MENNONITE COLLEGE OF NURSING atIllinois State University

Parent Child Nursing - 316

IV.E. Nutritional Needs of the Infant--Bottlefeeding

I.Infant Feeding

A.Introduction—the choice of how to feed is an individual one each pregnant woman and her partner must make. The nurse can help provide essential information to make the most informed decision for each individual family.

B.Choosing A Method --

INFANT FEEDING: BREAST VS BOTTLE

BOTTLE: ADVANTAGES
1. Infants gain wt. faster
2. Convenient once bottles are prepared
3. No need for vitamins
4. Digested more slowly and infant may
feed only q. 3-4 hours
5. If done properly, will still foster mother/infant bonding
6. May involve father and siblings in
feeding process
7. Available in ready-to-feed, powder,
or concentrate / BOTTLE: DISADVANTAGES
1. Inconvenience due to sterilization
procedure.
2. Water additives may be harmful to
infants
3. High concentration of solutes and iron
in formula
4. Expense involved in purchasing the
bottles and formula
5. May promote obesity in that infant is
expected to take entire bottle
6. Higher stool pH makes E. coli and Strep
faecalis most predominant organism
7. Risk of improper mixing (excess dilution
by low socioeconomic persons to make
it last longer)
BREASTFEEDING: ADVANTAGES
1. Provide antiviral, antiprotozoan, anti-
inflammatory antibodies. Colostrum
contains macrophages
2. Nonallergic and easily digested. (Fore
milk is > dilute and low in fat. Hind milk
is higher in fat and protein
3. IgA present--protective anti-absorptive
effect keeps protein molecules from
passing through intestines
4. No need to supplement with vitamins
5. Optimal food for first 4-6 months
according to Amer. Academy of
Pediatrics
6. Aides in maternal-infant bonding
7. No vitamins lost during the re-heating
process.
8. Promotes good jaw and tooth
development
9. Low pH of stools of breastfed babies
inhibits growth of bacteria like E.Coli
and Strep. Faecalis.
10. Natural laxative for babies
11. Natural emollient to heal tender nipple
tissue
12. Promotes uterine involution in mother / BREASTFEEDING: DISADVANTAGES
1. Many maternal demands on physical
and mental health, nutritional status
2. Maternal inconveniences such as
leaking breasts, engorgement, sore
nipples, and constant demands on time
3. Food intolerances and drugs are
transmitted through breast milk
4. Father may feel excluded from feeding
process
5.  possibility of breast milk jaundice
6. Easily digested infant may nurse every
2-3 hours, or more.

A.Bottle feeding or artificial feeding

  1. Breast Care
  2. During pregnancy—no real preparation necessary if planning to bottlefeed.
  3. After delivery—avoid stimulation of breast; wear firm supportive bra; use ice to decrease circulation and alleviate discomfort; take analgesics prn; use cabbage leaves applied to skin to decrease engorgement; have patience.
  4. Types of formula
  5. “ready to feed”—most expensive, most convenient. Once opened, bottles that have been offered to infant are only safe for 1 ½ -2 hours and should then be discarded. Cans are safe for 24 hours if kept refrigerated.
  6. Concentrate—less expensive than ready to feed. Must mix in appropriate ratio for adequate nutrition. Use distilled or nurserywater for first 3 months minimum. Have water tested if using well water for safety by state.
  7. Powder—least expensive of the 3 types. Dilute as directed with distilled or nursery water as above.
  8. Additives in formula—DHA, ARA and Lipil are additives that have helped to make cow’s milk based formula more similar to breast milk.These essential fatty acids are said to help promote visual acuity and cognitive development.
  9. Soy-based formulas—not recommended for premies; only recommended for full-term babies who have galactosemia (primary lactase-deficiency); or bottlefeeding moms who are vegans.

3.Formula requirements: must have adequate fat, carbohydrate, and protein

content as well as water. AAP recommends the iron-fortified formula for bottlefed babies. It has 12mg/L in an ionic form that should NOT contribute to constipation. Standard infant formula contains 20kcal/oz. Premie formulas can contain 22, 24,27 Kcal/oz.

4.Whey/casein ratio—in breast milk it is 60:40. This ratio is more easily digested

and absorbed. Cow’s milk ratio of whey/casein is 20:80. By hydrolyzing the milk, formula companies can make the whey/casein ratio more similar to breast milk

5.How long on formula—AAP recommends infants to be on breastmilk or formula

for one year.

6."Non-fat" milk use—dried, non-fat milk should never be used for infants because

it lacks essential nutrients and calories needed for normal growth and development. It is cheap but not safe for infants.

7.Assessment—ask mom about knowledge of formula preparation for safety of

Infant. Observe feedings to assess knowledge of baby positioning, bottle positioning, etc.

8.Nursing diagnosis—Knowledge deficit ; Anxiety

9.Nursing interventions

a.formula preparation—review guidelines in text re: safe water, careful

washing of all utensils—bottles, caps, nipples; how long prepared formula can be stored in refrigerator , and safe way to warm bottles.

b.bottle positioning—keep baby’s head above hips, and bottle tipped

upward so baby doesn’t swallow excess air. Be sure nipple of bottle is inserted far enough into baby’s mouth to elicit sucking reflex

c.burping—upright or over the shoulder, every ½ - 1 ounce

d.first feeding—start with a few swallows of sterile water to ensure patency

of esophagus to stomach (r/o esophageal atresia and trachea-esophageal fistula). Follow with 15-30ml formula.

e.fostering attachment—encourage enface positioning, cuddling,

involvement of father, significant other, siblings in feeding process. Teach NO BOTTLE PROPPING.