+
Nurse’s Role in Breastfeeding
Must have the necessary knowledge and skills to provide breastfeeding education to all mothers.
Foundation for Successful Breastfeeding:
- Proper positioning
- Latching-on
- Sucking,
- Swallowing
Although breastfeeding is recommended by international and national organizations, the nurse must respect and support all mothers in either of the infant feeding methods chosen
Advantages of Breastfeeding
Immunologic Properties (Antibodies prod by mom)
Easy digestion
Content varies according to infant’s needs
Helps w/ attachment
Convenient, safe, & free
Reduces risk of SIDS
Lowers risk of breast cancer
Lowers risk of postpartum complications
Better neurodevelopment
Reduces risk of chronic disease
Disadvantages of Breastfeeding
Meds passed through milk
HIV transmission
Limits partner involvement
Employment and childcare
Can be stressful and painful
Not possible with Hx breast surgery
Affects body image
Lack of knowledge and support
Culture and stigma
Surrogacy or Adoption
Physiological Changes to Prep for Breastfeeding
Breasts increase in size and functional ability in preparation for breastfeeding during pregnancy
Estrogen stimulates growth of the milk collection (ductal) system, while progesterone stimulates growth of the milk production system.
W/in the 1st month of gestation, the ducts of the mammary glands grow branches, forming more lobules and alveoli.
- Make the breasts larger, more tender, and heavy.
- Each breast gains nearly 1 lb in weight by term, the glandular cells fill with secretions, blood vessels increase in number, and the amounts of connective tissue and fat cells increase
Role of Prolactin
Secreted from anterior pituitary gland
- Increasing levels throughout pregnancy
Colostrum
Develops during pregnancy and lasts several days after delivery
Synthesized from prolactin, estrogen, and progesterone during pregnancy
Yellowish, thicker than milk
Small quantity
Nutrient dense: low fat, high protein, many vitamins and minerals
Rich in antibodies to help produce passive immunity
Coats and protects baby’s digestive tract, helps establish healthy gut flora
Laxative effect, helps prevent jaundice
It is only after birth takes place, when the high levels of estrogen and progesterone are abruptly withdrawn, that prolactin is able to stimulate the glandular cells to secrete milk instead of colostrum.
- Takes place within 4 to 5 days after giving birth
Transition Milk
Produced from end of colostrum stage until about 2 weeks postpartum
Quantity increases, changes in appearance and composition
Contains: more fat, sugar, vitamins, and calories
Mature Milk
Thinner and waterier than cow’s milk
White, can be slightly blue-tinged in color
Foremilk- beginning of feeding
-More water and lactose
Hindmilk- end of feeding
-Higher fat content
~20kcal/oz
How is breast milk produced?
1) Mammary glands grow and mature due to estrogen and progesterone
- During pregnancy breasts mature, causing growth of mammary glands (ducts, alveoli, vessels, fat)
- Can cause heaviness and tenderness
2) Placenta delivery triggers release of prolactin & oxytocin
3) Prolactin: Triggers milk synthesis
- Creates milk supply
4)Oxytocin: Triggers milk ejection “let down”
5) Breast Stimulation: Prolactin and oxytocin surge, Creates supply in response to demand
- The more the breast is emptied, the more milk is made
Role of Oxytocin & Prolactin
Acts so that milk can be ejected from the alveoli to the nipple
- When the newborn sucks at the nipple-> milk release
Also plays a role in uterine contractions during birth
A decrease in the quality of stimulation causes a decrease in prolactin surges and thus a decrease in milk production.
Prolactin levels increase in response to nipple stimulation during feedings.
Prolactin and oxytocin result in milk production if stimulated by sucking
- If the stimulus (sucking) is not present, as with a woman who is not breastfeeding, breast engorgement and milk production will subside within days postpartum
Let-Down Reflex
A tingling sensation in both breasts that occurs immediately before or after breastfeeding
The Golden Hour
Baby alert and ready to feed within 1-2 hours after birth
Optimum place for baby to recover from birth is skin to skin on mother’s chest
Newborn will instinctively root and seek out breast
Recovery sleep
Newborns have senses and skills that enable early initiation of feeding at the breast.
