Chapter 24: Newborn Nutrition and Feeding: Newborn Nutrition—Sherpath

Question 1 of 11

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Which type of commercial formula requires dilution with equal parts water?

• • Ready-to-feedReady-to-feed formula does not require dilution; it comes premixed and is ready to use.
• Correct
  • ConcentrateConcentrate formula requires dilution with equal parts of formula and water.
• • PowderPowder formula requires mixing of 2 oz of water with every scoop of formula.
• • Hydrolysate formulaHydrolysate formula is a category of infant formula that may be available as ready-to-feed, concentrate, or powder. Preparation of this formula should follow the instructions on the container.

Question 2 of 11

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Which factors are likely to support breastfeeding as the family’s feeding method choice?

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  • Support from familySupport and encouragement from family and friends is a major influence on feeding method choice and has been shown to increase breastfeeding choice.
• • Formula accessFormula access, particularly in hospitals, has been shown to increase formula feeding choice.
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  • Cultural practicesCultural practices are highly influential on feeding method choice. Duration of breastfeeding is also highly influenced by culture.
• • Return to workReturn to work is associated with choosing formula and/or discontinuing breastfeeding.
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  • Health care provider knowledgeHealth care provider breastfeeding knowledge is highly influential on the choice to breastfeed because the health care provider may assist with establishing breastfeeding, troubleshooting common challenges, and sharing advantages of breastfeeding.

Question 3 of 11

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Which advantages are associated with human milk (expressed and/or donor milk) feeding?

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  • Improved infant immunityImproved infant immunity is an advantage of human milk feeding and exclusive breastfeeding.
• • Lowest infant feeding-related costsThe infant feeding method with the lowest cost is exclusive breastfeeding; human milk feeding requires additional supplies for expressing and storing the expressed breast milk.
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  • Ability to track amount of milk consumedHuman milk feeding allows for the tracking of the amount of milk consumed because the infant is fed expressed breast milk from a bottle.
• • Easy storage and shelf lifeExpressed breast milk does not have a long shelf life nor is it easily stored; storage requires special supplies and handling. Long shelf life is an advantage of powdered formula.
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  • Others able to feed infantAn advantage of human milk feeding is that others are able to feed the infant because the infant receives expressed breast milk.
• • Promotes maternal-infant attachmentMaternal-infant attachment is not promoted with human milk feeding; skin-to-skin contact during exclusive breastfeeding promotes attachment.

Question 4 of 11

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Which infant actions are common cues indicating a readiness to feed?

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  • SuckingSucking is a common feeding cue.
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  • RootingThe rooting reflex is a common feeding cue characterized by the newborn turning and rooting with the mouth when the cheek or lip is touched.
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  • MouthingMouthing is a common feeding cue characterized by the newborn sucking when the mouth is stimulated.
• • CryingCrying is not a common feeding cue but may be a cue for a variety of unmet needs.
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  • Hand-to-mouth movementsHand-to-mouth movements are a common feeding cue characterized by bringing hand(s) to the mouth.
• • VocalizationsVocalizations are a common cue to engage socially with the infant. However, they are not considered a feeding cue.

Question 5 of 11

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Which education would the nurse provide a mother who reports latch difficulty with breastfeeding?

• • “The newborn is likely sleepy. You should wait until the baby is fully awake.”Sleepy newborns have difficulty with staying awake during feeding but do not necessarily have latch difficulty. Education for latch difficulty includes ensuring the mouth is open wide before inserting the nipple.
• • “Use a breast pump for a few minutes before feedings to increase nipple size.”Use of a breast pump is recommended for engorgement, but it will not promote latching and is not taught as part of proper newborn latch technique.
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  • “Wait until the mouth is open wide to insert the nipple into the newborn’s mouth.”The mother should be taught that if the mouth is not open wide before the nipple is inserted, it is more difficult for the newborn to get sufficient milk and can cause nipple pain.
• • “Apply ointment to the nipple. It has a sweet taste and will prompt the newborn to breastfeed.”Ointment on the mother’s nipple will not necessarily promote latch and is not taught as part of proper newborn latch technique.

Question 6 of 11

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Which recommendations would the nurse make to the family whose newborn falls asleep after 2 to 3 minutes of breastfeeding?

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  • “The baby needs to be awakened, so unwrap the newborn and gently stroke his palms or soles.”Newborns who fall asleep shortly after beginning the feeding need to be woken up to feed properly. Unwrapping and gently stroking the newborn will help to awaken for feeding.
• • “This is a sign that the newborn is full, so breastfeeding should stop until the baby shows hunger cues.”Falling asleep after 2 to 3 minutes of feeding is a sign of a sleepy newborn, not that the newborn is full. Two to three minutes of feeding is not enough time for an adequate intake of breast milk.
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  • “Change the newborn’s diaper to wake your newborn up.”Changing the diaper is a useful strategy for awakening a sleepy newborn for feeding.
• • “The newborn is having trouble establishing breastfeeding, so switch to bottle feeding.”The newborn falling asleep while breastfeeding is not an indication to switch to bottle feeding. It is a sign of a sleepy newborn who needs to be awakened.
• • “This is a sign of nipple confusion, so provide pacifiers between feedings.”The newborn falling asleep while breastfeeding is not an indication of nipple confusion. Signs of nipple confusion include poor sucking during breastfeeding. Furthermore, pacifiers should be avoided in the event of nipple confusion.

