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SPRING16 N833 Adv Pedi > Infant & Toddler Feeding > Flashcards

Infant & Toddler Feeding Flashcards

1
Q

What were the millenium developmental goals?

A

UN Initiative 2000-2015

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2
Q

When do we use WHO vs CDC growth charts?

A

WHO <24 months

CDC >24 months

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3
Q

Why use the WHO growth charts?

A
  • for <24mo
  • Growth of BF infant is standard
  • Better description of physiological growth in infancy
  • Based on high quality study aimed at developing growth charts
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4
Q

What is stunting?

A

Low height for age (2 SD)

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5
Q

When does stunting start?

A

•before birth ( poor maternal nutrition)

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6
Q

Why does stunting occur?

A
  • Before birth: poor maternal nutrition
  • Poor feeding practices
  • Poor food quality
  • Frequent infection (–> slowed growth)
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7
Q

What is wasting?

A

Low Weight for Height
by 2 SD

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8
Q

Definition of underweight

A

Low Weight for Age

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9
Q

Major contributor to under-five deaths?

A

Undernutrition

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10
Q

Interventions to prevent undernutrition?

A
  • Breast feeding within one hour of birth
  • Exclusive breast feeding through 6 mos
  • Adequate complementary feeding
  • Micronutrient supplements
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11
Q

Why is breastfeeding recommended?

A
  • Bonding
  • Nutritional value
  • Availability
  • Different effects on metabolism
  • Self regulation
  • More open to variety of tastes (formula always tastes the same, BM flavor varies w/mom’s diet)
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12
Q

Why is formula used?

A

As a substitute for human milk

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13
Q

How is formula regulated in the U.S.?

A
  • •Carefully controlled by FDA
    • –Nutrients (sugar, fat and protein)
    • –Safety
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14
Q

Preparations of formula on the market

A

Ready to feed

Powder

Concentrate

make sure you ask how they prepare their formula - ensure doing correctly

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15
Q

Why is iron fortification recommended in formula?

A

•Rationale

–Meet hgb needs after maternal stores depleted (RBCs last 120 days - after 4 months needs restoring)

–Increase stores prior to whole cow’s milk: Prevent IDA

–Improve alertness, ability to interact and learn

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16
Q

Iron absorption from breast milk vs formula?

A
  • 50% of iron absorbed from breast milk
  • 12% of iron absorbed from formula
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17
Q

How much iron in iron fortified formulas?

A
  • Iron fortified formulas contain 10-12 mg/l
  • Low iron formulas discontinued (were used for fussy babies - no evidence and deprives of needed Fe)
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18
Q

Formula recommendations for non-breast fed term healthy babies?

A

–Start on CM formula at 20cal/oz

–Iron-fortified formula

–0-12 mos

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19
Q

What is DHA/ARA and why is it being added to formulas?

A

newer ingredients

•DHA(Omega-3)/ARA (Arachidonic acid)

–Structural fats found in brain and retina

–Better cognitive and visual development (until 18 months)

–Now all formulas fortified

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20
Q

Why are prebiotics being added to formula?

A

to help develop the immune system

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21
Q

Rationale for avoiding palm oil in formula?

A

Improved calcium absorption w/o palm oil

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22
Q

What are the various types of formula on the market?

A
  • Cow’s milk
  • Soy protein
  • Partially hydrolyzed
  • Elemental
  • Lactose free
  • AR
  • DF
  • Preterm
  • Specialty
  • Follow-up
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23
Q

Contents of Cow’s Milk Formulas

A
  • Sugar – lactose
  • Protein– cow’s milk
  • Minor differences in whey/casein ratios
  • Non-nursing babies started on CM formula
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24
Q

Brands of Cow’s Milk Formula available? Position of AAP?

A
  • Similac, Enfamil, Good Start, store brands
  • AAP – no statement supporting brand
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25
Q

What is different about Similac Organic formula?

A

•Meets USDA criteria: 95% free

–Hormones

–Antibiotics

–Other chemicals

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26
Q

How is does Similac organic compare to non-organic similac?

A
  • Same nutrition as other Similac
  • DHA, ARA supplements
  • AAP – no benefit to organic BUT:

–Lower exposure to pesticides

–Meats not treated with antibiotics

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27
Q

2012 Position of AAP on organic foods?

A

•no benefit to organic BUT:

–Lower exposure to pesticides

–Meats not treated with antibiotics ( resistance)

–No large studies to prove better

–Higher costs to families

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28
Q

What age group os Similac Newborn intended for?

A

Birth to 3 months

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29
Q

Benefits of Similac Newborn?

