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Pediatrics > Infant and Child Nutrition > Flashcards

Infant and Child Nutrition Flashcards

1
Q

Pre-milk secretion in breast feeding moms present for 2-3 days after delivery

A

Colostrum

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2
Q

What is the color and content of colostrum

A

Color: yellow
Content: high protein
vitamin A
immunoglobulin
sodium, chloride
lower carbs, potassium, and fat than mature breast milk
normal laxative action and ideal starter food

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3
Q

What are recommendations for the duration of breast feeding according to the WHO and AAP?

A

Exclusive form of nutrition for the first 6 months of life (with complimentary feedings added at 6 months)
Continued breastfeeding through at least 1 year with appropriate complementary feeding

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4
Q

What might prevent breast feeding?(what we can do)

A
  • Lack of funding for first-time mother classes
  • Hand out formula instead of training staff
  • Once moms leave, may have poor support
  • Rates of breastfeeding drop considerately at 6 months due to working moms, pumping, storage
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5
Q

Barriers to breast feeding

A
  • Lack of knowledge about breastfeeding
  • Misconception that formula is equivalent
  • Breastfeeding is not social norm in many communities
  • Poor family and social support
  • Embarrassment about feeding in public
  • Lactation problems
  • Returning to work and accessing supportive childcare
  • Policies and practices by some health services and health care providers
  • Promotion and marketing of infant formula
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6
Q

How can health care providers support breastfeeding?

A
  • Promote prenatal and postpartum education
  • Frequent mother-baby contact
  • Advice about technique
  • Early follow up after delivery

This increases maternal confidence
Support from other family members, adequate maternity leave, and advice about common problems can foster success

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7
Q

What happens during the first feed?

A
  • Suckling reflex is intense immediately after birth
  • Baby introduced to breast which stimulates breasts to produce milk and establish supply
  • Signals uterus to contract and decrease chance of excessive bleeding after delivery
  • Placing baby skin to skin helps encourage baby to smell colostrum and want to latch and begin
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8
Q

How often do babies need to be fed going forward?

A
  • 8-12 times per day on demand, or every 2-3 hours, with longer intervals (4 hours) at night)
  • 1st day: 5 minutes per breast
  • 2nd day: 10 mins per breast
  • 3rd day and beyond: 10-15 mins per breast
  • Eventually infant may only need approx 15 total
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9
Q

How does growth velocity of breast-fed infants compare to formula babies

A
  • First 3 months equal to formula-fed infants
  • 6-12 months typically weigh less than formula-fed babies
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10
Q

What should be monitored with breast feeding?

A
  • Growth
  • Weight gain
  • Voiding
  • Stooling patterns
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11
Q

What are normal stools?

A
  • Void approx 6-8 times per day
  • Stooling should occur 4-6 times per day
  • Clay/semi-runny consistency, with a yellow seedy look
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12
Q

How much weight gain should be seen?

A

1/2 oz to 1 oz per day

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13
Q

What can be done if having difficulty breast feeding?

A
  • Lactation consultant
  • Supplement with formula or expressed breat milk if slow weight gain, generally 1-2 oz after session of breastfeeding
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14
Q

How should weight change between birth and 5 months and a year

A

Should double by 5 months and triple by a year

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15
Q

What does breast milk contain?

A
  • Low but highly bioavailable protein
  • High essential fatty acids
  • Unsaturated fatty acids
  • 20 cal/ounce
  • Low sodium and solute load but bioavailable Ca, iron, Zinc
  • Generally free of microorganisms (exception HIV)
  • Bacterial and viral antibodies
  • Immune factors, macrophages and nucleotides
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16
Q

What does breast milk not contain and how do you supplement it?

