Infant feeding Flashcards
why is nutrition important?
- prevents disease
- Growth not just about increasing size but change in brain and body structure, composition and function
Phases of growth
Infant, Child and Pubertal
nutrition led
growth hormone led
sex steroid led
Birth size and weight?
Maternal size (diabetic mother - larger baby) Placental function Gestation
95% of weight comes from what weeks?
20-40 weeks
10-16% body weight is fat
average term infant weight?
3.3kg
why do babies need nutrients?
Physical activity
Thermogenesis
Tissue maintenance
Growth
how much calories does an infant require per day?
- 100kcal and 2g protein/kg/day
babies have low fat stores and protein - can he halted with frequent illness
average weight gain from 0-3 months?
200g per week
average weight gain from 3-6 months
150g per week
average weight gain from 6-9 months
100g PW
average weight gain from 9-12 months
50-75g pw
babies should double and triple weight by what age?
6 months and 1 year
after a year old, the average weight a baby should increase each year?
2kg
after a year old, the average height a baby should increase each year?
5cm
why is Breast fed the best?
calcium and phosphate fats?
- Well tolerated
- Less allergenic
- Low renal solute load
- Ca:PO4, Iron, LCP FAs
- improves cognitive development
- boosts active immunity
Breastfeeding a baby reduces the risk of infection - give some examples?
- Macrophages and lymphocytes
- Interferon, lactoferrin, lysozyme
- Bifidus factor
breast feeding helps to reduce the risk of?
breast cancer and endometriosis, and greater postpartum weight loss and lower body mass index (BMI) in the longer term
Risks of using formula?
No anti-infection properties Risk of contamination No transmition of BBVs/drugs High antigen load Expensive Doesn’t need mum Accurate feed volumes Provides Vit K Less jaundice
what is the recommended breast feeding time ?
6 months of age
From 6 months, complementary breast feeding alongside solids is supported
standard formulas are typically based with
cows milk
- there are specialised options for:
1. cows milk protein allergy
2. nutrient dense
3. disease specific (PKU)
Nutrient dense formulas include?
Infatrini / Smiliac High Energy / SMA High Energy 100kcal/100ml
- those with cardiac issues/ oncology
First line feed choice for cows milk allergy
Nutramigen - hydrolysed protein
Aptamil
Second line feeds for those who are more unwell/allergic to cow milk
Amino acid based feeds - alfamino
Babies with severe colitis/enteropathy/ symptoms on breast milk
Are over prescribed (and expensive!)
16-40% of babies with reflux may have?
cows milk allergy
those with a cows milk allergy should have a trial of what ? NICE guidelines
6-8 week trial of an extensively hydrolysed or amino acid formula to bottle fed infants<6 months with moderate to severe eczema that has not been controlled by optimal topical treatment particularly if associated with GI symptoms and FTT.
Children on a milk free diet for 8 weeks should..?
be referred to a dietician
Lactose intolerance features
Reduced levels of the enzyme (lactase)
Seen to minor degree in some breast fed babies
Post gastro enteritis (Transient and self resolving)
Lactose free milk for secondary lactose intolerance is seen in?
- what can it be confused with?
Short lived condition eg post gastro-enteritis
Confused with cow’s milk protein intolerance
Lactose free/ “Comfort” milks are not CMP free
Soya Milks contain lots of?
Phytoestrogens
soya milk indications?
- Milk allergy when hydrolysed formulae refused
- Vegan families, if not breast fed
- Consider for children>1 year still on milk free diet
over what age can you introduce non- formula milk?
1 year
rice milk is not advised for children,,?
goat’s and sheep milk?
oat and nut milk?
under 5
under 1
how much calcium calcium fortified “milk” do you need to meet calcium requirements
400-500ml
- calcium softies
Breast feeding mothers on dairy free diet need to take?
Accrete or Cacit D3
when do solids begin to be Introduced?
6 months
early solid use can be associated with?
Higher risk of Fe deficiency and coeliac disease.
What is neophobia
- fear of trying new foods
- Associated with maternal neophobia
Vitamin D deficiency can cause?
can affect who?
rickets and poor muscle strength
- Dark skinned children not on vitamin drops at risk
- Prolonged breast feeding and mum not on Vit D
Supplements for vitamin D - how much do babies need if they are not taking 500mls of formula?
8.5-10 ug Vitamin D
Everyone over one year of age vit D supplement?
10 ug Vitamin D
what is GOR?
effortless passage of gastric contents into oesophagus with or without regurgitation and vomiting.
What is GORD?
when the reflux of gastric contents causes troublesome symptoms and/or complications
When is the peak age that babies will regurgitate 1-4 times daily or more?
3-4 months
typical thickeners?
Infant Gaviscon sachets (NOT an antacid)
Carobel - 5kcal/100ml - most common
Red flag signs with reflux symptoms (6)
Weight loss or poor weight gain Recurrent or bilious vomiting GI bleeding Persisting diarrhoea Dysphagia Stridor / cough / hoarseness
High risk groups for reflux??
Preterm babies, neurological impairment, chronic respiratory illness, anatomical, some genetic disorders e.g. Down’s syndrome
GORD treatments?
Medical referral Trial of milk free diet Continuous NG/jejunal feeds Consideration of anti reflux surgery Drug therapy
With GORD, babies require what suppression?
- what does this reduce?
acid supression
Reduced gastric acid may increase risk of pneumonia, gastroenteritis and candidiasis
Drug therapy for GORD - first line treatment
Gaviscon Liquid
can also use low dose erythromycin
H2 blockers block?
example?
block histamine
Ranitidine
Alimemazine - how does it work?
(anti histamine)
- relives symptoms
PPIs decrease the acidity of stomach - give an example?
Omeprazole / Lansoprazole
Esomeprazole for tubes
Pro-kinetics like Domperidone promote what ?
gastric emptying
Colic - inconsolable crying is?
how long?
<3 months of age, >3hours/day, >3 days/week
at least a week
no red flag symtoms
what can be used for Colic
Probiotics
Trial of cows milk protein avoidance
Lactase drops
Anti spasmodics
Factors associated with lower iron status at birth include ?
include low infant birthweight, and maternal iron deficiency anaemia, obesity, smoking status and gestational hypertension.
periods of peak brain development?
Neonatal period & 6 months to 3 years
May need to ask GP to check FBC/ferritin
laxatives for infants
Lactulose
laxatives for older children
Movicol / Laxido
