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Y3 paediatrics > infant nutrition > Flashcards

infant nutrition Flashcards

1
Q

why is nutrition important

A
  • fundamental aspect of life
  • first 1000 days - provide best start to life
  • growth: increasing size, change in brain and body structure, composition and function
  • prevention of disease
  • prevention of malnutrition - responsible for ~50% of all preventable deaths <5y/o
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2
Q

recognised phases of childhood

A

neonate <4w

infant <12m

toddler ~1-2y

pre-school ~2-5y

school age

adolescent

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3
Q

recognised phases of growth and what drives them

A

infant - nutrition led

  • rapid phase of growth in neonates and infants

child - growth hormone led

pubertal - sex steroid led

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4
Q

what influences birth size and weight

A

some genetics

maternal size

maternal health e.g. gestational diabetes

placental function

gestation - 95% of weight gain between 20-40wks, 10-16% of body weight is fat

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5
Q

average term infant weight

A

3.3kg

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6
Q

what is energy needed for

A

physical activity

thermogenesis

tissue maintenance

growth

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7
Q

what determines energy requirement

A

energy expended + energy deposited in new tissue

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8
Q

growth demands during childhood

A

~35% of energy intake in infants but falls for rest of childhood (0-3mths is when there is the highest energy requireement)

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9
Q

why is infant nutrition important

A

need to fuel rapid growth and maintenance

  • infants can become rapidly malnourished
  • high demands for growth and maintenance
    • 100kcal/kg/day and 2g protein/kg day (adults 35kcal and 1g protein/kg/day)

infant is dependent on carer, low stores of fat and proteins and frequent illness

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10
Q

average weight gain for infants

A

0-3mths 200g/wk

3-6mths 150g/wk

6-9mths 100g/wk

9-12mths 75-50g/wk

double weight by 6mths and triple by 1yr

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11
Q

growth in children

A

after 1yr ~2kg and 5cm/yr until puberty

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12
Q

weight loss in children

A

4kg baby w/ 4wks of static weight - 20% underweight

like an adult losing 20kg

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13
Q

why is breastfeeding recommended

A

nutritionally complete feed for full term babies

  • well tolerated, less allergenic, low renal solute load, Ca:Po4, iron, LCP FAs
  • improves cognitive development
  • reduces risk of infection: macrophages and lymphocytes, interferon, lactoferrin, lysozyme, bifidus factor
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14
Q

breast milk vs formula

A

BREAST MILK:

  • ‘perfect’ nutrition for 6mths, ‘near perfect’ for up to 1yr
  • tailor made passive immunity, development of infant’s active immunity, development of infant’s gut mucosa, reduced infection, antigen load minimal
  • reduced risk of breast cancer for mum

FORMULA:

  • no anti-infection properties, risk of contamination, high antigen load
  • no transmission of BBVs/drugs, doesn’t need mum, accurate feed volumes, provides vit k, less jaundice
  • expensive
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15
Q

what age is breastfeeding recommended until

A

exclusively BF till ~6mths

from 6mths, complementary feeding alongside solids, supported up to 2y/o or beyone

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16
Q

human milk fortifiers

A

commonly used as a dietary supplement when babies are premature - esp <33wks

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17
Q

UNICEF baby friendly - 10 steps

A
  1. written breast feeding policy
  2. train all health care staff in skills
  3. inform all pregnant women about pros/management of breasfeeding
  4. help mother’s initiate breastfeeding within 30mins of birth
  5. show mothers how to breasfeed and maintain lactation, even if they should be separated from their infants
  6. give newborn babies no food/drink other than breast milk unless medically indicated (meds, vits, oral rehydration)
  7. rooming in: allow mothers and infants to remain together 24h/day
  8. encourage breast feeding on demand
  9. no artificial teats or dummies to breastfeeding infants
  10. establishment of breast feeeding support groups and refer mothers to them on discharge from hospital/clinic
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18
Q

what to do if breast feeding isn’t possible

A

support families who formula feed to do so as safely as possible

standard formula are cow’s milk based

various brands available - no significant difference, use whey dominant ‘first milks’

powder or ready to feed

various compositions based on age

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19
Q

normal feeding patterns

A
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20
Q

types of milk for infants

A

standard first infant formula - cows and goat milk based, 66kcal and1.2g protein/100ml

hypoallergenic

lactose free

anti-reflux and comfort milks

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21
Q

standard infant formula availabel

A
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22
Q

other types of formula

A

pre-term: powder and ready to feed, 80kcal adn 2.6-2.9g protein/100ml

post discharge - poswer and ready to feed, 72-73kcal and 2g protein/100ml

nutrient dense - 100kcal and 2.6g protein/100ml

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23
Q

cow’s milk protein allergy - 1st and 2nd line formula feeds

A

1st line: extensively hydrolysed protein feeds, 90% should respond, palatability a problem in older babies

2nd line: aa based feeds: (for the 10% that react to 1st line) babies w/ severe colitis/enteropathy/symptoms on breast milk, overprescribed and expensive

