Feeding, Infant: Breast-Feeding and Formula-Feeding



Feeding, Infant: Breast-Feeding and Formula-Feeding







CLINICAL GUIDELINES



  • Infant feeding is performed by family members or healthcare providers. Authorized volunteers working at the facility may participate in infant feeding when approved to do so by the registered nurse (RN) or licensed practice nurse (LPN) assigned to that infant.


  • Infants must have adequate intake to maintain weight gain along their own growth curve.


  • Infants are exclusively breast-fed or fed human milk for the first 6 months of life whenever possible. Contraindications to breast-feeding include galactosemia, maternal use of illegal drugs, untreated active tuberculosis, human immunodeficiency virus (HIV) infection, and administration of certain drugs (e.g., radioactive isotopes, antimetabolites, and cancer chemotherapy).



caREminder

In economically underdeveloped countries, mothers with a positive HIV status are recommended to provide their infants with exclusive breast-feeding for the first 6 months of life, as the risks of malnutrition, diarrheal disease, and mixed feeding are greater with exclusive formula-feedings to the infant.



  • Infants are fed human milk or iron-fortified infant formula for the first 12 months of life.


  • If the infant has special needs requiring specific feeding interventions, referrals are made as indicated and family members are educated on specific feeding techniques for their child.


  • Infants who are receiving adequate fluid and calories have about six to eight wet cloth diapers or five to six wet disposable diapers and three to four stools per day, nurse approximately 10 to 12 times a day, seem satisfied after nursing (e.g., not irritable or fussy), and gain approximately 1/2 to 1 oz a day in the first 3 months of life. See Table 42-1 for Nutritional Needs of Infants.


  • Guidelines for breast milk handling and storage are presented in Chapter 23.


  • Prepared formula can be kept refrigerated for 24 to 48 hours, although it is safest to consume within the first 24 hours.


  • Open cans of concentrated formula powder have a shelf life of 30 days.


  • When providing formula to the infant, select glass bottles or plastic bottles that do not contain bisphenol A in their composition.




EQUIPMENT

For breast-feeding:



  • Nonsterile gloves


  • Washcloth and soap (if needed)


  • Pillow or blanket roll


  • Drinking water for the mother

For formula preparation and feeding using a bottle:



  • Measuring cups


  • Appropriate formula, either stored breast milk, powdered concentrated liquid, or ready-to-feed formula


  • Scoop


  • Bottled or distilled water


  • Additives as prescribed by the healthcare prescriber (e.g., oil, Polycose)


  • Long-handled spoon


  • Bottles with appropriate nipples and rings or disposable bottle liners with nipple, rings, and support form


CHILD AND FAMILY ASSESSMENT AND PREPARATION



  • Assess infant’s general health status (including weight and length), developmental age, chronologic age, and previous feeding experiences.


  • Assess infant’s oral motor development, particularly if the infant has been intubated, was drug exposed in utero, or has a congenital defect (such as cleft lip or palate).


  • Assess mothers’ preference to breast-feed or bottlefeed. Explain merits of breast-feeding and the American Academy of Pediatrics (AAP) support of this feeding
    method. Clarify any misconceptions regarding breastfeeding.








    TABLE 42-1 Nutritional Needs of Infants























    Age

    Breast Milk or Formula

    Solid Foods

    Total Caloric Needs


    Newborn-3 months

    1-6 oz every 2-4 hours (intake varies with age and weight)

    No solid foods should be introduced.

    (89 × weight [kg] – 100) + 175


    4-6 months

    6-8 oz every 4½-6 hours

    Introduce solid foods beginning with cereal products. Breast-fed infants can be sustained on mother’s milk alone.

    (89 × weight [kg] – 100) + 56


    7-11 months

    6-8 oz every 6-8 hours (with a maximum of 32 oz per day)

    Introduce solid foods. Introduce the cup. Offer finger foods.

