Infants with Special Needs

Ten Steps Curriculum, Session 10A

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:1

The Preterm Infant

 Preterm

milk is more suited to the preterm infant than mature milk composition of preterm milk is unique:
levels of nitrogen, long-, medium- and shortchain fatty acids, sodium, chloride and iron are higher in preterm milk

 The

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:2

Establishing Milk Supply For a Preterm Infant

 Rental

grade electric pumps are ideal  Double collecting kit is preferred  Optimal stimulation comes from 8 or more pumping sessions per 24 hours, with total pumping time of 120 minutes per day  Follow collection, storage and handling protocols carefully
Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

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Encourage mother to be as involved as possible in the care of her infant. Help her learn to identify infant states, and observe baby language.  Skin-to-skin contact (kangaroo care) stimulates organization and maturation in the infant.  Skin-to-skin also assists mother in conditioning her let-down reflex.


Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:4

Feeding the Preterm Infant

Gavage or tube feeding is used when infants are too small to coordinate suck-swallow-breathe. Gavage may also be used to supplement during or after breastfeeding.  Cup feeding is also used to supplement breastfeeding in infants with suck-swallowbreathe and gag reflex.  Breastfeeding may be initiated when the infant is stable and can gag. Offer opportunities for non-nutritive suckling before actual feeding.


Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:5

Physiological Advantages of Breast v. Bottle Feeding for Preterm Infants

 Breastfeeding

fosters longer, more rhythmic suckling more stable oxygen saturation less bradycardia more normal heart rate
10A:6

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

Early Feeding Strategies

 Mother

should have realistic expectations of feeding.  Practice will be required for proficient breastfeeding.  Skin-to-skin care has positive impact on breastfeeding, maturation and growth, parenting, digestion and immune system.
Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:7

Discharge Strategies
a follow-up team to ensure adequate growth and development and continuation of breastfeeding postdischarge  Foster frequent communication to address issues as needed
 Establish

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:8

Low Birth Weight Infants

Are at risk for infection, jaundice and hypoglycemia  Advantages of human milk feeding include: easier digestion and absorption of fats and proteins fat and amino acid profile tailored to infant needs enzymes which enhance maturation of gut anti-infective properties

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:9

Breastfeeding Multiples: Twins



Positioning strategies for nursing twins simultaneously:  feet to feet with one twin higher than the other  head to head in the football hold Feeding twins simultaneously helps to develop synchrony of feeding schedule and increased prolactin levels. Feeding each twin separately takes more time, but is more individualized.

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:10

Breastfeeding Higher Order Multiples

 Individualized

feeding plans need to be

developed  Infants may require supplementation, especially if one is smaller and/or weaker than others. Weight gain should be closely observed. Ideal weight gain is 15 30 gms daily.
Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:11

The Infant With Jaundice

 

Early jaundice is distinct from late jaundice Physiological jaundice occurs when extra red blood cells needed by the fetus break down.  Feeding, especially with colostrum, ensures earlier passage of meconium and subsequent lower bilirubin levels.  Lasts two to three days, then begins to recede.  Generally intervention is not needed for physiological jaundice.

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:12

Physiological jaundice (cont.) increasing breastfeeding frequency and/or improving latch-on is most effective in resolving this type of jaundice

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:13

Infants with Craniofacial Defects

 Benefits

of breastfeeding for infants with cleft defects:

fewer upper respiratory infections less otitis media speech improvement through optimal use of oral-facial musculature

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:14

Cleft Lip Strategies

If infant has unilateral cleft lip, angle breast so that it fills the cleft.  Mother may use thumb to cover alveolar ridge defect (if any). This may help create better suction.  Infants with cleft defects take longer to feed. Use pillows to help support infant position and make mother comfortable to avoid fatigue.


Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:15

Cleft Palate Strategies

impact of the cleft defect on breastfeeding depends on the severity of the defect.  Explore many different nursing positions to determine which work best.  With unilateral cleft, direct nipple toward intact side.  Assess growth frequently to ensure adequate intake and growth.
 The
Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:16

Repair of Cleft Defects

Timing of surgical repair of cleft defects varies  Lip repair can occur as early as 2 days of life and as late as 3 months.  Palate repairs usually occur after 10 months of life.  Breastfeeding after surgery is less stressful to the repair than allowing the infant to cry in hunger  Use of obturators can be of great benefit to breastfeeding

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:17

Neurologically Impaired Infants

 

Can feed at the breast with proper physical and emotional support for the dyad Physical conditions which can affect breastfeeding:  absent or weak sucking reflex  weak suck  incoordination of suck  low muscle tone

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:18

Table 14-2 Conditions Associated with Depressed Sucking Reflexes Central Nervous System (CNS) Dysmaturity CNS Maldevelopment Prematurity Trisomy 18 Delayed maturation Trisomy 21 Prader-Willi's syndrome Prenatal CNS Insults Congenital infections Vascular accidents Perinatal CNS Insults Asphyxia Meningitis Hypoglycemia Kernicterus Trauma Drugs administered to the mother in labor Drugs administered to the infant Neonatal narcotic abstinence

Systemic Problems in the Infant Congenital heart disease Sepsis Hypothyroidism

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:19

Table 14-3 Conditions Causing Weakness of Sucking Mechanisms Central nervous system abnormalities associated with severe hypotonia Trisomy 21 Prader-Willi's syndrome Medullary lesions Pseudobulbar palsy (congenital or after an insult) Bulbar atresia Moebius' syndrome Arnold-Chiari malformation Motoneuron disease: Werdnig-Hoffman's syndrome (usually not present at birth) Abnormalities of the neuromuscular junction Neonatal myasthenia gravis (affected mother) Congenital myasthenia gravis Familial infantile myasthenia Botulism Abnormalities of muscle Congenital myotonic dystrophy Congenital myopathies (nemaline and myotubular) Metabolic myopathies
Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:20

Table 14-4 Conditions Associated with Incoordination of Sucking Mechanisms

Central nervous system insults Asphyxia Kernicterus Hypoglycemia Bilateral cerebral bleeds Neonatal narcotic abstinence Central nervous system maldevelopment Arnold-Chiari malformation Oral-buccal apraxia Miscellaneous Leigh's disease Dysautonomia Cornelia de Lange's syndrome

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

10A:21

Feeding Strategies for Infants with Neurological Impairment



   

Use team approach with neonatologists, primary care nurses, occupational therapists, speech pathologists with neurodevelopmental treatment (NDT) training, lactation consultants.... Assess for presence of suck, swallow, and gag reflexes in an ongoing fashion Interventions should be tailored to infant needs. Offer non-nutritive suckling at the mothers breasts (after breasts are expressed) Position infant to offer maximal support

Ten Steps Curriculum, 4th edition, Copyright 2010, Healthy Children Project Inc

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