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108 Cards in this Set
- Front
- Back
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What is the importance of good nutrition in infancy?
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Fosters optimal growth and development
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What are the functions of infant feeding?
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1. Provision of nutrition
2. Opportunity for social, psychologic, and educational interaction between parent and infant 3. Establish a basis for developing good eating habits that last a lifetime |
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What is colostrum?
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The fluid in the breast from pregnancy into the early postpartal period. It is rich in antibodies, which provide protection from many diseases; high in protein, which binds bilirubin; and laxative-acting, which speeds the elimination of the meconium and helps loosen mucus
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What is engorgement?
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Distention or vascular congestion. In obstetrics, the process of swelling of the breast tissue brought about by an increase in blood and lymph supply to the breast, which precedes true lactation. It lasts about 48 hours and usually reaches a peak between the third and fifth postbirth days.
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What is foremilk?
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Colostrum
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What is mastitis?
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Infection in a breast, usually confined to a milk duct, characterized by influenza-like symptoms and redness and tenderness in the affected breast
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What is milk-ejection reflex (MER)?
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Release of milk caused by the contraction of the myoepithelial cells within the milk glands in response to oxytocin
(also called LETDOWN REFLEX) |
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What is non-nutritive sucking?
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Sucking by infants of nonfood items (thumb, pacifier, etc.)
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What is oxytocin?
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Hormone produced by the posterior pituitary that stimulates uterine contractions and the release of milk in the mammary gland (letdown reflex)
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What is prolactin?
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A pituitary hormone that triggers milk production
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What are the benefits of breastfeeding?
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1. Enhances maturation of the GI tract and contains immune factors that contribute to a lower incidence and severity of diarrheal illness, necrotizing enterocolitis, Crohn's disease, and celiac disease
2. Antibodies and cell-mediated immunologic factors that help decrease the incidence and severity of otitis media, respiratory illnesses, UTIs, bacteremia, and bacterial meningitis 3. Protection against development of eczema, asthma, lymphoma, leukemia, and IDDM 4. May enhance cognitive development and jaw development, which decreases problems with malocclusions and malalignment of teeth 5. Decreases risk of childhood obesity 6. Saves money ETC.... |
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What is a major barrier of breastfeeding for many women?
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Influence of family and friends, especially for lower-income mothers
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What are the contraindications of breastfeeding?
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1. Newborns who have galactosemia
2. Mothers with active TB or HIV infection 3. Mothers are positive for human T-cell lymphotrophic virus type I or type II 4. Mothers with active herpes lesions on their breasts 5. Mothers receiving chemotherapy of radioactive isotopes 6. Mothers who abuse "street drugs" |
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What is the key to encouraging mothers to breastfeed?
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Education, beginning as early as possible during pregnancy and even before pregnancy
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What is common in nonindustrialized countries?
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Breastfeeding, with durations that extend well beyond the first year
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Why have immigrants adopted formula feeding in the U.S.?
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Because they believe that the method is more "modern" therefore better, or they want to adapt to the U.S. culture and perceive that it is the custom to formula feed. Additionally, they make lack the family support to breastfeed.
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What is the onset of breastfeeding?
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Varies among cultures - some do not feed during colostrum, some breastfeed each time infant cries, some practice food traditions before each feeding, etc.
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What is important in many Asian cultures regarding breastfeeding?
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The balance between energy forces, hot and cold, or yin and yang is integral to the diet of the lactating mother
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What is the fluid requirements for normal infants?
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100 to 140 ml of water per kg of body weight per 24 hours
(100-140 ml/kg/day) |
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How much water does breast milk contain?
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87%, which easily meets fluid requirements
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How do infants lose water?
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Through excretion of urine and insensibly through respiration
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What are the energy needs of infants?
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1. During first 3 months -- 110 kcal/kg/day
2. From 3 to 6 months -- 100 kcal/kg/day 3. From 6 to 9 months -- 95 kcal/kg/day 4. From 9 months to 1 year - 100 kcal/kg/day |
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How much energy does human milk provide?
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20 kcal/oz
OR 67 kcal/100 ml |
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What is the average daily intake of carbohydrates for infants?
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10 to 30 g/kg
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What is the most abundant carbohydrate in the diet of infants up to age 6 months?
