Ch. 24 Newborn Nutrition & Feeding

Question 1

is the gold standard for infant nutrition

Answer 1

human milk

Question 2

to advocate for breastfeeding - know that human milk is the absolute gold standard for infant nutrition; it is species specific it is uniquely designed to meet the needs of a human infant- the composition of human milk changes to meet the nutritional needs of the growing infant: highly complex with anti-infectives and nutritional components combined with growth factors and enzymes and digestion and absorption and fatty acids

Answer 2

job:

Question 3

American Academy of Pediatrics (AAP) recommends infants be breastfed exclusively for first 6 months of life
Breastfeeding should continue for at least 12 months and thereafter as desired
Complementary foods can be introduced after 6 months

Answer 3

Recommended infant nutrition

Question 4

American Academy of Pediatrics recommends infants be breastfed exclusively for the first 6 months of life
exclusively means nothing but human milk for the first six months of life

Answer 4

American Academy of Pediatrics (AAP) recommends infants be breastfed exclusively for first 6 months of life

Question 5

breastfeeding continues as complimentary Foods or introduced thereafter breastfeeding should continue for one year and thereafter is desired

Answer 5

Breastfeeding should continue for at least 12 months and thereafter as desired

Question 6

Human milk designed specifically for human infants; nutritionally superior to any alternative

Answer 6

Benefits of breastfeeding

Question 7

reduction in infant and child mortality reduced risks for asthma and allergies in general decreased risk for SIDS
Allergies in general
decrease ear infections and lower respiratory infections and GI issues
enhanced neurodevelopment outcomes: slightly higher intelligence
Associated with health benefits for mother and infant
Psychological benefits
Convenience
Economical
Environmental benefits

Answer 7

Human milk designed specifically for human infants; nutritionally superior to any alternative

Question 8

Mom decreased postpartum bleeding
concept of the maternal role is important in the decision to breastfeed women who decide to breastfeed or likely to be breastfeeding as a natural extension of pregnancy and childbirth and it is much more than simply a means of Supply nutrition
women seek the unique bonding experience between mother and infant that is characteristic of breastfeeding
partner and family support is a major factor in a woman’s decision to breastfeed
breastfeeding alone is difficult - nurses: of how well the baby’s latching but most of it is education and support that’s what the nurses are doing at the bedside for some women and their Partners perceptions of breast function influence decision
how perception of her breast function influenced her decision to formula feed vs breastfeeding
response to pressure so almost shaming them into breastfeeding not shaming them from because they’re not bottle feeding but now we’re shaming them into forcing them to breastfeed
another benefit of breastfeeding it does actually protect against postpartum mood disorders

Answer 8

Associated with health benefits for mother and infant

Question 9

major obstacle to breastfeeding for some women is employment and the need to return to work after birth so many of us are full-time employed when we have our kids we don’t have the luxury of staying home with them for that first year so they have to weigh out okay well I can breastfeed my child but I’m going to have to wean them or transfer you know to formula feeding by the time I go back to work because I don’t work in an environment that is really suitable for me to to breastfeed or to pump in a safe and clean environment

Answer 9

Economical

Question 10

it’s all about their perceptions and things that they’ve heard
our job is Educators and nurses is to educate them on the actual facts of breastfeeding and not buying to the the anecdotal evidence
Breastfeeding (BF)
Formula-feed

Answer 10

Choosing an infant feeding method

Question 11

Parents should be aware of the benefits of BF for their infant, as well as the risks of not BF
A natural extension of pregnancy and birth
Support by the partner and family is necessary
Mothers tend to select the same method of infant feeding for all of their children

Answer 11

Breastfeeding (BF)

Question 12

Choosing to Parents often make this decision without complete information
Myths and misconceptions about BF
BF may be seen as embarrassing
See formula-feeding is a way for family members to feed the baby
Mothers on WIC are more likely to formula-feed

Answer 12

Formula-feed

Question 13

Maternal cancer therapy or diagnostic and therapeutic radioactive isotopes
Active tuberculosis (not treated)
Human immunodeficiency virus (HIV)
Maternal herpes simplex lesion on a breast
Galactosemia in infant
Varicella
Maternal substance abuse
Maternal human T-cell leukemia virus type 1 or type 2
Some medications may be incompatible with BF

