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NUR360 LS1 > Newborn Nutrition and Feeding > Flashcards

Newborn Nutrition and Feeding Flashcards

1
Q

Breastmilk Composition

A

• Immune factors (bacteriostatic, bactericidal)
- Antibodies from the mom come through

• Growth factors
- And cholesterols

• Proteins (approximately 70% whey and 30% casein)

  • Primary is whey and changes over time; in cow’s milk it’s more casein than whey
  • One of the reasons breastmilk is easier to digest

• Fats (variable)
- This is what changes the most; in one feed changes from foremilk to hindmilk (higher fat content; satisfied for longer and helps them grow)

• Carbohydrates (predominately lactose)
- Helps with brain development

  • Vitamins (A, B complex, C, D, E, and K)
  • Minerals (calcium, sodium, chloride, copper, zinc, iron, selenium, iodine, fluoride)
  • 87% water
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2
Q

Benefits of Breastfeeding

A

• Easily digested and absorbed
• Laxative effect
• Transfer of antibodies and immune factors
• Enhanced maturations of GI tract
- Really important for premature infants
• Neurodevelopmental advantage
- Lactose
• Analgesic effect (decreases pain)
• Better facial, oral and speech development
- Not from breastmilk itself but from the act of breastfeeding

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3
Q

Risk of not Breastfeeding - Infant

A 
• Overall higher risk of infection and chronic diseases
• Gastrointestinal infections
• Otitis media
• Atopic dermatitis 
• Respiratory tract infections 
• Asthma (no family history)
• Childhood leukemia
• Celiac disease
• Ulcerative Colitis 
• Chron’s disease
• Atherosclerosis
• Hypertension
• High cholesterol 
• Reduced immune protection 
• Obesity
- In relation to the bottle feeding; people think the baby should finish the bottle but not necessary
- When babies breastfeed, they do not overfeed; they stop when they’re full
• Lower cognitive function 
• Type 1 and 2 diabetes
• SIDS
• Necrotizing Enterocolitis
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4
Q

Benefits of Breastfeeding - client

A

• Decreased risk of cancer (ovarian, uterine, breast), RA, Type 2 DM, hypertension and CVD
• Convenient and less expensive than infant formula
- Really beneficial for low income families
• Promotes uterine involution and return to pre-pregnancy weight
- Decreases risk pf PPH
- Doesn’t decrease pre-pregnancy weight by a lot – breastfeeding parent burns about 500 extra calories a day but usually increase what they eat
• Provides unique bonding experience
- Lactation hormone released though breastfeeding help the client learn to parent
- Teaches clients/parents to read and respond to cues
- Breastfeeding on demand; attend to baby’s needs

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5
Q

Bonding experience of Breastfeeding

A

• The amount of milk produces may not be as important to families as the special relationship that can come with breastfeeding
• Transgender parent – chest feeding
- Feeding tubes, medication; to provide breastmilk
• Adoption
- Parents take medication to pump and get breastmilk going so when baby comes to them so they can breastfeed
• Surrogacy

• Options:

  • Inducing lactation
  • Lactation Aid – attaching tube to breast and use formula or milk)
  • Donor milk – not promoted in the community (not safe, unpasteurized)
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6
Q

Risk of not breastfeeding - client

A

• Decrease oxytocin, decrease uterine involution, increase risk of PPH
- Cramping when breastfeeding is a good sign, oxytocin release
• Increased risk of ovarian, uterine, breast cancers
• Increased risk of developing type 2 diabetes
• Increased change of developing chronic conditions

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7
Q

Contraindications to breastfeeding - Infant

A
  • Galactosemia – cannot have any breastmilk

* Metabolic Disorders (limited human milk volumes)

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8
Q

Contraindications to breastfeeding - client

A
  • Chemotherapy
  • Radioactive isotopes (temporary)
  • Active TB or Varicella (EMB ok)
  • HIV
  • Human T-Lymphotropic Virus
  • Herpes lesion in breast
  • Substance abuse
  • Select medications
  • CMV infected donor milk
  • Chagas’ disease (parasite)
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9
Q

Current recommendations for breastfeeding

A

• Exclusive breastfeeding for the first 6 months
- But including Vitamin D drops
• Introduce complementary foods at 6 months
• Continuation of breastfeeding for up to 2 years and beyond
• On demand
• Baby led

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10
Q

Canadian Public Health Survey of “Mother’s voices”

A
  • Plan to breastfeed; 90%
  • Start breastfeeding; 90%
  • 3 months some breastfeeding; 68%
  • 3 months exclusive breastfeeding; 52%
  • 6 months some breastfeeding; 54%
  • 6 months exclusive breastfeeding; 14%
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11
Q

