infant feeding
Cooler with 3 frozen ice packs (59 F; 15 C)
24 hours
Formula Feeding Detractors
Cost Does not promote uterine involution Does not provide additional immunologic benefits for the infant
Maternal Problems/Poor Breastfeeding
Engorgement Mastitis Nipple trauma Flat/inverted nipples Plugged milk ducts Maternal sepsis Previous breast surgery Cultural factors Lack of family support Employment Breastfeeding multiple infants (multiple births) Maternal anxiety Nutritional/fluid intake Modesty Nipple tenderness/pain
Types of milk
Foremilk Hind milk
Barriers to Breastfeeding
Lack of Knowledge Lactation problems Poor family & social support Social norms Embarassment Employment & childcare Health services
Positioning
No bottle propping -risk for regurgitation & aspiration
Colostrum
Thick, yellow "First milk" High in fat, vitamins, minerals High in immunoglobulins Laxative effect to pass meconium
Mature milk
Thinner, bluish Appears after first 2 weeks postpartum
Common for infants to lose up to 10% of birth weight in first few days from..
Water loss Less calorie consumption
Wet nurses
Women who were employed to nurse an infant not her own or used when a child was abandoned Used in England in the 1500 - 1700's as is was not proper for the wealthy to nurse their children 1940's to 1960's: More bottle-feeding vs. breastfeeding
Thawed breastmilk
use within 24 hours
Baby-Friendly Hospital Initiative
A global program that was launched by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. It recognizes and awards birthing facilities who successfully implement the: -Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes No gift bags containing formula
Preventing Problems -Breastfeeding
Answer questions while in the hospital -Positioning -Frequency -Length of feeds Danger signs -Sudden temperature -Reddened, swollen bumps or nodules on breast -Purulent nipple drainage Do not offer water Educate, educate, educate!! -There is no such thing as too much
Nipple Assessment
Assess for anatomical issues that may pose a challenge to breastfeeding mothers -Inverted -Flat -Everted Nipple assessment: indicator of how breastfeeding is going: -red, bruised, blistered, fissured, tender; signs of "poor latch"
Breastfeeding interventions: Postpartum
Assess maternal status, nipples, uterine cramping Educate: -On demand feedings -Infant feeding cues -Positioning , latching, pumping, storage, growth spurts Evaluate need for follow up after discharge -Lactation support and support groups
AAP Recommendations
Begin solid food around 6 months Only breastmilk or formula in a bottle May begin cow's milk (or alternative) at age 1 year.
Benefits of Breastfeeding
Breastfeeding protects your baby from gastrointestinal trouble, respiratory problems, and ear infections Breastfeeding can protect your baby from developing allergies. Breastfeeding may boost your child's intelligence Breastfeeding may protect against obesity later in life Breastfeeding may protect your baby from childhood leukemia Breastfeeding may protect your baby from developing type 1 diabetes Breastfeeding may protect preemies from infections and high blood pressure later in life Breastfeeding may lower your baby's risk of SIDS Breastfeeding helps you lose weight Breastfeeding can lower your stress levels and reduce postpartum bleeding Breastfeeding may reduce your risk of some types of cancer Breastfeeding may protect against osteoporosis later in life
Cabbage for Engorgement
Cabbage contains sinigrin, magnesium, oxylate, mustard oil, rapine and sulphur heterosides. The natural mixture of the compounds listed above decreases tissue congestion by dilating the small blood vessels to improve blood flow to the area. Women who are allergic to sulfa or cabbage should not use cabbage to decrease engorgement or inflammation.
