Class 10: Infant Feeding Flashcards
1
Q
what is the recommended route for infant nutrition for the 1st 6 months of life?
A
- exclusive breast/human milk
2
Q
what supplementations are recommended for infants who are breats/human milk fed
A
- vitamin D supplementation of 400 IU daily
3
Q
how can the birther give the infant vitamin D supplementation
A
- comes in drop form –> put drop on nipple
4
Q
if infants are weaned off human/breast milk before age 12 months, what should they receive?
A
- should receive iron-fortified infant formula
5
Q
what % of people initiate breast/chest feeding? what % continue exclusively for 6 months?
A
- 90.9% initiate
- 34.4% continue exclusively for 6 months
6
Q
what factors are associated w breast/chest feeding (3)
A
- social & economic factors
- marital status
- age of birther
7
Q
what are examples of social & economic factors that are associated w breast feeding (3)
A
- food insecurity
- lower income
- lower education
8
Q
what impact does marital status have on breast feeding?
A
- single birthers were more likely to stop
9
Q
what impact does age of the birther have on breast feeding? (2)
A
- older age = higher chance of breastfeeding for 6 months
- adolescent birthers more likely to stop
10
Q
what are reasons for stopping breast feeding before 6 months (2)
A
- inadequate amt of breast milk (rare, assess)
- difficulty w technique
11
Q
describe the absorption and amt of nutrients in human milk (2)
A
- nutrients in human milk are more easily absorbed than those informula
- human milk is designed for human infants –> nutritionally superior to any alternative
12
Q
human milk is considered… why?
A
- living tissue
- bc it contains almost as many live cells as blood
13
Q
describe the bacteria in human milk
A
- bacteriologically safe
14
Q
due to the differences in absorption of nutrients in human milk, what impact does this have on stools?
A
- stools will be different on formula
15
Q
what are benefits of human milk to the newborn? (5)
A
- immunity
- on demand, safe & fresh w easily absorbed nutrients
- analgesic of NBs
- enhances brain development
- decreases risk of various health conditions
16
Q
what does human milk reduce the risk of in newborns? (15)
A
- gastroenteritis
- necrotizing enterocolitis (preterms)
- childhood obesity
- IBD
- celiac
- RSV
- OM
- pneumonia
- UTIs
- bacteremia
- bacterial meningitis
- allergies
- SIDs
- childhood lymphoma
- DM1 and 2
17
Q
the analgesic benefit of human milk is used for?
A
- minimally invasive procedures such as venipuncture
18
Q
what are benefits of chest feeding to the birth (4)
A
- decreased risk of various health conditions
- helps decrease weight after pregnancy
- help w bonding w infant
- convenient and free
19
Q
what does human milk reduce the risk of in the birther? (8)
A
- PPH (helps uterine involution)
- ovarian, uterine, and breast cancers
- RA
- T2DM
- HTN
- hypercholesterolemia
- CVS
- PPD
20
Q
what should be considered when choosing an infant feeding method (4)
A
- provide factual info about nutrition & immunological needs met by human milk
- provide info to parents in non-judgmental manner & respect their decision
- consider cultural influences on infant feeding
- provide affirming & respectful care to individuals who are part of sexual and/or gender minority populations
21
Q
describe the presence of fluids in breast milk
A
- breastmilk = 87% water
22
Q
describe supplementation of water for the infant
A
- never give baby plain water within 1st 6 months of life
- no supplementation w water is recommended
= breastmilk or formula only
23
Q
what should be monitored closely in the early PP time? how can this be done?
A
- fluid intake & weight loss shoudl be monitored closely
- document voids, stools, daily weights, feeding times/amts
24
Q
breastmilk provides the calories, nutrients, vitamins, and minerals required for infants with the exception of:
A
- vitamin D
25
due to the lack of vitamin D in breast milk, what is done
- vitamin D supp, 400 IU daily
26
describe vitamin K after birth
- we provide vitamin K injection after birth, then the infant will start making their own
27
B12 sufficiency with breast feeding depends on?
- depends on diet of individual feeding the infant
28
those with what type of diet need to supplement vitamin B12? why is this important?
- vegan diet --> should take supplements or it will be low in breast milk
29
describe iron in breastmilk
- iron is not high in any milk, but iron in human milk is well absorbed by infants --> no need to provide sources until 6 months of age
30
how many stages of lactogenesis are there?
- 3 stages
31
describe stage 1 of lactogenesis: when does it begin? end?
- begins in pregnancy
- ends with the beginning of increased milk production after delivery (start of stage II)
32
describe stage 2 of lactogenesis: when does it start?
