Infant Feeding Pearls Flashcards
The AAP recommends exclusive breast feeding for the first
6 months of life
If breastfeeding is not possible:
an infant, iron fortified formula should be used
Between 4-6 months:
solids should be introduced
Mother’s conditions impacting breastfeeding:
HIV-1, HIV-2
HTLV-1, HTLV-2
Herpes simplex virus is contraindicated only if active breast lesions are present
Tuberculosis infection
Infant conditions impacting breastfeeding:
Classic galactosemia (galactose 1-phosphate uridyltransferase deficiency)
Maple syrup urine disease
Phenylketonuria (partial breastfeeding is possible with careful monitoring)
Medications contraindicated when breastfeeding:
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
First days and weeks: Initially, babies will nurse,
8-12 times a day (or every 2-3 hours) around the clock.
Breast fed babies can lose up to 10% of:
Birth weight, and be slower to regain birth weight
Babies grow on average of
1oz per day of life
Babies should regain birth weight by the:
2 week visit
Until the 2 week visit;3 hours to eat babies should be awakened every:
3 hours to eat
The best way to know that a baby is eating enough is by assessing adequate:
weight gain – wet diapers and stools are not always a solid indication
First days and weeks cont.:
Babies should not be put on a schedule or
be expected to go long periods of time without eating
First days and weeks cont.: Breastfed and formula fed babies frequently will:
“cluster feed” – usually during known growth spurts. I.e.: 2 weeks, 6 weeks and 4 months.
First days and weeks cont.: Formula fed babies will eat every:
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
First days and weeks cont.: Easy way of determining the average amount a baby will take with each feed:
– 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
Introductions of solids:
Solids can be introduced safely when the baby is showing signs of:
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
Introductions of solids: Signs of readiness –
sits up in high chair, interested in family eating, mimicking eating, tongue thrust diminishing
Introductions of solids:
First foods? No longer need to introduce one food over a:
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
Introductions of solids: AAP recommends
iron fortified cereal
Introductions of solids: All solids should be given on a:
Spoon—no rice cereal in the bottle!
Introductions of solids: Other first foods –
– avocado, egg yolk, meats, veggies, fruits
New recommendations for peanut and egg introduction
Introduction of solids cont.: Introducing peanut butter:
Severe eczema, egg allergy or both; Family history of peanut allergy
Recommendation: strongly consider measuring IgE. If negative, may introduce. If positive (>=0.35), send to allergy.
Introduction of solids cont.: Earliest age of peanut introduction:
4-6 months
Introduction of solids cont.: Introducing peanut butter:
Moderate-to-severe eczema
Recommendation: introduce peanut-containing food
Earliest age of peanut introduction: around 6 months
Introduction of solids cont.: Introducing peanut butter:
No eczema or any food allergy
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)
How much should they drink and eat? Expressed breast milk/formula:
Initially and until 6 months:
28 – 32 ounces
How much should they drink and eat? Expressed breast milk/formula:
6 – 12 months:
24 – 28 ounces
How much should they drink and eat? 4 months:
0-1 meal
How much should they drink and eat? 6 months:
1-2 meals
How much should they drink and eat? 9 months:
3 meals
How much should they drink and eat? 12 months:
3 meals and a snack
Goals of feeding: Breast fed baby – continue breast feeding for the:
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
Goals of feeding: Formula fed baby – by 12 month birthday:
taking around 24 ounces of formula with three meals and snack
Goals of feeding: At 1 year of age, transition to:
whole milk – no more than 24 ounces a day and in a sippy cup –
Goals of feeding: At 2 years of age, transition to:
a low fat milk
Goals of feeding: At 2 years of age, life is less bout:
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**
