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Paediatrics > Feeding Babies > Flashcards

Feeding Babies Flashcards

1
Q

First line feed choice for cow’s milk protein allergy

A

Extensively hydrolysed protein feeds

90% respond, 10% react

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2
Q

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?

A

Palatability - less likely to take the feed

Nutramigen LGG Lipil 1 and 2
Aptamilk Pepti 1 and 2

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3
Q

What are the second line feed choices for cow’s milk protein allergy?

A

Amino acid-based feeds

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4
Q

When might amino acid-based feeds be appropriate for babies with cow’s milk protein allergy?

A

Babies with severe colitis, enteropathy or symptoms on breast milk

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5
Q

What percentage of children with reflux may be milk allergic?

A

16-40%

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6
Q

How can you determine whether a child with reflux is milk allergic?

A

No or poor response to anti-reflux medications
Aversive feedings
Personal or family history of atopy

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7
Q

What is lactose intolerance and when is this seen?

A

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

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8
Q

What is secondary lactose intolerance?

A

Short-lived conditions e.g. post-gastroenteritis
Confused with cow’s milk protein intolerance
Lactose free/”comfort” milks are not CMP free

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9
Q 
What is the average weight gain in babies;
0-3 months 
3-6 months
6-9 months
9-12 months 
after 1 year?
A

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

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10
Q

What are the reasons for nutrition issues beyond infancy?

A

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
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11
Q

What are the phases of growth?

A

Infant - nutrition led, feeding is particularly important

Child - growth hormone led

Pubertal - sex steroid led

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12
Q

Why is nutrition important?

A

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

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13
Q

What are some influencing factors of birth size and weight?

A 
Maternal size 
Placental function 
Gestation 
- 95% of weight between 20-40 weeks 
- 10-16% of body weight as fat
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14
Q

What is the average weight of a term infant?

A

3.3kg

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15
Q

What is the energy requirement?

A

Energy expended + energy deposited in new tissue

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16
Q

Why is energy required?

A

Physical activity
Thermogenesis
Tissue maintenance
Growth

17
Q

What percentage of energy intake is used up by growth demands in infants?

A

35%

18
Q

Why are infants at risk of poor nutrition?

A 
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
19
Q

What are the types of feed for infants?

A

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

20
Q

Why should cow’s milk not be drunk as main drink until at least 1 year old?

A

As it contains no iron

21
Q

What are the indications for soya milk use?

A

Milk allergy when hydrolysed formulae refused
Vegan families if not breastfed
Consider for children > 1 year still on a milk-free diet

22
Q

At what age can you introduce non-formula milks?

A

> 1 year

23
Q

What are the non-formula milks?

A

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

24
Q

What is the calorie and calcium content of full fat cow’s milk?

A

65kcal/100ml

120mg calcium/100ml

25
Q

Why is full fat cow’s milk better nutritionally that organic milks?

A

Organic/unsweetened milk substitutes are low in calories
Organic milks are not calcium supplemented
Need 400-500ml of a calcium-fortified milk to meet calcium requirements

26
Q

When do you need to supplement calcium?

A

If < 500ml calcium fortified substitute - alliance calcium liquid if > 3, calcium softies, accrete or cacit D3 for breastfeeding mums

27
Q

What is weaning and why is it done?

A

Transition from milk to a mixed diet - nutritional and developmental changes

Starts at about 5-6 months

  • smooth purees
  • cereal
  • fruit and veg
  • meat
  • lumps/finger foods from 6-7 months
  • holding cup from 7 months

Milk alone is inadequate - source of vitamins and trace elements, encourage tongue and jaw movements in preparation for speech and social interaction

28
Q

What children are at risk of rickets?

A

Dark-skinned children not on vitamin drops

Prolonged breastfeeding when mother is not taking vitamin D

29
Q

When are vitamins supplemented?

A

All breast-fed babies from 1 month
Bottle fed babies taking < 500ml formula
All children from 1-4 years
Health start vitamins
Abidec/dalivit 0.3 ml < 1 year or 0.6ml > 1 year
Suggest OTC children’s vitamins

30
Q

Why is “breast best”?

A

Nutritionally best for full-term babies

  • well tolerated
  • less allergenic
  • low renal solute load
  • Ca:PO4, iron, LCP FAs

Improved cognitive development

Reduces infection

  • macrophages and lymphocytes
  • interferon, lactoferrin, lysozyme
  • bifidus factor
31
Q

Advantages of breast feeding

A

Suckling/bonding
Perfect nutrition for 6 months for most infants (not premature)
Tailor-made passive immunity
Increased development of infant’s active immunity
Increased development of infant’s gut mucosa
Reduced infection
Antigen load minimal
Potential reduced risk of breast cancer

32
Q

Advantages and disadvantages of formula feeding

A 
Near-perfect nutrition for up to a year for pre-term infants
Doesn't need mum 
Accurate feed volume 
Provides vitamin K 
Less jaundice 
No transition of BBVs/drugs

No anti-infection properties
Risk of contamination
High antigen load
Expensive

33
Q

What should be used if breast feeding is not possible?

A 
Formula feeding common 
All are cow's milk based 
Various brands available 
Powder or ready to feed
Various compositions based on age
34
Q

What are the UNICEF baby friendly 10 steps?

A

Have a written breast-feeding policy - routinely communicated to all staff
Train all health care staff in skills necessary to implement this policy
Inform all pregnant women about the benefits/management of breastfeeding
Help mothers initiate breastfeeding within half an hour of birth
Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants
Give newborn infants no food and drink other than breast milk, unless medically indicated
Practice rooming-in - allow mothers and infants to remain together, 24 hours/day
Encourage breast-feeding on demand
Give no artificial teats, pacifiers to breastfeeding infants
Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital or clinic

Paediatrics (8 decks)

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