Hatfield PPT CH 15

Chapter 15
Newborn Nutrition
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Newborn Nutrition
• At birth, the passive intake of nutrition ends and the

newborn must actively consume and digest food
• Newborn has unique nutritional needs
• Healthy term newborn requires
– 80 to 100 mL/kg/day of water to maintain fluid
balance and growth
– 100 to 115 kcal/kg/day to meet energy needs for
growth and development

Selection of a Feeding Method
• Two main types of nourishment suitable for the healthy

term newborn
– Breast milk
– Commercial formula
• Two delivery methods:
– Breast and bottle

Selection of a Feeding Method (cont.)
• Feeding method choices:

– Breast-feed exclusively
– Breast-feed and supplement with expressed breast
milk in a bottle
– Breast-feed and supplement with formula
– Formula-feed exclusively

• Factors that influence choice of method

– Culture
– Sociodemographic factors
– Prior experience with or exposure to breast-feeding
– Intent or need to return to work or school

• Factors that influence choice of method (cont.)
– Culture
• Acceptability of breast-feeding in public
• Amount and quality of family and community
support for breast-feeding
• When a woman initiates breast-feeding
• How many times per day a woman breast-feeds
• Whether or not a woman supplements
• When a woman stops breast-feeding

– Culture (cont.)
• In the United States
– Women receive mixed messages
– General bias toward bottle-feeding
– Advertising by formula companies

– Culture (cont.)
• In the United States (cont.)
– 83% (highest): Asian or Pacific Islander descent
– 59% (lowest): Non-Hispanic African American
women
– Hispanic or Latino: Higher initiation rates (81%)
than white women at 77%
– Hispanic women are more likely to breast-feed if
they are of Mexican descent and have not
completely acculturated

– Sociodemographic factors
• Breast-feeding rates differ by age, amount of
education, and socioeconomic status
– Past experiences of a woman and her support system
• The feeding experiences and attitudes of the
individuals who compose a woman’s support
system strongly influence a woman’s choice of
feeding method


– Intent to return to work or school
• Plays an important role in a woman’s feeding
choice
• Nursing considerations
– Provide education
– Support the woman

Question
Cultural influences on the choice of feeding method for a
newborn include:
a. Whether females in the extended family breast-

fed
b. Whether breast-feeding is acceptable in public
c. Whether the woman was breast- or bottle-fed
d. Whether the grandmother is still alive

Answer
b. Whether breast-feeding is acceptable in public
Rationale: A woman’s culture often strongly influences her

newborn feeding choice. One culturally influenced factor
is the acceptability of breast-feeding in public.

Breast-Feeding
• Recommended method for feeding newborns
– Breast milk is nutritionally superior to commercial
formulas
– The American Academy of Pediatrics (AAP)
recommends
• Exclusive breast-feeding until 6 months of age
• Continuation of breast-feeding until at least 12
months of age
– Healthy People 2020 goals
• Increase proportion of women who breast-feed
their babies

Advantages and Disadvantages of Breast-
Feeding
• Maternal advantages
– More rapid uterine involution, less bleeding in the
postpartum period
– Stress levels decrease; may enhance immune
function
– More sleep at night; weight loss is faster on average
– Long-term advantages
• Decreased incidence of ovarian and
premenopausal breast cancers
• Potential osteoporosis protection
−Additional research needed
Feeding (cont.)
• Newborn advantages
– Breast milk contains substances that facilitate critical
periods of growth and development, particularly in
the brain, immune system, and gastrointestinal tract
– Breast milk provides immunologic properties
– Lower incidences of otitis media, diarrhea, and lower
respiratory tract infections

Feeding (cont.)
• Newborn advantages (cont.)

– Possible benefits
• Protective effect against SIDS, T1DM, allergies
• Enhanced cognitive development correlation

Feeding (cont.)
• Benefits for the family and society

– Breast-feeding is economical
– Always available; no preparation or storage; no
cleanup of utensils or dishes after feeding
– Reduces health care costs
– Could possibly decrease the risk for child abuse and
neglect

Feeding (cont.)
• Disadvantages
– No physiologic disadvantages to either the woman or
the newborn
– Maternal conditions or situations in which breast-
feeding is contraindicated
• Illegal drug use
• Active untreated tuberculosis
• Human immunodeficiency virus (HIV) infection
• Chemotherapy treatment
• Herpetic lesions on the breast
Feeding (cont.)
• Disadvantages (cont.)
– Newborn contraindications
• Galactosemia
• Phenylketonuria
• Other medical conditions
• Mother producing insufficient breast milk

Breast-Feeding (cont.)
• Misperceptions, perceived barriers to breast-feeding

– Others cannot feed or care for newborn
– Inability to return to work or school
– Too difficult or uncomfortable
– Detracts from sexuality
– Make baby “too clingy”

Question
Tell whether the following statement is true or false.
Breast milk contains substances that interfere with critical

periods of growth and development, particularly in the
brain, immune system, and gastrointestinal tract.

