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Paediatrics > Infant feeding and weaning > Flashcards

Infant feeding and weaning Flashcards

1
Q

When do the first teeth usually appear?

A

6 months

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2
Q

What is the average birth weight?

A

3.3kg

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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

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4
Q

How many mils are in an oz?

A

30mls

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5
Q

How many calories are in 150mls of breast milk?

A

110 kcals

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6
Q

When should children be weaned from breast milk?

A

6 months

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7
Q

What initial solids should be introduced?

A

Baby rice, fruit and vegetables

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8
Q

When should egg and wheat be avoided until?

A

6 months

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9
Q

When should you continue puree to and introduce finger foods?

A

7 months

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10
Q

What is the benefits of offering food later?

A

Less allergies

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11
Q

When should complementary breast or formula feeds be continued to?

A

1 year

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12
Q

When should you drink full fat milk until?

A

5 years

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13
Q

Which vitamin supplementation should be continued to 5 years?

A

A,C,D

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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

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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) .

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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

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17
Q

What is breast milk composed of?

A

Colostrum, fore milk, hind milk and mature milk.

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18
Q

What is fore milk?

A

This is stored behind the areola and is watery in nature

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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.

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20
Q

What is mature milk?

A

This has an increasing quantity of fate with babies age.

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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

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22
Q

How many calories are found in 100mls of whey based formula?

A

67kcals

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23
Q

What is the average length of feeds?

A

15 mins to 45mins

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24
Q

If the baby feeds for less than 15 mins, what could this mean?

A

The baby is tiring

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25
Q

Which feeding is best to ensure successful breast feeding?

A

Demand feeding.

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26
Q

When is casein dominant formula recommended?

A

This is usually recommended for hungrier babies.

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27
Q

What is the ratio of whey to casein in casein dominant formulas?

A

20% whey, 80% casein. This is the same protein ratio as cows milk.

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28
Q

Give examples of casein dominant formulas?

A

Cow & Gate Hungrier baby,
SMA Extra hungry milk
Aptamil hungry milk
HIPP Organic Hungry infant milk

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29
Q

When is follow-on formula suitable from?

A

6 months

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30
Q

What is the composition changes in follow-on milk?

A

Slightly higher in protein, iron and other minerals but no significant advantages over normal infant formula.

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31
Q

What is follow-on used for?

A

To supplement weaning diet.

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32
Q

Give examples of follow on milks….?

A

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)

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33
Q

How do you make up a feed and how many scoops are needed per oz?

A

Water first, then one scoop per oz of water.

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34
Q

Roughly how many weeks does it take for lactation to become fully established?

A

3-6 weeks

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35
Q

When should you introduce feeds from a cup/beaker?

A

6 months

36
Q

When can you have mashed up adult food and finger food?

A

9 months

37
Q

What should be happening with meals between 9-12 months?

A

Family meals mashed up, messy play, fun and enjoyable.

38
Q

What is the approx feed volume and frequency at 1-2 weeks?

A

Around 50-70mls per feed and 7-8/24 hours. So every 3 hours around.

39
Q

What is the approx feed volume and frequency at 2-6 weeks?

A

Around 75-110mls per feed and 6-7/24 hours. So every 3-4 hours.

40
Q

What is the approx feed volume and frequency at 2 months?

A

Around 110-180mls per feed and 5-6/24 hours. So every 4-5 hours.

41
Q

What is the approx feed volume and frequency at 3 months?

A

Around 170-220mls per feed and 5/24 hours. So every 5 hours.

42
Q

What is the approx feed volume and frequency at 6 months?

A

Around 220-240mls per feed and 4/24 hours. So every 6 hours.

43
Q

How do you initiate weaning?

A

1-2 table spoons of baby rice mixed with formula milk to thin consistency. Gradually increase amount and frequency of solids given.

44
Q

What are coleaf drops?

A

They are drops which can be added to milk to help break down the lactulose in milk.

45
Q

What is colic?

A

It is acute spasmodic abdominal pain, typically between the ages of 3 weeks & 3-4months, often occurring in the EVENING.

46
Q

How can you treat colic?

A

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
Q

What are the typical symptoms of a cows milk protein allergy?

A

Colic, urticaria, vomiting, eczema, asthma and diarrhoea.

48
Q

What formulas can be used in CMPA?