Baby Friendly Initiative (BFHI)

A

• Launched in 1991 by WHO and UNICEF
• Designed to
- “Protect, promote and support breastfeeding”
- Remove hospital barriers to breastfeeding
- Provide evidence-based training of health care workers
- Promote an international standard
• Hard for hospitals to obtain, only a few in Ontario have it
• Baby friendly designation is achieved when
- Free or low-cost substitutes are not accepted
- Feeding bottles and teats are not accepted
- Successful implementation of the 10 steps

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12
Q

10 Steps to Successful Breastfeeding

A
  1. Have a written breastfeeding policy that is routinely communications to all healthcare staff
  2. Train all healthcare staff in skills necessary to implement this policy
  3. Inform all pregnant women about the benefits and management of breastfeeding
  4. Help mothers initiate breastfeeding within half an hour of birth
    • Big part of this is promoting skin to skin
  5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants
  6. Give newborn infants no food or drink other than breastmilk, unless medically indicated
    • Medically indicated reasons: issues gaining weight, medical condition where baby needs extra calories, preterm infants might need extra protein or calories (breastmilk fortified)
  7. Practice “rooming in” – allow mothers and infants to remain together 24 hours a day
  8. Encourage breastfeeding on demand
  9. Give no pacifiers or artificial nipples to breastfeeding infants
    • Pacifiers given to babies who are ill and cannot feed at the breast and needs to suck on something; there’s always exceptions to the rules
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge form the hospital or clinic
    • Step that is most correlated to exclusive breastfeeding long term
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13
Q

Lactogenesis

A

• The synthesis of breast milk occurs in three stages:

  • Lactogenesis I – Differentiation
  • Lactogenesis II – Activation
  • Lactogenesis III – Maintenance
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14
Q

Lactogenesis I - Differentiation

A
  • .Occurs mid pregnancy
  • Prolactin (pregnancy hormone) stimulates cell differentiation so that the breast will be able to produce milk
  • Progesterone inhibits the onset of copious milk secretion
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15
Q

Colostrum

A

• Thick, clear to yellowish in appearance
- Thickness can also help babies when they’re first learning how to swallow
• Available at birth up to 2-3 days postpartum
• Volume varies from 2-20 mL/feed
- Only little amounts need to be given; only made in small amounts
- Small amount packed with a lot of nutrients
- Has laxative effect to clear the meconium
• Lower in fat and sugar than mature milk
• High in protein and minerals
• Contains IgA
• Easily digested
• Laxative effect

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16
Q

Lactogenesis II - Activation

A

• “Milk coming in” – transition from colostrum to mature milk
• Changes in hormones after birth of the placenta (30-40 hours after birth)
- Decrease in; progesterone, estrogen, placental lactogen (hormones that decrease milk production)
- Increase in; oxytocin and prolactin (hormones that increase milk production)
• Feedback inhibitor of lactation (FIL)
- Small whey protein that acts as local negative feedback mechanism
- Becomes whiter; less protein found

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17
Q

Transition Milk

A
  • Present 2-5 days to 2 weeks postpartum
  • Less yellow in appearance
  • Dramatic increase in volume
  • Higher fat, lactose and calories than colostrum
  • Less protein than colostrum
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18
Q

Lactogenesis III - Maintenance

A

• Establishment of mature milk
• Dependent of effective removal of milk from breast – supply and demand
- If breasts not emptied less milk is made
• Whiter, thinner than transitional milk
• Mature milk = fore milk + hind milk gradient
- Important for infant to get both
- Keep infant on one side until breast is drained then switch breast
- If only get fore milk they won’t be as satisfied, stool is greenish, can cause stomach discomfort
- If getting hind milk, stool will have that yellow seediness to it

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19
Q

Fore Milk vs Hind Milk

A

• Fore milk

  • Bluish-white in appearance
  • Low fat; high water content milk at start of feed

• Hind milk

  • Creamy in appearance
  • High fat and calories; released well into feed
  • Satisfies hunger, promotes weight gain, content between feeds
  • Stools have seedy appearance
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20
Q

How to stimulate milk production

A

• Suckling on the breasts (simulating the nipple, areola and grasping at the breast) causes the hormone to be released in the client’s brain

1) The alveoli in the breast begins to make the milk in response to the release of prolactin
2) Oxytocin contracts the muscle cells around the alveoli and causes ‘let down’ which sends the milk down the ducts to be available to the infant

