1. Purpose a. Mothers who are breastfeeding may be asked to fill out a Postnatal Nutrition

Transcription

1 Medical Nutrition Therapy Diet: Lactation Brittany Wrasman 1. Purpose a. Mothers who are breastfeeding may be asked to fill out a Postnatal Nutrition Risk Screen as shown below. If the patient answers yes to any of the following nutritional indicators, the registered dietitian must be notified. The patient s nutritional status is assessed using the Breastfeeding/Lactation- Criteria to Assign Risk form, as seen below. A total score of 0-5 is representative of a lowrisk patient; 6-10 indicates medium risk; and a score >10 means the patient is at high risk for nutritional deficiencies. Based on the results, a consult with a registered dietitian may be initiated to help the mother optimize her own nutritional intake and nutritional status in order to ensure optimal breast milk production (quantity and quality) for her infant s growth and development (Eat Right, 2014). 1

2 2. Population a. Overview i. Breastfeeding provides many health benefits to both the mother and infant. b. Disease Process While breastfeeding, it is important that the mother consumes a healthful and balanced diet for proper milk production and to meet her nutritional needs. Breastfeeding burns a significant amount of energy; therefore, a mother s energy needs are also increased. i. During pregnancy and lactation, the breasts increase in size due to the production of milk. The milk is produced in small clusters of cells called alveoli where it then travels down the milk ducts to the milk sinuses. The suckling action of the baby creates a suction that causes the milk to flow into the baby s mouth from the openings present in each nipple. Nerve stimulation caused from the infant s suckling triggers the pituitary gland to release the hormones prolactin and oxytocin. Prolactin causes the alveoli to take proteins and sugars from the blood supply and turn them into breast milk. Oxytocin is responsible for the let-down reflex, or the passing of the milk down the ducts (Sutter Health CPMC, 2013). The mother s diet correlates directly with her breast milk production and quality (Eat Right, 2014). c. Biochemical and Nutrient Needs i. Women who exclusively breastfeed require an additional 500 kcal/day for the first 6 months and an additional 400 kcal/day for the second six months or when using a formula as well (Eat Right, 2014). In addition to maintaining milk production, meeting these energy needs will promote a 1-2 lb weight loss per month after the first month of feeding. Breastfeeding mothers are not recommended to consume less than 1,800

3 kcal per day (Eat Right, 2014). Nutrients particularly important while breastfeeding include protein, calcium, iron, folate, and vitamins A and C (Better Health Channel, 2011). Mothers who exclusively breastfeed are recommended to consume a minimum of 65 g of protein per day during the first six months. This is required for breast milk production in addition to replacing the mother s protein stores. Protein needs decrease slightly to 62 g/day after 6 months while weaning (Eat Right, 2014). During pregnancy, the mother s iron stores are depleted, which means they need to be restored post-pregnancy. Some iron rich foods include red meats, chicken, and fish; legumes; nuts and dried fruit; wholegrain bread and cereals; and green leafy vegetables. Such foods can be consumed to help the mother reach her 15 mg/day recommended requirements. Calcium plays a key role in bone strength and is also a major component of breast milk. The best food sources for a mother to consume to meet her 1,000 mg/day calcium needs include dairy products (Better Health Channel, 2011). Folate is important in the prevention of major birth defects, but also plays a role in heart health and preventing cell changes that can lead to cancer. Folate can be found in leafy vegetables, citrus fruits, beans, and whole grains (Office of Women's Health, 2012). Folate requirements for a breastfeeding mother are 500 mcg/day (Eat Right, 2014). Needs for vitamins A and C increase during lactation to make up for the losses in breast milk. Foods that commonly contain vitamin A include dark green and yellow vegetables. Vitamin C is found in citrus fruits, berries, tomatoes, and potatoes (Better Health Channel, 2011). 3. General Guidelines a. The emphasis during lactation is on educating the mother on how she can meet 3 her energy needs through a healthy diet while promoting a steady weight loss

4 back to her pre-pregnancy weight. Educational points would include: what foods she can consume that will contribute to a healthy diet, the need for sufficient fluid intake, and the risks of consuming excess amounts of caffeine and alcohol while breastfeeding. b. Nutrition Rx i. Encourage a balanced diet to help the client meet individual requirements and prevent overconsumption of empty calories. Use MyPlate as a tool to educate clients on the appropriate servings needed from each food group. c. Adequacy of Nutrition Rx i. Nutrients needed in increased amounts while breastfeeding include magnesium, copper, zinc, iodine, selenium, vitamins A, K, and E, and the B vitamins. A well-balance diet that corresponds to the recommendations made for breastfeeding women according to MyPlate would be sufficient to meet these nutrient needs. However, a multivitamin supplement may be recommended to women who are of lower-economic status or are not meeting their caloric needs (Eat Right, 2014). d. Goals (Eat Right, 2014): i. Optimal nutrition for infant and mother ii. Normalize body composition gradually so the mother returns to her ideal/pre-pregnancy weight. iii. Support the mother to continue breastfeeding for a minimum of 1 year and thereafter as long as mutually desired. iv. Decrease the development of nutritional risks in the mother. v. Promote adequate infant growth and development, including bone mineralization.

