CHAPTER 19 - NUTRITIONAL NEEDS OF A NEWBORN

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1. ASSESSING FOR ADE-

QUATE NUTRITION

2. How do you know if baby is -There are at least 6-8 wet diapers a day
getting enough milk/formu- -There are 2-3 BMs
la? (@ 1 week old) -Baby sleeps between feedings
-No excessive crying
-Gaining weight (Loses no more than 10% of
birth weight)
-Good skin-turgor

3. NUTRITIONAL AL-
LOWANCES

4. Calories -A 2 month old needs 50-55 calories per

pound every 24 hours

-Calorie needs to vary with individual activity

level and growth rate

5. Protein 2.2 gm/kg 1st 2 months) necessary for new

cell growth and maintenance of existing cells

6. Cows milk is not recommended until 1 year old.

Infants kidneys are overwhelmed with the pro-

tein contents cows milk and it is not easily
digested.

7. Fat Linoleic acid (amino acid) needed for

brain/nerve growth and skin integrity.

Breast milk has generous supply

8. Carbs (Lactose) improves calcium absorption; de-

creases intestinal illness

Lactose intolerance is rare in infants

9. Fluids
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Babies have a large surface area in relation to
body mass, so they easily lose H20 by vapor.
(Dehydration)

Need 150-200 ml/kg of water daily, which is

met through breast milk or formula. (no fruit
juice) This is until 6 months or older

10. Minerals Calcium = needed for rapid skeletal growth

Iron = infants have iron stores for 1st 3

months, then begin to produce HGB. Iron for-
tified formulas are recommended.

continued

11. Minerals continued If the newborn is only breastfed, then they

may need a supplement of iron fortified cereal

Fluoride = for strong teeth/prevent tooth de-

cay (drink fluoridated water); may be needed
about age of 6

12. Vitamins supplement of 400 IU/day of Vitamin D is rec-

ommended by AAP

13. BREAST FEEDING Educate mothers on the benefits of breast

feeding.

Help initiate breastfeeding within 30 mins af-

ter birth

Help maintain lactation even when separated

from the infant

continued

14. BREAST FEEDING CONTIN- No pacifiers - these can reduce sucking initia-
UED tive

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Support rooming in 24 hours a day

Encourage breastfeeding on demand

Refer mothers to support groups/lactation

consult at discharge

15. BREAST FEEDING CONTIN-

UED

16. Breast Milk formed in the alveolar cells of the mammary

glands.

The hormone, prolactin, stimulates the pro-

duction of milk

When an infant is actively sucking at the

breast, this stimulates further production of
prolactin.

17. PHYSIOLOGY OF BREAST

MILK PRODUCTION

18. Colostrium Is thin/watery/yellow.

Contains protein, sugar, fat, water minerals,

vitamins, maternal antibodies.

Provides nutrients for infant's 1st 3-4 days of

life, easy to digest.

19. True/mature breast milk Starts on the 10th day

20. How may calories do new- 20 calories

borns receive from 1 oz of
breast milk

21. Fore milk Presents when infant starts suckling

22. Oxytocin
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is released with sucking, which causes mam-
mary glands to contract, forcing milk through
the nipples - this is the let down reflex

23. New milk is called hind milk

Hind milk has a high fat content than fore milk

which is important for infant growth

24. ADVANTAGES OF BREAST

FEEDING

25. Mother Release of oxytocin aids in uterine involution

Protective against breast and ovarian cancer

Return to prepregnancy weight sooner

26. Mom continued Reduces cost of feeding and prep time

Decreased risk of hip fractures and osteo-

porosis in the postmenopausal period for the
woman

Improves bonding with the newborn

27. Infant Breast milk contains Immunoglobulin A (IgA)

protecting infant from viruses and bacteria in
the GI tract.

