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Maternity and Women - Chapter 25

The document discusses recommended infant nutrition including breastfeeding benefits and recommendations. It provides breastfeeding rates in the US and benefits for infant, mother, and society. The document also covers lactation anatomy and physiology, care of breastfeeding mothers and infants, and considerations for formula feeding.

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Sam Jones
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34 views6 pages

Maternity and Women - Chapter 25

The document discusses recommended infant nutrition including breastfeeding benefits and recommendations. It provides breastfeeding rates in the US and benefits for infant, mother, and society. The document also covers lactation anatomy and physiology, care of breastfeeding mothers and infants, and considerations for formula feeding.

Uploaded by

Sam Jones
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Chapter 25 – Newborn and Nutrition and Feeding

Recommended Infant Nutrition


• Human milk is the gold standard for infant nutrition
• Composition of human milk changes to meet the nutritional needs of the infant
• Breastfeeding vs. exclusive breastfeeding vs. human milk feeding
• AAP recommends exclusive breastfeeding of human milk for the first 6 months and continued
for at least 12 months
• WHO recommends to continue BF until age 2
• During the second 6 months, appropriate complementary solid foods are added to diet
• If infants are weaned from breast milk before 12 months they should receive iron-fortified
formula, NOT cow’s milk

Breastfeeding Rates
Exceeded Healthy People 2020 goals:
• Infants ever breastfed & exclusively BF at 3 months
Fell short of Healthy People 2020 goals:
• Breastfeeding and exclusively BF at 6 months
• U.S. rates – CDC (2018)
• Infants ever breastfed, 83.2%
• 6 months, 57.6%
• 12 months, 35.9%
• Exclusive BF 46.9% at 3 months, 24.9% at 6 months

Benefits of Breastfeeding
Benefits for the infant
• Reduced risk for nonspecific gastrointestinal infections
• Reduced infant mortality including birth defects
• Decreased incidence of type 1 and type 2 diabetes
• Decreased incidence of leukemia and lymphomas
• Reduced risk of adolescent and adult obesity
• Decreased incidence of asthma and allergies
• Enhanced cognitive development, especially in preterm infants
• Analgesic effect for painful procedures
• Reduced risk for Celiac disease
• Reduced risk of developing asthma, dermatitis and eczema

Benefits for the mother


• Decreased postpartum bleeding
• More rapid uterine involution
• Reduced risk of ovarian and breast cancer
• Lower risk of ___________, hypercholesterolemia and cardiovascular disease
• Reduced risk of Rheumatoid arthritis
• Earlier return to prepregnancy weight
• Unique bonding experience
• Increased maternal role attainment
Benefits to society
• Convenient, ready to feed
• No bottles or other equipment
• Less expensive than infant formula
• Reduced annual health costs
• Less parental absence from work because of ill infant
• Reduced environmental burden related to disposal of formula cans
Choosing an Infant feeding Method
• Breastfeeding is a natural extension of pregnancy and childbirth
• Women tend to select the same feeding method for all their children
• Support by family and partner is a major factor in feeding choice
• Parents who formula-feed often make this decision with incomplete information
• Social factors can create obstacles to breastfeeding
• Breastfeeding contraindications
• Galactosemia
• Active tuberculosis
• Active herpes lesions on breast
• HIV infection
• Chemotherapy
Supporting breastfeeding mothers
• Education and anticipatory guidance
• Should begin early in pregnancy
• Prenatal preparation should include the father/partner
• Connect expectant mothers with other women who have successfully breastfed
• Promote feelings of confidence
Cultural influences on infant feeding
• Beliefs and practices are a significant influence
• Immigrants from poor countries tend to formula-feed
• Belief in the harmful nature or inadequacy of colostrum
• Las dos cosas: practice of combining formula and breastfeeding by Mexican women
• Specific food intake to foster milk production

