Nutrition During Lactation PDF

Chapter 7 Nutrition During Lactation: Conditions and Interventions Copyright © 2017 Cengage Learning. All Rights Reserved. ...

Chapter 7 Nutrition During Lactation: Conditions and Interventions Copyright © 2017 Cengage Learning. All Rights Reserved.  Common Breastfeeding Conditions Include: – Sore, flat, or inverted nipples – Letdown failure – Hyperactive letdown – Hyperlactation – Engorgement – Plugged duct or mastitis – Low milk supply Copyright © 2017 Cengage Learning. All Rights Reserved.  Sore Nipples May be prevented by proper positioning of baby on breast – Mother’s nipple approximates to the junction of the hard and soft palate So far back that it is beyond reach of the tongue compression wave Copyright © 2017 Cengage Learning. All Rights Reserved.  Flat or Inverted Nipples Should not impact breastfeeding if the latch is correct – If difficult to latch: roll nipple between fingers or use a breast pump prior to feeding Helps to draw out the nipple Copyright © 2017 Cengage Learning. All Rights Reserved.  Letdown Failure Milk does not eject from the breast – Not common – Oxytocin nasal spray may be prescribed – Relaxation techniques may help enhance letdown Copyright © 2017 Cengage Learning. All Rights Reserved.  Hyperactive Letdown Streams of milk come from breast – If too active, may cause infant to cough, choke, or gulp Management: – Wait for milk flow to slow down before putting the infant to the breast – Express milk until the flow slows then allow infant to nurse Copyright © 2017 Cengage Learning. All Rights Reserved.  Hyperlactation Milk volume produced exceeds intake – Symptoms in mother: Breasts not drained completely or plugged ducts Leaking between feedings Pain with letdown or deep in breast – Symptoms in baby: Spitting up Poor weight gain Difficulty maintaining latch Copyright © 2017 Cengage Learning. All Rights Reserved.  Hyperlactation (cont’d.) Management: – Cabbage leaves or cold compresses may be used to decrease production – Nurse baby on one side only and express for comfort on the other Copyright © 2017 Cengage Learning. All Rights Reserved.  Engorgement Breasts are overfilled with milk – Results when supply-and-demand process is not yet established and milk is abundant Best prevention: nurse frequently – Newborns may nurse every hour and a half Cabbage leaves may be used to reduce discomfort Copyright © 2017 Cengage Learning. All Rights Reserved.  Plugged Duct Localized blockage of milk resulting from milk stasis – Caused by milk staying in the ducts – Painful knot may form in breast – Treated by massage and warm compress – Prevented by complete emptying of breasts and changing position of infant while feeding Copyright © 2017 Cengage Learning. All Rights Reserved.  Mastitis Inflammation of the breast – May be infective or non-infective – Occurs in one to 33 percent of breastfeeding women – Most common at two to three weeks after birth – May result from sore or cracked nipples or missing a feeding Copyright © 2017 Cengage Learning. All Rights Reserved.  Low Milk Supply Most common reason for cessation of breastfeeding – May be real or perceived – Causes: ineffective emptying or breast or stress Management – Nurse or pump every two to three hours during day and once at night – Galactogogue may be prescribed Copyright © 2017 Cengage Learning. All Rights Reserved.  Maternal Medications Most medications are excreted in breast milk – Variables to consider: Pharmacokinetic properties of the drug Time-averaged breast milk/plasma drug concentration ratio Drug exposure index, dose, strength, duration Ability to absorb, detoxify, and excrete drug Age, feeding pattern, total diet, and health Copyright © 2017 Cengage Learning. All Rights Reserved.  Maternal Medications (cont’d.) Milk/plasma drug concentration ratio (M/P Ratio) – Ratio of concentration of drug in milk to the concentration of drug in maternal plasma Exposure index – Average infant milk intake per kilogram body weight per day X 100 Copyright © 2017 Cengage Learning. All Rights Reserved.  Maternal Medications (cont’d.) Drug categories – Cytotoxic drugs – Drugs of abuse – Radioactive compounds – Drugs with unknown effect – Drugs with significant effect – Medications compatible with breastfeeding – Agents with no effect on breastfeeding Copyright © 2017 Cengage Learning. All Rights Reserved.  Maternal Medications (cont’d.) Safety of oral contraceptive use during lactation – Evidence suggests combined oral contraceptives (OCs) may reduce breast milk volume – Recommendation: avoid use of combined OCs from six weeks to six months postpartum Copyright © 2017 Cengage Learning. All Rights Reserved.  Herbal Remedies Scientific information about herb use during lactation is sparse – Medicinal herbs should be viewed as drugs – Many are considered not appropriate during lactation Refer to Tables 7.4, 7.5, and 7.6 Copyright © 2017 Cengage Learning. All Rights Reserved.  Herbal Remedies (cont’d.) Specific herbs used in the United States – Echinacea: insufficient data – Ginseng root: not advisable – St. John’s wort: may reduce milk supply – Fenugreek: may increase milk supply; infants may have reactions – Goat’s rue and milk thistle/blessed thistle: increasingly used as galactogogue Copyright © 2017 Cengage Learning. All Rights Reserved.  