L8 Infant Formula and Introducing Solid Foods Flashcards
Why not other milk?
infant formulas modified to resemble breastmilk composition as much as possible
- infant formula contents and formulation regulated (Food and Drug Regulations)
- unmodified cow milk (and other milks) poorly suited to infant’s needs
What are the only proper substitutes for breast milk?
iron fortified formula until 9-12 months and pasteurized breast milk from donors that have been screened and tested.
What are some comparisons to cows milk?
In general the nutrient composition is different.
higher protein in cows = potential for kidney dysfunction
cows milk is less bioavailable = possible iron deficiency
infant formulas are categorized by protein source. What are they?
Cow milk
Soy
Non-intact (hydrolyzed or elemental)
What is the nutrient content in formula?
almost identical to breastmilk energy: 0.67 kcal/g protein: 9-13% fat: 45-50% CHO: 39-45%
How is cow’s milk formula available?
Mostly powder, concentrate and ready to feed
What are the protein, CHO and lipid sources for cow’s milk?
protein: when and casein, some 100% whey
CHO: lactose
lipid: veg oils like coconut, palm, soybean, sunflower, safflower)
some additional AA and DHA, nucleotide, and probiotics
What are the sources of protein, CHO, and lipids for soy based formulas?
protein: soy protein with methionine
CHO: corn, sucrose in some
Lipids: veg oils (coconut, palm, sunflower, soybean, safflower)
Additional AA, DHA, nucleotide, probiotics
When is a soy based formula a good choice?
vegans, galactocemia, congenital lactase deficiency
Why is soy formula not recommended when there is an allergy to cows milk?
15-40% are allergic to both
Why islactose free cows milk formula not recommended for children with galactosemia or congenital lactase deficiency?
There can be some residual galactose. Uses glucose instead but no known benefit.
Why use elemental formula?
Only under medical supervision.
An allergy to cow milk protein or malabsoprtion of proteins, CHO, or lipids
What are the sources for protein, CHO, and lipids for elemental formula?
protein: peptides, amino acids
CHO: corn, sucrose, monosaccharides
Lipid: veg oils (coconut, palm, sunflower, soybean, safflower) and some with medium chain fats
What are some issues with elemental?
May inhibit digestive capacity. May not be able to transition to solid foods at 6 months
What are 3 other formulas?
Thickened rice starch formulas (swallowing issues)
Follow up formulas (just marketable)
Preterm formulas (higher energy density)
When to transition to solid foods?
6 months with breastfeeding or formula. (less risk of allergies)
Why is timing important in the transition to solid foods?
- to facilitate developmental skills
- ensure nutritional requirements
- minimize risk to allergies
Why would you not transition to solid foods before 6 months?
- risk of decreased growth due to decreased breastmilk bc less hungry)
- risk of nutrient deficiencies (iron = less absorption with other foods)
- associated with increased risk of allergy, obesity, and chronic disease
Why not transition to solid foods later than 6 months?
- risk of developmental feeding problems
- nutrient deficiencies (fetal hemoglobin was recycles and stores start to decrease about 6 months but iron is still needed for growth)
How much energy should be from breastfeeding at 6-11 months?
12-24 months?
= 50%
= 1/3
What are some examples of first foods?
single grain iron fortified cereals (rice, barley, oatmeal), and meat and meat alternatives
How does the solid texture progress with age?
6 months - semi solids (purees, mashed)
6-8 months - soft solids (finger foods, dissolvable solids)
9-12 months - harder textures (cheerios, crackers)
6 -10 months - mashed-soft-hard)
How often do you introduce a new food?
every 1 -2 days for allergies
When do you introduce dairy and alt.?
9-12 months
Why dont foods marketed to children under 2 years disclose type of fat content?
dont want to discourage/limit fat intake
What are 3 food goals at 1 year?
- drinking from a cup rather than bottle
- eating same food as family at meals
- self feeding
What are some food safety concerns?
choking hazards like raisins, popcorn, peanuts, grapes. delay intro until 4-5 years and always sit to eat.
no honey for 1 year = botulism
What are the energy recommendations and how do they vary?
birth to 6 months: 100kcal/kg
7-12 months: 80kcal/kg
varies on growth rate, sleep/wake cycle, physical activity, temp, climate, health status, recovery from illness
What are the CHO recommendations for infants?
mostly lactose to facilitate calcium absorption.
increases variety and consumption of more complex CHO with age
What are the protein recommendations for infants?
higher protein per kg than in adults
AI 0-6 months: 1.5g/kg/d
RDA 7-12 months: 1.2g/kg/d
Premature infants: 4g/kg/d
What are the fat recommendations for infants?
about 50%
not restrictions under 2 years
e.f.a.’s and cholesterol are important for brain development.
LCPUFA’s are important for the CNS from 3rd trimester to 18 months (1.5 year critical period)
What are the recommendations for meeting the micro nutrient needs of an infant?
breast milk with n-dense foods at 6 months
- 400IU vitamin D brith - 12 months for full or partial breast fed
- iron rich first foods
What did 3 meta studies determine about obesity and breastfeeding?
breastfeeding decreased risk of childhood obesity (even in comparison to formula) and decreases risk with longer duration
What are some thoughts on why breastfeeding decreases obesity/
Neonatal Growth Hypothesis: b.f. babies grow slower, insulin and IGF-1 are lower in b.f babies
Response to hunger and satiety cues which carry on into late life
Neuroendocrine programming during critial period of growth
