Chapter 24 Newborn Nutrition and Feeding All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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 2 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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 3 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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 4 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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 5 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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.) 6 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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.) 7 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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 8 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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.) 9 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Fluids  Energy  Carbohydrate  Fat  Protein  Vitamins  Vitamin D  Vitamin K  Minerals Nutrient Needs 10 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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 11 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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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.) 14 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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.) 15 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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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.) 17 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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.) 18 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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.) 19 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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 20 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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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.) 22 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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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.) 27 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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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.) 31 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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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.) 35 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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 Common concerns  Engorgement  Sore nipples  Insufficient milk supply  Plugged milk ducts  Mastitis  Follow-up after hospital discharge The Breastfeeding Mother and Infant (Cont.) 37 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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 Parent education  Readiness for feeding  Feeding patterns  Feeding techniques  Bottles and nipples  Common concerns Formula-Feeding 39 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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 Parent education  Infant formulas  Formula preparation  Vitamin and mineral supplementation  Weaning  Complementary feedings Introducing solid foods Formula-Feeding (Cont.) 42 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 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 43 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.