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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 optimal feeding choice for most infants. 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. Breastfeeding concerns such as sore nipples, engorgement, perceived insufficient milk supply, positioning and latch should be identified and addressed.

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 refrigerated soon after pumping (within 1 hour). Breast milk stored for later use 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.

Handling of Breast Milk

Breast milk is a body fluid and may contain viral or bacterial pathogens. Care must be taken to ensure that breast milk is fed to the correctly identified infant. All expressed breast milk (EBM) should be double checked, signed and recorded in the patients record. When handling breast milk remember to use universal precautions.

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.

Formula Feeding

With the exception of unopened "ready to feed" formulas, all feeding and expressed breast milk (EBM) must be refrigerated until needed and used by expiry date listed on label.

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
References: SickKids Policy: Handling, storage, thawing and administration of expressed breast milk.