Chapter 24

Newborn Nutrition and Feeding

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American Academy of Pediatrics (AAP) recommends infants be breastfed exclusively for first 6 months of life

Breastfeeding should continue for at least 12 months and thereafter as desired

Complementary foods can be introduced after 6 months

Recommended Infant Nutrition

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Risen steadily over the past decade 76% initiation 47% at 6 months 25% at 12 months

Healthy people 2020 goals 81% any breastfeeding 60% at 6 months 34% at 12 months

Breastfeeding Rates

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Human milk designed specifically for human infants; nutritionally superior to any alternative Associated with health benefits for mother and infant Psychological benefits Convenience Economical Environmental benefits

Benefits of Breastfeeding

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Breastfeeding (BF) Parents should be aware of the benefits of BF for

their infant, as well as the risks of not BF A natural extension of pregnancy and birth Support by the partner and family is necessary Mothers tend to select the same method of infant

feeding for all of their children

Choosing an Infant Feeding Method

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Cultural influences on infant feeding Hispanic women BF is the norm African-American families more likely to formula-feed Muslim and Jewish cultures value BF Cultural knowledge about BF Must be comfortable in social settings

Choosing an Infant Feeding Method (Cont.)

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Choosing to formula-feed Parents often make this decision without complete

information Myths and misconceptions about BF BF may be seen as embarrassing See formula-feeding is a way for family members to

feed the baby Mothers on WIC are more likely to formula-feed

Choosing an Infant Feeding Method (Cont.)

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Maternal cancer therapy or diagnostic and therapeutic radioactive isotopes

Active tuberculosis not under treatment Human immunodeficiency virus Maternal herpes simplex lesion on a breast Galactosemia in infant

Contraindications of Breastfeeding

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Varicella Maternal substance abuse Maternal human T-cell leukemia virus type 1 or

type 2 Some medications may be incompatible with BF

Contraindications of Breastfeeding (Cont.)

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Fluids Energy Carbohydrate Fat Protein Vitamins

Vitamin D Vitamin K

Minerals

Nutrient Needs

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Milk production Female breast composed of 15 to 20 segments

(lobes) embedded in fat and connective tissues; well supplied with blood vessels, lymphatic vessels, and nerves

Each lobe is glandular tissue consisting of milk producing cells the contractor symptoms milk forward to the nipple

Anatomy and Physiology of Lactation

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Lactogenesis After birth precipitates a decrease in estrogen and

progesterone levels; triggers release of prolactin from anterior pituitary gland

Prolactin levels highest during first 10 days after birth Prolactin produced in response to infant suckling and

emptying of breasts• Production as a supply-meets-demand system

Anatomy and Physiology of Lactation (Cont.)

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Lactogenesis Oxytocin: other hormone essential to lactation As nipple is stimulated by suckling infant, posterior

pituitary prompted by hypothalamus produces oxytocin

• Responsible for milk-ejection reflex (MER) Thoughts, sights, or sounds of the baby can stimulate

MER

Anatomy and Physiology of Lactation (Cont.)

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Uniqueness of human milk The ideal food for human infants Dynamic substance to meet the changing needs of

the infant Contains immunologically active components

Anatomy and Physiology of Lactation (Cont.)

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Uniqueness of human milk Colostrum, a clear, yellowish fluid (day 1 to 3)

• More concentrated than mature milk • Extremely rich in immune globulins• Higher concentration of protein and minerals• Less fat than mature milk

Anatomy and Physiology of Lactation (Cont.)

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Uniqueness of human milk Composition changes during each feeding

• Lower fat “foremilk” changes to higher fat “hindmilk” Milk production increases as the baby grows

• Growth spurts occur at 10 days, 3 weeks, • 6 weeks, 3 months, and 6 months

Anatomy and Physiology of Lactation (Cont.)

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Supporting breastfeeding mothers Education and anticipatory guidance Prenatal classes La Leche League and Mocha Moms WIC Baby-Friendly Hospital Initiative

The Breastfeeding Mother and Infant

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Supporting breastfeeding mothers Positioning Latch-on Milk ejection or let-down Frequency of feedings Duration of feedings Indications of effective BF Supplements, bottles, and pacifiers

The Breastfeeding Mother and Infant (Cont.)

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Special considerations Sleepy baby Fussy baby Slow weight gain Jaundice Preterm infants Late preterm infants Multiple infants

The Breastfeeding Mother and Infant (Cont.)

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Expressing and storing breast milk Hand expression Mechanical milk expression Types of pumps Storage of breast milk Working and BF Weaning Milk banking

The Breastfeeding Mother and Infant (Cont.)

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Care of mother Diet Breast care BF and contraception BF and pregnancy BF and obesity Medications, smoking, alcohol, caffeine Herbal preparations

The Breastfeeding Mother and Infant (Cont.)

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Common concerns Engorgement Sore nipples Insufficient milk supply Plugged milk ducts Mastitis Follow-up after hospital discharge

The BreastfeedingMother and Infant (Cont.)

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Parent education Readiness for feeding Feeding patterns Feeding techniques Bottles and nipples Common concerns

Formula-Feeding

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Parent education Infant formulas Formula preparation Vitamin and mineral supplementation Weaning Complementary feedings

• Introducing solid foods

Formula-Feeding (Cont.)

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Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them about pumping, storing, and transporting the milk needs to assess their knowledge of lactation. What statement is valid?

A premature infant more easily digests breast milk than formula. A glass of wine just before pumping will help reduce stress and

anxiety. The mother should only pump as much as the infant can drink. The mother should pump every 2 to 3 hours, including during the

night.

Question

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