Week 3 - Newborn Nutrition & Feeding Flashcards
• Explain current newborn feeding recommendations, initiatives and best practices. • Outline key assessment parameters which promote newborn feeding success. • Describe the RN’s role in the hospital and community to facilitate and promote successful feeding. • Identify common potential feeding problems and their related nursing interventions
WHAT ARE THE COMPONENTS OF BREASTMILK?
- Immune factors (bacteriostatic, bactericidal)
- 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 (calcium, sodium, chloride, copper, zinc, iron, selenium, iodine, flouride)
- 87% wate
BENEFITS OF BREASTFEEDING FOR THE INFANT INCLUDE…
- 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
WHAT ARE THE RISKS OF NOT BREASTFEEDING
- Gastrointestinal 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 • Necrotizing Enterocoliti
BENEFITS OF BREASTFEEDING FOR THE CLIENT INCLUDE…
Decreased risk of cancer (ovarian, uterine, breast), RA, Type 2 DM, hypertension and CVD • Convenient and less expensive than infant formula
• Promotes uterine involution and return to prepregnancy weight
• Bonding experience: • Lactation hormones help the client learn to parent
• Teaches clients/parents to read and respond to cues
WHICH OTHER POPULATIONS BENEFIT FROM BREASTFEEDING?
Transgender parent – chest feeding Adoption Surrogacy Options: - Inducing lactation - Lactation Aid - Donor milk
RISKS OF NOT BREASTFEEDING - Client
- \/oxytocin + \/ uterine involution + /\ risk of PPH
- increased risk of ovarian, uterine, breast cancers
- increased risk of developing type 2 diabetes
- increased chance of developing chronic conditions
CLIENT CONTRAINDICATIONS TO BREASTFEEDING
Chemotherapy • Radioactive isotopes (temporary) • Active TB or Varicella (EBM ok) • HIV * • Human T-Lymphotropic Virus • Herpes lesion on breast • Substance abuse • Select medications • CMV infected donor milk • Chagas’ disease (parasite)
INFANT CONTRAINDICATIONS TO BREASTFEEDING
- Galactosemia
* Metabolic disorders (limited human milk volumes)
HOW LONG SHOULD A PERSON EXCLUSIVELY BREASTFEED?
THE FIRST 6 MONTHS
(Then introduce complementary foods - and continue breastfeeding for up to 2 year)
-on demand
-baby led
What are the current trends in plans to breastfeed vs. actual practice of EBF @6month
90% plan to BF»>14% actually EBF for 6 months
huge discrepancy in reality
Mother’s Voices Survey 2009
WHAT IS THE BFHI
The Baby Friendly Hospital Initiative
-launched by WHO and UNICEF in 1991
•designed to “protect, promote and support breastfeeding”
• Remove hospital barriers to breastfeeding
• Provide evidence based training of health care workers
• Promote an international standard
WHAT CRITERIA MUST A BFH MEET IN ORDER TO ACHIEVE THIS DESIGNATION?
- 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 BREASTFEEDING?
BFHI
- Have a written breastfeeding policy that is routinely communicated to all 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
LACTOGENESIS is the synthesis of breastmilk and includes these three stages…
i- Differentiation
ii - Activation
ii - Maintenance
LACTOGENESIS - STAGE I
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
Describe COLOSTRUM.
Thick, clear to yellowish in appearance
Available at birth up to 2-3 days postpartum
Volume varies from 2 to 20 mls/feed
Lower in fat and sugar than mature milk
High in protein and minerals
Contains IgA
Easily digested
Laxative effect
LACTOGENESIS - STAGE II
• “Milk coming in” - transition from colostrum to mature milk
ACTIVATION
• Changes in hormones after birth of the placenta (30-40 hours after birth:
- 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
Describe TRANSITIONAL MILK.
- Present 2-5 days to 2 weeks postpartum
- Less yellow in appearance
- Dramatic increase in volume
- Higher fat, lactose and calories than colostrum
- Less protein than colostrum
LACTOGENESIS - STAGE III
MAINTENANCE
• 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
FORE MILK VS. HIND MILK
Fore Milk:
• Bluish-white in appearance
• Low fat; high water content milk 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 TWO HORMONES STIMULATE MILK PRODUCTION? AND HOW?
- The alveoli in the breast begins to make the milk in response to the release of prolactin.(ANT pituitary)
- Oxytocin (POST pituitary) contracts the muscle cells around the alveoli and causes ‘let down’
WHAT STIMULATES THE MILK EJECTION REFLEX (MER)?
- Hearing a baby cry
- Thinking about the baby
- Preparing to breastfeed
- Being the usual time the baby feeds
INHIBITORS: fear, pain, embarrassment, anxiety, breast surgery
LIST THE BENEFITS OF SKIN TO SKIN FOR BOTH THE BABY AND THE CLIENT.
Benefits for baby: Improved thermo and cardiorespiratory regulation, reduced serum cortisol, stabilizes blood glucose, reduced crying, self-latching, improved exclusivity.
