Infant Care - nutrition

Question 1

What does folic acid prevent

Answer 1

neural tube defects such as
spina bifida - spine or its covering stick out the back
anencephaly - absence of part of the brain
encephalocele - part of brain grows outside skull

Question 2

When does the neural tube form

Answer 2

forms in the few weeks of pregnancy, and closes by week 6

Question 3

When should folic acid be taken

Answer 3

initiated 3 months before pregnancy
• The multivitamin should be continued throughout pregnancy, and continued for 4-6 weeks after pregnancy or as long as breastfeeding

Question 4

How much folic acid to take if there is a low risk level of NTD (no personal/family history)

Answer 4

Multivitamin with 0.4-1mg folic acid

Question 5

How much folic acid to take if there is a moderate risk of NTD

Answer 5

Multivitamin with 1 mg folic acid until 12 weeks gestation, then multivitamin with 0.4- 1.0mg folic acid (12 weeks before and after)

Question 6

What results in moderate risk of NTD

Answer 6

• Personal history of folate sensitive anomalies
• Family history for NTD
• Diabetes, Type I or II (female partner)
• Teratogenic medications by folate inhibition (female partner; ex. anti-seizure medications)
• GI malabsorption that reduces RBC folate (female partner; ex. Crohn’s Disease)

Question 7

How much folic acid to take if there is a high risk of NTD (personal history or previous pregnancy)

Answer 7

Multivitamin with 1 mg folic acid plus 3x1.0 mg tabs (or multivitamin with 5 mg) pre-conception until 12 weeks gestation, then multivitamin with 0.4-1.0mg folic acid

Question 8

Why is iron needed during pregnancy

Answer 8

– Needed to support growth of baby

– Also needed due to extra blood volume

Question 9

What is the recommended amount of iron

Answer 9

27 mg daily (specifically during 2nd/3rd trimester) – Found in most prenatal vitamins
someone with anemia will need more

Question 10

How much weight should be gained during pregnancy (based on BMI)

Answer 10

Less than 18.5………………12.5 to 18 kg (28 to 40 lb)
Between 18.5 and 24.9…….11.5 to 16 kg (25 to 35 lb)
Between 25 and 29.9………….7 to 11.5 kg (15 to 25 lb)
More than 30…………………..5 to 9 kg (11 to 20 lb)

Question 11

Should weight be lost during pregnancy

Answer 11

No (can lose before pregnant)

Minimize weight gain in first trimester (particularly in women with obesity)

Question 12

How many calories should be eaten during pregnancy

Answer 12

Extra calories not needed in first trimester

• In second and third trimester –2-3 extra food servings (340-450 extra calories per day)

Question 13

How much caffeine can a pregnant woman have

Answer 13

Up to 300mg/day (about 2 cups of coffee, tea has 60mg)

– This amount does not increase miscarriage risk or likelihood of preterm birth

Question 14

How much fish can be eaten during pregnancy

Answer 14

– Avoid large fish due to mercury content (ex. shark, swordfish)
– Shrimp, canned light tuna, salmon, pollock, and catfish can be eaten in small amounts (~1-2x per week)

Question 15

What foods can lead to listeriosis (which causes miscarriage, stillbirth, premature birth)

Answer 15

– Avoid unpasteurized milk, soft cheeses (feta), raw/undercooked meat
– Heat prepared meats (ex. weiners, deli meats) until steaming

Question 16

how many calories to be eaten during breastfeeding

Answer 16

Extra 500 calories per day (around 2500 per day)

Question 17

how much water to drink while breastfeeding

Answer 17

– Minimum 8 glasses per day

– Drink a glass of water each time you breastfeed

Question 18

how much calcium to take when breastfeeding

Answer 18

~1000 mg/day (dietary and supplemental sources) - ex. 3 dairy servings

Question 19

How long to breastfeed and when to introduce foods?

Answer 19

– Exclusive breastfeeding for the first 6 months
– Breastfeeding can continue until child is 2 years old and beyond (as long as mother wants)
– Introduce other foods around 6 months

Question 20

what are the benefits of breastfeeding for baby

Answer 20

– Contains antibodies/immune factors to prevent illness (ex. otitis media, respiratory tract infections, asthma, etc)
– Easy for baby to digest – less constipation/diarrhea

Question 21

benefits of breastfeeding for mother

Answer 21

– Reduced postpartum bleeding
– Weight loss
– Reduced risk of breast and ovarian cancer
– Improved bone health

Question 22

What is colostrum

Answer 22

– First milk produced when baby is born
– Thick, yellowish
– Rich in proteins (including antibodies) and other nutrients
– Changes to breastmilk ~72 hours birth (breasts feel fill)

Question 23

what is the difference between foremilk and hindmilk

Answer 23

– Foremilk is released at the beginning of a feeding; watery, satisfies thirst
– Hindmilk is released as feeding continues; rich, fatty, satisfies hunger, provides calories

make sure breastfeeding lasts several minutes to get hindmilk

Question 24

How often to breastfeed

Answer 24

– Feed on demand whenever baby is hungry
– Usually every 2-3 hours at first, 8-12 times a day
– Feed more often during growth spurts

