alcohol, caffeine, drugs and tobacco

Fetal alcohol syndrome(FAS)

- subnormal physical and mental development cause by mother’s
excessive use of alcohol during pregnancy.
- Many infants with FAS are premature and have low birth weight

- Physical characteristics includes:

- A small head
- Short eye skits that makes eyes appear to be set far apart
- A flat midface
 And a thin upper lip
 There is always a growth deficiency

 Fetal alcohol effect

 It is another condition caused by ingesting alcohol while pregnant
 They are born with less dramatic or no physical defects but with many of
the behavioral and psychosocial problems assocated with FAS
 Cannot live with normal lives due to deficits in intelligence and
behavioral and social abilities.
 When the mothers drink alcohol, it enters the fetal blood stream in the same
concentration as it does the mothers. Unfortunately, the fetus does not have the
capacity to metabolized it quickly as the mother. So it stays longer in the fetal blood
than it does in the maternal blood.
 Abstinence is recommended

 Caffeine
 Is known to cross the placenta, and it enters the fetal bloodstream.
 Safety measures, it is suggested that pregnant women limit their caffeine intake to 2
cups of caffeine containing beverages each day or less than 300mg/day.

 Drugs
 It vary in their effects, but self prescribed drugs, including vitamins and minerals
supplements and dangerous illegal drugs cal all damage the fetus.
 Drugs derived from vit A can cause fetal malformations and spontaneous abortion.
 Illegal drugs can cause the infant to be born addicted to whatever substance the mother
 Used nd, possibly to be born with the human immunodeficiency virus(HIV)
 AZT (Zidovudine)
 is prescribed in an attempt to prevent the spread of disease to the developing fetus.

 Tobacco smoking
 In pregnant women for some time associated with babies of reduced birth weight.
 The more the mother smokes, the smaller her baby will be
 Because smoking reduces the oxygen and nutrients carried by the blood.

 Other risk associated with smoking are:

 Sudden infant death syndrome (SIDS)
 Fetal death
 Spontaneous abortion
 Also affect the intellectual and behavioral development of the baby as it grows up
 lactation
 a production and secretion of breast milk for the purpose of nourishing an infant.
 Prolactin – responsible for the milk production
 Oxytocin – is involve in the milk ejection from the breast

 Let down reflex – the infants sucking initiates the release of oxytocin which causes
the ejection of milk into the infant’s mouth.
 It is a supply and demand mechanism. The more an infant nurses, the more milk
the mother produces.
 Human milk is formulated to meet the nutrient needs of infants for the first 6
months of life. Iron content in breast milk is very low but it is very well absorbed;
therefore n iron supplement is needed for breastfed babies.
 Benefits of breastfeeding
 Nutritional
 Contains just the right amount of lactose, water, essential fatty acids
and amino acids for brain development, growth and digestion.contains
at least 100ingredients not found in formula
 Breastfed babies have a lower incidence of ear infections, diarrhea,
allergies, and hospital admissions.
 Receives immunities from their mother for the disease that their
mother has had or has been exposed to
 When baby was ill- mothers immune system will start making
antibodies for the baby
 Sucking the breast promotes good jaw development and encourages
the growth of straight heathy teeth
 Facilitates bonding between the mother and the child
 Helps in losing the pounds gained during pregnancy and stimulating the
uterus to contract to its original size
 A calorie incinerator
 You may have heard that nursing burns up to 500 calories a day. And
that’s almost right. “Breast milk contains 20 calories per ounce,”
Lawrence explains. “If you feed your baby 20 ounces a day, that’s 400
calories you’ve swept out of your body.”

 Economical, always at the right temperature and readily available

 Breast milk will keep 8-10 hrs at room temp

 8 dyas in refrigerator
 3- month freezer 12 months in deep freezer
 Better healing post delivery
 The oxytocin released when your baby nurses helps your uterus
contract, reducing post delivery blood loss. Plus, breastfeeding will
help your uterus return to its normal size more quickly—at about six
weeks postpartum, compared with 10 weeks if you don’t breastfeed
 Less risk of cancer
 Breastfeeding can decrease your baby’s risk of some childhood cancers.
And you’ll have a lower risk of premenopausal breast cancer and
ovarian cancer, an often deadly disease that’s on the rise.
 A custom-made supply
 Formula isn’t able to change its constitution, but your breast milk
morphs to meet your baby’s changing needs. Colostrum—the “premilk”
that comes in after you deliver—is chock-full of antibodies to protect
your newborn baby. “It’s also higher in protein and lower in sugar than
‘full’ milk, so even a small amount can hold off your baby’s hunger,”
says Heather Kelly, an international board-certified lactation consultant
in New York City and a member of the Bravado Breastfeeding
Information Council’s advisory board.

