Chapter 15: Newborn Nutrition

Which response is most appropriate when a new breastfeeding mother expresses concern about breastfeeding in public?

"Breastfeeding is natural, and you should feed whenever and wherever you feel comfortable, whether in public or in private." The nurse should encourage a woman to breastfeed when and where she please. Breastfeeding is a natural action and the woman should not feel ashamed for breastfeeding. Some women are more comfortable breastfeeding in private, but that is a personal and not a moral choice. Breastfeeding has many benefits for the newborn and should be encouraged if possible. A mother can feed prior to running errands; however, this is no guarantee that the infant will not become hungry while the mother is still out in public.

Which statement by the nurse would best support a new mother's choice to bottle-feed her baby?

"By formula-feeding your newborn, you will know how much the baby takes each feeding and allows others to fed the baby." If a mother chooses to formula-feed her newborn, the nurse needs to support her decision and offer encouragement. The mother needs to be well informed about the advantages of breast-feeding, but it is her choice how she feeds her baby. Telling her that breast-feeding is the recommended method of feeding will only make her feel guilty, as would mentioning that she may feel guilty. Presuming that the reason for the mother's choice is her lack of support at home is an assumption that is not validated and may offend the mother.

A new mother asks the postpartum nurse if she can leave the unit for a few minutes to smoke. Which response by the nurse is most appropriate at this time?

"I cannot stop you from smoking. However, I would caution you about exposing your newborn to secondhand smoke." Cigarette smoking is not a contraindication to breastfeeding, but women should be aware some nicotine is carried in breast milk. Nicotine has the potential to decrease a mother's milk supply. If the infant is exposed to secondhand smoke, it could lead to an increase in respiratory illnesses. It is true that the nurse cannot stop the mother from leaving the unit. It is not therapeutic to put in a consult to the smoking cessation counselor until the nurse visits with the client to see if she is motivated to comply. All mothers should wash their hands prior to breastfeeding, not just mothers who smoke.

A G1 P1 mother asks the nurse "Why is my baby losing weight? He dropped 6 oz from yesterday to today. Is my breast milk not good?" Which answer is the best response to this new mother?

"It is normal for breastfed newborns to lose as much as 7% of birth weight the first 3 days after birth." Breastfed newborns may lose up to 3% of birthweight on day 1, 5% of birth weight on day 2, and 7% of birthweight on day 3; a breastfed infant regains birth weight at about 14 days. Babies are born with the ability to suck milk from either a breast or a bottle. Deferring to answer the question will make the mother think something is wrong with her infant when, in fact, weight loss is normal. It will take about 2 weeks to regain weight, rather than months.

A new mother who is about to be discharged expresses concern about how to know her baby is getting enough breast milk. Which response should the nurse prioritize?

"Observe if your baby is eating 8-12 times a day." Breastfeeding mothers may fear their newborns are not getting adequate amounts of breast milk at each feeding. This may be especially true when the newborn cries for reasons other than hunger. Mothers cannot measure the amount of breast milk the newborn ingests each feeding. Nurses can reassure mothers by instructing them to look for signs the newborn is voiding and defecating within the acceptable range and waking for feedings 8-12 times in 24 hours. The amount of time at the breast is not a good indication that an infant is getting adequate nutrition. Each infant is different and will receive an adequate amount over varying lengths of time at the breast. Nipple pain can be a sign of an ineffective latch, not of inadequate supply.

Parents ask the nurse why they are not supposed to throw a bottle of milk into the microwave to warm it. Which response is most accurate?

"The microwave causes the milk in the center of the bottle to become hotter than near the sides." It is not recommended to warm bottles in a microwave oven because the milk in the center of the bottle can become hotter than the milk near the sides. The best method to warm formula is to stand the bottle in a bowl of warm water or hold it under a faucet of running hot water for a few minutes. Caution parents not to use a pan on the stove to warm formula because if the pan boils dry, the bottle of milk will burst. Milk warmed in a microwave does not grow bacteria faster than other methods of warming, and milk components do not break down when microwaved.

A mother who is breastfeeding asks the nurse when she should start weaning her infant. Which time factor should the nurse point out is the recommended time?

1 year The American Academy of Pediatrics recommends infants be breastfed for 1 full year (exclusively for 6 months). However, it is ultimately the woman's decision as to how long she will breastfeed. If she chooses to stop breastfeeding at 3 or 6 months, she will need to initiate formula feeding to ensure the infant receives adequate nutrition. The World Health Organization recommends exclusive breastfeeding up to 6 months and continuation up to 2 years.

The mother of a newborn is concerned her newborn is not getting enough calories. When answering this woman's questions, the nurse should point out it is recommended the newborn should receive how many calories per day?

110 kcal/kg to 120 kcal/kg Newborns and infants younger than 2 months of age have a very high caloric intake owing to development during this period. They need 110 to 120 kcal/kg of body weight (50 to 55 kcal/lb) over a 24-hour period to thrive.

The nurse is conducting prenatal counseling with pregnant women in the community. An 18-year-old G1 P0 in her 36th week states, "I don't know if I should breast-feed or not. Isn't formula just as good for the baby?" What is the nurse's best response?

The immunologic properties in breast milk cannot be duplicated in formula. Breast milk is a unique substance that commercial formulas have been unable to duplicate, especially with regard to the immunologic factors in breast milk.

