Although this column typically addresses intake by infants, I have altered the focus somewhat for this issue to address maternal nutrition when breastfeeding. The benefits of breastfeeding for mother and infant are well documented (Ip et al., 2007). But what happens when a breastfeeding mother encounters problems or has questions about her nutrition? In September, I had the opportunity to spend some time with a lactation consultant. During our interaction, we talked about the importance of a mother's nutrition, including her intake of dairy products. Because nurses often are the healthcare providers to whom breastfeeding mothers turn for nutrition advice when breastfeeding, I thought it would be helpful to review maternal nutrition while breastfeeding, because it has a direct impact on infant nutrition.
General Guidelines
A well-balanced diet is one that follows the food "MyPyramid" recommendations and provides adequate intake of calories, protein, fruits, and vegetables. The Recommended Dietary Allowances (RDAs), thought to be greater than required, indicate that a lactating mother should consume 500 additional calories (Riordan, 2005). Caloric needs, however, are influenced by the mother's current weight and height and by her age and activity level. A mother can visit the MyPryamid Web site (http://www.mypyramid.gov/mypyramidmoms/breastfeeding_nutrition_needs.html) and actually generate a nutrition plan that takes these factors into account. Frequently, however, breastfeeding mothers consume less than the RDAs because they wish to lose the weight gained during pregnancy, access to food supplies is limited, or they are not active enough to meet their caloric needs (Riordan, 2005). Nurses should explore these possibilities during interactions with breastfeeding mothers.
Fluid intake is important. Women who breastfeed exclusively can produce between 750 and 800 mL of milk a day. Consequently, maintaining adequate hydration is important. Nurses can encourage mothers to drink when thirsty and observe for early signs of dehydration, such as dry mouth, infrequent urination, and concentrated urine. Mothers can be assured that although bone mass decreases during pregnancy, "bone density is restored after weaning" (Riordan, 2005, p. 441). Breastfeeding mothers also should consume 1000 mg of calcium daily. Nurses can encourage mothers to consume vegetables high in calcium (e.g., spinach and broccoli) and dairy products (e.g., yogurt and cheese).
Cues to Infant Allergies
Although certain foods (e.g., beans, broccoli, and cauliflower) may cause gastric distress for an infant, there are others to which an infant may be allergic. The most frequent foods ingested by a breastfeeding mother that can contribute to the development of infant sensitivity or allergy include cow's milk, eggs, nuts, and peanuts. A mother may notice that her infant spits up or vomits consistently, experiences considerable gastric pain made evident by pulling the knees up in pain, or has increased mucous or blood in the stools. These signs may indicate the presence of an allergy. Nurses should instruct the mother to avoid eating foods that seem to initiate this response. One reference suggests that mothers keep a journal to record what is consumed on a daily basis in order to better understand which foods could have resulted in infant symptoms. Breastfeeding mothers who encounter nutrition issues while breastfeeding can still continue to breastfeed if they are willing to alter their own nutritional intake to accommodate their infant's allergy. Sensitive and informed nurses can make a significant difference in the success a breastfeeding mother achieves as she adjusts her diet accordingly.
Nurses may find the following Web sites helpful when discussing nutritional issues with breastfeeding mothers:
http://www.patients.uptodate.com/print.asp?print=tru&file=c_health/9297
http://www.cdc.gov/breastfeeding/faq/index.htm
http://www.kidshealth.org/parent/growth/feeding/breastfeed_eating.html
References