Newborn Nutrition: What are gastric muscles & GI motility like at birth?
Gastric muscles are weak at birth GI motility is pretty slow, and empties in 2~3 hours
What's the stomach capacity at birth?
What are the caloric needs of a full term new born from 1~3 months?
What are the caloric needs of a full term newborn at 3~12 months
How many calories/oz does human milk provide?
What are the carbohydrate needs of newborns?
They have small hepatic glycogen stores. Nutritional source should supply 40% to 45% of total calories
What are the primary source of carbs for babies?
Human milk-lactose Slow in breakdown and absorption Formula: corn syrup solids or glucose polymers Need to supplement the lactose in cow's milk
What is the ideal source of protein for newborn infants? Why is that?
Human milk protein is the ideal source of newborn. Human milk also contains more lactalbumin (whey) and this is more easily and rapidly digested than casein*. Casein is in cow's milk
Why is EFAs (essential fatty acids) required for term babies?
EFAs are required for growth and tissue maintenance. Fat in human milk is easier to digest and absorb
What special supplement must be done for newborns being fed cow's milk?
Since newborns can't digest cow's milk fat, it needs to have another fat source, i.e corn oil
Why can't newborns be fed whole milk/evaporated milk?
They don't have digestible fat
Why can't skim/low fat milk be fed to newborns?
They don't have EFAs
Why is breast feeding better than formula?
It has live cells, and helps enhance cognitive development
What are fluid requirements for babies a day?
Requirement: 80~100 ml/kg/day Human milk is 87% water
What's a caution with feeding water to newborns?
It decreases overall caloric consumption by filling them up with empty calories
What causes would require some breast fed infants to have vitamin D supplementation?
decreased sun exposure, dark skinned, preterm, vegan maternal diet
Why is vitamin K given to infants?
Vitamin K enhances blood coagulation, and is produced by intestinal bacteria. Since the gut is sterile at birth, the shot is given.
How is human milk beneficial for iron absorption?
Iron in human milk is better absorbed compared to cow's milk High lactose and vitamin C levels in human milk helps with absorption. Babies that were just breastfed have adequate iron stores for 4~6 months of life.
What can excessive fluoride amounts do to babies?
It can cause spotting of permanent teeth.
When are fluoride supplements recommended?
When infants are not receiving fluoridated water after 6 months of age
Stages of Lactation
When does Lactogenesis Stage I occur?
Colostrum production is around 16 weeks, describe the benefits of colostrum (4)
Lactogenesis Stage 1 beings in pregnancy
- Colostrum is more concetrated than mature milk
- Rich in immunoglobulins
- High concentrations of protein facilitates bilirubin binding
- Laxative action promotes early passage of meconium
Stages of Lactation
Lactogenesis Stage II
What occurs at this stage?
milk comes in
Colostrum gradually changes to mature milk around 3~5 postpartum dependent on amount of stimulation
Stages of Lactation
Lactogenesis Stage III
What occurs to milk production around this time?
What is the composition of the milk
By 2 weeks, how much milk does the mother produce?
How do you increase milk production?
Milk production around 10 days postpartum is fully mature.
The composition of milk changes with each feeding.
Foremilk is made up of 60% skim milk & 35% whole milk
Hind milk 5% cream, denser calories
By 2 weeks, the motehr produces 900 ml/24 hours
You can increase milk production by having more frequent feeding.
What triggers the release of prolactin?
When are the levels the highest? (2)
What does it promote?
Triggered by decrease in estrogen and progesterone after birth and released by the anterior pituitary.
Prolactin levels are highest during: 1. First 10 days. 2. at night.
Prolactin is produced in response to infant suckling and emptiness of breasts.
Prolactin promotes relaxation
What are four roles of oxytocin?
- Responsible for milk ejection (let down) reflex
- Contracts myoepithelial cells and squeezes milk through the ducts to the nipple
- Stimulate uterine involution (cramping)
- Active swallowing in infant
What are some characteristics you may take in consideration when assessing the breast? (up to 9)
- Breast size
- accessory breast/nipple tissue
- widely spaced
- large areola
- tubular appearance
- milk lines
What are key teaching points in teaching mothers how to breastfeed? (6)
- Early initiation
- Feeding cues
- Proper positioning and correct latch
- Milk production is related to supply and demand. More feeding=more prolactin to keep a production of milk
- How to tell if the baby has eaten enough
- manual expression
What are a couple of feeding cues?
1. Rooting reflex
2. Hand to mouth activity
What are signs of correct latch? (4)
- Mother reports firm tug on her nipple, no pain
- Infant sucks with cheeks rounded, not dimpled
- Infant's jaw glides smoothly with sucking
- Swallowing is audible
*nipple shold end up on the soft palate in the infant's mouth
How many newborn feedings are there in a day?
8~12 feedings a day
must be fed at least every 3 hours during the day.
Baby must be fed during the night for the first few weeks.
Average time feeding is 15 min for each breast.
What are 5 treatments for sore nipples?
- Shorter, more frequent feedings
- Rotate positions, start on least sore side
- Express milk on to nipples, lanolin on nipples after feeding
- Breast shells or gel pads
What is engorgement of the breasts?
Temporary condition caused by hormonal changes and increase in blood & lymphatic flow
Symptoms: firm, painful, lump breasts
low grade fever may occur
What are risk factors to getting engorged breasts? (3)
How do you treat this?
- Inadequate feedings or formula feeding
- Small breast size: decreases storage capactiy
- Severe engorgement with alst pregnancy
Treatment: Cold cabbage leaves, ice to make breast colder and vasoconstrict
What are risk factors for plugged ducts and mastitis? (3)
- Incomplete breast emptying
- Infrequent or missed feeding
- obstructed milk flow
What are contraindications to breast feeding? (3 main ones)
- Infant galactosemia: baby doesn't have enzyme to breakdown lactose
- HIV positive
- Illegal drugs (meth, coke, heroin)
What would cause temporary cessation of breastfeeding? (6)
- •Maternal active TB infection
- •Active herpes infection of breast
- •Maternal medications
- •nuclear radiopharmaceuticals for diagnostic studies
- • cytotoxic drugs
- Modification - phenylketonuria
What's the frequency of formula feeding in the first 24 hours of life?
How much is fed per feeding?
Every 3~4 hours in the first day of life
15~30 ml per feeding
Increase feeding each day by 15~30 ml per feeding over the next month till 24 oz/day
Rule of thumb is to multiply baby's weigh in lb by 2.5 oz to get total amount required
What are the frequencies of wet diapers?
One wet diaper each day old, then 5!6 wet diapers daily after day 6
At what # day should the the meconium change
Around day 5
Why should you delay solid foods to the baby?