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PDAT1 > 15 - Infant Nutrition > Flashcards

15 - Infant Nutrition Flashcards

1
Q

Physiologic considerations of
INFANTS

A

1 Month baby = 1 oz stomach (size of fist)

WEIGHT GAIN
lose 6% in 1st/2nd week of life
DOUBLE birth weight by 5-6 months
5 pounds per year on average

LENGTH

  • *50%** increase in 1st year
  • *100%** increase in 1st 4 years
  • *300%** increase by 13 years
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2
Q
  • *RDA**
  • *DIETARY intake for Children**
A

38-42weeks gestation >2500gm

Birth - 6 months
110 kcal/kg/day

6 - 12 months

  • *80 kcal/kg/day**
  • not a sig difference between GENDER*
  • PRETERM / <2500gm*
  • *<130 kcal/kg/day**
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3
Q

RDA
for Birth - 6 months

A

110 kcal/kg/day

Breastfeeding is recommended for this age range

@ 4-6 months of age:
digestive system ready to take complex food/cereal/babyfood
better neck/head control
some teeth

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4
Q

RDA

6 - 12 months

A

80 kcal/kg/day

not a sig diff between boys/girls <10 y/o
LESS THAN birth -6 months = 110

Master chewing & finger foods

Try CUPS / utensils

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5
Q

RDA
for PRETERMor<2500gm

A

<130 kcal/kg/day

needs MORE than full term children 110->80

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6
Q

Breastfeeding info

A
  • *PREFERRED** source of nutrition for FIRST 6 MONTHS
  • only CONTRAINDICATED if:*
  • HIV / Chemo Medication / TB*

Frequency is MORE OFTEN
1-2 hours, more than usual

Bowel Movement = after each feeding

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7
Q

Content of Formulas

A

WANT TO BE IDENTICAL TO HUMAN MILK

40-50% Carbohydrates
lactose is main source

30-40% Fats

5-10% Protein

Water

Micronutrients

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8
Q

Lactose Deficiency

A

Lactose Intolerance:
Diarrhea / Ab pain / Bloating
infants < 36 weeks gestation

  • *SECONDARY** lactase deficiency:
  • *TEMPORARY** decrease in lactase cause by
  • *gastroenteritis / malnutrition**
  • *Congenital** lactase deficiency:
  • *INBORN** error of metabolism = Rare
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9
Q

FAT

Content of Formula

A

Varies between products, but mainly:
TRIGLYCERIDES

no restriction < 2 y/o
needed for proper neurologic development

Minimum requied in formula = 30% of calories as fat
MAX = 54%

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10
Q

Protein
Content of Formula

A

Whey Protein
more soluble & remains in solution throughout stomach
20% cows milk vs 50-60% human milk

Casein Products
CURDS –> form micelles

Whey:Casein Ration = 60:40
for HUMAN milk, 20:80 for cows milk

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11
Q

Protein Requirements

A

Birth - 6 months:
2.2 gm/kg/day

6 months - 1 year:
1.6 gm/kg/day

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12
Q

WATER
Content of Formula
+ RDA for WATER

A

_NO supplemental water is Necessary_
even once starting baby food

Fluid Maintenance:
100 ml/kg/day for 1st 10kg
PLUS + 50 ml/kg/day for each additional-kg between 10-20kg

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13
Q

Vitamins & Minerals
needed for Infant SUPPLEMENTATION

A

VITAMIN D
All infants : 400 IU/day
starting within 1st few days of life

IRON
Full-term breastfed: 1 mg/kg/day after 4 months of age
varies by preterm/formula

FLUORIDE
Based on the amount of fluoride present in water source
fluoridated toothpaste

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14
Q

Vitamin D Supplementation

A

ALL INFANTS
400 IU/day

starting within the first few days of life

  • UNLESS receiving at least*
  • *>1 liter of fortified formula/day**
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15
Q

IRON SUPPLEMENTATION

for infants

A

FULL Term + Breastfed
1 mg/kg/day after 4 months of age

Pre-term Breastfed
2 mg/kg/day after 1 month

Partial Breastfed
if 50% HUMAN milk fed –> use ABOVE dosing

Formula Fed:
Iron-fortified formulas supply sufficient iron for first 12 months of life

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16
Q

Fluoride SUPPLEMENTATION

A

Based on the amount of fluoride present in WATER SOURCE
NOT recommended @ <_6 months_

Fluoridated TOOTHPASTE should be used

<3y/o –> use grain of rice amount

>3 years of age –> pea size apoint

start with first tooth eruption

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17
Q

Milk Comparisons

A

FDA LIMIT for
Renal Solute Load= 277

Cow’s Milk:
20% Whey : 80% Casein
308 Renal Solulte load

_*DO NOT RECOMMEND COW’S MILK IN*
FIRST YEAR OF LIFE_

18
Q

Soy-Based Formulas

A
  • *Corn Starch / Tapioca Starch / Sucrose**
  • for the CARB – instead of LACTOSE*

recommended if lactase deficient or allergy
NOT recommended for pre-term infants

HIGH concentration of
PROTEIN / MANGANESE

19
Q

Therapeutic Formulas

Casein-Hydrolysate-Based Formulas

A

Pregestimil // Nutramigen // Alimentum

= BROKEN-down proteins –> AA’s
so that it is easier to digest

Indicated for patients w/

  • *GI Distrubances**
  • less palatable*
20
Q

Therapeutic Formulas

WHEY-Hydroysate Based

A

Carnation Good-Start

  • *MORE Palatable** vs Casein
  • maybe more acceptable if need for*
  • *GI INTOLERANCE**
21
Q

