Infant Feeds Flashcards
What are the different phases of childhood?
- Neonate
- <4 weeks
- Infant
- <12 months
- Toddler
- 1-2 years
- Pre-school
- 2-5 years
- School age
- Teenager/adolescent
What factors lead the growth in the following phases:
- infant
- child
- pubertal
- Infant
- Nutrition led
- Child
- Growth hormone led
- Pubertal
- Sex hormone led
What is birth size and weight impacted by?
- Maternal size
- Placental function
- Gestation
- 95% of weight between 20-40 weeks
- 10-16% of body weight as fat
What is the size of the average term infant?
3.3kg
What is energy required for?
- Physical activity
- Thermogenesis
- Tissue maintained
- Growth
Why are children at risk of inadequate nutrition?
- Characteristic feature is need to fuel both rapid growth and maintenance
- Infants can become rapidly malnourished
- Dependent on carer
- High demands for growth and maintenance
- Infants 100kcal and 2g protein/kg/day
- Adults 35kcal and 1g/kg/day
- Low stores (fat and protein)
What is the average weight gain in g/week for:
- 0 to 3 month old
- 3 to 6 month old
- 6 to 9 month old
- 9 to 12 month old
- 0 to 3 months
- 200g
- 3 to 6 months
- 150g
- 6 to 9 months
- 100g
- 9 to 12 months
- 50 to 75
By when does a baby double its weight, and then triple?
Babies double weight by 6 months and triple by 1 year:
- After 1 year, about 2kg and 5cm/year until puberty
What is growth monitred by?
Growth charts
How much calories and protein per day do:
- children require
- adults require
- Infants 100kcal and 2g protein/kg/day
- Adults 35kcal and 1g/kg/day
Why is weight maintenance for children like an adult losing weight?
With children, weight maintenance is like adults losing weight, as they should be growing
Why is breast feeding the best form of feed?
- Well tolerated
- Less allergenic
- Low renal solute lead
- Calcium, phosphate, iron, fatty acids
- Improves cognitive development
- Reduces risk of infection
- Macrophages and lymphocytes
- Interferon, lactoferrin, lysozyme
- Bifidus factor
Compare and contrast breast milk and formula?
When is breast feeding recommended until?
- Exclusively breast feeding to around 6 months
- From 6 months, complementary breast feeding alongside solids is supported
What are some of the principles of UNICEF baby friendly “ten steps”?
- Written breast feeding policies communicated with staff
- Train all health care staff to implement policies
- Inform all pregnant woman about the benefits of breast feeding
- Help mothers initiate breastfeeding within a half hour of birth
- Show mothers how to breast feed
What are standard formula milks prepared from?
Cow milk
What does specialised formula exist for?
- Specialised formulas exist for cow milk protein allergy
- Nutrient dense
- Disease specific
When is cow milk not suitable as the main drink before and why?
Cows milk not suitable as main drink until 1 year as they contain no iron
What are some examples of available formula milk?
- Pre-term formula
- Typically higher in protein (2g vs 1.5g) and higher calorie (80kcal vs 67kcal) / 100ml
- Nutrient dense formula
- 100kcal/100ml
- Cows milk protein allergy
- Disease specific
Describe the normal feeding pattern (volume, times per day, suggested milk intake per day) for:
- up to 2 weeks
- 2 weeks to 2 months
- 2 to 3 months
- 3 to 5 months
- 6 months
- 7 to 9 months
- 10 to 12 months
Cow’s milk protein allergy - epidemiology
- Most common allergy in infants
Cow’s milk allergy - management
- Nutramigen
- First line feed of choice
- Amino acid based feed
- Second line based feed
- Indications – severe colitis/enteropathy breast milk
What is the first and second line feeds for cow milk protein allergy?
- Nutramigen
- First line feed of choice
- Amino acid based feed
- Second line based feed
- Indications – severe colitis/enteropathy breast milk
At what age do babies begin the milk ladder?
When babies reach one year begin milk ladder:
- Slowly introduce more dairy into diet
What are indications for lactose free milks?
- Lactose intolerance
What can lactose intolerance be secondary to?
Can occur primary or secondary, due to:
- Short lived conditions such as post-gastroenteritis
What are possible complications of soya milk usage?
They are high in phytoestrogens, complications:
- Which can be concerning in infants under 6 months
- Cross reactivity with cows milk
What are indications for soya milk?
- Milk allergy when hydrolysed formula refused
- Vegan families, if not breast fed
- Consider for children > 1 year still on milk free diet
What are some non-formula milks other than cow milk?
- Soya milk
- Lactose free milk
- Rice milk
- Not advice for children under 5 years
- Goats and sheeps milk
- Not suitable for under 1st
- Many children react
- Oat and nut milk
- Organic versions
- Are not calcium fortified
How do organic/unsweetended versions of cow milk compare in calories and calcium to cow milk?
Full fat cows milk:
- 65kcal/100ml and 120mg calcium/100ml
- Organic/unsweetened milk substitutes low in calories
- Organic milks have no calcium supplemented
How much calcium fortified milk is required to meet calcium requirements?
Need 400-500ml of calcium fortified milk to meet calcium requirements:
- Supplement if <500ml calcium fortified substitute
- Alliance calcium liquid or if >3 years calcium softies
- Breast feeding mums Accrete or Cacit D3
When should a calcium supplement be given?
