feeding new

8/3/2019 Feeding New

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Identify the nutritional requirements duringinfant stage.

List the Benefits of breastfeeding for

mothers and infants

Demonstrate technique of breast feeding.

Differentiate between component of humanmilk cow's and formula feeding.

List principles of weaning

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Optimal nutrition during the first year of life is very important

because growth is proceeding veryrapidly and requiring adequateamounts of various nutrition.Feeding provide time for meetingthe emotional needs of infants.

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Calories: 110 Kcal/kg/day

2: Fluid: 150 ml/Kg/day. Protein: 2 gm/Kg/day.

Vitamin C: 40 mg/day.

Vitamin A: 4000 IU/day.

Vitamin D: 400– 800 IU/day. Iron: 6 mg/day.

Calcium: 600 mg/day

Nutritional Requirements during Infancy



Breastfeeding Artificial feeding

Bottle Feeding

weaning



Breastfeeding is the most suitable forhuman infant. It contains all the

elements for growth and developmentin easily digested forms. It containsall the necessary vitamins and ofcourse no other food is as completefor the infant as breast milk. Itprovides psychological and emotionalsatisfaction for both mother andchild.

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The breasts or mammary glands aresecreting milk after childbirth tonourish the infant.

The small raised nipple is at the centerof each breast.

Surrounding the nipple is a larger

circular areola.Both the nipple and areola are darker

than surrounding skin.

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Montgomery tuberclesare sebaceous glands

in the areola. Theyare inactive exceptduring pregnancy andlactation, when theyenlarge and secrete asubstance that keepsthe nipple soft.



SFCC: Figure 14.14



The breast is composed of glandular tissue, some fatty

tissue and covered by skin. Theglandular tissue is divided intoabout 15-20 lobes which are

separated by fibrous tissue.



Each lobe is composed of the

following structures:• Alveoli are small sacs that contain acinar

cells to secrete milk.

• Around each alveolus lie myoepithelialcells, which contract and eject the milk intothe lactiferous duct when signaled bysecretion of the hormone oxytocin from the

posterior pituitary gland.



• The lactiferous ducts become wider underthe areola and are called lactiferoussinuses in this area. The lactiferoussinuses narrow again into ducts as theyopen to the outside in the nipple.



During pregnancy estrogen andprogesterone secreted by the placenta

prepare the breasts for lactation. Theestrogen inhibits milk production until theend of pregnancy.

The blood level of estrogen andprogesterone fall by the 3rd stage of laborand during the next 48 hours. This

stimulates the anterior pituitary gland toproduce the Prolactin hormone.



The milk is pushed along the

lactiferous ducts and some is storedin the lactiferous sinuses which lie

just under the areola. When the baby

sucks, he takes the nipple and theareola into his mouth and partly by avacuum which is created mostly by a

chewing action of his jaws. Milk ispushed into his mouth and heswallow.



When lactiferous sinuses and lower ducts areemptied, milk is pushed from the alveoli by

contraction of the myoepithelial cells. So, the actof sucking by the baby is the stimulus whichkeeps lactation going on by some neuro-hormonal reflex mechanism which activates the

anterior pituitary gland to produce lactotrophinand the posterior pituitary lobe to produceoxytocin which reaches the breast through theblood stream leading to contraction of

myoepithelial cells and expulsion of milk results.



neuro-hormonal reflex mechanismwhich activates the anterior pituitary

gland to produce lactotrophin andthe posterior pituitary lobe toproduce oxytocin which reaches thebreast through the blood streamleading to contraction of myoepithelial cells and expulsion of milk results.

Oxytocin also stimulates the uterinecontractions as well as after painsand lochial discharge duringbreastfeeding.



More convenient than bottlefeeding and needs no preparation.Many mothers find great

satisfaction in feeding the infantat the breast.Prevention of postpartum

hemorrhage oxytocin helps

uterine contraction that controlspostpartum hemorrhage.

For mother

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Cheapest and most economicalmethod of feeding.

Lower the incidence rate of uterineand breast cancer in woman.

Women regain their normal weight

and activities faster.

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For infant

◈Human milk is warm, ready,

and sterile and perfectly balanced and nutritionally complete food for babies.◈It is more easily digested than cow's milk.

◈Breast-fed infants have greater immunity to certain childhood diseases.



Breast milk is available all times.Infants are less likely to have

gastrointestinal disorders, anemia andvitamin deficiency.Infants are less likely to acquire

infection in homes where cleanliness isdifficult to attain.Infants are secure through constant

contact with his mother and this has an

effect on the child's psychology anddevelopment.



