Newborn Feeding

Question 1

What can incomplete removal of milk from the breasts lead to?

Answer 1

Incomplete removal of milk from the breasts can lead to decreased milk production.

Question 2

What is the first stage of Lactogenesis? When does it begin?

Answer 2

Stage I (secretory differentiation)

Beginning in mid-pregnancy to day 2 or day 3 postpartum, the breasts develop the capacity to secrete breast milk, including the secretion of colostrum.

Question 3

What is feeding frequency determined by?

Answer 3

Feeding frequency is determined by counting from the beginning of one feeding to the beginning of the next. Once the newborn is feeding well and gaining weight adequately, cue-based feeding may look different, with some infants feeding less than eight times in 24 hours.

Question 4

What is the third stage of Lactogenesis? When does it begin?

Answer 4

Stage III (galactopoiesis)

From approximately day 9 postpartum and onward, the volume of breast milk produced is maintained through a supply and demand mechanism.

Question 5

Symptoms of engorgement?

Answer 5

When mothers experience more intense fullness or engorgement, breasts become enlarged, reddened, painful, shiny, and edematous. Nipples may become effaced, milk flow decreases, and the newborn can have difficulties latching on.

Question 6

What should we tell parents who smoke and breast feed?

Answer 6

Lactating parents who continue to smoke should be advised not to smoke within 2 hours before breastfeeding, and they, along with other family members who smoke, should go outside to smoke.

Question 7

When are prolactin levels the highest?

Answer 7

Prolactin levels are highest during the first 10 days after birth, gradually declining over time but remaining above baseline levels for the duration of lactation

Question 8

What is a late hunger cue?

Answer 8

Crying

Question 9

What are some examples that can affect the decisions of infant feeding?

Answer 9

Breast enhancement and mastectomy can effect breastfeeding

Medication

Cultural practices

Decisions made around trauma (women who are exposed to sexual violence)

Advice that’s given from people of importance in their lives

Level of health literacy

If the mother is able to produce breast milk (high performing/professional athletes are less likely able to produce milk due to high cortisol and adreline)

Question 10

What are the nutrtional beinfits of breast milk?

Answer 10

1.) Milk proteins

2.) Whey/casein ratio is high

3.) Makes it readily digestible

4.) Long chain polyunsaturated fatty acids

5.) Myelination of the spinal cord and other nerves

6.) Impacts visual acuity and cognitive and behavoural functions

7.) Fatty acids are important for growth, neurological development, and visual function

8.) DHA - docosahexaenoic acid

9.) ARA - arachidonic acid

Question 11

Characteristics of sore nipples (complication of breastfeeding)

Answer 11

While mild nipple discomfort at the beginning of feedings is common, severe soreness and abraded, cracked, or bleeding nipples are not normal and most often result from poor latch, improper suck, or infection.

Question 12

What is the nutritional requirements of vitamin D, Iron, and water for a formula-fed infant?

Answer 12

Vitamin D: Daily supplement of 400 IU is required (Alberta Health Services)

Iron: Iron-fortified formula is required until age 1

Water: No supplement is required

Question 13

What is the only thing that can not be replicated in formula?

Answer 13

Passive immunity

Question 14

What is breastfeeding frequency influenced by?

Answer 14

Breastfeeding frequency is influenced by a variety of factors, including the infant’s age and weight, the infant’s stomach capacity and gastric emptying time, and the storage capacity of the breast (i.e., the milk available when the breast is full).

Question 15

What can caffeine intake lead to in an infant?

Answer 15

Caffeine intake can lead to a reduced iron concentration in breast milk and consequently contribute to the development of anemia in the infant

Question 16

What can decrease spitting?

Answer 16

Burping the infant several times during a feeding, such as when the infant’s sucking slows down or stops, can decrease spitting.

Question 17

What is the second stage of Lactogenesis? When does it begin?

Answer 17

Stage II (secretory activation)

Beginning on day 2 or day 3 postpartum until day 8, breast milk volume increases rapidly and then abruptly levels off.

Question 18

What are the 6 indications of a good latch?

Answer 18

*The mother feels a firm tugging sensation on the breast, but feels no pinching or pain.
*The baby sucks with cheeks rounded, not dimpled.
*The baby’s jaw glides smoothly with sucking.
*Swallowing is usually audible and sounds like a series of “ca” sounds.
*The baby cannot be easily removed from the breast.
*The mother’s nipple is not distorted when the baby releases from the breast.

Question 19

what are the 4 main benefits to the mother for breastfeeding?

Answer 19

Decreased postpartum bleeding due to the release of oxytocin

It increases weight loss efforts!!!! (need to have an extra 500 calories in daily diet to make up for this)

Delayed return of period (8 or more feeds a day)

Increases bonding and helps mom feel that they are able to be successful in their role of a mother

Question 20

What is the fourth stage of Lactogenesis? When does it begin?

Answer 20

Stage IV (involution)

Involution occurs, on average, 40 days after the last breastfeeding, when breast milk secretion ceases.

Question 21

what should you do if the infant spits up?

