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1. Newborn Nutrition
DR: Ragaa Gasim Ahmed Mohmmed
Al-Baha university
Faculty of applied medical sciences –
Nursing Department
DR: Ragaa Gasim Ahmed1

2. Objectives
On completion of this lecture, the student should be able to
Describe factors that influence the woman’s choice of feeding method.
Count advantages of breastfeeding for both the woman and the newborn.
Analyze situations for which breastfeeding would not be recommended.
Describe the physical and hormonal control of the breast during lactation.
Describe the role of the nurse when assisting a woman to breast-feed.
Count appropriate nursing interventions for three common problems the breast-feeding woman
might encounter.
Count signs that a newborn is not breast-feeding well.
Describe the various types of formulas available to feed newborns and infants.
Count situations in which formula feeding would be beneficial.
Count appropriate teaching topics for the bottle-feeding woman.
Count several questions the nurse should ask the parents of a newborn who is not tolerating
formula.
DR: Ragaa Gasim Ahmed2

3. Introduction
- In utero the fetus obtains all of its nutrition in a passive
manner. At birth, this passive intake of nutrition ends,
and the newborn must actively consume and digest
food.
- The newborn has specific nutritional needs. The
healthy term newborn needs 108 kcal/kg/day and 160
to 180 mL/kg/day. Breast milk, or an iron-fortified
infant formula, will provide the newborn with all the
calories and fluids necessary.
- In addition, breast milk and infant formulas are
balanced to meet the carbohydrate, protein, and fat
needs of the newborn.
DR: Ragaa Gasim Ahmed3

4. Daily Nutritional Needs of the
Newborn
• Protein : 2.2 g/kg
• Vitamin A :400 microgram/day
• Vitamin C : 40 mg/day
• Vitamin D : 5 microgram/day
• Vitamin E :4 mg/day
• Vitamin K : 2.0 microgram/day
• Calcium: 210 mg/day
DR: Ragaa Gasim Ahmed4

5. CHOOSING A FEEDING METHOD
- The choice is ultimately the woman’s to make.
The nurse has a clear role in providing the
woman with enough information for her to make
an informed decision.
- There are many factors that influence the
woman’s decision about whether to breast-feed
or bottle-feed.
- Some of these factors are culture, age, prior
experience with or exposure to breast-feeding,
and her intent or need to return to work or
school.
DR: Ragaa Gasim Ahmed5

6. BREAST-FEEDING
• Breast-feeding is the recommended method for feeding
newborns.
• The American Academy of Pediatrics (AAP) advocates
exclusive breast-feeding until 6 months of age and
continuation of breast-feeding until at least 12 months of age.
• The infant does not have to be weaned at 12 months; the
benefits of breast-feeding for both the woman and the infant
continue as long as the woman is nursing.
• Breast milk is superior nutritionally to artificial nutrition, that
is, infant formula.
DR: Ragaa Gasim Ahmed6

7. Advantages
of Breast-feeding
The advantages for the woman:
include more rapid uterine involution and less
bleeding in the postpartum period, a quicker
return to her prepregnancy weight level, and
decreased incidence of ovarian and
premenopausal breast cancers (AAP, 2005).
DR: Ragaa Gasim Ahmed7

8. Cont
The advantages for the newborn :
•Breast milk provides immunologic properties from the woman that help
protect the newborn from infections and strengthen the newborn’s immune
system.
•Breastfeeding also provides a unique experience for maternal– newborn
bonding.
•There is a decreased risk in overfeeding of the breast-fed newborn, which
results in a lower incidence of overweight infants.
•Breast-fed infants tend to have lower incidences of otitis media, diarrhea,
and lower respiratory tract infections.
•Breastfeeding also provides a possible protective effect against certain
conditions or diseases, such as sudden infant death syndrome, insulin-
dependent diabetes, and allergic diseases.
•Finally, there is a possible correlation between enhanced cognitive
development and breast-feeding (AAP, 2005).DR: Ragaa Gasim Ahmed8

9. Cont
• However, there are certain maternal conditions or
situations that would contraindicate breast-feeding.
Examples of these conditions include:
• Illegal drug use
• Active untreated tuberculosis
• Human immunodeficiency virus (HIV) infection
• Chemotherapy treatment
• Herpetic lesions on the breast
DR: Ragaa Gasim Ahmed9

10. Physiology of Breast-feeding
• Newborn Features That Facilitate Breast-feeding:
1- Newborn Facial Anatomy.
The nose, which looks flattened after birth, is designed
to create air pockets when up against the breast. The
newborn’s mouth is designed to compress the milk
ducts located behind the nipple under the areola.
The tongue, pharynx, and lower jaw are unique in
their shape when these structures are compared
with those of the older child or adult. The newborn
also has fat pads on each cheek that aid in the
sucking process. DR: Ragaa Gasim Ahmed10

11. Physiology of Breast-feeding .cont
2-Rooting and Sucking Reflex.
When the newborn feels the woman’s breast
touching his face, he turns toward the breast
and opens his mouth.
DR: Ragaa Gasim Ahmed11

12. Physiology of Breast-feeding .cont
• The Breast
1- Breast Anatomy. The breast is very vascular, with a
rich lymphatic and nervous supply. The breast is
made up of 15 to 20 lobes containing the milk
producing alveoli. The alveoli are clustered together
and empty into ducts. The alveoli produce the milk.
The alveoli are surrounded by smooth muscle cells,
which help to eject the milk into the ducts. The ducts
lead to the nipple, where the milk is released.
DR: Ragaa Gasim Ahmed12

13. Physiology of Breast-feeding .cont
2- Physical Control of Lactation. When the
breast is emptied, either by the newborn
sucking or by use of a breast pump, the breast
responds by replenishing the milk supply. If the
breast is not emptied completely, it will not
make as much milk the next time. This is why
it is important for the newborn to nurse long
enough to establish a good milk supply.
DR: Ragaa Gasim Ahmed13

