Infant feeding (not finished)

Question 1

What factors determine birth size and weight?

Answer 1

Genetics

Maternal size

Placental function

Gestation (length, any issues etc)

Question 2

What is the average birth weight of term neonate?

Answer 2

3. 3 kg
4. 3 lbs

Question 3

Proportionally, how much energy & protein does an infant require compared to an adult?

Why is this?

Answer 3

Infants - 100 kcal/kg/day & 2g protein/kg/day

Adults - 35 kcal/kg/day & 1g protein/kg/day

Infants require so much more energy/protein due to the high demand of growth and maintenance, low stores of fat & protein and frequent illness

Question 4

How does the rate of weight gain change in the first year of a baby’s life?

At what age should a baby have…

• doubled in weight?
• tripled in weight?

Answer 4

0-3 months - ~200g per week

3-6 months - ~150g per week

6-9 months - ~100g per week

9-12 months - ~50-75g per week

Double weight by 6 months

Triple by 1 year

Question 5

At what rate do baby’s roughly gain weight and height after 1 year?

Answer 5

2kg per year

5cm per year

(until puberty)

Question 6

Why is breast feeding best?

Answer 6

Nutritionally complete

Improves cognitive development

Reduces risk of infection

Question 7

Why is breast milk nutritionally much better than formula milk?

Answer 7

Better tolerated

Less allergenic

Less renal solute load

Better content of Ca:PO4, iron, LCP Fatty acids

Question 8

Why is breast milk better than formula milk in terms of immunity?

Answer 8

Breast milk provides tailor made passive immunity but also increases the baby’s active immunity

This all leads to reduced infections

Question 9

True or false:

a) Breast milk feeding prevents babies from being exposed to any pathogens
b) Breast milk feeding allows development of the gut mucosa
c) Formula feeding cannot provide vitamin K whereas breast feeding does
d) Formula feeding has a lower risk of causing jaundice than breast milk

Answer 9

a) FALSE - breast milk feeding risks transmission of BBVs & drugs from the mother to the baby. However - the overall risk of infection is lower in breast fed babies.
b) TRUE - breast milk feeding allows development of the gut mucosa
c) FALSE - pretty much the only vitamin that breast milk is missing is vitamin K - which formulas tend to have
d) TRUE - formula feeding does have a lower risk of causing jaundice than breast milk, but breast milk jaundice is pretty normal

Question 10

What is the link between breast feeding and breast cancer?

Answer 10

Breast feeding reduces the risk of breast cancer

Question 11

What are the recommendations on how long a mother should breastfeed their baby?

Answer 11

Exclusively breast feed for first 6 months

Complimentary breastfeeding alongside solid foods after 6 months

Question 12

What are the recommendations on the types of milk that should be used to feed babies?

Answer 12

Breast milk exclusively for 4-6 months

Breast feeding & cows milk formula (or alternative*) for next 6 months

Cows milk not as as main drink until 1 year (no iron)

Question 13

What alternatives exist for cows milk formula?

Answer 13

Pre-term formulae:

• inpatient eg - SMA gold prem 1, C&G nutriprem 1
• post discharge eg - SMA gold prem 2, nutriprem 2
• Higher calorie & protein content

Nutrient dense formulae - eg Infatrini

Cows milk protein allergy formulae

Disease specific formulae

Question 14

How does the volume of feeds change in the first year of a baby’s life?

Answer 14

Starts at 60-70 ml (2.0-2.5 oz)

Increases until it peaks at 6 months at 210-240 ml (7-8 oz)

Then decreases to 100-200 ml at 1 year

Question 15

How does the frequency of feeding change over the first year of a baby’s life?

Answer 15

Starts at 7-8 feeds per day

Gradually decreases over the first year to usually 3 per day at 12 months

Question 16

What alternative formulae can be used in babies with cows milk allergies?

Answer 16

Nutramigen lipil 1 and 2

Alfamino (babies with severe colitis/enteropathy)

Question 17

When is a milk ladder done?

What sort of things are at the bottom & top of the ladder?

Answer 17

Up to a year old

In child with mild/moderate cows milk allergy

To gradually introduce (challenge) them to cows milk when wanting to stop breastfeeding

Start with cookie/muffin (baked) and then progress to cheeses - then to yoghurt and then finally milk by itself

Question 18

Lactose tolerance is caused by _______

When can lactose intolerance occur in babies?

Answer 18

Caused by reduced levels of the enzyme lactase (not an allergy)

1) can just happen
2) Post-gastroenteritis
3) in certain ethnic groups post-weaning

Question 19

Why can a baby with a cows milk allergy not have lactose free ‘comfort’ milks?

Answer 19

They still contain Cows milk protein (CMP)

Question 20

What are the indications for using soy milk formulae?

Answer 20

Milk allergy - when hydrolysed milk formulae refused

Vegan families - because theyre annoying

>1 year on milk free diet - if unlikley to change