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NS 7100 > Module 7: Infant Feeding > Flashcards

Module 7: Infant Feeding Flashcards

1
Q

What are 4 health benefits of breastfeeding to infant?

A
  • Enhanced lifetime immunity

Reduced risk for:
- Gastrointestinal infections
- Respiratory tract infections
- SIDS
- Adolescent and adult obesity
- type 1 and 2 diabetes
- Celiac disease
- Asthma
- Eczema
- Otitis media
- Acute lymphocytic and myeloid leukemia

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2
Q

What are 4 health benefits of breastfeeding to pre-term infant?

A
  • Decreased incidence of sepsis
  • Decreased risk of necrotizing enterocolitis (GI disease)
  • Enhanced neurodevelopment
  • Quicker weight gain

Short + Long term benefits:
- protection from necrotizing enterocolitis
- protection from infection
- increased feeding tolerance
- earlier attainment of full enteral feedings
- decreased risk for later allergy
- improved retinal function
- improved neurocognitive development
- suppression of oxidative stress
- reduced heart disease later in life

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3
Q

What are 4 health benefits of breastfeeding to mother?

A
  • Decreased postpartum bleeding
  • More rapid involution
  • Increased maternal role attainment
  • Decreased incidence of postpartum depression

Reduced risk for:
- Ovarian and breast cancer
- Type 2 diabetes
- Hypertension
- Cardiovascular disease
- Rheumatoid arthritis

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4
Q

What are 4 health benefits of breastfeeding to families and society?

A
  • Convenient (ready anytime, anywhere, no bottles, plastic nipples, or sterilizing required)
  • Less expensive than formula
  • Reduced annual health care costs
  • Less parental absence from work due to illness
  • Reduced environmental impact (no packaging, no garbage)
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5
Q

What are 4 risks of formula feeding indicated by Stuebe (2009)?

A
  • increased risk of infectious morbidity in the first year of life,
  • 3.6 fold increased risk of hospitalization for respiratory illness in the first year,
  • 2.8 times more likely to have GI infections,
  • increased risk of SIDS,
  • increased risk of obesity, and type 2 diabetes.
  • double the risk of otitis media than for breastfed infants,
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6
Q

What is the composition of breast milk?

A
  • Human milk is species-specific and designed for human brain growth and development.

The follow composition and properties are only a few of the nearly 400 components in breast milk
- carbohydrates: lactose, oligosaccharide
- protein: whey, casein
- fat: essential fatty acid
- anti-infective properties: neutrophils and lymphocytes
- immune properties: IgA
- hormones: leptin and adiponectin

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7
Q

What are the carbohydrates in breast milk?

A
  • Carbohydrates constitute 7% of the composition of mature milk
  • major carbohydrate for human milk is lactose: supplies 40% of the body’s caloric needs
  • Other carbohydrates include oligosaccharides: play a role in protecting the gut from organisms by promoting growth of bifidus factors
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8
Q

What are the protein in breast milk?

A
  • level of protein in breast milk is not affected by the mother’s diet
  • two major protein: Whey and Casein
  • protein content in mature human milk is probably not nutritionally available to the infant; it serves immunological purposes
  • lactoferrin: prevents an overgrowth of potentially harmful organisms
  • immunoprotective protein, lactoferrin, is not present in artificial milk
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9
Q

What are the fat in breast milk?

A
  • main source of calories (energy) for the infant is from fat - about 50% of the infant’s caloric needs
  • breast milk’s most variable component
  • Maternal dietary fat intake does not affect the total amount of fat in a mother’s milk, but the types of fat in the diet do influence the composition of fatty acids in the milk
  • essential fatty acids (EFAs) which are important for growth, neurologic development, and visual function
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10
Q

What are the anti-infective properties in breastmilk?