A newborn is being breastfed. To evaluate nutritional adequacy, you should be aware that breast milk contains an average of how many calories?

20 calories per ounce Twenty calories per ounce is not only the calorie content of breast milk but also that of commercial formulas.

A breastfeeding client asks how much breast milk to put in a bottle for her 3-month-old baby. The nurse will recommend placing how much breast milk in each bottle?

5 to 6 oz (142 to 170 g) A quick rule of thumb to estimate how much an infant will drink at a feeding is to add 2 or 3 oz (57 to 85 g) to the infant's age in months. After initially taking 0.5 to 1 oz (14 to 28 g) for the first 2 days, a newborn (0 age) will take 2 to 3 oz (57 to 85 g) each feeding; a 3-month-old child, 5 to 6 oz (142 to 170 g); and a 6-month-old child, 8 oz (227 g).

Which of the following correctly identifies the daily caloric requirement per pound for a newborn?

50 to 55 Newborns have rapid metabolisms and need proportionally more calories per pound than adults.

What will the nurse recommend to a breastfeeding client experiencing sore nipples?

Apply a few drops of breast milk to the nipples after feeding and gently massage it into the areola. Appropriate nipple care is important to prevent skin breakdown of the nipples. The nurse can also recommend applying a few drops of breast milk to the nipples after feeding and gently massaging it into the areola. The components of breast milk have healing properties. Alcohol is very harsh and drying to the nipple. Sore nipples are not a contraindication to breastfeeding as long as a proper latch is obtained. A nipple shield, worn while breastfeeding, can protect the nipple while the reasons for poor latch are determined. A nipple shell, not a shield, is worn over the nipple in between feedings to promote healing and protect the nipple from irritation.

A new mother is concerned about how she will know whether her newborn is receiving enough breast milk. The nurse should explain that which factor is the least accurate measure of how much nutrition the baby is receiving?

How long the baby nurses Once infant feeding begins, assess whether the parents know how to gauge the adequacy of the amount their infant is receiving—not by how long the newborn breast-feeds at one feeding or by how much formula is taken at a feeding, but by a larger measure, such as whether the newborn is voiding, growing, and alert.

A new mother asks the nurse if this thin, watery milk is adequate enough to meet her newborn's nutritional needs. Which information is accurate for the nurse to share with this mother? Select all that apply.

Colostrum is easy for the newborn to digest since it is high in protein and low in sugar and fat. Colostrum has maternal antibodies that will help protect the newborn from illness. Colostrum, a thin, watery, yellow fluid is composed of protein, sugar, fat, water, minerals, vitamins, and maternal antibodies. For the first 3 or 4 days after birth, colostrum production continues. Because it is high in protein and fairly low in sugar and fat, colostrum is easy to digest and capable of providing adequate nutrition for a newborn until it is replaced by transitional breast milk on the second to fourth day. True or mature breast milk is produced by the 10th day. Hind milk, which is higher in fat than fore milk, is the milk that makes a breastfed infant grow most rapidly. There is no need to supply the newborn with cow's milk at this time.

During a home visit, the nurse learns that a new mother is experiencing breast engorgement. What should the nurse recommend to help alleviate this problem?

Encouraging her to continue regular breastfeeding A common suggestion to relieve breast engorgement is to empty the breasts of milk by having the infant suck more often or at least continue to suck as much as before. Breastfeeding should not be discontinued. Applying cream to the breasts will not help with engorgement. The mother does not need to be placed on a fluid restriction.

The nurse takes a newborn into the mother's room for feeding following a cesarean delivery. The nurse notes that the mother has large breasts when assisting her to feed the newborn. Which position would the nurse recommend to this mother?

Football hold For mothers who have undergone surgery, have large breasts or have twins, the football hold is the recommended feeding position. Cradle hold would work well for any infant. Side-lying position is recommended for women following surgery and to encourage rest.

When asked by a father to compare the feeding habits of formula-fed and breastfed infants, what is the correct response from the nurse about breastfed infants?

Go approximately 3 hours between feedings. Formula is harder than breast milk to digest. Therefore, breastfed babies typically feed more frequently than formula-fed babies (ie, every 3 hours instead of every 4 hours).

The lactation nurse is working with a woman who is experiencing some difficulties getting her newborn to "latch on" to her breast. They are trying various positions to see which is best for this infant. The nurse will document which nursing problem related to this teaching session?

Imbalanced nutrition, less than body requirements related to poor latch The nursing problem related to difficulty in getting the newborn to latch on to the breast would be: Imbalanced nutrition, less than body requirements, related to poor newborn response, poor latch, or ineffective transfer of milk. There is no indication that the mother wants to switch to bottle-feeding or that she feels like a failure, resulting in anxiety or impaired parenting.

While assessing a new mother breastfeeding, the nurse notices that she is dimpling her breast. Which nursing teaching should the nurse prioritize?

It puts pressure on the milk ducts and decreases the flow of milk. When the newborn is latched onto the breast, make sure the woman does not dimple the breast near the newborn's mouth and nose. Many women do this because they think they are providing breathing space for the newborn. However, this action can interfere with breastfeeding in several ways. It can cause the nipple to be pulled out of the mouth completely. It can cause the nipple to be pulled to the front of the mouth and lead to sore nipples. It can put pressure on the milk ducts, thereby reducing the flow of milk to the newborn and preventing the breast from emptying completely.