• This is suitable time for the baby tolearn to suck.

• Rooting and sucking reflexes are

maximal.• The nipple stimulation from sucking

releases oxytocin, promoting uterinecontraction, thus reducing the chance

of post-partum hemorrhage.

Breastfeeding should be startedimmediately after delivery because of:



• The first hour or soon after

birth is the best time forbonding and make the motherlove and care for her baby.

• Early mother infant contact inpost-partum period increasesthe incidence and / or durationof breastfeeding thereafter.



Variability of breast milk

according to

stage of lactation



• Is the bright lemon yellow, alkaline, viscousfluid secreted from breast during the first 5-7days and it is beneficial because of:

– Rich in protein but contains less amount of CHOand Fat.

– Rich in antibodies and leukocytes.

– Rich in cholesterol. – Rich in Vit A.

– It has laxative effect.

Colostrum



• B-Transition Milk:

Follow the Colostrum

• Mature Milk:

it secreted by the 10 th -20 th after delivery. itsfat contents are higher in early months oflactation.



Fat content of the last amount ofmilk of each feed (hind- milk)

is more than in beginning offeed (Fore-milk).



• Breast should be cleansed every daywith plain water and dries thoroughly.

• Mother's clothes should not be tight overthe breast and clean.

• The mother should wash hand

thoroughly before nursing her infant.• The infant should be hungry, dry and

warm.

Technique of breastfeeding



• Mother should comfortably sit in order torelax.

• characteristic of good positioning:

Infant body is close to the mother.

Infant body is turned towards the mother

Infant whole body is well supported

The infant's nose should be at the levelof the nipple.

Infant neck is straight or bent slightlyback.



7. Feeding positions:

• Cradle position.

• Cross cradle position.

•

Foot-ball holds position.• Horizontal position.

• Back-ward position.

• Positions for two babies.



• The mother cup her breast(C hold)

• Rub the nipple or finger gently againstthe infant's cheek or lips to stimulaterooting reflex.

• When mouth is fully open, the baby ispushed toward the breast.



• the part under the nipple inside theinfant's mouth because the tongue and

lower jaw do the job of stripping the milkfrom the breast.

• When the lips seal the areola, the baby

sucking will compress the milk reservoirbehind the areola then milk will beswallowed. The baby should latch on or

grasp the nipple and outer areola into themouth.



• Eructate the infant 1-2 times during andonce at the end of the feed.

• Regurgitation of 5-15 cc of milk wheneructate or after feeding is normal.

• When nursing is completed, the infantshould be placed in a crib on his right

side.



Time and frequency of feedin

• Unrestricted breastfeeding, self-demandmethod

• All newborn infants need some nightfeeds.

• Some may need to feed as many as 10-15times or as few as 6-8 times within 24

hours.

E l i b tf di



Exclusive breastfeeding

means:• No food or drink other than breastfeeding

is offered to breastfeeding baby up to 6months

• Fed on demand, day and night

• No restriction on the length or frequencyof breastfeeding. (Vitamins drops are

allowed).

C it i f d t b t



Criteria for adequate breast

feeding• Infant is calm and satisfied after feeds.

• Infant sleeps well 2-4 hours after feeds.

•

Normal motions (bowel movements 4-8 / 24 hours).

• Normal amount of urine (6 or more /24hours).



Normal weight gain (150/210 grams/week)This can be assessed by:

Weight chartTest weighing: The infant is weighed at 4

days interval at a fixed time of the day and

under the same circumstances. E.g. thesame clothes and before feeding. If weightgain is 100 grams or more the amount ofbreast milk is adequate.



Breast engorgement

I-Maternal breastfeeding problems



♣It is an accumulation of increased

amount of blood and other body fluidsas well as milk in the breast.

Causes:♣Delay in starting breast feeding

after delivery.♣Poor attachment to breast

♣Poor sucking♣Incomplete emptying of breast



. Clinical manifestation:

• Breast is painful, tender and swollen with shiny

overlying skin, distended veins and hard palpablenodules felt behind the areola.

• Fever may be present.



Nursing management

Apply moist warm packs to the involved breast 2-3minutes before each feeding.

Massage and hand express to facilitateattachment.

Cold packs after feeding.

Stress reduction relaxation techniques.

Neck and back massage.

Mild analgesics.

Sore nipple and cracked or



Sore nipple and cracked or

fissure nipple • Tenderness and soreness of the nipple

are usually the result of the trauma andirritation

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Cause:

Incorrect positioning and technique.

Engorgement.

Irritants such as soap or lotions.

