Newborn Nutrition & Feeding Ch 27 Flashcards
Other than establishing a basis for healthy eating habits, what is newborn feeding good for?
Provides an opportunity for social and psychological interaction between parent and infant
What are the recommendations for infant nutrition?
Breastfeed exclusively for first 6 months
Can start incorporating foods after 6 months in addition to BF (BF max of 2 years)
Supplement with vit D until 1 y/o
Infant formula should be iron-fortified
BF should be on-demand and baby-led
T or F: Human milk is nutritionally superior to alternative food sources for infants
True because nutrients in breast milk are more easily absorbed than in formula
What are the benefits of BF to Infants
- Enhances maturation of GI tract & contains immune factors that contribute to lower risk of disease and obesity
- Lowers risk of certain allergies
- Lower risk of sudden infant death syndrome (SIDS)
• Easily digested and absorbed
• Laxative effect
• Neurodevelopmental advantage
• Analgesic effect
• Better facial, oral and speech development
What are the benefits of BF to mothers
- Decreased risk of some chronic diseases (certain cancers, r.arthritis, T2 diab, CVD, hypertension)
- BF promotes involution and is associated with a decreased risk of PPH
- Tend to return to their pre-pregnancy weight faster
- May protect against osteoporosis and hip fractures
- Provides unique bonding experience, enhances maternal role development, may provide protection against PPD
What are the general benefits of BF to the family
- Convenience: no need for other equipment
- Portable: no supplies needed to be carried
- Saves money: no need for other purchases
- Parental absenteeism from work is decreased
What are some contraindications to breastfeeding
- Chemotherapy or radioactive isotopes
- Active TB or Varicella
- HIV
- Substance abuse (e.g., cocaine, marijuana, etc.)
- Herpes lesion on a breast
- Human T Lymphotropic Virus
- Certain medications
- Chaga’s disease
- Hep A, B, C
- CMV +
- Infant galactosemia
- Infant metabolic disorders
What is breastmilk composed of?
87%: water 13%: • Immune factors • Growth factors • Proteins (approximately 70% whey and 30% casein) • Digestive enzymes • Fats (variable) • Carbohydrates (predominantly lactose) • Vitamins (A, B complex, C, D, E, K) • Minerals
What are some risks of not breastfeeding for the infant?
GI infections Otitis media Atopic dermatitis Respiratory track infections Asthma (no family history) Childhood leukemia Celiac Disease Ulcerative Colitis Crohn’s Disease Atherosclerosis Hypertension High cholesterol Reduced immune protection Obesity Lower cognitive function Type 1 and 2 diabetes SIDS
What are some risks of not breastfeeding for the mother?
decr oxytocin = decr involutoin = incr risk of PPH
increased risk of ovarian, uterine, breast cancers
increased risk of developing T2 diabetes
increased chance of developing chronic conditions
Why was the Baby Friendly Health Initiative (BFHI) created?
“Protect, promote and support bf
Remove hospital barriers to breastfeeding
Provide evidence based training of health care workers
Promote an international standard
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
What are the 10 Steps to Successful BF?
- Have a written breastfeeding policy that is
communicated to health care staff. - Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about the benefits and
management of breastfeeding. - Help mothers initiate breastfeeding within half an hour of birth.
- Show mothers how to breastfeed and how to
maintain lactation, even if they are separated from their infants. - Give newborn infants no food or drink other than breast milk, unless medically indicated.
- Practice “rooming in” allow mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Give no pacifiers or artificial nipples to breastfeeding
infants. - Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
What is Lactogenesis and what are the 3 stages
The synthesis of breast milk
I - differentiation
II - activation
III - maintanence
When does the first phase of lactogenesis begin and what occurs during that period
Differentiation 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
When does the second phase of lactogenesis begin and what occurs during that period
•“Milk coming in” aka transitional milk
• Changes in hormones after birth of the placenta (30 40
hours after birth) cause this
- Decrease in : progesterone, estrogen, placental
lactogen
- Increase in : oxytocin and prolactin
• Feedback inhibitor of lactation (FIL)
- Small whey protein that acts as local negative
feedback mechanism
When does the third phase of lactogenesis begin and what occurs during that period
- Establishment of mature milk
- Dependent on effective removal of milk from breast supply and demand
- Whiter, thinner than transitional milk
- Mature milk = fore milk + hind milk gradient
Colostrum
Thick, clear to yellowish in appearance
Available at birth up to 2-3 days postpartum
2 - 20 mls /feed
Low in fat and sugar, high in protein and minerals
Contains IgA
Easily digested, laxative effect
Transitional Milk
Present 2-5 days to 2 weeks postpartum Less yellow in appearance than colostrum Dramatic increase in volume Higher fat, lactose and calories than colostrum Less protein than colostrum
Compare Fore Milk vs. Hind Milk
Fore Milk:
- Bluish white in appearance
- Low fat; high water content milk that comes 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
What causes milk production hormones to be released
Suckling on the breast (stimulating the nipple, areola and grasping at the breast) causes milk production stimulating hormones to be released from the brain
What are the two hormones related to the stimulation of milk production
Prolactin - causes alveoli in breasts to begin milk production
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.