The nurse is assisting a new mother to begin breastfeeding her newborn. Which action should the nurse prioritize?

Position the infant in her arms, across her abdomen, stroking the infant's cheek with her nipple For the initial feedings, it is best for the mother to assume a sitting position, hold the infant in a tummy-to-tummy position and gently stroke the infant's cheek with the nipple to stimulate the rooting reflex. The infant should take the entire nipple and areola in it's mouth to properly stimulate and drain the breast as well as prevent nipple soreness. The lying position is not recommended for initial feedings as it requires the infant to latch more independently. This position will be more appropriate after the infant has learned the technique. It will also assist with the bonding if the mother cuddle's the infant while initially feeding the newborn. Each new mother may need some guidance and instruction as they start breastfeeding their newborn.

Nurses know that which factor most influences whether women decide to initiate breastfeeding?

Prenatal education. Research has shown that when health care providers discuss breastfeeding within prenatal education, they can influence women to breastfeed following their infants' births. The other factors are important but not as influential as prenatal education.

When counseling a mother about the benefits of breastfeeding, all of the following should be stated except:

Prevents the transmission of group beta streptococcus skin infections A group beta streptococcus skin infection is one that the fetus would contract in utero from bacteria colonizing in the mother's vaginal vault. Breastfeeding would not prevent colonization on the skin.

Dietary needs change from pregnancy to lactation. What should breastfeeding mothers be advised?

That even if a mother has adequate fat stores, calorie intake should increase Women use approximately 500 calories above their normal total daily calorie needs to produce breast milk. Thirst is usually a reliable indicator of need; caffeine should be restricted because it does enter breast milk; and breast milk will not be deficient of calcium even if the woman does not consume enough calcium.

The nurse is teaching a class called "Care for the Breastfeeding Mother" to a class of nursing students. The nurse knows that the students need further teaching when they state:

When caring for the client with plugged milk ducts, advise the client to take a warm shower, wear a support bra, take acetaminophen, massage the site, and take antibiotics." The client with plugged milk ducts needs to be taught to use a variety of positions, avoid incomplete emptying of the breast, if infant does not empty breast pump/express milk after feedings, wear a sports bra or none at all, and avoid bunching clothing up under the arm during breast-feeding. For engorgement, teach client to breastfeed frequently, massage breasts before feeding, breastfeed longer, warm shower over breast, use rousing feeding techniques, avoid bottles. Sore nipples are caused by improper latching and positioning. For mastitis, apply warm packs to site, take NSAIDs for fever and to decrease inflammation and take antibiotics as ordered.

Which postpartum client will the nurse recommend to formula-feed her infant? Select all that apply.

a new mother who is receiving radioactive iodine to treat a cancer nodule on her thyroid a new mother who tested positive for herpes and has lesions on her nipples a mother with a history of bipolar disease being treated with lithium and who has some documented compliance issues a mother who has tested positive for HIV who is receiving several medications to control the disease Breastfeeding is the ideal nutrition for human infants. However, it is contraindicated in only a few circumstances, such as: herpes lesions on a mother's nipples; maternal exposure to radioactive compounds like radioactive iodine; mothers receiving prescribed medications that would be harmful to an infant, such as lithium for bipolar disease; and women who are positive for HIV and who are advised not to breastfeed in the United States until further studies confirm that the risk of not breastfeeding outweighs the risk of breast milk transmission of the virus. As to alcohol and marijuana, the woman can be educated to eliminate these substances until after the child is weaned. If compliant and motivated to change, this decision regarding breastfeeding will be made on an individual basis.

A G1 P1 new mother asks what position she should place the newborn in while feeding formula? Which response by the nurse is best?

holding infant with head slightly elevated A parent needs a comfortable chair and adequate time to enjoy the process of feeding the baby. Holding the baby with the head slightly elevated reduces the danger of aspiration and retention of air bubbles. The nurse should remind parents not to prop up bottles because babies are in danger of aspiration if a bottle is propped. Side-lying in a crib does not provide closeness to the baby, and the bottle would be propped. Totally sitting upright is uncomfortable and hard to maintain in newborns until they can sit by themselves.

When working with a new mom sharing information as to when the newborn is getting hungry, the nurse should include which manifestations? Select all that apply.

increase in restlessness mouth movements fussiness leading to crying Part of a feeding assessment includes recognizing signs of hunger in the newborn. The nurse should ask parents if they can identify restlessness, tense body posture, and mouth movements as signs of hunger in their infant. Otherwise, they may wait for their infant to cry, and this is actually a late sign of newborn hunger. There are many causes of kicking in a newborn, and kicking is not specific to hunger. Drooling is not specific to hunger and can be related to such things as teething or chewing on a toy.

A new mother of twins asks the nurse if there is any way she can feed them both at the same time. Which piece of equipment would the nurse recommend for this situation?

pillow supports designed with wider sides to allow the twins to feed at the same time Nurses can recommend pillow supports designed to allow twins to feed simultaneously. These pillows are similar to the pillows used to support one baby, but they are wider on the sides to support two babies for simultaneous feedings. The other equipment items are not needed to breastfeed twins.

