Infant Feeding Pearls

Question 1

The AAP recommends exclusive breast feeding for the first

Answer 1

6 months of life

Question 2

If breastfeeding is not possible:

Answer 2

an infant, iron fortified formula should be used

Question 3

Between 4-6 months:

Answer 3

solids should be introduced

Question 4

Mother’s conditions impacting breastfeeding:

Answer 4

HIV-1, HIV-2
HTLV-1, HTLV-2
Herpes simplex virus is contraindicated only if active breast lesions are present
Tuberculosis infection

Question 5

Infant conditions impacting breastfeeding:

Answer 5

Classic galactosemia (galactose 1-phosphate uridyltransferase deficiency)
Maple syrup urine disease
Phenylketonuria (partial breastfeeding is possible with careful monitoring)

Question 6

Medications contraindicated when breastfeeding:

Answer 6

Antineoplastic agents
Fetal death, congenital anomalies, organ system toxicity

Immunosuppressants
Potential suppression of the immune system

Lithium
High potential for toxicity

Chloramphenicol
Blood dyscrasias, aplastic anemia

Ergot alkaloids
Ergotism poisoning

Radiopharmaceuticals
Potential toxicity; brief to full interruption of breastfeeding recommended

Bromocriptine
Suppresses prolactin secretion; hyperprolactinemic mothers taking drug can breastfeed successfully

Iodides
Thyroid suppression

Question 7

First days and weeks: Initially, babies will nurse,

Answer 7

8-12 times a day (or every 2-3 hours) around the clock.

Question 8

Breast fed babies can lose up to 10% of:

Answer 8

Birth weight, and be slower to regain birth weight

Question 9

Babies grow on average of

Answer 9

1oz per day of life

Question 10

Babies should regain birth weight by the:

Answer 10

2 week visit

Question 11

Until the 2 week visit;3 hours to eat babies should be awakened every:

Answer 11

3 hours to eat

Question 12

The best way to know that a baby is eating enough is by assessing adequate:

Answer 12

weight gain – wet diapers and stools are not always a solid indication

Question 13

First days and weeks cont.:
Babies should not be put on a schedule or

Answer 13

be expected to go long periods of time without eating

Question 14

First days and weeks cont.: Breastfed and formula fed babies frequently will:

Answer 14

“cluster feed” – usually during known growth spurts. I.e.: 2 weeks, 6 weeks and 4 months.

Question 15

First days and weeks cont.: Formula fed babies will eat every:

Answer 15

2-3 hours and typically take 1-2 ounces for the first few days/weeks of life – as the baby grows and puts on weight the baby will demand more with each feed

Question 16

First days and weeks cont.: Easy way of determining the average amount a baby will take with each feed:

Answer 16

– divide their weight by 2 and that is the amount of ounces they will typically demand —

Example: 6 lb baby will likely want around 3 ounces with each feed.

Formula fed babies lose less weight initially and are quicker to regain birth weight

Question 17

Introductions of solids:
Solids can be introduced safely when the baby is showing signs of:

Answer 17

readiness – there is no urgency to introduce solids – breast milk/formula is the main source of nutrition for the first 6 months of life regardless of solid introduction

Question 18

Introductions of solids: Signs of readiness –

Answer 18

sits up in high chair, interested in family eating, mimicking eating, tongue thrust diminishing

Question 19

Introductions of solids:
First foods? No longer need to introduce one food over a:

Answer 19

7 day period –
Breast fed babies can have a new food every day
Formula fed babies can have a new food every couple of days

Question 20

Introductions of solids: AAP recommends

Answer 20

iron fortified cereal

Question 21

Introductions of solids: All solids should be given on a:

Answer 21

Spoon—no rice cereal in the bottle!

Question 22

Introductions of solids: Other first foods –

Answer 22

– avocado, egg yolk, meats, veggies, fruits

New recommendations for peanut and egg introduction

Question 23

Introduction of solids cont.: Introducing peanut butter:
Severe eczema, egg allergy or both; Family history of peanut allergy

Answer 23

Recommendation: strongly consider measuring IgE. If negative, may introduce. If positive (>=0.35), send to allergy.

Question 24

Introduction of solids cont.: Earliest age of peanut introduction:

Answer 24

4-6 months

Question 25

Introduction of solids cont.: Introducing peanut butter:
Moderate-to-severe eczema

Answer 25

Recommendation: introduce peanut-containing food
Earliest age of peanut introduction: around 6 months

Question 26

Introduction of solids cont.: Introducing peanut butter:
No eczema or any food allergy

Answer 26

Recommendation: introduce peanut-containing food
Earliest age of peanut introduction: age appropriate and in accordance with family preferences and cultural practices (basically then around 6 months)

Question 27

How much should they drink and eat? Expressed breast milk/formula:
Initially and until 6 months:

Answer 27

28 – 32 ounces

Question 28

How much should they drink and eat? Expressed breast milk/formula:
6 – 12 months:

Answer 28

24 – 28 ounces

Question 29

How much should they drink and eat? 4 months:

Answer 29

0-1 meal

Question 30

How much should they drink and eat? 6 months:

Answer 30

1-2 meals

Question 31

How much should they drink and eat? 9 months:

Answer 31

3 meals

Question 32

How much should they drink and eat? 12 months:

Answer 32

3 meals and a snack

Question 33

Goals of feeding: Breast fed baby – continue breast feeding for the:

Answer 33

first year of life with the introduction and incorporation of solids – three meals a day, snack and breast milk

typically 24 ounces of EBM or 4-5 nursing sessions during the day time hours

Question 34

Goals of feeding: Formula fed baby – by 12 month birthday:

Answer 34

taking around 24 ounces of formula with three meals and snack

Question 35

Goals of feeding: At 1 year of age, transition to:

Answer 35

whole milk – no more than 24 ounces a day and in a sippy cup –

Question 36

Goals of feeding: At 2 years of age, transition to:

Answer 36

a low fat milk

Question 37

Goals of feeding: At 2 years of age, life is less bout:

Answer 37

milk and more about the fat, calcium and vit d – keep in mind as some breast fed babies who wean do no take to whole milk**