14. Physiology of Breast-feeding .cont
3- Hormonal Control of Lactation. The breast
also is under hormonal control. When the
newborn sucks on the breast, the anterior
pituitary gland releases prolactin, which causes
milk production and milk release in the breast.
DR: Ragaa Gasim Ahmed14

15. Composition of Breast Milk
The breast starts to produce colostrum, a thick and
yellowish gold substance, during the second
trimester. Colostrum is higher in antibodies than breast
milk and has a lower fat and higher protein content
than what is found in breast milk. There is between 2
and 20 mL of colostrum present for each feeding until
the woman’s milk comes in about the 3rd day
DR: Ragaa Gasim Ahmed15

16. Composition of Breast Milk. cont
The woman’s milk usually comes in between 3 and 5
days. Breast milk has 20 calories per ounce on the
average. Breast milk has two different compositions:
foremilk and hind milk.
Foremilk is very watery and thin and may have a bluish
tint. This is what the infant first receives
during the nursing session. As the session
progresses, the milk changes to hind milk. Hind
milk is thicker and whiter.
DR: Ragaa Gasim Ahmed16

17. Nursing Care of the
Breast-feeding Woman
• Assessing Breast-feeding Readiness
• Assisting With Breast-feeding Technique
• Positioning the Newborn.(Cradle Hold,
Football Hold, Side-Lying Position, Latching
On.
• Assessing the Breast-feeding Session
• Assessing Newborn Fluid Intake
• Teaching About Breastfeeding Special
Concerns DR: Ragaa Gasim Ahmed17

18. Cradle Hold
DR: Ragaa Gasim Ahmed18

19. Football Hold
DR: Ragaa Gasim Ahmed19

20. Side-Lying Position
DR: Ragaa Gasim Ahmed20

21. Breast Milk Storage
Location of Storage
•Room temperature (19C–22C)
•Refrigerator (0C–4C)
•Freezer with door opening
frequently
•Separate freezer
compartment with door
opening frequently
•Separate deep freeze
•Thawed after being frozen
Duration of Storage
Up to 10 hours
Up to 8 days
2 weeks
4 months
6 months
24 hours
DR: Ragaa Gasim Ahmed21

22. FORMULA FEEDING
Artificial nutrition, that is, infant formula or
another type of animal milk, has been given to
infants since ancient times.
DR: Ragaa Gasim Ahmed22

23. Advantage
• Some women feel it is easier to formula feed
than to breast-feed their infant.
• Formula feeding also allows others to be
involved in the infant’s care by feeding the
infant and preparing the formula and bottles
for feeding.
• For many women it is easier to quantify how
much the infant has consumed with formula
feeding
DR: Ragaa Gasim Ahmed23

24. Cont
If the newborn has an inborn error of
metabolism, such as phenylketonuria, maple
sugar urine disease, or galactosemia, a specific
formula that the newborn can digest is needed
to avoid or minimize the problems associated
with such diseases.
DR: Ragaa Gasim Ahmed24

25. Disadvantages
• Formula feeding has several disadvantages.
• It is inferior nutrition and has none of the
immunologic properties provided by breast milk.
• Formula is harder for the newborn to digest than
breast milk.
• There is a higher correlation between infants who
are formula fed and some illnesses, such as otitis
media and allergies.
• Infant formula also is expensive.
DR: Ragaa Gasim Ahmed25

26. Composition of Formula
• There are three main types of formula: milk-
based, soy-based, and hypoallergenic
formulas.
• Most term newborn formulas are derived
from cow’s milk and the main carbohydrate
source is lactose or corn syrup solids. The
protein used is a whey-casein blend to
simulate what is found in breast milk.
DR: Ragaa Gasim Ahmed26

27. Cont
• The iron co position in infant formula is
defined as either high or low.
• Iron-fortified formulas contain 1.2 mg of iron
per 100 mL.
• Iron-fortified, or high-iron formula, is the
preferred formula to give to the healthy term
newborn.
DR: Ragaa Gasim Ahmed27

28. Cont
• Soy-based infant formulas are for newborns
who are allergic to cow’s milk or when there is
a strong family history of cow’s milk allergies.
• Hypoallergenic formulas are for newborns
with allergy or malabsorption problems.
DR: Ragaa Gasim Ahmed28

29. Nursing Care of the
Formula-Feeding Woman
• Assisting With Formula-Feeding Technique
• Teaching About Formula Feeding Special
Concerns (Preparing Bottles of Formula,
Adding Supplements).
DR: Ragaa Gasim Ahmed29

30. Common Problems in the Formula-
Fed Newborn
• The woman needs to be taught to monitor for
problems in the formula-fed newborn.
• These include the newborn not wanting to
eat, not tolerating the formula, and dental
caries.
DR: Ragaa Gasim Ahmed30

31. Conclusion
• The woman’s decision to breast-feed is influenced by several
factors. Some of these factors include culture, age, education,
past experience with breast-feeding, and the woman’s intent
to return to work or school.
• Maternal advantages of breast-feeding include more rapid
uterine involution, less bleeding in the postpartum period,
and less ovarian and premenopausal breast cancers.
• Newborn advantages to breast-feeding include a
strengthened immune system, fewer overweight infants, and
lower incidences of certain infections, such as otitis media,
diarrhea, and lower respiratory tract infections.
DR: Ragaa Gasim Ahmed31

32. References
• Nancy T. Hatfield. (2007) Broadribb’s
Introductory Pediatric Nursing. Albuquerque,
New Mexico. 7th
EDITION.
DR: Ragaa Gasim Ahmed32