A student nurse asks the preceptor how breastfeeding protects the infant from getting ill due to viruses and bacteria. Which physiologic concept will the nurse discuss with this student?

properties of immunoglobulin A (IgA) Breast milk contains secretory immunoglobulin A (IgA), which binds large molecules of foreign proteins, including viruses and bacteria, thus keeping them from being absorbed from the gastrointestinal tract. Neither the spleen nor the lymphatic system play a role in protecting the infant from illness. White cells rather than red blood cells have a role in protecting the body from illness.

Which feeding position should the nurse suggest as most beneficial for the mother who had a cesarean birth?

sitting in a chair using a football hold with the newborn on a pillow on the mother's lap Using a football hold with the newborn supported on a pillow may be helpful, especially if a mother had a cesarean birth. This position is also helpful if the baby is having difficulty latching due to large breasts that obstruct the mother's view. The other positions are also acceptable for the woman to try until she and her infant find the position that works best for them.

A client is 6 weeks postpartum and has been breastfeeding exclusively. She began pumping 2 days ago in anticipation of going back to work. She notices that her milk is blue-tinged. How should the nurse counsel this client?

"A slightly bluish color is normal." Breast milk is thick and white and can have a bluish tinge. This is a normal finding, and this client needs only reassurance.

A breast-feeding mother calls the clinic, asking how much water she should be giving her 2-month-old infant. What would the nurse recommend to this mother?

The infant does not need any water supplement if nursing well. Breast milk is superior to any other food and provides the infant with all the fluids needed each day, so exclusively breast-fed infants do not need any supplemental water.

A nursing instructor is teaching new mothers about nutrition and the actual calories infants need for maintenance and growth. Which of the following statements by one of the mothers indicates a need for further instruction?

"All infants require the same amount of calories." The actual calorie requirement depends on an infant's individual activity level and growth rate. For example, an active infant needs more calories than one who is more passive and content to spend long hours playing quietly.

A woman who has small breasts is afraid that she will not have enough breast milk. Which of the following is the nurse's best response to this?

"This is a common concern. The size of breasts, however, does not reflect the number of milk glands present." As the size of breasts is largely determined by the number of fat cells present, this does not influence the number or size of milk glands or milk ducts present.

During a home visit, a new mother tells the nurse that her nipples are sore from breast-feeding. What should the nurse instruct the mother at this time? Select all that apply.

Apply lanolin to nipples after air exposure. Expose the nipples to air so the nipple dries. Position the baby differently for each feeding. Massage a few drops of breast milk to the areola. To help with sore nipples from breastfeeding, the nurse should instruct the mother to apply lanolin to nipples after air exposure, expose the nipples to air so the nipple dries, position the baby differently for each feeding, and massage a few drops of breast milk to the areola. The mother should be discouraged from inserting plastic liners into the nursing bra because these prevent air from circulating around the breast.

A nurse is working with four new mothers and assessing their ability to breastfeed. For which mother would breastfeeding be appropriate and safe?

A mother who smokes cigarettes Cigarette smoking is not a contraindication to breastfeeding but women should be aware some nicotine is carried in breast milk. The milk of mothers who smoke also tends to be lower in protein and may be less in amount. Breastfeeding is contraindicated in all of the other situations listed.

The nurse is teaching a breast-feeding class for nursing students. Teaching has been effective when the student can cite which of the following maternal conditions in which breast-feeding is contraindicated? Select all that apply.

Active untreated tuberculosis Chemotherapy Illegal drug use HIV There are certain maternal conditions or situations in which breastfeeding is contraindicated. Examples are illegal drug use, active untreated tuberculosis, HIV, chemotherapy, and herpetic lesions on the breast. Chlamydia is not a contraindication to breastfeeding.

When teaching a woman about ingesting drugs while breastfeeding, which of the following statements is most accurate?

Almost all drugs are excreted to some extent in breast milk. Almost all drugs are excreted in breast milk, over-the-counter as well as prescription.

It is important to assess the breast-feeding mother and her infant during a feeding session. What assessment has priority during the feeding session?

Assess the position, latching on, and sucking of the newborn. Correct positioning and latching on of the newborn will help avoid nipple tissue trauma and sore nipples. Once the newborn is nursing, evaluate the effectiveness of the latch and sucking.

Which of the following statements is true about breastfeeding?

Breastfeeding offers a good chance for bonding with the infant. Breastfeeding reduces the risk of breast cancer and enhances uterine involution. It provides the opportunity for mother-infant bonding.

A woman who had a cesarean is getting ready to be discharged from the hospital. Before she leaves, she asks you to assess her breasts because she has pain on both sides. The nurse notices that both breasts are hard, warm, and tender to the touch. Her vital signs are normal. What does the nurse suspect?

Engorgement Because you know that this patient had a cesarean and is being discharged today, she is most likely on postpartum day 3 or 4, when engorgement is most common. Although mastitis, nipple thrush, or a plugged duct may happen during this time, they more commonly occur after 2 weeks postpartum. Also, mastitis, thrush, and a plugged duct are usually unilateral, and this patient's symptoms are bilateral. Hard, warm, and tender breasts on the third or fourth day with normal vital signs is most likely the result of engorgement.

A new mother calls the lactation consultant at the hospital because she is concerned that her 1-week-old baby is not getting enough to eat when he is breast-feeding. What reported behavior by the baby would the nurse be concerned about?