HA formula no longer suitable for babies w/ cow milk protein allergy

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24
Q

cow milk protein formulae w/ added probiotic

A

aptamil pepti syneo: whey based extensively hydrolysed formula, bifidobacterum breve M-16V

neocate syneo: aa, bifidobacterium breve M-16v

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25
Q

milk ladder

A

milk-free diet for ~6mths-1yr

infants generally do well with the milk ladder

start with baked milk (less allergenic) build up quantity if tolerated, add cheese, yoghurt then cow’s milk

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26
Q

soya infant formula

A

not used in cow’s milk allergy - cross reactivity

carbohydrate source is maltodextrin - greater potential to cause dental caries

phytoestrogens posed a potential risk- most concern <6m/o, limited evidence on risks to reproductive safety

suitable for vegetarians - no vegan infant formulae available

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27
Q

millk over 1y/o

A

follow on formula - no evidence of any nutritional/health advantage in using

introduce non-formula milks - cow’s, soya, alternatives

  • goat’s and sheep millk - many children w/ milk allergy will react to
  • oat, pea, coconut, hemp and nut milks
  • rice milk - not advised for <5y/o

some children w/ allergy may require prescription milk - aa (neocate jr)

28
Q

lactose free infant formula

A

lactose intolerance isn’t an allergy

  • seen to a minor degree in some breast fed babies
  • also in certain ethnic groups post weaning

for 2y lactose intolerance:

  • short lived condition e.g. post-gastroenteritis
  • confused w/ cow’s milk proten intolerance
  • lactose free milks aren’t CMP free
29
Q

calories and calcium in full fat cow’s milk

A

65kcal/100ml and 120mg Ca/100ml

organic/unsweetened milk substitutes are low in calories

organic milks aren’t calcium supplemented

need 400-500ml of calcium fortified ‘milk’ to meet calcium requirements

30
Q

supplements if <500ml calcium fortified substitute

A

well kids calcium liquid or calcium softies

breast feeding mums OTC supplement, accrete or cacit D3

31
Q

stages of developmental progress - liquids

A

up to 6mths - breast/formula

~6mths - cp may be introduced w/ adult support, along w/ breast/bottle

6-9mths - baby continues to develop stability w/ cup drinking, normal to lose some liquid

12mths - tongue may protrude under the cup to provide stability

18mths - may bite on side of cup to stabilise

2yrs - should be able to stabilise cup

32
Q

stages of developmental progress - solids

A

17wks-6mths - pureed foods

~6mths - thicker consistency, some lumps, soft finger foods introduced under supervision, may initially spit out food, gradually learn to suck from the spoon

6-9mths - increase variety of textures and tastes, finger foods gradually introduced under supervision

9-12mths - mashed, chopped and minced, finger foods gradually increased

12mths - mashed, chopped family foods, thicker food from a spoon, variety of finger foods

18mths - introduction of new tastes and textures, increasing variety of finger foods

33
Q

solids - when are they introduced, how to tell baby is ready

A

complementary feeding alongside milk

baby is developmentally ready to actively accept foods

starts around 6mths (17-26wks) - look for signs of readiness, head control, interest in food

96% families wait until at least 4mths, 46% till 6mths

34
Q

why are solids introduced into the baby’s diet

A

transition from milk to a mixed diet - nutritional and developmental changes

milk alone is inadequate - require new sources of protein/energy/vits/minerals/trace elements, encourage tongue and jaw movements in preparation for speech and social interaction

35
Q

pre-term weaning - when is baby ready

A

support themselves in a seated position - premature babies might need extra support

hold their head in a stable position

show an interest in other people eating

lean forward and open their moth towards a spoon/food

put things to their mouth and make munching, up and down movements

  • wait until you see a few of these signs before starting weaning
36
Q

what is neophobia

A

fear of something new

food refusal is a normal part of child development - most resolve w/ time

rejection of novel/unknown foods in childhood, usually peaks around 18mths

37
Q

what can influence neophobia

A

distaste, distrust, contamination influence intake

constipation, anaemia and GOR may be a factor

38
Q

how to increase acceptance of food in neophobia

A

repeatedly offer a variety of foods

parents can exacerbate food refusal

39
Q

GOR in babies

A

effortless passage of gastric contents into oesophagus w/ or w/o regurgitation and vomiting

doesn’t need special tests or affect growth

40
Q

GORD in babies

A

when the reflux of gastric contents causes troublesome symptoms and/or complications

41
Q

how common is GOR in babies

A

vomiting is common in babies

normal physiological phenomenon - effortless vomiting w/ no discomfort

40-70% of babies regurgitate 1-4x daily or more

peaks at 3-4mths

refluxed milk is pH neutral for 2hrs post feed

42
Q

managing GOR in babies

A

babies are well

reassure parents over natural course

advice of feeding - overfed? (check vol 150ml/kg)

improves from 6mths w/ solids and sitting upright - may suggest early weaning, minimum 17wks

need no specific treatment

thickened formula/thickener or if no improvement consider 2-4wk trial of milk free diet

