Infant feeding and weaning Flashcards
1
Q
When do the first teeth usually appear?
A
6 months
2
Q
What is the average birth weight?
A
3.3kg
3
Q
What is the normal nutritional requirement for infants?
A
Day 1 60mls/kg
Day 2 80mls/kg
Day 3 100mls/kg
then 150mls/kg until one
4
Q
How many mils are in an oz?
A
30mls
5
Q
How many calories are in 150mls of breast milk?
A
110 kcals
6
Q
When should children be weaned from breast milk?
A
6 months
7
Q
What initial solids should be introduced?
A
Baby rice, fruit and vegetables
8
Q
When should egg and wheat be avoided until?
A
6 months
9
Q
When should you continue puree to and introduce finger foods?
A
7 months
10
Q
What is the benefits of offering food later?
A
Less allergies
11
Q
When should complementary breast or formula feeds be continued to?
A
1 year
12
Q
When should you drink full fat milk until?
A
5 years
13
Q
Which vitamin supplementation should be continued to 5 years?
A
A,C,D
14
Q
How can you avoid iron-deficiency anaemia?
A
Restricting milk to 1 pint per day
Include foods rich in iron (red meat, cereals, beans)
Vitamin C supplementation can aid iron absorption
15
Q
Why should you not give your child lots of fruit juices etc?
A
Excessive consumption of fruit juices or squashes can contribute to chronic non-specific diarrhoea of childhood (toddler diarrhoea) .
16
Q
What is colostrum and what does it contain and when does true milk arrive?
A
This is pre milk, it is rich in antibodies and protein, it has a low volume watery liquid. True milk arrives day 3-5
17
Q
What is breast milk composed of?
A
Colostrum, fore milk, hind milk and mature milk.
18
Q
What is fore milk?
A
This is stored behind the areola and is watery in nature
19
Q
What is hind milk?
A
This is made in the breast tissue and follows late in a feed. This has a greater amount of FAT.
20
Q
What is mature milk?
A
This has an increasing quantity of fate with babies age.
21
Q
What is whey based milk made up of and give examples?
A
It’s protein composition and renal solute load more closely resemble breast milk (60% whey, 40% casein).
It is RECOMMENDED from birth in PREFERENCE to casein dominant formula.
SMA first milk
Cow and Gate 1
Aptamil First 1
HIPP Organic first milk
22
Q
How many calories are found in 100mls of whey based formula?
A
67kcals
23
Q
What is the average length of feeds?
A
15 mins to 45mins
24
Q
If the baby feeds for less than 15 mins, what could this mean?
A
The baby is tiring
25
Which feeding is best to ensure successful breast feeding?
Demand feeding.
26
When is casein dominant formula recommended?
This is usually recommended for hungrier babies.
27
What is the ratio of whey to casein in casein dominant formulas?
20% whey, 80% casein. This is the same protein ratio as cows milk.
28
Give examples of casein dominant formulas?
Cow & Gate Hungrier baby,
SMA Extra hungry milk
Aptamil hungry milk
HIPP Organic Hungry infant milk
29
When is follow-on formula suitable from?
6 months
30
What is the composition changes in follow-on milk?
Slightly higher in protein, iron and other minerals but no significant advantages over normal infant formula.
31
What is follow-on used for?
To supplement weaning diet.
32
Give examples of follow on milks....?
Cow & Gate 2 (>6 months),
Cow & Gate 3 Growing Up Milk for toddles (1-2years), SMA 2-follow on.
Aptamil 2 follow on (>6 months)
HIPP Organic 2 follow on milk (>6months)
33
How do you make up a feed and how many scoops are needed per oz?
Water first, then one scoop per oz of water.
34
Roughly how many weeks does it take for lactation to become fully established?
3-6 weeks
35
When should you introduce feeds from a cup/beaker?
6 months
36
When can you have mashed up adult food and finger food?
9 months
37
What should be happening with meals between 9-12 months?