Answer 21

Parents need to know what to do if the infant spits up. They may need to decrease the amount of feeding or feed smaller amounts more frequently

Question 22

What factors can contribute to engorgement?

Answer 22

Factors that contribute to engorgement include delayed initiation of breastfeeding, infrequent or time-restricted feedings, feeding supplementation, inefficient infant latch, breast surgery, or any situation where milk stasis occur

Question 23

What are we assessing/observing for during a breastfeeding assessment?

Answer 23

Condition of breast (soft, filling, firm)
Condition of nipples (intact, bleeding, blistered)

Scars, piercing or implants

Positioning

Latching on

Maternal response (comfort in handling infant, level of confidence, signs of discomfort or pain, recognition of infant hunger cues and signs of satiety)

Infant response (suck, swallow, and gag reflexes, regurgitation, signs of correct latch)

Partner response

Question 24

What is a major factor in a persons decision to breastfeed? Why?

Answer 24

The support of the partner and family is a major factor in a person’s decision to breastfeed and in their ability to do so successfully. Patients are more likely to breastfeed successfully when partners and family members have a positive view of breastfeeding and support the mother’s decision.

Question 25

When should infants be fed hydrolyzed protein formula?

Answer 25

Infants with documented IgE allergies caused by cow’s milk should be fed an extensively hydrolyzed protein formula, because about 10 to 14% of infants with cow’s milk–based formula intolerance will also have a soy protein allergy. Soy protein–based formulas have not been proved to be effective in preventing colic or allergy in healthy or high-risk infants.

Question 26

What are the 3 milk stages?

Answer 26

1.) Colostrum

2.) Transitional Milk

3.) Mature milk, Foremilk, and Hind milk

Question 27

What are the 3 main recomendations we make as nurses for infant feeding?

Answer 27

1.) Breast is recommended for the first 6 months

2.) We need to decide and go with what ever is best for the family and the mother (we need to help them without any overlay and/or judgement)

3.) If mother wants to breastfeed and is a high performing athlete we will want to tell her to scale back while she pregnant

Question 28

What are the benefits of breastfeeding for the infant/child?

Answer 28

Reduced infant and child mortality

*Enhanced maturation of the gastrointestinal tract and immune factors

*↓ risk for gastroenteritis, celiac disease, Crohn disease, necrotizing enterocolitis in preterm infants; obesity in childhood, adolescence, and adulthood

*helps protect against otitis media, respiratory illnesses such as respiratory syncytial virus and pneumonia, urinary tract infections, bacteremia, and bacterial meningitis

*Lower incidence of certain allergies among breastfed infants, particularly for families at high risk

*Less likely to die from SIDS

*May have a protective effect against childhood lymphoma and type 1 and type 2 diabetes mellitus

*Decreased risk of dental malocclusions

*May enhance cognitive developmental for term and preterm infants

*Pain relief for newborns undergoing painful procedures

Question 29

In terms of vomiting, what should parents report?

Answer 29

Parents should report vomiting of one third or more of the feeding at most feeding sessions or projectile vomiting to the health care provider and should be cautioned to refrain from changing the infant’s formula without consulting the health care provider

Question 30

When is the first feeding of formula ideally given?

Answer 30

The first feeding of formula is ideally given after the initial transition to extrauterine life. Newborns generally show feeding cues within the first hour of birth

Question 31

What are some contraindications to breastfeeding?

Answer 31

Maternal cancer therapy, diagnostic and therapeutic radioactive isotopes or radioactive iodine

*Active tuberculosis not under treatment in the mother

*Human immunodeficiency virus (HIV) infection in the mother, in high-income countries

*Galactosemia (classic) in the infant

*Maternal substance use (e.g., cocaine, methamphetamines, marijuana). Mothers on methadone treatment plans can breastfeed.

*Maternal human T-cell leukemia virus type 1 or II (HTLV)

*Some medications (although rare) that may exert an untoward effect on the breastfeeding infant; use of these requires consultation of the health care provider and available references, such as Hale (2019) or LactMed.

Question 32

What hormone is responsible for the “milk ejection reflex”?

Answer 32

Oxytocin is another hormone essential to lactation. As the nipple is stimulated by the suckling infant, the posterior pituitary is prompted by the hypothalamus to produce oxytocin. This hormone is responsible for the milk ejection reflex (MER), or let-down reflex.

Question 33

What are “other” (not early) cues for feeding?

Answer 33

Other feeding-readiness cues include stability of vital signs, bowel sounds, an active sucking reflex, and an effective breathing pattern

Question 34

What is affected by maternal alcohol use?

Answer 34

It is speculated that the infant’s psychomotor development may be affected by maternal alcohol use

Question 35

What are the 8 guidelines for breastfeeding support?

