Infant Feeding-
Breast and Artificial Feeding
and About Weaning.
Nurse’s Responsibility
Infant Feeding
During the first year of life, the infant grows rapidly. By 6 months of age, the birth weight is doubled; and by one year it probably is tripled. To support this rapid rate of growth, sufficient calorie and protein intake is critical; the other nutrients also play an important support role in the growth process.
Breast Feeding
Breast feeding is the best food for the baby. It not only give nourishments but suffice the baby’s emotional needs. The advantages of breast feeding are:
1. Makes the mother feel close to the baby emotionally.
2. Gives a baby a sense of security of oneness with the mother.
3. Saves the mother’s time in preparing a formula.
4. It is economical.
5. Protects the child from communicable diseases as it contains protective antibodies.
6. Protects the child from intestinal upsets as breast milk is sterile.
7. The mother’s nipple satisfies the sucking reflex more adequately than the artificial nipple and the infant is less likely to be thumb sucker.
8. Aids in the involution of the uterus.
9. Breast milk is at correct temperature.
10. Breast fed baby is said to have better tissue and bone development and resistance to infection.
The contraindications to breast feeding are:
1. Diseases of the breast, e.g., breast abscess, mastitis etc.
2. Active tuberculosis, cancer, cardiac diseases, contagious diseases.
3. Unconscious mothers.
4. Mental diseases in the mother.
5. When another pregnancy ensures.
6. Premature babies and sick babies who are very weak to suck.
7. Babies with hare lip and cleft palate.
Points to Remember in Breast Feeding
1. Mother should take bath daily and wear clean cloths.
2. Mother should clean breasts and hands before starting the feeding.
3. Mother should be clean and there should be no hurry or tension.
4. Mother and baby should be in a comfortable position. Mother sits on a low stool, leaning slightly forward. Support the breasts in the palm of her hands, allowing the nipple to pass through the index and middle fingers into the infant’s mouth; the baby’s nose should not be obstructed by the breast tissue.
5. The feeds should be given at frequent and regular timings. The feedings are usually spaced at 3 hourly intervals, omitting one feed at night (5-8-11-2-5-8-10). The 2 A.M. feeding is left out. If the babies are fed on their demand they are fed when they show signs of hunger – they usually establish a regular habit. Rigidity in feeding infants builds up hostility and insecurity.
6. The maximum time for feeding the baby is 20 minutes, 10 minutes on each breast. Since the baby empties the first breast completely, change the breast with each feed e.g. if the baby starts the feeding on the right breast at 5 A.M., the left breast should be given first at 8 A.M.
7. Air swallowed with the milk may fill the stomach before the child had enough milk. In order to prevent this:
The infant should be held with the head higher than the abdomen while nursing – a position said to make the gas rise towards the cardiac opening of the stomach.
Atleast once during the feeding period and at the end, the infant should be held over the shoulders for several minutes and gently patted over the back which helps to expel the gas.
Burping can be done by holding the baby in a sitting position with adequate support and pat his back gently.
8. Baby should be dressed in clean clothes before feeding. He should be kept warm.
9. The adequacy of the breast feed can be determined by the weight gained by the baby or by a test feed. If the breast feeds are adequate, the babies are satisfied after the feeding and they go to sleep till the next feed. They also gain weight. For test feed, weigh the baby before and after the breast feeding. The difference in weight gives the amount of milk taken.
Artificial Feeding
It is the feeding of an infant with other foods in the absence of breast milk. Breast milk is often substituted by cow’s milk. The cow’s milk is substituted by dried, milk, evaporated milk etc.
Difference between Human Milk and Cow’s Milk
Human – Carbohydrate: 7%, fat: 3.5% and protein: 1.5%.
Cow – Carbohydrate: 4%, fat: 4% and protein: 4%.
Cow’s milk can be humanized by diluting, boiling and adding sugar. It is not desirable to give whole milk to the infant in the first few weeks, because the protein in the cow’s milk is not in an easily digestible form. By 6 to 8 months, the baby can have undiluted milk.
Preparation of Formula
The milk formula should be planned to meet the nutritional requirement of the infant which is based on his age and weight.
The nutritional requirement of the infant is as follows:
Caloric requirement – 110 calories per kg of body weight
Fluid requirement – 165 ml per kg of body weight
Milk requirement – 100 to 130 ml per kg of body weight
No of feeds in 24 hours interval – 7
Interval – 3 hourly
To calculate the milk formula for a day for a baby aged 1 month weighing 4 kg.
Formula for fluid requirement – 150 ml per kg body weight X body weight. 150 X 4 = 600 ml
Milk requirement – 115 X 4 = 460 ml
Water requirement – 600 -460 = 140 ml
Calories available from the milk = 460X20/30 = 307
(20 calories from 30 ml of milk)
Total calories required 100 X4 = 400
Balance of calories to be made = 440-307 = 133
Amount of sugar to provide 13 calories = 133/15 = 9 teaspoonful. (1 teaspoon sugar provides 15 calories)
To prepare the milk formula for a day
Take 460 ml of milk, 140 ml of water and add 9 teaspoonful of sugar and boil it and keep it in the refrigerator. For each feed, take 85 ml of milk, warm it and feed the baby.
