Chapter 24

Chapter 24: Newborn Nutrition and Feeding

Author: Vicky White MSN, RNC-LRN

Recommended Infant Nutrition

The American Academy of Pediatrics (AAP) sets forth guidelines suggesting that infants should be exclusively breastfed for the first 6 months of life. Breastfeeding is encouraged to continue for at least 12 months, and thereafter for as long as mutually desired by mother and child. Complementary foods may be introduced after 6 months of age, reflecting a gradual transition from exclusive breastfeeding to incorporating solid foods into the infant's diet. Moreover, it is observed that mothers often tend to choose the same method of feeding for all of their children, which indicates a pattern of decision-making influenced by previous experiences.

Breastfeeding Rates

In recent years, breastfeeding rates have shown a steady increase. Currently, the initiation of breastfeeding in hospitals stands at 76%. However, the ongoing rates reflect a decline, with 47% of infants being breastfed at 6 months of age, and only 25% at 12 months. The Healthy People 2020 initiative set ambitious goals aiming for 81% initiation of breastfeeding during hospital stays, 60% at 6 months, and 34% at 12 months.

Choosing an Infant Feeding Method

Cultural Influences

Diverse cultural backgrounds significantly impact infant feeding practices:

  • Hispanic Women: Breastfeeding is the norm within this cultural group.

  • African-American Families: There is a noted tendency towards formula feeding.

  • Muslim and Jewish Cultures: Both cultures place a high value on breastfeeding.

It is essential for mothers to possess cultural knowledge about breastfeeding and to feel comfortable in social settings while practicing it.

Decision to Formula-Feed

The choice to formula-feed often stems from a lack of complete information. There are prevalent myths and misconceptions regarding breastfeeding, leading some to perceive it as embarrassing. Additionally, formula feeding allows for other family members to partake in feeding the baby. Research indicates that mothers enrolled in the Women, Infants, and Children (WIC) program may be more likely to opt for formula feeding. For mothers choosing formula feeding, guidance should be offered on how to effectively reduce milk supply.

Contraindications of Breastfeeding

Certain medical conditions and circumstances may contraindicate breastfeeding. They include:

  • Maternal cancer therapy or use of diagnostic and therapeutic radioactive isotopes.

  • Active tuberculosis not being treated.

  • Human Immunodeficiency Virus (HIV) positive mothers.

  • Maternal herpes simplex lesions on a breast.

  • Galactosemia diagnosed in the infant.

  • Varicella virus in the mother.

  • Maternal substance abuse.

  • Maternal Human T-cell leukemia virus type 1 or type 2.

  • Some medications that are incompatible with breastfeeding.

Anatomy and Physiology of Lactation

Lactogenesis

Lactogenesis refers to the processes involved in the production of milk. A crucial hormone in this process is oxytocin, which is released by the posterior pituitary gland upon stimulation of the nipple during breastfeeding. The hypothalamus prompts the posterior pituitary to secrete oxytocin, facilitating the milk-ejection reflex (MER). Interestingly, visual or auditory stimuli linked to the baby can also trigger milk letdown.

To meet the nutritional demands of breastfeeding, mothers typically need to consume an additional approximate 500 calories per day during lactation. Furthermore, it is important for mothers to learn which foods may be intolerable for their infants, such as spicy or garlic-rich foods.

Milk Composition

Human milk has unique characteristics, notably:

  • Colostrum: This is the first milk produced in a clear, yellowish form during days 1 to 3 postpartum. It is more concentrated than mature milk and exceptionally rich in immune globulins, providing essential immune support to the infant. Colostrum also has a higher concentration of protein and minerals, yet contains less fat than mature milk.

  • Foremilk and Hindmilk: The composition of milk changes throughout a feeding session. The initial milk, known as foremilk, is lower in fat, while the milk toward the end, referred to as hindmilk, is richer in fat.

Milk production is dynamic and increases as the baby grows, typically experiencing growth spurts at notable intervals (10 days, 3 weeks, 6 weeks, 3 months, and 6 months). Many parents express concerns about whether their baby is receiving adequate nutrition. Indicators of sufficient intake include the baby having 6-8 wet diapers daily, 2-3 loose bowel movements a day, regaining birth weight by days 10 to 14, and consistent weight gain thereafter. The supply-demand principle of breastfeeding suggests that increased nursing leads to increased milk production.

The Breastfeeding Mother and Infant

Supporting Breastfeeding Mothers

To successfully support breastfeeding, education and anticipatory guidance is paramount. Resources include:

  • Prenatal classes aimed at preparing expecting mothers for breastfeeding.

  • Support groups such as La Leche League and Mocha Moms can provide community support and information.

  • The WIC program often includes resources to promote breastfeeding.

  • The Baby-Friendly Hospital Initiative endorses practices and policies that improve breastfeeding rates and experiences.

Expressing and Storing Breast Milk

Mothers may need to express and store breast milk for various reasons. Techniques include:

  • Hand expression.

  • Mechanical milk expression using pumps.

  • Different types of milk pumps available on the market.

  • Guidelines for proper storage of expressed breast milk to ensure it remains safe for the infant.

Additionally, considerations must be made for mothers who are working and wish to continue breastfeeding. Topics of weaning and milk banking are also important aspects of applying breastfeeding knowledge.

Maternal Care During Lactation

The well-being of the breastfeeding mother is crucial. Component areas of care include:

  • Dietary needs specific to lactating mothers.

  • Management of breast health.

  • Effects of breastfeeding on contraception practices.

  • Considerations for breastfeeding during subsequent pregnancies.

  • Addressing obesity-related concerns in breastfeeding mothers.

  • Safe medication use during lactation and the effects of substances such as smoking, alcohol, caffeine, and herbal preparations on breastfeeding.

Common Concerns Among breastfeed mothers

Breastfeeding challenges may include:

  • Engorgement of the breasts.

  • Sore nipples experienced during feeding.

  • Insufficient milk supply as a concern for new mothers.

  • Plugged milk ducts creating discomfort.

  • Occurrence of mastitis, an inflammation of breast tissue, when not addressed.

Additionally, it is important to schedule follow-up appointments after hospital discharge to monitor maternal and infant health closely.

Practical Scenario and Assessment

In a practical scenario, parents are encouraged to provide breast milk for their prematurely born infant, who was born at 32 weeks of gestation. The instructional nurse must assess the parents' understanding of lactation. Relevant statements about lactation include:

  • It is valid to state that a premature infant can more easily digest breast milk than formula.

  • Conversely, saying that a glass of wine just before pumping will help reduce stress and anxiety is misleading.

  • Pumping limitations should be addressed, emphasizing that the mother should only pump as much as the infant can drink.

  • Finally, pumping should occur every 2 to 3 hours, including during nighttime hours, to maintain milk supply.

References

Perry, S.E., Lowdermilk, D.L., Cashion, K., Rhodes, K., Olshansky, E.F., Hockenberry, M.J., Wilson, D., Rodgers, C.C. (2018). Maternal Child Nursing Care (6th ed.). Elsevier: St. Louis, MO.