Nutrient Needs
• Fluids
• First 2 days of life: 60-80ml water per kilogram/day
• Day 3-7: 100-150ml/kg/day
• Day 8-30: 120-180ml/kg/day
• Breastmilk contains 87% water
• Feeding water to infants is contraindicated—decreases caloric consumption
• Energy
• Fat portion of milk provides greatest amount of energy
• Carbohydrates
• Fat
• Protein
• Vitamins
• Human milk contains all vitamins with exception of Vitamin D
• Minerals

Anatomy and Physiology of Lactation


Anatomy of lactating breast; composed of:
• 15 to 20 segments (lobes)
• Alveoli
• Milk-producing cells within lobes
• Myoepithelial cells
• Contract to send milk to ductules
• Ductules
• Enlarge into lactiferous ducts and sinuses
• Milk collects behind the nipple

Lactogenesis
• After birth, progesterone levels fall and this triggers release of Prolactin
• Prolactin prepares the breast to secrete milk
• Supply-meets-demand system
• Oxytocin: essential for lactation and MER
• Milk ejection reflex (MER)
• Nipple-erection reflex
• Inverted nipples
Uniqueness of human milk
• Contains antimicrobial factors (antibodies)
• Immunoglobulin A (IgA) major antibody
• IgG, IgM, IgD and IgE are also present
• Colostrum: more concentrated than mature milk and extremely rich in immunoglobulins
• Higher concentrations of protein and minerals but less fat than mature milk
• Composition of mature milk changes during each feeding
• Important to breastfeed infant long enough to supply balanced feeding
• Hindmilk or crème (approximately 5%) is usually released 10 to 20 minutes into
the feeding – necessary for optimal growth
• Milk production increases as the baby grows
Breastfeeding
• Feeding readiness cues
• Positioning
• Latch-on
• Milk ejection or let-down
• Frequency of feedings
• Duration of feedings
• Indicators of effective breastfeeding

Care Management: The Breastfeeding Mother and Infant


• Breastfeeding
• Supplements, bottles, pacifiers
• Pacifier use is recommended for healthy term infants to reduce risk of
SIDS
• Sleepy baby
• Fussy baby
• Slow weight gain
• Typically lose 5-6% body weight before gaining
• S & S ineffective breastfeeding?
• Jaundice associated with breastfeeding
• Preterm and late preterm infants
• Recommended to start pumping asap to establish milk supply
• Breastfeeding multiple infants
Breastfeeding
• Expressing breast milk
• Hand expression
• Pumping
• Storing breast milk
• See “Teaching for Self-Management” p.549
• Maternal employment
• Weaning
• Milk banking
• Breastfeeding
• Care of mother
• Diet: additional 450-500 calories/day
• Encourage consumption of prenatal vitamin
• Weight loss
• Rest
• Breast care
• Flat or inverted nipples
• Breast support
Breastfeeding: Care of mother
• Breastfeeding and contraception.
• Oral contraceptives not recommended d/t potential for decreasing milk supply
• Breastfeeding during pregnancy.
• Can BF during pregnancy if no medical contraindications
• Breastfeeding after breast surgery
• Medications, alcohol, smoking, caffeine and breastfeeding
• Breastfeeding: Common concerns of the breastfeeding mother
• Engorgement: volume can exceed storage capacity with the increase in milk
production
• If milk is not removed, alveoli distend causing impairment of capillary blood flow
• Blood vessels become congested, fluid leaks into surrounding tissue, resulting in
edema
• Breastfeeding: Common concerns of the breastfeeding mother

• Sore nipples
• Insufficient milk supply
• Plugged milk ducts
• Mastitis
• Follow-up after hospital discharge
Formula feeding
• Parent education
• Readiness for feeding
• Feeding patterns
• 15-30ml q3-4h is normal in the first 24-48 hrs
• Gradual increase during first week
• Feeding technique
• Common concerns
• Burping frequently, keeping baby upright for 30min post feed can help with
regurgitation
• Bottles and nipples
• Parent education
• Formula preparation
• Powdered formula
• Concentrated formula
• Ready-to-feed
• Vitamin and mineral supplementation
• Weaning
• Introducing solid foods
• Complementary feedings to start at 6 months of age – cereals, vegetables &
fruits

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