A

Neutrophils: most common type of WBCs (50-70%)
- they ingest and kill foreign infectious bacteria in an infant’s digestive system

Another WBCs: B and T lymphocytes:
- involvement in creating antibodies targeted against specific microbes
- killing infected cells directly or sending out chemical messages to mobilize other defenses
- strengthening an infant’s own immune response

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11
Q

What are the immune properties in breast milk?

A
  • Immunoglobulins are antibodies that play a critical role in mucosal immunity
  • Approximately 90% of breast milk immunoglobulins are IgA
  • IgA: fights infection without causing inflammation
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12
Q

What are the hormones in breast milk?

A
  • Leptin and adiponectin: metabolism of sugars and lipids

Functions of leptin include:
- regulation of body fat
- regulation of food intake and body weight
- recognition of hunger

Functions of adiponectin include:
- mediates insulin sensitization in peripheral tissues

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13
Q

What is the recommended dose of vitamin D for infants that are breastfed? Prevent what?

A
  • receive a daily vitamin D supplement of 400 IU
  • recommended to prevent rickets
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14
Q

What two main hormones prepare breasts for lactation?

A
  • estrogen, progesterone
  • Breasts increase in size, blood flow increases, nipples and areola enlarge, and colostrum is produced
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15
Q

What is colostrum?

A
  • creamy white to yellowish pre-milk that may be expressed from nipples as early as 16 weeks gestation
  • fluid in breast during pregnancy into early postpartum period
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16
Q

What is prolactin? What triggers the release of it?

A
  • Prolactin is a hormone made by the pituitary gland
  • After delivery of the infant, progesterone levels drop which triggers the release of prolactin
  • Prolactin is produced in response to infant suckling and emptying of the breasts to produce milk
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17
Q

What is the principle of supply and demand in regards to breastmilk?

A

-the more the infant suckles and empties the breast, the more milk is produced
- Breastfeeding early + often increases the number of prolactin receptors and causes the alveoli to produce milk.

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18
Q

Why is oxytocin essential for breastfeeding?

A
  • responsible for the milk ejection reflex also known as the let-down reflex
  • Oxytocin is released in response to touch, smell, sight, and sound.
  • reason why breastfeeding women may experience the let-down reflex in response to hearing an infant cry
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19
Q

What 2 two hormones are called the “mothering hormones?”

A
  • prolactin and oxytocin
  • as they can affect a woman’s mood, emotions, and physical state
  • when the hormones are released can decrease maternal stress and promote maternal-infant attachment
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20
Q

What is autocrine (or local) control?

A
  • Ongoing milk production depends on how effectively the breasts are emptied
  • takes over from the initial endocrine control of milk production in the early days of postpartum
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21
Q

What is the rate of milk synthesis or how fast cells make milk depends on?

A
  • Rate of milk synthesis or how fast the secretory cells make milk is related to the degree of emptiness (or fullness) of the breast
  • As the alveolar lumen fills, components in the retained milk itself (feedback inhibitor of lactation [FIL], peptides, fatty acids and possibly other components) signal the secretory cells to slow down milk synthesis.
  • The emptier the breast is, the faster it tries to refill.
  • When milk is regularly and thoroughly removed from the breast, milk synthesis is unrestricted
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22
Q

How can milk synthesis be unrestricted?

A
  • When milk is regularly and thoroughly removed from the breast
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23
Q

What are the key principles to support breast milk production?

A

Early and often:
- Skin to skin contact immediately after birth and continuing
- Frequent feeds including night feeds

Effective feeding:
- Effective latch
- Active sucking
- Infant completes feeds

Exclusive breastfeeding:
- No artificial nipples

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24
Q

Why is it important to have infant undressed on mothers chest?

A
  • uninterrupted skin to skin contact is beneficial for both the infant and Marnie and that it is especially important in supporting milk production
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25
Q

Why is it important that infant and mom room in together during their hospitalization stay?

A
  • rooming in is an important aspect of promoting and supporting breastfeeding and
  • that night feeding is required to establish and support milk production.
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26
Q

Why is breastmilk better than formula?