He is feeding 6 times per day. Breast-fed babies usually nurse every 2 hours or at least nine to 10 times per day. Nursing only six times in 24 hours is not adequate for a newborn. Seven to eight wet diapers is normal, as is the increased nursing time, which indicates that the baby is growing and needs more nutrition. Normal breast-fed stools are yellow or mustard-colored seedy, soft stools.

The nurse is conducting a prenatal class on the pros and cons of breastfeeding versus formula feeding. Which deciding factor should the nurse prioritize when assisting these parents to make their decision?

It based on their personal preference and situation. An assessment of newborn nutrition begins during pregnancy with an assessment of the mother's and her partner's attitudes and choices about infant feeding. Breastfeeding is widely accepted as the preferred method of human newborn nutrition and should be recommended but not forced on the parents. If a mother chooses not to breastfeed as a personal preference based on her situation, it is important she not be made to feel guilty for her choice. Most importantly, parents need to feel comfortable with and confident about the feeding method they choose. Feeding should be a pleasurable experience, so both parents should be comfortable with the chosen method. There are a few reasons why an infant should be formula-fed. These include adverse reactions to the mother's milk and allergies. The nurse should ensure the parents are provided information for both forms of feeding so they can make an informed decision and then the nurse should support their decision and assist them as they learn how to care for their infant.

The postpartum nurse is teaching a nutrition class for a group of new breastfeeding mothers. Which topics should be included in this presentation? Select all that apply.

Recommend the mothers increase their water intake to at least four to six 8-oz glasses/day. Caffeine intake can affect the newborn while breastfeeding, so mothers should try to limit consumption if possible. The nurse should remind women a good fluid intake is necessary to maintain an adequate milk supply and should also recommend they drink at least four 8-oz glasses of fluid a day; many may need to drink six glasses. They also need to increase their calorie intake by about 500 calories per day. Alcohol and caffeine can affect the newborn and should be avoided by the breastfeeding mother. Cigarette smoking is not a contraindication to breastfeeding, but women should be aware some nicotine is carried in breast milk.

The nurse will assess the newborn for which potential cause of excess sleepiness? Select all that apply.

Review bilirubin level for elevation. Check glucose level for possible hypoglycemia. Often, a newborn being breastfed becomes sleepy at the breast, especially in the first 24 hours of life. Jaundice and hypoglycemia are also causes of sleepiness at the breast. Anemia is rare in newborns. After assessing the infant for jaundice and hypoglycemia, the nurse should consider substances that may be in the mother's milk, such as narcotics or illicit drugs.

Breastfeeding is generally encouraged except under certain conditions. Which conditions contraindicate breastfeeding? Select all that apply.

When the mother takes certain medications, such as antineoplastics When the mother has active tuberculosis When the mother is diagnosed with breast cancer Breastfeeding is contraindicated when the mother is being treated with certain medications, when the mother has untreated tuberculosis, and when breast cancer is diagnosed during pregnancy. Other contraindications include when the mother is positive for human immunodeficiency virus, and when there is an inborn error of metabolism in the infant.

A postpartum mother is experiencing sore nipples. The woman asks the nurse what she is doing wrong that is causing this problem. The nurse identifies which breastfeeding technique or condition may result in sore nipples? Select all that apply.

allowing the newborn to stay latched on to the breast for a prolonged period after feeding not assessing that the newborn has a highly arched palate that interferes with proper latching setting the breast pump on a higher pressure setting to empty milk faster Painful nipples may result from improper positioning of the newborn, improperly removing a newborn form the breast, and abnormalities of the palate and/or tongue. A palate that is highly arched or flat may affect proper latching. Positioning the newborn so that the head is level or in the sniffing position is the proper positioning. When the newborn's chin is on the chest, it cannot open the mouth wide enough to get a good latch. A mother placing a finger in the newborn's cheeks to break seal prior to removing the newborn from the breast is the proper technique.

A patient in the early stage of labor informs the nurse that she is planning to breastfeed. She tells the nurse that this is her first baby and wants to begin breastfeeding as soon as possible. When should the nurse tell the mother she will be able to start breastfeeding?

immediately after birth Most hospitals begin breastfeeding immediately after birth.

The nurse asks a new mother how she is planning on feeding her newborn. The mother responds that she is planning on formula feeding her baby. Which of the following is the best response for the nurse to give the mother?

"Have you considered breastfeeding? There are some real benefits that it can offer you and your baby." It is universally agreed breast milk is the preferred method of feeding for newborns, because it provides numerous health benefits to both a mother and an infant; it remains the ideal nutritional source for infants through the first year of life. Nurses are prime health care professionals to teach women about the benefits of breastfeeding and provide anticipatory guidance for problems that may occur. Thus, the nurse should not simply support or even acknowledge the mother's decision without mentioning the benefits of breastfeeding, in case the mother is not aware of them. However, she should not speak in a judgmental, negative way regarding formula feeding, either, as it may be the mother's only option, and although it does not have the same benefits as breastfeeding, it is not "unhealthy" for the baby.

The nurse would provide additional teaching if which statement was made by a new mother?

