Week 3 - Newborn Nutrition & Feeding Flashcards by Jessica Goncalves

WHAT ARE THE COMPONENTS OF BREASTMILK?

Immune factors (bacteriostatic, bactericidal)
Growth factors
Proteins (approximately 70% whey and 30% casein)
Digestive enzymes
Fats (variable)
Carbohydrates (predominantly lactose)
Vitamins (A, B complex, C, D, E, K)
Minerals (calcium, sodium, chloride, copper, zinc, iron, selenium, iodine, flouride)
87% wate

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BENEFITS OF BREASTFEEDING FOR THE INFANT INCLUDE…

Easily digested and absorbed
Laxative effect
Transfer of antibodies and immune factors
Enhanced maturation of GI tract
Neurodevelopmental advantage
Analgesic effect
Better facial, oral and speech development

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WHAT ARE THE RISKS OF NOT BREASTFEEDING

Gastrointestinal infections • Otitis media • Atopic dermatitis • Respiratory track infections • Asthma (no family history) • Childhood leukemia • Celiac Disease • Ulcerative Colitis • Crohn’s Disease
Atherosclerosis • Hypertension • High cholesterol • Reduced immune protection • Obesity • Lower cognitive function • Type 1 and 2 diabetes • SIDS • Necrotizing Enterocoliti

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BENEFITS OF BREASTFEEDING FOR THE CLIENT INCLUDE…

Decreased risk of cancer (ovarian, uterine, breast), RA, Type 2 DM, hypertension and CVD • Convenient and less expensive than infant formula
• Promotes uterine involution and return to prepregnancy weight
• Bonding experience: • Lactation hormones help the client learn to parent
• Teaches clients/parents to read and respond to cues

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WHICH OTHER POPULATIONS BENEFIT FROM BREASTFEEDING?

 Transgender parent – chest feeding
 Adoption 
 Surrogacy Options: 
- Inducing lactation 
- Lactation Aid 
- Donor milk

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RISKS OF NOT BREASTFEEDING - Client

\/oxytocin + \/ uterine involution + /\ risk of PPH
increased risk of ovarian, uterine, breast cancers
increased risk of developing type 2 diabetes
increased chance of developing chronic conditions

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CLIENT CONTRAINDICATIONS TO BREASTFEEDING

Chemotherapy 
• Radioactive isotopes (temporary) 
• Active TB or Varicella (EBM ok) • HIV * 
• Human T-Lymphotropic Virus 
• Herpes lesion on breast 
• Substance abuse 
• Select medications 
• CMV infected donor milk 
• Chagas’ disease (parasite)

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INFANT CONTRAINDICATIONS TO BREASTFEEDING

Galactosemia

* Metabolic disorders (limited human milk volumes)

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HOW LONG SHOULD A PERSON EXCLUSIVELY BREASTFEED?

THE FIRST 6 MONTHS
(Then introduce complementary foods - and continue breastfeeding for up to 2 year)
-on demand
-baby led

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What are the current trends in plans to breastfeed vs. actual practice of EBF @6month

90% plan to BF»>14% actually EBF for 6 months

huge discrepancy in reality

Mother’s Voices Survey 2009

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WHAT IS THE BFHI

The Baby Friendly Hospital Initiative
-launched by WHO and UNICEF in 1991
•designed to “protect, promote and support breastfeeding”
• Remove hospital barriers to breastfeeding
• Provide evidence based training of health care workers
• Promote an international standard

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WHAT CRITERIA MUST A BFH MEET IN ORDER TO ACHIEVE THIS DESIGNATION?

Free or low cost substitutes are not accepted
Feeding bottles and teats are not accepted
Successful implementation of the 10 steps

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WHAT ARE THE 10 STEPS TO SUCCESSFUL BREASTFEEDING?