A
  • breast milk is composed of nearly 400 properties that are uniquely suited to the human infant.
  • The anti-infective and immune properties as well as the composition of fats, proteins, and carbohydrates cannot be mimicked by artificial infant formula.
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27
Q

Do infants need to cry to indicate that they need to eat?

A
  • crying is a late feeding cue and infants feed best when they are awake and calm
  • much easier to latch an infant at the first signs of feeding readiness than when already upset or crying
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28
Q

What are 3 early cues in regards to infant feeding?

A
  • i’m hungry: stirring, mouth opening, turning head, seeking/rooting
  • Baby is moving into a drowsy state of awake.
  • good opportunity to position baby at the breast.
  • When stimulated, infants will usually become more awake.
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29
Q

What are mid cues in regards to infant feeding?

A
  • i’m really hungry: stretching, increasing physical movement, hand to mouth
  • Mid Cues: The baby is very aware of his/her hunger and will eagerly root.
  • Ensure correct position and latch.
  • The mother can manually express drops of colostrum/milk to entice baby to lick and taste.
  • This will also help the baby coordinate his/her motions to obtain a successful latch.
30
Q

What are late cues in regards to infant feeding?

A
  • calm me, then feed me: crying, agitated body movements, colour turning red
  • Late Cues: If attempts to latch the baby have not been made before this point, the baby becomes frantic and difficult to settle.
  • The mother becomes very anxious because of her baby’s state and the baby feels this tension. This becomes a vicious circle.
  • An unsuccessful feeding and unpleasant experience is usually the result.
  • If the infant is at the crying stage, it is important to console him/her prior to attempting to breastfeed.
  • Skin-to-skin contact, swaddling, decreasing environmental stimulation, and rocking may calm the infant and allow a transition to quiet alert.
31
Q

What is the breast crawl?

A
  • When an infant is skin to skin with the mother in the first hour, you may observe what has been called the “breast crawl”, where the infant crawls towards and naturally finds the nipple to latch onto
32
Q

What are 3 traditional positions for breastfeeding?

A
  • cradle hold,
  • side-lying
  • football or clutch hold (under the arm): offers the advantage of allowing the woman to see the infant’s mouth easily when latching the infant
  • modified cradle
33
Q

What are 5 steps to promote effective latch?

A
  • Infant’s chin to breast and nipple aligned with baby’s nose
  • Mother gently strokes the infant’s lips with her nipple to encourage a wide open mouth
  • The nipple is aimed towards the roof of the mouth.
  • The nipple can elongate in an effort to position itself in the ‘suck spot’ or ‘comfort zone’ where the hard and soft palate meet.
  • Lips are flanged outward
34
Q

What are 4 signs of effective latch?

A
  • infant’s chin touches the breast with the nose slightly away from the breast.
  • mother feels a tug but it does not hurt.
  • Infant begins to suck – the cheeks are full and rounded
  • infant sucks quickly, with short rest pauses. After a few minutes that rate of sucking changes becoming slower with a pause for a swallow. The muscles by the temples move with each suck.
  • Audible swallowing may be heard (listen for a “ca” sound): as milk increases and may sound like gulping.
  • Clicking or smacking sounds: infant is not latched correctly.
  • nipple looks rounded, not flattened/beveled, when the infant comes off the breast.
  • nipples do not have cracks, blisters, or bleeding.
  • evidence of milk transfer: appropriate output and weight loss/gain for age.
35
Q

What are 4 signs of non-effective latch?