Answer
False
Rationale: Breast milk contains substances that facilitate

critical periods of growth and development, particularly in
the brain, immune system, and gastrointestinal tract.

Physiology of Breast-Feeding
• Newborn features that facilitate breast-feeding

– Newborn facial anatomy
• Designed uniquely for breast-feeding
• Nose breathers
– Rooting and sucking reflex
• Present at birth

Physiology of Breast-Feeding (cont.)
• The breast and lactation

– Unique organ designed to provide newborn
nourishment via lactation
– Consists of 15 to 20 lobes containing milk-producing
alveoli
– Makes milk in response to several different stimuli
• Physical emptying of breast
• Hormonal stimulation
• Sensory stimulation
• Physical control of lactation

– When the breast is emptied, it responds by
replenishing the milk supply
– If emptied incompletely, it will decrease milk supply
• Hormonal control of lactation
– Pituitary gland releases prolactin and oxytocin
– Lactogen

• Sensory stimulation
– Skin
– Visual
– Auditory
– Scent
• Letdown reflex
– Results in milk flow

• Composition of breast milk
– Unique substance that commercial formulas cannot
duplicate, especially immunologic factors
– Colostrum
• Higher in antibodies; lower in fat; higher in protein
– Milk appears approximately three to five days after
birth
– Breast milk supplies 20 calories per ounce
• Foremilk
• Hindmilk
Nutritional Needs of the Breast-Feeding
Woman
• Approximately 500 kcal/day above her prepregnant

needs
• Plenty of fluids
• Rest
• Eat a balanced diet
• Multivitamin each day

Nursing Care of the Breast-Feeding
Woman
• Assessing breast-feeding readiness

– Flat or inverted nipples
– History of breast surgery
– Attitudes toward breast-feeding
– Quality of support for breast-feeding
– Refer to lactation consultant if special needs exist

Woman (cont.)
• Assisting with and assessing breast-feeding techniques
– Beginning the breast-feeding session
– Positioning the newborn
• Cradle hold, football hold, and side-lying position
– Latching on
– Assessing the breast-feeding session
• Effectiveness of the latch and sucking
– Ending the breast-feeding session

Woman (cont.)
• Assessing newborn fluid intake

– Satiated between feedings and after nursing appear
to be drowsy or asleep
– By end of third day of life at least six wet diapers and
about three bowel movements per day
• Characteristics of breast-fed infant stool
– Monitor the newborn’s weight daily during the
hospital stay

Question
How many kcal/oz does breast milk supply to the newborn?
a. 10 kcal/oz
b. 15 kcal/oz
c. 20 kcal/oz
d. 25 kcal/oz

Answer
c. 20 kcal/oz
Rationale: Breast milk supplies 20 calories per ounce on

average.

Woman (cont.)
• Teaching about breast-feeding special concerns

– Relieving common maternal breast-feeding problems
• Sore nipples
• Engorgement
• Plugged milk ducts
• Mastitis

Woman (cont.)
• Signs the newborn is not feeding well

– Dry mouth
– Not enough wet diapers per day
– Difficulty rousing the newborn for feeding
– Not enough feedings per day
– Difficulty with latching on or sucking

Woman (cont.)
• Growth spurts
– Infants nurse longer, more frequently for a few days
– Increases milk supply
• Available resources for the breast-feeding woman
– Lactation consultants
– The La Leche League
– Breast-feeding support groups in the community

Woman (cont.)
• Using newborn supplements

– Exclusive breast-feeding provides all fluid needs
– Should not introduce any solids, including rice cereal,
until infant is at least 6 months of age
• Breast-feeding amenorrhea
– Return of woman’s menstrual cycle occurs between
six and 10 weeks postdelivery
– Ovulation can occur in absence of a menstrual
period, and she can become pregnant

Woman (cont.)
• Contraception while breast-feeding

– Contraceptives containing hormones, especially
estrogen, can lead to decrease in milk supply
– First choice of contraception for breast-feeding
women should be nonhormonal
• Mini-pill

Woman (cont.)
• Pumping and storing breast milk
– Teach woman to wash her hands before pumping, use
clean equipment
– Stimulation of letdown reflex
– Pump until the flow of milk has stopped, usually 15 to
20 minutes
– Refrigerate, freeze, or use immediately
• Store in hard plastic bottles or breast milk bags
• Avoid glass containers
– Reheating
Woman (cont.)
• Returning to work
– Doesn’t mean you have to stop breast-feeding
– Breast-feed exclusively for first six weeks before
introducing bottle
• Establishes milk supply
– If newborn nursing well at six weeks
• Introduce one feeding/day of expressed milk
– Pump during bottle-feeding to maintain milk supply

Question
One of the signs that a breast-fed newborn is not feeding
well is:
a. Drowsy after nursing

b. A little milk left in the mouth after nursing
c. Needs to be roused to nurse
d. Nursing eight times a day

Answer
c. Needs to be roused to nurse
Rationale: One of the signs that a breast-fed newborn is

not getting enough to eat is that he or she needs to be
roused to nurse.

