Newborn Nutrition Flashcards
What is breastfeeding ?
transfer of human milk from mother to the infant directly from the mother’s breast
What is exclusive breastfeeding ?
infant receives no other liquid or solid food
What is human milk feeding ?
infant fed expressed breast milk from the mother or donor milk bank
What is formula-fed
infant fed commercially-made alternative to breastmilk
What is complimentary foods ?
nutrient-dense foods that are semi-solid, mashed, or pureed
What does the American Academy of Pediatrics (AAP) recommend ?
- infants exclusively breastfed for first 6 months
- continue for at least 12 months and beyond as desired
- complimentary food introduced after 6 months
What does WHO recommend ?
- exclusively breastfeed for first 6 months
- continue until 2 years of age or beyond
- complimentary foods beginning at 6 months
What are some newborn benefits of breastfeeding ?
- decreased incidence of illness
- decreased rates of infant mortality (SUIDS, DM, obesity, asthma)
- analgesic effect
- enhanced cognitive development
What are some mother benefits of breastfeeding ?
- decreased postpartum bleeding
- decreased rates of ovarian and breast cancer, HTN, heart disease, and osteoporosis
- increase in “maternal role”
- unique bonding experience
What are some society benefits to breastfeeding ?
- less environmental waste
- convenient and cost effective
- less parental absence from work due to sick child
What are some contraindications to breastfeeding ?
- newborns with galactosemia
- HIV (different in some countries)
- illicit drug use
- ebola
Temporary - meds
- diagnostic imaging with radiopharmaceuticals
- active HSV lesion on breast
Expressed milk only - active TB
- active varicella
What are some newborn nutrition needs ?
- no supplemental H20
- rapid growth and brain development in first 3 months = highest energy needs
- high fat content needed for brain growth
- all Vita and mineral provided (except Vita D in human milk) (breastfed infants will need supplemental Vita D)
- full-term infants have enough iron stored for 1st 6 months of life, then can introduce iron-fortified cereals (iron-deficiency anemia more common in preterm infants)
- cow’s milk lacks complete nutrition and is not as easily digested as human milk or formula (can introduce after 12 months)
What are some breast changes during pregnancy ?
- estrogen, progesterone, human placental lactogen affect changes on breasts
- increase in size d/t growth of glandular and adipose tissue
- blood flow doubles
- sensitivity increased
- nipples and areola enlarge and darken
- Montgomery glands (small goosebump-like glands on the areola)
How many stages of lactation are there ?
human milk composition and volume varies by stage of lactation
- 3 stages
What is the 1st stage of lactation ?
Lactogenesis Stage 1
- begins 16-18 weeks of pregnancy
- prepares colostrum
- “liquid gold”
- high concentration of protein and minerals, low in fat
- rich in immunoglobulins
What is the 2nd stage of lactation ?
begins at birth
- drop in estrogen and progesterone
- triggers release of prolactin from anterior pituitary gland
What is the 3rd stage of lactation ?
- day 10 and beyond
- supply meets demand
- mature milk
How does a RN support prenatal education on breastfeeding ?
- assess knowledge, provide info, help develop goals and plans
- include significant other and family
How does a RN support breastfeeding info during admission ?
- assess plans for breastfeeding and knowledge of benefits
- review obstetric and medical history
- physical exam of breasts and nipples
How does a RN support breastfeeding during delivery & postpartum ?
- assist with feedings, assessing hold and latch
- encouragement and promote confidence
- lactation consultant
- connect with community support (WIC, la leche league, hospital-based groups_
When do you initiate breastfeeding ?
within 1 hr of birth
- Feeding readiness cues: hand-to-mouth, sucking motions, rooting reflex, mouthing, crying & deep sleep are late signs of hunger
What are the different positions for breastfeeding ?
- Football/clutch: recommended for early feedings & c/sections
- cross-cradle: using opposite hand to support the newborn head
- cradle: widely used after good breastfeeding habits established
- side-lying: recommended for perineal pain or swelling
What are the steps to latching baby for breastfeeding ?