A 
(mead johnson) Nutramigen Lipil 1/ (2>6months)
Aptamil Pepti
SMA althera
Similac Alimentum (some MCT)
SMA Wysoy (>6months)
Paediasure Peptide >8kg
Nutrini peptisorb
49
Q

How can you treat GORD in an infant?

A

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
Q

So, if an infant has diarrhoea after being switched to COw and Gate 1 from breast then what should you do?

A

Check adequate fluid intake, consider adding calogen to feeds? trial lactose free formula, and hydrolysed formula CMPA

51
Q

How should you advise parents on treating constipation?

A

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
Q

If a child is obese and drinking from a bottle, what should be recommended?

A

Switch from a bottle to a beaker or cup.

53
Q

What advice should you give concerning faddy eating?

A

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
Q

From what age can you introduce full fat cows milk?

A

1 year

55
Q

From what age can a child have semi-skimmed milk?

A

2 years

56
Q

From what age could a child have skimmed milk?

A

5 years

57
Q

What can cause iron-deficiency anaemia in kids?

A

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
Q

Why should you reduce cows milk intake?

A

This will INCREASE APPETITE. Also give vitamin C rich foods with an iron rich meal to help absorption.

59
Q

What could faltered growth plus loose stools plus melena indicate?

A

Cows milk protein allergy.

60
Q

What can you offer a child with CMPA?

A

Extensively hydrolysed formula, Cow and Gate Pepti Junior.

61
Q

Which formulas can you give for all allergies?

A

Cow and Gate Pepti Junior (high MCT), Pregestimil Lipil (high MCT) medium chain triglycerides.

62
Q

When should you give an amino acid formula for a food allergy?

A

Last resort formula.

63
Q

How do you manage faltering growth?

A

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
Q

If a child has a food allergy, how would you approach weaning?

A

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
Q

What are good sources of calcium?

A

Milk, yoghurt, cheese, milky pudding, (3 portions of dairy per day), supplements, sandocal

66
Q

What are good sources of vitamin D?

A

Milk, eggs, oily fish, fortified cereals, and margarine. Majority of vitamin D is obtained from the sunlight NOT diet.

67
Q

What formulas can you use on preterm babies?

A

Cow and gate nutriprem 1, hydrolysed nutriprem (hospital use only). Also breast milk and breast milk fortifier can be used in hospitals only.

68
Q

When can you add coarsely chopped foods into the babies diet?

A

12 months

69
Q

When can you add small sandwiches?

A

18 months

70
Q

Why should cows milk not be used in the young infant?

A

Cow’s milk should not be used in the

young infant due to its deficiency of iron, and vitamins A, C and D.

71
Q

What problems can introducing cows milk too early have?

A

Problems:

  • Iron deficiency anaemia
  • Constipation
  • Cholestasis
72
Q

Why are little calories needed in the first few days?

A

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
Q

When should a baby double in birth/treble weight by?

A

5 months/1 year

74
Q

How soon does a baby need to feed?

A

In the first 2/3 hours of life.

75
Q

What does breast milk contain?

A

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
Q

What does sole breast feeding beyond 6 months lead to?

A

poor weight gain, rickets

77
Q

What is the disadvantage of breast milk concerning vitamin K?

A

Insufficient Vit K in breast milk to prevent haemorrhagic disease
of the newborn

78
Q

When should the baby be fed sat upright with support?

A

6 months

79
Q

When should a baby be fed without support?

A

9 months

80
Q

How do you assess nutrition in kids?

A

Height/age and weight/height

81
Q

What does height/age determine?

A

A measure of stunting and an index of chronic malnutrition

82
Q

What does weight/height determine?

A

A measure of wasting and an index of acute malnutrition

83
Q

What is marasmus?

A

Weight less than 60% of the mean for age. Oedema is not present, reduced skinfold thickness, affected children are
withdrawn.

84
Q

What is kwoshiorkor?

A

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
Q

What is vitamin D deficiency?

A

Deficiency in intake or defective metabolism of Vitamin D causing a low serum calcium.

86
Q

Why does vitamin D deficiency cause bone weak bones?

A

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
Q

What is the presentation of vitamin D deficiency?

A

Bony deformity
o Symptoms of hypocalcaemia – seizures, TETANY, apnoea, stridor
o More common <2years due to high demand for calcium in rapidly growing
bone

Paediatrics (23 decks)

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