A
  • Vitamin D
  • Supplement with drop at 1 mL 1qd while breast milk source of nutrition
  • Can be given into cheek or off mother’s breast
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17
Q

Benefits of breastfeeding for baby

A
  • Milder symptoms, shorter duration and severity of infections
  • Limits exposure to environmental pathogens introduced through contaminated foods, fluids, or feeding devices
  • GI infection prevented and attenuated with effects against rotavirus, giardia,, shigella, and E. coli
  • Respiratory illnesses, including wheezing and lower respiratory tract disease reduced in frequency and duration
  • Protection against Hemophilus and S. pneumonia
  • Exclusively breast fed for 4 months, half number of cases of OM
  • Protect form necrotizing enterocolitis
  • Reduce UTIs
  • Reduce severity of botulism
  • Possible reduce chronic childhood illnesses like Crohn’s, lymphoma, leukemia, T1DM, hypercholesterolemia, asthma
  • Reduce food allergies and eczema
  • Reduce adolescent obesity
  • Increase cognitive and motor abilities
  • Provide analgesia
  • Increase visual acuity
  • Economically better
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18
Q

Maternal benefits of breastfeeding?

A
  • Maternal- infant bonding
  • Increases uterine contractility due to increase in oxytocin in first hour and reduces postpartum hemorrhage
  • Postpartum weight loss, especially if exclusivey breastfeeding for at least 6 months
  • Reduce stress hormone levels
  • Provides contraceptive effect if used exclusively for 4-6 months due to suckling reflex –> increases prolactin, suppresses GnRH, which does not allow FSH/LH to be released
  • Decrease risk of breast cancer, ovarian cancer, diabetes II
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19
Q

Is breast size related to breast feeding succes?

A

No.
Small breast size may limit volume of milk stored and necessitate more frequent feeding to provide sufficient milk

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20
Q

Contraindications to breast feeding

A
  • Mom has TB
  • Mom has HIV
  • Chemotherapy
  • Infants with galactosemia
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21
Q

Proceed with caution when breast feeding

A
  • Breast surgery
  • HSV - women with herpetic breast lesions should not breast feed from that side and cover lesions to prevent infant contact
  • HbSag: should receive immune globulin and vaccine to elimate breastfeeding concerns
  • Women who abuse drugs should not breastfeed until drug free
  • No large ingestion of alcohl
  • Watch for certain medications (methotrexate, lithium)
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22
Q

What are common troubles with breastfeeding?

A
  • Nipple pain
  • Breastfeeding jaundice
  • Dehydration from low milk volume
  • Clogged ducts/mastitis
  • Engorged breasts
  • Working mothers/pumping/etc
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23
Q

What is breastfeeding jaundice?

A
  • Exaggerated physiologic jaundice associated with inadequate intake of breast milk, infrequent stooling, and unsatisfactory weight gain
  • Increase feeding and can augment with breast pump
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24
Q

If dehydration from low milk volume, what can be done?

A
  • Order total serum/direct bilirubin
  • Then increase volume of feedings
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25
Q

What are variations on formulas?

A
  • Ready to feed or easy to mix
  • Concentrate or powdered
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26
Q

How is formula prepared? How often does it need to be administered?

A
  • Mix with sterile water
  • Feedings 6-8 times per day or every 3-4 hours with longer intervals at night
27
Q

What is in formula?

A
  • Fat source- vegetable oil, soy, coconut, corn, oleo, safflower oils
  • Carbohydrates - lactose (lactose free formulations exist)
  • Caloric density of 20 kcal/oz
28
Q

Types of formula

A
  • Milk based
  • Soy based
  • Hydrolyzed
29
Q

Which infants receive milk based formula?

A
  • Healthy term infants
  • No CI to milk formula
  • Most have lactose
30
Q

Which babies should receive soy based formula?

A
  • Galactosemia
  • Milk allergy
  • Soy consipating and not commonly used
31
Q

Which babies should receive hydrolyzed formula?

A
  • Milk protein allergy
  • Blood/mucousy stools
  • Great for supplementation for breastfed babies (digested more like breast milk)
  • Cows milk proteins broken down unlikely to cause allergic reaction
32
Q

What are indications for specialty formulas?

A
  • Premature or very slow weight gain-higher calorie formulas
  • Specialized - generally used when still having issues on completely hydrolyzed formula for severe milk protein allergy
  • Special formulas for metabolic abnormalities or inborn errors of metabolism also
33
Q

Facts about formula

A
  • Tend to gain more weight than breast babies and grow more rapidly around 3-4 months
  • Possibly because of excess water retention
  • At greater risk of obesity later in childhood, possibly due to differences in feeding practices and metabolic effects of human milk
34
Q

Formula feeding advantagea?

