Newborn Feeding Flashcards
Nutritional Needs of the Newborn
Calories
___ kcal/kg of body weight daily
Weight Loss
Infants may lose up to ___% of their body weight in first few days
108
10%
Nutritional Needs of the Newborn cont’d
Nutrients
* Carbohydrates, proteins, & fats are provided in breastmilk or formula
> Breastfed infants may need Vitamin D supplementation
Fluid Intake
___ mL/kg of fluid per day
100
Breast Milk Composition
Lactogenesis Stages I, II, & III
Colostrum
Transitional Milk
Mature Milk
Breast Milk Composition - ?
Can have a bluish color; rx’s & illness can also affect color
Contains 20 kcal/oz & sufficient nutrients to maintain infant needs
Mature Milk
Breast Milk Composition - ?
Immunoglobulins & proteins start to decrease
Lactose, fats, & calories start to increase
Transitional Milk
?
A thick, yellow milk
Contains higher levels of protein, vitamins, & minerals
Lower in carbohydrates, fat, & lactose
Rich in immunoglobulins
Colostrum
Breast Milk Composition
Nutrients
* Proteins (amino acids, casein, whey)
* Carbohydrates (lactose)
* Fats (mostly in ___ ?)
* Vitamins (A, E, and C high)
* Minerals (iron; which is absorbed better than the iron in formula [that is iron-fortified]
hindmilk
Breast Milk Composition cont’d
Enzymes
* Pancreatic amylase (helps to break down foods in the GI system)
Infection-Preventing Components
* Immunoglobulins, secretory IgA
- Vitamin D is low in breastmilk
- If the mother is vegan, may need Vitamin B12 supplement
Infant Formulas
Variety of formulas available, varying in price & ingredients
* Modified cow’s milk formulas (unmodified can cause anemia & GI bleeding in infant)
* Soy formulas
* Protein hydrolysate formulas
* Amino acid formulas
* Lactose-free formulas
* Low Phenylamine formulas
The American Academy of Pediatrics (AAP) recommends infants receive only breastmilk for the first ___ months of life, and breastfeeding should continue at least ___ months w/the addition of complimentary foods
6
12
Benefits of Breastfeeding - For the Infant
* Less likely to develop allergies
* Prevents infection - provides immunoglobulins
* Decreased incidence of SIDS & chronic illnesses like asthma & diabetes
* Composed to meet infant-specific needs
* Nutritional & immunologic properties change according to infant needs
* Less likely to result in overfeeding & to develop constipation
* Unlikely to be contaminated
Benefits of Breastfeeding - For the Mother
* Oxytocin release enhances uterine involution
* Less blood clots, delayed return of menses
* Delays ovulation
* Reduces the risk of certain cancers
* Able to rest during feedings
* Encourages balanced diet which improves healing
* Frequent skin-to-skin enhances bonding
* Convenient & economical
* Working mothers miss less time to care for sick infants
* Makes travel easier
Reasons for Formula Feeding
* Embarrassed by breastfeeding
* Dislike the thought & the sensation
* Minimal experience w/ relatives/friends who breastfed
* Lack of support for breastfeeding
* Want partner to be able to help w/feedings
* Maternal rx’s that cross into the breastmilk
Factors Influencing Feeding Choice
* Support from others
* Culture
* Employment (the return to work)
* Staff knowledge
* Other factors (i.e. the woman’s knowledge, past experiences)
Normal Breastfeeding
* Breast changes during pregnancy
* Milk production
* Hormonal changes at birth
* Continued milk production (a supply-and-demand process)
* Preparing the breasts for breastfeeding
* Colostrum is present at ___ to ___ weeks of pregnancy
* Most of milk is made during suckling
12-16
* Prolactin levels are highest during suckling & during the night
* Oxytocin increases in response to nipple stimulation & this causes the milk ejection reflex
Breast Assessment
Breast
* Soft, filling, engorged
Nipples
* Red, bruised, blistered
* Fissured, bleeding, tender
Hunger Cues in the Infant
* Licking or sucking movements
* Lip smacking
* Rooting (turning head)
* Hand-to-mouth movements
* Sucking on hands
* Increased activity
* Crying (late sign)
Latch Score
L = ?
