Lecture 10 Flashcards
Complementary feeding
Complementary feeding
Defined as the process starting when breast milk alone is no longer sufficient to meet nutritional requirements, and therefore other foods and liquids are needed along with breastmilk or formula
recommended age for Complementary foods
Around 6 months of age
Ready to fee… around 6 months of age
-Nutrient needs no longer met by breastmilk
-Reached a developmental stage whereby the infant is able to initiate solid foods
-Texture, variety and flavour introduction and motor development of self feeding are important components of enhancing cognitive development
Readiness to feed
Newborn:
-Infants are born with reflexes that prepare them to feed
-Rooting, mouthing, head turning.gagging, swallowing and coordinate breath and swallow
Ready to start solids -signs
-Baby is around 6 months of age
-Baby can hold their head up
-Baby can sit well when supported
Baby opens their mouth as food approaches
-Baby can keep food in their mouth and then swallow it, instead of pushing the food out
-Baby shows signs of biting and chewing
Complementary feeding -risks of early introduction (<5 months)
Increased risk of
- Eczema and food allergies
- Respiratory disease
-Gut infection
-Diarrhoea and dehydration
-Impaired iron absorption and iron deficiency
-Malnutrition due to decrease in milk energy and inadequate complementary foods
Complementary feeding -Risks of late introduction (>7 months)
Increased risk of:
-Iron deficiency
-Feeding difficulties
-Growth faltering
-Other micronutrient deficiencies
-Development food allergies
What age are NZ babies introduced to complementary foods
20- 4 months
36.8- 5 months
38.6- 6 months
Eruption of teeth
when the baby is around six to nine month old
Teeth are not necessary for an infant to start on solid food- strong gums
Texture progression
Pureed -> Mashed -> Chopped -> Family foods
move quickly through the stages of texture for eating development
Developmental stages and food texture
Head up (0-6 months)
-Suck , swallow, extrusion reflex
-Move liquid only from front to back of mouth
Supported sitter (6-7 mo)
-Being able yp move tongue from side to side without moving the head; elicit munching and jaw movements
-Smooth, runny puree mixture
Independent sitter (7-8 mo)
Thick puree, small soft lumps, or mashed
Crawler (8-12 mo)
Chew and swallow soft mashed, minced, grated, chopped foods
Beginning to walk (12-24 mo)
Family foods
Sensitive period for texture development
Prolonged use of puree foods (>9 months) and introducvtion of lumpy foods later than 10 months is associated:
- Feeding difficulties (commonly refusal) in older children
-Low intake of nutrient rich foods
WHO complementary feeding
6-8 months
-Milk given before food
-CF given 2-3 times per day (200kcal/d based on decreasing BM energy)
WHO complementary feeding
9-11 months
-CF 3 times per day with 1-2 nutritious snacks (-686 kcal/d)
-Milk given after food (top-up)
Responsive feeding
-Sensitive to hunger and satiety cues
-Feed slowly and patiently and encourage children to eat but not force them
-If child refuses food, experiment with different food combinations, tastes, textures and methods of encouragement
-Feeding time is period of learning and low (talking and eye contact)
5 Signs a baby is hungry
- Opening mouth (seeking and rooting reflex)
-Fussing and leaning toward breast or food
-Increased physical movements that become agitated /exited
-Crying in a distressed, intense way
-Asking for or pointing at foods
5 signs baby has had enough
-Pushing or arching away, pushing food or plate away
-Turning head away or shaking head to communicate ‘no more’
-Spitting out food
-Using words like ‘all done or get down’
-Becoming distracted and more interested in what is going on around them
MOH recommendation
recommended serving sizes ….
Once complementary fooda are introduced…..