Answer 35

1.) Ensures uninterrupted skin-to-skin contact immediately after birth until the newborn completes their first feeding

2.) Promotes nonseparation of mothers and babies—rooming-in 24 hours a day and encouraging family support around the clock

3.) Teaches responsive feeding to help parents identify early feeding cues

4.) Encourages breastfeeding early and often—at least 8 to 12 times per day (without supplementation)

5.) Helps mothers to recognize when their babies are feeding well

6.) Encourages breastfeeding, especially for preterm and low-birth-weight newborns

7.) Reinforces the recommendation for exclusive breastfeeding for the first 6 months, with the introduction of complementary foods at 6 months and continued breastfeeding up to 2 years and beyond

8.) Ensures community follow-up

Question 36

What are the 4 things we are looking for when we are looking at an effective latch?

Answer 36

1.) Baby has good deal
2.) Good position (whole breast is filling the mouth)
3.) We shouldn’t hear any more then the audible swallow which doesn’t happen after day 3 of post partum
4.) Cheaks should be full in shape

Question 37

How do we prepare a mother for feeding?

Answer 37

1.) Hygiene
2.) Comfort
3.) Positioning
-Cradle hold (traditional)
-Cross cradle hold
-Football Hold (clutch)
-Side Lying
-Laid back

Question 38

What is the nutritional requirements of vitamin D, Iron, and water for a breast-fed infant?

Answer 38

Vitamin D: Daily supplement of 400 IU required

Iron: Draws on reserves for 1st 6 months; then iron required

Water: No supplement required

Question 39

What are some complications of breastfeeding?(5)

Answer 39

1.) Sore nipples
2.) Engorgement
3.) Plugged ducts
4.) Yeast infection
5.) Mastitis

Question 40

What is Masstitis?

Answer 40

Although the term mastitis means inflammation of the breast, it is most often used to refer to infection of the breast

Question 41

What are the benefits of breastfeeding for the mother? (8)

Answer 41

*Decreased postpartum bleeding and more rapid uterine involution

*Decreased risk of ovarian cancer, breast cancer, rheumatoid arthritis, hypertension, hypercholesterolemia, cardiovascular disease, and type 2 diabetes

*More rapid postpartum weight loss

*May provide protection against development of osteoporosis

*Delayed return of menses

*Unique bonding experience

*Increased maternal role attainment

*May provide protection against perinatal mood disorders when breastfeeding difficulties are appropriately addressed

Question 42

What can minimize symptoms of breast engorgement?

Answer 42

Frequent, effective feeding (or milk removal) and breast massage may minimize severe symptoms

Question 43

What are some predisposing risk factors for Mastitis?

Answer 43

Inadequate emptying of the breasts is common, related to engorgement, plugged ducts, a sudden decrease in the number of feedings, abrupt weaning, or wearing underwire bras. Sore, cracked nipples may lead to mastitis by providing a portal of entry for the causative organism (staphylococci, streptococci, and E. coli are most common). Stress and fatigue, parental illness, ill family members, breast trauma, and poor parental nutrition also are predisposing factors for mastitis

Question 44

What are some early cues an infant is hungry?

Answer 44

-Stirring
-Mouth opening
-Turning head
-Seeking/rooting

Question 45

What is the breastfeeding assessment?

Answer 45

L (characteristics of latch-on)
A (degree of audible swallowing)
T (type of nipple)
C (maternal comfort)
H (holding skills)

Question 46

What are some common newborn hunger cues?

Answer 46

Hand-to-mouth or hand-to-hand movements
*Sucking motions
*Rooting reflex—infant moves toward whatever touches the area around the mouth and attempts to suck
*Mouthing
*Flexed arms and legs with clenched fists held over chest and tummy (sometimes called hunger posture)

Question 47

After 6 months of birth, how much supplementation of daily fluoride is required?

Answer 47

After 6 months, fluoride supplementation of 0.25 mg/day is required if the local water supply is not fluoridated.

Question 48

What is prolactin produced in response to?

Answer 48

Prolactin is produced in response to newborn suckling and emptying the breasts (lactating breasts are never completely empty; milk is constantly being produced by the alveoli as the infant feeds). Milk production is a supply-meets-demand system (i.e., as milk is removed from the breast, more is produced).

Question 49

When are most infant feeding decisions made?

Answer 49

1.) During the early phase of the first stage of labour

2.) In the last trimester of pregnancy, when colostrum appears

3.) Well before the infant is born, including before conception

Question 50

What are the milk ejection reflex stages/steps?

Answer 50

1.) Infant laches to the breast

2.) Nerve endings in the areola and nipple are stimulated

3.) A message is sent to the posterior pituitary gland to release oxytocin into the bloodstream

4.) Oxytocin stimulates the cells around the alveoli to contract, squeezing milk into the ducts and towards the nipple

Question 51

What kind of risk does moderate caffeine intake pose by lactating parents?

Answer 51

Moderate intake of caffeine by lactating parents appears to pose no risk to healthy full-term infants. Minimal amounts of caffeine pass through to the infant in the breast milk.

Question 52

When are soy protein based formulas recommended?

Answer 52

Soy protein–based formulas are only recommended for infants not able to consume dairy products for religious or cultural reasons or infants with galactosemia

Question 53

what is breastmilk considered to be? What does it create?

Answer 53

Breatmilk is also known to be more digestible due to it having less sugar – creates more digestive ease