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OB > newborn nutrition > Flashcards

newborn nutrition Flashcards

1
Q

recommended infant nutrition 0-6 months

A

exclusive breastmilk

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2
Q

recommended infant nutrition 6-12 months

A

breastmilk with complementary solid food

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3
Q

recommended infant nutrition 12+ months

A

continued as desired by mom and baby

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4
Q

what should infants receive if weaned before 12 months

A

iron fortified milk
*not cow’s milk

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5
Q

benefits of breastfeeding for baby

A

-decreased risk cardiovascular disease
-decreased risk diabetes
-decreased risk infant mortality and SIDS
-decreased allergies and resp symptoms

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6
Q

benefits of breastfeeding for mom

A

-better control of diabetes and blood sugar
-decreased risk cancers

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7
Q

calorie requirements for baby for first 3 months life

A

110 cal/kg/day

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8
Q

calorie requirements for baby for months 3-6

A

100 cal/kg/day

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9
Q

calorie requirements for baby for months 6-9

A

95 cal/kg/day

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10
Q

why can babies not digest fat well when they are younger

A

pancreatic insufficiency

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11
Q

what hormone causes milk production

A

prolactin

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12
Q

what hormone causes milk let down from nipple stimulation

A

oxytocin

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13
Q

when does lactogenesis occur

A

day 3 after birth

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14
Q

what hormone levels drop when placenta is delivered

A

progesterone
estrogen

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15
Q

what can help prolactin levels stay high between breastfeedings

A

breastfeeding/pumping 8+ times a day

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16
Q

3 stages of maturation of breastmilk

A

-colostrum
-transitional
-mature milk

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17
Q

what days after birth are transitional milk produced

A

days 3-5

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18
Q

when does the mature milk come in

A

days 10-15 after birth

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19
Q

first milk that comes out of breast at start of breastfeeding session

A

foremilk

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20
Q

characteristics of foremilk

A

-mostly water
-satisfies thirst

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21
Q

milk that comes out of breast near end of breastfeeding session

A

hindmilk

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22
Q

characteristics of hindmilk

A

-concentrated fat content
-calming effect
-produces feeling of fullness
-promotes growth and weight gain

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23
Q

consequences of supplementation with formula

A

-delay/decrease mother’s amount of breastmilk
-associated with early cessation of breastfeeding
-nipple confusion
-decreased infant intake of protective antibodies
-exposure to potential allergens
-changes in infant’s gut flora

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24
Q

maternal indications for supplementation with formula

A

-delayed lactogenesis (day 5 or later) and signs of infant problems
-delayed lactogenesis and inconsolably hungry baby
-intolerable pain during feedings
-unavailability of mother due to extreme illness or geographic separation
-primary lactation failure
-retained placenta causing delayed lactogenesis

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25
Q

infant indications for supplementation with formula

A

-hypoglycemia
-significant dehydration
-weight loss of 8-10% accompanied by delayed lactogenesis
-delayed bowel movements (meconium by day 5)
-hyperbilirubinemia related to poor intake
-prematurity or low birth weight

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26
Q

best choice breastfeeding supplementation

A

expressed mother’s breast milk

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27
Q

second best choice breastfeeding supplementation

A

pasteurized donor breast milk

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28
Q

third best choice breastfeeding supplementation

A

commercial infant formula (cow’s milk based)

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29
Q

fourth best choice breastfeeding supplementation

A

vegetable based infant formula (soy)

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30
Q

breastfeeding supplementation that should almost never be used

A

glucose water

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31
Q

techniques for supplementation

A

-cup, spoon, dropper, finger feeding
-supplemental nursing device at breast
-bottle feeding (last choice)
*skin to skin during supplementation

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32
Q

how to prepare breast for breastfeeding

A

-gently massage breast with 3 fingers
-rolling nipple to express a little bit of colostrum

position:
-upright or side lying
-comfortable

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33
Q

breastfeeding positions options (4)

A

-cradle hold
-cross cradle hold
-football hold (easiest for new moms and babies)
-side lying hold

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34
Q

what breastfeeding position is recommended for pt who had C/S or 3rd/4th degree perineal tear

A

side lying hold

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35
Q

recommended hold for supporting breast during breastfeeding

A

“C hold”

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36
Q

characteristics of correct latch during breastfeeding

A

-babies nose and mouth are far apart
-lips are flanged out (not tucked under)
-chin into breast and nose tilted back
(*chin not tilted down onto baby’s chest)

after:
-nipple is soft, round, non-distorted
-no biting or pinching, comfortable
-softening of breast
-baby appears satisfied