A

–27 oz. provides all Vit D (vs 32 oz)

• no need for supplement

–Whey-casein (60-40) ratio more similar to BM in first 6 mos

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30
Q

When and why was soy-based formula introduced?

A

•1929- intolerance to CM formula

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31
Q

Brands of soy-based formula?

A

•All brands equivalent

–Prosobee

–Isomil

–Alsoy

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32
Q

Is soy formula iron fortified?

A

yes

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33
Q

Calories /nutrition in soy based formula vs cow’s milk formula?

A

Same calories

BUT recent studies call into question nutritional adequacy and safety

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34
Q

Composition of soy’based formula?

A

•CHO sources

–Sucrose

–Corn syrup solids

–Maltodextrin

  • Protein: soy
  • Fats from vegetable oil
  • Iron fortified, zinc fortified
  • Meet vitamin, mineral, -lyte specs
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35
Q

What are phytoestrogens?

A

•Non-steroidal estrogens (isoflavones)

found in soy

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36
Q

What are potential negative effects for kids of phytoestrogens?

A

–Sexual development and reproduction

–Neurobehavioral development

–Immune and thyroid function

•No conclusive data re kids or adults

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37
Q

What are potential benefits of phytoestrogens to adults?

A

–Coronary artery disease

–Some cancers

•No conclusive data re kids or adults

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38
Q

Why was soy based formula previously used in diarrhea?

A

If diarrhea, gp off formula, use a kind of ORS, then titrate up on soy. Theory had washed lactase out of system w/diarrhea and thus not give lactose. Recent info does not hold this up.

•Similac Soy Expert Care DF: plays on this belief

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39
Q

Should soy based formula be used for recovery from AGE?

A

•Most infants OK with breast or CM formula during recovery from AGE

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40
Q

Should soy based formula be used in preterm infants?

A

NO.

  • Serum phosphorous lower
  • Alkaline phosphatase higher
  • Degree of osteopenia increased even with Ca and D supplements
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41
Q

Relationship between soy formula and cow’s milk sensitivity

A

•Cross reactivity to soy protein if enterocolitis from CM formulas

–Bloody diarrhea

•High incidence of sensitivity to CM AND soy

–25% < 6mos

–5% 6-12 mos

42
Q

Indications for Soy Formula

A

•Disorders of carbohydrate metabolism

–Galactosemia ( newborn screening)

–Primary lactase deficiency ( very rare)

•Family’s desire to avoid animal products

43
Q

Benefit of soy formula in colic?

A
  • 10-20% of 0-3month old infants with “colic”
  • Calming attributed to sucrose and fiber in soy
  • Controlled studies – no differences in soy or CM
44
Q

What formulas are marketed for colic?

A

•CM protein partially broken down = partially hydrolyzed

–Similac Sensitive

–Carnation Good Start

–Enfamil GentleEase

  • Reduced lactose
  • Marketed for fussiness and gas
45
Q

Rule of 3s for colic

A

“3 weeks old, 3 hours a day, 3 months”- normal!

Doesn’t mean they need treatment, have gerd, etc

46
Q

What percentage of infants have a CM protein allergy?

A

2-3%

47
Q

Types of CM protein allergy reactions

A
  • IgE mediated reactions (antibody-mediated)
  • Non IgE mediated (cell- mediated)
48
Q

Immediate response (IgE) to CM protein allergy?

A

–Urticaria

–Angioedema

–Vomiting

–Acute flare of eczema

–Severe GI symptoms

•Bloody mucousy stools

49
Q

Delayed response to CM protein allergy

A

–Irritability

–GER

–Atopic dermatitis

–Enteropathy

50
Q

Diagnosis of CM protein allergy

A

–Positive skin prick

–Positive serum specific IgE

51
Q

Prognosis for CM protein allergy

A
  • 75% outgrow by 3 yrs
  • 90% outgrow by 6 yrs
52
Q

MGMT recommendations for CM protein allergy, BF and non

A
  • Anaphylaxis rare
  • Breast feeding encouraged
  • Management if symptoms con’t with BF:

–Mom to avoid all milk products

–Read labels!!

–Try for 2-4 weeks

53
Q

When to use elemental formulas?

A

•If

–careful nursing

–CM or (?) soy formula tried

•And

–still severe symptoms

54
Q

Brands of elemental formulas?

A
  • Alimentum
  • Nutramigen
  • Pregestimil

–Fat malabsorption and protein allergy

55
Q

When should you see improvement on elemental formulas?

