1. Newborn Nutrition and Feeding
Chapter 25
Newborn Nutrition and Feeding
Copyright © 2016 by Elsevier Inc. All rights reserved.

2. Learning Objectives
Describe current recommendations for infant feeding.
Explain the nurse’s role in helping families choose an infant feeding method.
Discuss benefits of breastfeeding for infants, mothers, families, and society.
Describe nutritional needs of infants.
Describe anatomic and physiologic aspects of breastfeeding.

3. Learning Objectives (Cont.)
Recognize newborn feeding-readiness cues.
Explain maternal and infant indicators of effective breastfeeding.
Examine nursing interventions to facilitate and promote successful breastfeeding.
Analyze common problems associated with breastfeeding and interventions to help resolve them.

4. Learning Objectives (Cont.)
Compare powdered, concentrated, and ready- to-use forms of commercial infant formula.
Develop a teaching plan for the formula-feeding family.

5. Recommended Infant Nutrition
Scientific evidence is clear that human milk provides the best nutrition for infants.
Human milk is the gold standard for infant nutrition.
AAP recommends exclusive breastfeeding of human milk for the first 6 months and continued breastfeeding for at least 12 months.
During the second 6 months, appropriate complementary solid foods are added to the diet.

6. Breastfeeding Rates Healthy People 2020 goals
Infants ever breastfed, 81%
Six months, 60.6%
12 months, 34.1%
U.S. rates from 2010 (CDC Report, 2013)
Infants ever breastfed, 77%
6 months, 49%
12 months, 27%
Exclusive BF 46% at 3 months, 25% at 6 months
Trends have not changed in breastfeeding rates among minority groups in the United States

7. Benefits of Breastfeeding
The evidence supporting breastfeeding as the ideal form of infant nutrition is so strong that health care professionals may need to present information about it from two perspectives:
Benefits of breastfeeding and
Risks of not breastfeeding
Long-term health benefits for both mom and baby
Enhanced bonding and attachment
Convenient, inexpensive
Environmental benefits

8. Choosing an Infant Feeding Method
The decision to breastfeed
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.
Cultural factors
Mother’s knowledge about the health benefits to the infant and her comfort level with breastfeeding in social settings

9. Choosing an Infant Feeding Method (Cont.)
Barriers to breastfeeding
Lack of broad social support for breastfeeding
Widespread marketing by infant formula companies
Lack of prenatal breastfeeding education
Insufficient training and education of health care professionals about breastfeeding
Employment and the need to return to work after birth
Pain, lifestyle incompatibility

10. Choosing an Infant Feeding Method (Cont.)
Formula feeding
Parents who choose to formula feed often make this decision without complete information and understanding of the benefits of breastfeeding.
Cultural beliefs, myths, misconceptions
Some view formula feeding as a way to ensure that the father, other family members, and daycare providers can feed the baby.

11. Choosing an Infant Feeding Method (Cont.)
Breastfeeding contraindicated in a few circumstances
Newborns with galactosemia
Mothers who are positive for human T cell lymphotropic virus types I or II
Mothers with untreated brucellosis
Mothers with active tuberculosis
Mothers with active herpes simplex lesions on the breasts
Mothers with HIV infection
Considered a contraindication in the United States
In developing countries where HIV is prevalent, the benefits of breastfeeding for infants outweigh the risk of contracting HIV from infected mothers

12. Choosing an Infant Feeding Method (Cont.)
Cultural influences on infant feeding
Immigrants to the United States from poorer countries often choose formula to appear more “modern” or to adapt to U.S. culture and customs
Breastfeeding beliefs and practices vary across cultures
Beliefs about the harmful nature or inadequacy of colostrum
Combining breastfeeding and commercial infant formula: las dos cosas
Specific food intake to foster milk production

13. Nutrient Needs Fluids Energy Carbohydrates Fat Protein Vitamins
Minerals

14. Anatomy and Physiology of Lactation
Anatomy of lactating breast
15 to 20 segments (lobes)
Alveoli
Milk-producing cells within lobes
Myoepithelial cells
Contract to send milk to ductules
Complex, intertwining network of milk ducts that transport milk from the alveoli to the nipple
The size and shape of the breast are not accurate indicators of its ability to produce milk.

