OB ch 16 PowerPoint

American Academy of pediatrics recommend

• Exclusive breast-feeding for the first six months

• Additional of solid foods along with breast-feeding for another six months

World, health organization, recommends

• Exclusive breast-feeding for six months

• Additional of appropriate food with breast-feeding for two years or more

Infant nutritional needs

• calories needs based on their age, size, and sex

• higher during , the first year of life

• measured by length and weight on growth chart

• Calories are from protein, fat, and carbohydrates in diet

• water from adequate breastmilk or formula

Infant stomach capacity day 1

5-7 mL

Infant stomach capacity Day 3

22-27 mL

Infant stomach capacity day 10

45-60 mL

Policies to promote breastfeeding

• Place the newborn in direct skin-to-skin contact with the mother after delivery

• Assist with latching-on during the first hour after birth

• Mother and infant should not be separated on the postpartum unit

• Mother and infant should sleep in close proximity

• Avoid supplements such as water or formula

lactogenesis or milk production

• Nipple stimulation occurs from latching the infant onto the breast

• Stimulates pituitary gland to increase prolactin

• Prolactin causes alveoli to take proteins, sugars, and fat from the blood supply and make breast milk

Colostum

Substance produced by the breast

• During second and third trimester

• Easy to digest

• Concentrated with carbohydrates and fat

• contains secretory immunoglobulin A

• has a laxative effective to help pass the first meconium stool

Immunoglobin A

Protect the baby from infections in the mucus membranes in the throat, lungs, and intestines. Leukocytes in colostrum also protect the newborn from infections.

How many times a day should a mother breast-feed

8-12 times a day

What does breast-feeding help with?

• stimulates pituitary to increase prolactin

• Increases volume of breastmilk

Mature milk

Produce third or fourth postpartum day

let-down reflex

• Release of prolactin to produce milk and oxytocin caused by nipple stimulation, baby, crying, or thinking about baby

• Tingly or warm sensation and breast

• Milk drip or spray during letdown

Components of breastmilk

• Proteins

• lactoferrin

• secretory IgA

• Lysozyme

• Bifidus factor

• Cholesterol and fats

• Vitamins

• Carbohydrates

• Antibodies

Proteins

60% whey, 40% casein-allow easy digestion

Lactoferrin

Has bactericidal and iron binding properties

Secretory IgA

Protects the infant from viruses and bacteria

Lysozyme

Enzyme that promotes the growth of healthy, intestinal flora, and has anti-inflammatory functions

bifidus factor

Supports the growth of lactobacillus, which creates an acidic environment in the intestines

Cholesterol and fats

Essential for brain development and the absorption of fat soluble vitamins, or a primary calorie source

Vitamins

Directly related to the mothers dietary intake

Carbohydrates

Lactose is the primary carbohydrate found in human milk

Antibodies

From the mother reduce the risk of neonatal infections

Stages of milk

1. Colostrum

2. Transitional milk

3. Mature milk

Foremilk

Milk produced and stored in the breast between feedings. It has higher water content than hind milk.

Hindmilk

Produced after several minutes of feeding and has a higher fat content and contributes to the filling of fullness and satisfaction for the infant

Advantages of breast-feeding

• provides exact nutrients

• immunological protection

• Convenient and economical

• Promotes close physical contact

• Low risk of developing premenopausal breast and ovarian cancer

Disadvantages of breast-feeding

• Mother must be available for feeding

• Embarrassment

• Medication's can interrupt breast-feeding

• Uncomfortable

• Leaking of breastmilk

Contradictions for breast-feeding

Infant diagnosed with Galactosemia

Mother with:

• HIV

• Taken anti-retroviral medication

• Untreated, active tuberculosis

• Infected with human T cell lymph tropic virus type one or type two virus that causes some leukemia and lymphoma

• Using or dependent on an illicit drug

• Herpes lesion on breast

• Taking prescribed cancer chemo agents

• undergoing radiation therapies

Newborn cues

Rutin, Megan hand to mouth movements, and making mouth and tongue movements while in a awake/alert state

Positioning

Comfortable sitting position or sideline in bed. Pillows for support.

Latch on

Football hole puts less stress on the abdomen at the mother is recuperating from a C-section

Signs of effective breast-feeding

• Mother's breast soften

• Hear infant swallowing

• number of wet diapers increases to at least 6 to 8 by 6 days old

• infant has 2 to 3 yellow stools by the fifth day after birth

Breast-feeding challenges

• Sore nipples

• Nipple confusion

• Low milk supply

• engorgement

• Flat or inverted nipples

Nipple confusion

Establish breast-feeding for at least 2 to 3 weeks before introducing a bottle

Low milk supply

Cluster feeding

Engorgement

The mother should breast-feed every 2 1/2 hours when the baby is awake

Flat or inverted nipples

• A breast pump may be used to evert or "pull out" the nipple

• before delivery, the lactation specialist may recommend that the pregnant woman wear a special device, called a breast shield or a supple cup to encourage the nipple to protrude from the breast

Warning signs of breastfeeding problems :

• Loss of more than 7 % of birth weight • Not gaining back birth weight by 10 days of age

• Not having at least two - three bowel movements per day after day 2

• Does not have at least six wet diapers per day by day 4 with clear or pale yellow urine

cow's milk

• not suitable for infants under one year of age

• High level of protein

• Fat witch is difficult for the infant to digest

• Poor source of iron

• Contains small amounts of vitamin C, E, and copper

• sodium level too high

Advantages of formula :

• Mother has a chronic illness and takes medications

• Provides adequate and acceptable nutrition

• Anyone can feed the infant

• More comfortable to feed in public

• Food or alcohol intake won't affect the baby

• Easier to leave the infant with a sitter or family member

Disadvantages of formula:

• Breastmilk may come in , causing engorgement

• Formula can be expensive

• Bottles , nipples , and formula must be purchased

• Bottles and formula must be carried along with the infant

• Increased risk of serious illness including GI illness

Types of formula :

• Most have 20 calories in each ounce • Prepared formula should be in a covered container in the refrigerator

• Unused formula thrown out after 24 hours

• Hypoallergenic formula should be used if allergy to milk - based formula is suspected

• Soy - based formula should be used if dairy - based products are not ingested for health , cultural , religious , or personal reasons , such as a vegan lifestyle

Ready to - feed formula :

can or carton ; should not be diluted

Liquid concentrated formula diluted with equal amounts of water

diluted with equal amounts of water

powder formula

dissolved in water

Bottle-feeding the infant

• Check the expiration date on the formula container

• Sterilize the bottles and nipples

• Washing bottle and nipples with soap and water or in the dishwasher is sufficient

• Follow package directions to prepare the formula

• Water supplies is not safe, mix the formula with boiled water

• Wash the formula container with soap and water before opening it

• Check temp of warm formula

• Use correct nipple size

• Wash hands before every feeding

• Angle the bottle

• Keep nipple filled with formula

• Stop and take burping and breaks

• Do not use a bottle sitting out for more than two hours

• Never force a baby to finish a bottle

• Do not let the baby fall asleep with a bottle in the mouth

Parents should be warned about the following practices that are not healthy or safe for the infant

• Infant cereal fed through a bottle - risk of choking

• Water or fruit juice given before six months of age

• Over diluting formula to reduce the expense

• Formula mixed with private water, not tested for safety

• Allowing a baby to sleep with a bottle in the crib