Breastfeeding Lecture

 

What is the Healthy People 2010 goal for breastfeeding?

The goal is for breastfeeding initiation rates to reach 75% CONTINUANCE RATES AT 6 MONTHS TO REACH 50% and that at least 25% of infants will still be breastfeeding at 1 year of age.

 

What does the American Academy of Peds say about breasfeeding?

They say that babies should be exclusively breastfed for 6 months (which means should not be given anything else) and breastfeeding should continue for at least 12 months.

 

How is feeding behavior different between bottlefed and breastfed babies?

Media advertises that correct position for feeding infants. Brestfeeding does not assume that same position. Breastfed babies would have to turn their necks and swallow-not easy to do.

 

What types of women breastfeed?

Women that don’t work outside the home

Western part of country

Over the age of 30

College educated

Women usually decide early on in life that they will breastfeed.

They need education as a culture- whites need support from their husbands;Hispanics-support comes from grandma or mother.

Breastfeeding needs to look like a sign of stature-to influence future generations and cultures to breasfeed.

 

What are the benefits to the mother that breastfeeds?

1. sucking stimulates pituitary to contract uterus so ther is a decrease in PP bleeding
2. increases child spacing
3. helps lose pregnancy weight-earlier return to pre-pregnancy weight
4. decreases the risk of breast and ovarian cancer
5. decreased risk of osteoporosis after menopause.

 

What are mothers that do not breastfeed at an increased risk for?

1. slower healing after childbirth
2. PP blood loss and anemia after childbirth
3. increased risk for ovarian and brest cancer
4. decreased child spacing
5. osteoporosis

 

How does breasfeeding benefit the baby?

1. fewer ear infections
2. less allergies-asthma/eczema
3. less URI
4. fewer hospital vists and fewer visits to the ped
5. lessened chance of childhood obesity
6. decreased necrotizing enterocolitis among preterm infants(seen in NICU)-less GI disturbances-diarrhea
7. less risk of getting type 1 diabetes
8. enhanced cognitive development-higher IQ scores

 

How can you tell the baby is ready to breastfeed?

ALWAYS wait until the baby is ready to feed-make sure NB has normal breathing pattern nor labored breathing, v.s. WNL, active bowel sounds, no ab distension.

Infant cues include:

1. hand movements-hand to mouth or hand to hand
2. tongue movements-mouthing, sucking, rooting
3. crying

NB usually feed within the first hour after birth

 

What is a late sign of hunger in a NB?

Crying

 

What causes milk to be produced and then let down?

There is a drop in estrogen and progesterone that releases prolactin from the anterior pituitary this causes milk production

 

Then the posterior pituitary produces oxyticin which signals the milk to be let down.

 

So- Prolactin tells breast to make milk and oxytoxin tells breasts to let down milk.

 

How much milk does a NB need?

A NB needs 110kcal/kg/day

Breastmilk has 20 kcal/oz-the greates amount of energy is provided by the fat content of breast milk.

 

What nutrients are in breast milk?

1. Protein-the protein requirement per unit of body weight is greater in the NB than at any other time of life.-Source of amino acids for growth. The immunologic properties effects against diarrhea and other infectious illnesses.
2. Fat-at least 15% of the calories provided must come from fat. The greatest concentration of fat is in the hind milk-fat in breastmilk is easily digested. Fatty acids are important in the development of cellular memebranes and are particularly important in eye and brain development.
3. Carbs-carbs should provide at least 40% to 50% of the total calories in the diet.

 

What is the difference between foremilk and hind milk?

Foremilk comes first-thinner milk (skim milk). Then comes hind milk-has a lot of fat. (whole milk-creamy)

 

Breast milk is low in iron. The composition of the milk changes as the baby ages.

Formula has corn syrup and a high carb proportion. Babies prefer the sweet taste.

 

Breast milk also contains antibodies that last 3 months-passive immunity.

 

How does milk production increases and decrease for babies needs?

Production depends on supply and demand.

The amount of milk that is made = the amount of milk that is needed.

As the baby has growth spurts-the breasts will make more milk.

In order to increases production feed often and don’t skip feedings.-every 2-3 hours.

Avoid supplements

Encourage night feedings-if don’t breasts don’t think they need to make as much milk.

 

How does the nurse promote successful breastfeeding?