A
  • ABle to cater to specific needs of child, including iron intake, PKU, galactosemia, milk protein allergy
  • No vitamin or mineral supplementation needed
  • More comfortable feeding in public
  • Can measure the volume - helps nervous moms
35
Q

How does cow’s milk protein allergy present?

A
  • Breast fed child may be allergic or sensitive to cow milk
  • Vomiting, esophagitis, colitis with blood/mucus in stool
  • Irritability
  • Slow weight gain
  • Diarrhea
  • Rashes
  • Associated with GERD signs and symptoms
36
Q

Treatment of milk protein allergy

A
  • Have mom decrease dairy intake as well as egg intake (cross reactive)
  • If no improvement and infant has slow weight gain and is symptomatic, switch to completely hydrolyzed formula
  • If infant on milk based formula, can switch to hydrolyzed
37
Q

Presentation of human milk allergy

A
  • Breast fed infant
  • Allergic colitis
  • Gastritis
  • Esophagitis
38
Q

Treatment of milk protein allergy

A
  • Decrease amount of cow’s milk or switch to hypoallergenic/completely hydrolyzed formula
39
Q

How can breast milk be stored?

A
  • Fridge for 4 days
  • Frozen for 6 months
  • Cannot be microwaved to warm up, place in cup of warm water
40
Q

What is complementary feeding?

A
  • Introduction of solid foods in normal infants at about 6 months of age
  • Introduction of variety of foods that should complement milk: fortified cereal, fruits, vegetables, eventually meats
41
Q

When is a baby ready for complementary feeding?

A
  • Able to hold head up
  • Can sit unassisted
  • Showing interest in foods - watch you eat and open when you take a bite
  • Ability to track spoon and open mouth
42
Q

Why 6 months complimentary feeding?

A
  • Before 6 monhts, solid object between lips is pushed out by tongue
  • At 6 months, spoon inserted between lips, part lips, tongue depresses and food drawn to back of pharynx
43
Q

Delay of introducing complementary food beyond 6 months is —- recommended because —–

A

not
increasing risk of micronutrient deficiencies

44
Q

How is complementary food introduced?

A

Single ingredient complementary food one at a time over 3-4 day interval chewing
By 7-9 months, foods requiring some chewing may be introduced

45
Q

How is complementary feeding accomplished between 7 and 9 months?

A
  • Rhythmic biting movements begin
  • Food that requires chewing an be introduced
  • Can given puffs, cheerios at 7 months with table food (bananas, pasta baked chicken) to be introduced at 8-9 months
  • Do not give items that child can easily choke on ie grapes, hot dogs
46
Q

What is the leading cause of injuries among young childrena nd infants?

A

Choking

One child in US dies from choking every 5 days and 75% occur under 3
Do not give hot dogs, peanuts, boned chicken, hard candy, pieces of meat, fish with bones, sunflower seeds and apples, popcorn

47
Q

foods that can trigger an allergic reaction

A
  • cows milk
  • eggs (eggs without red lion stamps should not be eaten raw or lightly cooked)
  • foods that contain gluten, including wheat, barley, and rye
  • nuts and peanuts (serve crushed or ground)
  • seeds (serve crushed or ground)
  • soya
  • shellfish (do not serve raw or lightly cooked)
  • fish
48
Q

How do you minimize the risk of allergy?

A
  • Introduce around 6 months as part of baby’s diet just like any other foods
  • Once introduced and if tolerated foods can become part of baby’s usual diet to minimize risk of allergy
  • Introduction of peanut and hen’s eggs beyond 6-12 months may increase risk of developing allergy to these foods
  • Lots of children outgrow allergies to milk or eggs, but peanut is generally lifelong
49
Q

What do breastfed babies need supplemented?

A

iron, cannot eat red meat and green veggies

50
Q

How does weaning occur?