Infection

washing of nipple and areola with waterand soap

Nursing management



• Apply moist heat and massage before feeding (3-5minutes).

• Begin each feeding on the least involved side/or stopfeeding from the affected breast for 1-2 days andexpress milk from it manually or by breast pump.

• Frequent, short feedings (2-2.5 hours).• Proper positioning, attachment, and removal technique.• Air/sun exposure.• Avoid engorgement.

• Avoid use of drying agents.• Treatment for infection• Mild analgesics.

Nursing management



Persistent sore nipple may be caused byCandida albicans also called monillia or

thrush. Causes:

• Thrush or candidal diaper rash in the

infant.• Recurrent candidal vaginitis in the

mother.

Candidiasis/thrush



Nursing management:

For mother:

Wash hands well, especially after changinginfant's diaper.

Wash clothes and other articles that come

into contact with breasts in very hot water.Keep area dry: expose nipples to air or sunand use a fresh bra liner every feeding.

Apply medication to nipples after everyfeeding for 14 days as ordered.



For infants:

Apply oral medication directly to affectedareas for 14 days.

Boil articles that come in contact with

infant's mouth for 20 minutes daily.

Treat diaper rash until healing is complete.



• It results in a tender area or painful lumpin the breast.

Causes:

• Infrequent nursing.

• Incomplete emptying.

•

Local pressure.



Nursing management:

Moist warm packs to area beforenursing.

Massage prior to and during nursing.Proper positioning, attachment, andremoval technique.

More frequent nursing.Check fit of clothing.



It is infection of breast tissues surroundingthe milk ducts.



Causes:

☺Nipple trauma.

☺ Untreated obstructed lactiferous duct orengorgement.

☺Contributing factors: as Stress, fatigue



Clinical picture:☺A tender reddened area of the breast

accompanied by:

☺Fever.

☺Chills.

☺Headache.

☺Generalized aches.



Nursing management:

– Start feeding the baby on the healthy side.

– Nurse frequently (2-2.5 hours)

– Proper positioning, attachment, and removaltechnique.

– Moist warm packs (3-5 minutes).

– Bed rest for 24 hours.

– Mild analgesics. – Antibiotics.

Breast abscess



Breast abscess

• Delayed or inadequate treatment ofmastitis leads to breast abscess.

• Causes:

• Improper treated mastitis.



• Nursing management:

– Antibiotics. – Incision and drainage.

– Warm packs.

– Breast feed from affected side if the incision isaway from the areola or mother need tohands express her milk until healing iscomplete.

– Rest.



II-Problems on

part of the

newborn

P t it



Pre-maturity

Breast milk changes in its compositionaccording to length of pregnancy. Milkfrom a mother giving birth pre-maturity

is well suited to the need of thepremature infants. It has more proteinand a different pattern of immune

bodies than milk of full term infants.

Management:



• Mother must maintain their milk supplyeither manual or by pumping at least 6-8 times day with one night time session.

• Give the expressed breast milk to infantby a dropper or gavage

• Mothers can increase the frequency of

feeding up to every 2 hours.

Management:



Cleft lip and cleft palate

An infant with a cleft palate is

usually unable to suckle at thebreast.

These infants may be given milk

by tube or through a special

long teat.



Congenital malformation-cardiac

diseases

Cardiac disorders may weaken the infantis that nursing is too exhausting. Mother

may pump her breasts and maintain thesick infant on breast milk given by a finetube, which passes from container (cup

or bottle) to the baby's mouth while thebaby is suckling.

Community resources which support the



• Alexandria University Children'sHospital.

• Ministry of Health.• Children Hospital.

• MCH Centers.

Community resources, which support the

mother for breast feeding



Include

• traditional Birth attendant

• Rural women leaders

• teachers

• mothers in low

• experienced mothers

• social workers

• religious leaders• Non-governmental

Organizations (NGOS).

Th t t



The ten steps

to successful

breastfeeding



Have a written breastfeeding policythat is routinely communicated to thehealth care staff.

Train all health care staff necessary toimplement this policy.

Inform all pregnant women about thebenefits and management ofbreastfeeding.

Help mothers initiate breastfeedingwithin half –hour of birth.



should be separate from their

babies. Give newborn babies no food or

milk other than breast milk unless

medically indicated. Practice rooming in allows

mothers and babies to remain

together 24 hours a day.



Encourage breastfeeding on

demand. Give no artificial teats or pacifiers to

breastfeeding babies.

Foster the establishment ofbreastfeeding support groups and

refer mothers to them on discharge

from the hospital or clinic.

feeding new

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