Infant & Child Nutrition Flashcards
Pre-Milk secretion in breast feeding moms
Yellowish alkaline secretion that is present for the first 2-3 days after delivery
what is this?
Colostrum
Colostrum has high levels of _____ and lower _____
High protein, vitamin A, immunoglobulin, sodium, chloride content
Lower carbs, potassium and fat content than mature breast milk
Breast-feeding , according to the WHO and AAP, should be the exclusive form of nutrition for approx _____, Wwth continued breastfeeding through ____ with appropriate complementary feeding
- the first 6 months of life (with complimentary feedings added at 6 mos)
- at least 1 year
Barriers/Issues that may impede breast feeding
- Lack of knowledge about breastfeeding.
- Misconception that formula is equivalent.
- Breastfeeding is not the 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.
- Low income hospitals are targets for budget cuts
Rates of breastfeeding mothers drop considerably at 6 mos d/t?
Working moms/ pumping/ storage
Perinatal hospital routines and early pediatric care have great influence on successful initiation of breastfeeding by:
- Promoting prenatal and postpartum education
- Frequent mother-baby contact
- Advice about technique
- Early follow up after delivery
This will increase maternal confidence - Other support from family members, adequate maternity leave, and advice about common problems (nipple soreness, mastitis) can foster success
- Baby is born with what reflex, which is stronger in some than others.
- Since this instinct is intense immediately after birth, introduce baby to breast within ____
- Result?
suckling reflex
first hour
- This will stimulate breasts to produce milk, beginning establishment of milk supply
- Signal uterus to contract and decrease chance of excessive bleeding after delivery
The first feeding will also help baby learn ____?
What can help encourage the baby?
to nurse
Placing baby skin to skin against mother’s chest will help encourage baby to smell the colostrum and want to latch and begin
Breast-fed babies will generally need to feed how many times per day on demand, or every ____ hours, with longer intervals (____) at night
8-12
2-3
(4 hours)
how many minutes on 1st, 2nd, and 3rd day for breastfeeding
- 1st day: 5 minutes per breast
- 2nd day: 10 min per breast
- 3rd day and beyond: 10-15 min per breast
- Eventually, the infant may only need approx 15 total
Growth velocity of breast-fed infants during the first ____ months equals and may exceed that of formula-fed infants
From ____ months breast-fed infants typically weigh less than formula-fed babies
3
6-12
A well nourished infant will void approx how many times per day
6-8
Stooling should occur from _____ times per day, with the stool being a ____ look
4-6
clay/semi-runny consistency, with a yellow, seedy
Monitoring parameters during breastfeeding
- Monitor growth, wt gain, voiding, and stooling patterns
- should double its weight by 5 mo and triple by a year
- Stooling should occur from 4-6 times per day, with the stool being a clay/semi-runny consistency, with a yellow, seedy look
- Will want to see ½ - 1 oz of wt gain per day
What is in breast milk
- low but highly bioavailable protein content, essential fatty acids; the presence of long-chain unsaturated fatty acids. 20 cal/ ounce
- low sodium and solute load but highly bioavailable concentrations of calcium, iron and zinc which provides adequate quantities of nutrients
- bacterial and viral antibodies (secretory IgA) and nonspecific immune factors
T/F: Breast milk does not need warmed, does not require clean water and is generally free of microorganisms
T
what nutritional factor does breask milk does NOT have?