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37
Q

early hunger cues

A

-head moves towards voice
-lips smack and tongue reaches out
-hand moves randomly
-fist moves to mouth

38
Q

things that can affect/interfere with infant hunger cues

A

-pacifier
-sucking thumb/fist
-supplementation that is not necessary
-rigid time schedules
-baby in nursery at night

39
Q

how to wake a sleepy baby when needing to feed

A

-skin to skin
-unwrap/undress to diaper
-change diaper
-hold infant upright
-eye contact
-talk to baby
-stroke torso and extremities
-warm washrag to face (last effort)

40
Q

causes of fussy baby

A

-not responding to early hungry cues
-pain: heel stick, circumcision
-traumatic birth
-startle reflex
-mother/baby separation
-passing baby around to many family members
-changing diaper

41
Q

interventions for fussy baby

A

-prevention
-positioning
-fluid enticement of breast
-skin to skin
-changing diaper in between feedings
-breastfeeding

42
Q

pt education for mom: when to get help with breastfeeding

A

-few/no wet diapers, or urine is concentrated
-few/no stools
-baby is lethargic and hard to wake up for feeds
-baby is constantly fussy and seems hungry after feeds
-nipple soreness unresolved/worsened
-painful/unrelieved engorgement

43
Q

how often should breastfed baby eat

A

-feeding every 1.5-3 hrs
-8-12 feedings in 24 hours

44
Q

pt education: how do you know if baby is eating enough

A

-weight gain
-normal elimination patterns (**#1 indicator)
-emptying of breasts when nursing
-baby is satisfied after nursing (usually sleep)

45
Q

when should nursing interventions start for infant physiological weight loss

A

when baby lost 5-8% body weight

46
Q

when should baby have regained birth weight

A

2 weeks after birth

47
Q

weight gain goal for baby after 2 weeks

A

1 oz per day

48
Q

when are infant growth spurts (5)

A

-7-10 days
-3 weeks
-6 weeks
-3 months
-6 months

49
Q

how to hand express breast milk (good for first 3 days of life, and if you need to express ocassionally)

A

-c hold
-press back toward chest wall
-compress finger and thumb toward each other
-relax

press-compress-relax

50
Q

how long can plastic bag be used for breast milk storage

A

short term use: <72 hrs

51
Q

how long can hard plastic/glass container with airtight seal be used for breast milk storage

A

long term use (>72 hrs)

52
Q

how long can breastmilk be stored at room temp

A

up to 4 hrs

53
Q

how long can breastmilk be stored in fridge

A

up to 4 days

54
Q

how long can breastmilk be stored in freezer

A

up to 12 months
(up to 6 months is optimal)

55
Q

instructions for preparing frozen breastmilk

A

-thaw in refrigerator or warm water
-never microwave
-use within 24 hrs
-shake well
-do not refreeze

56
Q

calorie need for breastfeeding mothers

A

1800 cals +300-500

57
Q

can you use soap on nipples when in the shower

A

no, just water

58
Q

should breastfeeding women wear bra with underwire

A

no, can compress milk ducts

59
Q

common challenges in breastfeeding (5)

A

-cracked/sore nipples
-engorgement
-flat/inverted nipples
-plugged ducts
-mastitis

60
Q

S+S engorgement

A

-breasts feel heavy and tender
-mother may have slight fever
-skin is stretched, nipples flatten
-difficult or impossible for baby to latch
-pain or discomfort

61
Q

when does engorgement usually resolve by

A

24 hrs

62
Q

Tx engorgement

A

-warm moist compresses before breastfeeding (3-5 mins)
-gently massage/stroke breast going towards areola before and during nursing
-frequent feeding
-hand express/pump for 1-3 mins before feeding
-supportive bra (no underwire)
-schedule ibuprofen around the clock
-ice packs after feeds
-green cabbage leaves (no more than 45 mins)

63
Q

how to evaluate for flat/inverted nipple

A

pinch test - goes inward

64
Q

interventions for flat/inverted nipples

A

-nipple rolling prior to latching
-pumping for 1-2 mins before latch attempt
-nipple shields/breast shells

65
Q

when should breast shells for inverted/flat nipples not be used

A

before 37 weeks gestation (can cause premature labor)

66
Q

inflammation of one or more area of breast due to poor milk drainage

A

milk duct

67
Q

signs of plugged duct

A

-develops gradually
-localized tenderness and pain
-may have palpable lump
-unrelieved engorgement