 When your full milk comes in (usually three to four days after delivery),
it is higher in both sugar and volume than colostrum—again, just what
your baby requires. “He needs a lot of calories and frequent feedings to
fuel his rapid growth,” Kelly explains. “Your mature milk is designed to
be digested quickly so he’ll eat often.”
 A menstruation vacation
 Breastfeeding your baby around the clock—no bottles or formula— will
delay ovulation, which means delayed menstruation. “Breastfeeding
causes the release of prolactin, which keeps estrogen and progesterone
at bay so ovulation isn’t triggered,”

 Kelly explains.
 “When your prolactin levels drop, those two hormones can kick back in,
which means ovulation—and, hence, menstruation—occurs.”
 Even if you do breastfeed exclusively, your prolactin levels will
eventually drop over the course of several months. Many moms who
solely nurse will see their periods return between six and eight months
after delivery, Kelly adds; others don’t for a full year.
 Less time off work
 Your baby will be ill less often, so that means fewer sick days for you.

 A great way to learn about your baby

 “You have to read your baby’s ‘satiety cues’ a little better, because unlike
with a bottle, you can’t see how much he’s eaten,” Kelly says. “You have
to rely on your own instincts and your baby’s behavior to know when your
baby is full.”
 . You can stash the condoms—for now
 Breastfeeding can be 98 percent to 99 percent effective as a post-baby
birth control option if a few guidelines are followed: Your period must
not have resumed; you must breastfeed at least every four hours
around the clock; you must not give your baby any pacifiers, bottles or
formula; and you must be less than six months postpartum.

 According to Kelly, nighttime feedings are the most important to the

“lactation amenorrhea method,” so do not let your baby (or yourself )
sleep through a feeding. “Going long stretches at night without nursing
seems to be directly responsible for the return of ovulation,” she says.
Prematurely sleep training your baby can also hasten ovulation.
 Common breast feeding conditions and management

 Sore nipples
 The most common cause of pain during breastfeeding is due to nipple
trauma caused by improper positioning and inappropriate latch-on.7 Other
causes include short/flat or inverted nipples, oral dysfunctions in the
infant, excessively short frenulum, prolonged nonnutritive sucking,
improper use of milk pumps, not breaking suction before taking the infant
off of the breast, use of creams and oils that cause allergic reactions on
the nipples, use of nipple shields and prolonged exposure to wet nursing
pads. The myth that fair-skinned women are more vulnerable to nipple
trauma than dark-skinned women has never been confirmed.
 May be prevented by proper positioning of baby on breast
 The areola should be in the baby's mouth with tongue extended against
lower lip
 Prevention
 Pain on breastfeeding is an important cause of weaning and, therefore, its prevention is
essential. Preventive measures include the following:8
 – use a proper breastfeeding technique;
 – keep the nipples dry by exposing them to air or sunlight and change the nursing pads
used to prevent milk flow, on a regular basis;
 – avoid products that remove the natural protection of nipples, such as soaps, alcohol or
any drying agent;
 – breastfeed on demand – infants who are put to the breast as soon as they show they
want to feed feel less hungry and tend not to suck vigorously on the breast;
 – manually express milk from the areola before breastfeeding if it is engorged, since this
increases flexibility and allows for a proper latch-on;
 – if a feeding has to be discontinued, slip the index or little finger into the infant's mouth
between his/her gums to break suction before the infant is taken off of the breast;
 – avoid the use of nipple shields.
 Treatment
 offer the least affected breast first;
 express enough milk before breastfeeding to stimulate the let-down reflex, thus
preventing the infant from sucking too vigorously on the breast;
 use oral systemic analgesics, if necessary.
 May be prevented by proper positioning of baby on breast

 The areola should be in the baby’s mouth with tongue extended against
lower lip
Condition: Flat or Inverted Nipples

 This should not impact breastfeeding if the latch is correct.