vitamin D
- can supplement with drop at 1 mL (400 IU) qd while breast milk is main source of nutrition
- Can be given directly into cheek or taken off Mother’s breast
benefits of breastfeeding for the baby
- benefits both infant and mother
- Breast-fed infants experience same kinds of infections but generally exhibit milder sx
- Duration and severity of illness seem to be shortened as well - 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
- Rsp illnesses, including wheezing and lower respiratory tract disease are reduced in frequency/duration
- Protection vs Hemophilus, and S. pneumo
- Infants exclusively breastfed for at least 4 mo may experience half the number of cases of OM
- protect premature infant from necrotizing enterocolitis
- Breast-fed infants have reduced incidence of UTI’s
- Reduced severity if they contract infant-botulism
- reduced incidence of chronic childhood illnesses (Crohn’s, lymphoma, leukemia, type 1 DM, hypercholesterolemia, asthma)
- reduce incidence of food allergies and eczema
- lower chance of adolescent obesity
- Can increase long-term cognitive and motor abilities
- ( Higher IQ)
- Provides analgesia
- Can increase visual acuity
- Economically better $$$$$
Maternal Benefits of Breastfeeding
- Better bonding
- Breastfeeding in first hour postpartum increases uterine contractility d/t increased oxytocin
- reduces postpartum hemorrhage - Postpartum wt loss may be facilitated in women, esp in women who breastfeed exclusively for at-least 6 mos
- Can reduce stress hormone levels
- contraceptive effect if used exclusively for 4-6 mos
- decrease risk of breast cancer, ovarian cancer, DM II
How does breast feeding provide contraceptive effect if used exclusively for 4-6 mos
Due to suckling reflex, increases prolactin, which in return suppresses GnRH, which does not allow FSH/LH to be released, thereby amenorrhea or anovulatory menses
breastfeeding CI
- If mom has TB
- If mom is HIV +
- Chemotherapeutic agents
- Infants with galactosemia
T/F: Breast size is an indicator of breast-feeding success.
F
* Small breast size is not an indicator of lactation failure due to majority of breast mass is fatty tissue, not glandular tissue
* Thus, small breast size may have plenty of glandular tissue to have successful breastfeeding
* Small breast size, however, may limit the volume of milk that can be stored and may necessitate more frequent feeding to provide the infant with sufficient milk intake
Breastfeeding is OK, but proceed with caution:
- Breast surgery (lumpectomy, augmentation, or trauma)
- HSV-women with herpetic breast lesions should not breastfeed from that side and should cover the lesions to prevent infant contact
- Infants born to hepatitis B surface antigen + should receive immune globulin and vaccine, eliminating concerns of transmission through breastfeeding
- Women who abuse drugs should not breastfeed until drug free
- Alcohol achieves high concentrations in human milk, no large ingestions of alcohol
- Watch for certain medications (methotrexate, lithium)-most are compatible though
common troubles with breast feeding
- Nipple pain
- Breastfeeding jaundice
- Clogged ducts/mastitis
- Engorged breasts
- Working mothers/ pumping / etc.
This condition is exaggerated physiologic jaundice associated with inadequate intake of breast milk, infrequent stooling, and unsatisfactory weight gain (increase feedings and can augment with breast pump)
Technically due to borderline dehydration from low milk volume
what is it?
Management?
Breastfeeding jaundice
Order Total serum/direct Bilirubin, then increase volume of feedings
If breastfeeding is not feasible, then the infant will still thrive on ?
an artificially prepared formula
difference between commercially prepared formulas vs “humanized” formula?
- Commercially prepared formulas for typical infants are modifications of whole cow milk that approximate the composition of human milk
- “humanized” formula compares favorably with breast milk in their content of protein, carbohydrates, and sat/unsaturated fats
Prepared as ready to feed or easy to mix
Concentrate or powdered versions
Must mix with sterile water (not from the faucet for first 4 months)
Feedings are generally 6-8x per day or q3-4h, with longer intervals at night
Formulas
What’s in formula?
- Fat source-vegetable oil, soy, coconut, corn, oleo, and safflower oils
- Carbohydrates-lactose
- lactose free formulations available
- Fortified with - Caloric density of 20 Kcal/oz is similar to that of breast milk
healthy term infants with no CI to milk based formula
Most have lactose, some are low lactose (Sensitive)
what type of formula?
Milk based- Milk protein
this formula is indicated for galactosemia, milk allergy (MPA )-(however, 20% are also allergic to soy)—very constipating and not commonly used
Soy based- Soy protein / No lactose
which formula has predigested protein / no lactose
Indicated for MPA and colic
Hydrolyzed
milk protein allergy, bloody/mucousy stools, great for supplementation for breastfed babies (digested more like breast milk)
which type of formula?