Recommended serving sizes for this age group are not given
Once complementary foods are introduced, the emphasis should be on growth and development, choice and texture, and appropriate eating behaviours and patterns
what are the two main things to feed a baby at 6 months so that they are able to get the iron required
Cooked pureed meat or even just the juices of the meat
baby rice cereal: iron-fortified cereal mixed with water, breast milk or formula
Conflict on baby rice
Some nutritionist do not recommend baby rice as it is processed (Amylase and Arsenic)
- Amylase By the time a baby is 6 months they have the same amount of amylase as a adult
-Arsenic you would need to consume 90g for it to be concern. The average consumption by NZ infants a day is 7g
Importance of iron
Iron Deficiency is prevalent in infancy due to:
-High requirement- High growth rate
-Iron stores received in utero begin to run low
Infants most at risk of iron deficiency:
-Low intake of high iron foods
-low birth weight
-Preterm infants
-Low socioeconomic status/food insecure whanau
Breast milk iron is highly bioavailable but ….
still not sufficient for a growing baby
Iron deficiency in how many NZ infants
n-364 NZ infants aged 7-8 months
Consequences of iron deficiency
-altered intestinal function
-Impaired cognitive, social and socio-emotional development
Iron deficiency anaemia
-Fatigue / decreased activity
- Sustained IDA may be associated with irreversible and detrimental effects on intellectual and motor performance
Prevention of iron deficiency
-Food first approach
- Iron supplementation for healthy young children
First foods -Vegetables and fruit
-provide important nutrients- Vitamins, minerals, fibre
-Early childhood intakes of vegetables and fruits improves immunity, aids digestion, decreases risk of obesity
-Offer variety of colours (repeated exposure necessary - acceptance)
Repeated exposure
Can take around 8 to 15 exposured before acceptance
any exposure -see, touch, smell, taste
Tastes
preference for sweet tastes - Just like breast milk
Offering vegetables as first foods improves acceptance of these vegetables at 9 months
Fluids
Breastmilk or formula
Other than these water is the only other fluid that should be given
Preparing foods -flavours
Infants and adults have different taste buds, foods may taste bland to you but not to them
Do not add salt, soy sauce, sugar, honey or artificial sweeteners to infants foods
Avoid honey
Honey should not be fed to infants <12 months
Can cuase infant botulism cuased by the toxin Clostridium botulinum
Survives cooking temps so should also not be added during cooking
Immuture guts are susceptible to food borne illnesses
-Wash hand with soap and dry thorouly
-wash equipment thorouly in hot soapy water
-sterilise equipment until infant is 6 months old
-Container should be kept in fridge for no more than 48hr
-Throw out food that has been sitting in room temp for >2hrs
Gagging
-Watering eyes
-Pushing tongue forward
-Retching movement to bring food forward
-May vomit
=loud / dramatic
Chocking
-May cough or gasp as trying to get air
-May go silent
-May make a struggling sound or raspy whisper
=Silent
Minimise risk -chocking
-Supervision
-offer food that matches their abilities
-alter food texture
-Caregivers need to learn CPR
-Be aware of foods that are more likely to cause chocking
Foods that are very susceptible to chocking
-Small hard foods
-Small round foods
-Foods with skin or leaves
-Compressible food
-Thick pastes
-Fibrous or stringy foods
Infant formula for special dietary use
Infants with cows milk protein allergy : require…
Require extensively hydrolysed infant formula
-Treated with enzymes to break down most of the cows milk protein
How to purchase Dietary option
Can often be purchased over the counter (without prescription) -> to change under “proposal P1028”
Cows milk should not be given as a drink until infants are older than
why?
one year (>12 months)
-concentration and bioavailability of iron is low
-May cause gastrointestinal blood loss (infants cant tollerate the high mineral content in cows milk)
High renal solute load
May replace other solid foods, reducing nutrient intake
Pathophysiological mechanism
-Undefined
-Immunological mechanism likely plays a role
-Five major protein in cows milk: ????
Cows milk and renal solute load
Cows milk has quite a high mineral content compared to human milk so the kidneys are relied on to manage the mineral concentration of cows milk which is difficult for an infant due to their immature kidneys
Cows milk in food
This is ok its more the high concentrations that is the issues
When baby is unwell : reduced intake can be concerning for caregivers
Consider inatke over the week rather than the day
Important to remain hydrated
- Regular offering of breat milk (or formula) and water
-Small portions of soft foods (easy to swallow)
Baby food pouches
occupy …
Concerns
energy…
Occupy a lot of supermarket space
Concerns about adverse health outcomes
-Dietition concerns: cannot see, touch or smell pouch contents
Energy contributes to weight gain due to high sugar content
Two approaches to starting solids
Spoon Feeding or Baby led weaning