History of Breastfeeding
Can be traced to biblical times and in many ancient texts of Greece, Rome, Egypt, and Europe The benefits of breastfeeding vs. formula feeding have long been documented back to Hippocrates and have been scientifically supported to the current day
Formula Feeding Benefits: Maternal/Paternal/Infant
Does not interfere with infant/parent bonding Allows father to be more involved Formula is heavier/may be more satisfying to infant Infant may sleep for longer periods of time Allows mother to sleep for longer periods of time
Returning to Work
Maternity leave is between 6-8 weeks long Breastfeeding mothers can continue to nurse their infants by pumping their milk while at work. Breastfeeding classes & support groups to increase knowledge & support Establish home supply of breast milk: -A few weeks prior to returning to work, mothers can pump at home an additional 1-2 x/day & store extracted milk for future use
Contraindications to Breastfeeding
Mother is HIV+ or has AIDS Mother has active untreated varicella or TB Mother has active herpes on her breast Mother uses illicit drugs or is an alcoholic Mother who smokes should time smoking to immediately after breastfeeding Mother is taking medications that are not safe for breastfeeding Infant has galactosemia
Nutritive suckling
Nutritive-rhythmic pattern of suckling with audible swallows
Benefits of Breastfeeding -Mom
Promotion of involution Assistance in weight control Psychological benefits -Oxytocin is believed to coincide with mood responses and increased feeling of maternal well-being -Skin to skin contact, Tactile communication. Learning infant behavioral cues and needs Contraceptive benefits -Natural birth control method -Delayed ovulation -Must not be used as the sole method of contraception Cost savings Less risk for Sudden Infant Death Syndrome (SIDS) Disease risk reduction: -Type 2 diabetes -Breast cancer -Ovarian cancer -Postpartum depression -Osteoporosis Breastfeeding mothers miss less work! -Infants are sick less often... because they get antibodies from mom
Infant Problems/Poor Breastfeeding
Sleepy infant -Wake it up! Unwrap blankets, talk to it, change diaper, stimulate by rubbing it's back Nipple confusion -If bottle introduced too early Suckling problems -Failure to open mouth wide at latch-on -Lower lip turned in -No audible swallowing Infant Jaundice/Phototherapy Prematurity Infant sepsis and congenital defects
Breastfeeding Nursing Interventions: Infant
Test the rooting reflex on the infant to see if the baby or neonate is ready to feed Use the nipple test described above or stroke the infants cheek towards the lips Have mother insert her finger into the baby's mouth and gently stroke the palate to trigger the sucking reflex
American Academy of Pediatrics Recommendation
The AAP recommends that babies be exclusively breastfed for about the first 6 months of life. This means the baby needs no additional foods (except Vitamin D) or fluids unless medically indicated. Babies should continue to breastfeed for a year and for as long as is mutually desired by the mother and baby.
Biology of Lactation
The biologic completion of the reproductive cycle. At 16 weeks gestation, the breast develops and prepares for lactation Pregnancy hormones (Estrogen/progesterone) stimulate alveoli/ductal system in breasts) Prolactin (stimulated by pituitary) stimulates milk production First hours postpartum, the breast responds to hormones and the stimulation of the infant's sucking to produce and release milk As Estrogen and Progesterone fall after birth, prolactin increases to stimulate milk production Oxytocin is released after birth in response to infant suckling and stimulates "let-down" reflex
Breastfeeding Nursing Interventions: Mother
The nurse should assist the new mother with breastfeeding optimally within the first hour after birth Provide a comfortable position before beginning to nurse infant -Cradle, football, side-lying -Mother must use the "C" hold or "V" hold to support her breast Touching the infants lips with the mother's nipple will incite "rooting' reflex in the infant to "latch-on"
Freezer (0 to 4 F; -18 to -20 C)
6-12 months
Is baby ready to feed?
Is baby awake and hungry? Sucking on hands Rooting Fussiness Crying (late sign)
Should regain up to birth weight by...
7-10 days
Hind milk
a thicker, richer, milk that provides more calories for weight gain and satisfaction
How much do infants usually intake per feeding by the end of the first week?
about 2-3 oz per feeding
Foremilk
watery first milk that quenches thirst
Refrigerator (39 F or lower; 4 C)
3-8 days
Is baby getting enough milk?
Appropriate weight gain Number of wet diapers -Book: 3 wet diapers/3 stools per day by 3rd day of life -Clinical rule of thumb: *6 - 8 wet diapers per day after 2-3rd day of life, 4-6 poopy diapers* Hearing baby swallow when breastfeeding
Common causes of decreased milk supply
Formula supplementation Inadequate rest or diet Smoking Alcohol Caffeine
How to breastfeed
Manually draw nipple out with fingers Position infant's mouth so it appears open over nipple "fish lips" with as much areola in the baby's mouth as possible Feed on demand (but approx. 15-20 min per side; may be 5-45 min) Burp in between sides Feed Q 1.5-3 hrs (4 hrs during night) Complete whole feeding -hind milk at end is most caloric -The emptying of the breast is what stimulates more milk to be produced Lactation consultant for a resource
Breastfeeding Benefits - Infant
Nutritional benefits -Easy to digest -Less constipation BM contains factors that establish normal intestinal flora Immunologic benefits -Builds immune system -Helps baby fight infection -Lowers risk of allergies Psychological benefits Disease risk reduction: -NEC (necrotizing entro colitis) -Lower respiratory infections -Asthma -Ear infections -Obesity -Type 2 diabetes -Childhood Leukemia -Atopic dermatitis -SIDS
Breastfeeding Challenges
Possible pain: nipple tenderness/uterine involution Leaking of breasts when full Feeling tied down Embarrassment Perception of diet restrictions Birth control options Vaginal dryness Medications and breastfeeding
Breast Assessment
Postpartum Breast Palpation Soft, filling, full, or engorged?
