Maternity - Newborn, part 7: Infant Nutrition, Breastfeeding and Formula Feeding Best Practices
Hi, I'm Meris with Level Up RN. And in this video, I'm going to be talking to you about nutritional concerns and guidance for the newborn. I'm going to be following along using our maternity flashcards. These are available on our website, LevelUpRN.com if you want to grab a set for yourself. And if you already have your own set, I would invite you to follow along with me. Let's go ahead and get started. So first off, we're talking about the newborn and nutrition, and we can't talk about those things without mentioning the fact that it is normal and expected for infants to initially lose 5 to 10 percent of their birth weight in the first few days following birth. That's normal. What's not normal is to go past that 10%, right? So this is why the baby's going to get weighed every day in the hospital and why we're going to weigh the baby once we go to the pediatricians for that first appointment following coming home from the hospital. We need to make sure that we are within those expected ranges. My daughter lost too much weight, and we actually had to stay an extra day because they were concerned about it. And then we also had to take her for a weight check to the pediatrician's office earlier than we would have if she had maintained her weight. Okay. So that was something that we had to do there. Normally within about two weeks, though, they have regained their weight. And that is why you will see that, "Oh, she was born six pounds, 12 ounces. But then she lost weight." That sort of a thing. That is normal and expected. Now hunger cues. You might think that a baby tells you that they are hungry by crying, but that is actually a late sign of hunger. The baby will give you lots of cues along the way that they are starting to get hungry that don't involve crying. So one of them is just opening their mouths. They do a lot of open mouth movements where they're just kind of lying there and they're like. That means like, "Hey, I'm hungry. Put something in my mouth." If they're doing hand to mouth motions, that again means like, "I'm looking for food. I'm hungry." Then we also have sucking and rooting. We talked about those reflexes in a previous video, and I told you that rooting is looking around, right? They're kind of-- they're searching for that nipple. We called it ostriching in my family when we had our kids because she literally was throwing her head around looking for food. So all of those things are going to be actual hunger cues before we get so upset that we're crying, right? Now parental guidance. Newborns do not need water. Tell me in the comments. At what age does an infant start to be allowed to have water? But newborns don't need any extra water, and in fact, if we give them water, that can put them at risk for hyponatremia because their fluid balance is different than an adult's. So do not give them extra water. And this is also why we say you should never water down formula. If you have difficulty making ends meet, it can be tempting to water down formula to try and stretch that a little longer because formula is expensive. But this is really dangerous for the infant and can cause serious harm and even death. So we don't water down formula. If the baby is being breastfed, then we want to supplement their vitamin intake with 400 IU's, international units, of vitamin D daily. And then after six months, they need iron fortified cereals and foods. But that vitamin D in the breastfed baby is important because they're not going to get very high levels of vitamin D through that breast milk. Now, formula fed babies, though, don't need that because formula is supplemented with vitamin D. However, they are
going to require iron fortified formula for that first year of life. This is why there's infant formula, and that's specific for that first year of life. And then there's stuff like toddler formula for if they have a hard time adjusting to drinking whole milk and things like that. There's other ways to supplement them. But we would not give them the same formula as an infant. Solid foods can be introduced around four to six months. This is one of those things where you are going to educate the parents to defer to the guidance of their pediatrician. Our pediatrician actually had us introduce allergens to our kids starting at four months. So we were not feeding them solid foods so much as we were taking a little bit of peanut butter on our finger and putting it on their tongues to prevent allergies is the best practice that we had at that time. Some other pediatricians will say nothing other than breast milk or formula until six months, but four to six months is that range that is considered universally kind of applicable here. And when we introduce solid foods, we do it one at a time. Meaning I'm not going to give you a blend of apples, carrots and whatever all at once. I'm going to give you just the apples or just the carrots, and we're going to do that for a couple of days, make sure you tolerate it well, and that we are not seeing signs of allergies. If I give you a blend of foods and you have an allergic reaction, I don't know what the allergy is because it could be any one of those foods. So that is a good way to help to identify allergens. Now, when we talk about breastfeeding, there are advantages to breastfeeding, and some of those advantages include preventing infections because I am passing maternal antibodies through breast milk. So baby is getting some antibodies of things that I have been exposed to. So we're helping to prevent infections, especially if the cold is going around or whatever. And I have some antibodies to that. Enhancing brain growth. So just based on the facts that are found in breast milk. And then reducing the risk of SIDS. Along with the fact that it's convenient and it's inexpensive, right? Unless you are pumping, breastfeeding is essentially free, and it's strapped to you at all times, and you don't have to carry around formula and things like that. So those are some of the advantages of breastfeeding. However, breastfeeding is not for everyone, and I just want to make it very clear that this video is not meant to shame. This video is not meant to imply that breastfeeding is the only way to feed a baby. Fed is best and doing whatever works for you and your family and your body and your relationship with your child is the best thing to do. However, when we're talking about patient teaching for breastfeeding, we want to feed the baby within 30 minutes of delivery. We've just gone from constant exposure to nutrition through the umbilical cord to nothing. So it's important to initiate feeding. That's also going to help with bonding and thermoregulation as well. We want to teach about the correct latch. So the nipple and areola are actually two separate parts. So the nipple is just the part like the erectile tissue. The areola is that dark part of the breast that surrounds the nipple. So a correct latch is when the baby's nose, cheeks, and chin all touch the breast with a portion of the areola in the infant's mouth. So we don't want just the nipple. That's not a correct latch. We want all of this touching the breast, and we want a portion of the areola in the infant's mouth. We also don't want to just pull the infant off the breast at any point. They have very strong suction, and that
