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NUR 360 Maternal > Newborn Nutrition & Feeding Ch 27 > Flashcards

Newborn Nutrition & Feeding Ch 27 Flashcards

1
Q

Other than establishing a basis for healthy eating habits, what is newborn feeding good for?

A

Provides an opportunity for social and psychological interaction between parent and infant

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2
Q

What are the recommendations for infant nutrition?

A

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

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3
Q

T or F: Human milk is nutritionally superior to alternative food sources for infants

A

True because nutrients in breast milk are more easily absorbed than in formula

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4
Q

What are the benefits of BF to Infants

A
  • 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
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5
Q

What are the benefits of BF to mothers

A
  • 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
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6
Q

What are the general benefits of BF to the family

A
  • 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
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7
Q

What are some contraindications to breastfeeding

A
  • 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
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8
Q

What is breastmilk composed of?

A 
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
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9
Q

What are some risks of not breastfeeding for the infant?

A 
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
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10
Q

What are some risks of not breastfeeding for the mother?

A

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

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11
Q

Why was the Baby Friendly Health Initiative (BFHI) created?

A

“Protect, promote and support bf
Remove hospital barriers to breastfeeding
Provide evidence based training of health care workers
Promote an international standard

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12
Q

Baby friendly designation is achieved when:

A

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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13
Q

What are the 10 Steps to Successful BF?

A
  1. Have a written breastfeeding policy that is
    communicated to health care staff.
  2. Train all health care 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.
  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 breast milk, unless medically indicated.
  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.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
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14
Q

What is Lactogenesis and what are the 3 stages

A

The synthesis of breast milk
I - differentiation
II - activation
III - maintanence

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15
Q

When does the first phase of lactogenesis begin and what occurs during that period

A

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

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16
Q

When does the second phase of lactogenesis begin and what occurs during that period

A

•“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

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17
Q

When does the third phase of lactogenesis begin and what occurs during that period

A
  • 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
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18
Q

Colostrum

A

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

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19
Q

Transitional Milk

A 
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
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20
Q

Compare Fore Milk vs. Hind Milk

A

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

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21
Q

What causes milk production hormones to be released

A

Suckling on the breast (stimulating the nipple, areola and grasping at the breast) causes milk production stimulating hormones to be released from the brain

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22
Q

What are the two hormones related to the stimulation of milk production

A

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.

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23
Q

What are some stimulating and inhibiting factors for the Milk Ejection Reflex (MER)

A 
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
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24
Q

What are the benefits of skin to skin for baby and mom

A 
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.
25
Q

What are some early, ideal state, and late cues for feeding

A

Early cue: rooting, lip-smacking, light sleep, fussiness
Idea state: quiet alert
Late cue: crying

26
Q

Name and describe some breastfeeding positions

A

Cross-cradle, cradle, football, laying down

27
Q

What are some steps for latching a baby

A 
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
28
Q

What are some signs you can use to assess a good latch

A 
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)
29
Q

What are some things you can watch for to assess for a proper suck and swallow

A

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

30
Q

Compare nutritive vs non-nutritive suckling

A

Non nutritive sucking does not involve milk transfer (2
sucks/sec) - signal milk let-down
Nutritive sucking involves milk transfer (1 suck/sec)

31
Q

Frequency & duration of BF

A

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)

32
Q

When do growth spurts usually occur and how is cluster feeding-related? What does cluster-feeding do to the milk supply?

A

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

33
Q

What is the Milk Ejection Reflex (MER)? What are some signs of MER?

A 
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
34
Q

What is milk transfer? What’s a sign of milk transfer in the mother? What are some signs of milk transfer in the baby?

A 
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
35
Q

Describe the elimination pattern of a baby in the first 5+ days

A

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

36
Q

How does the stool of a baby change in the first 5+ days

A

Meconium (dark sticky) -> Transitional (green dark) -> yellow, soft, seedy (mustard)

37
Q

How does the baby’s weight change in the first few weeks of life?

A

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

38
Q

What are some factors that may cause potential problems in bf?

A

The impact of medical interventions
Sore nipples
Engorgement
Mastitis

39
Q

What are some medical interventions that may impact bf?

A
  • 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
40
Q

What are some common causes of sore nipples?

A

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

41
Q

What are some remedies for sore nipples?

A
  • 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
42
Q

Prevention for sore nipples

A
  • 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
43
Q

What is engorgement? When does it occur? How long does it last?

A

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

44
Q

What does engorgement result in? How can it be avoided?

A

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

45
Q

What are some treatments for engorgement?

A
  • 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)
46
Q

What is mastitis? What are some symptoms?

A
  • 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)
47
Q

What are some forms of treatment for mastitis (or duct blockage in general)

A 
Feed/pump frequently
Rest
Warm/cool compresses
Analgesia/anti inflammatory
If not resolving within 24hrs, seek medical attention
• Antibiotics may be given for infection
48
Q

What kind of support can nurses provide during/for feeding

A
  • 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
49
Q

What are some ways a parent can seek support for feeding their baby after discharge

A 
Public Health
Breastfeeding clinics
Private Lactation Consultants
La Leche League
Internet
mothertobaby.org
Support groups
50
Q

What are some teachings to give the client about formula feeding?

A
  • 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
51
Q

What 2 things should you never do with formula?

A

Never microwave formula

No powdered formula until 3 months

52
Q

What is good formula feeding technique?

A
  • 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
53
Q

What is the composition of formula?

A

Cow’s milk that has been modified to resemble human milk (contains all nutrients required for first 6 months)

54
Q

What are some differences between formula and milk composition?

A

Formula has butter fat removed, reduced protein content, addition of
vegetable oil and carbohydrates

55
Q

What illnesses is a baby at higher risk for if they are drinking formula milk?

A 
GI infections
Asthma
Allergies
Otitis media
Diabetes
Childhood cancers
Obesity
56
Q

What are some alternative risks that must be considered with formula feeding

A 
Increased risk of
infection or illness
from contaminated
formula and/or
supplies
Errors when mixing
formula
COST
57
Q

What factors that impact the choice to feed with formula or breast milk?

A
  • 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
58
Q

Breastfeeding key points

A 
early
often
effective
exclusive
skin to skin

NUR 360 Maternal (3 decks)

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