Question 7 of 11

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Which action would the nurse take for a breastfeeding mother who is afebrile but reports erythema and tenderness over her right breast?

• • Apply cold compress.A cold compress is recommended after breastfeeding when the breasts are engorged. The patient’s symptoms indicate a plugged mammary duct, not engorgement.
• • Administer local anesthetic.The patient’s symptoms indicate a plugged mammary duct. The nurse may provide pain-relieving measures, but a local anesthetic does not correct the patient’s problem.
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  • Teach breast massage technique.The patient’s symptoms indicate a plugged mammary duct. The nurse would teach the mother to massage the breast to relieve pain and unplug the milk duct.
• • Administer intramuscular antibiotic.The patient’s symptoms indicate a plugged mammary duct. Antibiotics are not necessary to treat this condition. Antibiotics are used to treat mastitis.

Question 8 of 11

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For which condition would the nurse teach the family that breastfeeding is contraindicated but feeding expressed breast milk is safe?

• • Infant galactosemiaInfant galactosemia is a contraindication to breastfeeding and expressed breast milk.
• • Mother with human immunodeficiency virus (HIV)Maternal HIV is a contraindication to breastfeeding and expressed breast milk.
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  • Mother with active tuberculosisWhile breastfeeding is contraindicated in mothers with active tuberculosis, expressed breast milk is considered safe. The nurse would teach this mother to feed her infant expressed breast milk.
• • Mother with active herpes simplex virus (HSV) lesions on the breastActive maternal HSV lesions are a contraindication to breastfeeding and expressed breast milk.

Question 9 of 11

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Which patient condition is a common breastfeeding cue in the first 24 hours following delivery?

• • MastitisMastitis is not common in the first 24 hours following delivery as the mother’s breasts generally only produce a small amount of colostrum in this time. Problems with mastitis tend to occur after mature milk forms some time later.
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  • Nipple sorenessNipple soreness due to poor latch or positioning is one of the most common complaints of women who are breastfeeding in the first 24 hours following delivery.
• • Plugged milk ductsPlugging of milk ducts, like mastitis, tends to occur due to incomplete emptying of the breast. Plugged ducts are seen after mature milk forms.
• • Everted nipplesEverted nipples are desirable for breastfeeding. They make it easier for the infant to transfer milk efficiently.

Question 10 of 11

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When teaching about infant feeding cues in the first days of life, which solution can the nurse consider to encourage the best time to initiate breastfeeding?

• • Whenever the newborn begins to cryCrying is a late sign of hunger. When a child is crying, that is a difficult time to initiate a breastfeed as the newborn tends to get frustrated easily. The infant should be quieted prior to initiating a feeding.
• • Every 2 hours, around the clockIn the first few days of life, the newborn will exhibit feeding cues every 2 to 4 hours or sometimes more frequently. The breast should be offered on demand whenever the mother observes a feeding cue.
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  • When the infant is in the quiet alert stateDuring the quiet alert state, the newborn is observing the world, and the newborn is calm and relaxed. This is an optimal time to initiate a feeding.
• • When the newborn naturally wakes itself up, regardless of the time intervalSome newborns will not wake up to eat. They must be woken up to feed. In general, infant feeding cues, such as sucking and rooting, can be observed even during sleep.

Question 11 of 11

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A patient in the early postpartum period asks, “How do I know if my baby is getting enough breast milk? I don’t feel anything there.” What are the desirable outcomes?

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  • “A good way to tell if your baby is taking in enough breast milk is if you continue to see enough wet and soiled diapers.”Monitoring newborn output is an important component when assessing whether intake is adequate.
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  • “If your baby is gaining weight with each checkup at the pediatrician, it usually means your baby is getting enough breast milk.”Adequate weight gain is the single most important consideration when determining whether breastfeeding is successful.
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  • “If your baby actively participates in a feeding, you can hear swallowing and your baby seems content in between feeding. These are all signs that your baby is satisfied with the quantity of breast milk your body is producing.”Swallowing and satiation are signs that the newborn is effectively transferring milk from the breast with feeding.
• • “If your baby feeds for at least 10 minutes on each breast with every feed, you know your baby is getting enough breast milk.”It is impossible to tell how much milk newborns transfer during breastfeeding, based on time alone. Some newborns will efficiently transfer milk on just one breast each feed or during a very short feed, whereas some take both breasts at each feed for long periods of time.
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  • “When your milk comes in, your breasts will feel full and most women will feel a milk letdown. This is a good sign that your body is producing enough breast milk for your baby.”Feelings of fullness in the breast and the sensation of letdown occur when mature milk forms in the breasts. These are signs that breastfeeding is going well and that milk supply is likely adequate.