could cause injury to mom. So instead, we're going to insert a finger and break that suction first. And then we can remove the baby from the breast if we needed to, for some reason. Breastfed infants have loose, watery, yellow stool. And it oftentimes has kind of like a mustard seed appearance to it. That's normal. I remember thinking it was very-- I thought something was wrong with my baby. I was like, "She has seeds in her poop." And they were like, "No, that's very normal." And then the most important thing that I want to point out here is that adequate hydration, adequate feeding in the newborn is going to be indicated by six to eight wet diapers per day. That is going to be the best way to assess the hydration status of the infant. Because unless you have a very specific type of scale where you can weigh the baby before and after a feed, you don't know how much you fed your baby. So instead, you need to monitor their outputs. Now, storing breast milk is very different from storing formula. We need to make sure that we teach this appropriately. So breast milk can be stored at room temperature for four hours versus formula is only about two. Why? We have white blood cells in breast milk that actually are fighting off bacterial growth. So that is why it can be stored at room temperature for longer. We can refrigerate it in the refrigerator itself, not in the door of the refrigerator, for four days. It can be frozen for up to six months, and it can be kept in a deep freezer for up to 12 months. We want to thaw frozen breast milk in the refrigerator or using lukewarm water. We would never want to microwave or do anything along those lines. We don't microwave anything for an infant, right? That is asking for scalds and burns. And then unused portions of breast milk need to be discarded versus being put back in the refrigerator. Because when the infant is sucking the breast milk out, there is some regurgitation of their own saliva, which has bacteria in it. So we could end up with bacterial growth. So we wouldn't want to store that breast milk again. We don't ever microwave breast milk. And we also don't ever refreeze thawed breast milk. So once it has been thawed, we do not refreeze it. Now let's talk about do's and don'ts for formula. So for powdered formula, it's going to tell you exactly on the label how much powder to how much water and you need to use that exact amount. We talked about that already. You also need to use water from a safe source. Now this could mean boiled water. But when I say this, I want you to understand that I mean you are preparing formula using water that you have boiled and then allowed to cool. We would never prepare formula using boiling hot water. We have boiled it to kill off any pathogens. It has cooled. Now we are preparing formula with it. You can also use things like nursery water, which is water that has been sterilized and purified, and you can just buy that at the store. Room temperature formula must be used within two hours of preparation. You can refrigerate formula for up to 24 hours. So when we eventually transition to formula with my kids, I would prepare a full day's worth of formula the night before and put it in the fridge. And that way it was ready to go, and I didn't-- all the air bubbles were out of it and things like that. I didn't have to prepare a bottle every single time.
Feed the baby in a semi-upright position. This is going to help to decrease pooling of that formula in the mouth, which can lead to infection in the ears because of the eustachian tubes being more horizontal than they are in an adult. Hold the bottle at an angle, and this is true for any sort of bottle feeding, even if that's with expressed breast milk. Hold the bottle at an angle and keep the nipple filled with formula so you don't need to-- look, I have my handy dandy baby here. We don't need to-- pretend this is my bottle. We don't need to have it like this, right? It doesn't need to be all the way up. Instead, we're actually going to hold the baby like this and just sort of put enough in the nipple so that the nipple is full without kind of drowning the baby with all that formula. That's too much pressure. I don't need all that pressure and also is going to help to decrease gas and air bubbles for that infant. Burp the baby. So when they take a break from eating, they sort of release suction for a minute. That's a good time to pick them up and burp them in the middle of the feeds to help reduce any sort of big gas accumulation. And then just as with breast milk, we're discarding any of that formula that the baby didn't drink. We are not holding on to it for later. We don't ever prop a bottle. Meaning we don't put the baby in some sort of baby carrier and prop the bottle up. We are going to be holding that bottle all of the time. We don't ever freeze formula. And again, we don't ever warm it up in a microwave. And we don't add water to what is called ready-to- feed formula. Powdered formulas require water, but you can buy a big bottle of ready-to-feed formula, which is already liquid. You don't add water to it. It becomes a watered down formula, and now the baby is at risk for hyponatremia. I hope that review was helpful. I'm going to ask you some quiz questions to test your knowledge of some key facts I provided you. Okay, so first up. Aside from crying name two hunger cues that the infant might show to you. I gave you a bunch so just tell me two. At what ages should solid food be introduced to the infant? At what age range is it okay to introduce solid foods? How can the parent of a breastfed child assess whether or not the newborn is receiving adequate feeding? For how long can breast milk be kept at room temperature? And lastly, tell me for how long can prepared formula be kept at room temperature? Let me know how you did in the comments. Thanks so much. And happy studying.
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