15. Anatomy and Physiology of Lactation (Cont.)

16. Anatomy and Physiology of Lactation (Cont.)

17. Anatomy and Physiology of Lactation (Cont.)
Lactogenesis
Prolactin prepares the breast to secrete milk.
Supply-meets-demand system
Oxytocin
Milk ejection reflex (MER): let-down reflex
Same hormone that stimulates uterine contractions during labor
Mothers who breastfeed are at decreased risk for postpartum hemorrhage
Nipple-erection reflex

18. Anatomy and Physiology of Lactation (Cont.)

19. Anatomy and Physiology of Lactation (Cont.)
Human milk is the ideal food for human infants.
Uniqueness of human milk
Contains many immunologically active, protective components:
Main immunoglobulin: IgA
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

20. Anatomy and Physiology of Lactation (Cont.)
Uniqueness of human milk (Cont.)
Composition of mature milk changes during each feeding
Stage I lactogenesis: begins 16 to 18 weeks of gestation
Stage II lactogenesis: begins with delivery of placenta
Stage III lactogenesis: mature milk is established, about 10 to 14 days after birth

21. Anatomy and Physiology of Lactation (Cont.)
Uniqueness of human milk (Cont.)
Composition of mature milk changes during each feeding.
The composition of human milk changes over time as the infant grows and develops.
Fat is the most variable component of human milk.
Milk production gradually increases as the baby grows.
Fairly predictable growth spurts (at about 10 days, 3 weeks, 6 weeks, 3 months, and 6 months)

22. Uniqueness of human milk (cont’d)
Colostrum, a clear yellowish fluid
More concentrated than mature milk
Extremely rich in immunoglobulins
Higher concentration of protein and minerals
Less fat than mature milk

23. Uniqueness of human milk (cont’d)
Composition changes during each feeding
Fat content of breast milk increases
Initially, foremilk is released that:
Is part skim milk: about 60% of volume
Is part whole milk: about 35% of volume
Provides primarily lactose, protein, and water-soluble vitamins

24. Uniqueness of human milk (cont’d)
Composition changes during each feeding
Hindmilk, or cream (about 5%), usually let down 10 to 20 minutes into feeding
Contains denser calories from fat for ensuring optimal growth and contentment
Changing composition of human milk during each feeding requires breastfeeding long enough to supply balanced feeding

25. Care Management: The Breastfeeding Mother and Infant
Supporting breastfeeding mothers and infants
Care providers with knowledge, skills, and attitudes to promote and support breastfeeding
Birthing environment in which breastfeeding is promoted and supported
Baby-Friendly Hospital Initiative (BFHI)

26. Care Management: The Breastfeeding Mother and Infant (Cont.)
Feeding readiness cues
Hand-to-mouth or hand-to-hand movements
Sucking motions
Rooting reflex—infant moves toward whatever touches the area around the mouth and attempts to suck
Mouthing

27. Care Management: The Breastfeeding Mother and Infant (Cont.)
Positioning
Latch
Milk ejection or let-down
Frequency of feedings
Duration of feedings
Indicators of effective breastfeeding

28. Frequency of Feedings Frequency of Feedings
Newborns need to breastfeed 8 to 12 times in a 24 hour period
Newborns should breastfeed every 3 hours during the day and every 4 hours at night
Feeding frequency is determined by counting from the beginning of one feeding to the beginning of the next feeding

29. Care Management: The Breastfeeding Mother and Infant (Cont.)

30. Care Management: The Breastfeeding Mother and Infant (Cont.)
Supplements, bottles, pacifiers
Special considerations
Sleepy baby
Fussy baby
Slow weight gain
Jaundice
Preterm and late preterm infants
Breastfeeding multiple infants

31. Slow Weight Gain
Newborns typically lose about 5 to 6 % of body weight before they begin to show a weight gain
Weight loss of 7 % in a breastfeeding infant during the first three days of life should be investigated
Infants should show a weight gain of 110 to 200 g per week or 20 to 28 g per day for the first three months
Breastfeed infants usually do not gain weight as quickly as formula-fed infants

32. Jaundice Jaundice Hyperbilirubinemia
Early onset or breastfeeding jaundice- usually occurs after 24 hours and peaks by the third day
Breastfeeding infant may be associated with insufficient feeding and infrequent stooling
Bilirubin is excreted from the body primarily through the intestines
Infrequent stooling allows bilirubin in the stool to be reabsorbed into the infant system