A = ?
T = ?
C = ?
H = ?
A score of 7 or higher is good; less than a 7 indicates assistance needed
L = Latch
A = Audible swallowing
T = Type of nipple
C = Comfort
H = Hold
Nursing Actions to Assist with Breastfeeding
* Initiate breastfeeding within the 1st hour after birth (if able)
* Assist the mother w/positioning herself & the infant
* Elicit latch-on from the infant
* Supervise 1st few feeds to assess latch & provide feedback
* Provide reassurance
* Teach how to properly unlatch the infant
* Educate the family on feeding frequency & expected length of feedings
* Breastmilk travels through the stomach twice as fast as formula
* Infant wakes every 2-3 hours for feeding; would have to wake them up
* Alternate breast used at each feeding
* Nutritive vs non-nutritive suckling
Breastfeeding Positions
Cradle / Cross-cradle / Football / Laid back / Side-lying
Foremilk vs Hindmilk
* Hindmilk has more fat & calories to help the infant gain weight
Your baby is probably getting enough milk if:
* You hear the baby swallow frequently during feedings
* You see nutritive suckling
* Your breasts get softer during the feeding
* You see milk in the infant’s mouth or dripping from the breast
* You feed your baby 8-12 times every 24 hours
! Your baby is producing enough wet & dirty diapers
* Your baby seems satisfied & relaxed after feedings
* Your baby is gaining weight @ well-checks
Common Breastfeeding Concerns: Infant
* Sleepy infant (difficulty in maneuvering breast vs bottle)
* Nipple confusion (pacifiers prevent SIDS but are discouraged in 1st 3-4 weeks of life while lactation established)
* Latch-on problems (dimpling of cheeks; compress on areola)
* Infant complications (jaundice; bili lights)
* Illness & congenital defects (i.e. cleft lip/palate)
* Poor feeding can be an early sign of illness
* Late preterm infants look full-term but have a lot of similarities to premature infants
* Poor coordination of suck, swallow, breathe
* Get sleepier @ breast
* Are at the greatest risk for poor feeding & hospital readmission for failure-to-thrive
Common Breastfeeding Concerns: Maternal
Engorgement / nipple pain (mastitis) / flat/inverted nipples (nipple roll)
Plugged ducts (massage, apply heat) / Illness (use breast pump) / Medication transfer (antihistamines can interfere w/milk production; NO breastfeeding if undergoing chemotherapy)
Previous breast surgery / employment / milk expression & storage / home care (support services)
Breastfeeding of multiples / weaning (if weaned, <12 months give pumped breast milk or iron-fortified infant formula only)
Don’t introduce regular milk, cow’s milk, soy milk, or similars until >12 months
Breastmilk Storage
* Fresh, unrefrigerated breast milk should be used within 1 hour
* Breast milk may be kept in a refrigerator up to 48 hours
* If freezing, place in freezer within 24 hours
> Regular freezer for 1 month
> Deep freezer for 6 months
> Thaw frozen milk in the refrigerator or by running under water
! Any milk not used should be discarded
* New milk should NOT be added to containers of prior pumped milk
* NEVER warm breastmilk (or formula) in a microwave (as it could cause infant burns)
Formula Feeding
* Assess prior knowledge of formula feeding
* Teach about the different types & preparations of formula (ready-to-use does not get diluted)
* Teach correct preparation techniques of formula
* Explain feeding techniques for bottle feeding (BPA-free; semi-upright position; burp > every 1/2 oz)
* Caution on common errors associated w/bottle feeding
! Open formula cans are to be used within 48 hours
* Powder formula NEW formula every feeding
* Concentrated liquids get diluted