Newborn Nutrition

Breast milk typically appears within

4-5 days after childbirth hormone levels at term Increase in Prolactin and Oxytocin and Decrease in Estrogen and Progesterone

Prolactin

milk making hormone, secreted from anterior pituitary, stimulated by rapid drop in estrogen/progesterone and sucking of baby Inhibited by incomplete emptying of breasts, repeated inhibition of the milk ejection reflex

Oxytocin

“let-down” hormone, Secreted from (posterior) pituitary, stimulated by -baby sucking / thoughts of baby, inhibited by maternal pain / fatigue / anxiety & depression

Breastfeeding Benefits for Baby decreased

Infection / Illness, Obesity rate, Stomach upset, increased

Breastfeeding Benefits for Baby Increase in

Maternal/infant bonding, , Promotes tooth and jaw alignment, Protects against food allergies, Improves passive immunity

Breastfeeding Benefits for Mom decreased

Bleeding risk, PPD risk, Cancer risk – Breast, ovarian & cervical , Diabetes risk

Breastfeeding Benefits for Mom increased

Bonding, Uterine contractions, Weight loss, Finances/Economics

BREASTFEEDING PREPARATION

Immediately after birth, the baby goes to the mom's abdomen (skin to skin), Allow baby and mom to bond

Initiate breastfeeding within

the first hour of life, Allow unrestricted access to breastfeeding, Avoid artificial nipples (pacifiers) or supplementation, Make sure a lactation consultant is accessible

BREASTFEEDING EDUCATION

Breastfeeding is a learned skill, Instruct mother to wash hands, afterpains will increase during breastfeeding, Make sure mother is in a comfortable and pain free position, Make sure baby is awake and look for hunger cues, Assist the mother in positioning the baby on the breast

Baby hunger cues

sucking sounds, steering, kicking, turning of head, rooting reflex, crying is last

Cradle hold

Baby lies across your front with their head in the crook of your elbow on the same side as the breast.

Cross-cradle hold

You support the baby’s head with the opposite arm while guiding them to the breast. (good if large breast)

Football hold

Baby is tucked under your arm on the same side as the breast, good for twins or C-section to get off abdomen

MASTERING THE LATCH

Tickle the baby’s lower lip with tip of nipple, Wait for baby’s mouth to open wide, Baby’s mouth should be around most of areola. Baby’s lips are relaxed and flanged forward, Ear, shoulder, and hip in straight line, Baby may self-detach or fall asleep when done

LATCH Assessment 2

Grasps breast, Tongue down, Lips flange, Rhythmic sucking

Audible swallowing

Spontaneous and intermittent > 24 hours old Spontaneous and frequent < 24 hours old

Comfort (breast/ nipple) 0

Engorged, Cracked, bleeding, large blisters or bruises, Severe discomfort

Comfort (breast/ nipple) 1

Filling, Reddened/small blisters or bruises. Mild/moderate discomfort

Signs of a good latch mouth

Wide open mouth with nipple and most of the areola in the mouth

Signs of a good latch Jaw

jaw glide that is long/rhythmical with movement at the infant's temple and near the infant's ear

Signs of a good latch

Audible swallowing, Bursts of sustained suckling, Mother feels rhythmical tugging on breast, Infant self-detaches

Signs of milk transfer diapers

at least 6-10 wet and 2 or more dirty pale yellow urine; yellow stools

Signs of milk transfer Feeding at least

8-12 times in 24 hours

Signs of milk transfer

Baby seems satisfied after most feedings; falls asleep, Weight gain

Colostrum color

thick and yellowish

Colostrum

birth to 1-4 days after birth, - high in protein, minerals, vitamins immunoglobulin A (IgA), aids in passing meconium

Transitional

• end of colostrum to day 10, - same as colostrum; thinner

Mature milk

carbohydrates, proteins and fats - 90% water, vitamins, minerals, enzymes, and Vit. D, composition varies throughout the feeding to fit baby’s needs

Mature milk color

bluish color not as thick

How often should a breast-fed baby eat?