Nurses can help facilitate the breast crawl as a continuation of the birthing process.
- Have a responsibility to promote the health of their childbearing families and provide evidence-based care
- Encouraging use of the breast crawl can be the first step in health promotion for every newborn.
Additionally, it achieves the same benefits if carried out by fathers
Breast Crawl
A newborn moves on their mother’s abdomen up to her breast instinctively
- Helps initiate breastfeeding immediately after childbirth
This instinct occurs when a newborn, left undisturbed and skin-to-skin on the mother’s trunk following birth, moves toward the mother’s breast for the purpose of locating and self-attaching for the first feeding
From there, the newborn uses leg and arm movements to propel toward the breast
Upon reaching the sternum, the newborn will bounce the head up and down and side to side
As the newborn approaches the nipple, the mouth opens and after several attempts, latch-on and suckling take place
Hunger Cues
Early Cues: Rooting, mouth opening, licking lips
Mid Cues: Eating hands, more active & wriggling
Late Cues: Crying & agitated
Latching
Correct latch allows efficient milk transfer and prevents sore and cracked nipples
Introduce nipple like a hamburger, not like a cigarette!
Scoring
Steps to Ensure Proper Breastfeeding & Latch On
1) Hold baby w/ their whole body facing the mother
2) Place baby’s nose & chin against mother’s breast
- “Sniffing” Position
3) Ensure mother supports neck, head, & back
Baby should draw both nipple & majority of areola in their mouth
- Listen for sucking noises
Breastfeeding should NOT be painful!
- If the latch is too uncomfortable, use a clean finger to sweep the nipple from the baby’s mouth
Latch Scoring
The systematic method used to assess and document the quality of a breast feed on a scale of 0-10
Latch Score of 0 points
Latch: Sleepy, reluctant, NO latch
Audible Swallow: NONE
Type of Nipple: Inverted
Comfort: SEVERE pain
- Engorged
- Cracked, bleeding nipples
- Blisters
- Bruising
Hold: FULL ASSIST (Staff holds baby)
Latch Score that Adds 1 Point
Latch: Attempts to hold nipple in mouth
- Sucks w/ stimulation
Audible Swallow: FEW
- A few w/ stimulation
Type of Nipple: Flat
Comfort: Moderate pain
- Reddened
- Blisters
- Bruises
Hold: Minimal Assist
- Teach one side, mom does other
- Staff holds, mom take over
Latch Score that Adds 2 Points
Latch: Rhythmic sucking
- Grasps breast deeply
- Tongue down
- Lip flanged
Audible Swallow: Spontaneous & intermittent ( < 24 hrs)
- Frequent ( > 24 hrs)
Type of Nipple: Everted
Comfort: No pain, comfortable
Hold: NO ASSIST
- Mom able to position/hold baby
Characteristics of Successful Breastfeeding
Nursing at least 8 times in 24 hours
- W/in the 1st 24 hrs, baby needs to have 1 wet & 1 poopy diaper
Adequate latch w/ infant swallowing
Breasts appear to soften after breastfeeding
The process is comfortable & pain-free
6-8 wet diapers daily
3+ stools daily
Infant weight gain
Baby is satisfied after feeding
Baby is calm & active when awake
Unsuccessful Breastfeeding
Anything that interferes with growth or integrity of breast, hormone levels, or breast stimulation can affect milk supply
Engorgement
A postnatal physiologic painful condition in which distention and swelling of the breast tissue occurs as a result of an increase in blood and lymph supply as a precursor to lactation
Usually peaks in 3 to 5 days postpartum and usually subsides within the following 24–36 hours.
If milk is not removed as it is formed, the alveolar space can become overdistended,
- Causes tender, swollen, and painful breasts
Can occur from infrequent feeding or ineffective emptying of the breasts and typically lasts about 24 hours.
Breasts increase in vascularity and swell in response to prolactin 2 to 4 days after birth.