Benefits for client: Increased oxytocin and prolactin, improved milk volumes, promotes bonding.
EARLIER, MORE EFFECTIVE BREASTFEEDING
WHAT ARE THE 4 EARLY FEEDING CUES?
- *Feed when QUIET & ALERT**
1. lip smacking
2. rooting
3. light sleep
4. fussiness
LSR/LSF
(LATE CUE: crying)
WHAT ARE THE 4 FEEDING POSITIONS?
- Cradle
- Cross Cradle
- Football hold
- Side Lying
When latching a baby…ALWAYS…?
- nose to nipple (to stimulate rooting reflex)
- Wait for a wide open mouth
- bring baby to breast (not breast to baby)
- make sure lower lip is out
- tummy to tummy with mummy
Compare Nutritive vs. Non-Nutritive Sucking
Non-Nutritive - does not involve milk transfer (2 sucks/sec
Nutritive - involves milk transfer (1 suck/sec)
How often should a new BF parent feed a newborn?
8-12 feedings/24hrs
Feed on demand (min q3h)
Wake (if neccessary) to feed
For 20-30mins
When are the typical growth spurts?
where baby feeds more often-cluster feeding
10days
3 & 6 weeks
3 & 4-6 months
What are the signs of MER in the BF client?
- Thirst
- Relaxation or drowsiness
- Milk leakage from opposite breast
- Uterine cramping
- Increased lochial flow
What are the signs of MILK TRANSFER in a baby?
- Sustained rhythmic suck-swallow patterns
- Gradual decrease in intensity and number of sucks
- Relaxed arms and hands
- Moist mouth
- Satisfied after feeding
- Audible swallowing
- Absence of hunger cues
- Weight gain
- Elimination pattern
What is the progression of stool changes?
Meconium (brown-black)
»> Transitional (yellow-brown)
»»»Yellow Soft Seedy
What should weight gain/loss be over the first few weeks?
- less than 10% loss in 3-5 days
- return to birth weight by week 2
- gain 4-8 ounces/week until baby doubles in weight
What causes sore nipples and how do you remedy the problem?
• Poor latch/positioning* • Improper suck • Pump problem • Thrush - Yeast • Eczema/Dermatitis INTERVENTIONS • Get a good latch where the nipple is safe • Start feeds from unaffected side • Pump affected side to allow nipple to heal • Breast shell for protection • Expressed breast milk • Nipple ointment • Continuous breastfeeding support
How do you prevent sore nipples?
- Proper latch
- Use of varied positions
- Break suction before taking baby off breast
- Express a few drops of milk, massage into nipple after each feed and allow to air dry
- What is the condition of engorgement?
2. When and why does it occur, and how can it be avoided.
- The milk stasis in the ducts and increased blood flow causes edema in the breast tissue which compresses the ducts and can reduce milk production. The breasts become firm, tender, swollen, hot, shiny, and red.
- It occurs 3-5 days postpartum, 24 in duration but can happen anytime throughout lactation.
How could you teach a client to avoid engorgement?
Encourage early frequent feeds and complete emptying of breasts.
How do you treat engorgement?
- Adequate breast emptying
- Cold therapy between feeds/pumping
- Cabbage leaves application
- Massage during feeds/pumping
- Analgesic/anti-inflammatory
- Reverse pressure softening
What are some of the symptoms of a blocked milk duct?
- Painful, firm lump in the breast
- May see white dot on the nipple - bleb
- Client may not feel ill, or may start to have flu like symptoms
- Can lead to infection and abscess
What would you teach the a client to do if they suspected a blocked milk duct?
- This needs to be expressed so the milk will flow
- Get the milk out – feed, hand expression, pump
- Warm water and massage often help
What are three potential problems of breastfeeding?
Engorgement
Blocked Milk Duct
Mastitis
What is mastitis?
It is an inflammation of breast tissue which causes milk-flow obstruction. S.Aureus enters through a nipple fissure.
How do you treat mastitis?
• Feed/pump frequently • Rest • Warm/cool compresses • Analgesia/anti-inflammatory If not resolving within 24hrs, seek medical attention • Antibiotics
List some DOs of FORMULA FEEDING.
- Use feeding/skin to skin to bond with baby
- 6-8 feedings/24 hours (feed on demand)
- Average initial intake 10-15 mls
- Follow instructions on packaging for preparation
- Sit baby upright
- Burp baby several times
- clean and maintain bottles/nipples properly
- Keep nipple half full, extend baby’s hips
List some DON’TS OF FORMULA FEEDING.
- Never microwave formula
- No powdered formula until 3 months
- DO NOT overfeed
- Never feed baby side lying
What are the key points of breastfeeding?
- Early
- Often
- Effective
- Exclusive
- Skin to skin
WHAT ARE THE 4 P’s OF BREASTMILK?
PAIN - has an analgesic effect for infant
POOP - laxative effect to move meconium out
PUFFY - very high in fat = increased brain development
PROTECTION - combats bacteria, it’s easy to digest