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Lactose
(because it is the primary CHO in human milk and cow's milk) |
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What CHO is important in the development of microflora in the intestinal tract of the newborn?
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Oligosaccharides
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What is the benefit of oligosaccharides?
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These prebiotics promote an acidic environment in the intestines, preventing the growth of gram-negative and other pathogenic bacteria, thus increasing the breast-fed infant's resistance to GI illness
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What is the daily fat intake for infants?
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5 to 7 g/kg/day
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Is fat in human milk or cow's milk easier to digest?
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Human milk
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What essential fatty acids are found in human milk?
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1. Linoleic acid
2. Linolenic acid 3. Arachidonic acid (ARA) - long chain polyunsaturated fatty acids 4. Docosahexaenoic acid (DHA) |
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Why are fatty acids important?
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Helps in the development of cellular membrane and are particularly important in eye and brain development
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What is the recommended daily allowance of protein for infants during the first 6 months?
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2.25 to 4 g/kg
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What is the protein content of human milk?
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Lower than that of unmodified milk, but is ideal for newborns
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What is the primary protein found in human milk?
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Whey, mainly consisting of lactoalbumin, lactoferrin, secretory immunoglobulin A (IgA), and enzymes (e.g. lysozyme and lipase)
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What is the function of immunoglobulin A (IgA)?
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The immunologic properties of IgA provide protective effects against diarrhea and other infectious illnesses
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Why is vitamin K required?
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For blood coagulation, to prevent hemorrhagic problems in newborns
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What produces vitamin K?
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Intestinal bacteria
(except newborns have sterile guts at birth, which is why they are injected with vitamin K after birth in the hospital) |
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What is the ratio of calcium to phosphorus in human milk?
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2:1, a proportion optimal for bone mineralization
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What problems can arise if infant's are fed unmodified cow's milk?
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Hypoglycemia, seizures, and tetany
(because cow's milk have a low ratio of calcium to phosphorus) |
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What is the ratio of calcium to phosphorus in commercial infant formula?
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In between that of human milk and cow's milk
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What is the level of iron in milk/formulas?
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LOW, but iron from human milk is better absorbed (50%) than that from cow's milk, iron-fortified formula, or infant cereals
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What is the benefit for an infant entirely breastfed during the first 6 months?
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Normally maintains adequate hemoglobin levels
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What is the composition of the female breast?
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1. Approximately 15 to 20 segments (lobes) embedded in fat and connective tissue
2. Well supply of blood vessels, lymphatic vessels, and nerves 3. Alveoli, the milk-producing cells 4. Myoepithelial cells, which contract to send milk forward to the ductules 5. Each ductule enlarges into lactiferous ducts and sinuses, where milk collects behind the nipple 6. Each nipple has 15 to 20 pores through which milk exits |
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What are the milk-producing cells?
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Alveoli
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What cells contract to send milk forward to the ductules of the breast?
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Myoepithelial cells
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When are prolactin levels highest?
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During the first ten days after birth
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What is a supply-meets-demand system?
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As milk is removed from the breasts, more is produced
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What hormone is responsible for the milk ejection reflex (MER)?
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Oxytocin
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What can trigger the MER?
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Thoughts, sights, sounds, or odors that the mother associates with her baby (or other babies), such as hearing the baby cry
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When else can let-down occur?
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During sexual activity because oxytocin is released during orgasm
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What stimulates uterine contractions during labor?
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Oxytocin
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What helps shrink the size of the uterus after giving birth?
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Breastfeeding
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What is the major antibody in human milk?
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Immunoglobulin A (IgA)
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What factors in human milk help to protect against infection?
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1. Lactoferrin
2. The bifidus factor 3. Oligosaccharides 4. Milk lipids 5. Milk leukocytes |
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What factors in human milk contribute to the maturation of the infant's intestines?
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1. Antiinflammatory agents
2. Growth factors 3. Hormones 4. Enzymes |
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What is colostrum?
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A clear, yellowish fluid that is more concentrated than mature milk and is extremely rich in immunoglobulins. It has higher [ ]'s of proteins and minerals but less fat than mature milk. The high protein level facilitates binding of bilirubin, and the laxative action promotes early passage of the meconium.
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What are some feeding-readiness cues of infants?