Completely broken down (hydrolyzed)
the cows milk proteins have been extensively broken down so they are unlikely to cause an allergic reaction—sometimes referred to as predigested because the milk protein has already been broken down into smaller proteins
indications for specialty formula
- Premature or very slow weight gain-higher calorie formulas (22-24Kcal/oz)
- when still having issues on completely hydrolyzed formula, for severe milk protein allergy
- metabolic abnormalities or inborn errors of metabolism also.
Formula Feeding Advantages
- Able to cater to specific needs of the child, including iron intake, PKU, Galactosemia, milk protein allergy
- No vitamin or mineral supplementation needed (vitamin D)
- More comfortable feeding in public
- Can measure the volume - helps nervous moms
A child with a cow’s milk protein allergy would present how?
May present with vomiting, esophagitis, colitis with blood/mucus in stool, irritability, slow weight gain, diarrhea, rashes on skin
Associated with GERD signs and sx
tx for milk protein allergy
- Have mom decrease dairy intake (soy milk, coconut/almond milk),
- 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 is currently on milk based formula, can switch to completely hydrolyzed formula as well
s/s and tx for human milk allergy in breast fed infants
- Sx such as allergic colitis, gastritis, esophagitis to mom’s breast milk
- persuade mom to decrease her amount of cow’s milk (not all infants respond to this) or switching to hypoallergenic/completely hydrolyzed formula
For a working mother, breastfeeding requires a great deal of patience, development of time-saving routines, and cooperation at the workplace
What may help with this?
breast pumps
Breast milk can be in the fridge for how long?
Can it be microwaved?
- 4 days and frozen for 6 months
- It cannot be microwaved to warm it up. Bottle is placed in a cup of warm water to warm it up
The AAP and WHO recommend the introduction of solid foods in normal infants at what age?
~6 months of age
Gradual introduction of what variety of foods should complement the breast milk/formula?
- fortified cereal
- fruits
- vegetables
- Meats
- Homemade or store bought
Complementary Feeding-When is an infant Ready?
- Able to hold head up
- Can sit unassisted
- Showing interests in foods-watch you eat and open when you take a bite
- Ability to track spoon and open mouth
why is 6 months the ideal age for complementary feeding?
- Before 6 months: when a solid object (spoon) is introduced between the lips of a young baby, the baby purses the lips, raises the tongue, and pushes against the object vigorously
- By 6 months, the behavior changes so that when a spoon is inserted between the lips, they part, the tongue depresses, and food placed in the mouth is drawn to the back of the pharynx and swallowed
Delay of introducing complementary foods beyond 6 months is not recommended because of ?
increasing risk of micronutrient deficiencies
You can incorporate single ingredient complementary foods at what interval?
When can you incorporate food requiring some chewing?
one at a time at a 3-4 day interval
By 7-9 months: puffs, cheerios, later some table food
Remember choking hazard?!
At approximately 7-9 months, ____ begin, even in the absence of teeth, allowing food that requires some chewing to be introduced
rhythmic biting movements
This enables puffs, cheerios to be introduced at 7 months, with table food (bananas, pasta, baked chicken) to be introduced at 8-9 months
Do not give items that a child can easily choke on such as?
grapes, hot dogs
peanuts , boned chicken, hard candy . pieces of meat , fish with bones , sunflower seeds and apples . POPCORN !
Foods that can trigger an allergic reaction are:
- cows’ milk
- eggs (eggs without a red lion stamp should not be eaten raw or lightly cooked)
- foods that contain gluten, including wheat, barley and rye
- nuts and peanuts (serve them crushed or ground)
- seeds (serve them crushed or ground)
- soya
- shellfish (do not serve raw or lightly cooked)
- fish
how/when can you introduce foods with known risk for allergy?
- introduced from around 6 months as part of your baby’s diet, just like any other foods.
- Once introduced and tolerated, these should become part of usual diet to minimise the risk of allergy.
Lots of children outgrow their allergies to ____ or ____, but a ____ allergy is generally lifelong.
milk or eggs
peanut
What is weaning?
How to do it?
How long?
- The age at which an infant is weaned from the breast should be based on a mutual decision between mom and baby.
- Generally occurs around the age of 1
- Process should be gradual
- Begin with substituting one breast-feeding with a bottle or cup feeding
- Once the bottle or cup is accepted, other breast-feedings are similarly eliminated
- Replaced gradually over a period of 1-4 weeks
During weaning, what happens to the mother’s milk supply?
