Newborn Nutrition & Feeding Flashcards
What is breastmilk made up of?
- immune factors
- growth factors
- proteins
- digestive enzymes
- fats
- carbohydrates
- vitamins (A, B complex, C, D, E, K)
- minerals
- 87% water
What are some benefits of breastfeeding for the infant?
- easily digested and absorbed
- laxative effect
- transfer of antibodies and immune factors
- enhanced maturation of GI tract
- neurodevelopmental advantage
- analgesic effect
- better facial, oral and speech development (through act of breastfeeding)
What are some risks of not breastfeeding?
- GI or respiratory tract infections
- reduced immune protection
- high cholesterol (atherosclerosis later)
- celiac disease
- crohn’s disease
- obesity
- type 1 and 2 diabetes
- lower cognitive functioning
etc.
How does breastfeeding benefit the birth parent?
- decreased risk of cancer (ovarian, uterine, breast), RA, type 2 DM, hypertension
- convenient and less expensive
- promotes uterine involution and return to pre-pregnancy weight
- bonding, foster attachment
What are some options for families with transgender parent, adoption or surrogacy?
- chest feeding
- tube feeding
- induced lactation
- donor milk
Contraindications to breastfeeding?
- chemotherapy
- active TB or varicella
- HIV
- herpes lesions on breast
- substance abuse
- select medications
Galactosemia
very rare condition in which infant is unable to have breastmilk
What are the recommendations on breastfeeding?
- exclusive breastfeeding for the first 6 months
- introduce complementary foods at 6 months
- Continue for up to 2 years and beyond
- On demand
- Baby led
What is the Baby Friendly Hospital Initiative (BFHI)?
Launched by WHO and UNICEF in 1991 to promote, protect and support breastfeeding
- remove barriers
- provide training to health care workers
- promote an international standard
Explain BFHI’s baby friendly designation
- free or low cost substitutes not accepted
- feeding bottles and teats not accepted
- successful implementation of the 10 steps
10 Steps to Successful Breastfeeding
- Written BF policy for staff
- Train staff in skills
- Inform clients about benefits and management
- Help clients initiate BF within half an hour of birth
- Show clients how to BF and maintain lactation
- Give breastmilk only, unless medically indicated
- Practice “rooming in”
- Encourage BF on demand
- Give no pacifiers or artificial nipples
- BF support groups after discharge
Lactogenesis
Synthesis of breast milk occurs in 3 stages:
- Lactogenesis I - Differentiation
- Lactogenesis II - Activation
- Lactogenesis III - Maintenance
Lactogenesis I - Differentiation
Prolactin stimulates cell differentiation so that breast will be able to produce milk
- occurs mid pregnancy
- progesterone inhibits the onset of copious milk secretion
Colostrum
- available at birth up to 2-3 days postpartum
- thick, clear to yellowish
- lower in fat and sugar than mature milk
- high in protein and minerals
- contains IgA
Lactogenesis II - Activation
Transition from colostrum to mature milk
- caused by changes in hormones after birth of placenta
- decrease in progesterone, estrogen and placental lactogen
- increase in oxytocin and prolactin
Transitional Milk
- 2-5 days to 2 weeks postpartum
- less yellow
- dramatic increase in volume
- higher fat, lactose and calories
- less protein
Lactogenesis III - Maintenance
Establishment of mature milk
- supply and demand: effective removal of milk
- whiter, thinner than transitional milk
Mature Milk
Fore milk (watery) + Hind milk (creamier) gradient
*important that infant gets both - keep baby on one side under hind milk comes in
Fore milk
bluish-white
low fat
high water content
Hind milk
creamy
high fat and calories
satisfies hunger and promotes weight gain
(stools have seedy appearance)
Stimulating Milk Production
Suckling on the breast causes hormones to be released:
- prolactin (anterior pituitary) –> alveoli in breast to make milk
- Oxytocin (posterior pituitary) –> contract muscle cells around alveoli and caused “let down” of milk into ducts
Positioning of successful latch
- the baby uses the tongue and lower jaw to milk the breast
- areola is covered
- tip of nipple should be at the back of baby’s mouth
- baby’s tongue is over gum line
What factors stimulate milk production?
- baby cry
- thinking about baby
- preparing to breastfeed
- being the usual time the baby feeds
What factors inhibit milk production?
- fear
- pain
- embarrassment
- anxiety
- breast surgery
Skin to Skin (how does it help breastfeeding?)
For baby:
- self latching
- improved thermo and cardiovascular regulation
- reduce crying
For mother:
- increased oxytocin and prolactin (more milk!)
- promote bonding
Early feeding cues
- rooting
- lip smacking
- light sleep
- fussiness
Ideal state for feeding
Quiet alert
Late feeding cues
Crying
Breastfeeding Positions
- Crosscradle (mom holds baby across abdomen towards right breast with left hand)
- Cradle (mom holds baby across abdomen towards right breast with right arm)
- Football/clutch (mom holds baby to the side towards left breast with left arm
- Sidelying (mom is turned on her side)
Principles of Latching
a. position fingers in c shape or u shape to match baby’s mouth
b. tummy to tummy
c. nose to nipple
d. stimulate rooting reflex
e. wait for wide open mouth
f. bring baby to breast
Latch Assessment
- Asymmetry
- Wide open mouth
- Lips visible and flanged outward
- Much of lower part of areola covered by mouth
- Tongue over lower gum line
- No pain
- No dimpling of cheek
- No clicking or smacking sounds
- Hands unclenched and relaxed
Suck & Swallow Assessment
Chin moves, jaw glides in rhythmic motion
Rhythmic suck-swallow pattern
Audible or visible swallowing
What is a typical sucking pattern?
- Short fast sucking to stimulate let down
- Sucking will slow down
- Baby pauses to swallow
Nutritive vs. Non-nutritive Sucking
Non-nutritive does not involve milk transfer (2 sucks/sec)
Nutritive sucking involves milk transfer (1 suck/sec)
Common errors associated with poor patching
- mouth not wide open, not enough breast in mouth
- chin not into the breast (wrong angle)
- lips not visible
Nipple Assessment
Everted
Flat
Inverted
How often should baby be fed?
Feed on demand, minimum q3h
8-12 feedings/day
Growth spurt at 2nd day, 10 days, 3 weeks, 6 weeks, 3 months and 4-6 months (cluster feeding)
Client’s signs of milk transfer
softening of breast
Signs of Milk Ejection Reflex
- thirst
- drowsiness
- milk leakage from opposite breast
- uterine cramping
- increased lochial flow
Baby’s signs of milk transfer
- relaxed arms and hands
- sustained rhythmic suck-swallow patterns
- weight gain
- elimination pattern
- absence of hunger cues
What is the expected elimination pattern?
1 wet & 1 stool on day 1 2 wet & 1-2 stools on day 2 3 wet & 3 stools on day 3 4 wet & 3 or more stools on day 4 consistently 6 of more wet & 3 or more stools after day 5
Baby loses how much weight in the first 3-5 days after birth?
Less than 10%
How does stool change?
Meconium
Transitional
Yellow, soft, seedy (day 5!)
What is baby’s pattern of weight gain?
Return to birth weight by week 2
Weight gain of 4-8 ounces per week until baby doubles birth weight
Problems that might interfere with breastfeeding
- impact of medical interventions
- sore nipples
- engorgement
- mastitis (breast infection)
