week 6 breastfeeding Flashcards
what to do if infants are weaned off breastmilk before 12 months?
should receive iron- fortified infant formula
benefits of breastfeeding infant/child
-Reduced infant and child mortality
-Enhanced maturation of the gastrointestinal tract and immune factors
-↓ risk for gastroenteritis, celiac disease, Crohn disease, necrotizing enterocolitis in preterm infants, obesity
-Helps protect against otitis media, respiratory illnesses, bacteremia, and bacterial meningitis
-Lower incidence of certain allergies among breastfed infants, particularly for families at high risk
-Less likely to die from SIDS
-Protective effect against childhood lymphoma and type 1 and type 2 diabetes mellitus
-Decreased risk of dental malocclusions
-Enhance cognitive developmental for term and preterm infants
-Pain relief for newborns undergoing painful procedure
-baby is less likely to get sick overall even in the beginning weeks of life
Benefits of Breastfeeding - mother
-↓ postpartum bleeding and more rapid uterine involution
-↓ risk of ovarian cancer, breast cancer, rheumatoid arthritis, hypertension, hypercholesterolemia, cardiovascular disease, and type 2 diabetes
-Helps in rapid postpartum weight loss
-May provide protection against development of osteoporosis
-Delayed return of menses
-Unique bonding experience
-↑ maternal role attainment
-May provide protection against perinatal mood disorders when breastfeeding difficulties addressed
Conditions that are NOT considered contraindications to breastfeeding are as follows
- Maternal infection with Hepatitis A or C
- Hepatitis B surface antigen (HBsAg)–positive status
(newborn receives immunoglobulin and vaccine) * Mothers who are cytomegalovirus (CMV) positive - Maternal herpes simplex lesion on a breast (Mothers can continue to breastfeed on the unaffected breast. Avoiding contact with the lesion is important.)
-moms on methadone
Contraindications to Breastfeeding
- Maternal cancer therapy, diagnostic and therapeutic radioactive isotopes or radioactive iodine
- Active tuberculosis not under treatment in the mother * Human immunodeficiency virus (HIV) infection in the
mother, in high-income countries - Galactosemia (classic) in the infant
- Maternal substance use (e.g., cocaine, methamphetamines, marijuana).
- Maternal human T-cell leukemia virus type 1 or II (HTLV) * Some medications (although rare) that may exert an
untoward effect on the breastfeeding infant;
when is an ideal time to begin breastfeeding post delivery?
should be 1 hour after birth -baby is quiet and alert at state
what is rooming-in?
Rooming-in ensures that the newborn stays in the room with the mother- helps with breastfeeding
what are the cues of feeding in babies
-hand to mouth- or hadn’t to hand movements
-sucking motions
-rooting reflex- infants move towards whatever touches the area around the mouth and attempts to suck
-mouthing
-flexed arms and legs with clenched fits, held over chest and tummy- called hunger posture
how to prevent trauma to the nipple when removing baby from breast?
-to prevent nipple trauma as the newborn is taken off the breast, the breastfeeding patient is instructed to break the suction by inserting their finger in the side of the infant’s mouth between the gums and keep it there until the nipple is completely out of the newborns mouth
latch on position
-mom feels a firm tugging sensation on the breast, but should feel no pinching or pain
-baby sucks with cheeks rounded and not dimpled
-baby’s jaw glides smoothly w/ sucking
-swallowing is usually audible and sounds like a “ca” sound
- the baby cannot be easily removed from the breast
- mother’s nipple is not distorted when the baby release from the breast
how many times should you breastfeed per/day?
8x per day or every 1-3 hours
Newborn Urine and Stool Output on Day 1
1 or more wet, clear, pale, yellow pee
1 or more meconium
Newborn Urine and Stool Output on Day 2-3
2-3 wets, clear, pale yellow
1 more meconium or greenish brown color
Newborn Urine and Stool Output on Day 3-5
3-5 wets, clear, pale yellow
3-4 transitional stools changing to loose and yellow
Newborn Urine and Stool Output on Day 5-7
4-6 wet, clear, pale and yellow
3-6 yellow or golden -usually loose stool
Newborn Urine and Stool Output on Day 7-38
frequent -clear, pale, yellow (at least 6)
BM: should be 5-10 yellow
sore nipples
-usually d/t a poor latch/ineffective suck
-break suction, and reposition baby again
-rub breast milk on the nipple after feed
-encourage air dying of nipples after feed and change nursing pads
-don’t wear a tight bra
engorgement
-often happens 2-6 days postpartum when there’s an increase in milk production
-breasts are hard, throbbing, nipples are flat
-feed frequently
-soften breasts w/ warm compress, shower, hand expressing before feed
-may cause a plugged duct
plugged ducts
-massage the breast before and during feed
-feed on unaffected side first and ensure emptying
-may be d/t engorgement
Mastitis:
-infection that commonly occurs 2-3 weeks postpartum
S/S
-fever, tachycardia, chills, malaise, headache, enlarged axillary nodes
-breastfeed every 2-3 hours
-use warm compress and massage the breast
- antibiotics and antipyretics
-this affects mom not baby, so yes you can continue to breastfeed
formula feeding
-feeding child solely on formula as a supplement to human milk
how can we tell is the infant is in stress during feedings?