Every 2-3 hours per day and every 4 hours at night, 8-12 feedings per day

How often should a bottle-fed baby eat

Every 3-4 hours per day; 6-8 feedings per day

Normal newborn weight loss and subsequent weight gain should be

Loss of 5%-10% AFTER BIRTH AND REGAIN 10-14 DAYS AFTER BIRTH Gain of 110-200g/wk for the first 3 weeks

During the first two days of life, healthy newborns need a fluid intake of

60-80 mL/kg/24 hours. From 3-7 days, the fluid requirement is 100-150 mL/kg/24 hr.

The first 3 months the newborn will require

110 kcal/kg/day. From 3-6 months, the requirement decreases to 100 kcal/kg/day. Both breastmilk and formula provide 20 kcal/oz.

recommend breastfeeding for the first

six months exclusively

Newborns who are breastfed may be prescribed

iron at about 4 months. formula-fed newborns have iron-fortified formula for the first year, 400 IU of Vit D if baby consumes less than 28 oz of milk

BREASTMILK STORAGE GUIDELINES

room temp for 4 hours, refrigerated for use within 4 days, frozen for up to 6 months and in a deep freezer for up to 1 year

Breatmilk Never

boil or microwave breastmilk, Never refreeze milk that has been thawed, Unused milk should be discarded after thawing or warming

What causes “Afterpains”

More milk is let-down as the baby sucks. The uterus contracts because oxytocin is released

BREAST ENGORGEMENT

a painful swelling and overfilling of the breasts with milk, usually occurring in the early days after giving birth when a mother's milk first comes in, causing the breasts to feel hard, tight, and very full due to an excess build-up of milk that the baby isn't fully draining.

BREAST ENGORGEMENT BREASTFEEDING

Wear a supportive bra, Manually express milk from breast or pump, Alternate breast when feeding, Increase frequency of feedings, Massage the breast, Apply a cold compress. Provide analgesic, Cabbage leaves on the breast

SUPPRESSING LACTATION INTERVENTIONS

Wear a well-fitted shirt with a supportive bra, Avoid stimulating the breast, Avoid hot showers. Let warm water from shower run over back, not breast, Apply cold compress to relieve engorgement

NIPPLE PAIN

Improper latching techniques causing cracks, redness, bleeding, or sore nipples

NIPPLE PAIN Interventions

Warm water to clean the breast, not soap, Avoid breast pads if bleeding, Express some milk before feeding and apply it to the nipple - helps toughen nipples, Avoid a bra that is too tight, Leave bra open to air, Rotate positions, Apply lanolin cream, Ibuprofen for discomfort

Flat nipples

Nipples that are flattened to the areola or inverted in appearance

Flat nipples Interventions

Stimulate nipples, Consult lactation consultant, Breast shields, etc.

MASTITIS

Inflammation of the breast due to blocked duct or cracked nipple allowing bacteria to enter the breast.

MASTITIS S/s

Flu-like s/s- chills, fever, malaise, aching, swelling, and redness of the breast (breast is hot to touch)

MASTITIS Interventions

Rest , Warm compress relaxes tissue, Cold compresses can relieve pain and inflammation, Antibiotics and analgesics, May continue to breastfeed, Educate mother

When is the newborn given formula Maternal illness

Antineoplastic drugs , Thyroid medications. Active TB, Active Herpes Simplex on breast, HIV. Galactosemia diagnosis

When is the newborn given formula

Supporting the mom that is returning to work, Increasing weight gain, Increasing satiety, Supplementing insufficient breast milk, Mom addicted to drugs, Neonatal congenital malformation, Newborn with hypoglycemia or dehydration

BENEFITS of FORMULA FEEDING

Rest and recovery for mom, as others can feed the baby, Decrease times to feed; formula slower to digest than breast milk, Formula has similar nutritional qualities to breast milk

How should formula be handled

Wash hands prior to preparing formula. Wash the lid with hot soapy water before opening and shake well. Use tap water (boil first if necessary) to mix concentrated or powder

The prepared formula can be refrigerated up to

48 hrs.

Always hold baby when feeding at

45-degree angle, do not prop bottle in baby’s mouth. Keep the nipple filled with formula, Allow the baby to burp several times during feeding, Place newborn on back after feeding