Therapeutic Formulas
OTHER CONSIDERATIONS

A

Premature Infant Formulas
decreased renal solule load –> whey predominant
want to mimic breast milk ratio = 60W:40C

Pre-Thickened Formulas
indicated for GERD

  • *Concentrated** Formulas
  • *24 vs 27kcal/oz** = HIGHER calorie
  • *Human Milk** Fortifiers
  • *Adds Calories**, without adding volume
22
Q

What is COLIC?

A

20% of infants experience this

Insoluble Crying
= worse in evening

Gassy / Hernia / Sensitivity to milk protein ???

usually subsides by _3 months of age_
needs a LOT of patience

23
Q

Considerations for CONSTIPATION

A
  • DO NOT USE*
  • *Low-Iron Formulas**

Honey - botulism risk

Plain Water? - NO NUTRITIONAL USE

JUST GIVE THEM MORE FORMULA
NO DRUG THERAPY
see a doctor if been going for too long

24
Q

Formula Warming

A

Bring to
ROOM TEMPERATURE

AVOID use of microwave
can have HOT SPOTS –> burn mouth

Sterilization of nipples/bottle

25
Q

Full Term Baby & 1 month old

Stomach Capacity

A

“SIZE of THEIR FIST”
Full Term
20 - 90mL = 1-3oz

1 month
90 - 150mL = 3-5oz

26
Q

Problems with Feeding:

GERD

A
  • *do NOT add CEREAL** to formula
  • may WORSEN the GERD*

Recommend:
formulas that THICKEN in the stomach

27
Q

Monitoring if
​Problems with Feeding:

A

Weight
use a weight curve
Height

Head Circumference

HYDRATION STATUS
# Wet Diapers (weight)
TEARS
soft fontanelle

28
Q

How MUCH to feed the baby?

A

◦Birth – 2 weeks:
2-3 ounces/feed

◦3 weeks – 2 months:
4-5 ounces/feed

◦2 months onward:
~ 6 ounces/feed

◦Birth to 6 months ~ 110 kcal/kg/day
◦6 months – 12 months ~ 80 kcal/kg/day

29
Q

How OFTEN to feed the baby?

A
  • *Healthy**, term infants = Q4 HOURS
  • preterm = q 2-3 hours*

FEED ON DEMAND!
until they are satisfied

Nightime feedings may stop after 1-2 months

during _illnesses –> frequency will VARY_
constipation –> MORE frequent
vomiting –> LESS frequent
DIARRHEA –> fluid/electrolyte replacement

30
Q

HOW TO PREPARE FORMULA?

LIQUID CONCENTRATE

A
31
Q

HOW TO PREPARE FORMULA?

POWDERED FORMULA

A

30 days after can is open

1 tbsp = 1 scoop

POWDER NEEDS MORE WATER

32
Q

Water for Baby Formulated

A
  • *Nursury Water** = Distilled Water
  • NOT sterile, has 0.7 ppm Fluoride*

Tap Water
usually contains fluoride, not sterile

no need to use distilled water, just use TAP

33
Q

Ready-to-Feed Formula

A

NO PREP NEEDED

  • *Expensive but CONVENIENT**
  • use within 48 hours of opening*
  • *unopened bottle** can be
  • *kept at room temperature!**
34
Q

Pharmacist Recommendations
for Baby Formula

A

Typically switching formulas
–> DOES NOT make a difference

  • *Calculate calories / Fluid amount**
  • may be using too much or too little, based on STOMACH SIZE*

Review PRODUCT PREP

35
Q

When to SEE MD
baby formula

A

no improvement in a FEW DAYS

weight loss / dehydration

BLOOD in stool

INCREASED Vomitting

36
Q

Regular Milk for babies?

A

NO COW’S MILK UNTIL > 1 yo

no need for supplementation or switching until after 12 months

  • *Whole milk = INCREASED RENAL SOLUTE LOAD**
  • risk of DEHYDRATION / GI Blood loss*
  • *iron deficiency**
37
Q

AAP MILK Recommendation for
AFTER 1 YEAR OF AGE

A

for those 1 - 2 years​​
use WHOLE MILK

EXCEPT: Overweight / risk of obesity (FH, too)
use 2% milk

AFTER 2 YEARS OLD:
ALL USE 1% MILK

38
Q

What FORMULA is NOT RECOMMENDED?

A
  • *ORGANIC** / Home-Made
  • other* Animal-milk-based formulas

due to:
dehydration / contamination / decreased nutrients

39
Q

Formula chart

GOOD START = WHEY

A
40
Q

Infant Weight Gain Considerations

A

◦Loss of about 6% of body weight during 1st – 2nd week of life

◦25-35 gm per day in 1st 3 months of life
1 oz

◦15 gm per day in the next 8 months

◦Double birth weight by 5-6 months

◦2-9 years old: 5 lb per year on average

PDAT1 (27 decks)

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