33. Preterm Infants Human milk is the ideal food
Breast milk enhances retinal maturation in the preterm infant and improves neurocognitive outcomes
Decreasing the risk of necrotizing enterocolitis
Mothers unable to breastfeed their preterm infant should begin pumping their breast as soon as possible

34. Breastfeeding Twins Breastfeeding Twins
Mothers breastfeeding twins needs extra nourishment -200 to 500 kcal per day for each baby
Each baby feeds from one breast per feeding usually for 20 to 30 minutes
Modified demand feeding schedule

35. Care Management: The Breastfeeding Mother and Infant (Cont.)
Expressing and storing breast milk
Hand expression
Mechanical milk expression (pumping)
Types of pumps
Storing breast milk
Maternal employment
Weaning
Milk banking and milk sharing
For infants who cannot be breastfed but who also cannot survive except on human milk, banked donor milk is critical.

36. Storage of Milk
Breast milk can be safely stored in any clean glass or plastic container
Freshly expressed milk can stored at room temperature for up to 8 hours
Refrigerated safely for up to 8 days
Milk can be frozen for 6 months in the freezer section of a refrigerator with a separate door

37. Weaning Infants can be weaned directly from the breast to a cup
Bottles are usually offered to infants younger than 6 months
Infant is weaned before 1 year, formula should be fed to the infant instead of cow’s milk

38. Care Management: The Breastfeeding Mother and Infant (Cont.)
Care of the mother
Nutrition
Rest
Breast care

39. Care Management: The Breastfeeding Mother and Infant (Cont.)
Care of the mother (Cont.)
Breastfeeding and contraception
Breastfeeding during pregnancy
Breastfeeding after breast surgery
Breastfeeding and obesity
Medications, alcohol, smoking, and caffeine
Herbal preparations

40. Care Management: The Breastfeeding Mother and Infant (Cont.)
Common concerns of the breastfeeding mother
Engorgement
Sore nipples
Insufficient milk supply
Plugged milk ducts
Mastitis
Follow-up after discharge

41. Formula Feeding Parent education Readiness for feeding
Feeding patterns
Feeding technique
Common concerns
Bottles and nipples

42. Formula Feeding (Cont.)
Parent education (Cont.)
Infant formulas (commercial formulas)
Cow’s milk–based formulas
Soy-based formulas, commonly used for children who are lactose or cow’s milk–protein intolerant
Casein- or whey-hydrolysate formulas, used primarily for children who cannot tolerate or digest cow’s milk– or soy-based formulas
Amino acid formulas, used for infants with multiple food protein intolerances

43. Positions for burping an infant.

44. Formula Feeding (Cont.)
Parent education (Cont.)
Formula preparation
Powdered formula: least expensive
Concentrated formula
Ready-to-feed: most expensive
Vitamin and mineral supplementation
Weaning
Introducing solid foods
Complementary feedings

45. Question
Benefits to the mother associated with breastfeeding include all except which of the following?
There is a decreased risk of breast cancer.
It is an effective method of birth control.
It increases bone density.
It may enhance postpartum weight loss.

46. Key Points
Human breast milk is species specific and is the recommended form of infant nutrition. It provides immunologic protection against many infections and diseases.
Breast milk changes in composition with each stage of lactogenesis, during each feeding, and as the infant grows.
During the prenatal period, expectant parents should be informed of the benefits of breastfeeding for infants, mothers, families, and society.

47. Key Points (Cont.)
Infants should be breastfed within the first hour after birth and at least 8 to 12 times every 24 hours thereafter.
Parents should be taught to recognize the signs of effective breastfeeding.

48. Key Points (Cont.)
Breast milk production is based on a supply- meets-demand principle: the more the infant nurses, the greater the milk supply.
Infants go through predictable growth spurts.
Sore nipples are most often caused by incorrect latch.

49. Key Points (Cont.)
Commercial infant formulas provide satisfactory nutrition for most infants.
Infants should be held for feedings.
Parents should be instructed about the types of infant formulas, proper preparation for feeding, and correct feeding technique.

50. Key Points (Cont.)
Solid (complementary) food should be started at about 6 months of age.
Unmodified cow’s milk is inappropriate for infants younger than 1 year of age.
Nurses must be knowledgeable about feeding methods and provide education and support for families.