A

2-4 weeks

56
Q

How long to use elemental formulas

A

Continue at least until 12 months

57
Q

What is a super hypoallergenic formula?

A

•Neocate /Elecare

–100% free amino acids

–No intact proteins

–Lactose free

58
Q

When to use a super hypoallergenic formula?

A
  • Multiple food protein intolerances
  • Soy and protein hydrolysate not helpful

–Previously only available by prescription, now OTC.

59
Q

What is a lactose free formula?

A

•Cow’s milk formula

–No lactose – corn syrup solids for CHO

–Promoted for “non-specific formula intolerance”

– Same calories/oz as standard formulas

60
Q

Why is a lactose free formula questionably necessary?

A

LI is not usually present at birth

61
Q

Why do preterm infants need special formulas?

A

–low body stores of nutrients

–deficient bone mineralization

–accumulated energy deficit

62
Q

Formulas available for preterm infants?

A

–Enfacare Lipil

–Neosure

63
Q

How many calories per ounce in preterm infant formulas?

A

–22 calories/oz

64
Q

How long should preterm infant formulas be used?

A

–Recommended until 9 months, often stopped earlier

65
Q

What spit-up formulas are available and why are they used?

A
  • Enfamil A.R. Lipil and Similac Spit Up
    • full-term infants who spit up frequently or who need a thickened formula

can thicken your own formula w/a spoonful of rice cereal

66
Q

How does spit-up formula compare to other formulas?

A

–Nutrients same

–Rice starch for thickening

–Viscosity 10 X routine formula

–Flows through standard nipple

–Milk–based fatty acid pattern similar to breast milk

–Iron fortified

–Easier preparation than adding rice to formula

–Contains DHA and ARA

67
Q

What are follow up formulas?

A
  • Marketed for 9 months through toddler
  • Increased iron and calcium

–Similac 2

–Enfamil Next Step

–Carnation Good Start Supreme 2

  • V/M of 2-3 servings of F/V in sippy cup!!!
  • NOT needed if good variety of solids
68
Q

Examples of when specialty formulas may be used

A

Inborn errors of metabolism:

  • PKU
  • Maple syrup urine disease
  • Homocystenuria
  • Methylmalonic acidemia
  • Organic acid disorders
69
Q

Problems with goat milk formula

A
  • Not the best alternative
  • Low

– Vitamin D

– Iron

– Vitamin B12

–Folate

•may lead to IDA or megaloblastic anemia

70
Q

Recommendations for patients using goat milk formula

A

–Chose

•Pasteurized, supplemented with Vitamin D and Folic Acid

–Supplement

•additional carbohydrate, such as sugar or corn syrup.

–Need vitamin supplements with iron

71
Q

Recommendation for Almond Milk Formula?

A

Just don’t

can lead to scurvy, FTT, etc

72
Q

Usefulness of differently shaped bottles

A

One option to try for fussy babies - before “flipping formulas”

73
Q

Why is Vit D important to G&D?

A
  • Essential for calcium absorption( bones)
  • Maintains healthy immune system
  • May help prevent

–Autoimmune disease

–Some cancers

–Type 2 DM

74
Q

Consequences of inadequate Vit D?

A

can lead to rickets and low calcium

75
Q
A
76
Q

How much Vit D supplementation is recommended (BF vs FF)

A

•Supplementation

–Breast fed infants: 400 IU

•TVS, PVS, D-VS*

–Formula fed < 32 oz/day: 400 IU

•

•*Vitamin D-Only: care with administration- risk of toxicity

77
Q

What are AAP’s 2014 fluoride recommendations?

A

•Toothpaste –

–When teeth emerge ( grain of rice am’t)

–At three years of age ( pea-sized am’t)

•Fluoride varnish

–At tooth emergence and every 3-6 mos

  • Community water fluoridation – YES
  • Dietary supplements

–If drinking water not fluoridated

•Fluoride rinse - ≥ 6 yrs old

78
Q

Considerations when introducing eggs, nuts, peanuts, shellfish - when and special considerations?

A
  • Previously eggs delayed until 12 months; Nuts, peanuts, shellfish until 2-3 yrs
  • Now: Solids held until 4-6* mos; above foods can be given unless

–Positive family history of food allergy (1 first degree relative-parent or sib), then wait until ~ 2 yrs

–Also controversial in literature

79
Q

Percent of 6 mo olds who are obese?