"I will have to buy bottled, 'natural' water for mixing formula." A mother may think she is helping her child by using bottled, "natural" water in formula rather than chlorinated (and fluoridated) water from a tap. Fluoride is essential for building sound teeth and for preventing tooth decay. Because teeth are already set in their primary form during pregnancy, it is important for women to drink fluoridated water during pregnancy. A lactating mother should continue drinking fluoridated water (although only a small amount of fluoride passes into breast milk), and formulas should be prepared with fluoridated water.

A new mother wants to prevent her newborn from developing severe jaundice because this happened to her first child. What statement is most accurate for the nurse to say to this mother?

"If possible, feed your baby as frequently as you can to allow the natural laxative in colostrum help pass both meconium and bile." To prevent this excess buildup of bilirubin in a newborn, women should feed frequently in the immediate postpartum period because colostrum is a natural laxative and helps promote passage of both meconium and bile. Jaundice occurs in about 15% of breastfed infants because pregnanediol (a breakdown product of progesterone) in breast milk depresses the action of glucuronyl transferase, the enzyme that converts indirect bilirubin (which cannot be excreted) to the direct form, which is then readily excreted in bile. Once diagnosed with jaundice, light treatment is one method to lower the bilirubin level.

A first-time mother learning to breastfeed her newborn is worried her baby is not getting enough milk. Which statement made by the nurse is most appropriate?

"Look at the number of wet and diapers with stool plus how many times the baby is feeding in a 24 hour period." Mothers cannot measure the amount of breast milk the newborn ingests each feeding. Nurses can reassure mothers by instructing them to look for signs the newborn is voiding and defecating within the acceptable range and waking for feedings 8 to 12 times in 24 hours. Brushing away their concerns by telling them to not worry is not therapeutic communication. A mother should be assured that the baby is healthy without pumping and then feeding from a bottle. Teaching the mother how to palpate fontanels is not an appropriate intervention for a worried mother.

A new mother asks the nurse how to determine if the baby is receiving enough breast milk. What response should the nurse make to the mother?

"The infant should gain weight and have six wet diapers daily." Acceptable criteria during the first week of life are wetting six to eight diapers within 24 hours or losing no more than 10% of birth weight. After the first week, weight gain and voiding six to eight times each 24 hours are good criteria to use. The infant will not become constipated when ingesting breast milk. Sleeping is individual for each baby and cannot be used to determine an adequate nutritional intake. Weighing the infant before and after feedings is not recommended.

A new mother is concerned that she will not have enough breast milk because of small breasts. What should the nurse respond to the mother?

"The size of breasts does not impact the amount of breast milk that is made." Breast milk is formed in the acinar cells of the mammary glands and begins production after the delivery of the placenta. When the progesterone level falls, the production of prolactin is stimulated, which cause breast milk to be made. The nurse can discuss the patient's concern; it does not need to be discussed with the physician. Supplementing a breastfeeding baby with formula is not recommended. The nurse's comment about milk production and the frequency of feeding does not address the mother's concern.

Which statement from the parents of a 20-week-old infant will require further teaching related to supplying protein needed by a newborn?

"We have a milk cow, so we never have to worry about running out of milk for this baby." Unaltered cow's milk is not recommended for newborns because it contains about 16% of its calories as protein, whereas human milk contains about 8%. This means cow's milk can create such a rich solute load (i.e., the amount of urea and electrolytes that must be excreted in the urine) that a newborn's kidneys could be overwhelmed. In addition, cow's milk can cause microscopic bleeding of the gastrointestinal tract, leading to blood loss and anemia. The alternative to cow's milk is either breast milk or formula for a baby this young.

A single mother with financial constraints asks the nurse if she can keep unused milk from one feeding for the next feeding. Which response is most accurate?

"With any type of bottle, the contents remaining after a feeding should be discarded, not reused." With any type of bottle, any contents remaining after a feeding should be discarded, not stored and reused. When sucking, an infant exchanges a small amount of saliva for milk. Because milk is a good growth medium for bacteria and everyone's mouth harbors many bacteria, the bacterial content in reused formula is likely to be high.

On admission to the labor and delivery unit for a scheduled elective induction, a 21-year-old P1001 expresses to the nurse her desire to bottle-feed. What is the best response from the nurse?

"Would you like any information on breastfeeding?" The nurse should respect and support a woman's decision about how to feed her baby without imposing personal views on the patient. A nurse may know that the breast is best; therefore, asking the patient if she would like information about breastfeeding is both nonthreatening and informative. The nurse should not assume that the patient had difficulties with her previous baby.

The nurse is teaching new parents how to calculate the amount of formula to feed their newborn each day. The baby weighs 8 lb. How much formula should the nurse teach the parents to provide each day?

20 to 24 oz The total fluid ingested for 24 hours must be sufficient to meet the infant's fluid needs and is calculated by determining 75 to 90 ml or 2.5 to 3.0 oz of fluid per pound of body weight per day. Because the infant weighs 8 lb, the amount of formula would be between 8.0 x 2.5, or 20 oz, and 8.0 x 3.0, or 24 oz. The other choices are inaccurate calculations for the amount of formula to provide to an infant weighing 8 lb.

A new mother calls for the nurse to come to her room while she is breast-feeding her newborn. She reports that the baby will not wake up and latch on. What can the nurse do to assist this mother in getting her newborn to nurse?

