Newborn Feeding

The American Academy of Pediatrics (AAP) provides guidelines on infant nutrition.
- Exclusive breastfeeding is recommended for the first 6 months of life.
- Breastfeeding should continue for at least 12 months and thereafter as desired by mother and infant.
- Complementary foods can be introduced after 6 months of age.
- Mothers often tend to use the same feeding method for all their children.

Rates of breastfeeding have risen steadily over the past decade:
- 76% initiation of breastfeeding in hospitals.
- 47% of infants are breastfed at 6 months of age.
- 25% continue breastfeeding at 12 months of age.
Healthy People 2020 goals establish targets for breastfeeding:
- 81% of infants should experience any breastfeeding during their hospital stay.
- 60% of infants should be breastfed at 6 months.
- 34% should be breastfed at 12 months.

Various cultures impact choices in infant feeding methods:
- Hispanic women: Breastfeeding (BF) is the norm.
- African-American families: More likely to formula-feed.
- Muslim and Jewish cultures: Value breastfeeding highly.
- Cultural knowledge and comfort in social settings can affect breastfeeding choices.

Parents may opt for formula feeding without complete information.
- Myths and misconceptions about breastfeeding can mislead decisions.
- Breastfeeding may be perceived as socially embarrassing for some.
- Formula feeding allows other family members to participate in feeding.
Mothers participating in the Women, Infants, and Children (WIC) program are more likely to formula-feed.
If formula feeding is chosen, it is important to teach mothers methods to dry up milk supply.

Lactogenesis involves the hormonal regulation essential for lactation:
- Oxytocin is produced when the nipple is stimulated by suckling.
- This hormone is synthesized in the posterior pituitary, as prompted by the hypothalamus, and is responsible for the milk-ejection reflex (MER).
- Stimuli can also include thoughts, sights, or sounds related to the baby.
To support breastfeeding, mothers typically need approximately 500 calories per day.
Mothers must identify foods that infants may not tolerate, such as spicy foods and garlic.

Colostrum is the first secretion that is produced from day 1 to 3:
- Clear, yellowish fluid that is more concentrated than mature milk.
- Extremely rich in immune globulins.
- Higher protein and mineral concentration, but lower fat than mature milk.
The composition of breast milk changes throughout each feeding:
- The initial milk produced, known as foremilk, is lower in fat.
- As breastfeeding continues, the milk transitions to hindmilk, which is richer in fat.
Milk production increases as the infant grows, with growth spurts typically occurring at:
- 10 days, 3 weeks, 6 weeks, 3 months, and 6 months.
Indicators of adequate nutrition for infants include:
- 6 to 8 wet diapers per day.
- 2 to 3 loose bowel movements per day.
- Regaining birth weight by day 10-14.
- Steady weight gain thereafter.
The principle of supply and demand applies: more nursing leads to increased milk production.

Support for breastfeeding mothers includes:
- Education and anticipatory guidance during prenatal classes.
- Organizations like La Leche League and Mocha Moms.
- WIC provides resources and support.
- The Baby-Friendly Hospital Initiative promotes practices that support breastfeeding.

Common issues that breastfeeding mothers may face:
- Engorgement: Swelling and pain in the breasts due to full milk supply.
- Sore nipples: Often a concern for new mothers.
- Insufficient milk supply: A worry for many, needing education and support to address.
- Plugged milk ducts: Can occur and need proper care to resolve.
- Mastitis: An infection that can affect breastfeeding.
Importance of follow-up care after hospital discharge to address these concerns.

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