Chapter 22: Infant Feeding Flashcards Preview

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Flashcards in Chapter 22: Infant Feeding Deck (60)
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how many calories does a full term newborn need?

  • breast fed: 39-45 calories/per pound of body weight
  • bottle fed: 45-50 cal/lb of body weight


how many calories are in each ounce of breast milk and formula?

20 calories/oz


how much weight can an infant lose? why does this happen?

when is the infant evaluated for weight loss?

  • during early days, infants may lose up to 10% of birth weight.
    • result of normal excretion of extracellular water and meconium and newborns consuming fewer calories than needed
  • infants should be evaluated for feeding problems if weight loss exceeds 7%, if weight loss continues beyond 3 days of age, or if birth weight is not regained w/in 10 days 


why are complex carbs and fats not well digested by the newborn?

  • because they are lacking pancreatic amylase and lipase


water needs of a newborn

  • newborn needs larger amounts of fluid in relation to size than an adult, b/c they lose more water thru the skin, kidneys, and intestines
  • they need approx 27-45 mL/lb during first 3-5 days
    • then gradually inc to 68-80 mL/lb a day
  • breast milk and formula supply the infant's water needs


composition of breast milk

  • lactogenesis: is the production of milk
    • lactogenesis I: starts during pregnancy and continues to early days after giving birth
      • breasts secrete colostrum
    • lactogensis II: begins 2-3 days after birth
      • transitional milk comes in
      • amount of milk inc as milk "comes in"
    • lactogenesis III: mature milk replaces traditional milk
      • breast milk is bluish and thin



  • made during lactogenesis I
  • higher in protein and some vitamins and minerals than mature milk
    • lower in carbs, fat, lactose
  • rich in IgA (good for GI infection protection)
  • helps establish normal flora of intestines
  • has a laxative effect to help pass meconium


Transitional Milk

  • made during lactogenesis II
  • appears over about 10 days
  • inc in amount as the milk comes in
  • immunoglobulins and proteins decrease
    • lactose, fat, and calories increase
  • vitamin content is the same as colostrum


mature milk

  • present during lactogenesis III
  • appears during 2nd week of lactation
  • bluish and thin
  • easily digestible
  • species specific 
  • contains approx 20 kcal/oz and nutrients sufficient to meet the infant's needs
  • provides immunoglobulins
  • low in iron and vitamin D, but absorbed well


protein in breast milk

  • breast milk is high in taurine which is important for bile conjugation and the brain
  • tyrosine and phenylalanine are low to correspond to low level of enzymes to digest them
  • casein and whey are proteins in milk
    • breast milk is easily digestible b/c made mostly of whey which does not form the insoluble curd like casein does
  • antigens in foods the mother has eaten may pass int obreast milk and may cause an allergy (including cow's milk, milk products, chocolate, cola, corn, citrus, wheat, peanuts_


how to protect against food allergies in the infant

  • infant should be exclusively breast fed for at least 4 months and allergic foods should be avoided by the mother if her infant under 6 weeks of age has colic


carbs in breast milk

  • lactose is the major carb
    • improves absorption of calcium and provides energy for brain growth
  • other carbs inc intestinal acidity and impede growth of pathogens


fat in breast milk

  • provides 50% of calories in breast milk
  • hindmilk: milk produced at the end of the feeding
    • produces satiety and helps the infant gain weight
  • triglycerides form the majority of fat content
    • cholesterol and long chain DHA and arachidonic acid are present to help with vision and growth of brain and nervous system


vitamins in breast milk

  • vitamin A, E, and C are in high levels
  • vitamin D is low
    • may need daily supplementation during first few days of life of 400 IU
    • breastfeeding infants who are not exposed to sun or have dark skin may need supplement
    • formula fed infants who drink less than 1 qt of vit D fortified milk per day should supplement


minerals in breast milk

  • iron is in low levels, but it absorbs well so infant's that are breast fed are not usually deficient
    • if breastfed exclusively, the infant will maintain iron stores for the first 6 mos of life until they start eating solids
    • preterm and formula fed infants need iron supplementation
  • Na, Ca, and phosphorus are higher in cow's milk than human milk, so if formula not diluted properly this could place a high solute load on immature kidneys


what components of breast milk help prevent infection?

