Formula Feeding Flashcards
Why is it important to monitor growth?
- reinforcing healthy growth patterns
- nutrition and health evaluation tool
- initiate further assessment in case of unusual growth patterns
- “teachable moments” with caregivers
- context for regular contact with primary health care services and public health
What does growth equate to?
Health
What growth charts can be used to monitor growth?
- centre for disease control (CDC)
- World Health Organization (WHO)
What do growth charts for birth to 2 years assess?
- Weight for age
- Length for age
- Head circumference for age
- Weight for length
Assessing growth as a reference
Seen with the CDC
- how infants/children growing within a population
- growth assessed relative to others within the population
Assessing growth as a standard
WHO based off this
- optimal growth in infants/children
- growth assessed relative to optimal
- identify inadequate or excessive growth
How were CDC growth charts developed?
Looked at growth when obegenic already a problem
- reference group is a large number of infants in the USA
- includes breastfed and formula fed
- indicates how infants growing compared to other infants
How where WHO growth standards developed
Standards based on optimal growth
- international growth charts
- longitudinal follow-up of children in six countries: Brazil, Ghana, India, Norway, Oman, USA
- selective in which infants included in dataset
WHO standards between BF and FF
Breastfed infants have a different growth pattern than formula fed infants
- slower rate of gain first year compared to formula fed
What growth chart does Canada use?
Based on WHO - Developed by Dietitians of Canada, Canadian Paediatric Society, others
- WHO 2006 Child Growth Standard birth to 5 years
- WHO Growth Reference 2007 5 to 19 years
What are key growth changes for healthy development of infant?
- 5-95th percentile “normal”
- Double birth weight by 3-6 months
- Triple birthweight by 1 year
History of infant formula
- Mid 1800s: first commercially available infant formula: wheat flour, malt, potassium bicarbonate
- Late 1800s: attempts to make more similar to breastmilk composition (ie use of lactose)
- 1960: use of isolated proteins
- 1962: composition regulated and heavily marketed that woman werent making enough
- 1980s-1990s: emphasis on breastmilk is best; regulations on the marketing of infant formula
What is the International Code of Marketing of Breast-milk Substitutes
From WHO in 1981 Health professionals must provide information about:
* the importance of breastfeeding
* the costs of formula feeding
* the difficulty of reversing the decision
* counsel those who have made a fully informed choice not to breastfeed on the use of breastmilk substitutes
When is formula recommended?
Circumstances where mothers are unable/unwilling to breastfeed
What can breastmilk be replaced with?
- pasteurized breastmilk from screened donors or commercial formulas
- iron-fortified formula until 9-12 months
Inappropriate breastmilk substitutes
- Non-human milk
- Diluted formula
- Homemade formulas
- Evaporated milk
- Powdered milk
- Coffee whitener
- Rice or soy beverages
Why should infants not be given other animal milks?
Infant formulas are modified to resemble breastmilk composition as much as possible and is regulated. Unmodified animal milk is poorly suited to infant’s needs
* milk produced by humans is perfectly suited for humans
Human milk compared to cow milk
- Althought PRO, Ca, P, and Fe are low they are highly bioavailable
- protein sources differ drastically
What is a benefit of infant formula?
complete infant food – no supplementation required
What are the categories of infant formula?
Categorized by protein source:
* Cow milk protein
* Soy protein
* Non-intact protein (partially hydrolyzed/elemental)
What are the common characteristics of breastmilk versus formula?
Almost all infant formulas are quantitatively nearly identical in nutrients – formulation to mimic nutrient availability in breastfed infants
* Energy: ~67-70 kcal/d
* Protein: 9-13%
* Fat: 45-50%
* CHO: 39-45%
Availability of cow milk based formulas
most commonly available and least expensive usually the “default” formula
* common brands: Enfamil, Similac, Bonamil, Good Start, many others
* most available as powders, concentrate, ready-to-feed; time and place for each of them
Content of cow milk based fromulas
- protein: intact protein from cow’s milk - whey:casein ration variable, some contain 100% whey
- carbohydrate: lactose
- lipid: primarily vegetable oils (coconut, palm, soybean, sunflower, safflower)
- additional contents in some formulas: AA, DHA, nucleotides, probiotics
Availability of soy based formulas
formulas with plant source protein which are readily available and often similar price to cow’s milk based
* common brands: Isomil, Prosobee, Soyulac, Alsoy
* most available in powder, concentrate, ready-to-feed
Content of soy based formula
- protein: intact soy protein with additional methionine (limiting aa in soy)
- carbohydrate: corn (dextrin-easily digested), sucrose in some
- lipid: vegetable oils (coconut, palm, soybean, sunflower, safflower)
- additional contents in some formulas: AA and DHA, nucleotides, probiotics
What are indications for using soy formula?
- vegans
- galactosemia
- congenital lactase deficiency
Why should soy formula not be used for cows milk allergy?
15-40% allergic to both cow’s milk and soy protein
* higher risk for peanut allergy
Partially Hydrolyzed formula
Cow milk and soy protein formulas with proteins partially hydrolyzed
* no evidence of benefit for infants since gut is pretty much functional already and able to break down the proteins
* might contain some intact proteins
Lactose- Free Formulas
Lactose-free cow milk protein formula with glucose polymers instead of lactose
* no evidence of benefit for infants
Hydrolyzed/ elemental formulas
hydrolyzed such that every component is elemental
* common brands: Nutramigen, Pregestimil, Alimentum, Neocate
* very expensive, 2-4 x cost of standard
* most only available in powdered form
What are indications for using hydrolyzed/elemental formulas?
specialized formulas for use under medical supervision
* allergy: especially now milk protein
* Malabsorption: protein, fat or carbohydrates
content of hydrolyzed/elemental formula
- protein: peptides, amino acids
- carbohydrate: corn (dextrin), sucrose, monosaccharides
- lipid: same as other formulas, some containing medium chain (fat malabsorption)
Other potential formulas
- thickened formulas (rice starch)
- follow-up formulas
- preterm formulas with higher energy density (typically under medical supervision)