-turning the head
-arching the back
-chocking- sputtering
-changing color
-moving the arms, and tensing fists
-infants swallow air from a bottle and need a chance to burp several times during a feeding
-pace feeding, risks overfeeding baby
formula feeding over-dilution and under-dilution
over-dilution- baby is not getting the required nutritions and calories needed to function
-under- dilution - can lead to hypernatremia- straining the newborns kidney’s
formula considerations
formula should never be microwaved!!!
-should be a room temp, warm, cold even but not hot
-Bottle fed infants do not need supplemental vitamin D for first 6 months
-Any formula left in the bottle after the feeding should be discarded because the infant’s saliva has mixed with it
-during feed, keep nipple full of milk, air bubbles may cause gas
-cleaning bottles, you can use soap and water, no need to sterilize anymore.
complementary feeding - introducing solids
-foods or liquids given to the infant in addition to breast milk or formula
-after 6 months of age
-iron-fortified cereal, meat, meat alternatives, are recommended to be the FIRST solids introduced
-start fruits and vegetables at 8 MONTHS
attachement
is an emotional bond between baby and its parent that results from the satisfying interaction between parent and infant.
Attachment and bonding are used interchangeable
postpartum blues
-Episodes of tearfulness, agitation, mood swings, anxiety, sleep and appetite disturbances, and feelings of being overwhelmed
-happens 1-5 days postpartum
-can be challenging to breastfeed
-associated with hormonal changes
-resolves after 2 weeks and does not disrupt the postpartum pt ability to care for themselves or there babies
s/s of postpartum blues
-mood swings, crying spells, feeling low, fatigue, frustrating, anxiety, emotional, confused or muddled thinking
nurse should validate, reassure, and educate
perinatal mood disorder
-triggered by hormonal changes, physical changes, emotional and social changes
-very stressful
-disrupts family life, and can negatively affect the couples relationship
-indigenous, black people, and adolescent have a higher chance of developing postpartum depression (SDH, colonization, racism, marginalization, poverty, + lack of culturally safe care)
risk factors for PMD
strongest risk factors:
-strongest risk factors would be a hx of psychiatric illness (depression/anxiety at any given time)
-prenatal symptoms of anxiety
-onset of depression during pregnancy or postpartum
risk factors for PMD
moderate risk factors:
-stressful life (divorce, losing a job)
-refugee or immigrant status
-low social support
-unfavourable obstetrical outcomes
-low -self esteem
-hx of physical or sexual abuse during life
-domestic violence
-hx of reproductive trauma. like infertility
-grief r/t miscarriage, stillbirth or infant loss
-substance abuse
weak risk factors of PMD -postpartum depression
- low socioeconomic status
-lack of a partner
-pregnancy-unplanned or unwanted
-breastfeeding challenges
complications of having PMD
-Mother–infant attachment issues
-Depression in the partner
-Long-term emotional behavioural and cognitive issues in the child
-Relationship issues and family breakdown
-Social, financial, and occupational complications
-Self-harm and suicide
Infant and sibling neglect and occasionally infanticide
Perinatal Anxiety
a feeling of constant worrying
-constant anxiety
provide medication relief
-selective serotonin reuptake inhibitors (SSRIs) and antianxiety medications
Benzodiazepines provided for short-term relief
-encourage to put usual chores on hold and ask for help
what is PDM
-perinatal depression
-intense and pervasive sadness w/ severe and labile mood swings that last longer than 2 weeks
-irritability
-feelings of detachment
-guilt and shame
-obsessive thought about harming the infant
-reluctant to share and seek assistance
Postpartum Psychosis
this is RARE
-episodes of abnormally high energy levels, cognition and mood swings (mania)
-characterized by depression
-hallucinations
-delusions
-thoughts of harming either infant or self - hight risk for suicide or infanticide
benzodiazepine is the treatment of choice - want to give antipsychotic medications, and mood stabilizers
-can also do electroshock therapy (ECT)
PMD screening
-Screening for anxiety or depression during pregnancy and the postpartum period aids in prevention and early intervention for PMD.
-Screening-Edinburgh Postnatal Depression Scale (EPDS)
-Postpartum Depression Screening Scale (PDSS)
-A maximum score on the EPDS is 30; patients with scores of 10 or higher may possibly have depression and need further assessment
4 stages of grief -phases can overlap
phase 1-shock and numbness - sense of unreality, loss of innocence and powerless, feeling like having a bad dream, denial, disbelief
-person can feel sad, devastated, emotional, cannot concentrate or make decisions
-may also express lack of effect, euphoria and calmness, numbness, denial
phase 2- searching and yearning
-feeling lonely, empty and yearning- guilt may occur, helplessness, anger, resentment, bitterness, and irritability
-phase 3- disorientation- deep sadness and depression, insomnia, social w/drawl, and lack of energy
-phase 4- reorganization and resolution
-self esteem and confidence, can cope with new challenges, and have placed the loss in perspective, kind of like accepting the loss