• With the asymmetrical latch, the baby uses the tongue and lower jaw to milk the breast

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21
Q

Milk Ejection Reflexes (MER)

A
  • Sucking stimulus creates nerve impulse up to the hypothalamus
  • Hypothalamus gets anterior pituitary to release prolactin and oxytocin; which in turn stimulates milk production and let down
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22
Q

MER Stimulating Factors

A
  • Hearing a baby cry
  • Thinking about the baby
  • Preparing to breastfeed
  • Being the usual time the baby feeds
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23
Q

MER Inhibitory Factors

A

• Make sure families are comfortable when breastfeeding to strengthen let down

  • Fear
  • Pain
  • Embarrassment
  • Anxiety
  • Breast surgery – if incision around areola, the nerve may be severed which can inhibit let down
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24
Q

Benefits for baby of S2S

A
  • Improved thermo and cardiorespiratory regulation
  • Reduced serum cortisol
  • Stabilizes blood glucose
  • Reduced crying
  • Self-latching
  • Improved prolactin
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25
Q

Benefits for client of S2S

A
  • Increased oxytocin and prolactin
  • Improved milk volumes
  • Promotes bonding

EARLIER, MORE EFFECTIVE BREASTFEEDING
• Correlation in spending time in skin to skin and increased production of milk

26
Q

Feeding cues

A 
Early cue:
• Rooting – poking at parent
• Lip smacking
• Light sleep – ideally want in that quiet alert state, not upset
• Fussiness

Ideal state:
• Quiet alert

Late cue:
• Crying

27
Q

Breastfeeding Positions

A

1) Cross-cradle
2) Football hold
3) Cradle
4) Side-lying

  • Whatever breastfeeding position is most comfortable it’s the best position for them
  • Cross-cradle and football position are recommended to clients who are learning to breastfeed for the first time
  • Football hold good for parent who had C/S or has a very large breast
  • “Angle of the dangle” – bring the baby to the breast
28
Q

Latching On

A 
• Position fingers in C-shape or U-shape
- Feed the hamburger to the baby
- Thumb and index finger are parallel to the baby lips
- Hold should be larger than the areola 
• Tummy to tummy
• Nose to nipple
• Stimulate rooting reflex
• Wait for wide open mouth
• Bring baby to breast
29
Q

Latch Assessment

A

• Asymmetric
- More areola on top than below
• Wide open mouth
• Lips visible and flanged outward
- If using lips meaning not a good latch
- Should be able to lift the lip and not break the latch
• Much lower part of the areola covered by mouth
• Tongue over lower gum line
• No pan/discomfort
- If initial discomfort should go away in the first couple of suck, meaning the baby was able to latch on deeper and get good latch
• No indrawing or dimpling of cheek
• No clicking or smacking sounds
- Meaning not sucking properly (using front of mouth) or breaking the seal
• Hands relax during the feed (unclenched)

30
Q

Suck and Swallow Assessment

A

• Chin moves, jaw glides in rhythmic motion
• Rhythmic suck-swallow pattern (short suck to stimulate milk switching to long draws with let-down)
- Short suck stimulated let down
- Once milk there the sucks slow-down in order to coordinate suck-swallow-breathe pattern
• Audible or visible swallowing
- With colostrum there are sporadic swallowing; with milk there is a distinct pattern of suck-swallow
- Swallow is a “cuk” sound

31
Q

Nutritive vs Non-nutritive suckling

A
  • Non-nutritive sucking does not involve milk transfer (2 sucks/sec)
  • Nutritive sucking involves milk transfer (1 suck/sec)
32
Q

Nipple Assessment for Breastfeeding

A
  • Everted, flat, inverted
  • Usually not a problem with any nipple type, because baby latches onto breast not nipple
  • Nipple shields can go over the nipple and create a tit for the baby to use; transitional tool
33
Q

Frequency and Duration of Breastfeeding

A

Determined by baby’s hunger and fullness of client’s breasts

  • Minimum 8-12 feeding/24 hours
  • Feed on demand, minimum q3h (wake infant if necessary)
  • Highly variable duration
  • Variable breast storage capacity
  • Can’t tell by outside of the breast; breasts can only hold a certain volume
  • Solution of baby feeding more frequently

• Average duration 20-30 minutes

  • Anywhere between 25-40 minutes is considered good
  • Less than 20 is not enough
  • More than 40 may be issues with latch

• Growth spurts at: 10 days, 3 weeks, 6 weeks, 3 months, and 4 to 6 months
- Cluster feed for a few days during growth spurts