Reduces risk of bacterial infections, respira-

tory infections, viruses, less incidences of di-
arrhea

28. Infant continued Perfect nutrition combination of fats, protein,

lactose, electrolytes and minerals and is eas-
ily digested

Reduces chance of allergies

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Prevents excessive weight gain

29. Infant continued Begin soon after birth - ASAP

Oxytocin is released by breastfeeding, starts

let-down of milk

need to urge women to have infant start on

breast that they last used to ensure emptying

30. Infant continued No bottles until 4-6 weeks

Rarely results in high bilirubin

Infants breast feed every 2-3 hours and rest

in between

31. SEE PAGE 500 FOR L.A.T.C.H

32. SEE PAGE 500 FOR HOLD

POSITIONS

33. EDUCATION RELATED TO

BREAST FEEDING

34. Provide immediate support if Issues need to be handled with an intelligent

problems arise response or there can be complications and
the mother will develop discouragement.

It can deter woman from enjoying breast feed-

ing and bonding with the newborn

Promote adequate sucking

Awaken the infant fully before feeding: change

positions; rub their backs

35. 1) Burp after they have emptied first breast

and again after the total feeding.
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Provide information regard-
ing techniques for burping 2) Hold the baby in a sitting position on lap,
the breast fed baby: lean them forward (index finger and thumb
support the head); this is often the best po-
sition because they do not have good head
control when on the shoulder

3) Laying the baby prone across the lap is

also effective

36. Prevent or relieve engorge- Empty the breast (manual expression, breast
ment pump, or feedings)

May be given a mild analgesic for pain relief

Wear a good supporting bra

37. Promote healing of sore nip- Position the infant differently for each feeding
ples
Expose nipples to air for 10-15 minutes after
feeding to dry them

Apply lanolin to nipples

38. Effective Breast Feeding Anticipate potential problems and suggest

methods for resolving them: not remembering
which breast to begin feedings; milk supply
can decrease if breast is not used.

Provide information on supplemental feed-

ings: breastmilk can be refrigerated for 5
days, frozen for 6 months

39. Effective Breast Feeding Provide information for a mother who works
continued outside the home: use breast pump at work.

Provide information on weaning: it is recom-

mended that they are to breast feed for 1 year.

The WHO recommends 2 years

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40. Formula Feeding

41. Preparation Commercial formula: power; condensed liq-

uid; ready-to-pour; prepackaged

Formula contains same nutrients as breast

milk ALTHOUGH breast milk contains immu-
nity compontent.

42. Prep continued Supplies needed: bottles; water; warm in bowl

of hot water, not microwave (too hot)

Powdered formula is cheaper but still contains

the same nutrients as pre-made

43. Formula Preparation For pre-sterilized liquid formula: Wash off top
of can with warm, soapy water and rinse.

Open the can and pour the desired amount

of formula and water into previously cleaned
bottle.

Put on nipple, taking care not to touch nipple.

44. Formula prep continued Place bottle cap over nipple and refrigerate or
use to feed immediately.

Powder - combine tap water with measured

amount of powder into a clean bottle. Place
cap on the bottle and shake to mix

45. READ PAGE 503

46. Discharge Planning Review mother's plans for feeding baby be-
fore discharge so there is time to answer re-
maining questions.

If needed, check to see if home care referral

or visit has been scheduled; make sure moth-
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er has telephone number to call if she has
questions before home visit occurs.

Review criteria to use to assess if infant is

receiving adequate fluid.

47. Additional Info After birth, a teaching plan addressing the

nutritional needs of both the woman and her
newborn should be developed.

Babies experience growth spurts during the

first year at about 3 months, 6 months and 9
months; during these times, they may need to
be fed more frequently to meet their nutrition-
al needs.

48. Additional info continued Be certain woman has appt with PCP for her
infant or the telephone number of this person
to call for an appointment.

Parents who choose formula feeding need to

pan ways to make feeding time an intimate or
special one for both themselves and the baby.

49. Helpful Internet sites for re-

ferral are La Leche League
International and Internation-
al Lactation Consultant As-
sociation

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