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Topic 6.

Nutritional Needs of the

Nutritional Needs of the Newborn

• Nutritional needs of newborn
• Advantages/disadvantages of breastfeeding and formula feeding
• Physiology of breast milk production
• Complications of breastfeeding
• Assessment of nutritional status of newborn
What Choice Should a Woman Make?

• Breast or Bottle
• What could influence choice or interfere with feedings?
• Allergies?
• contraindicated in baby with galactosemia (can’t digest lactose in milk)
• General health of the infant
• Who should not breastfeed?
• Maternal medications
• Untreated TB or HIV
• Women who abuse drugs / alcohol
• Herpes lesions on breasts
• Ultimately it is important to meet the nutritional needs of the
Nutritional Needs of the Newborn

• Calories
• Protein
• Fat
• Carbohydrate
• Fluid
• Minerals: Calcium, iron, flouride
• Vitamins

• Numerous benefits: to mom and baby

• We can encourage breastfeeding by:
• Educating all pregnant women about benefits
• Help women initiate breastfeeding
• Help women maintain lactation even if separated from baby
• Encourage on demand feeding
Physiology of Breast Milk
• Prolactin (pituitary hormone) acts on mammary glands to
stimulate milk production
• Colostrum-thin, watery fluid-protein, and a little fat and sugar,
maternal antibodies
• Fore milk-at the beginning of feeding. Good protein/sugar levels,
still has some antibodies
• Hind milk-lower volume of milk at the end of feed-it provides
the fat content baby needs
Advantages of Breastfeeding

• Advantages for the mother

• Protective function for breast cancer
• Helps with uterine involution
• Economical
• bonding
• Advantages for the infant
• Protection for infant-anti infective properties
• Easily digested

• Breast care
-good supporting bra
-wash breasts daily with water
NO SOAP as it dries nipples/areola
-examine breasts/nipples daily once breast
feeding is underway
• Also practice breast massage to move milk forward to milk ducts
• Begin as soon after birth as possible

• Position of baby
• Belly to belly with mother
• Make sure nipple is erect
• Stroke baby’s cheek and give the breast when mouth is wide open only.
• Ensure that the correct technique is being used to break the latch when
removing baby rom the breast

• Positions for breastfeeding.

-chair, bed, couch
Cradle hold, football hold, side-lying on
bed or couch

General tips for breastfeeding:

Try hand expressing a little breast milk on nipple to
“tempt” the baby. Baby may lick it off and then open
mouth wide.
Make sure baby is in an appropriate “state” – DO NOT
try to latch a baby who is in “deep sleep” mode.
Quiet alert mode is best time to try and latch
If actively alert and crying, soothe baby first then try to
Mother can use clean finger to stimulate suck, press
down on tongue and tickle palate with finger. Let baby
suck for a few moments and then transfer to breast.

• Sleepy baby
• Baby refuses to take the breast
• Express colostrum/milk,
• Pump to initiate the let-down so milk flows faster for
• Feed small amount of breast milk via
dropper/spoon/cup as baby may be “too tired” to suck.
Offer breast 5 minutes later
• Weaning
• Wean slowly to minimize breast engorgement
• Start by eliminating one feed per day

• Suggest mother alternate breasts at each feed.

• Allow baby to determine pattern of feeding. Some

feeds will be long others short and snacky. (Just like we
• Some babies will “cluster feed”. This can be frustrating for
mom as it feels like baby is always on the breast
• Do not limit time at breast – at least 10-15 minutes at
first breast (or longer) before switching. Some
newborns only take one breast at each feed.
• Important to use both breasts. Alternate which breast baby
starts with.
Breastfeeding Problems

• Sore nipples
• Pure lanolin products help
• Expose breasts to air
• Do not use perfumed soaps or body wash
• Breast engorgement
• Blocked Ducts
• Apply heat before feeding to help milk let down
• Gently massage duct while eeding
• Older babies can go on strike and not latch.
Breastfeeding Problems

• MASTITIS (Inflammation/infection of the

breast issue)
• If caught early, rest, fluids, nutrition, EMPTY
• If temperature elevated, flu-like symptoms, reddened
area on breast lobe, hard, indurated, then MUST SEE
doctor or midwife and get antibiotics.
• IMPORTANT to teach that mother can still continue
breastfeeding from affected breast. If doctor says no
then he/she does not understand lactation process
Breastfeeding Problems
Breastfeeding Jaundice
• Insufficient breastfeeding during first few days of life.
Baby is essentially a little dehydrated and cannot get rid
of breakdown of RBC’s
• Colostrum (first milk) is natural laxative, promotes
bowel movements, encourages elimination of bile in gut
instead of being recycled through enteric hepatic
pathway and reabsorbed
Breastfeeding Problems

• If the Mother’s milk supply dwindles down after a few

months. See doctor, check thyroid. Could be thyroid
problem. WATCH for depression.
• Mother’s milk gets less as more and more formula is
being given by others in family.

• Supplemental feedings of water or formula

should NEVER be offered to the HEALTHY
newborn who is breastfeeding.
• Hungry infant will nurse and stimulate mother’s
breasts to produce milk.
• Supplements of formula are only used if there is
a medical indication – express mother’s breast
milk first and give baby. If no milk and baby is
dehydrated/hungry then offer formula

• Breast milk can be expressed by hand, pump and stored

in fridge for 48 hours, small fridge freezer for 6-8 weeks
and large deep freeze for up to six months.

• It is best to use it sooner so that nutrients are fresh.

Fresh milk is always the best choice
Ongoing feeding of newborn

• Public Health will continue with information and

support for feeding the newborn, infant, toddler etc.
• Le Leche League of Nursing Mothers
Formula Feeding

• We need to support the mother’s choice of

feeding her infant. Formulas have definitely
improved over the last 50 years but do not yet
simulate breast milk.

• It is important that the mother bond and attach

to her baby and too much criticism of how she
chooses to care for her baby can interfere with
this. Be positive and encouraging.

• What kinds of formula are available?

• What form do they take?
• Why is it important to educate mothers on formula
• Why must we carefully read and follow the directions on
the can?
Formula Feedings

• Do the bottles need to be sterilized at home??

• Does formula need to be heated?
• How could we heat formula?
• Should we use the microwave
• How long should prepared formula be
• When do we burp a formula fed baby?
Formula Feeding

• How do we hold a bottle of formula when we feed a

• What should we assess if feed is taking too long – more
than 15-20 minutes?
• Who determines how often a baby should be fed?
Feeding the Newborn

Nutritional Status Assessment:

• How can we tell if a newborn is getting enough
formula/or breastmilk?
• Number of wet diapers in 24 hours.
• Day 1 – usually one or two large wet diapers\
• Day 2 – two wet diapers
• Day 3 – 3 wet diapers
• Day 4 – 4-5 wet diapers
• Day 5-7 4-6 wet diapers and perhaps more.
• What does the newborn, breastfed baby’s stool look like?