Infant Nutrition 2

Question 1

Water

Answer 1

Breast milk or formula provide adequate hydration for healthy infants up to 6 months
All forms of fluid contribute to water intake
Additional plain water needed in hot, humid climates
Dehydration is common in infants with illness

Question 2

How infants learn food preferences

Answer 2

Based on experience with good 
Flavour of breast milk by mothers diet 
Genetic predisposition to sweet taste 
Food preference from infancy sets stage for lifelong food habits 
Positive parental modelling 
Non threatening and relaxed environment

Question 3

Supplements for infants

Answer 3

Fluoride for breastfed infants post 6 months or if in area with no fluoridated water
Iron if mother is anaemic and preterm infants (recommended fortified foods from 6 months)
Vit B 12- if mother vegan and exclusively BF or infant vegan
Vit D if low sun exposure / exclusively breastfed/ mum deficient

Question 4

Failure to thrive- weight loss or poor weight gain

Answer 4

Organic - diagnosed medical illness
Inorganic not based on medical diagnosis
Not just as simple as increasing energy and protein
May be complex and involve a team approach including the dietitian

Question 5

Colic

Answer 5

Sudden onset of irritability, fussiness or crying (often lasting >3 hours)
Episodes may appear at the same time each day
Cause unknown but associated with GI upset, infant feeding practices
Recommendations: rocking, bathing, swaddling, burping to relieve gas, mothers diet

Question 6

Constipation / diarrhoea

Answer 6

Infants typicalknhave 2-6 stools per day 
Can be caused by virus or bacteria
Infection
Food intolerance
Change in fluid intake 

Diarrhoea:
Continue to feed as normal 
Adequate fluids 
Constipation:
Ensure adequate fluid 
Prime or some other fruit juice

Question 7

Prevention of baby bottle caries and ear infections

Answer 7

Linked to feeding practices
Techniques to reduce: 
Limit use of bedtime bottle
Offer drink in cup
Only give water bottles at bedtime
Examine and clean emerging teeth

Question 8

Food allergies and intolerances

Answer 8

About 6-8% of children <4!63/5: have allergies
Early diet appears to play a role
Absorption of intact proteins causes allergic reactions
Common symptoms are wheezing or skin rashes
Common foods: eggs, cows milk, peanuts
BF exclusively for 6 months decreases associated risk
FPIES: food protein induced enterocolitis syndrome
Treatment may consist of formula with hydrolysed proteins- diagnosed cows milk allergy exclusively HA. Infant high risk is partially HA
Continue BF whilst allergens are introduced
Optimum timing of food introduction to high risk infants is debatable, but 6 months perfect time to promote tolerance
No evidence for mothers to restrict diet during pregnancy and lactation to prevent allergies
Infants diagnosed with atopic disease maternal diet restriction is less conclusive

Question 9

Lactose intolerance

Answer 9

Inability to digest the disaccharide lactose
Characterised by cramps, nausea and pain and alternating diarrhoea and constipation
Lactose intolerance is uncommon and tends to be overestimated
GI infections may cause temporary LI
Many infants outgrow lactose intolerance
Recommendations are LF formula

Question 10

Cross cultural considerations

Answer 10

Commercial baby foods do not reflect ethnic diversity
Some cultural practices are harmful; others are harmless or helpful
Other safe alternative or discourage

Question 11

Vegetarian diets

Answer 11

Infants receiving well planned vego diets grow normally
Breastfed vegan infants need supplements:
Vit D
Vit B12
Possibly iron and zinc
Fortified foods

Question 12

Severe preterm birth and nutrition

Answer 12

Nutrition support generally required
High metabolic rates
Protein requirements are much higher
Very late term infants are unable to duck

Preterm infants fed by nutrition support
Parenteral nutrients delivered directly to the blood stream then enteral nutrients delivered directly to the GI tract
Feed;
Breast milk
Human milk fortifier
Preterm infant formulas- vary in caloric content, MCT oil, whey protein, increase PR, Ca, PO4, Fe

Question 13

Feeding problems with VLBW and LBW infants

Answer 13

Feeding problems seen in 40-45% 
Challenges include fatigue, low tolerance of volume, disorganised feeding 
Nutrition interventions: 
Frequent growth assessment 
Monitor intake 
Adjust feeding frequency/ volume 
Adjust timing of nursing, snacks or meals
Assess feeding position and support 
Nutrient density to facilitate feeding 
Parent education 
Observe parent infant interactions 
Consider developmental ability