Valerie Hill - Nutrition

Nutrtional Guidelines for Infant

Exclusive breastfeeding (i.e only breastmilk and potentially supplements) for the first 6 months of life. Nutrient rich complementary foods (esp high in iron. Ex: spinach puree) should be introduced at 6 months, but breastmilk should continue to be given until 2 years or longer. If weaned off before 12 months, infants should receive iron rich formula.

Caloric Requirements for Breastfed Newborns

• 85-100cal/kg/day

Caloric Requirements for Formula Fed Newborns

• 100-110/cal/kg/day

Human Milk/Formula Cals/100ml

67cal/100ml

Carb Requirements for Newborns

60g/day for first 6 mos and 95g/day for next 6 mos. 40-50% of cals must come from carbs.

Fat Reqirements for <6mos

31g/day

Vit D

Breast milk contains all vitamins except Vit D so infants should receive 10mcg of Vit D a day.

How often do infants breastfeed

Every 4ish hours or 8 times a day

Breast Anatomy

• A breast is composed of 15-25 lobes/sections that are embedded in the fat. 

  • Lobes contain glandular tissue which contains alveoli (milk producing cells). Alveoli are surrounded by myoepithelial cells which contract to push the milk produced towards the nipple. 

  • A lactating breast has double the glandular tissue than the adipose tissue. A non lactating breast has equal amounts of both.

  • Milk ducts transport milk from the alveoli to the nipple.

Patho of Lactogenesis

Fall in progesterone after birth → Release of prolactin from anterior pituitary → Promotes milk production and secretion → infant feeds → more prolactin secretion + oxytocin secretion to promote let down (myoepithelial cells contract)

Lactogenesis Stage I, II, and III

• Lactogenesis Stage I: Colostrum is secreted in the first few days. It is higher in protein and lower in fat, which helps facilitate the binding of bilirubin, and also acts as a laxative, and also promotes lactobacillus flora.

• Lactogenesis Stage II: Milk coming in. Transition milk. Lasts 10ish days

• Lactogenesis Stage III: Mature milk established

LATCH Tool

• L: Latch on characteristics

• A: Audible swallowing

• T: Type of nipple

• C: Comfort of mother

• H: Holding skills.

Voids and Stooling patterns

• Voids: Wet diapers = number of days old up to 6 days

• Stools: 1 stool/day in the first 2 days greenish brown meconium. 3-6 from days 3-7 that is transition stool. 5-10+ yellow stools from 1 week onwards. As the infant gets older stooling patterns may decrease similar to that of an adult.

Meds for Increasing Breast Milk Supply

• Metoclopramide and domperidone are medications used to increase prolactin levels.

PURPLE Crying

• P: Peak of crying (babies cry more each week and peak at 2 months)

• U: Unexpected

• R: Resists soothing

• P: Pain like face

• L: Long lasting

• E: Evening