Infant Nutrition & Breastfeeding (pg 523-531)

Question 1

Lactation

Answer 1

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

Question 2

Maternal Lactation Needs

Answer 2

Increased water intake
Variety of nutrient dense foods
Increase ~500kcal/day

Question 3

Breastfeeding

Answer 3

A dynamic process, which requires coupling between periodic motions of the infant’s jaws, undulation of the tongue, and breast milk ejection reflex

Question 4

Newborn Nutrition Needs

Answer 4

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+

Question 5

Nurse’s Role in Breastfeeding

Answer 5

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

Question 6

Advantages of Breastfeeding

Answer 6

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

Question 7

Disadvantages of Breastfeeding

Answer 7

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

Question 8

Physiological Changes to Prep for Breastfeeding

Answer 8

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

Question 9

Role of Prolactin

Answer 9

Secreted from anterior pituitary gland
- Increasing levels throughout pregnancy

Question 10

Colostrum

Answer 10

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

Question 11

Transition Milk

Answer 11

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

Question 12

Mature Milk

Answer 12

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

Question 13

How is breast milk produced?

Answer 13

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

Question 14

Role of Oxytocin & Prolactin

Answer 14

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

Question 15

Let-Down Reflex

Answer 15

A tingling sensation in both breasts that occurs immediately before or after breastfeeding

Question 16

The Golden Hour

Answer 16

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

Question 17

Breast Crawl

Answer 17

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

Question 18

Hunger Cues

Answer 18

Early Cues: Rooting, mouth opening, licking lips

Mid Cues: Eating hands, more active & wriggling

Late Cues: Crying & agitated

Question 19

Latching

Answer 19

Correct latch allows efficient milk transfer and prevents sore and cracked nipples

Introduce nipple like a hamburger, not like a cigarette!

Scoring

Question 20

Steps to Ensure Proper Breastfeeding & Latch On

Answer 20

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

Question 21

Latch Scoring

Answer 21

The systematic method used to assess and document the quality of a breast feed on a scale of 0-10

Question 22

Latch Score of 0 points

Answer 22

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)

Question 23

Latch Score that Adds 1 Point

Answer 23

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

Question 24

Latch Score that Adds 2 Points

Answer 24

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

Question 25

Characteristics of Successful Breastfeeding

Answer 25

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

Question 26

Unsuccessful Breastfeeding

Answer 26

Anything that interferes with growth or integrity of breast, hormone levels, or breast stimulation can affect milk supply

Question 27

Engorgement

Answer 27

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

Question 28

Breast Engorgement Treatment

Answer 28

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.

Question 29

Mastitis

Answer 29

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

Question 30

Hand Expression

Question 31

Breast Pumps

Question 32

Breast Milk Storage Guidelines

Answer 32

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

Question 33

How long is leftover milk good for?

Answer 33

Use w/in 2 HRS after the baby has been finished feeding

Question 34

Formula Storage

Answer 34

Can prepare up to 24hr in advance and stored in fridge

Question 35

Preparing Milk

Answer 35

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

Question 36

Lactation Suppression

Answer 36

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

Question 37

The Baby Friendly Initiative: 10 Steps to Successful Breastfeeding (Nursing Interventions)

Answer 37

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.