Family meals mashed up, messy play, fun and enjoyable.
38
What is the approx feed volume and frequency at 1-2 weeks?
Around 50-70mls per feed and 7-8/24 hours. So every 3 hours around.
39
What is the approx feed volume and frequency at 2-6 weeks?
Around 75-110mls per feed and 6-7/24 hours. So every 3-4 hours.
40
What is the approx feed volume and frequency at 2 months?
Around 110-180mls per feed and 5-6/24 hours. So every 4-5 hours.
41
What is the approx feed volume and frequency at 3 months?
Around 170-220mls per feed and 5/24 hours. So every 5 hours.
42
What is the approx feed volume and frequency at 6 months?
Around 220-240mls per feed and 4/24 hours. So every 6 hours.
43
How do you initiate weaning?
1-2 table spoons of baby rice mixed with formula milk to thin consistency. Gradually increase amount and frequency of solids given.
44
What are coleaf drops?
They are drops which can be added to milk to help break down the lactulose in milk.
45
What is colic?
It is acute spasmodic abdominal pain, typically between the ages of 3 weeks & 3-4months, often occurring in the EVENING.
46
How can you treat colic?
It usually resolves by itself, check if the baby if hungry/thirsty and make sure in correct feeding position, increasing the frequency of feeds can help plus or minus a dummy. You could consider trial of a hydrolysed formula/lactose free.
47
What are the typical symptoms of a cows milk protein allergy?
Colic, urticaria, vomiting, eczema, asthma and diarrhoea.
48
What formulas can be used in CMPA?
```
(mead johnson) Nutramigen Lipil 1/ (2>6months)
Aptamil Pepti
SMA althera
Similac Alimentum (some MCT)
SMA Wysoy (>6months)
Paediasure Peptide >8kg
Nutrini peptisorb
```
49
How can you treat GORD in an infant?
Smaller volumes, more regularly (up to 8 times a day). Stop gavison, and instead use a pre-thickened formula, eg SMA stay down, Johnson Enfamil AR, Cow and gate comfort. Start on ranitidine. Or add one scoop of
thick and easy (from 3 years)
Cow and gate instant carobel from birth
Abbott multithick from 3 years old
50
So, if an infant has diarrhoea after being switched to COw and Gate 1 from breast then what should you do?
Check adequate fluid intake, consider adding calogen to feeds? trial lactose free formula, and hydrolysed formula CMPA
51
How should you advise parents on treating constipation?
Make sure fluid intake enough, ensure fruit and veg, some fibre should be offered in the form of cereal, bread, chipatti. Bran not recommended.
52
If a child is obese and drinking from a bottle, what should be recommended?
Switch from a bottle to a beaker or cup.
53
What advice should you give concerning faddy eating?
Give 3 meals and 2-3 small snacks. Offer a variety of foods, no force feeding, limit excessive milk or juice and eat at family meal times, realistic portions.
54
From what age can you introduce full fat cows milk?
1 year
55
From what age can a child have semi-skimmed milk?
2 years
56
From what age could a child have skimmed milk?
5 years
57
What can cause iron-deficiency anaemia in kids?
Over-reliance on cows milk/juice, early introduction of cows milk as main drink (before 1 year, shouldn't get introduced until 1 year). Poor intake of iron rich foods. Also too much calcium blocks iron absorption. Change from a bottle to a cup. Reduce cows milk ti increase appetites
58
Why should you reduce cows milk intake?
This will INCREASE APPETITE. Also give vitamin C rich foods with an iron rich meal to help absorption.
59
What could faltered growth plus loose stools plus melena indicate?
Cows milk protein allergy.
60
What can you offer a child with CMPA?
Extensively hydrolysed formula, Cow and Gate Pepti Junior.
61
Which formulas can you give for all allergies?
Cow and Gate Pepti Junior (high MCT), Pregestimil Lipil (high MCT) medium chain triglycerides.
62
When should you give an amino acid formula for a food allergy?
Last resort formula.
