Newborn Nutrition PowerPoint

Question 1

recommendations for nutrition

Answer 1

• Evidence shows human milk (breast feeding) is the ideal food for newborns and provides the best nutritional value
• Breast milk is the gold standard for infant nutrition
• American Association of Pediatrics recommends exclusive breastfeeding of human milk for the first 6 months and continued breastfeeding for at least 12 months
• After 6 months, appropriate complementary solid foods may be added to the diet

Question 2

decision to breastfeed

Answer 2

• Natural extension of pregnancy and childbirth
• Women tend to select the sam feeding method for all their children
• Support by family and partner is a major factor in feeding choice
• Cultural factors
• Mother’s knowledge about the health benefits to the infant and her comfort level with breastfeeding in social settings

Question 3

barriers to breastfeeding

Answer 3

• Lack of broad social support for breastfeeding
• Widespread marketing by infant formula companies
• Lack of prenatal breastfeeding education
• Insufficient training and education of healthcare professionals about breastfeeding
• Employment and the need to return to work after birth
• Pain, lifestyle incompatibility

Question 4

some breastfeeding contraindications

Answer 4

Newborns with galactosemia

Mothers who are positive for human T cell lymphotropic virus types I or II

Mothers with untreated brucellosis

Mothers with active TB

Mothers with active herpes simplex lesions on the breasts

Mothers with HIV infection

• Considered a contraindication in the US
• In developing countries where HIV is prevalent, the benefits of breastfeeding for infants outweigh the risk of contracting HIV from infected mothers

Question 5

formula feeding decision

Answer 5

• Parents who choose formula feed often make this decision without complete information and understanding of the benefits of breastfeeding
• Cultural beliefs, myths, misconceptions
• Some view formula feeding as a way to ensure that the father, other family members, and daycare providers can feed the baby

Question 6

cultural influences on infant feeding

Answer 6

Immigrants to the US from poorer countries often choose formula to appear more “modern” or to adapt to US culture and customs

Breastfeeding beliefs and practices vary across cultures

• Beliefs about the harmful nature or inadequacy of colostrum
• Combining breastfeeding and formula: las dos cosas
• Specific food intake to foster milk production

Question 7

nutritional needs

Answer 7

• Fluids
• Energy
• Carbohydrates
• Fat
• Protein
• Vitamins
• Minerals

Question 8

newborn weight changes

Answer 8

• Normal weight loss after birth = 5-10%
• Regain of weight by 10-14 days after birth
• First 3 months gain S/B 110-200g/week

Question 9

fluid intake

Answer 9

first 2 days = 60-80 mL/kg/day (24hrs)

day 3-7 = 100-150 mL/kg/day

Question 10

caloric intake

Answer 10

day 1 to 3 months = requires 110kcal/kg/day

3-6 months = requires 100kcal/kg/day

breast milk/formula = 20kcal/oz

adequate caloric intake is essential for energy
- allows for growth, digestion, metabolic needs, and activity

Question 11

newborn caloric need

Answer 11

110 kcal/kg/day

Question 12

calories in breast milk/formula

Answer 12

20 kcal/oz

Question 13

1 lb =

Answer 13

16 oz

Question 14

Baby Brian was born 6 days ago and now weighs 7 pounds 6 ounces. His mother is concerned that he is not getting what he needs. In the last 24 hours he has had 21 ounces of formula. (2 oz at 7am yesterday, then 1 oz at 10am, 1 oz at noon, 1.5 oz at 1:30, 2.5 oz at 3:30, 2 oz at 6pm, 1.5 oz at 7:30pm, 1 oz at 8:30pm, 1.5 oz at 10:00, 1.5 oz at midnight, 2 oz at 2am, 1.5 oz at 4am and 2 oz at 6:45am.)

1. How many calories did Brian need in the 24 hours?
2. How many calories has he had?
3. Did he receive a sufficient amount for his weight?

Answer 14

First find out what he needed.

He weighs 7pounds 6 oz.- you need to change ounces to a partial pound
- pounds = 1 pound/16 oz. X 6oz/? = 0.375 pounds now add the 7 pounds = 7.375 pounds. To change to kg divide by 2.2. (there are 2.2 pounds for every kg). Baby Brian weighs 3.352 kg

1. Needs 110kcal/kg/day 110kcal X 3.352 = 368.72 = 369 kcal/day
2. Received 20kcal/oz 20kcal x 21ounces = 420 kcal/day
3. He received an adequate amount of formula.
   This is the time to teach the mom the importance of good feedings
   wet & dirty diapers.

Question 15

what should you feed baby

Answer 15

Unmodified cows milk = NO!!! only if last resort per pediatrician (many other options)

Formula = recommended by pediatrician with additives such as iron, B12, etc.

Breast Milk = THE BEST!

• Has a composition that changes to meet the nutritional needs of the growing infant
• The more the infant feeds, the more mom will produce
• Contains immunological active components that provide early life protection
• If a premature infant is born, the mother will produce enough milk for the gestational age of that infant

Question 16

carbohydrate needs

Answer 16

1st 6 months = 60g/dau

2nd 6 months = 95g/day

40-50% of total calories

Question 17

fat needs

Answer 17

1st 6 months = 31g/day

Composed of lipids, triglycerides, cholesterol, fatty acids

Cholesterol essential element for brain growth

Fatty acids - growth, neurologic development, visual function

Cow’s milk does not have the fatty acids needed to slow down the ingestion part and can lead to lower weight gain

Question 18

protein needs

Answer 18

9g needed to maintain good growth

2 main proteins - whey & casein (breast milk 70:30, compared to cow milk 20:80) - makes milk more digestible