Formula-Feeding
• Has been used since ancient times

• Commercially prepared infant formula
– Available in US since early 1900s
• Alternative formulas to meet specific infant needs

Advantages and Disadvantages of
Formula-Feeding
• Advantages
– Specific circumstances in which formula-feeding is
necessary
• Adoption
• Cases in which breast-feeding would be harmful to
the infant
– Reduces the worries of some women about the infant
getting enough to eat
– Some women feel it is easier

Advantages and Disadvantages of
Formula-Feeding (cont.)
• Disadvantages
– Inferior nutrition
– No immunologic properties provided by breast milk
– Harder for newborns to digest
• Illness
• Allergies
– Expensive
– Potential for preparation errors
Composition of Formula
• Three main types

– Milk-based
– Soy-based
– Hypoallergenic formulas
• Used for allergy or malabsorption problems
– The iron composition in infant formula is either high
or low
– Alternative formulas available for special medical
needs
Composition of Formula (cont.)
• Preterm formulas differ from term formulas

– Vitamins, minerals, caloric, and iron content
– Higher levels of sodium, potassium, calcium, and iron
– 22 or 24 calories per ounce
• Term formulas
– 20 calories per ounce

Nursing Care of the Formula-Feeding
Woman
• Assisting with formula-feeding techniques
– Check primary care provider’s order
– Compare newborn’s and woman’s ID bands
– Formula-feeding woman should be in upright position
– Keep light on in room
– Baby should be held in semireclined position in arms;
bottle should not be propped
– Feed 1 to 2 oz per feeding
• Burping every 0.5 oz
– Teach: Cues baby is full and done eating
Woman (cont.)
• Assessing the formula-feeding woman and newborn
– Assess
• Newborn’s feeding ability
• Amount of formula consumed at each feeding
• Infant formula tolerance
• Woman’s comfort level with formula-feeding
• Infant’s bowel movements
−Characteristics of formula-fed stool

Woman (cont.)
• Teaching regarding formula-feeding, including special

concerns
– Correct formula bottle preparation
• Water use
– Need for supplements
– Solid food introduction
• Maternal breast care

Common Problems in the Formula-Fed
Newborn
• Newborn not wanting to eat
– Contact pediatrician: May be an underlying medical
condition
• Not tolerating the formula: Contact pediatrician
– Emesis
– Diarrhea
– Dehydration: Occurs quickly in newborns
• Dental caries
– “Baby bottle syndrome” or “bottle mouth caries”
– Prevention
Question
How do preterm infant formulas differ from term infant
formulas?
a. Lower iron content

b. Lower level of sodium
c. Higher caloric values
d. Higher lactose content

Answer
c. Higher caloric values
Rationale: Preterm formulas differ from term formulas in

the amounts of vitamins and minerals and the caloric and
iron content. Preterm formulas have higher levels of
sodium, potassium, calcium, and iron than term infant
formulas. Preterm formulas are usually 22 to 24 cal/oz.

Hatfield PPT CH 15

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Hatfield PPT CH 15

Uploaded by

Copyright:

Available Formats

Chapter 15

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• At birth, the passive intake of nutrition ends and the

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Two main types of nourishment suitable for the healthy

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Feeding method choices:

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Factors that influence choice of method

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Factors that influence choice of method (cont.)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Factors that influence choice of method (cont.)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

a. Whether females in the extended family breast-

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Rationale: A woman’s culture often strongly influences her

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Newborn advantages (cont.)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Benefits for the family and society

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Misperceptions, perceived barriers to breast-feeding

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Breast milk contains substances that interfere with critical

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Rationale: Breast milk contains substances that facilitate

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Newborn features that facilitate breast-feeding

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• The breast and lactation

• Physical control of lactation

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Approximately 500 kcal/day above her prepregnant

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Assessing breast-feeding readiness

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Assessing newborn fluid intake

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Rationale: Breast milk supplies 20 calories per ounce on

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Teaching about breast-feeding special concerns

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Signs the newborn is not feeding well

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Using newborn supplements

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Contraception while breast-feeding

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

a. Drowsy after nursing

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Rationale: One of the signs that a breast-fed newborn is

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins