Nutrition During Lactation 2 Flashcards
Identifying breastfeeding malnutrition
Normal weight loss for newborns approx 7% of birthweight in first week. Weight loss of 10% needs evaluation by health professional
Malnourished infants become sleepy, non responsive, have a week cry and wet few diapers
By day 5-7 infants should have 6 wet diapers and 3-4 soiled diapers
Tooth decay risk factor is frequent nursing at night after 1 year. All children should be seen by dentist 6 months after 1st tooth erupts or at 1 year of age
Nutrient requirements for breastfeeding women
Differ depending on age
Veg and legumes/ beans: 7.5
Fruit: 2
Grains:9
Meat, poultry, fish, eggs: 2.5
Milk, yoghurt, cheese and alternatives 2.5
Additional 2-2.1MJ/ day assuming full breast feeding
Difficult to make a single recommendation due to differences in lactation storage, extent of weaning etc
Due to 0.78L/d milk production with energy content of milk 2.8kj/g in first six months
In second six months 0.60L/d but with depleted fat stores
Protein 14-18yo- 63g. 19-51yo- 67g
Weight loss during pregnancy
Caloric RDI assumes loss of 0.8kg/ month
Most women do not reach prepreg weight by 1 year after birth
Modest or shirt term energy reductions do not decrease milk production
Exercise is safe. Modest energy restriction coupled with increased activity assists in weight loss and body fat, exercise does not inhibit milk production or inhibit growth
Vit and mineral supplements not needed in well noutished women’s
Women should drink 10 glasses water/d
Alternative diets- vegan, GF for coeliac
Colic
Defined as crying for more than 3 hours a day with no medical cause Components of maternal diet may be linked- more likely with mothers ingestion of: Cows milk Onions Cabbage Broccoli Chocolate Fodmaps?
Factors influencing breastfeeding initiation and duration
Overweight and obesity prior to pregnancy and excess prenatal weight gain breastfeed for shorter duration Age Education level SES/income Maternal employment Embarrassment Time and social constraints Lack of support from family and friends Lack of confidence Concerns about diet and health fear of pain
Breastfeeding promotion and support
Healthcare system plays an influential role: provides prenatal breastfeeding education and support- breast is best, effective in increasing number who choose to breastfeed.
Lactation support in hospitals and birthing centres- distribution of free formula samples is discouraged
Other Social support networks Positive media promotion Workplace support Policies and legislation Paternal support Community attitudes Marketing by formula companies Cultural perceptions
Lactation support after discharge
First few days after delivery are critical and hospital practices are influential
Breastfeeding support is essential in the first few weeks after delivery as lactation is being established
As paediatrician, nurse or other knowledgable health care practitioner should see all breastfed infants at 2-4 days of age
Lactation consultants
Aus breast feeding association
- classes
- pump hits
- counselling
- breastfeeding helpline
- local support groups
Etc
Nutrition during lactation conditions and interventions
Condition: low milk supply common for cessation of breastfeeding (real or perceived) Causes: Insufficient breastfeeding or pumping Ineffective emptying Stress Imposing feeding schedule Forcing baby to sleep through night
Management:
Nurse/ pump every 2-3 hours
Drugs or herbs may be prescribed- milk thistle, metoclopramide, fenugreek
Prohibited: cytotoxic or chemo drugs, abuse drugs, radioactive iodine
Alcohol and breastfeeding
Level in plasma equal to breast milk
Peak occurs 30-60 mins after consumption or 60-90 with food
Alcohol decreases oxytocin and let down, affects odour of milk, decreases volume consumed by infant and interferes with sleep pattern
Recommendations: not drinking alcohol in first month
Limit to 2 standard drinks in 1 day
Takes approx 2 hours to clear 1 std drink
Express prior to alcohol
Caffeine
Moderate intake- no problem
Level in breast milk only 1% of that in mothers plasma
May accumulate in infants younger than 3-4 months- varies from individuals
May interfere with sleep or cause hyperactivity and fussiness of infant
Infant allergies
EBF for greater than 4 months protects against allergies, ectopic dermatitis and wheezing
Development of food allergies influenced by:
Genetics, duration of BF, intro of their food, maternal smoking, air pollution exposure to infectious disease, maternal diet and immune systems
Consumption of omega 3 fa may protect against allergies
Food intolerances
Low allergen maternal diet associated with reduction in distressed behaviour (colic).
Allergen foods eliminated were cows milk, eggs, peanuts, tree nuts and fish
New research being done on fodmaps and lactation
Human milk collection and storage guidelines
Freshly expressed in close container:
- room temp 6-8 hours
- 3-5 days in fridge
- 3-6 months in separate freezer
Previously frozen, thawed in refrigerator:
- took temp 4 or less hours
- stored in refrigerator for 24 hours
- do not freeze
Thawed outside refrigerator in warm water:
- room temp for completion of feeding
- refrigerate for 4 hours until next feed
- do not refereeze
Infant begun feeding:
Only use for completion of feeding
Milk banking
Human milk banks provide human milk to infants who cannot be breastfed by their mothers
Gives parents the choice of donated breast milk when the mothers own milk is not available
Screens, pasteurises and distributed donated human milk to infants and mothers in need