- starts w the increase in milk production
33
describe stage 3 of lactogenesis: what happens and when?
- when mature milk is produced
- usually around day 10-14 after birth
34
the female breast is composed of?
- composed of 15-20 segments (lobes) embedded in fat & connective tissues
35
the female breast is well supplied with.. (3)
- blood vessels
- lymphatic vessels
- nerves
36
within each lobe of the female breast, what is present? what are these?
- alveoli = the milk-producing cells
37
what are the alveoli of the female breast surrounded by? what do these do?
- surrounded by myoepithelial cells that contract to send milk forward into the ductules
38
what occurs after the milk is sent forward into the ductules during lactogenesis?
- ductules enlarge into lactiferous ducts & sinuses, where milk collects behind the nippled
39
each nipple has? what function do these have?
- each nipple has pores through which milk is transferred to the ducking infant
40
after birth, the drop in estrogen & progesterone levels triggers?
- release of prolactin from the anterior pituiatry gland
41
what is the function of prolactin
= milk production
42
when are prolactin lvls highest
- during first 10 days after birth
43
describe the declination of prolactin
- gradually decline but remain above baseline lvls for the duration of lactation
44
prolactin is produced in response to.. (2)
- infant suckling
- "emptying" of breasts"
45
describe the "emptying" of breasts
- lactating breasts never completely empty
- suckling triggers positive feedback loop tp produce milk = milk is constantly produced as the infant feeds
46
what function does oxytocin have in lactogenesis
- stimulates milk-ejection reflex or let-down reflex
47
describe the production of oxytocing for lactogenesis
- as the nipple is stimulated by suckling infant, posterior pituitary prompted by hypothalamus produced oxytocing
48
describe the production of oxytocing for lactogenesis
- as the nipple is stimulated by suckling infant, posterior pituitary prompted by hypothalamus produced oxytocin
49
what is integral to lactation
- the nipple-erection reflex
50
what role does human milk play in the immune system?
- contains immunologically active components
= provides some protection against broad spectrum bacterial, viral, and protozoal infections
51
what is the major immune globulin in huamn milk
- secretory immunoglobulin A
52
what is a colostrum?
- first form of breastmilk that is released by the mammary glands
53
what does colostrum look like?
- clear, yellowish fluid
54
when is colostrum present?
- at birth
55
describe the concentration of colostrum (3)
- more concentrated than mature milk
- high conc of protein, fat soluble vitamins, and minerals
- extremely rich in immune globulins
56
describe the fat concentration of colostrum
- less fat than transitional or mature milk
57
what is transitional milk
- increase in amt of milk compared with 1st few days
58
what composition changes occur w transitional milk (5)
- immunoglobulins decrease
- proteins decrease
- lactose increases
- fat increases
- total calories increase
59
describe the composition of mature milk (3)
- fat content increases
- lactose increases
- protein decreases
*compared w colostrum & transitional milk*
60
describe milk composition with each feeding
- changes during each feeding
61
initially, foremilk is released that is part.. (2)
- is part skim milk, about 60% of volume
- is part whole milk, about 35% of volume
62
initially, foremilk is released that provides primarily (3)...
- lactose
- protein
- water-soluble vitamins
63
when is hindmilk usually let down?
- 10-20 min into feeding
64
describe calorie composition of hindmilk
- denser calories from fat
65
the changing composition of human milk during each feeding requires...
- breastfeeding long enough to supply balanced feeding
66
watch SickKids video on breastfeeding position and latch
know
- details about latching
- assessing latch
- how to set up position
67
describe breast feeding positioning (3)
- mother semi-reclines
- skin-to-skin
- tummy-to-tummy
68
why is skin to skin contact imp when breastfeeding
- promotes alertness in infant during feeding
69
define: latch
- infant's mouth over nipple, areola and breast, making a seal between the mouth & breast to create adequate suction for milk removal
70
milk ejection or let down is stimulated by?
- infant suckling
71
describe the freq of feedings
- cue based
- 8-12 feedings / 24 hrs
72
describe the duration of feedings
- avg, 20 min per breast
73
what are indications of effective breast feeding (4)
- urine
- stools
- weight
- infant satisfied & relaxed
74
what should be established prior to introducing bottle?
- until BF established
75
what is the concern w introducing bottles too early to infants?
- can make breastfeeding harder since it's easier to latch to a bottle
76
what should happen after a feed?
- pumping, unless the birther has heavy milk letdowns (in which case done before feed)
77
describe holding of the newborn during breastfeeding
- do not hold the back of the baby's head during latching --> support the neck & bring beast to baby
78
during breastfeeding, the nipple should align with?? chin should contact?? tongue should be ??