Question 25

How to determine if baby is drinking enough breastmilk

Answer 25

– 6 or more wet diapers per day
– Stools are soft, yellow, seedy
– Weight gain

Question 26

What are the types of infant formulas

Answer 26

• cow milk
• lactose free cow milk
• soy protein isolate
• hydrolyzed protein formulas
• amino acid

Question 27

What is cow-milk based formula

Answer 27

• most common
• example: Enfamil
  Variations:
  • Added DHA/arachidonic acid (omega 3/6 fatty acids) - for brain/eye development
  • Probiotics - to increase gut health, microbiome
  • Lower iron - not recommended; formula can cause constipation which is why some get lower iron

Question 28

What is lactose free cow milk based formulas

Answer 28

– Lactose is replaced with maltodextrin and sucrose (can still have trace lactose)
– Used for congenital lactase deficiency (rare)
– Parents often purchase this if they suspect gassiness/fussiness is due to lactose intolerance
• However lactose is important in mineral absorption and bacterial colonization, so a switch should not be made without careful consideration
– May be useful after a bout of diarrhea

Question 29

What is soy protein isolate-based formulas

Answer 29

– Free of cow milk protein and lactose (no trace lactose)
– Iron-fortified
– Recommended for galactosemia or congenital lactase deficiency
– Can also be used if vegetarian diet is desired
– Potential cross-reactivity with milk protein allergy, use with caution

Example: similac isomil

Question 30

What are hydrolyzed protein formulas

Answer 30

– Extensively hydrolyzed–proteins have been heat-treated and enzymatically hydrolyzed into peptide chains and free amino acids
• Ex. Nutramigen
• Used for infants with allergy to intact cow milk protein and soy protein
• Also may be beneficial in infants with malabsorptive disease
• Lactose free
• Expensive, less palatable

– Partially hydrolyzed formulas also available
• Less expensive, more palatable than extensively hydrolyzed formulas
• Marketed to relieve gas, fussiness
Ex. Enfamil Gentle ease

Question 31

What are amino acid-based formulas

Answer 31

– AKA “elemental” formulas
– Contain free amino acids (easy to digest)
– Used in infants with severe milk protein hypersensitivity
– Also used for infants with malabsorption-associated diseases who have persistent symptoms with a partially hydrolyzed formula
- more expensive, less palatable

Ex. Similac alimentum

Question 32

What are other types of formula

Answer 32

– Formulas for premature infants (more caloric dense)
– Pre-thickened formulas
• For treatment of regurgitation, vomiting
– Follow-up formulas for 6-24 months
• Contain more protein, minerals, vitamins
• Usually less expensive

Question 33

What are the forms of infant formula

Answer 33

• Powder
– Most common
– Least expensive

• Concentrated liquid
– Prepared by diluting with equal amount of water
– Intermediate cost

• Ready-to-use liquid
– Most expensive
– Does not require any preparation
– Can be purchased in ready-to-use bottles (great for traveling)

Question 34

When is iron supplementation needed in infants

Answer 34

• in low birthweight infants (born preterm, etc)
• stores of iron are depleted around 4-6 months in breastfed babies: introduce iron rich foods at 6 months
• if formula fed - use iron fortified
• iron deficiency can impact cognitive development

Question 35

When is vit D supplementation needed in infants

Answer 35

• breastfed babies: Usually 400 IU per day (vit D drops = 1 drop/day)
  – May need more in northern communities
• formula fed babies do not need supplementation (exception: northern communities)

Question 36

When is a baby ready for solid foods

Answer 36

around 6 months, follow cues:
- Baby seems hungrier than usual
- Can sit up without support, and has good control of neck muscles.
– Holds food in mouth without pushing it out on tongue right away.
– Shows interest in food when others are eating, and opens mouth when sees food coming
– Can let you know doesn’t want food by leaning back or turning head away.

Question 37

What are good first foods to give to baby

Answer 37

• source of iron
  – Most common: single-grain iron-fortified infant cereal (ex. rice, barley, oat or wheat cereal)
  – Alternatives:
  • Pureed meat, poultry, cooked egg yolk and well cooked legumes (beans, lentils, chick peas) are also good sources of iron

– Start with small amount (~1tsp), liquid consistency

Question 38

How often to introduce new foods

Answer 38

one at a time, 3-5 days apart to identify allergic reactions

Question 39

What foods are not recommended for baby

Answer 39

– Sugary drinks or foods, such as candies, soda/pop or energy drinks.
– Honey to babies under 1 year old, as there is a risk of infant botulism (food poisoning)

Question 40

When should allergens be introduced

Answer 40

• do not delay
• (ex. peanuts, eggs)
  – Delayed introduction increases allergy development