BFHI

Have a written breastfeeding policy that is routinely communicated to all health care staff.
Train all health care staff in skills necessary to implement this policy.
Inform all pregnant women about the benefits and management of breastfeeding.
Help mothers initiate breastfeeding within half an hour of birth.
Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
Give newborn infants no food or drink other than breast milk, unless medically indicated.
Practice “rooming in”- allow mothers and infants to remain together 24 hours a day.
Encourage breastfeeding on demand.
Give no pacifiers or artificial nipples to breastfeeding infants.
Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

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LACTOGENESIS is the synthesis of breastmilk and includes these three stages…

i- Differentiation
ii - Activation
ii - Maintenance

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LACTOGENESIS - STAGE I

DIFFERENTIATION

occurs mid pregnancy
PROLACTIN - (pregnancy hormone) stimulates cell differentiation so that the breast will be able to produce milk
PROGESTERONE inhibits the onset of copious milk secretion

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Describe COLOSTRUM.

 Thick, clear to yellowish in appearance
 Available at birth up to 2-3 days postpartum
 Volume varies from 2 to 20 mls/feed
 Lower in fat and sugar than mature milk
 High in protein and minerals
 Contains IgA
 Easily digested
 Laxative effect

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LACTOGENESIS - STAGE II

• “Milk coming in” - transition from colostrum to mature milk
ACTIVATION
• Changes in hormones after birth of the placenta (30-40 hours after birth:
- Decrease in: progesterone, estrogen, placental lactogen
- Increase in: oxytocin and prolactin
• Feedback inhibitor of lactation (FIL)
- Small whey protein that acts as local negative feedback mechanism

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Describe TRANSITIONAL MILK.

Present 2-5 days to 2 weeks postpartum
Less yellow in appearance
Dramatic increase in volume
Higher fat, lactose and calories than colostrum
Less protein than colostrum

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LACTOGENESIS - STAGE III

Study These Flashcards

MAINTENANCE
• Establishment of mature milk
• Dependent on effective removal of milk from breast – supply and demand
• Whiter, thinner than transitional milk
• Mature milk = fore milk + hind milk gradient

FORE MILK VS. HIND MILK

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Fore Milk:
• Bluish-white in appearance
• Low fat; high water content milk at start of feed
Hind Milk:
• Creamy in appearance
• High fat and calories; released well into feed
• Satisfies hunger, promotes weight gain, content between feeds
• Stools have seedy appearance

WHAT TWO HORMONES STIMULATE MILK PRODUCTION? AND HOW?

Study These Flashcards

The alveoli in the breast begins to make the milk in response to the release of prolactin.(ANT pituitary)
Oxytocin (POST pituitary) contracts the muscle cells around the alveoli and causes ‘let down’

WHAT STIMULATES THE MILK EJECTION REFLEX (MER)?

Study These Flashcards

Hearing a baby cry
Thinking about the baby
Preparing to breastfeed
Being the usual time the baby feeds

INHIBITORS: fear, pain, embarrassment, anxiety, breast surgery

LIST THE BENEFITS OF SKIN TO SKIN FOR BOTH THE BABY AND THE CLIENT.

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Benefits for baby: Improved thermo and cardiorespiratory regulation, reduced serum cortisol, stabilizes blood glucose, reduced crying, self-latching, improved exclusivity.
Benefits for client: Increased oxytocin and prolactin, improved milk volumes, promotes bonding.
EARLIER, MORE EFFECTIVE BREASTFEEDING

WHAT ARE THE 4 EARLY FEEDING CUES?

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*Feed when QUIET & ALERT**
1. lip smacking
2. rooting
3. light sleep
4. fussiness

LSR/LSF

(LATE CUE: crying)

WHAT ARE THE 4 FEEDING POSITIONS?

1. Cradle 2. Cross Cradle 3. Football hold 4. Side Lying

When latching a baby...ALWAYS...?

- nose to nipple (to stimulate rooting reflex) - Wait for a wide open mouth - bring baby to breast (not breast to baby) - make sure lower lip is out - tummy to tummy with mummy

Compare Nutritive vs. Non-Nutritive Sucking

Non-Nutritive - does not involve milk transfer (2 sucks/sec | Nutritive - involves milk transfer (1 suck/sec)

How often should a new BF parent feed a newborn?