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1. Hand-to-mouth or hand-to-hand movements
2. Sucking motions 3. Rooting 4. Mouthing |
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How much milk in consumed by infants per feeding?
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1. 15 to 30 mL during first 24 hours of life
2. 60 to 90 mL by end of first week |
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What is the tongue extrusion reflex?
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An innate reflex in which infants will push out of the mouth anything that is placed on the tongue
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When does the tongue extrusion reflex disappear?
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By 6 months of life - indicating a physiologic readiness for solids
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What are the indications for introduction of solid foods?
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1. Increased capacities for salivary, gastric, pancreatic, and intestinal digestion
2. Disappearance of the tongue extrusion reflex |
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What is latch-on?
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Attachment of the infant to the breast for feeding
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What is the infant assessed for during feedings?
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1. Latch-on
2. Position, alignment 3. Sucking and swallowing |
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What interventions promote successful breastfeeding?
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1. Basics such as latch-on and positioning
2. Signs of adequate feeding 3. Self-care measures such as prevention of engorgement |
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What are the types of positions for breastfeeding?
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1. Football hold
2. Cradle 3. Modified cradle or across-the-lap 4. Side-lying position |
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Which position should be initially used?
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The one that easily facilitates latch-on while allowing maximal comfort for the mother
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What is the football hold?
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Infant is tucked underneath arm during suckling. This position is often recommended for early feedings because the mother can easily see the baby's mouth as she guides the infant to the nipple. Usually preferred by mothers who gave birth by cesarean.
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Which position works well for early feeding, especially with smaller babies?
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Modified cradle or across-the-lap
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What position allows the mother to rest while breastfeeding?
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Side-lying position
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What position is often preferred by women with perineal pain and swelling?
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Side-lying position
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What position is the most common for infants who have learned to latch on easily and feed effectively?
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Cradling position
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What is important for the mother to do during breastfeeding?
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Support the baby's neck and shoulders with her hand and not push on the occiput
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Why should mothers avoid pushing on the occiput while breastfeeding?
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Pushing on the back of the head may cause the newborn to bite, hyperextend the neck, or develop an aversion to being brought near the breast
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What is the correct alignment of the baby during breastfeeding?
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Ears, shoulders, and hips are in a straight line
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How is latch-on assessed to be successful?
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1. The mother reports a firm tugging sensation on her nipples, but no pinching or pain
2. The baby sucks with cheeks rounded, not dimpled 3. The baby's jaw glides smoothly with sucking 4. Swallowing is audible |
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How is the infant removed from the breast to prevent nipple trauma?
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The mother should break the suction by inserting a finger in the side of the baby's mouth between the gums and leaving it there until the nipple is completely out of the baby's mouth
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What signs indicate that let-down, or milk ejection, has occurred?
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1. Mother has ingling sensation in the nipples
2. Baby's suck changes from quick, shallow sucks to a slower, more drawing, sucking pattern 3. Swallowing is heard as the baby sucks 4. Mother feels uterine cramping and may have increased lochia during and after feedings 5. Mother feels relaxed, even sleepy, during feedings 6. The opposite breast may leak |
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What is the frequency of feedings?
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8 to 12 times in a 24-hour period
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What is demand feeding?
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The infant determines the frequency of feedings
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What is the duration of feedings?
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Average time of 30 to 40 minutes, or approximately 15 to 20 minutes per breast
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What are the indicators of effective breastfeeding?
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1. Baby is alert when awake and appears hydrated with normal skin turgor and moist mucosa
2. Fontanels are soft and flat 3. Infant is breastfed 8 to 12 times a day 4. Baby latches on easily and sucks with gliding jaw movements in bursts of 10 to 12 sucks 5. Swallowing is audible 6. Infant should have frequent stools 7. Nipples are intact 8. Breasts are full, soft, and without engorgement 9. Mother should have no fever 10. No pain during breastfeeding |
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What are the behavioral signs or feeding cues?
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1. REM under the eyelids
2. Sucking movements 3. Hand-to-mouth motions |
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What techniques can be used to wake a sleepy newborn?