- will diminish
- Due to the stimulus of regular emptying of the breast is removed
- If demand is low, supply shrinks
Whole milk is introduced at what age, when weaning off formula/breast milk?
why?
1 year
NOT introduced < 1 year to avoid anemia, specifically iron deficiency (low iron content of cow’s milk, inhibits absorption of iron d/t calcium and casein, both high amounts in cow’s milk)
AAP recommends a child stay on whole milk until what age unless there is a reason to switch?
why?
2 years of age
Medical condition, family history of obesity, heart disease, or hyperlipidemia
how is whole milk important to the growth and development until the age of 2?
- During this time, baby’s brain and nervous system make amazing gains in size and complexity
- Because brain and nervous tissue are composed mostly of fat, it is reasonable to think whole milk greatly contributes to this
why do you not give skim milk to children until age 2
skim milk provides too few calories, excessive protein, and inadequate amount of essential fatty acids
At age 2, a transition to 2%, 1%, or skim milk should be undertaken
Sharp drop in appetite after ? birthday
Growth slows, and doesn’t require as much food
Will turn head, spit food out, throw fits
1st
how to making feeding a 1 y/o easier?
- They will eat when they are hungry, don’t force it! - The harder you push, the less likely to get compliance
- Offer a larger selection of nutritious items, and let them decide/choose
- Vary consistencies, tastes, and textures
- Don’t let them fill up on sweets
meal regimen/nutrition recommendations for toddlers 2 years and up
- 3 regular meals/day, and 1-2 healthful snacks according to appetite, activity and growth needs
- Inclusion of a variety of foods: nutritionally complete and promote optimal growth and activity
- High-fiber diet recommended
- Limit grazing behavior, eating while watching TV, and consumption of soft drinks and other sweetened beverages
- Limit sodium intake
- Eat lean cuts of meats, poultry, and fish
- Skim/low fat milk (< or = to 24oz), whole-grain breads and cereals with plentiful amounts of fruits and vegetables
- Limit juice to 4-6oz per day for toddlers and young children; 7-18y/o - 8-12oz - OR NONE AT ALL
How many Kcal per day as an infant vs by 1 year
-
120kcal/kg/days as an infant , down to 90kcal/kg/day by 1 year
- +1 yr: +100kcal/y to base of 1000 cal/day
- By end of adolescence: daily energy requirement is about 40 kcal/kg/d - Appetite and growth are reliable indices of caloric needs in most healthy children
What is WIC?
- Special supplemental nutrition program
- Provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breast-feeding, or non-breastfeeding postpartum women, and to infants and toddlers up to age 5 who are found to be at a nutritional risk
- Effective in improving health of pregnant women, new mothers, and their infants
unexplained paroxysms of irritability, fussing, or crying which may develop into agonized screaming. The infant may draw up his/her knees against his/her tense abdomen as if there were abdominal pain
colic
Presentation of Colic
- baby is an otherwise healthy infant
- cry for >3hrs a day, for >3days a week, for >3 weeks
- severe and paroxysmal crying that occurs mainly late afternoon-evening
- Peaks at 2-3 months, generally ending around 4m
effect of colic on parents?
- Frustrating for parents
- Babies may seem inconsolable
- May continue to cry despite interventions such as feeding, diaper changes, and soothing techniques - Can lead to feelings of inadequacy and anxiety
- Exact cause remains elusive (theories include food allergies, GERD, temperament, parental stress)
H&P of colic (what is the most important diagnostic tool)
- Complete history is most important diagnostic tool
- As providers, we must understand when symptoms began, how often, part of day, how long
- What have parents used to soothe baby, what helps
- ROS should be tailored to rule out organic illnesses
- Review feeding techniques
- PE works to r/o pathological abnormalities
- Lab testing seldom indicted
tx for colic
- Parent education and reassurance #1, point to PE
- Assure them that their baby is healthy
- Assure them that crying can increase and will likely abate by 3rd-4th month
- Assure them they are 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 members: take a break
- Possible switch of formula
- Possible tx of GERD