8-12 feedings/24hrs Feed on demand (min q3h) Wake (if neccessary) to feed For 20-30mins

When are the typical growth spurts? | where baby feeds more often-cluster feeding

10days 3 & 6 weeks 3 & 4-6 months

What are the signs of MER in the BF client?

* Thirst * Relaxation or drowsiness * Milk leakage from opposite breast * Uterine cramping * Increased lochial flow

What are the signs of MILK TRANSFER in a baby?

* Sustained rhythmic suck-swallow patterns * Gradual decrease in intensity and number of sucks * Relaxed arms and hands * Moist mouth * Satisfied after feeding * Audible swallowing * Absence of hunger cues * Weight gain * Elimination pattern

What is the progression of stool changes?

Meconium (brown-black) >>> Transitional (yellow-brown) >>>>>>Yellow Soft Seedy

What should weight gain/loss be over the first few weeks?

- less than 10% loss in 3-5 days - return to birth weight by week 2 - gain 4-8 ounces/week until baby doubles in weight

What causes sore nipples and how do you remedy the problem?

``` • Poor latch/positioning* • Improper suck • Pump problem • Thrush - Yeast • Eczema/Dermatitis INTERVENTIONS • Get a good latch where the nipple is safe • Start feeds from unaffected side • Pump affected side to allow nipple to heal • Breast shell for protection • Expressed breast milk • Nipple ointment • Continuous breastfeeding support ```

How do you prevent sore nipples?

* Proper latch * Use of varied positions * Break suction before taking baby off breast * Express a few drops of milk, massage into nipple after each feed and allow to air dry

1. What is the condition of engorgement? | 2. When and why does it occur, and how can it be avoided.

1. The milk stasis in the ducts and increased blood flow causes edema in the breast tissue which compresses the ducts and can reduce milk production. The breasts become firm, tender, swollen, hot, shiny, and red. 2. It occurs 3-5 days postpartum, 24 in duration but can happen anytime throughout lactation.

How could you teach a client to avoid engorgement?

Encourage early frequent feeds and complete emptying of breasts.

How do you treat engorgement?

* Adequate breast emptying * Cold therapy between feeds/pumping * Cabbage leaves application * Massage during feeds/pumping * Analgesic/anti-inflammatory * Reverse pressure softening

What are some of the symptoms of a blocked milk duct?

* Painful, firm lump in the breast * May see white dot on the nipple - bleb * Client may not feel ill, or may start to have flu like symptoms * Can lead to infection and abscess

What would you teach the a client to do if they suspected a blocked milk duct?

* This needs to be expressed so the milk will flow * Get the milk out – feed, hand expression, pump * Warm water and massage often help

What are three potential problems of breastfeeding?

Engorgement Blocked Milk Duct Mastitis

What is mastitis?

It is an inflammation of breast tissue which causes milk-flow obstruction. S.Aureus enters through a nipple fissure.

How do you treat mastitis?

``` • Feed/pump frequently • Rest • Warm/cool compresses • Analgesia/anti-inflammatory If not resolving within 24hrs, seek medical attention • Antibiotics ```

List some DOs of FORMULA FEEDING.

* Use feeding/skin to skin to bond with baby * 6-8 feedings/24 hours (feed on demand) * Average initial intake 10-15 mls * Follow instructions on packaging for preparation * Sit baby upright * Burp baby several times * clean and maintain bottles/nipples properly * Keep nipple half full, extend baby's hips

List some DON'TS OF FORMULA FEEDING.

* Never microwave formula * No powdered formula until 3 months * DO NOT overfeed * Never feed baby side lying

What are the key points of breastfeeding?

* Early * Often * Effective * Exclusive * Skin to skin

WHAT ARE THE 4 P’s OF BREASTMILK?

PAIN - has an analgesic effect for infant POOP - laxative effect to move meconium out PUFFY - very high in fat = increased brain development PROTECTION - combats bacteria, it’s easy to digest