Change the diaper and gently rub the newborn's back In order to assist a mother in getting her newborn to nurse, the nurse should have the mother sit up in a comfortable position, change the infant's diaper, and gently rub the infant's back and head to wake the newborn up. The mother may also try placing the newborn skin-to-skin for stimulation for nursing. The nurse would never remove the mother's gown due to modesty issues or vigorously pat the newborn's bottom since that would be too forceful.

Why is the use of contraceptives containing estrogen not recommended for breast-feeding women?

Contraceptives containing estrogen reduce the milk supply. It has been proven that hormones containing estrogen can reduce the mother's milk supply when used for contraceptives. Estrogen does not increase the incidence of mastitis, affect the let-down reflex or affect the nursing newborn.

All of the following are maternal benefits of breastfeeding except:

Decreased risk of adult-onset asthma A decreased incidence of asthma is seen in the newborn, not the mother. Uterine involution, weight loss, and decreased risk of ovarian and breast cancer are all maternal benefits of breastfeeding.

A nurse is teaching a new mother the benefits and protective effects of breastfeeding. The nurse should point out breastfeeding is known to provide protection against which disorder?

Diarrhea Breastfeeding an infant for up to 6 months helps to prevent diarrhea in the infant. In addition, breastfeeding also protects the infant from otitis media, colds, wheezing, and asthma during childhood. Typhoid, edema, or cholera are not prevented by breastfeeding in infants.

A mother will be making infant formula by adding water to concentrated formula. Which water sources are safe to use in making the formula? Select all that apply.

Distilled water Tap water Distilled water and tap water are safe to use in making infant formula. Mineral water, spring water, and glucose water are not safe to use because they contain other substances that alter the content and/or osmolarity of the formula.

A nurse is giving a new mother some tips regarding breastfeeding. Which of the following should she mention?

Empty one breast completely before feeding the baby from the other breast An important principle for women to learn is milk forms in response to being used. If breasts are completely emptied, they completely fill again. If half emptied, they only half fill, and, after a time, milk production will become insufficient for proper nourishment. Urge women to always place their infant first at the breast at which the infant fed last in the previous feeding, to help ensure each breast is completely emptied at every other feeding. Because it takes less energy for an infant to suck at a bottle, urge parents not to offer bottles of breast milk until 4 to 6 weeks of age, or after the infant is thoroughly accustomed to breastfeeding. Teach women to wash their breasts before beginning with clear water because soap tends to dry and crack nipples. Be certain infants open their mouths wide enough to grasp both the nipple and the areola (the pigmented circle surrounding the nipple) when sucking. This gives them effective sucking action and helps to empty the collecting sinuses completely.

The nursing instructor is conducting a teaching session illustrating the basics of feeding newborns. The instructor determines the class is successful after the students correctly choose which disorder as a contraindication to breastfeeding?

Galactosemia Galactosemia is an inborn error of metabolism for which a special formula is necessary because the infant lacks the necessary enzymes to break down the sugar in breast milk. Newborns with PKU may supplement with breast milk in small amounts but will require special formula to complete their diet. Hypothyroidism and hypertension are not contraindications for breastfeeding.

Which is true regarding mineral requirements in the newborn?

Infants who are formula-fed should drink an iron-enriched formula for at least 12 months. Breast milk contains an adequate amount of iron, and infants who are breastfed do not need to supplement with oral iron. However, infants do not make adult hemoglobin until 3 to 6 months of age; they therefore need iron-enriched formula. The American Academy of Pediatrics recommends iron-enriched formula for at least 1 year. Mothers who are breastfeeding should drink some fluoridated water. Spring water is not enriched with fluoride.

Which of the following instructions should a nurse give to a lactating client about how to break suction during a feeding?

Insert a finger into the corner of the baby's mouth between the gums The nurse should instruct the client to insert her finger into the corner of the baby's mouth between the gums to break the suction. The mother should not tug at the nipple, as this might damage the infant's unexposed teeth. Pressing both the cheeks of the infant simultaneously or shifting the infant to the football hold from the cross-cradle hold will not help break the suction.

Which of the following is an advantage of breastfeeding that directly benefits the mother?

It aids in uterine involution. One of the advantages of breastfeeding that benefits the mother is that the release of oxytocin from the posterior pituitary gland, which is triggered by breastfeeding, aids in uterine involution. The other advantages listed directly benefit the baby, not the mother.

The nurse is conducting a prenatal class on breastfeeding. The nurse determines the class is successful when the young parents correctly choose which time frame is recommended for breastfeeding the infant?

One year It is recommended that the infant be fed exclusively by breastfeeding for the first six months and then continued with supplemental breastfeeding until the infant is 1 year old. However, when the mother stops breastfeeding is a personal choice as some will continue breastfeeding until the infant is 2 years old.

Choose the correct statement regarding breast milk production.

Oxytocin is responsible for the let-down reflex, and prolactin stimulates milk production. As the level of progesterone decreases drastically after birth, the anterior pituitary is stimulated to produce prolactin. Prolactin triggers the mammary glands to stimulate the production of milk. Oxytocin, released from the posterior pituitary, causes the mammary glands to contract and triggers the let-down reflex.

