Newborn Nutrition

Question 1

Recommendations for nutrition in newborns?

Answer 1

Evidence shows human milk (breast feeding) is the ideal food for newborns and provides the best nutritional value.
Breast milk is the gold standard for infant nutrition.
American Association of Pediatrics recommends exclusive breastfeeding of human milk for the first 6 months and continued breastfeeding for at least 12 months.
After 6 months, appropriate complementary solid foods may be added to the diet.

Question 2

Choosing the Right Feeding Method that fits the mom’s and baby’s needs?

Answer 2

The decision to breastfeed:
Natural extension of pregnancy and childbirth
Women tend to select the same feeding method for all their children.
Support by family and partner is a major factor in feeding choice.
Cultural factors
Mother’s knowledge about the health benefits to the infant and her comfort level with breastfeeding in social settings

Question 3

Benefits of breastfeeding for the mom?

Answer 3

Decrease risk of breast, ovarian and uterine cancer
Decrease risk of Type 2 diabetes mellitus
Enhanced postpartum weight loss
Enhanced involution (caused by uterine contractions, triggers by release of Oxytocin) and decreased risk of postpartum hemorrhage
Enhanced bonding with infant
Less expensive than formula

Question 4

Benefits of breastfeeding for the baby?

Answer 4

Enhanced immunity through the transfer of maternal antibodies; decreased incidence of infections including otitis media, respiratory infections, pneumonia, urinary tract infections, gastrointestinal infections and necrotizing enterocolitis, bacteremia and bacterial meningitis
Enhanced maturation of GI tyract
Decreased risk of Sudden Infant death syndrome
Decreased risk of developing Type 1 diabetes
Decreased risk of asthma
Decreased risk of child obesity
Decreased pain during procedure such as an injection

Question 5

Benefits of breastfeeding (for family and society)?

Answer 5

Convenient : ready to feed
No bottles or extra necessary equipment
Less expensive
Reduces annual health costs
Less parental absence from work due to ill infant
Reduced environmental burden due to disposal of formula packaging and equipment

Question 6

More feeding decisions?

Answer 6

Barriers to breastfeeding:
Lack of broad social support for breastfeeding
Widespread marketing by infant formula companies
Lack of prenatal breastfeeding education
Insufficient training and education of health care professionals about breastfeeding
Employment and the need to return to work after birth
Pain, lifestyle incompatibility

Question 7

Breastfeeding contraindications?

Answer 7

Breastfeeding contraindicated in a few circumstances:
Newborns with galactosemia
Mothers who are positive for human T cell lymphotropic virus types I or II
Mothers with untreated brucellosis
Mothers with active tuberculosis
Mothers with active herpes simplex lesions on the breasts
Mothers with HIV infection
Considered a contraindication in the United States
In developing countries where HIV is prevalent, the benefits of breastfeeding for infants outweigh the risk of contracting HIV from infected mothers

Question 8

Formula feeding?

Answer 8

Parents who choose to formula feed often make this decision without complete information and understanding of the benefits of breastfeeding.
Cultural beliefs, myths, misconceptions
Some view formula feeding as a way to ensure that the father, other family members, and daycare providers can feed the baby.

Question 9

Cultural influences?

Answer 9

Immigrants to the United States from poorer countries often choose formula to appear more “modern” or to adapt to U.S. culture and customs

Breastfeeding beliefs and practices vary across cultures:
Beliefs about the harmful nature or inadequacy of colostrum
Combining breastfeeding and commercial infant formula: las dos cosas
Specific food intake to foster milk production

Question 10

What are nutritional needs?

Answer 10

fluids
energy
carbohydrates
fat
protein
vitamins
minerals

Question 11

Normal weight loss after birth? Regain of weight? First 3 month gain?

Answer 11

Normal weight loss after birth – 5% - 10%
Regain of weight by 10-14 days after birth
First 3 months gain S/B 110-200 grams per week

Question 12

Fluid intake?

Answer 12

First 2 days = 60-80 mL/kg/day (24 hours)
Day 3-7 = 100-150 mL/kg/day (24 hours)
From day 8 to day 30 = 120-180 mL/kg/24 hours

Question 13

Caloric Intake?

Answer 13

Adequate caloric intake is essential for energy. This allows: growth, digestion, metabolic needs, and activity
Day 1 to 3 months – requires 110kcal/kg/day (24 hours)
3months to 6 months – requires 100kcal/kg/day (24 hours)
Breast milk & formula provide 20kcal/oz

Question 14

What should I feed my baby?

Answer 14

Unmodified Cows Milk NO!!!!!! Only if a last resort per the pediatrician. So many other options

Formula – recommended by the pediatrician with additives such as iron, B12, etc.

Breast Milk – The Best!! It has a composition that changes to meet the nutritional needs of the growing infant. The more the infant feeds, the more mom will produce. Contains Immunological active components that provide early life protection.

If a premature baby is born, the mother will produce enough milk for the gestational age for that infant.

Question 15

Carbohydrates?

Answer 15

1st 6 months 60g/day, second 6 months 95g/day
40% - 50% of total calories

Question 16

Fat?

Answer 16

1st 6 months 31g/day
Composed of lipids, triglycerides, cholesterol, fatty acids
Cholesterol essential element for brain growth
Fatty acids: growth, neuro, development, visual function
Cow’s milk does not have the fatty acids needed to slow down the ingestion part and can lead to lower weight gain

Question 17

Protein?

