feeding

Question 1

Normal Growth: Weight
normal birth weight
expected gain in first 12 m

Answer 1

Normal birth weight 3.5kg
Loss of 10% of weight in 1st week
Regain birth weight by 2 weeks
Expected gain
200g per week for 1-3 months
150g per week for 4-6 months
100g per week for 7-9 months
50-75g per week for 10-12 months

Question 2

from 1y to 5 weight
when Doubling
Triple
Quadrable birth weight

Answer 2

Slows after 1st year eg 2.5kg in 2nd year;
 2.5 kg per year thereafter til 2-5years
Older children (age + 4) x 2
Doubling of weight at 4 month
Triple birth weight at 1 year
Quadrable birth weight at 2 year
16 kg at 4 year

Question 3

Length

Answer 3

Normal birth length 50cm
Expected growth
1st year 25cm
2nd year 12cm
2-5 year 7-8 cm per year
6-11 year 6-7 cm per year
Double birth lenght at 4years
Triple birth lenght at 13 years
Supine length until age 2

Question 4

OFC

Answer 4

Normal head circ at birth 35cm
12 cm per first year(48cm by 1 yr)
6 cm in 2 year
Then 5 cm
Reflects brain growth
Above eyes, upright, looking straight ahead

Question 5

Upper/lower segment ratio

Answer 5

1.7 at bith
1.3 at 3 years
1 at 7 years

Question 6

Breast feeding hormones

Answer 6

Oxytocin: for breast development and Milk ejection

Prolactin: for milk production

Question 7

Macronutrients in breast milk

Answer 7

protein Whey:Casein (60:40)

Whey: soluble and easy to digest
IgA
Lactoferrin
Growth factors
carbs lactose
fat
LCT and MCT
Essential fatty acids 
and lipase

Question 8

micronutrient in breast milk

Answer 8

Water: 90%
Minerals:
Iron
Vitamen D
Ca : Phosphorus
        human milk 2:1 cow’s milk 1:1

Question 9

Composition of breast milk and transformation

Answer 9

Colostrum → Transitional Milk → Mature
First few days
3 days-2 weeks
>2 weeks

Throughout any given feeding session
Foremilk → Hindmilk

Question 10

Colostrum

Answer 10

First 2-5 days
Yellow thick milk
Has Laxative effect: 
passage of meconium
Lowering bilirubin

Higher protein and IgA content
Lower Na, carbs, fat content

Question 11

mature milk

Answer 11

Less protein, more fat and energy
Carbohydrate 
contains lactose = improved Ca absorption
Minerals 
higher bioavailability of iron and zinc
low sodium content

Question 12

Enough or not?

Answer 12

Al least 8 times/day for neonates
About 10-15 min per breast each feed
The infant should take from each breast each feed
Feeding every 2-3 hours, not longer than 4-5 hours
Feeling of breast emptying
Sleeping after feeding
Passing of urine *6
Passing of stool *4
Increasing weight

Question 13

Contraindications

Not contraindicated

Answer 13

Galactosemia and congenital lactase deficiency
Chemotherapy and radiotherapy

HIV mother
Tuberculosis infection

Temporary:
         Active Herpes, or chicken pox
Not contraindicated
Hepatitis B, C
Smoking and alcohol

Question 14

Infant Formulas – Protein Content classification

with indication

Answer 14

Divided into 4 classes of formulas
Cow’s milk based formulas
Soy formulas - Galactossemia
Lactase deficiency
Casein hydrolysate formulas- cow milk allergy
Amino acid based formulas - Cow’s milk protein allergy not responding to Casein hydrolysate formulas

Question 15

Soy formulas are not indicated in:

Answer 15

Soy formulas are not indicated in:
Premature infants < 1800g (increases risk of osteoporosis and rickets)
CF patients
Infantile colic
Patients with cow milk protein allergy frequently are as sensitive to soy protein and should not be given isolated soy protein-based formula routinely.

Question 16

Infant Formulas – Carbohydrate Content

Answer 16

Main types of carbohydrates in formulas
Lactose 
Sucrose
Glucose polymers
What type of formula should be used in patients with galactosemia?  Why?
Soy formulas because they do not contain lactose
Which formulas contain sucrose?
Alimentum and soy formulas

Question 17

When are MCTs beneficial?

Answer 17

Impaired fat absorption or lymphatic abnormalities as chylothorax , congenital lymphangiectasia

Question 18

Solid food should be introduced at 6 mths
?why Not before 4 months
why by 6 months

Answer 18

Solid food should be introduced at 6 mths
? Not before 4 months:
-milk meets all nutrient requirements
-immature GIT & limited renal capacity
-Poor neuromuscular co-ordination
? by 6 months:
-increasing energy & nutrient needs
-decreased body stores : Fe & Zn
-aids chewing & speech development
-food refusal less likely

Question 19

Feeding Skills Development

Answer 19

4-6 mos - experience new tastes.
Give rice cereal with iron.
6-7 mos - sits with minimal support.
Add fruits and vegetables.
8-9 mos - improved pincer grasp.
Add protein foods and finger foods: food served in such a form and style that it can conveniently be eaten with the fingers
10-12 mos - pulls to stand, reaches for food.
Add soft table food, allow to self-feed.

Question 20

Type I Failure to Thrive

Answer 20

Patients with type I failure to thrive arereferred to asbeing “wasted”, meaning that they are underweight for their height (evidenced by a low weight:length ratio)

Question 21

Type II Failure to Thrive

Answer 21

Patients with type II failure to thrive are referred to as being “stunted” meaning that their height for age is decreased, often in proportion to weight. Therefore, these patients have a normal weight:length ratio or BMI.
familial short stature
constitutional growth delay
hypothyroidism, growth hormone deficiency, hypopituitarism
And chronic malnutrition

Question 22

Type III Failure to Thrive

Answer 22

This growth pattern often begins at and usually results from:
intrauterine infections
chromosomal abnormalities
prenatal exposure to toxins

These patientsoften appear dysmorphic or have CNS abnormalities.

These patients, like those with type II failure to thrive, are typically stunted with a normal weight:length ratio or BMI.