What are some stimulating and inhibiting factors for the Milk Ejection Reflex (MER)
Stim: Hearing a baby cry Thinking about the baby Preparing to breastfeed Being the usual time the baby feeds
Inhibit: Fear Pain Embarrassment Anxiety Breast surgery
What are the benefits of skin to skin for baby and mom
for baby: - improved thermo and cardiorespiratory regulation - reduced cortisol - stabilizes blood glucose - reduced crying - self latching - improved exclusivity. for client: Increased oxytocin and prolactin, improved milk volumes, promotes bonding.
What are some early, ideal state, and late cues for feeding
Early cue: rooting, lip-smacking, light sleep, fussiness
Idea state: quiet alert
Late cue: crying
Name and describe some breastfeeding positions
Cross-cradle, cradle, football, laying down
What are some steps for latching a baby
Position fingers in c shape or u shape to support breast have baby tummy to tummy Nose to nipple Stimulate rooting reflex Wait for wide open mouth Bring baby to breast Nipple should be on roof of mouth
What are some signs you can use to assess a good latch
ASYMMETRIC - more ariola above the mouth than below Wide open mouth Lips visible and flanged outward Much of lower part of the areola covered by mouth Tongue over lower gum line No pain/discomfort of nipple No indrawing or dimpling of cheek No clicking or smacking sounds Hands relax during the feed (unclenched)
What are some things you can watch for to assess for a proper suck and swallow
Chin moves, jaw glides in rhythmic motion
Rhythmic suck swallow pattern (short sucks to stimulate
milk switching to long draws with let down)
Audible or visible swallowing
Compare nutritive vs non-nutritive suckling
Non nutritive sucking does not involve milk transfer (2
sucks/sec) - signal milk let-down
Nutritive sucking involves milk transfer (1 suck/sec)
Frequency & duration of BF
Ultimately determined by baby’s hunger demand & fullness of breasts
minimum of 8-12 feedings in 24 hours (min q3h)
Average is 20-30 min total (10-15 min per breast)
When do growth spurts usually occur and how is cluster feeding-related? What does cluster-feeding do to the milk supply?
Growth spurts at 10 days, 3 weeks, 6 weeks, 3 months, and 4 to 6 months
Cluster feeds supply energy for the growth spurts and is necessary to build up further milk supply
What is the Milk Ejection Reflex (MER)? What are some signs of MER?
The mechanism by which milk is transported from the breast alveoli to the nipple. Signs include: Thirst Relaxation or drowsiness Milk leakage from the opposite breast Uterine cramping Increased lochial flow
What is milk transfer? What’s a sign of milk transfer in the mother? What are some signs of milk transfer in the baby?
The movement of milk from the maternal breast to the suckling infant. A sign is the softening of the breast as the feed progresses. Signs of milk transfer in the baby: Sustained rhythmic suck swallow patterns Gradual decrease in intensity and number of sucks Relaxed arms and hands Moist mouth Audible swallowing Absence of hunger cues Satisfied after feeding Weight gain Elimination pattern
Describe the elimination pattern of a baby in the first 5+ days
First 24 hours: 1 wet & 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
How does the stool of a baby change in the first 5+ days
Meconium (dark sticky) -> Transitional (green dark) -> yellow, soft, seedy (mustard)
How does the baby’s weight change in the first few weeks of life?
First 3-5 days: weight loss (up to 10% loss is okay)
By week 2: return to birth weight
Every week following: weight gain of 4-8 ounces until the baby doubles birth weight
What are some factors that may cause potential problems in bf?
The impact of medical interventions
Sore nipples
Engorgement
Mastitis
What are some medical interventions that may impact bf?
