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🍉paeds > Infant Feeding > Flashcards

Infant Feeding Flashcards

1
Q

What leads growth at each stage?

A 
Infants = Nutrition
Children = GH
Pubertal = Sex Steroids
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2
Q

How much weight should a child gain each week in the 1st yr?

A

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

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3
Q

How much calories and protein do infants need?

A

100Kcal & 2g protein /kg/day

Vs only 35Kcl & 1g Protein in adults

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4
Q

What are the advantages of breast milk?

A
  • 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
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5
Q

Pros and cons of formula?

A
  • 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

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6
Q

What are the 10 steps of the UNICEF “baby friendly” policy?

A

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

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7
Q

What would a kid with a Cow’s Milk Protein Allergy (CMPA) look like?

A
  • Vomiting
  • Diarrhoea
  • Abdo pain/distension
  • Eczema

Its a delayed hypersensitivity reaction (So non-IgE)

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8
Q

How do you identify a CMPA?

A

4wk trial exclusion by either using a special formula or a milk-free diet for mum
Then re-introduce at 4wks to be sure

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9
Q

How long does it take kids to outgrow a CMPA?

A

~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

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10
Q

What formula would you give a child with CMPA?

A

Extensively Hydrolysed Protein Feeds e.g. Nutramigen LGG Lipil 1 or 2

If that fails use an Amino Acid Based Feed

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11
Q

What is Lactose Intolerance?

A

A deficiency in lactase, not an allergy.

It’s usually transient following gastro-enteritis and will self-resolve

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12
Q

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?

A
  • Milk allergy & Hydrolysed formulae are refused
  • Vegan
  • Still avoiding cow’s milk >1yr
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13
Q

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?

A

Nutrient Dense Formula

E.g. SMA high energy

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14
Q

What kind of feed do we give pre-term babies?

A

Pre-term Formulae!

They have higher protein and cal

E.g. SMA Gold Prem

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15
Q

At what age can Cow’s milk replace formulae as the child’s main drink?

A

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

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16
Q

When would we give an infant calcium supplements?

A

If they are taking <500ml of formula

As they require ~500ml of Ca Fortified “Milk” to meet Ca requirments

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17
Q

When do you start weaning?

A

~6months

Start with smooth purees –> lumps & finger foods
Cup from 7 months

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18
Q

What kids should receive a Vit D supplement?

A
  • 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

19
Q

what is energy requirement equation?

A

Energy requirement = energy expended + energy deposited in new tissue

20
Q

what % are growth demands from energy requirement?

A

35%

21
Q

when should you breastfeed?

A

exclusively breast feed to around 6 months of age

From 6 months, complementary breast feeding alongside solids is supported

22
Q

what is the first line feed choice (except breast milk)

A

Extensively hydrolysed protein feeds

23
Q

what is the second line feed choice and when is it used?

A

Amino acid based feeds

For Babies with severe colitis/enteropathy/ symptoms on breast milk

24
Q

how many mls of calcium fortified ‘milk’ do you need to meet requirements?

A

400-500m

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

25
Q

what is neophobia?

A

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

26
Q

what children are at risk of low vis d?

A

Dark skinned children not on vitamin drops at risk

Prolonged breast feeding and mum not on Vit D

27
Q

difference between GOR and GORD?

A

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

28
Q

Is GOR normal in babies?

A

yes
40-70% of all babies regurgitate 1-4 times daily or more
Peaks at 3-4 months

29
Q

How would you treat GOR?

A

Thickened formula / thickener or if no improvement consider 2-4 week trial of milk free diet

30
Q

what are some examples of thickness?

A

Infant Gaviscon sachets (NOT an antacid)

Carobel - 5kcal/100ml

31
Q

Red flag signs in GOR?

that would suggest GORD(?)

A 
Weight loss or poor weight gain
Recurrent or bilious vomiting
GI bleeding
Persisting diarrhoea
Dysphagia
Stridor / cough / hoarseness
32
Q

what are high risk groups of GORD?

A

Preterm babies, neurological impairment, chronic respiratory illness, anatomical, some genetic disorders e.g. Down’s syndrome

33
Q

GORD treatments?

A

-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
34
Q

what drug therapy is available for GORD?

A

-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)

35
Q

what is colic?

A

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

36
Q

how to diagnose colic?

A

Diagnosis of exclusion

No red flag symptoms
Explanation and reassurance
Probiotics
Trial of cows milk protein avoidance
Lactase drops
Anti spasmodics
37
Q

possible causes for colic?

A

Breast fed baby
Functional lactose overdose

All babies
Consider cow’s milk protein allergy
Psychosocial issues
Maternal mental health

38
Q

RF for low iron at birth

A 
low infant birthweight,
maternal iron deficiency anaemia,
 obesity, 
smoking status 
gestational hypertension.
39
Q

what type of stool should you aim for?

A

type 4

40
Q

what is constipation?

A

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.

41
Q

what laxatives to use in infants?

A

Lactulose

42
Q

what laxatives to use In older children?

A

Movicol / Laxido

43
Q

other things to help constipation?

A

Fruit, vegetable and wholegrains intake encouraged
Constant routine – sitting on potty or toilet after meals
Give praise and encouragement

🍉paeds (42 decks)

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