• Cluster foods necessary to build up milk supply

  • Second night the baby often cluster feeds
  • As long as baby looks okay and no signs of issues it’s fine; weight gain
  • Also examine the elimination pattern
34
Q

Signs of Milk Transfer - Client

A

• Softening of breasts as feed progresses

35
Q

Signs of MER - Client

A 
• Thirst
• Relaxation or drowsiness
• Milk leakage from opposite breast
• Uterine cramping 
- In first few days
• Increased lochial flow 
- But these do not say anything about the milk transfer; have to look for signs in baby
36
Q

Signs of Milk Transfer - Baby

A

• Sustained rhythmic suck-swallow pattern
• Gradual decrease in intensity and number of sucks
- Means they are emptying the breast
• Relaxed arms and hands
• Moist mouth
• Satisfied after feeding
• Audible swallowing
• Absence of hunger cues
• Weight gain
- Gold standard that the baby is getting enough
• Elimination pattern

37
Q

Elimination Pattern

A
  • First 24 hours: 1 wet and 1 stool (meconium)
  • By day 2: 2 or more wet diapers, 1-2 stools
  • By day 3: 3 or more wet diapers, 3 or more stools
  • By day 4: 4 or more wet diapers, 3 or more stools
  • By day 5 and beyond: 6 or more wet diapers, 3 or more stools
  • Expect to see predictable stool changes
38
Q

Stool Changes

A
  • Meconium: 0-3 days old
  • Transitional: 3-6 days old
  • Yellow, soft, seedy: 6 days+
39
Q

Potential Problems when Breastfeeding

A
  • Impact of medical interventions
  • Sore nipples
  • Engorgement
  • Mastitis
40
Q

Impact of anesthesia/analgesia when breastfeeding

A
  • Makes them more drowsy

- Epidural may affect comfortable position and what they can feel

41
Q

Impact of C/S on breastfeeding

A
  • Tolerance of abdominal pressure; football hold
42
Q

Impact of vacuum/forceps on breastfeeding

A
  • Make the baby drowsier than usually
  • Hematoma; blood can make it more likely to have jaundice, make them more tired
  • Forceps can affect nerves in the face, affect feeding
  • Both can cause bruising; can making feeding uncomfortable
43
Q

Impact of IV on breastfeeding

A
  • Cause edema in breastfeeding parent, extend to areola and make breastfeeding more difficult
44
Q

Impact of Oxytocin on breastfeeding

A
  • Increase neonatal jaundice and make breastfeeding more difficult
45
Q

Causes of sore nipples when breastfeeding

A

• Poor latch/positioning
- Getting that latch deeper in order to activate that deep sucking reflex; nutritive sucking
• Improper suck
• Pump problems
- Wrong size, cause pain or not enough milk; suction too high
• Thrush/yeast
• Eczema/dermatitis

46
Q

Treatment of sore nipples

A

• Get a good latch where the nipple is safe
• Starts feeds from unaffected side
- Switch which side they’re starting the feed from
• Pump affected side to allow nipple to heal
• Breast shell for protection
• Expressed breast milk
- Rub into nipple after feed to help with healing and moisturizing
• Nipple ointment
- Lansinoh
• Continuous breastfeeding support

47
Q

Prevention of sore nipples

A

• Proper latch
• Use of varied positions
• Break suction before taking baby off breast
- Can be painful if you don’t
• Express a few drops of milk, massage into nipple after each feed and allow to air dry

48
Q

Engorgement

A

• Milk stasis in the ducts and increased blood flow causes edema of the breast tissue which compresses the ducts
- In initial engorgement it is not just milk, also swelling
- Can pinch the milk ducts completely shut
• Firm, tender, swollen, hot, shiny, red breasts
• Latching difficult
- A bit of hand expression, reverse pressure softening (move fluid away from nipple so the baby can get on)
• Occurs postpartum day 3-5; 24 hr duration but can happen anytime throughout lactation
• Can be avoided with early frequent feeds and complete emptying of breasts
• Can reduce milk production

49
Q

Treatment of engorgement

A

• Adequate breast emptying
• Cold therapy between feeds/pumping
- Cold to help the swelling, for 20 minutes
- Can do heat right before feeding but in general it won’t help
• Cabbage leaves application
- Cold cabbage leaves; enzyme in leaves that helps decrease inflammation
• Massage during feeds/pumping
• Analgesic/anti-inflammatory
• Reverse pressure softening

