feeding Flashcards
Normal Growth: Weight
normal birth weight
expected gain in first 12 m
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
from 1y to 5 weight
when Doubling
Triple
Quadrable birth weight
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
Length
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
OFC
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
Upper/lower segment ratio
1.7 at bith
1.3 at 3 years
1 at 7 years
Breast feeding hormones
Oxytocin: for breast development and Milk ejection
Prolactin: for milk production
Macronutrients in breast milk
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
micronutrient in breast milk
Water: 90%
Minerals:
Iron
Vitamen D
Ca : Phosphorus
human milk 2:1 cow’s milk 1:1Composition of breast milk and transformation
Colostrum → Transitional Milk → Mature
First few days
3 days-2 weeks
>2 weeks
Throughout any given feeding session
Foremilk → Hindmilk
Colostrum
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
mature milk
Less protein, more fat and energy Carbohydrate contains lactose = improved Ca absorption Minerals higher bioavailability of iron and zinc low sodium content
Enough or not?
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
Contraindications
Not contraindicated
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
Infant Formulas – Protein Content classification
with indication
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
Soy formulas are not indicated in:
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.
Infant Formulas – Carbohydrate Content
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
When are MCTs beneficial?
Impaired fat absorption or lymphatic abnormalities as chylothorax , congenital lymphangiectasia
Solid food should be introduced at 6 mths
?why Not before 4 months
why by 6 months
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
Feeding Skills Development
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.
Type I Failure to Thrive
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)
Type II Failure to Thrive
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
Type III Failure to Thrive
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.