68
Q

causes plugged duct

A

-skipped or delayed feedings
-constriction (tight clothing, purse, baby sling)
-inadequate emptying of breast
-one sided nursing
-sleeping positions that put pressure on one area of breast
-previous breast surgery
-pressure/continued breast compression that blocks ducts
-position of baby in nursing

69
Q

Tx plugged duct

A

-increase nursing frequency
-begin feedings on affected breast
-comb breast
-gently massage during feeding
-change baby’s position during nursing

70
Q

how to comb breast to treat plugged duct

A

-in warm shower
-put food grade oil on breast
-wide tooth comb from high in chest toward areola
-feed or pump
-repeat several times for 24 hrs

71
Q

causes mastitis

A

-usually preceded by nipple trauma
-untreated plugged ducts or engorgement
-overabundant milk supply
-contributing factors: stress and fatigue

72
Q

S+S mastitis

A

-sudden onset
-hot, reddened, tender area with/without streaking
-intense localized breast pain
-fever >101 F
-flu like symptoms (muscular aching, headache, general malaise)

73
Q

Tx mastitis

A

-antibiotics and antipyretic
-breastfeed/pump affected breast every 2-2.5 hrs
-suggested bed rest for 24 hrs
-apply moist heat to breast before feedings
-ice after breastfeeding to reduce swelling
-drink fluids

74
Q

ONSET:
-engorgement
-plugged duct
-mastitis

A

-engorgement: gradual, immediately postpartum
-plugged duct: gradual, after feedings
-mastitis: suddenly, after 10 days

75
Q

SITE
-engorgement
-plugged duct
-mastitis

A

-engorgement: bilateral
-plugged duct: unilateral
-mastitis: usually unilateral

76
Q

SWELLING/HEAT:
-engorgement
-plugged duct
-mastitis

A

-engorgement: generalized
-plugged duct: may shift, little/no heat
-mastitis: localized, red, hot, swollen

77
Q

PAIN:
-engorgement
-plugged duct
-mastitis

A

-engorgement: generalized
-plugged duct: mild to severe, sharp and radiate
-mastitis: intense but localized

78
Q

BODY TEMP:
-engorgement
-plugged duct
-mastitis

A

-engorgement: normal
-plugged duct: normal
-mastitis: fever

79
Q

SYSTEMIC SYMPTOMS:
-engorgement
-plugged duct
-mastitis

A

-engorgement: feels well
-plugged duct: feels well
-mastitis: flu like symptoms

80
Q

primary sources causing sore/cracked nipples

A

-poor positioning/latching
-suction lesions
-traction on nipple
-engorgement issues
-mechanical problems (pump issues)
-tongue issues

81
Q

secondary sources causing sore/cracked nipples

A

-infection (baby has thrush)
-dermatitis
-acute/chronic skin conditions

82
Q

Tx sore/cracked nipples

A

-refer to lactation consultant
-topical meds: mother’s milk, lanolin, polysporin, bactroban (severe trauma or wound that won’t heal)
-systemic meds: antibiotics (may be necessary if early signs infection)

83
Q

how to wean

A

-drop 1 feeding q3-4 days
-gradual
-feed from cup, bottle, or supplementary solid food for dropped breastfeeding
-if <1 yo, wean to infant iron-fortified formula

84
Q

formula feeding patterns (how much and how often)

A

-at 24-48 hrs of life: 15-30 mL/feed
-gradually increase
-feed on demand, atleast q3-4h (takes longer to digest)
-avoid rigid scheduling
-increase formula by 30 mL at each growth spurt

85
Q

very important pt education for formula feeding bottles

A

never prop bottle
never leave baby alone

86
Q

how many cal/oz is a can of full-term baby formula

A

20 cal/oz

87
Q

cleaning instructions for first use of bottle

A

-warm water and soap wash
-in boiling water for 5 mins

88
Q

cleaning instructions for subsequent uses of bottle

A

-wash hot and dry in dishwater

89
Q

3 types formula

A

-powdered (least expensive)
-liquid concentrate
-ready to feed

90
Q

cleaning instructions for formula cans

A

first time opening can: wash in warm water and scrub lid

91
Q

at what infant resp rate should you not feed them

A

> 60
-could use their energy
-could cause aspiration

92
Q

what to do for feeding if infant resp rate is >60

A

-notify provider
-anticipate gavage feeding

OB (21 decks)

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