    (89 × weight [kg] – 100) + 22



  • Assess family members’ level of comfort with feeding, and knowledge knowledge about positioning infant during feeding, formula preparation and storage, infant’s nutritional needs, and how to assess child’s hydration status.


  • If using formula, determine type of formula per healthcare prescriber’s orders, formula source (e.g., ready to feed, concentrated liquid, powdered), and calorie amount based on birth weight, history of prematurity, allergies, and presence of pathology.


  • Assess financial resources of the family to purchase formula and equipment and whether a social service referral may be needed.


  • Determine infant state before feeding and assist infant to achieve quiet alert state. Ensure that the infant is awake and stimulate if necessary.


  • Provide nursing mother or person feeding the infant with a relatively quiet environment that is as private as possible and free from interruptions. Assist the person feeding the infant to assume a position of comfort using a comfortable chair, pillows for arm support, and a footstool to support the feet and the infant.


  • Recommend restricting or avoiding pacifier use until breast-feeding is well established, usually between 4 to 6 weeks of age. Pacifier use has been associated with an overall decline in breast-feeding duration, although the specific cause of this decline is not known.



PROCEDURE
Breast-Feeding







































Steps

Rationale/Points of Emphasis 1


1 Perform hand hygiene and don gloves.

Standard precautions to reduce transmission of microorganisms.


2 Assist nursing mother as needed to perform hand hygiene before feeding and wash and dry breasts if wearing perfume, oils, powders, or lotion other than lanolin cream.

Reduces transmission of microorganisms. Cleansing of the breasts removes perfume, lotion, or oils that may interfere with the infant accepting the breast. Removal of dried milk reduces potential irritation of the mother’s nipples.


3 Position the infant close to the mother with head slightly elevated and abdomen turned in contact with mother’s body. Direct skin-to-skin contact is ideal. Infant should be lined up with mouth, chin, and umbilicus in a line. Infant should be able to latch onto the breast, taking the entire areola or as much of it as possible with his or her mouth wide open. The infant’s nose and chin should touch the breast with equal pressure. Use pillows or blanket rolls as needed to assist in positioning the infant.

Promotes successful breast-feeding by making the milk flow better, stimulates a good milk supply, and helps prevent overly engorged breasts. If the infant latches on to just the nipple, pain or trauma may occur. Pillows and blanket rolls can help support the infant in a position of comfort for the mother and infant.


imageKidKare “Tickling” the infant’s cheek with the nipple of the breast elicits the rooting reflex and encourages the infant to open his or her mouth wider to latch on properly.


4 The mother should rotate which breast the infant starts on with each feeding.

Infants are more awake and energetic at the beginning of the feeding and tend to empty the first breast more completely. By rotating, you avoid emptying the same breast every time.


5 Encourage mother to have infant nurse 10-15 minutes per side, burping the infant in between breasts and at the end of feeding.

Although most milk is released in the first 10 minutes of a feeding, most babies will breast-feed for 15-60 minutes. Although not as much milk is produced toward the end of a feeding, this hind milk contains much more fat and calories than the milk at the beginning of the feeding. Infants may continue to suckle at breast for comfort and nonnutritive sucking.


6 To break suction while infant is feeding, instruct mother to insert the tip of her little finger between the breast and the corner of infant’s mouth and pull slightly downward.

Breaks the seal and prevents trauma to the nipple.


7 Offer mother water to drink during breast-feeding.

Inadequate maternal hydration slows milk production.


8 When done breast-feeding, assist the mother to place infant in safe and secure supine position in the crib (with side rails up) or bassinet. Assist mother as needed to redress and assume position of comfort.

Ensures safety of infant and mother. Supine position prevents aspiration.


9 Perform hand hygiene.

Reduces transmission of microorganisms.



Tags:
Jul 9, 2020 | Posted by in NURSING | Comments Off on Feeding, Infant: Breast-Feeding and Formula-Feeding

Full access? Get Clinical Tree
Get Clinical Tree app for offline access