5 vi. Discourage use of foods and drinks that should be limited or avoid. 4. Education Material a. Tips for Breastfeeding Moms Facts Sheet b. Sheets explaining what counts as a serving for each food group necessary for a 5. Sample Menu a. balanced diet Hour Recall Suggestions for Improvement Suggested Meal Plan Breakfast: Drinking a moderate amount (no more 2 oz. Grains 2 c. Coffee 4 T. Half and Half Cream 2 T. Splenda 1 Medium Banana than 3 cups/day) of coffee or other caffeinated beverages does not affect your baby (USDA, 2014). However, caffeine can pass into the breast milk, so large amounts of caffeinated beverages should be avoided (Better Health Cannel, 2011). Switch to a lower fat or skim milk option to add to your coffee. Add two pieces of whole-wheat toast or 1 cup of oatmeal to your breakfast to add some whole grains into your diet and 1 cup Fruits ½ cup Dairy Lunch: 1 c. FF Greek Yogurt ½ c. Sliced Strawberries ¼ c. LF Granola Ham Sandwich (2 slices white bread, 2 slices deli ham, 1 slice cheddar cheese) 16 oz. Diet Pepsi Dinner: 2 oz. Baked Chicken (boneless, skinless) 2 c. Spinach (raw) 4 T. Honey Mustard Dressing 1 Large Chocolate Chip Cookie 2 Glasses Wine 5 increase your caloric intake for the day. Replace the refine white bread with two slices of whole wheat bread. Try switching to a low-sodium deli meat and adding some vegetables to your sandwich such as tomato and lettuce. Adding some raw vegetables to your lunch will also help you meet your vegetable needs for the day. Try switching the Diet Pepsi out for a glass of water or drink the decaffeinated form. Add a glass of low fat or skim milk to dinner. Switch to a reduced fat dressing. Add some brown rice or whole grain pasta to your meal to balance your plate off with a grain source. Drinking alcohol is not recommended any earlier than 3 months post partum while breastfeeding. Once your child is three months old, it is recommended that you 2 oz. Grains 1 cup Vegetables ½ cup Fruits 1 cup Dairy 2 ½ oz. Protein 2 oz. Grains 1 cup Vegetables 1 cup Dairy 3 ½ oz. Protein

6 Dinner: 2 oz. Baked Chicken (boneless, skinless) 2 c. Spinach (raw) 4 T. Honey Mustard Dressing 1 Large Chocolate Chip Cookie 2 Glasses Wine Snacks: None Add a glass of low fat or skim milk to dinner. Switch to a reduced fat dressing. Add some brown rice or whole grain pasta to your meal to balance your plate off with a grain source. Drinking alcohol is not recommended any earlier than 3 months post partum while breastfeeding. Once your child is three months old, it is recommended that you wait at least four hours after having a single alcoholic drink before breastfeeding. Or you can breast pump before having a drink and use it to feed your child later (USDA, 2014). Eating small frequent meals or adding snacks throughout the day will help contribute to a balanced diet and help 2 oz. Grains 1 cup Vegetables 1 cup Dairy 3 ½ oz. Protein Afternoon Snack: 1 cup Vegetable ½ cup Dairy 6. Websites a. b References a. Journal articles references i. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776 ii. American Dietetic Association. Position of the American Dietetic Association: Promoting and supporting breastfeeding. J Am Diet Assoc. 2005;105(5): iii. Dewey, KG. Energy and protein requirements during lactation. Annu Rev Nutr. 1997;17: iv. Escott-Stump S. Pregnancy and lactation. In: Nutrition and Diagnosis Related Care. Baltimore: Lippincot, Williams, and Wilkins; 2008: References Academy of Nutrition and Dietetics (2013). Pocket guide for international dietetics & nutrition terminology (IDNT) reference manual: Standardized language for the nutrition care process. Chicago, Ill: Academy of Nutrition and Dietetics. Better Health Channel (2011). Breastfeeding and your diet. Retrieved from et?ope CDC (2013). Breastfeeding: Frequently Asked Questions (FAQs). Retrieved from

7 Eat Right (2014). Breastfeeding/lactation- Nutrition Care Manual. Retrieved from on%20care Mayo Clinic (2014). Pregnancy weight gain: What's healthy? Retrieved from Nelms, M. N., Sucher, K., Lacey, K., & Roth, S. L. (2011). Nutrition therapy and pathophysiology (2nd ed.). Belmont, CA: Brooks/Cole Cengage Learning. Office of Women's Health (2012). Folic acid fact sheet. Retrieved from Sutter Health CPMC (2013). How milk is produced- Women & Infants Center. Retrieved from USDA (2014). Nutritional Needs while Breastfeeding. Retrieved from USDA (2014). SuperTracker. Retrieved from USDA (2013). Tips for Breastfeeding Moms. Retrieved from 7