Answer 17

9 g needed to maintain good growth (Book says 9.1 but 9 is sufficient AAP).
2 main proteins whey & casein (breast milk 70:30 compared to cow milk 20:80) makes milk more digestible.
Whey: protects against gram+ and gram- anaerobes and yeast
casein: enhances absorption of iron

Question 18

Vitamins?

Answer 18

Vitamin D added for both breastfed babies and bottle-fed babies 400IU or vit D daily
Facilities absorption of Ca, Phosphorus, bone mineralization, and Ca+ reabsorption
Vit. K: required for bld coagulation and produced in the intestines
mother’s dietary intake or formula may need to have B12 added

Question 19

Minerals?

Answer 19

Too many minerals in cows milk

Breastmilk iron is better absorbed than formula iron

No fluoride added until after6 months. 6 months to 3 years fluoride is based on amount of fluoride in the water supply

Question 20

Breast milk and hormones?

Answer 20

Oxytocin = milk let down
Prolactin = milk production

Question 21

Feeding readiness cues?

Answer 21

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

Question 22

Care MGMT in breastfeeding?

Answer 22

Positioning
Latch
Milk ejection or let-down
Frequency of feedings
Duration of feedings
Indicators of effective breastfeeding

Latching should include the complete areola. Baby jaw should be wide. Latching is a good time to check for ankyloglossia – short or tight frenulum “tongue tied”

Question 23

Removing the baby from the breast?

Answer 23

Never pull the baby from the breast. The mom should place her finger between the breast and the baby’s mouth. Gently break the suction.

Question 24

Storing Breast Milk?

Answer 24

Room Temperature – < 77 degrees F up to 4 hours

Refrigerator – 39 degrees F 4 days Do not store near other items.

Freezer – 24 degrees F 6 months optimal, 12 months acceptable.

Word of advice: If a bottle has been used (breastmilk or formula) once it has been opened for 1 hour throw away any unused formula/breast milk due to the chance of bacteria introduction.

Do not want thrush – yeast
Store in back of refrigerator or freezer

Question 25

Care of the mother?

Answer 25

good nutrition
plenty of rest
breast care
breast feeding moms:
- wash only with H20 no soap
- if using creams such as lanolin, use sparingly, can block the montgomery gland
- In the first few day after birth use colostrum (natural cream)
Formula moms: no stimulation of the breast

Soap can dry nipples and give baby a bad taste to the point where they will not want to nurse. Also can cause newborn to have diarrhea sometimes.

Question 26

Common concerns of the breastfeeding mother?

Answer 26

Engorgement
Over production of milk
Remove the milk by feeding the baby or pumping

Sore nipples
Keep from happening by having good latching techniques
Mouth should be wide open before latching. Needs the whole areola in its mouth
Wipe nipples with clean washcloth to reduce amount of saliva baby has left

Insufficient milk supply
Don’t give up – assess weight, latch, feeding technique, maternal medications,

Plugged milk ducts
Most often breasts are not being cleaned after every feeding or too tight clothes/bra
Warm compresses or leaning over a bucket of warm water

Mastitis
Inflammation/infection of the breast
Make sure breast are being emptied.
– Follow-up after discharge

Question 27

Formula feedings parent education?

Answer 27

Parent education:
Readiness for feeding
Feeding patterns
Feeding technique
Common concerns
Bottles and nipples

Watch the bottle for air delivery. If not held at a good angle the infant could receive air resulting in a baby with painful abdomen & flatus

Infant formulas (commercial formulas)
Cow’s milk–based formulas
Soy-based formulas, commonly used for children who are lactose or cow’s milk–protein intolerant
Casein- or whey-hydrolysate formulas, used primarily for children who cannot tolerate or digest cow’s milk– or soy-based formulas
Amino acid formulas, used for infants with multiple food protein intolerances

Formula preparation:
Powdered formula: least expensive
Concentrated formula
Ready-to-feed: most expensive

Vitamin and mineral supplementation
Weaning
Introducing solid foods: (Complementary feedings)

Question 28

Key points?

Answer 28

Human breast milk is species specific and is the recommended form of infant nutrition. It provides immunologic protection against many infections and diseases.

Breast milk changes in composition with each stage of lactogenesis, during each feeding, and as the infant grows.

During the prenatal period, expectant parents should be informed of the benefits of breastfeeding for infants, mothers, families, and society.

Question 29

Key points pt. 2?

Answer 29

Infants should be breastfed within the first hour after birth and at least 8 to 12 times every 24 hours thereafter.

Parents should be taught to recognize the signs of effective breastfeeding.

Answer 30

Breast milk production is based on a supply-meets-demand principle: the more the infant nurses, the greater the milk supply.

Infants go through predictable growth spurts.

Sore nipples are most often caused by incorrect latch.

Commercial infant formulas provide satisfactory nutrition for most infants.

Infants should be held for feedings.

Parents should be instructed about the types of infant formulas, proper preparation for feeding, and correct feeding technique.

Solid (complementary) food should be started at about 6 months of age.

Nurses must be knowledgeable about feeding methods and provide education and support for families.

Unmodified cow’s milk is inappropriate for infants younger than 1 year of age.

Question 31

Benefits to the mother associated with breastfeeding include all except which of the following?

A. There is a decreased risk of breast cancer.
B. It is an effective method of birth control.
C. It increases bone density.
D. It may enhance postpartum weight loss.

Answer 31

B. It is an effective method of birth control. –> Breastfeeding delays the return of fertility; however, it is not an effective birth control method.