Newborn Nutrition

nipple

delivery system for milk

Fish and shellfish recommended amounts: when breastfeeding

Limit 6 oz per week: albacore tuna, tuna steaks, freshwater tuna Limit 12 oz per week: any ocean, coastal and other commercial fish (canned tuna)

areola

dark circle that surrounds the nipple

what time of day is the easiest to eliminate when weaning

mid-day feeding

how long do newborn infants feed on each side

15-20 minutes

how long can milk be stored in fridge

3-4 hours

A woman who is breast-feeding should increase her daily caloric intake by approximately 500 calories. a. True b. False

A

Other Dietary Considerations for breastfeeding

Alcohol and caffeine , as well as other meds

Benefits to the mother associated with breastfeeding include all except which of the following? a. There is a decreased risk of breast cancer b. It is an effective method of birth control c. It increases bone density d. It may enhance postpartum weight loss

B

For the woman who is not breast-feeding her newborn, which measure would be most appropriate to relieve engorgement? a. Warm showers b. Nipple stimulation c. Ice to the breasts d. Manually expressing milk

C

vitamin recommendations when breastfeeding

Calcium Folic Acid Iron

treatments for sore nipples

Colostrum or Lansinoh/nipple butter Hydrogel pads Breast shells Lactation Consultant

Lactogenesis Stage I (16-18 weeks gestation)

Colostrum production begins -Immunoglobulins: IgA (main one), IgM, IgG, IgD, IgE

Lactogenesis Stage II (After delivery of placenta)

Colostrum rich in antibodies, very concentrated -High in protein -"Milk comes in" around day 3 postpartum -Transitional milk introduces Lactobacillus bifidus flora to infant intestinal tract

how does decreased estrogen levels affects contraception

Decreased estrogen levels cause vaginal dryness.

Maternal Indicators for Formula Supplementation

Delayed lactogenesis Intolerable pain Previous breast surgery

common concerns for breastfeeding

Diet Engorgement Sore nipples Insufficient milk supply Plugged milk ducts Mastitis Follow-up after hospital discharge

Frequency and Duration of Feeds: interventions

Encourage parent to offer both breasts at each feeding. Start feedings on the breast on which the infant completed the last feeding. Encourage parents to respond to hunger cues even if that means breastfeeding more frequently than every 2-3 hours!

amount of formula for 1st 48 hours and by 2nd week

First 48 hours: 15-30 mL/feeding By 2nd week: 90-150 mL/feeding

how much carbohydrates infants need in first 6 months and second 6 months

First 6 months of life need 60 g/day and the second 6 months need 95 g/day

assessment for sore nipples

Flat? Inverted? Cracks? Soreness? Blisters? Bleeding? Assess and correct latch Proper feeding position

symptoms of mastitis

Flu-like symptoms Breast pain, tenderness, reddened area, fever Antibiotics, rest, warm compress, adequate fluid and nutrition Breastfeeding and/or pumping to encourage emptying of that side

why are fluids important for infants

Infants can become dehydrated quickly

how long can milk be stored in freezer/deep freezer

Freezer for 6 months (deep freezer 12 months)

engorgement treatments(breastfeeding mothers)

Frequent feeding, warmth before, ice after feed, mild analgesia

how long can milk be stored in fridge

Fridge for 72 hours (5-8 days OK)

keys of weaning

Gradual weaning is facilitated by substituting a cup or bottle for a breastfeeding little by little "Cold turkey" or sudden weaning may lead to breast engorgement

when do growth spurts occur

Growth spurts occur at 10 days, 3 weeks, 6 weeks, 3 months, and 6 months

Breastfeeding Contraindications

HIV positive mother Mother receiving chemo or radiation (until milk is cleared) Mother using "street drugs" Infant with classic galactosemia Mother with untreated tuberculosis Active herpes lesion on the breast

ways to support breast

Hand in "C-shape" or "U-shape" Nipple sandwich

hunger cues

Hand-to-mouth or hand-to-hand movements Sucking, mouthing motions Rooting reflex Crying is a late hunger cue

Infant Indicators for Formula Supplementation

Hypoglycemia Dehydration Weight loss > 7% with delayed lactogenesis Delayed BM or Meconium to Day 5 Hyperbilirubinemia

keys for latching cont

Infant should have wide-open mouth Point nipple toward infant's nose to facilitate filling infant's mouth with breast tissue Infant's top and bottom lip should be "flanged outward" Infant's mouth should cover or almost cover the entire areola Avoid letting the infant "hang" from the nipple Break suction by a clean, dry finger between the infant's jaw to avoid "tugging" on the nipple

mature milk

Lower fat "foremilk" changes to higher fat "hindmilk"

importance of fat in infants

Major energy source for infants, 50% of the calories in breastmilk and formula

Lactogenesis Stage III (10-14 days after delivery)