 If difficult to latch:
 Mother may roll her nipple between her fingers, or use a breast pump
prior to feeding. It helps to draw out the nipple.
 Technique used: Hoffman technique
 Place your thumbs opposite each other on either side of the nipple.
Gently draw your thumb away from the nipple. Them place your thumb
above and below the nipple and repeat. Do this 2x a day for a few
minutes.
 Condition: hyperactive letdown
 Stream of milk comes from breast
 If too active may cause infants to choke while nursing
 Management:
 Wait for the milk flow to slow down before putting the infant into the
breast
 Mothers can express milk until the flow slows then allow infants to nurse
 Mastitis
 Mastitis is inflammation of the breast
 May be infective or non-infective
 Occurs in 3 to 20% of breastfeeding women
 Most common at 2-6 weeks postpartum
 May result from:
 Sore and cracked nipples
 Blood borne source of bacterial infection
 Missing a feeding resulting in engorgement, then plugged duct
may precipitate engorgement
 Condition: Low Milk Supply
 Most common reason for cessation of breastfeeding
 May be real or may be perceived
 Causes:
 Insufficientbreastfeeding or pumping
 Ineffective emptying
 Stress
 Management
 Nurse or pump every 2-3 hours
 Drugs or herbs may be prescribed
 Milk cup technique
 Begin by wearing a cup under the bra for short periods and gradually
work up to 8-10 hours a day.
 You can allow your skin to breath by removing the cup for short periods
or by wearing only the base part.
 Wearing the cup is painless. It is not noticeable when worn in the bra
unless the woman is wearing a tight-fitting jersey.
 Condition: Poor let-down reflex
 Particularly for the first time nursing mother, anxiety can be high and
can inhibit the let-down-reflex, which occurs when the milk descends
from the upper parts of the breast(hind milk) and comes down to the
areola(the darker skin around the nipple) Oxytocin (a hormone)
promotes this reflex. A lactating woman can usually identify when the
let down reflex is occurring because there is a momentarily “pins- and-
needles” feeling in the breast area.

 The hind milk is richer and higher in a fat content than milk from the
other parts of the breast. Because of the high caloric value of fat found
in the hind milk, the let down reflex is crucial for the infants adequate
weight gain. Relaxation techniques are important for successful
lactation. Humor is useful in helping the nursing mother to relax; it
should be encouraged by the nurse and healthcare professional.
: breast engorgement
 is a common occurrence in a first few days after delivery. Temporary
measures to release excess milk include taking of warm shower or
leaning with exposed breast over a sink full of warm water.
 When engorgement diminished, the infant will be better able to grasp
the nipple thereby allowing emptying of the breast. Short frequent
feeding can help keep engorgement under control.

 Breasts are overfilled with milk

 Results when supply-and-demand process is not yet established and milk
is abundant
 Best prevention: nurse frequently—newborns may nurse every 1 to 2
hours
Calorie requirement during lactation

 Approximately 85 calories – required to produce 100ml of milk

 or (3 ½ oz)

 750ml or 25 oz – average daily milk production per day for the first 6
months.

 640 cal required for the mother

 600 ml or 20oz milk production for 2-6 months.
 Each ounce of human milk contains 20 calorie.
 10 grms of protein secreted in the milk each day.

 Indication when the infant is already full

 Playing with the nipple
 Fall asleep while feeding

 Criteria's that infants id getting enough/sufficient nutrients and caloties from

breastfeeding
 A. if there are 6 or more wet diapers
 B. there is normal growth
 C. there are 1 or 2 mustard colored bowel movements in a day
 D. Breast become less full during nursing
Recommended food for pregnant and lactating mother
 Pregnant woman lactating mother
 Milk
 adult 3cup/more 4c/more
 adolescent 5cup/more 5c/more
 Veg/fruit
 Citrus/vit c 2 serving 2-3 serving
 Dark green leafy
 Veg, deep orange veg 1 serving daily 1-2 serv/daily
 Other fruits/veg
 Including potatoes 2 servings 2 servings
 Meat or alternative 3 serving /more 3 serving/more
 (6oz cooked/more)
 Cereal/bread/
 Whole grain 6 serving/more 6 serving/more
 Infancy
 Infants react to their parent’s emotions. If food is forced on a child or
withheld until the child is uncomfortable, or if the food is presented in a
tense manner the child react with tension and unhappiness. If the
parents is relaxed an infants mealtime can be pleasure for both parents
and child.
 Feed the infants on demand.
 It prevents the frustration that hunger can bring and helps the child
develop trust n people.
 The newborn may require more frequent feedings, but normally the
demand schedule averages approximately every 4 hours by the time the
baby is 2 to 3 months old.
 First year of life is the most rapid growth’s in one’s life.
 Doubles its birth weight by 6 months of age
 Triples within the first year
 Breast milk provides all the nutrients an infant needs for the first 4 to 6
months of life
 Introduction of early foods before the age of 4 to 6 months is not
recommended, because the child’s gastrointestinal tract and kidneys are
not sufficiently developed to handle solid food before that age.
 Infants with altered nutritional needs