A nurse is caring for a pregnant client who inquires about the benefits of breast feeding. The nurse explains that secretory immunoglobulin A found in breast milk helps the infant by:

Protecting the gastrointestinal tract from foreign proteins Secretory immunoglobulin A found in breast milk specifically protects the infant's gastrointestinal tract from foreign proteins. Overall, infants who are breast fed up to 6 months are protected from otitis media, have lowered rates of asthma during childhood, and are capable of overcoming family history of allergies.

When educating a woman about newborn feedings, what instruction should the nurse give on the proper way to heat a bottle?

Running it under warm water or in a bottle warmer Milk and formula do not need to be warmed before they are consumed. Placing the bottle in a pan on the stove or over steam can overheat the milk. The microwave is not recommended because pockets of milk can be extremely hot and may burn the newborn. Running warm water over the bottle or using a bottle warmer is the best way.

A mother has opted to formula feed her 2-month-old baby. She proudly announces to the nurse during an office visit that she uses only the best bottled spring water to prepare the formula. How should the nurse respond?

She should tell the mother to switch to using fluoridated water from the tap Fluoride is essential for building sound teeth and for preventing tooth decay. A lactating mother should continue drinking fluoridated water (although only a small amount of fluoride passes into breast milk), and formulas should be prepared with fluoridated water. This is an essential point to remember, because a mother may think she is helping her child by using bottled, "natural" water in formula rather than chlorinated (and fluoridated) water from a tap. Fluoride toothpaste should not be used with children under 2 years of age as they tend to swallow toothpaste, and too much fluoride can be detrimental. A fluoride supplement, 0.25 mg daily, may be given to the infant beginning at 6 months of age, but not earlier (this child is only 2 months old).

A new mother is ambivalent about breastfeeding and agrees to do it for at least 3 months. What response should the nurse provide to the patient at this time that would support the 2020 National Health Goals?

Six months to 1 year of age is the best time frame to support the baby's growth needs. Six months to 1 year of age is one of the 2020 National Health Goals for breastfeeding. Although breastfeeding can help the mother return to prepregnancy weight, this is not a 2020 National Health Goal for breastfeeding. Three months is not the recommended time frame for the baby's nutrition. Breast milk can be donated; however, this is not a 2020 National Health Goal for breastfeeding.

Which factors affect a woman's decision to breastfeed? Select all that apply.

Socioeconomic Culture Past experience Family Work status The decision to breastfeed is multifaceted. Several factors can influence a woman's decision regarding whether to breastfeed. These include family influences, peer influences, socioeconomic factors, culture, past experiences, whether the mother intends to return to work, and more.

Which of the following is true regarding storing breast milk?

Thawed breast milk must be used within 24 hours. Breast milk can be frozen for 2 to 6 months depending on the grade of the freezer. It can sit out at room temperature for 2 to 4 hours depending on the outside air temperature. It cannot be used if it sits out at room temperature overnight. Once it is thawed from frozen, it must be used within 24 hours.

A mother has expressed two bottles of breast milk and asks the nurse about how to store it for later use. Which explanation would be accurate?

The breast milk will be good for up to 1 week if refrigerated at 39℉ (4℃) or less. Freshly expressed breast milk is good for 4 to 6 hours after expression. If refrigerated, breast milk is good for up to 8 days but the ideal time is 72 hours. Frozen breast milk is good for 6 months in a deep freezer and if thawed, is good for 24 hours.

A nurse is reading a journal article about recommendations for breastfeeding. The nurse discovers the American Academy of Pediatrics recommends which time period for exclusively breastfeeding of an infant?

The first 6 months of age The American Academy of Pediatrics recommends an infant be fed exclusively by breastfeeding for the first 6 months and continuation of breastfeeding for at least 12 months, with the mother deciding how long to continue after that.

A mother delivers her newborn and has chosen to formula-feed her baby. She asks the nurse how to keep her breasts from making milk. How would the nurse respond to the mother's question?

The mother needs to understand that she will produce some milk, but wearing a constrictive bra will help dry up the milk supply. Wearing a tight bra is the best way to support the engorged breasts and aid in drying up the mother's milk supply, because all postpartum women produce milk. Manually expressing milk stimulates milk production. Health care providers no longer prescribe medications to dry up the breast milk because the benefits do not outweigh the associated risks of the medications.

Annie, a new mother, is talking with the nurse about breast-feeding. She asks, "How does lactation work?" The best answer by the nurse is:

The newborn sucking on the breast stimulates the pituitary gland causing the release of prolactin and oxytocin. Prolactin causes synthesis and release of breast milk and oxytocin causes contraction of the smooth muscle around the alveoli of the breast. Prolactin stimulates the alveoli to produce milk and then to release it. Oxytocin causes contractions of the muscle cells that surround the alveoli in the breast, which push milk downward toward the nipple.

The nurse is assisting a new mother with breastfeeding her infant who has shared she wants to cradle her baby close to her. Which position will the nurse assist the mother in placing the infant?

Tummy-to-tummy with its mother In the cradle hold, the newborn's abdomen is facing and touching the woman's abdomen. Make sure the newborn is not lying on his back and turning his head toward his shoulder to reach the breast. He or she should be on his side and "tummy-to-tummy" with the woman. The newborn may have difficulties with latching on if lying on the bed side-by-side with the mother and should not be used for the initial attempts. The football hold is when the infant is held tucked in the mother's arm, resting on a pillow. This position is a good position to prevent pressure on an incision site from cesarean delivery or if the woman has large breasts.