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Systems: Paediatrics AB > Infant Feeding > Flashcards

Infant Feeding Flashcards

1
Q

What are the recognised phases of childhood?

A
  • Neonate (<4w)
  • Infant (<12m/1y)
  • Toddler (~1-2y)
  • Pre-school (~2-5y)
  • School age
  • Teenager/ Adolescent
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2
Q

What drives infant growth?

A

Nutrition

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3
Q

What drives child growth?

A

Growth hormone

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4
Q

What drives pubertal growth?

A

Sex steroids

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5
Q

Why is nutrition important?

A
  • Fundamental aspect of life
  • Required for changes in body structure, composition and function
  • Prevention of malnutrition
  • Disease prevention
  • Treatment in metabolic disease and allergy
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6
Q

What is birth size and weight dependent on?

A
  • Maternal size
  • Placental function
  • Gestation
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7
Q

What is the average weigth of a term infant?

A

3.3kg

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8
Q

What is energy needed for?

A
  • Physical activity
  • Thermogenesis
  • Tissue maintenance
  • Growth
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9
Q

What is the growth demands of infants?

A

About 35% of energy intakee

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10
Q

Why can infants rapidly become malnourished?

A

-Dependent on carer
-High demands for growth and maintenance
Low protein and fat stores
-Frequent illness

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11
Q

What is the average weekly weight gain of infants?

A
  • 0-3months 200g
  • 3-6 months 150g
  • 6-9 months 100g
  • 9-12 months 75-50g
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12
Q

What are the benefits of breast feeding?

A
  • 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
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13
Q

Why does breast milk reduce infection?

A

Contains

  • Macrophages and lymphocytes
  • Interferon, lactoferrin ad lysozyme
  • Bifidus factor
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14
Q

What are the advantages of formula feeding?

A
  • No transfer of BBVs or drugs
  • Accurate feed volumes
  • Provides vitamin K
  • Less jaundice
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15
Q

What are the disadvantages of formula feeding?

A
  • No anti-infection properties
  • Risk of contamination
  • High antigen load
  • Expensive
  • Doesn’t need mum
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16
Q

What are UNICEF’s baby friendly 10 steps?

A
  • 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
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17
Q

What happens if breast-feeding is not possible?

A
  • Formula feeding is common
  • All are cows milk based
  • Based on age
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18
Q

Why is cows milk not suitable as the main drink for <1 years?

A

Contains almost no iron

19
Q

When is milk the exclusive feed?

A

For the first 4-6 months

20
Q

What type of specialised formulas are there?

A
  • Cows milk protein allergy
  • Nutrient dense
  • Disease specific
21
Q

What formula is available for pre-term infants?

A
  • SMA Gold Prem
  • Typically 2g (vs 1.5) protein and 80kcal (vs 68)/100ml
  • Post discharge prescribable eg Nutriprem 2
22
Q

What nutrient dense formula is available?

A
  • Infatrini/SMA High Energy

- 100kcal/100ml ,prescribable to 18 months

23
Q

What type of reaction is CMPA?

A

Majority are delayed, non IgE reactions

24
Q

How can CMPA present?

A
  • Vomiting
  • Diarrhoea
  • Abdominal discomfort
  • Abdominal distension
  • Eczema
25
Q

What is the test for CMPA?

A

Exclusion of CMPA

26
Q

What is the CMPA pathway?

A
  • 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
27
Q

What is the milk ladder approach?

A

Not all forms of milk are equally allergenic

  • Cookie/biscuit
  • Muffin
  • Pancake
  • Cheese
  • Yoghurt
  • Pasteurised milk/infant formula
28
Q

What is the first line feed choice in CMPA?

A
  • 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
29
Q

What is the second line feed choice in CMPA?

A
  • Amino acid based feeds
  • Babies with severe colitis/enteropathy/ symptoms on breast milk
  • Overprescribed and expensive
30
Q

What is lactose intolerance?

A
  • NOT AN ALLERGY

- Reduced levels of lactase enzyme

31
Q

Who can lactose intolerance be seen in?

A
  • Seen to minor degree in some breast fed babies
  • Post gastro enteritis (Transient and self resolving)
  • Also in certain ethnic groups post weaning
32
Q

What is secondary lactose intolerance?

A
  • Short lived condition eg post gastro-enteritis
  • Confused with cow’s milk protein intolerance
  • Lactose free/ “Comfort” milks are not CMP free
33
Q

What are the indications for soya milk?

A
  • Milk allergy when hydrolysed formulae refused
  • Vegan families, if not breast fed
  • Consider for children>1 year still on milk free diet
34
Q

Why should soya milks be avoided in infants?

A
  • They contain phytoestrogens

- Cross reactivity with cows milk

35
Q

What non formula milks can be introduced into children’s diets?

A
  • 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
36
Q

What is the nutritional value of full fat cows milk?

A
  • 65kcal/100ml and 120 mg calcium/100ml
  • Organic/ unsweetened milk substitutes low in calories
  • Organic milks are no calcium supplemented
37
Q

How much milk is required to meet daily requirements?

A
  • Need 400-500ml of a calcium fortified “milk” to meet calcium requirements
  • Supplement if <500ml calcium fortified substitute
38
Q

What types of calcium supplements are available?

A
  • Alliance calcium liquid or (if >3y) Calcium softies

- For breast feeding mums Accrete or Cacit D3

39
Q

What is weaning?

A

Transition from milk to a mixed diet

40
Q

When does weaning occur?

A

Starts around 6 months

41
Q

Why do we wean children?

A
  • 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
42
Q

Who in particular requires vitamin D?

A
  • Dark skinned children, who breast feed from mum not on supplements
  • Scots (unable to synthesis from September to April)
43
Q

Who should receive supplements?

A
  • All breast fed babies from 1 month
  • Bottle fed babies taking <500ml formula
  • All children from 1-4 years
44
Q

What nutrition issues are there beyond infancy?

A
  • Picky eaters
  • Frequent illness
  • Dependence on carer
  • Learning to be independent
  • Chronic disease
  • Obesity
  • Puberty
  • Eating disorders

Systems: Paediatrics AB (31 decks)

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