Infant feeding Flashcards
Infant calorie requirement [1]
Rate of weight gain in infant at 6m and 1y [3]
Infants 100kcal and 2g protein/kg/day
Double weight by 6 months
Triple by 1 year
2kg and 5cm per year thereafter
How long to exclusively breastfeed according to WHO recommendation
4-6 months of exclusive breastfeeding
Types of specialized formula [4]
For cows milk protein allergy
Nutrient dense
Disease specific
Preterm formulae
Guidelines on: Soy milk problems [2] but indicated in [3]
Phytoestrogens
Cross reactivity with cows milk
But indicated in
- Milk allergy when hydrolysed formula refused
- Vegan families if not breast feed
- Consider for children >1y still on milk free diet
Guidelines on
Rice milk [2] Goat and sheep milk [2] Organic versions of milks [1]
Rice milks - high concentration of arsenic so not advised for children under 5yo
Goats and sheeps milk - not suitable for <1yo as many children will react
Organic versions not calcium fortified
Why is breast the best? [7]
Suckling/bonding
Well tolerated, less allergenic minimal antigen load
Tailor made passive immunity
Reduces infection - macropahges, lymphocytes, interferon, lactoferrin, lysosyme
- Increased development of infant’s active immunity
- Increased development of infant’s gut mucosa
Ca PO4 - for bone development, low renal solute load
Improve cognitive development
Decreased risk of breast cancer and cheap
What are some cons of breastfeeding? [4]
Contraindicated in HIV
Can cause reactions in cows milk allergies
Risk of transmission of BBVs/drugs
Preterm - insufficient protein - need to play catch up
Formula feed pros [4]
Formula feed cons [4]
Pros
- Doesn’t need mum
- Accurate feed volumes
- Less incidence of breastmilk jaundice
- Provides vitamin K
Cons
- Risk of contamination - not sterile
- No anti-infection properties
- High antigen load
- $$$
UNICEF Baby friendly programme
- Policy
- Train staff
- Inform mothers benefits
- Help to initiate within 30 min of birth
- Train mothers
- Exclusive breastfeeding
- Rooming-in
- On demand
- No teats/dummies
- Support groups
UNICEF Baby friendly 10 steps [full]
- Have a written breast-feeding policy- routinely communicated to all staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about the benefits/management of breastfeeding.
- Help mothers initiate breastfeeding within a half-hour of birth.
- Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
- Give newborn infants no food and drink other than breast milk, unless medically indicated.
- Practise rooming-in - allow mothers+ infants to remain together - 24h/day
- Encourage breast-feeding on demand.
- Give no teats or dummies to breastfeeding infants.
- Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.
Cows milk allergy ddx between lactose intolerance
CMPA - allergy to milk protein
Lactose intolerance - caused by reduced levels of lactase
Management of CMPA - the CMPA pathway [5]
4 week trial of milk avoidance
Give special formula or milk-free diet for breast feeding mums
Reintroduce at 4 weeks unless clear benefit to avoidance
Re-challenge after 6m of improvement as usually outgrow
Milk ladder approach
Specialised feeds for CMPA
First line
What is it? [1]
Problem in older babies? [1]
Give 2 egs
First line feed choice
Extensively hydrolysed protein feeds
Palatability a problem in older babies
Nutramigen, aptamil
Specialised CMPA feeds
Second line is costly to NHS and is over-prescribed
What is it made out of?
Indicated in [3]
Amino acid based feeds, synthetic
Indicated in more severe IgE mediated CMP eg severe colitis, enteropathy
Failure to thrive
Significantly low rate of weight gain where the trajectory of growth is crossing centiles