A
  • infant falls asleep at the breast; one of the most common indicators of a poor latch. If the infant has a good ‘mouthful of breast’ the nipple touches the junction of the hard and soft palate and this stimulates sucking. If the infant doesn’t get a good latch, she/he gives up.
  • infant keeps squirming or pulls off and on the breast. This behavior which is indicative of a poor latch, illustrates that the infant is struggling to get a functional latch and will continue to complain until she/he does.
  • infant sucks quickly but if the mother moves the breast away, the infant lets go without resistance. Sometimes the infant is happily sucking but is not latched onto the breast.
  • mother has significant pain. Most mothers have some nipple soreness in the first week, but if it really hurts, the infant is probably causing damage.
  • Cracked, scabbed, blistered or bleeding nipples are NOT normal.
  • excessive weight loss or poor weight gain may be about a poorly latched or ineffectively feeding infant
  • Sometimes all of the external signs look good but when the infant lets go of the breast, the nipple looks pointed at the tip or like a new tube of lipstick. With a good latch, the nipple looks rounded.
36
Q

What are 4 ways for nurses to support mother while she is nursing her baby?

A
  • minimize distractions in the room, including my own activities.
  • turn down the lights to provide a more relaxed and intimate atmosphere (also, the baby will be more likely to open his/her eyes if the lights are dim).
  • make sure she has a drink nearby and that she is comfortable.
  • try to prevent any interruptions as Marnie is nursing her baby.
37
Q

What are some guidance on frequency and duration of feeds?

A
  • feed about every 1-3 hours or
  • 8 or more times in 24 hours
  • each feed takes approximately 15-20 minutes per breast
  • night feeds are important: prolactin levels are highest between 0200-0600
  • infants go through periods of cluster feeding, when it is hard to know whether this is the ‘last feed’ or the ‘next feed’. This is common during the first 24-36hrs when the infant is recovering from birth and helps to establish milk production. This is not a sign of insufficient breast milk therefore, no supplementation is required.
38
Q

What is cluster feeding?

A
  • when their infant suddenly wakes up and seems to require all night feeding – usually on the second night after birth
  • infants go through periods of cluster feeding, when it is hard to know whether this is the ‘last feed’ or the ‘next feed’. This is common during the first 24-36hrs when the infant is recovering from birth and helps to establish milk production. This is not a sign of insufficient breast milk therefore, no supplementation is required
39
Q

What are 4 cues infant signal when they have had enough milk?

A
  • by slowing the suck/swallow pattern,
  • falling asleep
  • turning away, or
  • releasing the nipple (pushing the nipple out of their mouth
  • breast should also feel soft
  • infant should appear content after a feed
40
Q

How often term infant voiding first few days? day 4?

A
  • first few days: void 2-6 times per day and the urine should be pale straw coloured
  • day 4: the infant should be voiding 6-8 times per day
41
Q

Is pink tinged urine in diaper normal after first few days after birth?

A
  • yes
  • this is uric acid crystals and this should disappear by the end of the first week
42
Q

What is meconium made up of (3)?

A
  • intestinal secretions
  • amniotic fluid constituents
  • mucosal cells
  • fills the lower intestine at birth
  • meconium is thick and sticky and dark green in colour
43
Q

When should most infants pass meconium?

A
  • pass meconium in the first 12-24 hours after birth
  • Some infants may not pass meconium until 48 hours after birth
44
Q

What colour is the stool first two day? 3rd day? 4th day?

A
  • first two day: Meconium is thick and sticky and dark green in colour
  • 3rd days: transitional stools become less sticky and more yellow/green in colour
  • 4th day: if the infant is breastfed, stools will become yellow and more pasty, while formula fed infant’s stools will be firmer and yellow to dark brown in colour
45
Q

How many stools should infant have by day 4?

A
  • 3-6 stools per day
46
Q

Should mother be worry if infant loses weight during the first few days?

A
  • weight loss of up to 8% of the birth weight during the first few days of life until the milk has come in (lactogenesis) is considered acceptable
  • weight loss of between 8% and 10%: raise a “red flag”
  • weight loss of greater than 10%: requires close monitoring and interventions
  • birth weight should be attained again by approximately 2 weeks of life
47
Q

What is the expectant weight gain for newborn by 5th day after? First four months?