Answer 13

Contraindications of breastfeeding

Question 14

Galactosemia - should not receive human milk
it is contraindicated for mothers who are positive for human T Cell lymphatropic virus types one or two
those with untreated brucellus active TB or an act of herpes lesion on the breast while pretty rare it can still happen neither of these conditions precludes a woman from expressing milk so she could pump the milk and give to her baby but the baby cannot come into contact with her breast

Answer 14

Maternal cancer therapy or diagnostic and therapeutic radioactive isotopes

Question 15

women who have active TB that’s not treated they can’t breastfeed but the woman who is active TB when they have been treated for at least two weeks then can breastfeed

Answer 15

Active tuberculosis (not treated)

Question 16

HIV is an absolute contraindication for breastfeeding

Answer 16

Human immunodeficiency virus (HIV)

Question 17

Fluids
Energy
Carbohydrate
Fat
Protein
Vitamins
Minerals

Answer 17

Nutrient needs

Question 18

in general neither breastfeed nor formula fed need to be given water - not even those living in very hot climates
they’re fluid requirement does increase as they get older - that is associated with their body weight - should be drinking half our body weight and water every day

Answer 18

Fluids

Question 19

So the energy needs of any particular infant is going to vary according to the age of the infant - thermal environment their growth rate their health status their activity level as they as they get older

Answer 19

Energy

Question 20

lactose is the most abundant carbohydrate in the diet of infants up to 6 months of age - supposed to be all that they’re eating whether it be breast milk or formula lactose
provides calories in an easily available form and it’s slow break down and absorption can also increase calcium absorption corn
solid corn syrup solids or glucose polymers are added to infant formulas to supplement the lactose in the cow’s milk and provide a sufficient amount of carbohydrates
corn syrup solids that’s what’s in your baby’s formula - another form of carbohydrate found in breast milk are critical in the development of the micro flora and intestinal tract these prebiotics promoted acidic environment in the intestines preventing the growth of gram-negative and other pathogenic bacteria so this is why infants who receive breast milk have a lower incidence of GI illness fat 50% of the calories in breast milk and formula are constitute fat constitutes 50% of the calories in breast milk and formula human milk

Answer 20

Carbohydrate

Question 21

contains a ton of essential fatty acids and ARA and DHA and all of those A’s that we try that we actually have to put into a formula’s cows milk contains fewer of the essential fatty acids and no polyunsaturated fatty acids
most formula companies do add that DHA to their products modified cow’s milk is used in most formulas

Answer 21

Fat

Question 22

protein requirement per unit of body weight is greater than the newborn than any other time of life
protein is super important
requirement is going to be greater than the newborn than any other time of Life protein and specifically human milk contains the two proteins
easily digestible and produces the soft stoolsense

Answer 22

Protein

Question 23

with the exception of vitamin D human milk contains all the vitamins required for infant nutrition never never
Vitamin D
Vitamin K

Answer 23

Vitamins

Question 24

vitamin D is the only thing that it’s lacking full term infants have enough iron stores we’re looking at minerals they have iron stores in the mother to last for the first four to five months younger than a year of age should never be fed whole milk
if a child decides to wean or mother decides the ween that child before the 12th month of Life they will have to replace that with infant formula

Answer 24

Vitamin D

Question 25

Milk production
Lactogenesis
Uniqueness of human milk

Answer 25

A&P of lactation

Question 26

the size and shape of the breast are not accurate indicators of its ability to produce milk - one of the first things that you can educate a women
effects of estrogen progesterone human place blood flow the breast increases sensitivity of the breast increase in the veins become more prominent
nipples become more erect areola get darker both a nipple and the area and large after the mother gives birth a precipitous fall and progesterone is what triggers the release of prolactin from the anterior pituitary
after birth gradually declining over time but remaining above supply and demand it is strictly supply and demand
incomplete removal of milk from the breast can actually lead to decrease milk supply
milk ejection reflex is dictated by oxytocin the milk ejection reflexes triggered multiple times during a feeding session: thoughts sights sounds are odors of the mother Associates with her baby can trigger that let down reflex: babies are crying, during sexual activity can actually be inhibited by fear stress and alcohol consumption
mothers who breastfeed or at a decrease risk for postpartum Hemorrhage because the oxytocin also is causing mom’s uterus to contract we want it to do that in the early postpartum time to help with control of that postpartum bleeding
Female breast composed of 15 to 20 segments (lobes) embedded in fat and connective tissues; well supplied with blood vessels, lymphatic vessels, and nerves
Each lobe is glandular tissue consisting of milk producing cells the contractor symptoms milk forward to the nipple

Answer 26

Milk production

Question 27

progesterone specifically triggers the release of prolactin which is going to initiate lactogenesis so that colostrum that she may be leaking you know at 7-9 months pregnant that is not milk
prolactin produced in response infant suckling and emptying of the breast that Supply needs to man system so a baby first gets the breast they’d have these really quick short circles and it’s delivering the message - have that milk ejection reflex from the from the posterior pituitary so going to release that oxytocin in response to the baby suckling
After birth precipitates a decrease in estrogen and progesterone levels; triggers release of prolactin from anterior pituitary gland
Prolactin levels highest during first 10 days after birth
Prolactin produced in response to infant suckling and emptying of breasts
Oxytocin: other hormone essential to lactation
As nipple is stimulated by suckling infant, posterior pituitary prompted by hypothalamus produces oxytocin
Thoughts, sights, or sounds of the baby can stimulate MER

Answer 27

Lactogenesis

Question 28

Production as a supply-meets-demand system

Answer 28

Prolactin produced in response to infant suckling and emptying of breasts

Question 29

Responsible for milk-ejection reflex (MER)

Answer 29

As nipple is stimulated by suckling infant, posterior pituitary prompted by hypothalamus produces oxytocin

Question 30

it is the ideal food for human infants
it has a dynamic substance that meets the needs of the infant - if the baby is sick you’ll see the composition of it’s going to change for the duration of the breastfeeding
if a baby is sick we tell Mom go sit wherever be around that baby you need to be exposed to the same germs babies being exposed to because Mom will make the antibodies and give them to the baby
it’s rich in those immunoglobulance higher concentration of protein and minerals but doesn’t really have any fat at all to it
Hungry all the time and the stools look more green and seedy it’s not finishing a feed because milk doesn’t have enough fat to it
The ideal food for human infants
Dynamic substance to meet the changing needs of the infant
Contains immunologically active components
Colostrum, a clear, yellowish fluid (day 1 to 3)
Composition changes during each feeding
Milk production increases as the baby grows

Answer 30

Uniqueness of human milk

Question 31

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

Answer 31

Colostrum, a clear, yellowish fluid (day 1 to 3)

Question 32

Lower fat “foremilk” changes to higher fat “hindmilk”

Answer 32

Composition changes during each feeding

Question 33

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

Answer 33

Milk production increases as the baby grows

Question 34

encouraging mothers to breastfeed is education and to supportory guidance
beginning as early as possible during and even before pregnancy so it’s providers we need to encourage that along the way even if we have a woman who in her preconception time period decides that she absolutely wants to breastfeed
promoting feelings of competence and confidence in the breastfeeding mother and reinforcing unequaled contribution
making toward the health and well-being of her infant are the responsibility of a nurse and other Health Care Professionals the first two weeks of breastfeeding can be the most challenging so this is the time when support is the most critical
insufficient milk supply painful nipples and problems getting the infant to feed so where else then to go and sit with other women who are breastfeeding and get that support and get help with those problems from certified lactation consultants and counselors and each other so just this helps women who are strongly connected to other breastfeeding moms will breastfeed longer
Supporting breastfeeding mothers
Supporting breastfeeding mothers
Special considerations
Care of mother
Common concerns

Answer 34

The breastfeeding mother and infant

Question 35

Education and anticipatory guidance
Prenatal classes
La Leche League and Mocha Moms
WIC
Baby-Friendly Hospital Initiative

Answer 35

Supporting breastfeeding mothers

Question 36

we can assess but it’s all her - why the encouragement and the support is super super important
if she’s not supported she will have a hard time continuing to breastfeed
mother needs to understand infant behaviors and relationship to breastfeeding and recognize the science of baby’s ready to feed so we need to teach her
build her confidence educate her a system with Basics such as positioning and signs of an adequate feed
self-care measures to help prevent her from getting engorged
Routine procedures should be delayed until that first feeding that should be the first thing that we encourage - women can comfortably breastfeed
Positioning
Latch-on
Milk ejection or let-down
Frequency of feedings
Duration of feedings
Indications of effective BF
Supplements, bottles, and pacifiers

Answer 36

Supporting breastfeeding mothers

Question 37

latch on is defined as the placement of the infant’s mouth over the nipple area and breast making a seal between the mouth and the breast to create adequate suction for milk removal the latch is not the nipple the latch is on the nipple and the area so when we get the baby to open up super wide - we want a good seal around the breast you should not be able to ever see lips
nursing well cuz Mom’s a mom can feel a firm tugging on her nipple
break the suction take your pinky finger slip it in there in the baby’s mouth between her breasts and the baby’s mouth and very gently break the suction and take the baby off
going well the baby sucks with cheeks rounded; jaw Glide smoothly with sucking and then you can actually hear them swallowing when the infant is latched on and sucking correctly breastfeeding is not painful
Deserve at least one feeding every 8 to 12 hours so during her shift she’s actually watch mom and baby together just assess the latch

Answer 37

Latch-on

Question 38

let down reflex system is stimulated she may actually complain of tingling sensation

Answer 38

Milk ejection or let-down

Question 39

Breast feed Going to be nursing and eating more often than a bottle-fed baby newborns
need to breastfeed at least 8 to 12 times in a 24-hour period
eat a bunch before they go to sleep and sleep a little bit longer regardless we need to be documenting and just keeping an eye on how often a baby is nursing
established a good feeding routine then it’s demand feeding your babies won’t tell you when they need to eat

Answer 39

Frequency of feedings

Question 40

some of the time at the breast is actually spent just non-nutritive sucking babies - a comforting thing for them
teach them to look for the signs the baby has actually finished the feed: come off the nipple and they fall asleep most the time I just stop nursing and fall asleep so if the sucking and swallowing pattern has slowed the breast feed like it’s empty the baby appears content they will just remove themselves in the breasts
how to determine if the baby is getting enough milk they worry about that because they can see it in a bottle they can’t say it in the breast so what we tell them - infants output: 6 to 8 wet diapers a day after the milk has come in
like to see is one stool and one void for every 24 hours of life

Answer 40

Indications of effective BF

Question 41

supplementation by Hospital staff undermines a new Mother’s confidence and Models Behavior that is counterproductive to establishing breastfeeding possible indications for supplementary feeding include infant factors such as hypoglycemia dehydration weight loss of more than 7%
Women who have had previous breast surgery such as augmentation or reduction breast issues may need to provide supplementary feedings for their infants however it is best to avoid bottles until breastfeeding is well established

Answer 41

Supplements, bottles, and pacifiers

Question 42

SNS - latched onto breast - baby latches onto nipple but able transfer milk from feeder to help baby attach to breast
Sleepy baby
Fussy baby
Slow weight gain
Jaundice
Preterm infants
Late preterm infants
Multiple infants

Answer 42

Special considerations

Question 43

Some babies need to be awakened for feedings for the first few days after birth - great teaching moment for the postpartum nurse to just show hey if baby is Sleepy doesn’t want to wake up we have to wake these babies up they have to feed so we’ll unwrap the baby will change the diaper set them up talk to them and try and get them to wake up to eat

Answer 43

Sleepy baby

Question 44

baby sometimes awaken from sleep just crying frantically although they are hungry they cannot focus on feeding until they’re calmed
calm the baby calm mom and get that baby latched on help baby get latched on got to calm the baby down first infants
persistent crying or refusing to breastfeed can actually indicate an illness

Answer 44

Fussy baby

Question 45

slow weight gain newborn infants typically lose 5 to 10% of body weight after birth before they begin to gain weight this is for formula fed and breastfed babies
weight loss of more than 7% and a breastfeeding infant during the first three days of Life needs to be investigated
need to be investigating why not gain weight is quickly because they’ve a little bit different as far as a composition of what they’re eating parents are taught the warning signs of ineffective breastfeeding including inadequate weight gain minimal output
not getting satisfied at the breast maternal factors can be a cause of slow weight gain
stopping the feeding if she has inadequate glandular tissue because of just how she was born or previous breast surgery
if she had a severe postpartum Hemorrhage that could absolutely affect her ability to nurse or affect babies ability to gain weight
medications that she’s taking that can decrease milk supply
illness stress fatigue so all of those things can actually contribute to a slow weight gain

Answer 45

Slow weight gain

Question 46

is associated with insufficient feeding and infrequent colostrum is a natural laxative effect and promotes early passage of meconium
bilirubin is excreted from the body primarily to the intestines infrequent stooling
allows bilirubin in the stool to be reabsorbed into the infant system thus increase

Answer 46

Jaundice

Question 47

Initially preterm milk contains higher concentrations of protein sodium chloride potassium iron and magnesium
infants who are not able to breastfeed their moms should begin pumping their breasts as soon as possible after birth with a hospital grade electric pump so we will do our best to encourage a woman who may not even really want to continue - imp cont for growth and development as preterm baby
And in the NICU we will encourage kangaroo care until the baby is able to breastfeed because it will enhance that milk production

Answer 47

Preterm infants

Question 48

are at risk for feeding difficulties because of their low energy stores and high energy demands - more prone to hypothermia hypoglycemia and hyperbilirubenemia
often Tire easily and have a weak suck and low tone these factors all contribute to inadequate milk intake resulting in dehydration and poor weight gain

Answer 48

Late preterm infants

Question 49

most mothers are capable of producing an adequate milk supply for multiple infants
Partners need extra support

Answer 49

Multiple infants

Question 50

Diet
Breast care
BF and contraception
BF and pregnancy
BF and obesity
Medications, smoking, alcohol, caffeine
Herbal preparations

Answer 50

Care of mother

Question 51

general the breastfeeding mother should eat a healthy well balanced diet
most women are able to add about 4 to 500 extra calories a day to their diet
will lose weight by doing that their bodies are working hard
She can avoid food completely and then try eat and look and see how that changes the baby’s behavior or try eating it again and closely observe the infant for distress keeping in mind that anything that a woman puts in her body will end up passing into the breast milk approximately 2 hours after she ate it
mothers are encouraged to drink fluids and response to their thirst so they need to not only drink their half their body weight

Answer 51

Diet

Question 52

bathing is absolutely necessary to keep her breasts clean but we always tell to avoid a lot of soaps on her breast and her nipples because you know especially if it has a very strong scent to it that will be kind of an aversion to the baby
the bra that she wears should be a good support bra
a good nursing bra preferably one with no underwires - can contribute to clogged milk ducts

Answer 52

Breast care

Question 53

although breastfeeding confers period of infertility it is not considered an effective method of contraception unless the mother is strictly following guidelines for that lactational amenorrhea method of contraception
we will use a progesterone only contraceptive or some of your long acting reversible contraceptives like iuds and then a barrier message natural Family Planning we do not want to use anything that has estrogen in it because that will inhibit milk supply breastfeeding and pregnancy women can continue to breastfeed

Answer 53

BF and contraception

Question 54

During pregnancy which can actually prompt some some children to self-wean cuz it totally changes the the flavor of it and it’s not as doesn’t have as high a fat content in it because it you know it’s preparing for what the new baby is going to need which is that colostrum so let’s see here it’s not really go into much detail