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1. Lay the baby down and unwrap
2. Change the diaper 3. Hold the baby upright, turn from side to side 4. Talk to the baby 5. Gently, but firmly, massage the chest and back 6. Rub the baby's hands and feet 7. Do baby "sit-ups". Gently rock the baby from a lying position to a sitting position and back again until the eyes open 8. Adjust lighting up for stimulation or down to encourage the baby to open eyes 9. Apply cool cloth to face |
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What are ways to calm a fussy baby?
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1. Swaddle the baby
2. Hold closely 3. Move or rock gently 4. Talk soothingly 5. Reduce environmental stimuli 6. Allow baby to suck on adult finger 7. Place baby skin-to-skin with mother |
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What can fussiness cause?
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GI distress
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What is the normal weight pattern of newborns?
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1. Typically lose about 5% of body weight before showing weight gains
2. Thereafter, normal weight gain of 140 to 200 g/week or 20 to 28 g/day for the first three months |
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What amount of weight loss warrants investigation?
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7%
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What are causes for slow weight gains in newborns?
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1. Inadequate breastfeeding
2. Maternal factors such as stress and fatigue that negatively affect milk production 3. Increased energy needs of newborn due to congenital heart disease, cystic fibrosis, or simply being SGA |
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What are the solutions to slow weight gain?
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Improve the feeding technique. Positioning and latch-on are evaluated, and adjustments are made. It may help to add an additional one or two feedings to the day.
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What is the breast massage technique?
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The mother massages her breast from the chest wall to the nipple whenever the baby has sucking pauses in order to increase the fat content of the milk and promote weight gain
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What is early breast milk jaundice?
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Jaundice associated with insufficient breastfeeding and infrequent stooling. Colostrum has a natural laxative effect and promotes early passage of meconium.
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What factors can interfere with effective breastfeeding?
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1. Sleepy or lethargic baby
2. Breast engorgement |
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What is late-onset jaundice?
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Jaundice developed in the second week of life, and all pathologic causes of jaundice have been ruled out. Typically, the newborn is thriving, gaining weight, and stooling normally.
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What is the ideal food for preterm infants?
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Human milk
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Why is human milk the ideal food for preterm infants?
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Because breast milk enhances retinal maturation in the preterm infant and improved neurocognitive outcome. It also decreases the risk of necrotizing enterocolitis.
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How is an optimal milk supply established?
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The mother should use a dual collection kit and pump 8 to 10 times daily for 10 to 15 minutes
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How long can breast milk be safely stored?
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In glass or plastic containers:
1. Up to 8 hours at room temperatures 2. Up to 5 days in the refrigerator (but not on the door) 3. Between 3 to 6 months in the freezer (but not on the door) 4. Between 6 to 12 months in a deep freeze (ZERO degrees Celcius) |
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When should weaning occur?
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When babies are introduced to foods other than breast milk
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How long does weaning take?
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Gradually, over a period of weeks or months
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How many calories should women who are breastfeeding eat?
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2700 kcal
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What is important to remember about dietary teaching?
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1. To consider the mother's family situation, cultural beliefs, socioeconomic status, and individual energy and nutrient needs
2. Ensure adequate amounts of calcium, minerals, and fat-soluble vitamins, as well as prenatal vitamins |
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What agents should not be applied/used on the nipples?
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1. Soap - cause dryness
2. Breast creams - clog up the Montgomery glands on the areola 3. Alcohol - cause dryness 4. Vitamin E oil - may cause toxic effects to infant since it is a fat-soluble vitamin |
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What is engorgement?
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Painful overfilling of the breasts, which can occur as a result of frequent or ineffective emptying of the breasts
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What is mastitis?
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The sudden onset of flulike symptoms such as fever, chills, body aches, and headache
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What ingredients are added to commercial formula to be similar breast milk?
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1. Iron
2. Nucleotides 3. Long-chain polyunsaturated fatty acids (LCPUFAs) 4. Probiotics |
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What is the purpose of probiotics?
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Promote the development of fecal flora and enhance the intestinal immune response
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Why is unmodified cow's milk not suited for the nutritional needs of infants during the first year of life?
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1. Excessive amounts of calcium, phosphorous, and other minerals
2. An imbalance of calcium and phosphorous 3. Excessive protein content 4. Poor absorption of the fat in cow's milk 5. Low iron concentration |
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Why is breast milk "better"?
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There is a proper balance of CHO, protein, and fat to grow properly
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