20 hour class session 10a

8/3/2019 20 Hour Class Session 10A

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Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc 10A:1

Infants with Special Needs

Ten Steps Curriculum, Session 10A




The Preterm Infant

Preterm milk is more suited to the

preterm infant than mature milk

The composition of preterm milk is

unique: levels of nitrogen, long-, medium- and short-

chain fatty acids, sodium, chloride and iron

are higher in preterm milk




Establishing Milk Supply

For a Preterm Infant

Rental grade electric pumps are ideal

Double collecting kit is preferredOptimal stimulation comes from 8 or

more pumping sessions per 24 hours,with total pumping time of 120 minutes

per day

Follow collection, storage and handlingprotocols carefully




Encourage mother to be as involved as possible

in the care of her infant. Help her learn to

identify infant states, and observe baby

language.

Skin-to-skin contact (kangaroo care) stimulates

organization and maturation in the infant.

Skin-to-skin also assists mother in conditioning

her let-down reflex.




Feeding the Preterm Infant

Gavag e or tube feeding is used when infants aretoo small to coordinate suck-swallow-breathe.Gavage may also be used to supplement during

or after breastfeeding. Cup feeding is also used to supplement

breastfeeding in infants with suck-swallow-breathe and gag reflex.

Brea stfeedin g may be initiated when the infantis stable and can gag. Offer opportunities fornon-nutritive suckling before actual feeding.




Physiological Advantages of

Breast v. Bottle Feeding forPreterm Infants

Breastfeeding fosters longer, more rhythmic suckling

more stable oxygen saturation

less bradycardia

more normal heart rate




Early Feeding Strategies

Mother should have realistic expectations

of feeding.Practice will be required for proficient

breastfeeding.

Skin-to-skin care has positive impact onbreastfeeding, maturation and growth,

parenting, digestion and immune system.




Discharge Strategies

Establish a follow-up team to ensure

adequate growth and development andcontinuation of breastfeeding post-

discharge

Foster frequent communication toaddress issues as needed




Low Birth Weight Infants

Are at risk for infection, jaundice andhypoglycemia

Advantages of human milk feeding include:

easier digestion and absorption of fats andproteins

fat and amino acid profile tailored to infant

needs enzymes which enhance maturation of gut

anti-infective properties




Breastfeeding Multiples:

Twins Positioning strategies for nursing twins simultaneously:

feet to feet with one twin higher than the other

head to head in the football hold

Feeding twins simultaneously helps to develop

synchrony of feeding schedule and increased prolactin

levels.

Feeding each twin separately takes more time, but ismore individualized.




Breastfeeding

Higher Order Multiples

Individualized feeding plans need to be

developed Infants may require supplementation,

especially if one is smaller and/or weaker

than others. Weight gain should be

closely observed. Ideal weight gain is 15 -

30 gms daily.




The Infant With Jaundice Early jaundice is distinct from late jaundice

P hysiolo g ical jaundice occurs when extra red blood

cells needed by the fetus break down. Feeding, especially with colostrum, ensures earlier

passage of meconium and subsequent lower

bilirubin levels.

Lasts two to three days, then begins to recede.

Generally intervention is not needed for

physiological jaundice.




P hysiolo g ical j aundice (cont.)

increasing breastfeeding frequency and/or

improving latch-on is most effective in

resolving this type of jaundice




Infants with Craniofacial

Defects

Benefits of breastfeeding for infants with

cleft defects: fewer upper respiratory infections

less otitis media

speech improvement through optimal use of

oral-facial musculature




Cleft Lip Strategies

If infant has unilateral cleft lip, angle breast so

that it fills the cleft.

Mother may use thumb to cover alveolar ridge

defect (if any). This may help create better

suction.

Infants with cleft defects take longer to feed.

Use pillows to help support infant position and

make mother comfortable to avoid fatigue.




Cleft Palate Strategies

The impact of the cleft defect onbreastfeeding depends on the severity of the defect.

Explore many different nursing positionsto determine which work best.

With unilateral cleft, direct nipple toward

intact side.Assess growth frequently to ensure

adequate intake and growth.




Repair of Cleft Defects

Timing of surgical repair of cleft defects varies

Lip repair can occur as early as 2 days of lifeand as late as 3 months.

Palate repairs usually occur after 10 months of life.

Breastfeeding after surgery is less stressful tothe repair than allowing the infant to cry inhunger

Use of obturators can be of great benefit tobreastfeeding




Neurologically Impaired

Infants

Can feed at the breast with proper physical and

emotional support for the dyad

Physical conditions which can affect breastfeeding:

absent or weak sucking reflex

weak suck

incoordination of suck

low muscle tone




T able 14-2

Conditions Associ ated with Depressed Suckin g Reflexes

Central Nervous System (CNS) Dysmaturity CNS Maldevelopment

Prematurity Trisomy 18

Delayed maturation Trisomy 21

Prader-Willi's syndrome

Prenatal CNS Insults Perinatal CNS Insults

Congenital infections Asphyxia

Vascular accidents Meningitis

Hypoglycemia

Kernicterus

Systemic Problems in the Infant Trauma

Congenital heart disease Drugs administered to the

Sepsis mother in labor

Hypothyroidism Drugs administered to the

infant

Neonatal narcotic

abstinence




T able 14-3

Conditions C ausin g Weakness of Suckin g Mechanisms

Central nervous system abnormalities associated with severe hypotonia

Trisomy 21 Prader-Willi's syndrome

Medullary lesions

Pseudobulbar palsy (congenital or after an insult)

Bulbar atresia

Moebius' syndrome

Arnold-Chiari malformation

Motoneuron disease: Werdnig-Hoffman's syndrome (usually not present at birth)

Abnormalities of the neuromuscular junction

Neonatal myasthenia gravis (affected mother)

Congenital myasthenia gravis

Familial infantile myasthenia

Botulism

Abnormalities of muscle

Congenital myotonic dystrophy

Congenital myopathies (nemaline and myotubular)

Metabolic myopathies




Table 14-4

Conditions Associated with Incoordination of Sucking Mechanisms

Central nervous system insults Central nervous system maldevelopment

Asphyxia Arnold-Chiari malformation

Kernicterus Oral-buccal apraxia

Hypoglycemia

Bilateral cerebral bleeds Miscellaneous

Neonatal narcotic abstinence Leigh's disease

Dysautonomia

Cornelia de Lange's syndrome




Feeding Strategies for Infants

with Neurological Impairment Use team approach with neonatologists, primary care

nurses, occupational therapists, speech pathologists

with neurodevelopmental treatment (NDT) training,

lactation consultants.... Assess for presence of suck, swallow, and gag reflexes

in an ongoing fashion

Interventions should be tailored to infant needs.

Offer non-nutritive suckling at the mother¶s breasts(after breasts are expressed)

Position infant to offer maximal support

20 hour class session 10a

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