Infant Nutrition Flashcards
List 3 differences between paediatric and infant nutrition
- Higher Requirements for Nutrition per kg of body weight
- Immaturity
- Dependence on others
Why do infants have Higher Requirements for Nutrition per kg of body weight?
This is due to mainly increased BMR (60% due to increased energy demand from the brain, liver, heart and kidney – in infants, this counts for 25% of body weight and 6% in adults).
It’s also due to higher activity levels, rapid rate of growth and temperature control.
Describe how immaturity affects nutrition
GIT immaturity due to difference in immune response and mucosal composition. Breastfeeding bridges the immunological gap by coating the infant mucosa with secretory IgA which resists digestion.
Immune system immaturity; during gestation, the infant acquires maternal IgG passively via placental transfer.
Renal system immaturity: children have a poor ability to excrete a large solute load until 3 months of age and so solute composition (e.g. protein and sodium) should be measured, as they’re vulnerable to excess plasma concentrations.
Infants also have a relatively high % of body water compared to adults and thus are at higher risk of dehydration.
Describe how dependence on others affects nutrition
Infants are completely dependent on others for a steady supply of food and water. Caregivers must ensure that they receive the correct balance of nutrients, which aren’t contaminated, at the correct temperature and texture for their age.
What makes a formula?
Mostly based on cow’s milk. More than 5 formulae avaible in Uk; follow guidelines of governments/European commission guidelines.
When are specialized formulae recommended?
for Malabsoprtion, auto-reflux, high energy/nutrient requirements and inborn errors of metabolism. They may be soya based or hypoallergenic, either being hydrolyzed (proteins turned into peptides) or elemental (protein turned to amino acids).
What are the disadvantages of formula?
- Solute load, there is a risk of inaccurate reconstitution.
- Doesn’t confer the advantages of breast milk
- Increased risk of nutrient imbalances if formulation wrong
- Increased risk of infection (esp. concern in developing countries).
What are the advantages of breast feeding?
• Lower risk of GI/respiratory/ear infection along with decreased days hospitalized, decreased GI illness during and beyond the period of breast feeding
• Lower risk of maternal breast cancer
• Nutritionally complete
• Correct temperature
• Appropriate solute load. No risk of inaccurate reconstitution, relatively low protein and sodium,
• High bioavailability
• Food digestibility
Promotes appropriate gut flora
• ??Some evidence of decreased risk of IDDM, IBD, obesity and allergy. The PROBIT study found no difference in obesity at 6 years old (observational studies suggest reduction) PROBIT found no difference in allergy after 6 years but conflicting evidence in retrospective data.
• ??Neurodevelopmental Advantage? PROBIT found the intervention group had better indices of developmental outcome at 6 years, but didn’t take into account maternal IQ interaction with the child being most important.
What are the disadvantages of Breast Feeding?
- Transfer of diseases such as HIV, CMV, hepatitis. For sick infants, banked milk is safe as pasteurized at high temps which destroys TB, HIV. CMV is destroyed by freezing process.
- Transfer of chemical pollutants such as Polychlorinated biphenyls (PCBs), Dioxins. HOWEVER, recent results suggest no effect on growth or neurodevelopment.
What occurs if weaning occurs very prematurely and prematurely
Weaning: the stopping of breast feeding and moving the infant from a liquid to solid diet. Early weaning can cause an increased risk of allergy and obesity. Very early weaning can lead to renal compromise and increased infection risk.
What happens if weaning occurs too late?
Faltered growth, iron deficiency and behavioural feeding problems.
What do UK guidelines suggest for low birthweight babies?
Low birth weight babies (<2.5 kg at term) have lower iron stores at birth, therefore run out of stores earlier. UK guidelines suggest that from 4-6 months combined formula and breastfeeding should be adopted to ensure adequate nutrition.
What are WHO aims for weaning? Initially and later?
exclusive breast-feeding until 6 months of age, then solid foods.
Initial aims include acceptance of new tastes and textures by the infant and to develop oro-motor skills.
Later aims of weaning include increasing nutrient density of food and refining oro-motor skills
