Infant Feeding

Question 1

What drives infant growth?

Answer 1

Nutrition

Question 2

What drives child growth?

Answer 2

Growth hormone

Question 3

What drives pubertal growth?

Answer 3

Sex steroids

Question 4

What is birth size and weight dependent on?

Answer 4

• Maternal size
• Placental function
• Gestation

Question 5

What is the average weigth of a term infant?

Answer 5

3.3kg

Question 6

What is energy needed for?

Answer 6

• Physical activity
• Thermogenesis
• Tissue maintenance
• Growth

Question 7

What is the growth demands of infants?

Answer 7

About 35% of energy intakee

Question 8

What is the average weekly weight gain of infants and children?

Answer 8

• 0-3months 200g
• 3-6 months 150g
• 6-9 months 100g
• 9-12 months 75-50g
• After 1 year approx 2kg and 5cm/year until puberty

Question 9

What are the benefits of breast feeding?

Answer 9

• Nutritionally best for full term babies
• Suckling/bonding
• Improves cognitive development
• Tailor made passive immunity
• Increase in development of active immunity
• Increase in development of gut mucosa
• Antigen load minimal
• Decreased breast cancer

Question 10

Why does breast milk reduce infection?

Answer 10

Contains:

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

Question 11

What are the advantages of formula feeding?

Answer 11

• No transfer of blood bourne viruses or drugs
• Accurate feed volumes
• Provides vitamin K
• Less jaundice

Question 12

What are the disadvantages of formula feeding?

Answer 12

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

Question 13

How should breast feeding be encouraged?

Answer 13

• 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

Question 14

What happens if breast-feeding is not possible?

Answer 14

• Formula feeding is common
• All are cows milk based
• Different compositions based on age

Question 15

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

Answer 15

Contains almost no iron

Question 16

When is milk the exclusive feed?

Answer 16

For the first 4-6 months

Question 17

What type of specialised formulas are there if there is a cows milk allergy?

Answer 17

• First line feed choice
  
  • Extensively hydrolysed protein feeds
    
    • 90% should respond (10% react)
    • Palatability a problem in older babies
• Second line feeds
  • Amino acid based feeds
  • Babies with severe colitis/enteropathy/ symptoms on breast milk

Question 18

What type of reaction is CMPA?

Answer 18

Majority are delayed, non IgE reactions

Question 19

What is weaning?

Answer 19

Transition from milk to a mixed diet

Question 20

When does weaning occur?

Answer 20

Starts around 6 months

Question 21

Why do we wean children?

Answer 21

• 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

Question 22

Who in particular requires vitamin D?

Answer 22

• Dark skinned children, who breast feed from mum not on supplements
• Scots (unable to synthesis from September to April)
  
  • diet is a poor source

Question 23

Who should receive supplements?

Answer 23

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

Question 24

What causes lactose intolerance?

Answer 24

• Reduced levels of the enzyme (lactase)
• Seen to minor degree in some breast fed babies
• Post gastro enteritis (Transient and self resolving)
• Also in certain ethnic groups post weaning