43
Q

thickeners and thickened infant formula

A

infant gaviscon sachets - not an antacid

carobel 5kcal/100ml

use large hole or variable flow teat

thickened milks (not normally recommended) - contain potato starch/carob/locust bean gum), mix w/ cool water

44
Q

red flags in reflux

A

weight loss or poor weight gain

recurrent or bilious vomiting

GI bleeding

persisting diarrhoea

dysphagia

stridor/cough/hoarseness

high risk groups: preterm babies, neurological impairment, chronic resp illness, anatomical, some genetic disorders e.g. Down’s syndrome

45
Q

GORD treatments

A

medical referral

require acid suppression - reduced gastric acid may increase risk of pneumonia, gastroenteritis and candidiasis

trial of milk free diet

continuous gastric feeds or move to jejunal feeds

consideration of anti reflux surgery

drug therapy

46
Q

drug therapy for GORD

A

alginate therapy - e.g. gaviscon liquid, ?1ml after feeds for babies, lnot advised <1yr

H2 receptor - ranitidine

PPIs - decrease acidity but we are looking to reduce quantity of acid produced, omeprazole/lansoprazole/esomeprazole for tubes

pro-kinetics - domperidone to promote gastric emptying, use restricted to short term only for N/V not long term use in GORD, ECG prior to use

anti-histamine - alimemazine, reduces nausea

47
Q

feeding problems in babies

A

refusal to feed and excessive crying in a baby isn’t always reflux

48
Q

how often do babies cry

A

110-118mins/day 0-6wks

72mins/day 10-12wks

49
Q

what is colic

A

diagnosis of exclusion

inconsolable crying in a baby - <3mths old, >3hrs/day, >3days/wk for at least 1 wk

no red flag symptoms

50
Q

management of colic

A

explanation and reassurance

probiotics

trial of cows milk protein avoidance

lactase drops

anti spasmodics

51
Q

other issues in babies w/ difficulty feeding

A

breast fed - functional lactose overdose

all babies - cows milk protein allergy, psychosocial issues, maternal mental health

52
Q

normal bowel function in babies

A

normal to open bowels 3x/day to 3x/wk

aim for type 4 stools (sausage)

constipation can occur at any age, ⅓ of children

53
Q

constipation in children

A

no bowel movement for 3 or more days

passing lots of small hard stools

when the bowel is full - soiling, loose stools that leak

holding on to stools - pushing, red face, avoidance techniques

54
Q

management of constipation

A

laxatives - lactulose in infants, movicol/laxido in older children

adequate fluid intake encouraged

fruit, veg and wholegrain intake encouraged

constant routine - sitting on potty/toilet after meals

praise and encouragement

55
Q

comfort infant formula

A

for the dietary management of colic and constipation

  • no evidence based benefit
  • use of prebiotics and palminate
  • partially hydrolysed whey protein
56
Q

vitamin D - who is at risk of deficiency

A

reduction when housebound or during COVID lockdown

dark skinned children not on vitamin drops are at risk of deficiency

also risk of deficiency when prolonged breast feeding and mum not of vit D

57
Q

poor vit D status among scots

A

higher risk of poor MSK health e.g. rickets, poor muscle strength

can synthesise vit D from april-sept 11am-3pm

diet is a poor source

58
Q

supplements for children

A

all babies from birth-1yr - 8.5-10ug vit D, not required if infant formula >500ml

everyone >1 - 10ug vit D

healthy start vitamins - >1mth, 233ug A, 200mg C, 7.5ug D

abidec/dalivit - 0.3ml (<1), 0.6ml (>1yr)

suggest OTC children’s vitamins

59
Q

iron deficiency

A

most common nutritional deficiency worldwide

iron status at birth is the most important determinant of iron status throughout infancy

60
Q

what are the periods of peak brain development

A

neonatal

6mths-3yrs

  • if iron deficiency present, check FBC/ferritin
61
Q

causes of iron deficiency

A

breast fed/pre term

cow’s milk - introducing as a drink before 1y, more than 500ml to drink after 1y

too much juice - drink after meals and with snacks, only milk and water are tooth friendly

no structure to meals/snacks and offering choices

62
Q

nutrition issues in toddlers and pre-school children

A

learning to feed self and find food

picky eaters

XS milk intake

dependent on carer, frequent illness

63
Q

nutrition issues in school age

A

learning to be independent

chronic disease

obesity

64
Q

nutrition issues in adolescents

A

independent, puberty, eating disorders

65
Q

other considerations to nutrition issues beyond infancy

A

high levels of deprivation

  • infants born to parents in the most deprived areas are 1.7x more likely to be born w/ low birth weight compared to the most affluent area
  • children who live in the most deprived areas are 2x as likely to be obese at 5y/o compared to the most affluent area

impact of COVID

Y3 paediatrics (45 decks)

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