Infant Nutrition

Breast feeding

Milk Formula Feeding

References.

Leifer, G. (2011). Introduction to maternity and pediatric nursing. (6th edition). Philadelphia:Saunders.

Ministry Of Health ( 2009) Food and nutrition guidelines for healthy pregnant and breastfeeding.

Breastfeeding

1. Physiology of Breast Milk Production and breast feeding

2. Advantages of Breast Feeding

3. Assessing newborn to determine adequate

nutrition

4. Formula Milk (Bottle) Feeding.

5. WHO /UNICEF. Baby Friendly Hospital Initiative, 10 Steps Policy.

6. NZ Breast Feeding Targets.

• Advantages of Breast Feeding: Baby

Meets the baby’s nutritional needs for 1st 4-6 weeks.

Species specific milk

that matches digestive

and metabolic processes

and requirements for

growth

• Advantages Baby

-enhances jaw and dental development

-has control over amount of milk taken

-meets needs of physical and emotional closeness, and promotes bonding and increase in maternal caretaker behaviors

-has low bacterial contamination

-reduces risk of food allergies

-may reduce SUDI

Optimal ratios of the fatty acids required for eye and brain development.

contains secretory

immunioglobulin A (IgA).

• Possible Disadvantages.

-may carry microorganisms, hepatitis, cytomegalovirus (but risk is small)

-HIV

-illicit and prescription drugs

-herpes on mothers nipples

• Advantages to Mother

-promotes uterine contraction

-lactation amenorrhea

-does not require storage

-may improve postpartum weight loss

-ecological and economic benefits

-lowered incidence of pre-menopausal breast cancer, ovarian cancer, bone loss and maternal depletion.

• Education and Support Groups

-98% of women are physiologically capable of breast feeding

-while lactation is a natural process, breastfeeding is a learned skill

-application of principles of teaching and learning apply

-nurses role is that of facilitator of best support person for the mother

• Revise anatomy of breast

-milk glands of breast divided into approx 20 lobes (see OHT)….acini cells produce milk.

-lactiferous sinus, with small lactiferous ducts carry milk from lobes to the nipple.

-areola dotted with Montgomery’s follicles.

-ampulla, small sac stores and releases milk into nipple holes

-alveoli at end of each lactiferous duct.

• Anatomy of the breast

Physiology of Milk Production.

Mother: After delivery of placenta, progesterone level falls, stimulates production of prolactin...acts on acini cells to stimulate milk production. (see OHT Fig. 9)

Oxytoxin (milk ejection ‘let down’) (OHT Fig11).

Baby: rooting reflex • sucking reflex• swallowing reflex

• Lactation: Three stages of human milk production

1. Colostrum

2. Transitional milk

3. Mature milk:

For-milk

Hind-milk

Has effect of producing less nitrogen waste from protein metabolism which has a positive effect on baby’s immature renal system.

• Successful breastfeeding usually results where:

-mother wants to breast feed, is relaxed and is given support.

(privacy, education and encouragement).

Successful breastfeeding

-correct attachment of the baby, attaching the baby over the nipple onto the areola, sucking at the end of the nipple results in sore cracked nipples.

-

Successful breast feeding

correct detaching. (a strong suction is created from the baby. Place a finger to the side of the nipple and the baby’s mouth to break the suction).

Successful breastfeeding

“demand and supply”

-remembering that breast feeding operates with a “demand and supply principle.”

“sucking”

It is the sucking at the breast by the baby which creates and maintains the supply of milk.

Feeding infants “on demand versus “clock related”

• http://www.youtube.com/watch?v=2RHIb_-a6bg

A mother may express breast milk for a variety of reasons:

-baby’s pre-maturity,

-abnormalities of the face

-illness

-lifestyle when she is away from the baby for a time.

.

Expressed breast milk

-expressed breast milk needs

to be stored safely in the

fridge (24 hours)

or up to 3-4 months

in the freezer.

-store using plastic

(not glass) containers.

label carefully as EBB with the date and time of expression.

-thaw without heating

-discard any left over after warming for a baby’s feed

WHO and NZ Health Goals: Breast Feeding

• NZ rates behind such countries as India, Nepal, and Bangladesh in breast feeding stakes. (Kennedy, 1997,cited Beasley etal, 1998).

1990 Innocenti Declaration, adopted by WHO and UNICEF.

• Directs governments to implement strategies which ensure that “all infants (would) be fed exclusively on breast milk up to 4-6 mths of age and to set appropriate targets for the 1990’s.

WHO/UNICEF B.F.H.I. Ten Steps

Establish written policy

Educate all Health care staff in skills required

Inform all pregnant women re benefits and management of BF

Help women within 1/2 hr of birth

Show mothers how to breast feed

Give new born infants only breast milk

Practice Rooming in 24 hour a day

Encourage breast feeding on demand

Give no pacifiers to breast feeding infants

Foster establishment of breast feeding support groups and refer mothers to them on discharge

New Zealand has many Baby Friendly Institutions

• http://www.health.govt.nz/publication/national-strategic-plan-action-breastfeeding-2008-2012

• Breast Feeding Support Groups

-La Leche League

-Parents Centres

-Royal NZ Plunket Society

-The NZ Lactation Consultant’s Association

-Journals. e.g.. La Leche Mosaic, Occupational Safety and Health Service, New and Expectant Mothers at Work: Guidelines.

-Internet. e.g.wwwprairenet.org/laleche

• Assessing newborn to determine adequate nutrition and hydration.

-sleeps between feeds

-loses no more than 10% of birth weight

-increases in weight

-good skin turgur

-moist mucosa

-fontanelle is flat and not sunken or raised

-fluid needs: 150-200 mls/kg/24 hours

-passes urine

• Formula / breast milk substitutes. -scientifically designed to try to match human

breast milk as much as possible. (excludes gamma globulins)

-commercially modified breast milk substitutes include:

-SMA Enfamil, vitamilk, Nurture, Karitane. Prosobee, Enfasoy

Fluid requirements for baby to meet hydration, growth and nutrition needs

= 150-200mls/kg/24hours.

When you are preparing milk formula for a baby you must be really, really careful to make according to the instructions on the side of the tin or bottle.

Explain.

• There are a few ways of sterilising bottles and teats and equipment used when reconstituting (making up) milk formula (including boiling, steaming, chemical solutions….)

• It is really important that you can describe these ways in detail (from the initial rinsing to the actual sterilising ready for use.

• For your project you are required to write about ways to sterilise bottles and teats, using references

• How much? How often?

• Example.• Fluid. A 4kg baby needs 4x150 mls=600 over 24

hours.• Calories: 120 kcal/kg• This means probably 8-12 breast feeds or …for

a formula fed baby, 6 feeds of 100mls every 4 hours.

Tutorial time:

Sally wants to learn how to breast feed her baby.

She asks you if you can help.

Explain how you would create a suitable environment for Sally to begin to breast feed. What information does Sally need to learn about breastfeeding?

Find out and explain various ways of sterilising teats, bottles, formula making equipment , dummies and expressed milk pumps.