1. Chapter 23 Newborn Feeding Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

2. Nutritional Needs of the Newborn  Full-term breastfed infants  85-100 kcal per kg (39-45 kcal per lb) daily  Formula fed infants  100-110 kcal per kg (45-50 kcal per lb) daily  Newborns may lose weight in the first 2 days of life as a result of insufficient intake and normal loss of extracellular fluid. 2Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

3. Composition of Breast Milk  Colostrum  Rich in protein, vitamins, minerals, and immunoglobulins  Transitional milk  Appears between colostrum and mature milk  Mature milk  Nutrients in proportions needed by newborns in an easily digested form  Contain factors that help establish normal intestinal flora and prevent infection 3Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

4. Formulas  A variety of commercial formulas are available.  Modified cow's milk  Soy-based  Hydrolysed  Formula for special indications  Galactosemia  Lactase deficiency 4Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

5. Considerations in Choosing a Feeding Method  American Academy of Pediatrics (AAP) recommendation  Exclusive breastfeeding for the first 6 months  Continued breastfeeding with the addition of foods until 12 months of age 5Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

6. Considerations in Choosing a Feeding Method (cont.)  Factors that influence the choice of feeding  Knowledge about each feeding method  Cultural influences  Employment 6Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

7. Question  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. Which statement is valid? 7Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

8. Question (cont.) A. A premature infant more easily digests breast milk than formula. B. A glass of wine just before pumping will help reduce stress and anxiety. C. The mother should only pump as much as the infant can drink. D. The mother should pump every 2-3 hours, including during the night. 8Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

9. Milk Production  Suckling causes the mother's posterior pituitary to release oxytocin, which triggers the let-down reflex.  Suckling also causes the anterior pituitary to release prolactin, which increases milk production.  "Supply and demand" applies to breastfeeding. 9Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

10. Prolactin, Oxytocin, and Milk Production 10Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

11. Preparation of the Breasts for Breastfeeding  Little preparation is needed during pregnancy for breastfeeding.  The mother should avoid soap on her nipples to prevent removal of the natural protective oils.  Cream and "nipple rolling" are not necessary.  Breasts should be assessed during pregnancy to identify flat or inverted nipples. 11Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

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13. Assisting with Breastfeeding  Position of the mother  Position of the infant  Position of the mother's hands  Latch-on techniques  Suckling pattern  Removal from the breast 13Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

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19. Infant's Position While Suckling 19Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

20. Feeding Techniques  Frequency of feeding  8-12 times each day until satisfied  Sleepy infants  Unwrapping the blankets  Placing the infant skin to skin with the mother  Talking to the infant  Changing the diaper  Rubbing the baby's back 20Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

21. Preventing Problems  Engorged breasts  Nurse frequently  Apply heat and cold  Massage the breasts  Express milk to soften the areola  Sore nipples  Check the positioning of the infant  Vary the position of the infant  Warm water compresses  Expose nipples to the air 21Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

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25. Signs of Infant Problems with Breastfeeding  Falling asleep within 5 minutes  Refusal to breastfeed  Tongue thrusting  Smacking or clicking sounds  Dimpling of cheeks  Failure to open mouth wide at latch-on  No audible swallowing  Short choppy motions of the jaw 25Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

26. Signs of Maternal Breastfeeding Problems  Hard, tender breasts  Painful, red, cracked, blistered, or bleeding nipples  Flat or inverted nipples  Localized edema or pain in either breast  Fever, generalized aching, or malaise 26Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

27. Employment  Breastfeeding offers many advantages for working women.  They are less likely to miss work because of illness of the infant.  Breast pumping  Hand or electric pump  Milk storage 27Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

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30. Formula Feeding  Types of formula  Ready to use  Concentrated liquid  Powdered  Preparation  Should be diluted exactly according to directions  Should not be heated in the microwave  Feeding techniques 30Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

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