- If engorged: Breasts will be hard and tender to touch.
- They are temporarily full, tender, and uncomfortable until the milk supply is ready
Breast Engorgement Treatment
Frequent emptying of the breasts helps minimize discomfort and resolve engorgement
Standing in a warm shower or applying warm compresses immediately before feedings will help to soften the breasts and nipples in order to allow the newborn to latch on more easily.
Treatments to reduce the pain of breast engorgement include:
- Heat or cold applications: Between feedings, applying cold compresses to the breasts helps reduce swelling
- Cabbage leaf compresses: Help draw excess fluid out
- Breast massage and milk expression
- Ultrasound
- Breast pumping: To maintain milk supply, the breasts need to be stimulated by a nursing infant, a breast pump, or manual expression of the milk
- Anti-inflammatory agents: A nonprescription anti-inflammatory medication can also be taken for the breast discomfort and swelling resulting from engorgement.
These measures will also enhance the let-down reflex.
Mastitis
Infection related to impaired skin integrity and milk stasis
- Inflammation of mammary gland.
Signs & Symptoms:
- Flu-like symptoms and red, tender breasts that are hot to the touch
Treatment: Antibiotics, NSAIDs, and effective milk removal
- May lead to abscess if left untreated
Hand Expression
Breast Pumps
Breast Milk Storage Guidelines
Type: Countertop 77 degrees F (25 degrees C) or colder (room temp) Milk
- Freshly expressed or Pumped: Up to 4 hrs
- Thawed previously frozen: 1-2 hrs
Type: Refrigerator 40 degrees F ( 4 degrees C)
- Freshly expressed or pumped: Up to 4 days
- Thawed previously frozen: Up to 1 day
Type: Freezer 0 degrees F (-18 degrees C) or colder
- Freshly expressed or pumped: Up to 6 months is best, 12 months is ok
- Thawed previously frozen: NEVER refreeze human milk after it has been thawed
How long is leftover milk good for?
Use w/in 2 HRS after the baby has been finished feeding
Formula Storage
Can prepare up to 24hr in advance and stored in fridge
Preparing Milk
Breastmilk and formula can be given at room temp
Never use microwave!
Boil water before mixing powdered formula if <2mo
Wait to cool before feeding
Feed semi-upright and stop to burp regularly
Never prop bottle!
Discard leftover after
Lactation Suppression
Up to 2/3 of women who do not breastfeed experience moderate to severe engorgement and breast pain when no treatment is applied
If a woman does not desire to breastfeed, some relief measures include:
1) Wear supportive, snug bra for 24hr daily
2) Shower with water hitting back, not breasts
3) Avoid breast stimulation including sucking and massage
4) Do not restrict fluid intake
5) Reduce salt intake to decrease fluid retention
6) Take mild analgesics to reduce discomfort
7) Use cool compresses or ice packs to decrease pain and swelling
Suppression may take 5-7 days
Avoiding exposing the breasts to warmth (e.g., a hot shower) will help relieve breast engorgement.
- In women who are not breast-feeding, engorgement typically subsides within 2 to 3 days with application of these measures
The Baby Friendly Initiative: 10 Steps to Successful Breastfeeding (Nursing Interventions)
1) Have a written breastfeeding policy that is routinely communicated to all health care staff.
2) Ensure that staff have sufficient knowledge, competence, and skills to support breastfeeding.
3) Discuss the importance and management of breastfeeding with pregnant women and their families.
4) Facilitate immediate and uninterrupted skin-to-skin contact, and support mothers in initiating breastfeeding as soon as possible after birth.
5) Support mothers in initiating and maintaining breastfeeding and manage common difficulties.
6) Demonstrate to all mothers how to initiate and maintain breastfeeding.
7) Encourage breastfeeding on demand.
8) Counsel mothers on the use and risks of feeding bottles and pacifiers.
9) Establish breastfeeding support groups and refer mothers to them.
10) Enable mothers and their infants to remain together and to practice rooming-in 24hr a day.
