NSG 3111: Week 3 - Transition to Parenthood

Attachment and bonding

Process by which parent and child come to love and accept each other over time

En face position

Position in which the adult's face and the infant's face are approximately 8 inches apart and on the same plane, as when the mother holds the infant up in front of her face or when she nurses the infant

Entrainment

Process of synchronizing a biological rhythm to an environmental stimulus; infant moving with parent's voice

Biorhythmicity

The infant being in tune with the mother's natural rhythms; infant soothed by the maternal heart rate

Reciprocity and synchrony

Mutually gratifying interaction among mother, infant, father

False

True or false? Skin to skin and rooming in are essential to the development of parent-infant attachment

Breastfeeding

Direct transfer of human milk from the breastfeeding parent to the infant

Exclusive breastfeeding

Infant receives no other liquid or solid foods besides the breastmilk

Human milk feeding

Infant is fed expressed breastmilk from the breastfeeding parent or a donor milk bank

True

True or false? The WHO recommends that infants be exclusively breastfed for the first 6 months of life and past 6 months in combination with food

6 months

When should complementary foods high in iron be introduced?

1 year

When can you stop giving vitamin D supplement drops?

Newborn galactosemia

Genetic deficiency of the enzyme required to break down lactose and galactose; contraindication to breast feedings

True

True or false? Alcohol can disrupt the release of oxytocin and prolactin, decreasing breast milk production and availability

Galactogogue

Agent that promotes the flow of milk; ex. domperidone

False

True or false? Oligosaccharides are in both formula and breastmilk

Vitamin D, K, B12

BM contains all required vitamins except...

It's mineral content is too high

Why should you not feed babies cow's milk?

Prolactin

Facilitates milk production; produced from the anterior pituitary, prepares breast to synthesize/secrete milk, levels elevate throughout lactation

Oxytocin

Facilitates in moving the milk, produced from posterior pituitary

Milk ejection reflex

Release of breast milk in response to oxytocin, also called the let-down reflex

Nipple erection reflex

Helps stimulate the infant's palate to latch; initiated by oxytocin

Stage I of lactogenesis

Begins 16-18 weeks pregnancy to birth; colostrum

Stage II of lactogenesis

Begins with delivery of placenta (drop in progesterone and estrogen trigger prolactin release); day 3-5 colostrum transitions to transitional milk; day 5-10 rapid volume increase & transition to mature milk

Stage III lactogenesis

10-14 days after birth, mature milk established

Colostrum

Yellow-orange colored milk rich in antibodies and proteins, low in fat; laxative action

Transitional milk

Mixture of colostrum and mature breast milk

Foremilk

Type of mature milk contained at the beginning of the feed; increased water content

Hindmilk

Type of mature milk released later in the feeding (10-20 minutes in) which has increased fat and energy content

Early hunger signs

Awake/restless, licking/smacking lips, sticking out tongue, sucking on hands, rooting

Late hunger signs

Crying, agitation/distress, frantically turning head from side to side

Laid-back breastfeeding

Football hold

Cross cradle

You are holding the baby with the arm opposite to the breast they are feeding on; allows for more control of upper body

Cradling

You are holding the baby with the arm on the same side as the breast they are feeding on

Side-lying position

Purpose of manual expression

Enticing infant to feed, stimulating milk flow/priming milk ducts, collection for infants unable to breastfeed, relieving breast fullness, antiseptic for sore nipples

Nape of neck

Where should you place your hand when the supporting the infant's head during breastfeeding?

False

True or false? When educating the patient on breastfeeding, you should explain the rule of "breast to baby, not baby to breast."

Sign of milk transfer

'suck-suck-pause-swallow' and audible 'ca' sound when swallowing

Insert finger into baby's mouth

How does one break the latch when breastfeeding?

8 or more in 24

What should you teach the breastfeeding patient about the frequency of feedings?

20-30 minutes to 1 hour

How long is a typical feed?

NB satiation cues

Slowed suck/swallow patterns, fall asleep, come off breast, arms and legs extended

7% by day 3 (then gaining weight)

What percent of weight is lost in NBs?

2 weeks

By when should the newborn return to their birthweight?

1 void, 1-2 BM

How many voids and BMs should we expect to see from the newborn on day 1?

≤ 6 hours

How long can you leave freshly expressed breast milk out at room temperature?

2 hours

How long can you leave warmed EBM or breast milk that the infant has started feeding from out at room temperature?

≤ 5 days

How long can you leave EBM in the refrigerator?

≤ 6 months

How long can you leave EBM in the freezer within the fridge?

≤ 12 months

How long can you leave EBM in a deep freeze?

3-4 weeks

How long should you delay bottle feeding if you are doing combined (breast & bottle) feeding?

Causes of insufficient milk supply

Ineffective/infrequent feeds, breast surgery, medication side effects, stress/fatigue

Treatment of insufficient milk supply

Increase feeding frequency or breast pump, increase rest, promote adequate nutrition, introduce galactagogues (domperidone)

Engorgement

Swelling of the breasts resulting from increased blood flow, edema, and milk stasis

Treated by promoting milk removal, warm shower prior to feeding, cold compress bt feedings, frequent/effective feeds

Blocked ducts

Plugged or clogged milk ducts; palpable mass on breast; does not resolve with BF, localized pain

Caused by inadequate duct drainage, milk stasis

Treated by feeding frequently, changing feeding positions, massaging duct after feed

Mastitis

Can be unilateral or bilateral; inflammation and infection of mammary gland caused by milk stasis

Treated by

Candida

Yeast infection of breast caused by transfer from vaginal yeast infection, antibiotic use, or nipple damage

S&S: shooting pains in breast throughout the entire feed, rash on areola; thrush in baby's mouth, fussy, gassy

Treatment: antifungal agents for mother and baby, hand hygiene & keeping nipple dry to prevent

10-30 mL

How much formula should you feed the baby in the first 24-48 hours?

Signs of distress during formula feeding

Wide eyes, sputtering, drooling formula, repeated swallowing without pausing, turning head, arching back, moving arms

Premature or LBW newborns (risk of infection)

What population of newborns should not receive powdered formula for the first 2 months?

False

True or false? Microwaving formula is okay if there is no access to a bottle warmer or boiling water

After 48 hours

When should you discard ready-to-feed and concentrated formula that has been in the fridge after openeing?

After 24 hours

When should you discard powdered formula that has been in the fridge after preparing?

Within 1 hour

When should you discard any remaining formula in the bottle after a feed?

>6 months

When can solid foods be introduced?