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Nursing

Feeding Infants and Toddlers

Breastfeeding

Breast milk production is a natural response occurring 48-72 hours after the birth of a baby. A system of supply and demand; the more milk removed from the breast, the more milk the body will produce.

Principles

Breast milk alone is the best possible food and drink for a baby in the first six months of life according to the World Health Organization and Unicef. Knowledge of breastfeeding resources and breastfeeding ‘basics’ information is required in everyday nursing practice. Altered breastfeeding patterns through illness of mother or infant require supportive nursing care and instruction for establishment and/or maintenance of lactation. Breastfeeding is a joint function of a mother and her infant, therefore both must be considered. Standards apply to all areas of nursing practice; within both in-patient and ambulatory settings.

Assessment

Breastfeeding assessment (i.e. correct position/latch, duration, suck/swallow patterns) should be a part of every admission and documented accordingly in the nursing history and/or progress notes. Nurses should identify and assess breastfeeding concerns such as sore nipples, engorgement, perceived insufficient milk supply, positioning and latch.

  • Evaluation

Application of knowledge of adequate nutrition and hydration is evident in ongoing planning for the breastfed baby. Daily documentation of the progress of parent teaching in preparation for the discharge of the breastfed baby is evident. Documentation is made that there is evidence of parental understanding and application of breastfeeding principles in the care of the infant.

Warning Signs and Risk Factors for Feeding Difficulties

Infant

Mother

  • Frequent/prolonged feeds
  • Irritable/unsatisfied post feed
  • Dehydration
  • Asphyxia/neurological impairment
  • Inadequate weight gain
  • Excessive sleepiness

 

  • Sore nipples
  • Decreased milk supply
  • Engorgement/mastitis
  • Hx of breast surgery
  • Psychosocial issues
  • Exhaustion/stress/illness
  • Depression
  • Maternal medication

 

Storage of Breast Milk

Breast milk should be frozen within 24 hours of pumping. Frozen breast milk that has started to thaw should be used within 24 hours. Do not re-freeze breastmilk that was previously frozen.

Breast milk should be stored in one of the following ways:

Where

How Long?

In the fridge

48 hours

Single door fridge - freezer

1 to 2 weeks

Two door fridge - freezer

2 weeks to 3 months

Chest or deep freezer

6 to 12 months

Handling of Breast Milk

All breast milk must be double checked by either two RN's or one RN and a caregiver. Breast milk may intrinsically contain a blood-borne viruses like Hepatitis B or HIV. All breast milk MUST be treated like any other potentially contaminated body fluid. When handling breast milk remember to use universal precautions.

Formula Feeding

Types of Formula

Indications for Use

Cows milk based

Term/preterm infants > 2 kg

Soy-based (e.g. Isomil, Prosobee)

Lactose intolerance, vegetarian, allergy to cow's milk protein; NB: 40% cross-sensitivity to cow & soy protein

Lactose-free cow’s milk based

Lactose intolerance

Partially hydrolysed protein

Cow's milk protein allergy (prevention), or delayed stomach emptying

Protein hydrolysate

Allergy to intact cow or soy proteins (high risk)

Premature
(e.g. Similac special care 20 & 24)

Preterm infants < 2000 grams

Amino Acid based formula

Severe allergy to cow or soy proteins

Energy Content of Formula

The energy/calorie content of formula can increase by concentrating the formula, &/or adding carbohydrates (e.g. Caloreen) or oils (e.g. Corn, Microlipid, MCT)

Kilojoules/litre (kJ/L)

 Kilocalories/ounce (kcal/oz)

 Kcal/100ml

2800

20

68

3300

24

80

3800

27

90

4200

30

100

Food Allergies

Food allergies are most frequently noted in the first years of life and susceptibility decreases before school age. The most common food allergies include:

  • cows milk
  • soy
  • eggs
  • strawberries
  • nuts
  • fish
  • seafood

  • chocolate
  • citrus fruits
  • tomatoes

Preventative measures, if a strong family history of food allergies exists, include:

  • breastfeeding exclusively for first six months and restricting mother's diet
  • using protein hydrolysate formula
  • adding one new flavor/food every 7-14 days
  • avoiding common allergenic foods in the first year of life

No Microwaving of Formula and Breast Milk

A microwave oven should not be used to thaw or heat any type of formula or breast milk. Microwaving creates hot spots that can burn the infant’s palate. A hospital approved waterless warmer should be used where available. Alternatively, heat formula and breast milk in a container submerged in warm water.