Nutritional Status: Breast feeding
Refer to Daily Food Guide Breastfeeding mothers require an additional 500 kcal/day (pregnant mothers need an additional 300) Prenatal vitamins for as long as breast feeding
Nutritional Status: Formula feeding
Refer to Daily Food Guide Prenatal vitamins for 6 weeks, then daily regular vitamin
What to do?
The success rate among mothers who want to breastfeed can be greatly improved through active support from their families, friends, communities, clinicians, health care leaders, employers
BFHI Ten Steps to Successful Breastfeeding
1) Have a written breastfeeding policy that is routinely communicated to all health care staff. 2) Train all health care staff in the skills necessary to implement this policy. 3) Inform all pregnant women about the benefits and management of breastfeeding. 4) Help mothers initiate breastfeeding within one hour of birth. 5) Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants. 6) Give 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 birth center.
Room Temp Breast Milk (66-78 F; 19-26 C)
4-6 hours
How many calories do full-term newborns require?
45-50 kcal/lb of body weight per day
Transitional milk
Lactose, fat, and calories increase "In-between" milk
Breast Preparation for Feeding
Ability to breast feed regardless of breast size: All women have approximately the same number of ducts Do not use soap or harsh body cleansers Do not roll, or pinch to toughen nipples Principle of supply & demand: more milk will be made by the mother to support the infants increasing caloric demands over time.
Feeding length
At least 10 - 15 minutes on each side if not longer Old protocol stated to have mom initially nurse only a few minutes on each side for first feeds Longer initial feeds are needed to stimulate the release Oxytocin for the "let-down" reflex
Feeding frequency
At least every 1.5 - 3 hours At least every 4 hours during the night At least 8 - 12 feedings every day
Breastfeeding Interventions: Birthing Room
First 30 minutes if possible Assess and teach to mom signs of readiness to feed Skin to skin Assess fetal status while feeding
Formula for special indications
Galactosemia Lactase deficiency
Reasons for a breast pump
If baby is in NICU Premature infants who can't take the breast yet To relieve breasts if latching problem "Pump n Dump" -If mom's on medications not considered safe for breastfeeding -If exposed to unsafe drugs/alcohol When mother needs to return to work To pump milk & give others an opportunity to feed the baby
Engorgement
If mother misses a feeding & can't pump Rock hard, painful breasts Difficult for infant to latch on Caused by congestion of veins and lymphatics Treatment: -More frequent feedings -Pump -Cabbage -Comfort measures: heat before, massage, cold after feeding
Combination feeding:
If parents choose to breast feed, the recommendation is to try exclusive breast feeding initially & not supplement with formula until breastfeeding is well established, usually about 6-8 weeks later.
Combination feeding
If parents choose to breast feed, the recommendation is to try exclusive breast feeding initially & not supplement with formula until breastfeeding is well established, usually about 6-8 weeks later. Helps prevent nipple confusion
Formula Feeding
If water supply is safe, sterilization is unnecessary Wash bottles & nipples with warm, soapy water, allow to air dry Burp every ½ ounce of formula Frequency: Every 3 - 4 hours -First feeding: up to ½ - 1 ounce -Subsequent feeds: Increases by 2 - 3 ounces by 3rd life day Do not heat in microwave/may feed formula at room temperature Do not offer water
Storage of Breast milk
In glass or plastic containers with tight seal -May use bags as well Milk should be frozen or stored in amounts likely to be used in one feeding Textbook storage recommendations: -Breast milk can be kept in a refrigerator for 48 hours -Breast milk can be in a regular freezer up to 1 month, and in a deep freezer for up to 6 months Stored milk should be heated under warm water, not in the microwave Unused milk must be discarded
Statistics
In the U.S., while 82 percent of mothers start out breastfeeding, only 61% percent of babies are breastfed at the end of six months, and only 34% continue to breastfeed for 1 year Rates are significantly lower for African-American infants.
No sleeping with bottle alone in crib
Increased risk for dental caries & otitis media
Growth Spurts
Infants have growth spurts during which they may feed more often -10 days, 3 weeks, 6 weeks, 3 months -"Feeding Frenzy" Usually last 24 to 48 hours, during which time they feed more frequently than normal
non-nutritive suckling
Non-nutritive pattern of suckling has irregular sucking pattern with no audible sucks
Types of formula
Powder Concentrate -If parents are mixing with water, emphasize not over-diluting. Ready-to-feed Large variety of commercial formulas available (monitored by FDA) -Modified cow's milk, soy based (pro-soy-bee), formulas for preterm infants & formulas for infants with special nutritional needs
Infants should be fed either breast milk or formula only. No water. Why?
They shouldn't drink water until 6 mos bc their stomachs are so small and we need to save room for something more rich in nutrients (breast milk, formula)
