newborn nutrition Flashcards
recommended infant nutrition 0-6 months
exclusive breastmilk
recommended infant nutrition 6-12 months
breastmilk with complementary solid food
recommended infant nutrition 12+ months
continued as desired by mom and baby
what should infants receive if weaned before 12 months
iron fortified milk
*not cow’s milk
benefits of breastfeeding for baby
-decreased risk cardiovascular disease
-decreased risk diabetes
-decreased risk infant mortality and SIDS
-decreased allergies and resp symptoms
benefits of breastfeeding for mom
-better control of diabetes and blood sugar
-decreased risk cancers
calorie requirements for baby for first 3 months life
110 cal/kg/day
calorie requirements for baby for months 3-6
100 cal/kg/day
calorie requirements for baby for months 6-9
95 cal/kg/day
why can babies not digest fat well when they are younger
pancreatic insufficiency
what hormone causes milk production
prolactin
what hormone causes milk let down from nipple stimulation
oxytocin
when does lactogenesis occur
day 3 after birth
what hormone levels drop when placenta is delivered
progesterone
estrogen
what can help prolactin levels stay high between breastfeedings
breastfeeding/pumping 8+ times a day
3 stages of maturation of breastmilk
-colostrum
-transitional
-mature milk
what days after birth are transitional milk produced
days 3-5
when does the mature milk come in
days 10-15 after birth
first milk that comes out of breast at start of breastfeeding session
foremilk
characteristics of foremilk
-mostly water
-satisfies thirst
milk that comes out of breast near end of breastfeeding session
hindmilk
characteristics of hindmilk
-concentrated fat content
-calming effect
-produces feeling of fullness
-promotes growth and weight gain
consequences of supplementation with formula
-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
maternal indications for supplementation with formula
-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
infant indications for supplementation with formula
-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
best choice breastfeeding supplementation
expressed mother’s breast milk
second best choice breastfeeding supplementation
pasteurized donor breast milk
third best choice breastfeeding supplementation
commercial infant formula (cow’s milk based)
fourth best choice breastfeeding supplementation
vegetable based infant formula (soy)
breastfeeding supplementation that should almost never be used
glucose water
techniques for supplementation
-cup, spoon, dropper, finger feeding
-supplemental nursing device at breast
-bottle feeding (last choice)
*skin to skin during supplementation
how to prepare breast for breastfeeding
-gently massage breast with 3 fingers
-rolling nipple to express a little bit of colostrum
position:
-upright or side lying
-comfortable
breastfeeding positions options (4)
-cradle hold
-cross cradle hold
-football hold (easiest for new moms and babies)
-side lying hold
what breastfeeding position is recommended for pt who had C/S or 3rd/4th degree perineal tear
side lying hold
recommended hold for supporting breast during breastfeeding
“C hold”
characteristics of correct latch during breastfeeding
-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
early hunger cues
-head moves towards voice
-lips smack and tongue reaches out
-hand moves randomly
-fist moves to mouth
things that can affect/interfere with infant hunger cues
-pacifier
-sucking thumb/fist
-supplementation that is not necessary
-rigid time schedules
-baby in nursery at night
how to wake a sleepy baby when needing to feed
-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)
causes of fussy baby
-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
interventions for fussy baby
-prevention
-positioning
-fluid enticement of breast
-skin to skin
-changing diaper in between feedings
-breastfeeding
pt education for mom: when to get help with breastfeeding
-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
how often should breastfed baby eat
-feeding every 1.5-3 hrs
-8-12 feedings in 24 hours
pt education: how do you know if baby is eating enough
-weight gain
-normal elimination patterns (**#1 indicator)
-emptying of breasts when nursing
-baby is satisfied after nursing (usually sleep)
when should nursing interventions start for infant physiological weight loss
when baby lost 5-8% body weight
when should baby have regained birth weight
2 weeks after birth
weight gain goal for baby after 2 weeks
1 oz per day
when are infant growth spurts (5)
-7-10 days
-3 weeks
-6 weeks
-3 months
-6 months