- 1st: mom will stimulate baby by rubbing nipple onto it’s mouth (use C-hold to support breast and this helps compress breast for milk expression)
- 2nd: stimulate until baby opens mouth wide and tongue down
- 3rd: quickly bring baby onto the breast and chin and cheeks should be touching breast (mouth should cover all of nipple and 2-3 cm of areola which creates seal for good suction)
- 4th: break latch by inserting finger in side of baby’s mouth (pulling baby off can cause nipple trauma and pain)
What are signs of a proper latch ?
- feel tugging sensation but not pain
- baby’s cheeks are rounded
- baby’s jaw glides smoothly and silently with sucking
- audible swallowing
What is the let-down reflex ?
milk ejected that is stimulate when baby begins sucking onto nipple which causes release of oxytocin from posterior pituitary gland
What are signs the let-down reflex is happening ?
- tingling sensation in nipple and breast
- slower, drawing sucking pattern
- audible swallow
- uterine cramping/increased lochia
- mother feels relaxed or drowsy
- opposite breast leaks
What is the frequency of feedings ?
- newborns feed 8-12x in 24 hrs or q2-3 hrs
- good feeding time is 15-40 mins
- newborns can be sleep first 24-48 hrs so need to arouse baby to feed
- cluster feedings typically happen 2nd night and during growth spurts
- demand feedings after breastfeeding established and gaining weight
What are indicators of effective breastfeeding ?
- feeding diary
- 6-8 wet diapers q24 hrs after day 4
- 3 BM q24 hrs after day 4
- easily releases breast at end of feeding
- infant is relaxed and content after feeding
When are pacifiers okay to give to baby ?
after breastfeeding established (3-4 weeks) to decrease risk of SIDS
What are some reasons for supplementation/pacifiers ?
- weight loss > 8-10% of birth weight
- hyperbilirubinemia
- hypoglycemia
- poor output
- physician order
Why would we not want to introduce pacifiers ?
can cause nipple confusion
- first choice expressed breast milk
What are some special considerations for supplementation ?
- sleepy baby
- fussy baby
- slow weight gain
- jaundice
- preterm infants
- multiples
What are some reasons for expressive and storing breast milk ?
- maternal/infant separation (NICU)
- engorgement
- emergency supply
- exclusive pumping
- meds “pump and dump”
What are the storage requirements for breastmilk ?
- room temp: 3-4 hrs
- refrigerated: 72 hr
- frozen: 6 months
How much formula should a infant consume ?
15-30 mL (0.5-1oz) with each feeding
How often does an infant need to be fed formula ?
q3-4 hrs or 6-8x in 24 hrs
- might need to be awakened to feed
- held snuggle, in semi-upright position with good head and neck support
What are signs of overfeeding ?
- infant falling asleep
- turning head
- cessation of sucking
How should bottles be cleaned ?
- warm, soapy water
- boiled for 5 mins after every use or put in dishwasher to sanitize
Why we do burp infants ?
to prevent regurgitation and emesis
- do halfway through and at end of feeding
What is cow milk based formula used for ?
most widely used
What is soy based milk formula used for ?
used for lactose or cow milk protein intolerance
What is casein or whey based formula used for ?
used if intolerant to cow’s milk and soy formula
What is amino based formula used for ?
used for intolerance to multiple food proteins ?
What are the different types of formula ?
- concentrated
- powder
- ready-to-feed
What is concentrated formula ?
- diluted with equal parts water and mixed
- use within 48 hrs (refrigerated)
What is powder formula ?
- least expensive, mixed with water
- 1 scoop per 60mL water
What is ready-to-use formula ?
- most expensive
- used directly from packaging
- once opened, use within 48 hrs (1 hr if individual bottle)
How do you heat refrigerated formula ?
in pan of warm water
- never use microwave
- do not save leftovers
- discard after 1 hr
