Infant Nutrition

• Nutritional requirements:

  • Newborns need 50 cal (2.5 oz) per lb of body weight per day
  • Formula & breast milk= 20 cal per oz
  • 6 lb needs 300 cal or 15 oz/24 hours
  • 8 lb needs 400 cal or 20 oz/24 hours
• May lose 5-10% of birth weight and regain in 10-14 days

  -Small tummies starting out

  -Begin to be concerned @7% weight loss
• Gastric size of newborn at birth is 6 mL/kg (15-24 mL)

  -Newborn intake is:

  2-10 mL for first 24 hours

  30-60 mL on day 4

  60-90 mL on day 7
• Hunger Cues:

  • Hand to mouth
  • Rooting
  • Sucking
  • Whimpering
  • Crying (LATE sign)
• Sleepy Babies:

  • If 5 hours since last feed- may do blood glucose. If WNL (more than or equal to 40-45), can wait 2-4 hours until next feeding
• Types of formula:

  • Cow's milk based & iron fortified: most formulas
  • Soy based: lactose-free and easier to digest but not complete protein
  • Elemental: lactose-free (glucose instead) easier digestion with amino acids
• Formula Feeding:

  • Demand feed: about every 3-4 hours
  • Upright position to decrease incidence of ear infections
  • Some restrict amount to 15-30 mL per feeding for first 24 hours
• Starting solids:

  • Formula or breast milk only for 6 months
  • Drooling at 4-6 months indicates adequate enzymes to digest carbohydrates
  • Delay regular cow's milk until 12 months of age
• Milk-ejection reflex (let down)

  Oxytocin
• Milk production

  Prolactin
• Human Breast milk:

  • Colostrum: precursor to milk (lactogenesis-1)
  • Transitional milk: milk coming in by 2-3 days (lactogensis-2)
  • Mature milk: by 10-14 days (lactogensis-3)
• Thirst-quenching milk

  Foremilk
• End of feeding, higher-fat concentration and main source of energy

  Hindmilk
• LATCH assessment tool: (What we want)

  • Latch: grasps breast, tongue down, lips flanged (turned back), and rhythmic sucking
  • Audible swallowing: spontaneous & intermittent less than 24 hours and spontaneous & frequent for older than 24
  • Type of nipple: everted (after stimulation)
  • Comfort (breast/nipple): soft, tender and no damage or ongoing pain
  • Hold (positioning): no assist from staff, mother able to position/hold infant
• Cross-cradle hold: mother has hand supporting babies head
• Nipple Shells: (HARD looking ones)

  • Flat or inverted nipples
  • Sore or cracked nipples
• Nipple shields: (SOFT ones)

  • Flat or inverted nipples
  • Sore or cracked nipples
  • Too much let-down and too much milk flow
• Pain, cracked or bruised nipples

  • Correct the improper latch
  • Change nursing positions
  • Keep breastfeeding
  • Shells or shields
  • Cool pads: hydrogel
  • Warm compress
  • Lanolin cream: does not need to be removed
  • Expose nipples to air between feeds
• Engorgement:

  • 3-5 days (during lactogenesis-2)
  • Breast edema, congestion and pain
  • Relieved by frequent nursing
  • May need to express milk to soften nipple
  • Warm shower before nursing
  • Supportive nursing bra 24 hours daily
• Plugged ducts and mastitis

  • From engorgement and missed feedings
  • Localized tenderness and firmness of breast tissue
  • Gentle massage, warmth, and continued BF