- nipple should align with infant nose
- chin should contact breast before mouth to promote good latch
- tongue should be down
79
since the tongue should be down when breastfeeding, the baby should be .... before latching
- soothe baby before latching --> if baby is crying tongue will be touching the roof of its mouth
80
describe the newborn nose during breastfeeding
- ensure nose is not compressed in the breath
81
describe void & stools during day 1
- 1 void
- 1 meconium stool
82
describe void & stools during day 2
- 2 voids
- 1-2 stools
83
if meconium is still present on days 3-4, what should be done
- reassess breastfeeding
84
know voids & stools expected in first 5 days of life
...
85
how often are latch assessments done
q8h
86
what is included in infant assessments for breast feeding?
- latch
87
what is included in mother assessments for breast feeding? (2)
- assess breasts
- assess nipples for erythema and cracks
88
what amt of weight loss in the baby is normal? when should this be regained?
- 5-10% weight loss over days 3-5 can be normal
- should regain this weight within 7-10 days of life
89
what is the formula for net weight gain/loss
current weight - previous weight = net weight gain or loss
90
what is the formula for % weight gain or loss
(net weight gain or loss / previous weight) x 100
91
what is assessed r/t general feeding (5)
- type (breast/chest or formula)
- LATCH-R assessment q8h
- if using other supplemental feeding (formula) along w breast feeding document type & volume
- note and document skin-to-skin
- voids, BMs, weight, skin turgor, lethargy, jaundice
92
what are early feeding cues of the NB (5)
- hand to mouth
- sucking motions
- rooting reflex
- mouthing
- flexed arms & legs w clenched fists
93
what is a late sign of hunger
- crying
94
on day 1, how many wet diapers should there be?
- at least 1 wet
95
on day 2, how many wet diapers should there be?
- at least 2 wet
96
on day 3, how many wet diapers should there be?
- at least 3 wet
97
on day 4, how many wet diapers should there be?
- at least 4 wet
98
from day 5-3 weeks, how many wet diapers should there be? what should the color be? how heavy?
- at least 6 heavy wet
- with pale yellow or clear urine
99
on days 1-2, how many soiled diapers should there be? color?
- at least 1-2
- black or dark green
100
on days 3-4, how many soiled diapers should there be? color?
- at least 3
- brown, green, or yellow
101
from day 5-3 weeks, how many soiled diapers should there be? consistency? color?
- at least 3 large
- soft, seedy
- yellow
102
describe the process of latching on
- when mouth is open, draw baby close
- nipple should be centered upward in infant's mouth
- as baby latches on, draw infant closer to breast & chin should be tucked in close to breast
- baby should be allowed to nurse until he or she stops swallowing
103
see figure 27-07 on correct attachment (latch-on) of infant at breast
...
104
what should be encouraged for the lactating individual
- good nutrition
- hydration
- exercise
- rest
105
what is included in care of the nipples & breasts with breastfeeding (5)
- bathe normally
- avoid soap on nipples
- avoid creams (will be ingested by infant)
- supportive bras or no bra is okay --> avoid underwire
- breast pads okay --> avoid plastic lined
106
what cream is okay with breast feeding
- lanolin
107
why is it imp to avoid underwire when breast feeding
- can cause mastitis
108
why is it imp to avoid plastic lined breast pads when breast feeding
- hold in moisture & cause breakdown of nipple
109
some individuals may feel more comfortable with feeding infants which way?
- expressing milk & bottle feeding as well
110
what is the benefit of both breast and bottle feeding ?
- infants will still get the benefits of the nutrition and immune support that is provided by breast milk
111
with bottle feeding, what can still be provided?
- skin to skin contact
112
what are special considerations with breast feeding (4)
- jaundice
- preterm infants, late perterm infants
- cleft lip/palate
- tongue-tie/ankyloglossia
113
how can preterm infants have issues w breastfeeding? (2)
- less of a suck swallow breathe reflex
- very premature infants will not be able to feed, expressed breast milk will be admin thru device
114
how can cleft palate contribute to issues w breast feeding?
- reduces latch suction
- may squeeze lip together to create a seal
- if palate is involved, direct breastfeeding is not usually possible
115
if there are issues with latch due to tongue ties, what may be done? what is a sign a tongue tie may cause problems?
- may but cut if there are issues w latch
- if can't put 1 finger under tongue = may cause problems
116
what effect does breastfeeding have on menstruation?
