Nutrition In Breastfeeding Flashcards
Why are infants restricted primarily to breastfeeding or specific formula?
They have low secretion of digestive enzymes and their kidneys have a low renal capacity
- this means that before 5 months old they cant eat solid food
- and until 12 months they cant fully digest/process solid foods with ease like adults
What are the body measurements used in growth charts for children based on age
0-36 month infants
- weight for age
- length for age
- weight for length
- head circumference for age
2-5 years
- weight for stature
2-20 years
- weight for age
- stature for age
- BMI for age
What is the AAP recommendation for breastfeeding
Unless medically recommended, the infant should be breastfeed for the first six months and continued ideally for 12 months total
- the baby is not to receive additional foods except for vitamin D supplementation
85% start breastfeeding built by 6 and 12 month milestones are at 58% and 35% respectively (mothers aren’t hitting the recommended goal as often)
If breast feeding is not possible = use iron-fortified infant formula should be used
What is the benefit of breast milk over formula
Breast milk contains distinct bioactive substances such as macrophages, Ig’s, cytokines, growth factors, anti microbes
Also contain monosaccharides and smaller easier to digest building blocks that an infant can digest
The three stages of breast milk and the unique features
1) Colostrum
- first breast milk secreted usually at time of bother and for the first few days
- is yellow clear and is super high in fat and low in proteins
- focuses more on immunological properties rather than nutrient (although it stills has nutrition obviously)
- contains high IgA, Lactoferrin and EGF
- contains high sodium, chloride and magnesium
- contains low lactose, potassium and calcium
2) transitional milk
- starts after colostrum and contains higher levels of lactose and potassium but lower sodium
- lasts from roughly 4-5 days -> 2 weeks postpartum
3) mature milk
- continues after 2 weeks until stopping breast feeding
- is more stable, provides more nutritional values vs immunological properties
Advantages to fetus and mother for breastfeeding
Fetus
- decreases incidence of respiratory/GI infections and otitis media
- decrease rates of SIDS
- decrease rates of atopic dermatitis, eczema and asthma
- decreases risk of obesity, diabetes celiac diseases, IBD and childhood leukemia and lymphoma
Mother
- decreased postpartum hemorrhage
- delayed ovulation
- more rapid uterine involution
- decreased postpartum depression
- decrease risk for chronic Morbidities (HTN, diabetes, etc)
- decreased risk for some cancers
- improved bonding
Breast milk storage in a bottle
Is a common practice and requires pumping
Can be stored in a fridge for 48 hrs or in a freezer for 3 months
baby will get benefits of breast milk as a whole but will not get the benefit of change in milk composition that occurs over the course of feeding in contact with mother skin
When is breast feeding contraindicated
Infants who are diagnosed with galacotsemia
Mothers who have type 1 or type 2 T-cell lymphotropic virus
Mother who are HIV positive
Mothers who abuse drugs and are not enrolled in any treatment program
Milk sharing
Using breast milk from another mother or women to use for the infant
This is NOT recommended since this runs the risk of transmitting infections (even if the women is asymptomatic)
When is using donor milk okay?
Only if its from a regulated agency and only for preterm infants who are very low weight
this is because the donor milk could be at a different stage of lactation which contains variable protein and zinc content of breast milk
Also this milk is pasteurized to guarantee safety, which means it will have less bioactive compounds
What nutrients can be altered in mother breast milk based on diet
Fatty acid concentration
Vitamin A/D
thiamin
riboflavin
niacin
Vitamin B6 and 12
all others appear to be not affected
Which vitamin do infants need to take supplementation for?
Vitamin D and K
- D = breast milk is low for the first 9 months of breastfeeding so often needs 400 IU supplementation for the first few days of birth (could give mother 4000/6400IU supplementation and that has been shown to increase levels in breast milk to optimal levels). These should be continued until 12 months when the baby can start mixing fortified cows milk
- K = need a single dose at brith and if diet is low for mothers = may need supplementation for the mother
- the GI tract lacks any sterile GI bacteria and also lacks vitamin K from maternal system = cant make clotting factors well
- vitamin K fortification increases clotting factors and helps prevent both hemorrhoid anemia of a newborn and GI infections that are chronic
Factors to successful breastfeeding
Initial breastfeeding should take place within the first hour of birth and direct skin-skin contact is needed
Mother need to be comfortable (sitting up or lying down)
Mother should adjust position with every feeding for the first few weeks
Should nurse 8-12 times a day (feed on demand not a schedule though if possible)
- on schedule = decreased breast milk production
How to tell if the baby is getting enough to eat
9-12 wet diapers a day (or 4-5 heavy wet diapers)
Babies should have bowel movements with most feedings
Baby should nurse 8-12 times a day and the baby should appear satisfied
Monitor the baby weight (on average babies gain 1 oz per day during the first three months of life)
If formula is in powdered form what must be done by strict guidelines
Reconstituted via a specific amount fo water
- too little water = too diluted
- too much water = too concentrated
3 month babies = sterile water only
- if using tap = boil it for 1 minute and then let it cool before adding
Older than 3 month babies = any water but the amount needs to be regulated
Should you microwave baby bottles
NO
- results in uneven patterns of heating with some areas of the bottle becoming too cold and some becoming too hot
- if its too hot = can cause facial and palatial burns to the baby and destroy antibodies in the milk
Introduction of solid foods
Are typically introduced at 6 months of age
- usually time with the ability of the infant to sit upright with little-no help, majority of primitive reflexes are gone
Should introduce 1 new food at a time and wait 3-5 days before introducing the next new food
Start with small amounts (1 tsp at most)
Start with dry infant cereal first (avoid infant rice cereal due to risk of arsenic exposure)
Follow with meats -> fruits -> vegetables in this order
Avoid salt and sugar but don’t restrict fat and cholesterol
Foods to avoid in infants <12 months
Any hard round foods (choking risk)
Honey (botulism risk)
Cows and plant-based milk (too complex to digest fully)
Fruit juice (not nutrient rich enough and doesn’t satisfy satiety enough (increased risk of obesity))
Sugar-sweetened beverages
Why must spinach, carrots, broccoli and beets NOT be puréed at home for infants
They contain trace amounts of nitrite that is sufficient enough to potentially cause methemoglobinemia in infants
Dental caries in newborns
Is the most common chronic disease of childhood
Associated with improper feeding practices or giving infants a poor/ unhealthy diet
Practices to help prevent
- local water fluoridation beginning at 6 months
- adding fluoride to breast milk or formula starting at 6 months
- avoid fruit juices and drinks during first 12 months
- putting only water in a bedtime bottle if the baby needs it
- clean infant teeth with a damp washcloth
- visit dentist by age 1 ow within 6 months after first tooth ergots
Food allergies in infants
Approximately 4% of infants get this and the most common are
- cows milk (most common)
- soy
- egg
- fish
- wheat
- tree-nuts
- peanuts
introduce these foods starting at 4-6 months and monitor to watch for reaction. DONT delay introduction because this is actually associated with an increased risk of developing an allergy
When to give water to an infant
Only if you notice a reduction in urine output or dark colored urine or if the baby is using formula
If breast feeding well and the baby is gaining weight adequately = usually normal hydration
also needs to be wetting at least 6 diapers a day = proper hydration
Di ions of responsibility feeding protocol
Developed by Ellyn Satter and is appropriate from birth to early adolescents
Encourages the caregiver to take leadership of
- what
- when
- where the feeding takes place
Encourages the child to determine
- how much
- weather to eat or not eat
