Formula Feeding Flashcards

1
Q

Why is it important to monitor growth?

A
  • 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
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2
Q

What does growth equate to?

A

Health

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3
Q

What growth charts can be used to monitor growth?

A
  • centre for disease control (CDC)
  • World Health Organization (WHO)
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4
Q

What do growth charts for birth to 2 years assess?

A
  • Weight for age
  • Length for age
  • Head circumference for age
  • Weight for length
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5
Q

Assessing growth as a reference

A

Seen with the CDC
- how infants/children growing within a population
- growth assessed relative to others within the population

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6
Q

Assessing growth as a standard

A

WHO based off this
- optimal growth in infants/children
- growth assessed relative to optimal
- identify inadequate or excessive growth

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7
Q

How were CDC growth charts developed?

A

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

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8
Q

How where WHO growth standards developed

A

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

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9
Q

WHO standards between BF and FF

A

Breastfed infants have a different growth pattern than formula fed infants
- slower rate of gain first year compared to formula fed

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10
Q

What growth chart does Canada use?

A

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

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11
Q

What are key growth changes for healthy development of infant?

A
  • 5-95th percentile “normal”
  • Double birth weight by 3-6 months
  • Triple birthweight by 1 year
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12
Q

History of infant formula

A
  • 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
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13
Q

What is the International Code of Marketing of Breast-milk Substitutes

A

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

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14
Q

When is formula recommended?

A

Circumstances where mothers are unable/unwilling to breastfeed

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15
Q

What can breastmilk be replaced with?

A
  • pasteurized breastmilk from screened donors or commercial formulas
  • iron-fortified formula until 9-12 months
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16
Q

Inappropriate breastmilk substitutes

A
  • Non-human milk
  • Diluted formula
  • Homemade formulas
  • Evaporated milk
  • Powdered milk
  • Coffee whitener
  • Rice or soy beverages
17
Q

Why should infants not be given other animal milks?

A

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

18
Q

Human milk compared to cow milk

A
  • Althought PRO, Ca, P, and Fe are low they are highly bioavailable
  • protein sources differ drastically
19
Q

What is a benefit of infant formula?

A

complete infant food – no supplementation required

20
Q

What are the categories of infant formula?

A

Categorized by protein source:
* Cow milk protein
* Soy protein
* Non-intact protein (partially hydrolyzed/elemental)

21
Q

What are the common characteristics of breastmilk versus formula?

A

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%

22
Q

Availability of cow milk based formulas

A

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

23
Q

Content of cow milk based fromulas

A
  • 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
24
Q

Availability of soy based formulas

A

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

25
Q

Content of soy based formula

A
  • 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
26
Q

What are indications for using soy formula?

A
  • vegans
  • galactosemia
  • congenital lactase deficiency
27
Q

Why should soy formula not be used for cows milk allergy?

A

15-40% allergic to both cow’s milk and soy protein
* higher risk for peanut allergy

28
Q

Partially Hydrolyzed formula

A

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

29
Q

Lactose- Free Formulas

A

Lactose-free cow milk protein formula with glucose polymers instead of lactose
* no evidence of benefit for infants

30
Q

Hydrolyzed/ elemental formulas

A

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

31
Q

What are indications for using hydrolyzed/elemental formulas?

A

specialized formulas for use under medical supervision
* allergy: especially now milk protein
* Malabsorption: protein, fat or carbohydrates

32
Q

content of hydrolyzed/elemental formula

A
  • protein: peptides, amino acids
  • carbohydrate: corn (dextrin), sucrose, monosaccharides
  • lipid: same as other formulas, some containing medium chain (fat malabsorption)
33
Q

Other potential formulas

A
  • thickened formulas (rice starch)
  • follow-up formulas
  • preterm formulas with higher energy density (typically under medical supervision)