Chapter 15: Newborn Nutrition

Selection of a Feeding Method Several factors influence the woman's decision to breast- feed. These include Culture Age Education Past experience with breast-feeding Woman's intent to return to work or school

Advantages and Disadvantages of Breast-Feeding Maternal advantages of breast-feeding include more rapid uterine involution, less bleeding in the postpartum period, and less ovarian and premenopausal breast cancers. Newborn advantages to breast-feeding include a strengthened immune system, less risk of becoming overweight, and lower incidences of certain infections such as otitis media, diarrhea, and lower respiratory tract infections.

Advantages and Disadvantages of Breast-Feeding (cont.) Maternal contraindications to breast-feeding include a woman actively using illegal drugs, one who has untreated tuberculosis, one with human immunodeficiency virus, or a woman receiving chemotherapy medications. A newborn condition that would contraindicate breast- feeding includes galactosemia. The breast is under both physical and hormonal control to stimulate lactation. The hormones prolactin and oxytocin stimulate milk production and release from the breast. The newborn sucking on and emptying the breast also leads to milk production.

Nursing Care of the Breast-Feeding Woman When assisting a woman with breast-feeding, provide for privacy, help the woman into a comfortable position, help the woman hold her newborn correctly, and monitor the newborn for correct latching on and positioning on the breast. Observe the woman's breasts and nipples, her comfort level with breast-feeding, her support system, and the newborn's feeding ability.

Nursing Care of the Breast-Feeding Woman (cont.) Give the breast-feeding woman information about common problems including signs the newborn is not feeding well, growth spurts, available resources, supplements, contraception, and pumping and storing breast milk.

Nursing Care of the Breast-Feeding Woman (cont.) When caring for a woman with sore nipples, observe the latching on and the positioning of the newborn during nursing. A few drops of expressed breast milk or a purified lanolin treatment applied to the nipples after breast-feeding may help with soreness.

Nursing Care of the Breast-Feeding Woman (cont.) When caring for a woman with engorgement, observe the infant for a good latch and advise the woman to breast- feed frequently. Cold packs to the breast and taking a mild analgesic help alleviate discomfort. Letting warm water flow over her breasts several times per day may stimulate milk release and relieve some of the pressure.

Nursing Care of the Breast-Feeding Woman (cont.) When caring for a woman with a plugged milk duct, advise the breast-feeding woman to apply warm packs to the site, take a warm shower, take acetaminophen (Tylenol), nurse in different positions, avoid constrictive clothing or bras, and massage the site.

Nursing Care of the Breast-Feeding Woman (cont.) When caring for a woman with mastitis, advise the breast-feeding woman to contact her health care provider, take the antibiotics as prescribed, and continue to breast-feed even on the affected side. If breast-feeding is too uncomfortable on the affected side, she should pump the milk at each feeding so her milk supply does not diminish.

Nursing Care of the Breast-Feeding Woman (cont.) Signs that a newborn is not breast-feeding well include dry mouth, fewer than expected wet or dirty diapers, difficulty rousing the newborn for feedings, increased weight loss, and not enough feedings per day.

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 Breast milk is superior to formula because it is easier to digest and has immunologic, bacteriocidal, and fungicidal properties that cannot be duplicated in artificial nutrition. Breast milk is economical and ready to feed and requires no special preparation or storage. Formula-feeding is beneficial in cases in which the woman is unavailable to breast-feed, such as adoption, surgery, or if she is taking a medication that passes through the breast milk and would be harmful to the newborn. Formula-feeding is also beneficial when the newborn has certain medical conditions, such as galactosemia.

Composition of Formula There are many types of formulas available. The ingredients vary by protein source, caloric content, and mineral and electrolyte concentration. The health care provider considers the newborn's gestational age and medical needs before recommending a specific formula.

Nursing Care of the Formula-Feeding Woman Show the formula-feeding woman how to feed her newborn and how much and when to increase feedings, how to prepare and store the formula and care for the equipment, how to care for her breasts after delivery, and when to notify the RN and health care provider.

Nursing Care of the Formula-Feeding Woman (cont.) For the formula-fed newborn who is having emesis or diarrhea, ask the parent: What type of formula is the newborn on and how is it prepared? How much is the newborn eating per session and per day? What does the emesis/bowel movement look like? What other foods is the newborn eating? How much emesis is there per episode? How many episodes has the newborn had in the last 24 hours?

Nursing Care of the Formula-Feeding Woman (cont.) Teaching regarding formula-feeding, including special concerns Correct formula bottle preparation Water use Need for supplements Solid food introduction Maternal breast care