Answer 54

BF and pregnancy

Question 55

Overweight - less likely to BF - tends be shortened

Answer 55

BF and obesity

Question 56

Few drugs are absolutely contraindicated during lactation we tell people that if it is safe to take him pregnancy it is safe to take while your breastfeeding
any medication that is given to an infant routinely is also safe for the mother who’s breastfeeding
the benefits of breastfeeding should be weighed against any risks of a medication to the infant breastfeeding there are some contradictions these medications - contrast: if she’s going to have to get injected with contrast she’s going to have to pump and dump; psytotoxic medications and drugs of abuse Like Cocaine amphetamines Etc or not compatible with breastfeeding
It’s actually been shown to help with the neonatal abstinence syndrome in those babies if Mom is receiving methadone while breastfeeding
pain in the postpartum breastfeeding mothers is most safely managed with a non opioid analgesic like ibuprofen but when opioids are used breastfeeding infants after delivery psychotropic medications or prescribe for breastfeeding moms based on risk and benefit considerations commonly used ones are antidepressant meds which are all safe to continue taking while they’re breastfeeding
she can have a couple sips of wine - she should not breastfeed for at least 2 hours
smoking breastfeeding moms we strongly discourage them from smoking that kind of goes with all parts of smoking we don’t want anybody to be smoking it will impair the milk production
too much caffeine we can see a behavior change in the infant

Answer 56

Medications, smoking, alcohol, caffeine

Question 57

Herbal preparations there is a lack of evidence related to the prevalence Effectiveness and safety of herbs during pregnancy

Answer 57

Herbal preparations

Question 58

Engorgement
Sore nipples
Insufficient milk supply
Plugged milk ducts
Mastitis
Follow-up after hospital discharge
Galactagogs - meds - increase milk supply; PB, genu greek, not evidence
Pharm - not support - increase prolactin levels - lack evidence

Answer 58

Common concerns

Question 59

can actually become plugged or clogged causing an area of breast to swell and be tender most often the result of inadequate removal of milk from the breast - clothing that’s too tight, poorly fitting bras or always using the same position for feeding
frequent feedings are recommended with the baby beginning the feeding on the affected side
actual help the fat emulsify that will help dissolve up that clogged up as well we do this cuz we don’t want her to end up with mastitis

Answer 59

Plugged milk ducts

Question 60

which is inflammation of the breast more often due to an actual infection in the breast what this feels like for her is like
she has localized breast pain and tenderness
usually one not both breasts and the red and then swollen usually a little engorged that infection just like the clogged up usually happens on the outer aspect of the breast most cases occur in the first two to four weeks
Chronic mastitis breast abscesses fungal infections of the breast
woman can become septic if she has mastitis untreated

Answer 60

Mastitis

Question 61

So common concerns engorgement is one of the most common concerns and it happens in response to the breast the sudden change and hormones and the onset of significant increase milk volume and that stage 2 of lactogenesis so usually around 3 to 5 days after delivery and that milk comes in
empty those breasts often early infrequent feedings are going to help prevent engorgement the risk of Engagement appears to be increased among the First Time Moms women who receive large amounts of IV fluids or had previous breast surgeries
Comfort would be like gel packs cold compresses ice packs cabbage leaves bags of frozen peas are like why
initiation of breastfeeding mild nipple tenderness during the first few days of breastfeeding is very common that severe soreness cracked bleeding nipples are not normal and they most often result from just poor positioning and poor latch

Answer 61

Follow-up after hospital discharge

Question 62

Feeding patterns
Feeding techniques
Bottles and nipples
Common concerns
Parent education

Answer 62

Formula-feeding

Question 63

do not understand about the capacity of a newborn stomach and will tend to overfeed a newborn infant
infants need to be held for all their feedings holding the infant in a semi upright position with good head support
slow flow nipples
different is these little guys need to actually be burped way more often than a breastfed there’s no air in a breastfeeding babies

Answer 63

Common concerns - Formula-feeding

Question 64

Infant formulas
Formula preparation
Vitamin and mineral supplementation
Weaning
Complementary feedings
Introducing solid foods
any animal Source should not be fed to infants because they are an inadequate to support growth and can contain excess protein or improper calcium to phosphorus ratios which will actually cause seizures
diluting (not consuming enough calories) it is going to put extra extra work on the kidneys - are immature and giving an infant overly
concentrated formula can provide protein and minerals and amounts that exceed the excretory ability of the kidneys for the day
after 6 months of age then you can start introducing complimentary Foods
first food should include the iron or zinc fortified cereals and meats then you’re going to introduce slowly your fruits and vegetables

Answer 64

Parent education - Formula-feeding