Infant Feeding Flashcards
What are the recognised phases of childhood?
- Neonate (<4w)
- Infant (<12m/1y)
- Toddler (~1-2y)
- Pre-school (~2-5y)
- School age
- Teenager/ Adolescent
What drives infant growth?
Nutrition
What drives child growth?
Growth hormone
What drives pubertal growth?
Sex steroids
Why is nutrition important?
- Fundamental aspect of life
- Required for changes in body structure, composition and function
- Prevention of malnutrition
- Disease prevention
- Treatment in metabolic disease and allergy
What is birth size and weight dependent on?
- Maternal size
- Placental function
- Gestation
What is the average weigth of a term infant?
3.3kg
What is energy needed for?
- Physical activity
- Thermogenesis
- Tissue maintenance
- Growth
What is the growth demands of infants?
About 35% of energy intakee
Why can infants rapidly become malnourished?
-Dependent on carer
-High demands for growth and maintenance
Low protein and fat stores
-Frequent illness
What is the average weekly weight gain of infants?
- 0-3months 200g
- 3-6 months 150g
- 6-9 months 100g
- 9-12 months 75-50g
What are the benefits of breast feeding?
- Nutritionally best for full term babies (low renal solute load, contains Ca PO4, LCP FAs)
- Improves cognitive development
- Tailor made passive immunity
- Suckling/bonding
- Increase in development of gut mucosa
- Increase in development of active immunity
- Antigen load minimal
- Decreased breast cancer
Why does breast milk reduce infection?
Contains
- Macrophages and lymphocytes
- Interferon, lactoferrin ad lysozyme
- Bifidus factor
What are the advantages of formula feeding?
- No transfer of BBVs or drugs
- Accurate feed volumes
- Provides vitamin K
- Less jaundice
What are the disadvantages of formula feeding?
- No anti-infection properties
- Risk of contamination
- High antigen load
- Expensive
- Doesn’t need mum
What are UNICEF’s baby friendly 10 steps?
- Written breast feeding policy
- Train all staff to implement policy
- Inform all pregnant women about benefits of breast feeding
- Help mothers initiate breast-feeding (within 30mins of birth)
- Show mothers how to breastfeed
- Give new-borns only breast milk
- Practise rooming
- Encourage on demand feeding
- No teats or dummies
- Advocate breast feeding support groups
What happens if breast-feeding is not possible?
- Formula feeding is common
- All are cows milk based
- Based on age
Why is cows milk not suitable as the main drink for <1 years?
Contains almost no iron
When is milk the exclusive feed?
For the first 4-6 months
What type of specialised formulas are there?
- Cows milk protein allergy
- Nutrient dense
- Disease specific
What formula is available for pre-term infants?
- SMA Gold Prem
- Typically 2g (vs 1.5) protein and 80kcal (vs 68)/100ml
- Post discharge prescribable eg Nutriprem 2
What nutrient dense formula is available?
- Infatrini/SMA High Energy
- 100kcal/100ml ,prescribable to 18 months
What type of reaction is CMPA?
Majority are delayed, non IgE reactions
How can CMPA present?
- Vomiting
- Diarrhoea
- Abdominal discomfort
- Abdominal distension
- Eczema
What is the test for CMPA?
Exclusion of CMPA
What is the CMPA pathway?
- 4 week trial of milk avoidance
- Special formula or milk free diet for breast feeding mums
- Reintroduction at 4 weeks unless clear benefit
- Re challenge after 6 months of improvement
- Milk ladder approach
What is the milk ladder approach?
Not all forms of milk are equally allergenic
- Cookie/biscuit
- Muffin
- Pancake
- Cheese
- Yoghurt
- Pasteurised milk/infant formula
What is the first line feed choice in CMPA?
- Extensively hydrolysed protein feeds
- 90% should respond (10% react)
- Palatability a problem in older babies
- Nutramigen LGG Lipil 1 and 2
- Aptamil Pepti 1 and 2
What is the second line feed choice in CMPA?
- Amino acid based feeds
- Babies with severe colitis/enteropathy/ symptoms on breast milk
- Overprescribed and expensive
What is lactose intolerance?
- NOT AN ALLERGY
- Reduced levels of lactase enzyme
Who can lactose intolerance be seen in?
- Seen to minor degree in some breast fed babies
- Post gastro enteritis (Transient and self resolving)
- Also in certain ethnic groups post weaning
What is secondary lactose intolerance?
- Short lived condition eg post gastro-enteritis
- Confused with cow’s milk protein intolerance
- Lactose free/ “Comfort” milks are not CMP free
What are the indications for soya milk?
- Milk allergy when hydrolysed formulae refused
- Vegan families, if not breast fed
- Consider for children>1 year still on milk free diet
Why should soya milks be avoided in infants?
- They contain phytoestrogens
- Cross reactivity with cows milk
What non formula milks can be introduced into children’s diets?
- Rice Milk (Not advised for children under 5 years)
- Goats’ and Sheep’s milk (Not suitable for under 1’s, Many children will react)
- Oat and nut milks
- Organic versions are not calcium fortified
What is the nutritional value of full fat cows milk?
- 65kcal/100ml and 120 mg calcium/100ml
- Organic/ unsweetened milk substitutes low in calories
- Organic milks are no calcium supplemented
How much milk is required to meet daily requirements?
- Need 400-500ml of a calcium fortified “milk” to meet calcium requirements
- Supplement if <500ml calcium fortified substitute
What types of calcium supplements are available?
- Alliance calcium liquid or (if >3y) Calcium softies
- For breast feeding mums Accrete or Cacit D3
What is weaning?
Transition from milk to a mixed diet
When does weaning occur?
Starts around 6 months
Why do we wean children?
- Milk alone is inadequate
- Source of vitamins and trace elements
- Man is an omnivore
- Encourage tongue and jaw movements in preparation for speech and social interaction
Who in particular requires vitamin D?
- Dark skinned children, who breast feed from mum not on supplements
- Scots (unable to synthesis from September to April)
Who should receive supplements?
- All breast fed babies from 1 month
- Bottle fed babies taking <500ml formula
- All children from 1-4 years
What nutrition issues are there beyond infancy?
- Picky eaters
- Frequent illness
- Dependence on carer
- Learning to be independent
- Chronic disease
- Obesity
- Puberty
- Eating disorders