Important Points to remember when Artificial Feeds are Given
1. Plan the formula according to the nutritional requirement of the baby.
2. The feeding bottle, teat and other articles used for the feeding should be sterile.
3. The milk feed should be warm. Test the temperature of the milk on the inner aspect of the wrist.
4. The mother and the child should be in a comfortable position. The bottle should be held at 45 degree celcius so that the teat is filled with milk.
5. Ensure a slow and steady flow of milk by making a hole in the teat neither too big nor too small. This is done with a red hot needle.
6. Burp the child in between and at the end of every feed.
7. Change the napkin before the feed if it is wet or soiled.
8. The mother should show no hurry or tension.
9. The feed should be given at regular intervals.
10. The mother should wash her hands thoroughly before preparing the feed and feeding the child.
11. Offer a small quantity of water at the end of each feed.
12. Never pinch the baby’s nose to make him to open his mouth; instead press his cheeks.
13. Add vitamin A in the form of liver oil, vitamin C in the form of orange juice and iron in the form of egg yolk from the first month itself.
Different Ways of Feeding an Infant
1. By using the feeding bottle and teat.
2. By nasal tubes.
3. By belcroy feeder.
4. By dropper.
5. By using spoon.
Nurse’s Responsibility in the Feeding of an Infant (with Feeding Bottle)
Preliminary Assessment
1. Check the physician’s orders for any specific precautions regarding the feeding.
2. Plan the formula according to the nutritional needs of the infant.
3. Check the time at which the last feed was given.
4. Check the general condition of the baby and the method by which the baby can feed safely.
5. Check the baby’s ability for sucking.
6. Check the articles available in the unit.
Preparation of Articles
Articles
A tray containing:
Mackintosh and towel
Purpose: to protect the nurse’s uniform.
Baby frock and napkin
Purpose: to change the dress if wet or soiled.
Baby sheet and bib
Purpose: to protect the baby’s garments.
Feeding bottle and teat in a sterile container
Purpose: to feed the baby.
Required amount of feed (sterile) kept in a bowl of warm water.
Purpose: to give the feed at a desired temperature.
Sterile water in a bottle
Purpose: to give to the baby at the end of the feed.
A piece of clean towel or flannel
Purpose: to cover the bottle to keep the feed warm
Gown and mask for the nurse
Purpose: to protect the child from infection especially when feeding premature babies.
Preparation of the Infants and the Unit
1. Assemble the equipment at the bedside.
2. Change the frock and napkin if soiled. Wash hands.
3. Bathe the baby if necessary. Usual bath is given before the second feeding in the morning.
4. Be seated in a low stool. The legs should reach the floor.
5. Protect the nurse’s lap with mackintosh and towel and protect the garments of the baby with the bib at the neck.
6. Pour the milk into the bottle without contaminating the bottle as well as the milk. Fix the teat carefully so that the teat is not contaminated. Wipe the outside of the bottle and cover it with flannel or towel and place it on the table.
Procedure
1. Hold the baby in a position similar to one used for breast feeding.
Reason: the baby should be comfortable to take its feed.
2. Test the temperature of the feed by dropping few drops on the inner aspect of the wrist joint.
Reason: feed should be just warm.
3. Hold the bottle at an angle of 45 degree celcius and bring the teat to the lips and then into the mouth of the baby, taking care to keep the teat filled with milk throughout the feeding.
Reason: proper positioning of the bottle helps the baby to suck on the teat. If the teat is filled with air, the baby may suck in air which causes vomiting of the feed later. If there is no steady flow of milk the baby will get tired.
4. Break the wind (burping) in between the feeds.
Reason: to prevent vomiting and abdominal distension of the baby.
5. When the feed is finished give sterile water to the baby.
Reason: to clean the mouth of the baby.
After Care of the Infant and the Articles
1. Keep the baby on the shoulders and pat over his neck.
2. Wipe the face.
3. Remove the bib and lay the baby in the cradle. Moving the baby can cause vomiting.
4. Take all articles to the utility room. Empty the feeding bottle. Wash it with cold water and then with warm soap solution
Clean the bottle and teat thoroughly under running water. Place the bottle in cold water and bring it to the boiling point. When the water is boiling, put the teat and boil. They are kept ready for the next use. Clean all the articles and replace them in their proper places.
5. Wash hands.
6. Record the feeding with date, time and amount in the nurse’s record.
7. Return to the child and see whether the child had any vomiting or not.
Weaning
Weaning is the transferring of an infant from breast feeding to normal feeding. Breast feed should not be stopped all of a sudden. Weaning can start from the 5th or 6th month. The process should be gradual. The child can be completely weaned at the end of 9th or 10th month. The breast milk can be replaced by cow’s milk and some solid food.
Points to Remember in the introduction of Solids to an Infant’s Diet
1. Introduce only one few food at a time. Allow the infant to become familiar with the same before starting another.
2. Give very small quantity of any new food.
3. Use very thin consistency when starting solid food.
4. Bribes or threats should never be used to get a child to eat.
5. Whenever possible the child should be permitted to feed himself, but quietly give help when he shows his inability to eat.
6. Never force an infant to eat more of a food than what he take willingly.
7. If after several trials, the baby dislikes a food, omit that item for a week or two and try it again. If the dislike persists, it is better to omit that food and substitute another.
8. Use foods of smooth consistency. When the baby is able to chew, gradually substitute finely chopped fruits and vegetable.
9. Mother or anyone feeding the baby must be careful to avoid showing any dislike for the food given to the infant.
10. There should be choice for food.