Infant Feeding

Question 1

What leads growth at each stage?

Answer 1

Infants = Nutrition
Children = GH
Pubertal = Sex Steroids

Question 2

How much weight should a child gain each week in the 1st yr?

Answer 2

up to 3 month = 200g/week
3-6months = 150g/wk
6-9months = 100g/wk
9-12months = 50-75g/wk

Doubles in 6 months, triples in 1yr and gains 2kg/yr till puberty

Question 3

How much calories and protein do infants need?

Answer 3

100Kcal & 2g protein /kg/day

Vs only 35Kcl & 1g Protein in adults

Question 4

What are the advantages of breast milk?

Answer 4

• Less allergenic
• Low renal solute load
• Perfect nutrition
• Improves cognitive development
• Reduces infection
• Promotes active immunity
• Promotes development of gut microbiota
• Suckling promotes bonding

Question 5

Pros and cons of formula?

Answer 5

• Doesn’t need mum
• Accurate feed volumes
• Provides Vit K
• No jaundice
• No risk of BBV or drug transmission

No anti-infection
Contamination
Expensive
High antigen load

Question 6

What are the 10 steps of the UNICEF “baby friendly” policy?

Answer 6

1) Written breast feeding policy
2) Trainn all staff to implement it
3) Inform pregnant women on benefits of breastfeeding
4) Help mums start breastfeeding within 1/2hr of birth
5) Show mum how to breastfeed and maintain lactation
6) Give infant no food/drink other than breastmilk
7) Practice Rooming-in
8) Encourage breast feeding on-demand
9) Give no teats or dummies
10) Foster breast-feeding support groups and refer new mums

Question 7

What would a kid with a Cow’s Milk Protein Allergy (CMPA) look like?

Answer 7

• Vomiting
• Diarrhoea
• Abdo pain/distension
• Eczema

Its a delayed hypersensitivity reaction (So non-IgE)

Question 8

How do you identify a CMPA?

Answer 8

4wk trial exclusion by either using a special formula or a milk-free diet for mum
Then re-introduce at 4wks to be sure

Question 9

How long does it take kids to outgrow a CMPA?

Answer 9

~6months
So re-challenge after 6 months

Can promote earlier tolerance by building up the “milk ladder” (As not all forms of milk are equally allergenic), starting with cookings

Question 10

What formula would you give a child with CMPA?

Answer 10

Extensively Hydrolysed Protein Feeds e.g. Nutramigen LGG Lipil 1 or 2

If that fails use an Amino Acid Based Feed

Question 11

What is Lactose Intolerance?

Answer 11

A deficiency in lactase, not an allergy.

It’s usually transient following gastro-enteritis and will self-resolve

Question 12

We don’t like to use soya milks (esp in <6months) because of high Phytoestrogens, also they are cross-reactive with cow’s milk.
When would we use a Soya Milk formula?

Answer 12

• Milk allergy & Hydrolysed formulae are refused
• Vegan
• Still avoiding cow’s milk >1yr

Question 13

What kind of feed would we give to a child who’s suffered from some illness e.g. cardiac baby and needs to catch up?

Answer 13

Nutrient Dense Formula

E.g. SMA high energy

Question 14

What kind of feed do we give pre-term babies?

Answer 14

Pre-term Formulae!

They have higher protein and cal

E.g. SMA Gold Prem

Question 15

At what age can Cow’s milk replace formulae as the child’s main drink?

Answer 15

Atleast 1 yr old.
If it’s earlier they won’t be getting nutrients from other foods and cow’s milk contains no iron so they get SUPER anaemic

Question 16

When would we give an infant calcium supplements?

Answer 16

If they are taking <500ml of formula

As they require ~500ml of Ca Fortified “Milk” to meet Ca requirments

Question 17

When do you start weaning?

Answer 17

~6months

Start with smooth purees –> lumps & finger foods
Cup from 7 months

Question 18

What kids should receive a Vit D supplement?

Answer 18

Breast-fed >1month old
Bottle Fed taking <500ml
All kids 1-4yrs old