50
Q

Blocked Milk Duct

A

• Painful, firm lump in the breast
• May see white dot on the nipple- bleb
- Blockage is down at the level of the nipple
- To treat; apply heat and use a towel to rub at it to try and release it
- If further up; apply heat and massage from behind the lumpy area towards the nipple
• Client may not feel ill, or may start to have flu like symptoms
• This needs to be expressed so the milk will flow
• If not expressed can lead to infection and abscess
• Get the milk out – feed, hand expression, pump
• Warm water and massage often help

51
Q

Mastitis

A

• S. Aureus enters through nipple fissure
- Infective and non-infective mastitis
• Milk flow obstruction
• Sudden onset of flu-like symptoms, fever
• Localized breast pain, redness, edema
• Can lead to breast abscess
• Other type is a plugged duct that has not been managed (non-infective)

52
Q

Mastitis Treament

A 
• Feed/pump frequently
- Empty it out and try to unblock it 
• Rest
• Warm/cool compress
• Analgesia/anti-inflammatory 
- For pain and swelling 
• If not resolving within 24hrs, seek medical attention 
- Antibiotics
53
Q

Providing support for breastfeeding

A

• Evidence based, up to date, consistent information
- BFI helpful to ensure everyone is giving the same information
• Encouragement, reassurance, feedback, support, caring, non-judgemental approach
- The first stages of breastfeeding is usually not easy
• Nurse to stay at bedside through duration of feed and help with positioning/latch
- Watch the full feed so you see it all
• Practical advice
• Information about support after discharge

54
Q

Community resources for breastfeeding

A

• Public health
• Breastfeeding clinics
- Usually one affiliated with the birth hospital
• Private Lactation Consultants
• La Leche League
- Breastfeeding sit together and support through the whole experience of feeding
• Internet
• mothertobaby.org
- Information on breastfeed on certain medications or over the counter
• Support groups

55
Q

Formula Feeding Fundamentals

A

• Use feeding/skin to skin to bond with baby

  • Hold your baby while feeding
  • Make sure you are watching the baby while they are feeding
  • 6-8 feedings/24 hours (feed on demand)
  • Average initial intake 10-15mL
  • Gradually increases to 90-150mL by end of 2nd week
  • Stools differ and are smellier
  • Growth spurts similar to breastfed babies
  • Same calorie content as breast milk (unless specialized)

• Never microwave formula
- Hot pockets can form and burn baby

• No powdered formula until 3 months

  • Not sterile, under 3 months the baby is at more risk
  • More likely to be contaminated and cause problems
  • Follow instructions on package for preparation
  • Added cost for name brands, special additives not necessary
  • Powdered, concentrated, ready-to-feed
  • Concentrated mix and dilute with water
  • Powdered add to water; can be rationing which is unsafe (especially with low income families or families that don’t speak English)
56
Q

Formula feeding technique

A

• Sit upright holding bay closely
• Burp baby several times during a feed
• Observe for satisfaction cues to avoid overfeeding
- Not about emptying the bottle
- Side-lying position
• Clean and maintain bottles and nipples properly

57
Q

Side-lying position for bottle feeding

A

• Most recommended position for breastfeeding babies
• Like they’re feeding in cross-cradle
• Hold the bottle horizontal; if the baby is not sucking the milk is not coming
- Baby can pull back
- Can slide out of side of mouth is too full
- Nipple half full

• Key points:

  • Keep nipple half full
  • Make sure baby’s hips are extended (to minimize pressure on stomach)
58
Q

Formula Composition

A

• Modified cow’s milk which is made to resemble human milk

• Butter fat removed, reduced protein content, addition of vegetable oil and carbohydrates
- Missing immune factors and growth factors found in mother’s milk

• All nutrients required for first 6 months:

  • Vitamins
  • Minerals
  • Sugars
  • Essential amino acids
  • Iron fortified
59
Q

Risks of formula feeding

A 
• Increased risk of:
- GI infections
- Asthma
- Allergies
- Otitis media
- Diabetes
- Childhood cancers
- Obesity
• Increased risk of infection or illness from contaminated formula and/or supplies
• Errors when mixing formula 
• COST – can be a huge strain on a family, may lead to mixing errors, potential of contamination
60
Q

Feeding choices

A

• Informed decision
• Conveyed messages strongly influence maternal/paternal sense of competence and success in ability to feed baby effectively
• Ongoing teaching and support is required to promote success
- No matter their decision
• “The first six weeks”
- Time where breastfeeding is established, where they need the most support, point where if there are issues they’ll give up

61
Q

Breastfeeding key principles

A
  • Early
  • Often
  • Effective
  • Exclusive
  • Skin to skin

NUR360 LS1 (6 decks)

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