Infant Feeding Flashcards
What leads growth at each stage?
Infants = Nutrition Children = GH Pubertal = Sex Steroids
How much weight should a child gain each week in the 1st yr?
up to 3 month = 200g/week
3-6months = 150g/wk
6-9months = 100g/wk
9-12months = 50-75g/wk
Doubles in 6 months, triples in 1yr and gains 2kg/yr till puberty
How much calories and protein do infants need?
100Kcal & 2g protein /kg/day
Vs only 35Kcl & 1g Protein in adults
What are the advantages of breast milk?
- Less allergenic
- Low renal solute load
- Perfect nutrition: Ca:PO4, Iron, LCP FAs
- Improves cognitive development
- Reduces infection:
Macrophages and lymphocytes
Interferon, lactoferrin, lysozyme
Bifidus factor - Promotes active immunity
- Promotes development of gut microbiota
- Suckling promotes bonding
Pros and cons of formula?
- Doesn’t need mum
- Accurate feed volumes
- Provides Vit K
- No jaundice
- No risk of BBV or drug transmission
No anti-infection
Contamination
Expensive
High antigen load
What are the 10 steps of the UNICEF “baby friendly” policy?
1) Written breast feeding policy
2) Trainn all staff to implement it
3) Inform pregnant women on benefits of breastfeeding
4) Help mums start breastfeeding within 1/2hr of birth
5) Show mum how to breastfeed and maintain lactation
6) Give infant no food/drink other than breastmilk
7) Practice Rooming-in
8) Encourage breast feeding on-demand
9) Give no teats or dummies
10) Foster breast-feeding support groups and refer new mums
What would a kid with a Cow’s Milk Protein Allergy (CMPA) look like?
- Vomiting
- Diarrhoea
- Abdo pain/distension
- Eczema
Its a delayed hypersensitivity reaction (So non-IgE)
How do you identify a CMPA?
4wk trial exclusion by either using a special formula or a milk-free diet for mum
Then re-introduce at 4wks to be sure
How long does it take kids to outgrow a CMPA?
~6months
So re-challenge after 6 months
Can promote earlier tolerance by building up the “milk ladder” (As not all forms of milk are equally allergenic), starting with cookings
What formula would you give a child with CMPA?
Extensively Hydrolysed Protein Feeds e.g. Nutramigen LGG Lipil 1 or 2
If that fails use an Amino Acid Based Feed
What is Lactose Intolerance?
A deficiency in lactase, not an allergy.
It’s usually transient following gastro-enteritis and will self-resolve
We don’t like to use soya milks (esp in <6months) because of high Phytoestrogens, also they are cross-reactive with cow’s milk.
When would we use a Soya Milk formula?
- Milk allergy & Hydrolysed formulae are refused
- Vegan
- Still avoiding cow’s milk >1yr
What kind of feed would we give to a child who’s suffered from some illness e.g. cardiac baby and needs to catch up?
Nutrient Dense Formula
E.g. SMA high energy
What kind of feed do we give pre-term babies?
Pre-term Formulae!
They have higher protein and cal
E.g. SMA Gold Prem
At what age can Cow’s milk replace formulae as the child’s main drink?
Atleast 1 yr old.
If it’s earlier they won’t be getting nutrients from other foods and cow’s milk contains no iron so they get SUPER anaemic
When would we give an infant calcium supplements?
If they are taking <500ml of formula
As they require ~500ml of Ca Fortified “Milk” to meet Ca requirments
When do you start weaning?
~6months
Start with smooth purees –> lumps & finger foods
Cup from 7 months
What kids should receive a Vit D supplement?
- all babies from birth to 1 year:
- 8.5-10 ug Vitamin D
- No need if infant formula >500ml
-everyone over 1:
10 ug Vitamin D
-should start “healthy start vitimins”
All kids 1-4yrs old
what is energy requirement equation?
Energy requirement = energy expended + energy deposited in new tissue
what % are growth demands from energy requirement?
35%
when should you breastfeed?
exclusively breast feed to around 6 months of age
From 6 months, complementary breast feeding alongside solids is supported
what is the first line feed choice (except breast milk)
Extensively hydrolysed protein feeds
what is the second line feed choice and when is it used?
Amino acid based feeds
For Babies with severe colitis/enteropathy/ symptoms on breast milk
how many mls of calcium fortified ‘milk’ do you need to meet requirements?
400-500m
Alliance calcium liquid or (if >3y) Calcium softies
what is neophobia?
Normal part of child development
To reject novel or unknown foods in childhood
Associated with maternal neophobia
Increase acceptance by repeatedly offering a variety of foods
what children are at risk of low vis d?
Dark skinned children not on vitamin drops at risk
Prolonged breast feeding and mum not on Vit D
difference between GOR and GORD?
GOR:
effortless passage of gastric contents into oesophagus with or without regurgitation and vomitting
GORD:
when the reflux of gastric contents causes troublesome symptoms and/or complications
Is GOR normal in babies?
yes
40-70% of all babies regurgitate 1-4 times daily or more
Peaks at 3-4 months
How would you treat GOR?
Thickened formula / thickener or if no improvement consider 2-4 week trial of milk free diet
what are some examples of thickness?
Infant Gaviscon sachets (NOT an antacid)
Carobel - 5kcal/100ml
Red flag signs in GOR?
that would suggest GORD(?)
Weight loss or poor weight gain Recurrent or bilious vomiting GI bleeding Persisting diarrhoea Dysphagia Stridor / cough / hoarseness
what are high risk groups of GORD?
Preterm babies, neurological impairment, chronic respiratory illness, anatomical, some genetic disorders e.g. Down’s syndrome
GORD treatments?
-Medical referral
-Require acid supression:
Reduced gastric acid may increase risk of pneumonia, gastroenteritis and candidiasis
- Trial of milk free diet
- Continuous NG/jejunal feeds
- Consideration of anti reflux surgery
- Drug therapy
what drug therapy is available for GORD?
-Gaviscon Liquid: Not advised<1 year
-H2 receptors
Ranitidine
-PPIs decrease acidity
Omeprazole / Lansoprazole
Esomeprazole for tubes
-pro kinetics:
Domperidone (promotes gastric emptying)
-Alimemazine (antihistamine)
what is colic?
when an otherwise healthy baby cries or fusses frequently for no clear reason
<3 months of age, >3hours/day, >3 days/week
for at least a week
how to diagnose colic?
Diagnosis of exclusion
No red flag symptoms Explanation and reassurance Probiotics Trial of cows milk protein avoidance Lactase drops Anti spasmodics
possible causes for colic?
Breast fed baby
Functional lactose overdose
All babies
Consider cow’s milk protein allergy
Psychosocial issues
Maternal mental health
RF for low iron at birth
low infant birthweight, maternal iron deficiency anaemia, obesity, smoking status gestational hypertension.
what type of stool should you aim for?
type 4
what is constipation?
No bowel movement for three or more days
Passing lots of small hard stools
Holding on to stools-pushing with signs of or her face becoming red
using avoidance techniques- soiling, loose stools that leak into pants, pyjamas and bedclothes. This happens when the bowel is full.
what laxatives to use in infants?
Lactulose
what laxatives to use In older children?
Movicol / Laxido
other things to help constipation?
Fruit, vegetable and wholegrains intake encouraged
Constant routine – sitting on potty or toilet after meals
Give praise and encouragement
