Feeding Babies Flashcards
First line feed choice for cow’s milk protein allergy
Extensively hydrolysed protein feeds
90% respond, 10% react
What is the problem with extensively hydrolysed protein feeds in older babies with cow’s milk protein allergy and what are the other feed options?
Palatability - less likely to take the feed
Nutramigen LGG Lipil 1 and 2
Aptamilk Pepti 1 and 2
What are the second line feed choices for cow’s milk protein allergy?
Amino acid-based feeds
When might amino acid-based feeds be appropriate for babies with cow’s milk protein allergy?
Babies with severe colitis, enteropathy or symptoms on breast milk
What percentage of children with reflux may be milk allergic?
16-40%
How can you determine whether a child with reflux is milk allergic?
No or poor response to anti-reflux medications
Aversive feedings
Personal or family history of atopy
What is lactose intolerance and when is this seen?
Not an allergy - reduced levels of the enzyme lactase
Seen to a minor degree in some breast fed babies, post-gastroenteritis and in some ethnic groups post-weaning
What is secondary lactose intolerance?
Short-lived conditions e.g. post-gastroenteritis
Confused with cow’s milk protein intolerance
Lactose free/”comfort” milks are not CMP free
What is the average weight gain in babies; 0-3 months 3-6 months 6-9 months 9-12 months after 1 year?
0-3 months 200g
3-6 months 150g
6-9 months 100g
9-12 months 50-75g
after 1 year approx. 2kg and 5cm per year until puberty
What are the reasons for nutrition issues beyond infancy?
Toddler and pre-school
- learning to feed self and find food
- picky eaters
- excess milk
- dependent on carer
- frequent illness
School age
- learning to be independent
- chronic disease
- obesity
Adolescent
- independent
- puberty
- eating disorders
What are the phases of growth?
Infant - nutrition led, feeding is particularly important
Child - growth hormone led
Pubertal - sex steroid led
Why is nutrition important?
Fundamental aspect of life
Growth not just increasing size but change in body structure, composition and function
Globally, malnutrition contributes to 54% of under 5 deaths
Disease prevention (breast feeding)
Primary treatment e.g. metabolic disease, exclusion diets in food allergy
What are some influencing factors of birth size and weight?
Maternal size Placental function Gestation - 95% of weight between 20-40 weeks - 10-16% of body weight as fat
What is the average weight of a term infant?
3.3kg
What is the energy requirement?
Energy expended + energy deposited in new tissue
Why is energy required?
Physical activity
Thermogenesis
Tissue maintenance
Growth
What percentage of energy intake is used up by growth demands in infants?
35%
Why are infants at risk of poor nutrition?
Characteristic feature is the need to fuel both rapid growth and maintenance Infants can rapidly become malnourished Dependent on carer High demands for growth and maintenance Low stores of fat and protein Frequent illness
What are the types of feed for infants?
Breast milk - WHO recommended
Standard formula - cow’s milk based
Specialised - for cow’s milk protein allergy, nutrient dense, disease-specific
Pre-term formulae e.g. SMA gold prem 1
Nutrient-dense formulae e.g. infatrini 100kcal/100ml
Why should cow’s milk not be drunk as main drink until at least 1 year old?
As it contains no iron
What are the indications for soya milk use?
Milk allergy when hydrolysed formulae refused
Vegan families if not breastfed
Consider for children > 1 year still on a milk-free diet
At what age can you introduce non-formula milks?
> 1 year
What are the non-formula milks?
Rice milk - not advised for children < 5 years due to arsenic content
Goat’s and sheep’s milk - not suitable for < 1s, many children will react
Oat and nut milks
What is the calorie and calcium content of full fat cow’s milk?
65kcal/100ml
120mg calcium/100ml
