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