how to hand express breast milk (good for first 3 days of life, and if you need to express ocassionally)
-c hold
-press back toward chest wall
-compress finger and thumb toward each other
-relax
press-compress-relax
how long can plastic bag be used for breast milk storage
short term use: <72 hrs
how long can hard plastic/glass container with airtight seal be used for breast milk storage
long term use (>72 hrs)
how long can breastmilk be stored at room temp
up to 4 hrs
how long can breastmilk be stored in fridge
up to 4 days
how long can breastmilk be stored in freezer
up to 12 months
(up to 6 months is optimal)
instructions for preparing frozen breastmilk
-thaw in refrigerator or warm water
-never microwave
-use within 24 hrs
-shake well
-do not refreeze
calorie need for breastfeeding mothers
1800 cals +300-500
can you use soap on nipples when in the shower
no, just water
should breastfeeding women wear bra with underwire
no, can compress milk ducts
common challenges in breastfeeding (5)
-cracked/sore nipples
-engorgement
-flat/inverted nipples
-plugged ducts
-mastitis
S+S engorgement
-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
when does engorgement usually resolve by
24 hrs
Tx engorgement
-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)
how to evaluate for flat/inverted nipple
pinch test - goes inward
interventions for flat/inverted nipples
-nipple rolling prior to latching
-pumping for 1-2 mins before latch attempt
-nipple shields/breast shells
when should breast shells for inverted/flat nipples not be used
before 37 weeks gestation (can cause premature labor)
inflammation of one or more area of breast due to poor milk drainage
milk duct
signs of plugged duct
-develops gradually
-localized tenderness and pain
-may have palpable lump
-unrelieved engorgement
causes plugged duct
-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
Tx plugged duct
-increase nursing frequency
-begin feedings on affected breast
-comb breast
-gently massage during feeding
-change baby’s position during nursing
how to comb breast to treat plugged duct
-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
causes mastitis
-usually preceded by nipple trauma
-untreated plugged ducts or engorgement
-overabundant milk supply
-contributing factors: stress and fatigue
S+S mastitis
-sudden onset
-hot, reddened, tender area with/without streaking
-intense localized breast pain
-fever >101 F
-flu like symptoms (muscular aching, headache, general malaise)
Tx mastitis
-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
ONSET:
-engorgement
-plugged duct
-mastitis
-engorgement: gradual, immediately postpartum
-plugged duct: gradual, after feedings
-mastitis: suddenly, after 10 days
SITE
-engorgement
-plugged duct
-mastitis
-engorgement: bilateral
-plugged duct: unilateral
-mastitis: usually unilateral
SWELLING/HEAT:
-engorgement
-plugged duct
-mastitis
-engorgement: generalized
-plugged duct: may shift, little/no heat
-mastitis: localized, red, hot, swollen
PAIN:
-engorgement
-plugged duct
-mastitis
-engorgement: generalized
-plugged duct: mild to severe, sharp and radiate
-mastitis: intense but localized
BODY TEMP:
-engorgement
-plugged duct
-mastitis
-engorgement: normal
-plugged duct: normal
-mastitis: fever
SYSTEMIC SYMPTOMS:
-engorgement
-plugged duct
-mastitis
-engorgement: feels well
-plugged duct: feels well
-mastitis: flu like symptoms
primary sources causing sore/cracked nipples
-poor positioning/latching
-suction lesions
-traction on nipple
-engorgement issues
-mechanical problems (pump issues)
-tongue issues
secondary sources causing sore/cracked nipples
-infection (baby has thrush)
-dermatitis
-acute/chronic skin conditions
Tx sore/cracked nipples
-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)
how to wean
-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
formula feeding patterns (how much and how often)
-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
very important pt education for formula feeding bottles
never prop bottle
never leave baby alone
how many cal/oz is a can of full-term baby formula
20 cal/oz
cleaning instructions for first use of bottle
-warm water and soap wash
-in boiling water for 5 mins
cleaning instructions for subsequent uses of bottle
-wash hot and dry in dishwater
3 types formula
-powdered (least expensive)
-liquid concentrate
-ready to feed
cleaning instructions for formula cans
first time opening can: wash in warm water and scrub lid
at what infant resp rate should you not feed them
> 60
-could use their energy
-could cause aspiration
what to do for feeding if infant resp rate is >60
-notify provider
-anticipate gavage feeding