A
  • Around age of 1
  • Gradual
  • Substitute one breast feeding with a bottle or cup feeding
  • Usually at midday meal
  • Once accepted, other breast-feedings eliminated
  • Replaced gradually over period of 1-4 weeks
  • Mother’s milk supply diminishes due to regular emptying of breast removed
  • If demand low, supply shrinks
51
Q

When is whole milk introduced?

A

1 year of age, when weaning off formula/breast milk
* Not introduced before 1 year of age to avoid anemia, specifically iron deficiency

52
Q

How long should a child stay on whole milk unless reason to switch? What are reasons to switch?

A
  • 2 years of age
  • Medical condition, family history of obesity, heart diseae, hyperlipidemia
53
Q

Why is whole milk until 2 important?

A
  • Brain and nervous system make gains in size and complexity
  • Brain and nervous tissue componsed mostly of fat
54
Q

At age 2, what should whole milk be transitioned to?

A
  • 2%, 1%, or skim milk
  • Do not give skim milk under 2
55
Q

What happens after 1st birthday?

A
  • Sharp drop in appetite
  • Growth slows and don’t require as much food
  • Turn head, spit food out, throw fits
  • Needs vary on growth, physical activity, and metabolism
  • They will eat when hungry, don’t force! Offer large selection of nutritious items and let decide/choose
  • Vary consistencies, tastes, textures
56
Q

What happens after 2 to diet recommendations?

A
  • Consumption of 3 regular meals per day
  • One to 2 healthful snacks according to appetite, activity, and growth needs
  • Inclusion of variety of foods
  • High-fiber diet recommended
  • Limitation of grazing, eating while watching TV, consumption of soft drinks and other sweetened beverages
  • Limitation of sodium by limiting processed foods and added salt
  • Consumption of lean meats, poultry, and fish encouraged
  • Skim/low fat milk, whole-grain breads, cereals with plentiful fruits and vegetables
  • Limit juice to 4-6 oz per day for toddler’s and young children; 7-18 years of age, limit 8-12 oz or none at all - no benefit unless for consipation relief
57
Q

How many kcal per day should be consumed?

A
  • 120 kcal/kg/day as infant
  • 90 kcal/kg/day by 1 year
  • 1 year up 100 kcal + 1000 calories a day
  • End of adolescence: 40 kcal/kg/day
  • Appetite and growth are reliable indices of caloric needs in most healthy children
58
Q

What is Women Infant Children?

A
  • Special supplemental nutritiion program
  • Provides federal grants to states for supplemental foods, health care referrals, nutrition education for low-income pregnant, breast-feeding, or non-breastfeeding postpartum women and infants and toddlers up to age 5 at nutritional risk
  • Effective in improving health of pregnant women, new mothers, and infants
  • Linked to lower Medicaid costs for women, babies, longer gestational periods, higher birth weights, and lower infant mortality rates
59
Q

Unexplained paroxysms of irritability, fussing, or crying which may develop into agonized screaming. Infant draws up knees against his/her tense abdomen as if abdominal pain

A

Colic

60
Q

What is a key component of colic?

A
  • Otherwise healthy infant
  • Cry for >3 hrs a day, for >3 days a week,, for > 3 weeks
61
Q

What are characteristics of colic?

A
  • Severe and paroxysmal crying that occurs mainly late afternoon-evening
  • Peaks at 2-3 months, generally ending around 4 months
  • Very common (20%)
  • Babies may seem inconsolable
  • May continue to cry despite feeding, diaper changes, sooting techniques
  • Can lead to feelings of inadequacy and anxiety
  • Exact cause elusive
62
Q

Components of colic history and physical exam?

A
  • Complete history
  • ROS to rule out organic illnesses
  • Review feeding techniques
  • Physical exam to rule out pathological abnormalities: complete physical most often normal
  • Lab testing seldom indicated
63
Q

Treatment for colic

A
  • Parent education and reassurance, point to PE for reassurance, tell crying can increase and will likely abate by 3-4 month, assure not to blame
  • Make sure baby is not hungry, soiled, or tired
  • Swaddle, gentle motions, pacifier
  • Can sometimes let infant cry for a short period
  • ENLIST HELP of family: take a break
  • Possible switch of formula
  • Possible treatment of GERD

Pediatrics (12 decks)

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