- Supplement if <500ml calcium fortified substitute
- Alliance calcium liquid or if >3 years calcium softies
- Breast feeding mums Accrete or Cacit D3
When do solids start getting used?
Used in complementary feeding in the transition from milk to mixed diet:
- Nutritional and developmental changes
Starts around 6 months of age (17-26 weeks):
- Look for signs of readiness
- Head control, interest in food
What are signs of readiness to try solids?
- Head control, interest in food
Why introduce solids to a babies diet?
- Milk alone inadequate
- Encourage tongue and jaw movements in preparation for speech and social interactions
- Neophobia
- To reject novel or unknown foods in childhood, increase acceptance by repeatedly offering a variety of foods
- Common
What is neophobia?
- Neophobia
- To reject novel or unknown foods in childhood, increase acceptance by repeatedly offering a variety of foods
- Common
What is weaning?
Weaning = introducing babies to solid food
What should you wait until before you start weaning?
Wait until they can support there own head
What solids can be given to babies of the following ages:
- 17 weeks to 6 months
- around 6 months
- 6 to 9 months
- 9 to 12 months
- 12 months
- 18 months
Why is vitamin D often low?
- Dark skinned children at risk
- Diet is a poor source, most comes from the sun
How much vitamin D should be given as supplement for:
- birth to 1 year
- everyone over 1 year
- Birth to 1 year
- 8.5-10ug
- Not required if infant formula >500ml
- Everyone over 1 year
- 10ug
What are the different kinds of reflux?
- GOR
- Effortless passage of gastric contents into oesophagus with or without regurgitation and vomiting
- GORD
- When the reflux of gastric contents causes troublesome symptoms and/or complications
What is GOR and GORD?
- GOR
- Effortless passage of gastric contents into oesophagus with or without regurgitation and vomiting
- GORD
- When the reflux of gastric contents causes troublesome symptoms and/or complications
GOR - epidemiology
(how common, age)
- Vomiting common in babies
- Peaks at 3-4 months
DOR - management
- Reassurance over natural course
- Advice on feeding, check if overfed
- No specific treatment
- Thickened formula
- Infant Gaviscon sachets
- Carobel
- If no improvement
- Trial or milk free diet
What are examples of thickended formulas that can be given for GOR?
- Thickened formula
- Infant Gaviscon sachets
- Carobel
What are red flag signs for reflux?
- Weight loss or poor weight gain
- Recurrent or bilious vomiting
- GI bleeding
- Persisting diarrhoea
- Dysphagia
- Stridor/cough/hoarseness
Who are high risk groups of reflux?
- Preterm babies
- Neurological impairment
- Chronic respiratory illness
- Anatomical
- Genetic disorders such as down syndrome
GORD - treatment
- Acid suppression
- Reduced gastric acid may increase risk of pneumonia, gastroenteritis and candidiasis
- Trial of milk free diet
- Continuous NG/jejunal feeds
- Consideration of anti-reflux surgery
- Drug therapy
- Gaviscon liquid – 1st line
- H2 receptor antagonist (Ranitidine)
- Proton pump inhibitors (Omeprazole/Lansoprazole)
- Pro-kinetics (Domperidone to promote gastric emptying, or low dose erythromycin)
- Only short term
- Anti-histamine (Alimemazine)
What drug therapy can be used for GORD?
- Gaviscon liquid – 1st line
- H2 receptor antagonist (Ranitidine)
- Proton pump inhibitors (Omeprazole/Lansoprazole)
- Pro-kinetics (Domperidone to promote gastric emptying, or low dose erythromycin)
- Only short term
- Anti-histamine (Alimemazine)
What are the normal crying times for:
- 0 to 6 weeks
- 10 to 12 weeks
What are common issues that cause feeding problems?
- In bread fed baby
- Functional lactose overdose
- All babies
- Cows milk protein allergy
- Psychosocial issues
- Maternal health issues
- Colic
What is colic?
Inconsolable crying in a baby:
- <3 months of age, >3 hours/day, >3 days/week
- For at least a week
No red flag symptoms
What is the criteria to be colic?
Inconsolable crying in a baby:
- <3 months of age, >3 hours/day, >3 days/week
- For at least a week
Colic - treatment
- Explanation and reassurance
- Probiotics
- Trial of cows milk protein avoidance
- Lactase drops
- Anti spasmodics
Iron deficiency - aetiology
- Breast fed/pre term
- Cow’s milk
- Not fortified with iron like formula
- Too much juice
- No structure to meals/snacks
- Constipation
Iron deficiency - epidemiology
(how common)
- Most common deficiency in the world
Iron is particularly important for development of what organ?
Iron important for brain development, periods of peak brain development:
- Neonatal period
- 6 months to 3 years
When are periods of peak brain development?
- Neonatal period
- 6 months to 3 years
What are examples of nutritional issues beyond infancy:
- toddler and pre-school
- school age
- adolescent
- Toddler and pre-school
- Picky eaters/excess milk
- Dependent on carer
- Frequent illness
- School age
- Learning to be independent
- Chronic disease
- Obesity
- Adolescent
- Independent
- Puberty
- Eating disorders