a. Premature infants – an infants born before 37 wks of gestation.

 lung function maybe compromised
 ability to suckle maybe impaired because of immature muscle
development
 tube feeding is required (TPN)
 Mothers breast milk – best food for the premature infant (contains more
protein, sodium, immunologic properties
 Many specialized formulas made for premature infants but breast milk is
still the best for its composition is made just for the babies.
 Cystic fibrosis
 - is a life-threatening, genetic disease that causes persistent lung
infections and progressively limits the ability to breathe.
 In people with CF, a defective gene causes a thick, buildup of mucus in
the lungs, pancreas and other organs. In the lungs, the mucus clogs the
airways and traps bacteria leading to infections, extensive lung damage
and eventually, respiratory failure. In the pancreas, the mucus prevents
the release of digestive enzymes that allow the body to break down food
and absorb vital nutrients
 Symptoms of CF
 People with CF can have a variety of symptoms, including:

 Very salty-tasting skin

 Persistent coughing, at times with phlegm
 Frequent lung infections including pneumonia or bronchitis
 Wheezing or shortness of breath
 Poor growth or weight gain in spite of a good appetite
 Frequent greasy, bulky stools or difficulty with bowel movements
 Male infertility
 Treatment
• Airway clearance to help loosen and get rid of the thick mucus that can
build up in the lungs. Some airway clearance techniques require help from
family members, friends or respiratory therapists. Many people with CF
use an inflatable vest that vibrates the chest at a high frequency to help
loosen and thin mucus.
• Inhaled medicines to open the airways or thin the mucus. These are liquid
medicines that are made into a mist or aerosol and then inhaled through a
nebulizer. These medicines include antibiotics to fight lung infections and
therapies to help keep the airways clear.
 Pancreatic enzyme supplement capsules to improve the absorption of vital
nutrients. These supplements are taken with every meal and most snacks.
People with CF also usually take multivitamins
 Nutritional needs of CF
a. Calcium. Patients with pancreatic insufficiency have difficulty absorbing
calcium and are especially at risk for developing osteoporosis (weak,
brittle bones), as are all kids with CF. Dairy products are good sources of
calcium (and the full-fat varieties also are good sources of fat and
calories). Many juices also are fortified with calcium.
 Essential fatty acids. Patients with cystic fibrosis have altered levels of
plasma fatty acids. Found in plant oils, safflower oil, and soybean oils, they
help in the building of cell membranes and may play a role in lung
function. It is suggested that CF patients try to incorporate more omega 3
fatty acids into their diet, which can be done with either food sources or
supplements. Salmon, walnuts are excellent food sources of omega 3 fatty
acids. Before giving your child any over-the-counter supplements, discuss
this with your CF dietitian or doctor.
 C. Iron.
 Many children with CF are at risk for developing iron-deficiency anemia,
which can cause fatigue and poor resistance to infection. Fortified cereal,
meats, dried fruits, and dark green vegetables are good sources of iron.
 d. Salt
 Kids with CF lose a lot of salt in their sweat, especially during hot
weather and when they exercise. So a CF dietitian may suggest adding salt
to an infant's formula and giving an older child salty snacks. The dietitian
may recommend sending sports drinks along when your child plays sports
or during hot weather.
 e. Zinc
 Important for growth, healing, and fighting infection, zinc is found in
meats, liver, eggs, and seafood.
 Increasing Caloric Intake
 It can be tricky to make sure that kids with CF eat enough fat and calories,
especially if they're sensitive to what's on the plates of siblings and peers.
One way to increase calories without creating an entirely separate menu is
to increase the calories and fat in one part of the meal.
 Here are some simple ways to do so:
• Add extra butter or margarine to sandwiches, sauces, and potatoes.
• Use dressings on salads or vegetables; add extra oil to the dressing.
• Prepare entrees with gravies and creamy sauces.
• Add bacon to burgers and chicken.
• Add dried skim milk powder to sauces and beverages.
• Add extra cheese to scalloped potatoes or macaroni and cheese; order extra cheese on
pizza.
• Top salads and sandwiches with avocados or guacamole.
• Add nuts to cookies, cakes, pancakes, and salads.
• Add extra cheese and deli meats to sandwiches.
• Grill sandwiches in butter or margarine.
• Use heavy whipping cream and whole milk when cooking.
• Make milkshakes.
• Add instant breakfast mixes to milk-based beverages.
• Make high-calorie smoothies.
• Prepare calorie-rich desserts such as pudding and cheesecake.
• Top hot chocolate, pudding, and other desserts with whipped cream.
• Provide high-calorie snacks like peanut butter crackers or trail mix.
• Prepare high-calorie versions of popular family recipes.
 FTT – Failure to Thrive
 syndrome was first observed in infants raised in institutional settings in
which they did not received adequate amounts of attention (physical
touch and emotional warmth). Since this was recognized, volunteers
have been used to cuddle premature infants in hospital settings to help
their chance of survival and growth.
 A medical diagnosis that includes a weight and length of less than the
third percentile of the infants age and less than normal ability in the
Denver Developmental Screening Test. (an observational test based on
the infant developmental progress.
 Causes
 Congenital abnormalities
 AIDS
 Lack of bonding
 Child abuse
 Neglect
 The main purpose of developmental assessment depends on the age of the
child:

• Tests may detect neurological problems such as cerebral palsy in the

neonate.
• Tests may reassure parents or detect problems in early infancy.
• Testing in late childhood can help detect academic and social problems
early enough to minimize possible negative consequences (although
parental concern may be just as good a predictor for some problems
 special consideration s for infants with metabolic
disorders
 Infants born with the inability to metabolizes specific nutrients –
 Inborn errors of metabolism
 These are cause mutations in the genes
 These results in mental retardation and sometimes retarded growth
 Early diagnosis with diet therapy increases chances of preventing
retardation.
 galactosemia
 A condition affecting 1 in 30,000 live birth, in which there is a lack of
liver enzymes transferase.
 Transferase - converts galactose to glucose
 Galactose is a simple sugar reslting from digestion of lactose, the sugar
found in milk.
 When transferase is missing and the infants ingest anything containing
galasctose, the amunt of galactose in the blood becomes so excessive
that it is toxic
 The newborn suffers diarrhea, vomiting and edema
 The childs liver does not function normally
 Cataracts may develop, galactosuria occurs, and mental retardation
ensues.
 If infants with classic galactosemia are not treated promptly with a low-
galactose diet, life-threatening complications appear within a few days
after birth.
 Affected infants typically develop feeding difficulties, a lack of energy
(lethargy), a failure to gain weight and grow as expected (failure to
thrive), yellowing of the skin and whites of the eyes (jaundice), liver
damage, and abnormal bleeding.
 Other serious complications of this condition can include overwhelming
bacterial infections (sepsis) and shock.
 Affected children are also at increased risk of delayed development,
clouding of the lens of the eye (cataract), speech difficulties, and
intellectual disability.
 Females with classic galactosemia may develop reproductive problems
caused by an early loss of function of the ovaries (premature ovarian
insufficiency).
 phenylketonuria
 Infants lack the liver enzyme phenylalanine hydroxylase, which is
necessary for the metabolism of amino acid phenylalanine.
 infants with classic PKU appear normal until they are a few months old.
Without treatment, these children develop permanent intellectual
disability.
 Seizures between 6 to 18 months, delayed development, behavioral
problems, and psychiatric disorders are also common. Untreated
individuals may have a musty or mouse-like odor as a side effect of
excess phenylalanine in the body.
 Children with classic PKU tend to have lighter skin and hair than
unaffected family members and are also likely to have skin disorders
such as eczema.
 Diet therapy
 Lofenalac – a commercial infant formulas for PKU babies.