  • bifidus factor: promotes the growth of lactobacilllus bifidus which is important to intestinal flora
  • leukocytes
  • macrochages: secrete
    • lysozyme: protects against gram + and enteric bacteria
    • lactoferrin: which binds iron in iron dependent bacteria to prevent their growth
  • immunoglobulins


does a mother's diet effect breast milk composition?

  • fatty acid content and levels of water soluble vitamins are influenced by the mother's diet
  • total fat, protein, carbs, and most minerals are not effected


cow's milk

  • unmodified: not recommended for infants under 12 mos
    • it contains too much protein, potassium, chloride, and sodium
    • it lacks fatty acids, vit E, iron, zinc
  • modified: is the source of most commercial formulas
    • formulate it for infants by reducing protein content to dec renal solute load
    • saturated fat is removed and replaced with vegetable fats
    • vitamins are added


soy formula

  • can be used for infants with galactosemia or lactase deficiency and for those whose families are vegetarians
  • but many infants are also allergic to this


what are the best formulas for infants with allergies?

  • protein hydrolysate formula
    • protein is treated to make it less allergenic
  • can also be used if infant has a malabsorption disorder


breastfeeding recommendations

  • AAP recommends infants only receive breast milk for first 6 mos after birth
    • then, breastfeeding should continue until infant is 12 mos old with the addition of foods


benefits of breastfeeding for the infant

  • less allergies
  • immunologic properties to prevent infection 
  • dec incidence of respiratory tract, ear, urinary tract, and GI tract infections
  • lower incidence of diabetes, asthma, obesity, SIDS, cancers
  • composition meets infant's needs
  • easily digested
  • unlikely to be contaminated
  • less likely to result in overfeeding or constipation


benefits of breastfeeding for the mother

  • oxytocin release enhances uterine involution
  • less blood loss b/c of delayed return of menses
    • delayed resumption of ovulation
  • reduction in cancer risk
  • increases attachment
  • convenient and always available
  • economical
  • infant less likely to be ill
  • easier to travel


why would a mother choose to feed the baby formula?

  • some women are embarrassed
  • lack of social support 
  • anxiety about not being able to tell how much milk the baby gets with BF
  • partner not supportive
  • taking medications that may harm the baby
  • lack of understanding or education


factors influencing how women choose to feed their babies

  • support from others
  • father feeling "left out" if choose BF
  • culture
    • most likely to BF if Asian, Pacific Islander, or Hispanic
    • least likely to BF if non-hispanic black
    • many times, colostrum is not valued in certain cultures, so they wait to breast feed until after going home
  • employment:
    • returning to work is often a reason women choose to stop breastfeeding
  • staff knowledge
  • past experience
  • feelings on modesty
  • time intensive


breast changes during pregnancy

  • changes start early in pregnancy
    • ducts, lobules, and alveoli develop in response to estrogen, progesterone, hCS, an dprolactin
    • prolactin is high but estrogen and progesterone prevent milk production
  • colostrum present at 16 weeks gestation
  • women should see an increase in breast size during gestation


milk production

  • produced by the alveoli of the breasts
  • milk is ejected from the secretory cells of the alveoli into the lumen by contraction of the myoepithelial cells
    • then, it travels thru the lactiferous ducts to the nipple
    • infant compresses the areola to move a stream of milk thru pores in the nipple


hormonal changes at birth in relation to lactation

  • at birth, loss of placental hormones results in inc prolactin which activates milk production
    • suckling and the removal of colostrum cause continued inc levels of prolactin
      • prolactin secreted in highest levels with suckling and at night
  • oxytocin inc in response to nipple stimulation and causes the milk ejection/let down reflex-->the release of milk from the alveoli into the ducts
    • this reflex can occur any time oxytocin is released which occurs when a mom sees, hears, or thinks about her baby


continued milk production

  • amount of milk produced depende on adequate stimulation of the breast and removal of the milk by suckling/breast pump which causes production of prolactin
    • "supply and demand" effect
  • early and frequent suckling causes prolactin to be released which makes more milk
  • if milk is not removed from the breast, this causes a feedback to decrease prolactin and dec milk production


preparation of breasts for breastfeeding

  • do not apply soap to the nipples b/c it removes protective oils
  • inverted or flat nipples make it harder for an infant to latch