• Whey = protects against gram+ & gram- anaerobes and yeast
• Casein = enhances absorption of iron

Question 19

vitamin needs

Answer 19

Vitamin D added for both breastfed babies and bottle-fed babies (400IU of Vit D daily)

Facilitates absorption of calcium, phosphorus, bone mineralization, and calcium reabsorption

Vitamin K = required for blood coagulation and produced in the intestines

Mother’s dietary intake or formula may need to have B12 added

Question 20

mineral needs

Answer 20

Too many minerals in cow’s milk

Breastmilk iron is better absorbed than formula iron

No fluoride added until after 6 months
(6mo to 3yr fluoride is based on amount of fluoride in water supply)

Question 21

milk let down hormone

Answer 21

oxytocin

Question 22

milk production hormone

Answer 22

prolactin

Question 23

feeding readiness cues

Answer 23

• Hand-to-mouth or hand-to-hand movements
• Sucking motions
• Rooting reflex (infant moves toward whatever touches the area around the mouth and attempts to suck)
• Mouthing

Question 24

care management in breastfeeding

Answer 24

• Positioning
• Latch
• Milk ejection or let-down
• Frequency of feedings
• Duration of feedings
• Indicators of effective breastfeeding
• Latching should the complete areola
• Baby jaw should be wide
• Latching is a good time to check for ankyloglossia

Question 25

short or tight frenulum (“tongue tied”)

Answer 25

ankyloglossia

Question 26

removing the baby from the breast

Answer 26

Never pull the baby from the breast

- Mom should place her finger between the breast and the baby’s mouth (gently break the suction)

Question 27

storing breast milk

Answer 27

Room temperature = (60-80*F) 3hrs optimal, 6-8hrs acceptable under very clean conditions

Refrigerator = (39*F) 72hrs optimal, 5-8days acceptable again under VERY clean conditions (do not store near other items)

Freezer = (24*F) 6 months optimal, 12 months acceptable

Note: if a bottle has been used (breast or formula) once it has been opened for 1hr, throw away any unused formula/breastmilk due to the chance of bacteria introduction

Question 28

care of mother

Answer 28

Good nutrition
Plenty of rest
Breast care

Breast feeding moms:

• Wash only with water (no soap - dry nipple and give baby bad taste where they may not want to nurse; can also cause them diarrhea)
• If using creams, such as lanolin, use sparingly (can block montgomery gland)
• In the first few days after birth, use colostrum (natural cream)

Formula moms:
- No stimulation of the breast

Question 29

common concern: engorgement

Answer 29

• Over production of milk

- Remove the milk by feeding the baby or pumping

Question 30

common concern: sore nipples

Answer 30

• Keep from happening by having good latching techniques
• Mouth should be wide open before latching - needs whole areola in its mouth
• Wipe nipples with clean washcloth to reduce amount of saliva baby has left

Question 31

common concern: insufficient milk supply

Answer 31

Don’t give up -> assess weight, latch, feeding technique, maternal medications

Question 32

common concern: plugged milk ducts

Answer 32

• Most often breasts are not being cleaned after every feeding or too tight clothes/bra
• Warm compresses or leaning over a bucket of warm water

Question 33

common concern: mastitis

Answer 33

• Inflammation/infection of the breast
• Make sure breasts are being emptied

causes:

• engorgement
• plugged ducts
• decrease in feedings
• abrupt weaning
• underwire bra
• sore cracked nipples
• stress
• fatigue
• maternal illness
• breast trauma
• poor maternal nutrition

Call MD if mom has a temperature
Treatment: 10-14 days antibiotics and ibuprofen (continue to feed or pump)
- Mom increase fluid intake

Question 34

formula feeding parent education

Answer 34

• Readiness for feeding
• Feeding patterns
• Feeding technique
• Common concerns (watch the bottle for air delivery - if not held at at a good angle, the infant could receive air, resulting in painful abdomen and flatus)
• Bottles and nipples

Infant formulas (commercial)

• Cow’s milk-based formula
• Soy-based formulas (commonly used for children who are lactose intolerant or cow’s milk protein intolerant)
• Casein or Whey-hydrolysate formulas (used primarily for children who cannot tolerate or digest cow’s milk- or soy-based formulas)
• Amino acid formulas (used for infants with multiple food protein intolerances)

Formula preparation:

• Powdered formula (least expensive)
• Concentrated formula
• Ready-to-feed (most expensive)
• Vitamin and mineral supplementation
• Weaning
• Introducing solid foods (complementary feedings)

Question 35

newborn nutrition key points

Answer 35

Human breastmilk is species specific and is the recommended form of infant nutrition
- It provides immunologic protection against many infections and diseases

Breastmilk changes in composition with each stage of lactogenesis, during each feeding, and as the infant grows

During the prenatal period, expectant parents should be informed of the benefits of breastfeeding for infants, mothers, families, and society

Infants should be breastfed within the first hour after birth and at least 8-12x/24hrs thereafter

Parents should be taught to recognize the signs of effective breastfeeding

Breastmilk production is based on a supply-meets-demand principle
- The more the infant nurses, the greater the milk supply

Infants go through predictable growth spurts

Sore nipples are most often caused by incorrect latch

Commercial infant formulas provide satisfactory nutrition for most infants

Infants should be held for feedings

Parents should be instructed about the types of infant formulas, proper preparation for feeding, and correct feeding technique

Solid (complementary) food should be started at about 6 months of age
- Start with rice cereal - less allergies and easy on the digestive system (then veggies and meats - fruits last [sweet])

Unmodified cow’s milk is inappropriate for infants younger than 1yr
- unmodified = regular milk from the store (modified = formula)

Nurses must be knowledgable about feeding methods and provide education and support for families