- typically will not ovulate for 6 months
117
describe contraceptive use when breast feeding (2)
- may need backup contraception like condoms just in case
- combined contraceptives not ideal
118
what types of contraceptives are preferred if using combined contraceptives (2)? when should this be initiated?
- progesterone only pills
- IUDs
- should not initiate until breastfeeding is well established
119
what impact does diabetes have on the person breastfeeding
- lower's birthers blood sugar
- benefits infant??
120
how long until alcohol hits peak lvl in breast milk
- 30-90 min
121
how long between smoking & feeding infant is recommended
- 2 hrs
122
describe the ingestion of caffeine & breastfeeding
- caffeine only problematic in very high doses
123
meds, illicit drugs & breast feeding
- ? relisten
124
engorgement of the breasts occurs when? how long does it last?
- days 2-5
- lasts ~24 hrs
125
describe the characteristics of the breasts during engorgement (7)
- should be bilateral (otherwise consider mastitis)
- firm
- tender
- swollen
- hot
- aerolae can become firm
- nipple flattens
126
what can cause sore nipples? (2)
- latch issues
- monilial infections
127
what are monilial infections? how are they treated?
- yeast infections
- treated w topical antifungals
128
what is assessed to determine if any insufficient milk supply
- assess for infant weight gain --> if gaining good weight, unlikely there is insufficient milk supply
129
describe vitamin D supplementation in infants who receive formula w vitamin D added
- would not require additional vitamin D supplementation unless they are at high risk for deficiency (individual considerations)
130
what is assessed in follow-up after hospital discharge (3)
- infant feeding patterns
- jaundice
- breast discomfort
131
what is included in general follow up after discharge r/t breastfeeding (3)
- community resources --> breastfeeding groups in each community in Winnipeg area
- PHN visit offered for everyone
- referral can be made to lactation consultant if needed
132
what should the birther be educated on if they choose formula feeding (3)
- choose a formula approved by Health Canada
- cow's milk based w iron
- always check expiry date
133
formula feeding amt should be based on?
- infant hunger cues
134
what is the general guidance on amt of formula feeding for 1st 24 hrs of life? 24-48 hrs?
- first 24 hrs = ~5-10 mLs per feed q2-3 hrs
- 24-48 hrs = ~10-15 mLs per feed q2-3 hrs
135
what is included in parent education r/t formula feeding (6)
- readiness for feeding
- feeding patterns
- feeding techniques
- common concerns
- bottles & nipples
- formula preparation
136
describe infant position when formula feeding
- position infant so they have to suck, not just receive passive gravity flow
137
what may occur and we should try to reduce as much as possible with formula feeding?
- some ingestion of air
138
what is critical with formula feeding prep
- sterile enviro
= sterilize water, bottles, etc.
139
is sterile liquid or powder recommended for preterm, immunocompromised infants
- sterile liquid
140
define: complementary feeding
- foods or liquid given to the infant in addition to breast milk or formula
141
when is complementary feeding offerred
- after 6 months of age
142
what are recommended to be the first solid foods introduced (3)
- iron fortified cereal
- meat
- meat alternatives
143
during pregnancy, perform an assessment r/t breastfeeding that includes: (6)
- intent to breastfeed
- breastfeeding history
- access to breastfeeding support
- breast examination
- medication use history
- develop prenatal care plan to prep the pt for lactation
144
after birth, what should the nurse do r/t skin-to-skin and breastfeeding (8)
- ensure uninterrupted skin-to-skin contact immediately after birth and until the newborn completes 1st feeding
- promote nonseparation of newborn and birther
- teach responsive feeding to help parents identify early feeding cues
- encourage breastfeeding early & often --> 8-12 x/day without supplementation
- help birther recognize when baby is feeding well
- encourage breastfeeding, esp for preterm and low-birth weight
- reinforce recommendation for exclusive breastfeeding for first 6 months, w intro of complementary foods at 6 months, and continued breastfeeding up to 2 years and beyond
- ensure community follow up
145
how often should the birther breastfeed?
- at least 8 foods per day (q1-3 hrs)
146
when breastfeeding, the baby should be sucking.. (4)
- strongly
- slowly
- steadily
- and swallowing often
147
in the first 3 days after birth, the baby loses how much weight on average?
7% of their birth weight
148
from day 4 onward, the baby should gain how much weight?
- 20-35g per day
- and regain their birth weight by 10-14 days
149
in addition to voids, stools, and weight gain, what are other signs that the baby is getting enough to eat? (4)
baby should:
- have a strong cry
- move actively
- wake easily
- breasts feel softer and less full after breastfeeding
