Infant nutrition Flashcards
what controls growth of an infant and child
Infant (nutrient-led)
Child (GH-led)
Pubertal (sex steroid-led)
describe the energy balance equation
energy intake is divided into losses e.g. urine and stools and metabolizable energy
Metabolizable energy is then divided into energy expended- BMR, activity, synthesis, thermo-regulation AND energy stored- protein and fat
finish the equation: energy intake= ___ + ___ + ___
energy expended + energy stored + energy excreted
what are energy requirements (kcal/kg/d) for the following:
- 1m
- 3y
- 5y
- 18y
1m: 115
3y: 95
5y: 82
18y: 34
4 components of nutrient supply for the term infant
Human milk
Formula milk
Vitamin supplementation
weaning
benefits of breast feeding
Baby: Nutritional, Gastro-intestinal function, Immunity
Mother
Societal
Contains Lactoferrin, lysozyme and sIgA are whey proteins important in host defence
Human milk contains LCPUFA important for brain/retinal development (AA, C20, n-6, DHA, C22, n-3). Cow’s milk contains only C18 LCPUFA, linoleic (n6) and linolenic (n3) precursors
Bile salt activated lipase
Human milk improves gastric emptying
Human milk important in preventing NEC (necrotising enterocolitis) in the preterm infant
components of breast milk important in immunity
sIgA lactoferrin lysozyme cytokines PAF acetylhydrolase oligosaccharides epidermal GFs cellular elements
role of sIgA
Specific immune response, binds bacterial adherence sites
role of lactoferrin
Inhibits bacterial growth by binding iron
role of lysozyme
Lyses bacterial cell walls
role of cytokines
anti-inflammatory cytokines predominate in human milk, allows human milk to protect but not injure the gastrointestinal tract
role of PAF acetylhydrolase
Inhibits platelet activating factor
role of oligosaccharides
Inhibit binding of enteric/respiratory pathogens epithelial cells
role of epidermal growth factors
Enhance development of gastrointestinal epithelium
role of cellular elements
Neutrophils and macrophages
short term benefits of breast feeding (2)
Improved immunity, less infections and infectious morbidity
This study shows that breastfeeding reduced the risk of sudden infant death syndrome by around 50% at all ages throughout infancy and for as long as the infant is breastfed
6 long term infant benefits of breast feeding
Type 1 and type 2 diabetes.
Obesity: Breastfeeding has been found to generally reduce the risk of obesity.
Allergic disease: There is evidence that breastfeeding for at least four months, compared with feeding infant formula made with intact cow’s milk protein, prevents or delays the occurrence of atopic dermatitis, cow’s milk allergy, and wheezing in early childhood.
Childhood leukaemia: A meta-analysis has concluded that both short-term and long-term breastfeeding reduce the risk of childhood acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML).
Cholesterol levels: adolescents have a reduction of 14% in their ratio of LDL to HDL cholesterol if they were fed breastmilk in infancy.
Blood pressure in young adults.
benefits of breast feeding for the mother
Breastfeeding releases oxytocin, which causes the uterus to contract , and reduces the risk of postpartum haemorrhage
Women who breastfed are at lower risk of:
-Breast cancer : good evidence to suggest that breastfeeding protects against breast cancer-
Biological mechanism: reduced oestrogen exposure
No significant effect of menopausal status
Ovarian cancer : suggestive evidence that lactation protects against ovarian cancer
Also:
Breastfeeding uses calories equivalent to swimming 30 laps in a pool!
societal benefits of breast feeding
Contraceptive effect, better family spacing, improved maternal health, and so improved child health
Less cost to individual families (cost of formula milk)
Less health care costs through reduced hospital admissions in infancy
Less health care costs through both child and adult chronic disease
which babies need vitamins
Current DOH advice is that all babies from 6 months onwards until their 4th birthday require a multivitamin supplement, unless consuming > 500mls formula milk/day
For preterm babies, there is no clear guidance on the gestational limit below which vitamin supplements are needed.
A pragmatic approach would be that babies > 34 weeks are usually able to establish oral feeding reasonably quickly, and are therefore able to ‘catch up’
a nutritional deficit
more rapidly than more
preterm infants.
Healthy start vitamin drops
contain vitamins A, D and C
why is vitamin K given?
prevent haemorrhagic disease of the newborn
Why is vitamin D important in infants
Vitamin D is required for the absorption of calcium and phosphorous from the intestine to enable bone mineralisation.
Vitamin D also has other functions including modulation of cell growth, neuromuscular and immune functio
what illness is caused by vit D def
rickets
infant nutritional intake components by end of 1st year
~500ml breastmilk/formula/full fat milk
3 meals
snacks between meals
multivitamin supplement
choice of milk in preterm infants
Maternal breast milk is the gold standard for feeding any baby, regardless of size or gestation.
For high risk infants, such as the growth restricted preterm infant, using formula milk will increase the baby’s chances of getting NEC 6-10 fold.
Preterm breast milk contains more protein, fat and sodium in the first few weeks of lactation, but this then drops to the same levels as seen in mature milk for term infants within 2-3 weeks (Hill et al, 2001).
The energy needs of the preterm infant can be met by breast milk, especially if mothers are encouraged to express the fat rich hindmilk.
Very small infants (< 1000 grams) may well need higher volumes of breast milk to meet their protein requirements (200+ ml/kg/day). Tolerance and fluid overload may preclude using these higher volumes.
All preterm infants receiving breast milk will need additional phosphorous.
do we need to fortify breast milk for preterm infants and why/not?
Yes- do not lactate according to gestation
what initial weight loss is expected for term babies
5-10%