Alcohol and Other Drugs and Exposures Alcohol – Quickly passes to breast milk – Level of alcohol in breast milk is same as in maternal plasma – Peak plasma levels occur at 30-60 minutes after consumption if consumed without food and 60-90 minutes if consumed with food Copyright © 2017 Cengage Learning. All Rights Reserved.  Alcohol and Other Drugs and Exposures (cont’d.) Impact of alcohol on lactation – Decreases oxytocin and letdown – Affects odor of milk – Decreases volume consumed by infant – Interferes with infant sleep pattern Copyright © 2017 Cengage Learning. All Rights Reserved.  Alcohol and Other Drugs and Exposures (cont’d.) Nicotine (smoking cigarettes) – Health risks posed by a smoking mother are many regardless of feeding choice Otitis media Exacerbation of asthma Respiratory infections Gastrointestinal dysregulation – Levels are one and a half to three times higher in breast milk than mother’s blood Copyright © 2017 Cengage Learning. All Rights Reserved.  Alcohol and Other Drugs and Exposures (cont’d.) Marijuana – Transferred and concentrates in breast milk and is metabolized by the nursing infant – May change DNA/RNA formation and neurotransmitter systems needed for growth Copyright © 2017 Cengage Learning. All Rights Reserved.  Alcohol and Other Drugs and Exposures (cont’d.) Caffeine – Moderate intake causes no problems for most breastfeeding infants and mothers – Level in breast milk is only one percent of that in maternal plasma – May accumulate in infants younger than three to four months (varies) – May interfere with sleep or cause hyperactivity and fussiness Copyright © 2017 Cengage Learning. All Rights Reserved.  Alcohol and Other Drugs and Exposures (cont’d.) Other drugs of abuse – Amphetamines, cocaine, heroin, and phencyclidine (angel dust, PCP) are classified by the AAP as drugs of abuse that are contraindicated during lactation Environmental exposures – Advantages of breastfeeding far outweigh potential risks from environmental pollutants Copyright © 2017 Cengage Learning. All Rights Reserved.  Neonatal Jaundice and Kernicterus Neonatal jaundice – Yellow color of the skin – Seen in 40 percent of full-term and 80 percent of preterm infants – Elevated bilirubin can cause permanent neurological damage if not resolved – Most frequent cause for hospital readmission for newborns Copyright © 2017 Cengage Learning. All Rights Reserved.  Neonatal Jaundice and Kernicterus (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Bilirubin Metabolism Byproduct of the normal physiologic degradation of hemoglobin – After birth, released hemoglobin is broken down by the reticuloendothelial system Bilirubin is released into the circulation bound to albumin or another transport protein – Production in neonate is double an adult because of breakdown of fetal erythrocytes Copyright © 2017 Cengage Learning. All Rights Reserved. Copyright © 2017 Cengage Learning. All Rights Reserved.  Physiologic versus Pathologic Newborn Jaundice Physiological – Begins after the first day of birth rising steadily with peak around the fifth day – Bilirubin is usually less than 12 mg/dL – Condition resolves within a few days Pathological – Begins within first day after birth, rises fast, and lasts longer – Bilirubin greater than eight mg/dL in the first day – Medical intervention with phototherapy – Cause: various pathological conditions Copyright © 2017 Cengage Learning. All Rights Reserved.  Hyperbilirubinemia and Breastfeeding Jaundice in the breastfed infant has been divided into types based on the age of onset – Early: breast-nonfeeding jaundice or breastfeeding jaundice – Late: breast milk jaundice Copyright © 2017 Cengage Learning. All Rights Reserved.  Hyperbilirubinemia and Breastfeeding (cont’d.) Breast non-feeding jaundice – Infants nursing infrequently or inefficiently are at risk for elevated bilirubin levels – Usually resolves after one to two weeks of birth Copyright © 2017 Cengage Learning. All Rights Reserved.  Hyperbilirubinemia and Breastfeeding (cont’d.) Breast-milk jaundice syndrome – Becomes apparent after the third day – Cause: a combination of factors Substance in most mothers’ milk that increases intestinal absorption of bilirubin Individual variations in the infant’s ability to process bilirubin Copyright © 2017 Cengage Learning. All Rights Reserved.  Prevention and Treatment for Severe Jaundice The AAP guidelines recommend phototherapy using fluorescent lights – Light is absorbed in bilirubin changing it to a water-soluble product – Guidelines encourage continuation of breastfeeding Copyright © 2017 Cengage Learning. All Rights Reserved.  Information for Parents Inform parents that most breastfed infants will become jaundiced – Most cases will be benign – Only a small fraction will develop extreme hyperbilirubinemia and kernicterus Copyright © 2017 Cengage Learning. All Rights Reserved.  Infant Allergies At least four months of exclusive breastfeeding – Protects against dermatitis and wheezing Food allergies – Influenced by numerous factors Genetics, duration of breastfeeding, time of introduction of other foods, maternal smoking, air pollution, exposure to infectious disease, and maternal diet and immune system Copyright © 2017 Cengage Learning. All Rights Reserved.  Infant Allergies (cont’d.) Food intolerance – No scientific evidence shows gassy foods in mother’s diet produce gas in infants – Low-allergen maternal diet associated with reduction in distressed behavior (colic) Allergenic foods eliminated were cow’s milk, eggs, peanuts, tree nuts, wheat, soy, and fish Copyright © 2017 Cengage Learning. All Rights Reserved.