A
  • by fifth day a weight gain of 20−30 g a day is the norm
  • expectant weight gain is 140−200 g per week for the first four months of an infant’s life
48
Q

What 3 weight loss situations need further assessment and investigation?

A
  • weight loss that continues after day 3-4 warrants close assessment of feeding situation
  • no weight gain by day 5
  • no return to birth weight by about 2 weeks.
49
Q

What are the top 3 reasons for women not breastfeeding or trying to breastfeed as per Health Canada (2010)?

A
  • mother has a medical condition (20.5%)
  • bottle feeding is easier (19.8%)
  • breastfeeding is unappealing (19%)
50
Q

What are 3 factors that influenced a woman on how to feed an infant?

A
  • age
  • socioeconomic status
  • cultural context
  • real and perceived support
  • knowledge
51
Q

What are 2 key nursing roles in regards to support/promote breastfeeding after birth?

A
  • Placing the infant skin to skin immediately after birth
  • Ensuring the infant latches within the first hour of life
52
Q

What are 4 nursing role/strategies to support breastfeeding?

A
  • providing practical information: positions and latch
  • encouraging women to have confidence in their ability to breastfeed
  • Educating women on infant feeding cues, and supply/demand principle
  • allowing them to determine the best position,
  • adopting a hands off approach when supporting a good latch,
  • providing positive feedback
  • how to deal with common breastfeeding challenge
53
Q

What are 4 practical ways for nurses to support initiation of breastfeeding?

A
  • Antenatal education,
  • discussing infant feeding on an ongoing basis,
  • keeping the infant skin to skin with the mother in the immediate postpartum period,
  • recognizing and teaching the parents the feeding cues,
  • ensuring the first feed occurs in the first hour after birth,
  • allowing the infant to attempt to latch without any assistance.
54
Q

What are 3 important topics of education related to breastfeeding?

A
  • information on positions and latch,
  • supply/demand principle,
  • feeding cues,
  • dealing with common challenges.
55
Q

What are 3 signs the infant is eating enough?

A
  • appropriate number of voids and stools,
  • content after feeds, and
  • gaining weight at the expected rate.
56
Q

What are 3 contraindications to breastfeeding?

A
  • maternal HIV
  • untreated active TB
  • active herpes lesions on the breasts (breast milk can be expressed and fed to infant)
  • recent varicella infection (5 days before and 2 days after birth)

Newborns:
- newborns with galactosemia
- Infants with phenylketonuria: a special phenylalanine-free formula is needed (some breastfeeding is possible, under careful monitoring)

57
Q

What are 3 clinical situations where breastfeeding may need to be interrupted temporarily?

A
  • severe illness that prevents a mother from caring for her infant, for example sepsis (supplementation may only be needed temporarily)
  • breast abscess: breastfeeding should continue on the unaffected breast; feeding from the affected breast can resume once treatment has started
  • mastitis: if breastfeeding is very painful, milk must be removed by expression to prevent progression of the condition. (The intense pain may lead women to stop breastfeeding, however, they need to be encouraged to empty the breast, either through feeding or pumping, in order to keep the duct(s) patent).
58
Q

When would an infant need other food in addition to breast milk for a limited period (3)?

A
  • infants born weighing less than 1500 g (VLBW)
  • infants born at less than 32 weeks of gestational age (very pre-term)
  • those with a significant weight loss in the presence of clinical indications (mother’s milk production not established)
  • newborn infants who are at risk of hypoglycaemia by virtue of impaired metabolic adaptation or increased glucose demand (such as those who are preterm, small for gestational age or who have experienced significant intrapartum hypoxic/ischaemic stress, those who are ill and those whose mothers are diabetic) if their blood sugar fails to respond to optimal breastfeeding
  • those who fail to regain birth weight by two weeks after birth
  • those with an average weight gain less than:
    115 g/week : 2 weeks-4 months
    85 g/week : 4-5 months
    60 g/week : 6-12 months
59
Q

What is infant formula made up of (5)?