Mature milk higher in fat -Production responds to growth spurts -Promotes colonization of infant's microbiome

how does mature milk change

Milk-Composition changes during each feeding

plugged duct symptoms

Mom is afebrile One area swollen and tender, may have some localized redness May feel hard, small pea-like lump Caused by tight clothing or some kind of pressure on breast Warm compress, frequent feeding, massage

characteristics of colostrum

More concentrated than mature milk Extremely rich in immune globulins Higher concentration of protein and minerals Less fat than mature milk

Indicators of Sufficient Feeding

Most breastfed infants should have 3-4 stool diapers by 4th day of life -Stool should no longer be meconium-like, but yellow in color. -Infant seems content between feeds -Infant gains weight -Urine is pale yellow and not concentrated

when is Vitamin D supplementation needed

Needed until infant drinks exclusive formula or around 1 year old

how often should newborn infants breastfeed

Newborn infants should breastfeed 8-12 times per day to establish a breastfeeding pattern and optimize the hormone levels.

Breastfeeding recommendations( The World Health Organization)

Organization recommends that infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.

keys for latch and positioning

Position is key for parent and baby Express colostrum wait for open mouth

keys in supporting breastfeeding parents

Positioning Latching Milk ejection or "let-down" Frequency of feedings Duration of feedings Indicators of effective BF Supplements, bottles, and pacifiers

what do pacifiers reduce the risk of

SIDS risk

Fish to avoid when breastfeeding

Shark, swordfish, king mackerel, and tilefish

how to wash formula bottles

Sterilize prior to use, then use hot soapy water and bottle brush

nutrients of concern when breastfeeding

Vitamin A, B6, D, and B12

engorgement treatments(non-breastfeeding mothers)

Well-fitted supportive bra, ice, cabbage leaves, mild analgesia, no stimulating milk production

keys for formula feeding

Wide variety of specialty formulas available Educate parents on preparation (RTF, concentrated, powder) Feed every 3-4 hours initially Never prop a bottle, always hold Nipple flow, slow-flow in newborn stage Burping techniques Washing bottles Vitamin D supplementation may be needed if combo feeding (formula and human milk)

colostrum

a clear, yellowish fluid (day 1 to 3)

when are pacifiers recommended

after feeding is well-established

Anatomy involved in breastfeeding

alveoli milk ducts nipple areola Montgomery glands

source of prolactin

anterior pituitary

how does milk production increase

as baby grows

What Do Infants Need?

fluids energy carbohydrates fat protein vitamins mineral

alveoli

grapelike clusters of milk-producing cells

expressing and storing breast milk

hand expression mechanicla milk expression types of pumps storage of breast milk working and BF weaning milk bankin

when does breastfeeding prevent ovulation

if the mother is breastfeeding on strict schedule (q 2-3 hrs

mastitis

inflammation of the breast

what does amount of formula depend on

nutritional needs

source of oxytocin

posterior pituitary

Breastfeeding recommendations( The American Dietetic Association )

recommends breastfeeding exclusively for the first six months of life, continuing in conjunction with other food at least until the newborn's first birthday.

Breastfeeding recommendations( The American Academy of Pediatrics)

recommends that mothers breastfeed their infants for at least one year, or as long as mutually desired by mother and infant.

what should contraception choice avoid and why?Contraception choice

should avoid estrogen as it can decrease milk supply in the first few months

latch scoring tool

slide 14

factors of oxytocin

triggers milk ejection from alveoli to nipple (let down)

factors of prolactin

triggers synthesis and secrestion of colosturm and milk

what vitamin are infants missing that arent contained in human milk

vitamin D`

what are some infectious diseases that babies who breastfeed have a decreased incidence for

•Bacteremia •Diarrhea •Respiratory infections •Necrotizing enterocolitis •Middle ear infections •Urinary tract infections

benefits of breastfeeding (baby)

•Decreased incidence of many infectious diseases •21% lower post-neonatal infant mortality rate in U.S. •Provides pain relief for infants during or after procedures •Higher IQ scores •Decreases length of hospitalization time for preterm infants

montgomery glands

•Glands-secrete a lubricating and sterilizing substance onto the areola and nipple

Expressed Milk Teaching Points

•Never thaw frozen milk in the microwave! •Do not re-use milk that has been introduced to the baby's mouth. •All unfinished bottle milk must be disposed of. •Thaw frozen breastmilk in a pan of warm water, bottle warmer or refrigerator

benefits of breastfeeding (maternal)

•Rapid uterine involution •Early return to pre-pregnancy weight (additional 250-500 calorie expenditure) •Decreased risk of ovarian cancer •Decreased risk of breast cancer •Decreased risk of type II diabetes •Increased bone density

milk ducts

•intricate system of ducts that transport milk from alveoli to the nipple