infant nutrition Flashcards

Question

milk ladder

Answer 1

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

Answer 2

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

Answer 3

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)

Answer 4

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

Answer 5

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

Answer 6

well kids calcium liquid or calcium softies breast feeding mums OTC supplement, accrete or cacit D3

Answer 7

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

Answer 8

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

Answer 9

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

Answer 10

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

Answer 11

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

Answer 12

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

Answer 13

distaste, distrust, contamination influence intake constipation, anaemia and GOR may be a factor

Answer 14

repeatedly offer a variety of foods parents can exacerbate food refusal

Answer 15

effortless passage of gastric contents into oesophagus w/ or w/o regurgitation and vomiting doesn't need special tests or affect growth

Answer 16

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

Answer 17

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

Answer 18

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

Answer 19

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

Answer 20

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

Answer 21

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

Answer 22

**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

Answer 23

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

Answer 24

110-118mins/day 0-6wks 72mins/day 10-12wks

Answer 25

diagnosis of exclusion inconsolable crying in a baby - \<3mths old, \>3hrs/day, \>3days/wk for at least 1 wk no red flag symptoms

Answer 26

explanation and reassurance probiotics trial of cows milk protein avoidance lactase drops anti spasmodics

Answer 27

breast fed - functional lactose overdose all babies - cows milk protein allergy, psychosocial issues, maternal mental health

Answer 28

normal to open bowels 3x/day to 3x/wk aim for type 4 stools (sausage) constipation can occur at any age, ⅓ of children

Answer 29

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

Answer 30

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

Answer 31

for the dietary management of colic and constipation * no evidence based benefit * use of prebiotics and palminate * partially hydrolysed whey protein

Answer 32

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

Answer 33

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

Answer 34

**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

Answer 35

most common nutritional deficiency worldwide iron status at birth is the most important determinant of iron status throughout infancy

Answer 36

neonatal 6mths-3yrs * if iron deficiency present, check FBC/ferritin

Answer 37

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

Answer 38

learning to feed self and find food picky eaters XS milk intake dependent on carer, frequent illness

Answer 39

learning to be independent chronic disease obesity

Answer 40

independent, puberty, eating disorders

Answer 41

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