63
How do you manage faltering growth?
Increase frequency of feed, consider high-energy formula, SMA high energy (up to 18 months). Food fortification, energy supplements. Consider other reasons for poor growth CMPA, GORD.
64
If a child has a food allergy, how would you approach weaning?
Exclude all cows milk containing foods, check the labels of biscuits etc, avoid goats milk, ensure adequate calcium intake- soya, oat milk, nut milk, (rice milk only >5 years), soya cheeses, yoghurts. Rice milk doesn't have the right amount of nutrients.
65
What are good sources of calcium?
Milk, yoghurt, cheese, milky pudding, (3 portions of dairy per day), supplements, sandocal
66
What are good sources of vitamin D?
Milk, eggs, oily fish, fortified cereals, and margarine. Majority of vitamin D is obtained from the sunlight NOT diet.
67
What formulas can you use on preterm babies?
Cow and gate nutriprem 1, hydrolysed nutriprem (hospital use only). Also breast milk and breast milk fortifier can be used in hospitals only.
68
When can you add coarsely chopped foods into the babies diet?
12 months
69
When can you add small sandwiches?
18 months
70
Why should cows milk not be used in the young infant?
Cow’s milk should not be used in the
| young infant due to its deficiency of iron, and vitamins A, C and D.
71
What problems can introducing cows milk too early have?
Problems:
- Iron deficiency anaemia
- Constipation
- Cholestasis
72
Why are little calories needed in the first few days?
Term babies have liver glycogen reserves as well as excess fluid
• Therefore little calories are needed in the first few days
• Reserves mean it is normal to lose 5-7% initial body weight
73
When should a baby double in birth/treble weight by?
5 months/1 year
74
How soon does a baby need to feed?
In the first 2/3 hours of life.
75
What does breast milk contain?
FAT – good digestion and absorption, high in polyunsaturates, contains lipase
• CARBS – high lactose, oligosaccharides, promotes lactobacillus (good bacteria)
• PROTEIN – balanced a.acid profile, high soluble protein (whey), human antigens
• MINERALS – low sodium and phosphate levels, bioavailable iron)
76
What does sole breast feeding beyond 6 months lead to?
poor weight gain, rickets
77
What is the disadvantage of breast milk concerning vitamin K?
Insufficient Vit K in breast milk to prevent haemorrhagic disease
of the newborn
78
When should the baby be fed sat upright with support?
6 months
79
When should a baby be fed without support?
9 months
80
How do you assess nutrition in kids?
Height/age and weight/height
81
What does height/age determine?
A measure of stunting and an index of chronic malnutrition
82
What does weight/height determine?
A measure of wasting and an index of acute malnutrition
83
What is marasmus?
Weight less than 60% of the mean for age. Oedema is not present, reduced skinfold thickness, affected children are
withdrawn.
84
What is kwoshiorkor?
Kwashiorkor is another manifestation of severe protein malnutrition where weight is 60-80% expected and generalised oedema is present along with:
o Flaky paint skin rash with hyperkeratosis (thickened skin) and desquamation
o Distended abdomen and enlarged liver
o Angular stomatitis
o Spare and depigmented hair
o Diarrhoea, hypothermia, bradycardia and hypotension
Severe case such as these require urgent correction of dehydration, acid-base balance and hypocalcaemia and treating any infection. Too much fluid though can
lead to cardiac failure
85
What is vitamin D deficiency?
Deficiency in intake or defective metabolism of Vitamin D causing a low serum calcium.
86
Why does vitamin D deficiency cause bone weak bones?
This triggers secretion of PTH and which normalises the serum calcium but demineralises the bone
• PTH causes renal losses of phosphate and therefore LOW serum PHOSPHATE levels, further reducing the potential for bone calcification
87
What is the presentation of vitamin D deficiency?
Bony deformity
o Symptoms of hypocalcaemia – seizures, TETANY, apnoea, stridor
o More common <2years due to high demand for calcium in rapidly growing
bone
