General infant nutrition

Question 1

Why is paediatric nutrition important?

Answer 1

They have higher requirements
Immaturity
Dependence on others

Question 2

How do children have higher requirements?

Answer 2

Different proportion of tissue components so BMR is higher (activity, growth and temperature control)

Question 3

What are the components of energy requirements from highest to lowest?

Answer 3

BMR- 60% of BMR is due to the brain and then liver/heart/kidneys
Activity
Growth
Temperature control

Question 4

In what way are infant’s systems immature?

Answer 4

GI tract- gut mucosa is leaky with immature GI immune response.
Renal system- infant renal systems have poor ability to excrete a large solute load until about 3 months
Immune system- some passive immunity through placenta

Question 5

What protection is there from the leaky gut mucosa and immature GI immune response?

Answer 5

Breast milk bridges this immunological gap by coating the mucosa with a layer of anti-septic paint- secretory IgA which resists digestion. Women who have been immunised to certain diseases pass this during breast feeding

Question 6

What is the infant renal system vulnerable to throughout infancy?

Answer 6

Excess solute (protein and sodium) and is compounded by high risk of dehydration due to high % body water compared to adults (especially at risk during d and v)

Question 7

How does breast feeding affect risk of infection?

Answer 7

Increases it

Question 8

What is the hygiene hypothesis?

Answer 8

Too clean an environment suggests that immune system is less robust and therefore have higher risk of allergies

Question 9

In what ways are infants dependent on others?

Answer 9

For food supply:
To give them correct balance
Must be clean
Must have correct temperature and balance

Question 10

What are the advantages of breast milk?

Answer 10

Lower risk of infection
Lower risk of maternal breast cancer 
Possibly lower risk of IDDM and IBD
Reduction in obesity
Reduction in allergies
Neurodevelopmental advantage
Solute load- no tisk of inaccurate reconstitution as relatively low protein and sodium
High bioavailability of iron and folate
Easily digested
Promotes appropriate gut flora
Correct temperature

Question 11

What are the disadvantages of breast milk?

Answer 11

Transfer of HIV, CMV and hep

Transfer of chemical pollutants such as polychlorinated biphenyls and dioxins stored in fat and released in milk

Question 12

What are most infant formulas based on?

Answer 12

Cow’s milk with constituents like nucleotides, probiotics, long-chain polyunsaturated fats and beta-carotene

Question 13

What are the disadvantages of infant formulas?

Answer 13

Inappropriate solute loads as risk of inaccurate reconstitution of powdered formula

Question 14

What is the WHO aim for weaning?

Answer 14

Exclusive breast feeding to 6 months then solid food

Results in decreased mortality and morbidity from infections and will predominantly benefit developing countries

Question 15

What is the problem with weaning too early?

Answer 15

Increased risk of allergy and obesity- unconfirmed
If very early- renal compromise- confirmed
Increased risk of infection- ocnfirmed

Question 16

How many babies are breast fed up to 6 months in developed countries?

Answer 16

Very few

Question 17

What is the problem with weaning too late?

Answer 17

Growth faltering
Iron deficiency- breast milk iron is well absorbed but low. LBW babies have low iron stores at birth so they run out earlier

Question 18

What are the aims of infant nutrition?

Answer 18

Early- accept new tastes, textures and develop oromotor skills
Later- Increase nutrient density of food, if on breast milk ensure additional iron and vitamin D, refine oromotor skills