Flashcards in Chapter 22: Infant Feeding Deck (22):
Precedes true milk
Higher fat milk
Milk ejection reflex
Allows milk to let down
Describe changes in the composition and appearance of:
b. Transitional milk:
c. Mature milk:
a. Colostrum: Colostrum is produced during lactogenesis I. It is a this yellow substance that is rich in immunoglobulins, especially IgA. It has laxative effects and is high in protein, some vitamins, and minerals. It is lower in carbohydrates, fat, lactose and some vitamins than mature milk.
b. Transitional milk: Transitional milk is produced during lactogenesis II. It is lower in immunoglobulins and proteins, but higher in lactose, fat, and calories than colostrum. The vitamin content is similar to that of mater milk.
c. Mature milk: Mature milk replaces transitional milk during lactogenesis III. It is bluish and provides 20 cal/oz. Immunoglobulins are provided in mature milk throughout lactation.
List components in breast milk that help prevent infant infections and describe the purpose of those components.
Bifidus factor promotes the growth of Lactobacillus bifidus, which increases acidity in the gastrointestinal tract. Leukocytes (macrophages) secrete lysozome. which acts against gram-positive and enteric bacteria. Lactoferrin inhibits the growth of iron-dependent bacteria. Immunoglobulins, particularly IgA, help protect against gastrointestinal infections.
Describe the purposes of prolactin and oxytocin in breastfeeding. What can enhance or interfere with their secretion?
a. Prolactin: Prolactin stimulates the breasts to produce milk. it is enhanced by suckling and removal of milk from the breasts. It is inhibited by estrogen, progesterone, and human chorionic somatomammotropin during pregnancy and by inadequate removal of milk after nursing begins.
b. Oxytocin: causes the milk ejection reflex. It is enhanced by comfort, thinking about the infant, and the stimulation of suckling. It is inhibited by discomfort or inadequate suckling.
What care can help the mother who has flat or inverted nipples? Are any precautions needed?
Rolling flat nipples stimulates them to become more erect. Pumping breasts for a few minutes before nursing or using a breast shield draws inverted nipples out so that the infant can grasp them. The use of breast shells in late pregnancy or between feedings to help draw nipples is controversial. Stretching or other manipulation of the nipples is unnecessary and should be avoided during pregnancy because it may cause uterine contraction.
Describe some differences in breast fullness.
a. Soft: Feel like a cheek
b. Filling: Slightly firmer than a cheek
c. Engorged: Hard, shiny, tender, taut tissue
Describe each of these hand positions for breastfeeding.
a. Palmar or C position:
b. Scissors or V position:
a. Palmar or C position: The mother cups the breast in her palm with her thumb on top and fingers underneath and behind the areola.
b. Scissors or V position: In the scissors or V position, the mother places her index and middle fingers above and beneath the areola to guide her nipple to the infant.
Describe useful techniques to teach the mother if the infant seems to have trouble breathing while nursing.
The mother can bring the infant into a more horizontal position and nearer to the body. She should not indent the breast tissue, because this could interfere with milk flow or change the position of the nipple in the infant's mouth and lead to sore nipples.
Describe differences between nutritive and non-nutritive suckling. How does infant swallowing sound?
a. Nutritive: Nutritive suckling is evidenced by smooth continuous movements, with occasional pauses to rest. Swallowing may follow each suck or after two or three sucks.
b. Non-nutritive: Non-nutritive suckling produces fluttery or choppy motions without the sound of swallowing.
c. Swallowing: Infant swallowing has a soft "ka" or "ah" sound.
What should the mother be taught about burping the infant?
a. When to burp:
b. Removing the infant from breast:
a. When to burp: For breastfeeding, burp when non-nutritive suckling begins and change to the other breast. For formula feeding, burp after approximately 0.5 oz of formula in the early days and then midway in the feeding when the infant;s intake increases.
b. Removing the infant from breast: Break suction before removing the infant from the breast by inserting a finger between the infant's gums or indenting the breast tissue near the infant's mouth.
How can you tell whether the infant needs more of the areola in the mouth? How much areola should be inside?
The infant's cheeks will show dimpling, and he or she will make smacking or clicking sounds if more of the areola should be in the mouth. the infant's lips should be 2.5-3.8cm from the base of the nipple if there is enough of the areola in the mouth.
How does frequent breastfeeding help resolve jaundice?
Frequent breastfeeding enhances milk production and stimulates peristalsis, which increases the number of stools and thus helps the body excrete bilirubin.
What are methods to prevent and treat engorgement.
a. Prevention: Early and frequent nursing ( every 2-3 hours) for adequate lengths of time during the day and night helps prevent engorgement. Avoiding formula or water supplements causes the infant to eat more often than if formula is used.
b. Treatment: Treatment includes feeding every 1.5-2 hours; cold applications between feedings; heat application shortly before feeding; massage to speed milk release; softening the areola by using a pump or expressing milk to begin flow or pressing gently on the areola to move swelling back. Give medication for discomfort; advise the mother to wear a well-fitting (but not tight) bra 24 hours a day.
In which maternal conditions is breastfeeding not advised?
Serious infections such as untreated tuberculosis, HIV infection, galactosemia, and maternal chemotherapy. Maternal substance abuse is usually also a contraindication to breastfeeding although some women taking methadone or buprenorphine may be allowed to breastfeed. Mothers with infectious conditions or who take medications unsafe for the infant also should not breast feed.
What should the mother be taught about the storage of breast milk?
b. Length of time to be stored in a refrigerator and freezer:
c. Thawing frozen milk:
a. Containers: Glass or rigid polypropylene plastic containers with tight caps.
b. Length of time to be stored in a refrigerator and freezer: Milk can be stored in the refrigerator for 72 hours or in the freezer for 1 month; it can be kept in a deep freeze at -17C (0F) for 6-12 months.
c. Thawing frozen milk: Do not microwave. Thaw in the refrigerator or by holding under running water.
How long should a mother breastfeed?
The American Academy of Pediatrics and American Dietetics Association recommend breast milk only for infants during the first 6 months. Although solid foods are added at approximately 6 months, the recommendation is for breastfeeding to continue for at least 1 year. However, the decision of how long to breastfeed is up to the mother.
Describe use and precautions associated with each type of formula.
a. Ready to use:
b. Concentrated liquid:
a. Ready to use: Open the bottle and add a cap for single-serving containers. For multiserving cans, wash the top of the can and the can opener just before opening and shake the can. Pour into washed bottles and cap. Do not dilute, Refrigerate an open can and discard any remaining milk after 48 hours.
b. Concentrated liquid: Dilute the concentrated liquid with an equal part of water. Do not over-dilute or under-dilute. Fill clean bottles with diluted formula as in ready to feed.
c. Powdered: Dilute formula in a clean bottle exactly as directed, usually one scoop for each 2 oz of water. Mix well. As in concentrated liquid formula, do not overdilute or underdulute. Cover opened cans of powder and use within 4 weeks of opening.