1. make the mom comfortable and relaxed
2. get a bunch of pillows and position the mother and infant in a comfortable position
3. Make sure infant is latching on correctly-#1 cause of sore nipples
4. Teach mom to offer both breasts at each feeding-the baby determines how long feeding will be (if baby wants to feed more often-baby is going through growth spurt-breasts get the message to make more milk)-feed every 2-3 hours
5. Formula is different-sits in stomach longer-Q 3-4 hours.
6. Make sure baby is removed from nipple properly-baby will get a good suck-have to break the suction before removing baby from breast
7. postpone pacifier and bottles for first few weeks-so NB won’t experience nipple confusion

 

What are some barriers to breastfeeding mothers?

1. diet, medications, smoking (nicotine does go into breast milk) fatigue
2. if mother had previous breast surgery-reduction/augmentation
3. flat/inverted nipples
4. contraceptives that are estrogen based will decrease estrogen supply-delay giving to woman until 6 weeks and then give minipill
5. mom has anxiety/modesty-K/D

 

What are some barriers that cause infants not to breastfeed?

1. baby is premature-doesn’t have strength to suck
2. baby is ill or disabled-sluggish
3. hypoglycemia
4. jaundiced babies don’t feed as well

 

What mothers should not breastfeed?

If mom has

1. Hep B or C
2. cocaine or drug addiction
3. HIV
4. active herpes near nipple
5. medications
6. PKU-breastfeed partially and have supplement with formula
7. if NB has severe illness or metabolic disorder

 

How does the mother know that her baby is getting enough breastmilk? (EXAM-Know what to teach parents)

If baby feeds at least 8X in 24 hours-Q 2-3 hours

If baby has at least 3 stools/day after day 1, then 4 stools per day by day 5

If baby has at least 6 wet diapers per day by day 5

If baby appears content and is satisfied after most feedings

If you hear or see baby swallowing

If baby loses less than 10% of birth weight and then is back to birth weight by 2 weeks.

 

How does the mother prevent cracked/sore nipples?

Pain with breastfeeding is normal in the first few weeks. But pain should not go on any longer than when the baby first latches on.

1. Make sure the baby is positioned correctly-number one way to get sore nipples
2. express milk after nursing and appt ot nipples
3. use cabbage leaves(not too long-they will dry up milk as well) and caffeine tea bags.

 

Describe Mastitis.

The sudden onset of flulike symptoms such as fever, chills, body aches, and headache. Localized breast pain and tenderness is usually accompanied by a warm, reddened area on the brest.

Antibiotics will be prescribed

Factors that cause mastitis:

1. plugged ducts
2. sudden decrease in number of feedings
3. abrupt weaning
4. wearing under wire bras
5. sore cracked nipples cause a portal of entry for bacteria

 

How does the mother prevent engorgement?

Engorgement causes breasts to be so full and painful.

1. The mother should feed frequently and avoid supplementing
2. wear a good supportive bra

To comfort engorgement have woman apply warmth (towels, shower)and gentle massage before nursing. Get milk out so breasts are empty.

 

How does woman handle engorgement if not nursing?

Tell her to do nothing to stimulate her breasts. Don’t want to put warm water on breasts. Use ice. Wear a tight bra.

 

How long is breast milk good for?

Keep milk at room temp-will be good for 24 hours

If put in fridge-milk goos for 3-4 days

If put in freezer-good for 6 months

 

How do you assess baby for allergies?

Try one formula and one new solid food at a time to monitor for allergic reaction.Wait at least three days between new foods. Monitor for rash, colic, diarrhea, bloody stool, respiratory symptoms.

 

Why are babies not given solid food prior to 6 months?

Babies are meant to be sucking-natural reflex of tongue to push out food. The babies digestive tract is not ready to handle foods.

 

Describe colostrums (first 2-3 day)

Colostrums is filled with antibodies,immunoglobulins, and vitamins

 

Describe transitional milk (7-10 days)

Milk has decreased antibodies and immunoglobulins than colostrums. But milk has increased fat and calories. Engorgement ceases and feedings become more regular.

 

Describe mature milk (11-14 days)

Milk has increased water, fats, and carbs (lactose) as well as antibodies. Breasts begin producing “supply” to meet baby’s demands.

 

What are the goals for effective breastfeeding?

1. baby will latch on and feed effectively 8 to 12 times per day.
2. baby will gain weight appropriately
3. baby will remain well hydrated-have 6 to 8 wet diapers and 3 to 6 BM every 24 hours after day 4.
4. sleep/ seem content between feedings

 

How many calories should a breastfeeding mother consume?

About 2700 cal per day-equal to 500 calories more than a nonpregnant woman.

 

Should a woman wash her breasts with soap?

No it can have a drying effect on the nipples.