- Anesthesia/analgesia effects - may make mom and/or baby drowsy = less likely to feed
- C/S - suture can make feeding position uncomfortable
- Vacuum/forceps - vacuum can make baby more drowsy than usual
forceps can effect nerves in the face
both cause bruising = baby discomfort - IV - can cause edema (swelling) in parent which can extend to the areola and make feeding difficult
- Oxytocin - causes drowsiness
What are some common causes of sore nipples?
Poor latch/positioning - most common problem that causes nipple damage
Improper suck
Pump problem - wrong size or power is too high
Thrush - a type of yeast infection that causes itchy and burning nipples
Eczema/Dermatitis - itchy nipples
What are some remedies for sore nipples?
- getting a good latch
- start feeds on unaffected side
- only pump the effected side to allow healing
- breast shell for protection
- rub expressed breast milk into nipple for healing
- nipple ointment
- continuous bf support
Prevention for sore nipples
- having a proper latch
- use of a varied positions
- break suction w finger before taking baby off breast
- massage a few drops of expressed milk into nipple after each feeding and allow to air dry
What is engorgement? When does it occur? How long does it last?
Milk stasis in the ducts and increased blood flow causes
edema in of the breast tissue
Occurs PP on day 3-5 and lasts for 24 hours
What does engorgement result in? How can it be avoided?
Results in:
- compression of the milk ducts
- Firm, tender, swollen, hot, shiny, red breasts
- can reduce milk production
- can cause latching difficulty
Can be avoided Can be avoided with early frequent feeds and complete
emptying of breasts
What are some treatments for engorgement?
- Adequate breast emptying
- Cold therapy between feeds/pumping
- Cabbage leaves application (cold cabbage helps reduce swelling)
- Massage during feeds/pumping
- Analgesic/anti inflammatory
- Reverse pressure softening (pushing around the aeriola to push milk away from it and then feeding to get the milk out)
What is mastitis? What are some symptoms?
- An infection of the milk ducts from S. Aureus bacteria that enters through the nipple fissure
- caused when there areclogged milk ducts that obstruct milk flow
- symptoms: sudden onset of flu-like symptoms & fever
- signs: localized breast pain, redness, edema
- can lead to breast abscess (build up of puss)
What are some forms of treatment for mastitis (or duct blockage in general)
Feed/pump frequently Rest Warm/cool compresses Analgesia/anti inflammatory If not resolving within 24hrs, seek medical attention • Antibiotics may be given for infection
What kind of support can nurses provide during/for feeding
- provide evidence based, up to date info
- Stay at bedside through duration of feed and help with positioning/latch
- Encouragement, reassurance, feedback, non judgmental approach
- provide discharge information for support resources
What are some ways a parent can seek support for feeding their baby after discharge
Public Health Breastfeeding clinics Private Lactation Consultants La Leche League Internet mothertobaby.org Support groups
What are some teachings to give the client about formula feeding?
- feeding should be done skin to skin to bond w baby
- feed on demand however there should be approx 6-8 feedings in every 24 hour period
- avg intake will increase from 10-15 mL initially to 90-150 mL by the end of week 2
- stools will be different and smellier
- formula will have same calorie content as breast milk
- name brands and formula with (unnecessary) additives will be more expensive
What 2 things should you never do with formula?
Never microwave formula
No powdered formula until 3 months
What is good formula feeding technique?
- Sit upright and hold baby close
- Hold baby in a sidelying position
- keep nipple half full (to allow baby’s sucking to control let-down and not gravity
- keep baby’s hips extended to minimize pressure on the stomach
- burp baby several times (more than bf)
- observe for satisfaction cues to avoid overfeeding and knowing when to stop
- clean and maintain bottles and nipples properly
What is the composition of formula?
Cow’s milk that has been modified to resemble human milk (contains all nutrients required for first 6 months)
What are some differences between formula and milk composition?
Formula has butter fat removed, reduced protein content, addition of
vegetable oil and carbohydrates
What illnesses is a baby at higher risk for if they are drinking formula milk?
GI infections Asthma Allergies Otitis media Diabetes Childhood cancers Obesity
What are some alternative risks that must be considered with formula feeding
Increased risk of infection or illness from contaminated formula and/or supplies Errors when mixing formula COST
What factors that impact the choice to feed with formula or breast milk?
- information (risks/benefits)
- conveyed messages (things that influence the parental sense of competence and success)
- Ongoing teaching and support is required to promote
success and preventing giving up for the first 6 weeks
Breastfeeding key points
early often effective exclusive skin to skin
