Infant Nutrition

Question 1

When should folic acid supplementation start and what doses of folic acid should be given to low, moderate and high risk patients?

Answer 1

Supplementation should be initiated 3 months before pregnancy and continued until 4-6 weeks after pregnancy, or so long as mom is breastfeeding.
Low risk: 0.4-1mg dy
Moderate risk: 1mg until 12 weeks gestation, then 0.4-1mg dy
High risk: 1mg + 3x1.0mg or 5mg until 12 weeks, then 0.4-1mg dy

Question 2

Differentiate between moderate and high risk patients in regards to folic acid deficiency

Answer 2

Moderate: personal or family history, if mother has diabetes, teratogenic medications, or GI malabsorption
High: personal history or previous NTD pregnancy

Question 3

When is iron supplementation important, and what dose?

Answer 3

Important during later pregnancy and 27mg daily

Question 4

How much extra should mother ben eating during pregnancy?

Answer 4

2-3 extra servings per day (340-450 calories) in the second and third trimester

Question 5

What foods should mother be cautious of during pregnancy?

Answer 5

Caffeine: up to 300mg/day
Fish: avoid large fish
Listeriosis: avoid unpasteurized milk, soft cheeses, and raw/undercooked meat

Question 6

How much extra food should mom have during breastfeeding?

Answer 6

500 extra calories a day
Drink a glass of water each time they breastfeed
Supplement with 1000mg calcium/day

Question 7

What are benefits of breastfeeding for the mother?

Answer 7

Reduced postpartum bleeding
weight loss
reduced risk of breast and ovarian cancer
improved bone health

Question 8

What are the 3 types of breastmilk?

Answer 8

Colostrum: the first milk produced when the baby is born. Rich in proteins and other nutrients. Changes to breastmilk within 72 hours
Foremilk: released at the beginning of a feeding, watery and satisfies thirst
Hindmilk: released as feeding continues, rich, fatty and satisfies hunger

Question 9

How do you know if the baby is getting enough food?

Answer 9

6+ wet diapers daily

Stool is soft, yellow and seedy

Question 10

What are the 5 main types of infant formula?

Answer 10

Cow milk-based formulas
Lactose-free cow milk-based formulas
Soy protein isolate-based formulas
Hydrolyzed protein formulas
Amino-acid based formulas

Question 11

Describe cows milk-based formulas

Answer 11

May have added arachidonic acid/DHA

Some may have low-iron formulas because it causes constipation, but formulas should have iron!!

Question 12

When should we consider lactose-free cow milk-based formulas?

Answer 12

Congenital lactase deficiency, or after a bout of diarrhea

Need to consider carefully before switching, as lactose is important in mineral absorption and bacterial colonization

Question 13

When should we consider soy protein isolate-based formulas

Answer 13

Recommended for galactosemia or congenital lactase deficiency, or if a vegetarian diet is desired
Should not be used if child has a milk protein allergy, as there’s potential cross reactivity

Question 14

When should we consider hydrolyzed protein formulas?

Answer 14

For infants intolerant to intact cow milk protein and soy proteins, may be useful for infants with malabsorptive disease.
Proteins have been broken into peptide chains and free amino acids

Question 15

When should we consider amino-acid based formulas?

Answer 15

In infants with severe milk protein hypersensitivities, or malabsorption-associated diseases when hydrolyzed formulas don’t work

Question 16

Should we supplement infants with iron?

Answer 16

May not be necessary for all infants
Iron stores in breastfed babies are depleted after 4-6 months as breastmilk is low in iron. Important for formulas to be iron-fortified
Deficiency can impact cognitive development

Question 17

Should we supplement infants with vitamin D?

Answer 17

Breastfed babies require 400 IU vitamin D supplementation daily, and more in northern communities
Formula fed babies only require supplementation if in northern communities

Question 18

When can infants start having food? What kind of food is good for first foods?

Answer 18

~6 months, when baby seems hungrier, has good control of neck muscles, and can show interest/disinterest
First foods should be a good source of iron, such as single-grain iron-fortified infant cereal.
New foods should be introduced one day at a time, 3-5 days apart to identify allergic reactions– should not delay introduction of allergens!