A

7%

80
Q

Overweight 5yo are __x more likey to be obese w/in 9 years

A

4

**obesity at 5y is a strong indicator for obesity as an adult

81
Q

Infant interventions to prevent obesity

A
  • Recognize hunger and satiety cues
  • Engage infant in other ways than feeding
  • No need to “finish the feeding”
  • Variety of foods after (4) 6 months
  • May need to introduce new foods (5-10x)
  • Avoid “kid foods” with ↑fat/calories
82
Q

Duration of infant feeding patterns

A

Last longer than previously thought!

Early taste preferences for F/V, sugary bevs last

83
Q

According to 2014 pediatrics study, when is the best time to set infant feeding patterns?

A

10-12 months - start early

Again, patterns last

84
Q

What is WIC?

A

Women, Infants, Children

•1970’s - nutrition program for low-income pregnant, breast feeding and non-breast feeding moms, infants and children <5yrs.

85
Q

Obesity and WIC

A

More obesity

86
Q

Where is WIC available?

A
  • 50 state health departments
  • 34 Indian Tribal Organizations
  • DC
  • 5 territories

–Puerto Rico

–Guam

–America Samoa

–Northern Mariana

–Virgin Islands

87
Q

WIC eligibility

A

•Nutritional risk

–Medical ( LBW, anemia)

–Diet

  • Inappropriate feeding habits
  • Does not meet current guidelines for Americans

Income

–185% of federal poverty guidelines

•Family size and income ( family of 4; 44,123)

–Medicaid and/or SNAP

88
Q

WIC services

A
  • Nutrition risk assessment
  • Nutrition education
  • Breast feeding education
  • Health, social and welfare referrals
89
Q

Outcomes associated with WIC services

A

Success:

  • Lower Medicaid costs for mom and baby
  • Longer gestations
  • Higher birth weights
  • Lower infant mortality
90
Q

How does WIC support breastfeeding?

A

•Incentives

–If fully breast feeding mom

  • More foods
  • More fruits and vegetables

–If fully breast fed baby

  • More fruits and vegetable
  • More baby meats
  • Less formula
91
Q

Recent revisions to WIC for infants (2009)

A

–No cereal until 5 months

–Decrease in amount of formula > 6 months

–Baby foods added

–No juice

92
Q

Recent revisions to WIC for children (2009)

A

–Juice limited

–Voucher for fruits/vegs @ FM

–Less milk and more calcium substitutions but not yogurt or rice milk in CT

–Whole wheat/grain bread

–Fewer eggs

93
Q

WIC Foods: Federal vs State decisions

A
  • Feds determine nutritional values
  • States determine specific foods

–Some allow organic milk, eggs, cheese

–All allow organic fruits and vegetables

–Food packages adapted to needs of family

•Allergy, intolerance, medical conditions

94
Q

APRN role in r/t WIC

A
  • Collaborate/communicate with WIC colleagues
  • Make both roles more effective in helping children to be healthy weight
  • Complete forms with essential information
95
Q

Immediate risks to obesity

A
  • Shame
  • Low self esteem
  • Negative body image
  • Depression
  • Lack of friends
  • Inability to play
  • Behavior problems
  • Poor academics
96
Q

Long term risks to obesity

A
  • Hypertension
  • dyslipidemia
  • Diabetes
  • Respiratory
  • Orthopedic
  • Hepatic
97
Q

Obstacles to healthy nutrition

A
  • Lack of knowledge/information from PCPs
  • Heavily marketed toddler foods
  • Resources
  • Parenting styles:

–Authoritarian: Rigid, controlling–> decreased intake of healthy

–Avoidance of conflict–> poor eating habits

–Flexible yet firm–> healthy eating habits

98
Q

High risk populations for obesity

A
  • Low SES
  • Southern region of US
  • African-American
  • Hispanic
  • American Indian
  • Difficult to separate SES and racial/cultural factors
99
Q

Challenge of feeding with Toddlers?

A

Developmentally: exploring, saying no

Erickson’s stages: independence. –> picky eating

Tricky to give healthy food!

100
Q

Approaches with Toddlers/Preschoolers

A
  • Self feed
  • Healthy choices and reasonable quantities

–Colorful, fun

•Limit milk ( 20-24 oz/day)

–WCM 12-24 months; Low fat or skim >24 months

–If significant family history – low fat milk @ 12 mos

  • Do not force to eat if not hungry or food averse
  • Avoid juices, sweetened drinks, cereals, candy, fast food
101
Q

Nutrition resources

A
  • CDC.gov
  • who.int/en
  • myplate.gov
  • AAP.org
  • nhlbi.nih.gov/health/public/heart/obesity/wecan
  • healthykids.org
  • nationaldairycouncil.org

SPRING16 N833 Adv Pedi (9 decks)

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