A
  • protein: may be cow’s milk based, soy protein, or hydrolyzed or amino acid formulas
  • carbohydrates,
  • fats,
  • vitamins
  • minerals
60
Q

How much should each formula feed be?

A
  • first 24-48 hours: each feed is approximately 15-30 ml of formula
  • end of the second week: each feed will be 90-120 ml
  • parenting resources recommend a total of 2.5 ounces per pound of body weight in 24 hours
61
Q

What is necrotizing enterocolitis (NEC)?

A
  • serious gastrointestinal problem
  • intestinal tissues becomes inflamed and dies
  • a hole (perforation) may form in baby’s intestine.
  • Bacteria can leak into the abdomen (belly) or bloodstream through the hole
  • NEC is the leading cause of neonatal morbidity and mortality and
  • the incidence can be reduced by 58% with human milk feeding
62
Q

Why is hand expression of colostrum/ breast milk first 24hours important?

A
  • to initiate breast milk production,
  • Hand expression of colostrum/breast-milk every 2-3 hours for the first 24 hours is recommended
  • then pumping is used to maintain the milk supply.
63
Q

What are the 10 steps to promote and protect breastfeeding for vulnerable infants?

A
  1. Informed decision
  2. Establishment and maintenance of milk supply
  3. Human milk management
  4. Oral care and feeding of human milk
  5. Skin-to-skin contact
  6. Non-nutritive sucking
  7. Transition to breast
  8. Measurement of milk transfer
  9. Preparation for discharge
  10. Appropriate follow-up
64
Q

What 5 topics re: feeding to discuss with woman that has just delivered a preterm infant?

A
  • benefits of breastfeeding for preterm infants,
  • how preterm breastmilk is specifically designed for preterm infant,
  • how to establish milk supply, supply/demand principle, storing breastmilk,
  • alternate feeding methods that may be used to administer her breastmilk to the infant,
  • benefits of skin to skin care.
65
Q

How is preterm breastmilk is specifically designed for preterm infant?

A

Preterm breast milk has:
increased protein content,
- lipid content that is more specific for a preterm infant
- higher IgA concentration.
- The predominant whey protein of preterm breast milk has many anti-infective properties while the lactose has increased absorption in preterm infants

66
Q

What other members of the interprofessional health care team may be consulted to support a new mother who wants to breastfeed her vulnerable infant?

A
  • lactation consultant
  • social worker
67
Q

What are the 2 top reasons why late preterm infants may be re-admitted to hospital after discharge?

A
  • feeding difficulties
  • jaundice
  • Late preterm infants (LPIs) are those born after 34 weeks and before 37 weeks (36 weeks plus 6 days)
68
Q

Why would late preterm infants have difficulty with feeding (3)?

A
  • late preterm infants neurologic immaturity may limit their ability to demonstration of feeding cues and regulate sleep/wake cycles
  • may not have mature sucking reflexes and
  • they may tire easily when feeding
  • immature sucking may result in inadequate milk transfer and the fatigue may be interpreted as satiation with the feed, both of which lead to insufficient hydration and calories being taken in
69
Q

Why are late preterm infants particularly vulnerable to feeding issues?

A
  • they lack the maturity to effectively feed at the breast,
  • yet they may not be cared for in the NICU and experience the coordinated breastfeeding support that exists for younger preterm infants
  • a comprehensive breastfeeding plan must be established early and ongoing community support is essential
70
Q

Are Initiation and duration rates for Canadian women almost equal?

A
  • While the majority of women in BC and Canada initiate breastfeeding, breastfeeding duration rates are not nearly as high.
  • Canadian statistics show a national average of 90% of women initiate breastfeeding
    =21% added formula by 1 week post birth, and
    = only 19.2% are exclusively breastfeeding at 6 months
    = only 26% of women put their baby to breast within the recommended time frame of 30 minutes to 2 hours post birth

NS 7100 (7 decks)

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