RDA DIETARY intake for Children

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

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

_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

15 - Infant Nutrition Flashcards by Karlo Sison

Physiologic considerations of
INFANTS

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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*RDA**
*DIETARY intake for Children**

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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RDA
for Birth - 6 months

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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RDA

6 - 12 months

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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RDA
for PRETERMor<2500gm

<130 kcal/kg/day

needs MORE than full term children 110->80

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Breastfeeding info

*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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Content of Formulas

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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Lactose Deficiency

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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FAT

Content of Formula

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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Protein
Content of Formula

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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Protein Requirements

Birth - 6 months:
2.2 gm/kg/day

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

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WATER
Content of Formula
+ RDA for WATER

_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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Vitamins & Minerals
needed for Infant SUPPLEMENTATION

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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Vitamin D Supplementation

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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IRON SUPPLEMENTATION

for infants

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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Fluoride SUPPLEMENTATION

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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Milk Comparisons

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_

Soy-Based Formulas

*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

Therapeutic Formulas

Casein-Hydrolysate-Based Formulas

Pregestimil // Nutramigen // Alimentum

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

Indicated for patients w/

*GI Distrubances**
less palatable*

Therapeutic Formulas

WHEY-Hydroysate Based

Carnation Good-Start

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

Therapeutic Formulas
OTHER CONSIDERATIONS

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

What is COLIC?

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

Considerations for CONSTIPATION

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

Formula Warming

Bring to
ROOM TEMPERATURE

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

Sterilization of nipples/bottle

**Full Term Baby** & **1 month old** **Stomach Capacity**

"SIZE of THEIR FIST" _Full Term_ **20 - 90mL** = 1-3oz _1 month_ **90 - 150mL** = 3-5oz

Problems with Feeding: ## Footnote **GERD**

* *do NOT add CEREAL** to formula * may WORSEN the GERD* ## Footnote **Recommend: formulas that THICKEN in the stomach**

**Monitoring if** Problems with Feeding:

**Weight** use a weight curve **Height** **Head Circumference** **HYDRATION STATUS** **# Wet Diapers** (weight) **TEARS** soft fontanelle

**How MUCH to feed the baby?**

_◦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

**How OFTEN to feed the baby?**

* *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

**HOW TO PREPARE FORMULA?** **LIQUID CONCENTRATE**

**HOW TO PREPARE FORMULA?** **_POWDERED FORMULA_**

**30 days after can is open** **1 tbsp = 1 scoop** POWDER NEEDS MORE WATER

**Water for Baby Formulated**

* *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*

**Ready-to-Feed Formula**

**NO PREP NEEDED** * *Expensive but CONVENIENT** * use within 48 hours of opening* * *unopened bottle** can be * *kept at room temperature!**

**Pharmacist Recommendations for Baby Formula**

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**

**When to SEE MD baby formula**

**no improvement in a FEW DAYS** **weight loss / dehydration** **BLOOD** in stool INCREASED **Vomitting**

**Regular Milk for babies?**

**_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**

**AAP MILK Recommendation for AFTER 1 YEAR OF AGE**

_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_**

**What FORMULA is NOT RECOMMENDED?**

* *ORGANIC** / **Home-Made** * other* **Animal-milk-based** formulas due to: **dehydration / contamination / *decreased nutrients***

Formula chart ## Footnote **GOOD START = WHEY**

**Infant Weight Gain Considerations**

◦***_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**