Infant Care: Infant Formula (1.5) Flashcards
Infant formula is the only suitable, safe alternative to breast feeding to meet the nutritional feeds of an infant.
Explain why it is not as desirable as breast milk, give 5 reasons
- Provides no protection against disease or infection
- High standard of hygiene required
- Costly
- Requires a level of literacy and comprehension
- Risks of over or under concentration
What aspects of infant formula cant be replicated? (3 marks)
- Breast milk changes within a feed, during a 24 hour period and with the age of the baby
- Human milk contains antibodies (secretory IgA, IgG and IgM), live cells (macrophages lymphocytes, neutophils and epithelial cells)
- Human milk contains human protein
What are some of the differences in the ingredients of infant formula to breastmilk?
- proteins: whey or casein dominant
- CHO source: lactose or lactose free (CHO source= corn syrup solids usually)
- Additives: LCPFUAs or LCPs (AA, DHA), Nucleotides, thickeners
A) For cow’s milk based infant formula and breast milk, explain what whey and casein is
B) What are the two types of cows milk based formula
A)
- Formula and breast milk contain protein in the form of whey (W) and casein (C)
- In breast milk, W:C changes from 90:10 in lactation stages to 50:50 > 8 months
- in formula = modified cows milk = casein dominant
B)
- Starter: Whey dominant W:C 60:40: suitable from birth to 12 months
- Follow on: Casein dominant (increased protein and increased iron): follow-on formula from 6 months onwards
What are some differences between human breast milk and cows milk?
- Cows milk is a static fluid that has a W:C ratio of 20:80 (casein dominant)
- Human breast milk is a dynamic fluid that is usually whey dominant but becomes less so throughout feed
- Whey is an easier form to digest protein
- Human breast milk has less g of protein per 100 mL which decreases risk of overweight/obesity
- Cows milk has a higher g of protein per 100 mL which is associated with higher weight gain
What is Hypo-Antigenic (HA) infant formula?
- 100% Whey proteins partially hydrolysed: postulated to prevent allergies in high risk infants <6 months of age
- Must be introduced as first formula
- Does not replace benefits of breast feeding
Describe some of the properties of specialised formulas for cow’s milk protein allergy
- Decreased protein size
- Deccreased allergincity (decreased palatability, increased cost)
Describe lactose free(LF) infant formula (CHO)
- Cows milk based and lactose free used in lactose intolerance (LI)
- Primary LI: rare genetic condition: fail to thrive from birth
- Seodnary LI: temproary and caused by gu lining damage
- Symptoms of LI: wind, abodminal pain, diarrhoea with frequent explosive watery stools
Temp change to LF formula for 2-4 weeks could be suggested
What are some additives in infant formula?
- Nucleotides
- Prebiotics
- Probitoics
- Carotenoids
- LCPUFA (long chain polyunstaturated fatty acids) –> E.g. AA and DHA
What is the role of LCPUFA in an infant? Does breast milk contain this?
- Develops infant’s visual and CNS
- Breast milk does contain LCPUFA in the form of DHA, AA and also fatty acid precursors (ALA and LA)
- Standard formula contains ALA (precursor to DHA) and LA (precursor to AA)
- Formula-fed babies require pre-formed DHA and AA to equal accumulation rates of breast fed infants
- Formula fed newborns upto 3 months have limited capacities to synthesise sufficient LCPUFA from precursor FAs
- AA and DHA added to ‘gold infant formula’
Should the amount of formula increase as a baby grows?
No, the volume of formula should increase not the strength
FORMULA IS DESIGNED TO REMAIN AT A CONSTANT STRENGTH
What to do if baby is experiencing reflux
- Use breast milk
- Thickened formulas, baby may vomit less
- Help by upright posture after feeds, sloping cot
What are some preparation risks when it comes to preparing infant formula?
- Wrong concentration prepared
- Poor hygiene when preparing formula (increasing infection risk)
- Baby prone to illness
- Water has to be FBC
- Dont interchange between formulas (creates confusion)
What are some guidlines that pharmacists have to know/adhere to?
- Promote breastfeeding to around 6 months of age, explain thats all that infants need for the first 6 months
- Continue breastfeeding with appropriate complementary foods until 12 months of age and beyond
- Advise on risks of not breastfeeding when parents considering a change
- Cow milk based formula is safe for 0-12 months
- Advise parents to select formulas according to individual health needs, cost comparison bettween the brands and availability for the formula
- FBC water may be used >6months if additional fluids are required
- Use of follow on formulas not necessary
- Use formula with lower protein value
- Dont interchange frequently, creates confusion with dosing
What are some of the things that pharmacists have to advise a patient on when a infant formula is being initiated
- Explore the reasons for formula feeding
- Provide accurate and relevant information
- Ensure promotion of best practice: disseminate fact not marketing
- Minimise the risks associated with formula feeding
- Avoid inducing guilt in the mother
