Lecture 10 - Complementary Feeding Flashcards
what is 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 the breast milk or formula
what is another word for complementary feeding
weaning
when is complementary feeding recommended
around 6 months of age
what allows newborns to be ready to feed
they are born with reflexes that prepare them to feed
such as : rooting, mouthing, head turning, gagging, swallowing and coordinate breath and swallow
baby must show all of these signs to be ready to start solids, what are they
- baby is around 6 months of age
- baby can hold their head up
- baby sits when well 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
what are the risks of early introduction (<5 months) to complementary feeding
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
what are the risks of late introduction of complementary feeding
increased risk :
- iron deficiency
- feeding difficulties
- growth faltering
- other micronutrient deficiencies
- development of food allergies
on average the first teeth being to erupt when the baby is :
around 6 to 9 months old
the full set of 20 deciduous teeth has usually erupted into the mouth by what age
around 3 years of age
do infants need teeth to eat food
no they do not
what is the progression of texture of food for infants
pureed
mashed
chopped
family foods
what is recommended about moving through the texture of foods with infants
move through the stages quickly, if you stay on pureed food to long you could miss critical period
what is the texture and development stage of a head up baby (0-6months)
suck, swallow, extrusion reflex
- move liquid only from front to back of mouth
what is the reflex and texture of food for a supported sitter baby (6-7 months)
being able to move the tongue from side to side without moving the head
- smooth, running puree
what is the texture of food like for an independent sitter (7-8 months)
thick puree, small soft lumps or mashed
what is the texture of food like for a crawler (8-12 months)
chew and swallow soft mashed, minced, grated, chopped foods
what is the texture of food like for a infant beginning to walk (12-24 months)
family foods, maybe different shapes but similar to what the family eats
Prolonged use of purée foods (> 9 months) and introduction of lumpy foods later than 10 months is associated:
- feeding difficulties (commonly refusal) in older children
- low intake of nutrient rich foods
what is responsive feeding ( how should children be feed and what to do if they refuse)
- sensitive to hunger and satiety cues
- feed slowly and patiently encourage children to eat but do not force them
- if child refuses food, experiment with different food combinations, tastes, textures and methods of encouragement
signs a baby is hungry
- opening mouth and turning head from side to side
- fussing and leaning toward the breast or food
- increasing physical movements that become agitated / excited
- crying in a distressed intense way
- asking for or pointing at foods
signs a baby is full
- pushing or arcing 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
what are the foods first recommendations
iron rich and then also vegetables and fruit
what are good choices for iron rich first foods
cooked pureed meat, chicken and fish
baby rice cereal : iron fortified cereal mixed with water, breast milk or formula
cooked and mashed plant based proteins
what are the conflicts on baby rice
- some nutritionists do not recommend baby rice as it is processed
- unsupported concerns on inadequate salivary amylase
- unsupported concerns about high arsenic
what are the unsupported concerns about inadequate salivary amylase
they were worried that the starch would cause GI concerns for the baby, however at 6 months babies have adult level functioning salivary amylase
iron deficiency is prevalent in infancy is due to
high requirement - high growth rate
iron stores received in utero begin to run low
what infants are most at risk of iron deficiency
- low intake of “high iron” foods
- low birth weight (<2,500g)
- pre term infants because they do not gain those additional iron stores in the past couples weeks
- low socioeconomic status / food insecure
what are the consequences of iron deficiency for infants
- altered intestinal function
- impaired cognitive, social and socio-emotional development
what are the consequences of iron deficiency anaemia for infants
- fatigue / decreased activity
- sustained IDA may be associated with irreversible and detrimental effects on intellectual and motor performance
prevention of iron deficiency
- food based (foods first) approach
- unknown risk of iron supplementation for healthy young children
- however, iron supplementation required for some infants
what is the first foods approach (vegetables and fruit)
- provide important nutrients : vitamins, minerals, fibre
- fresh, washed in clean water, frozen or canned
early childhood intakes of vegetables and fruit improves what
improves immunity, aids digestion, decreases risk of obesity
what is repeated exposure of vegetables important for
important for acceptance from the infant as they are used to the sweetness of breastmilk and vegetables are often bitter tasting
how many exposures to a food can it take for acceptance
8-15 exposures
what are ways of exposing children to food
see, touch, smell, taste
- providing the food in different forms may help with exposure
what liquids should infants be ok to have
only breast milk, formula and water
what are the guidelines with preparing foods for infants and why
do not add salt, soy sauce, sugar, honey or artificial sweeteners, they have very sensitive taste buds
honey should be avoided for what age infants
< 12 months
why should honey be avoided in infants
can cause infant botulism caused by the toxin Clostridium botulinum
equipment must be sterilised for infants until what age
6 months
Home-prepared and commercial infant foods can be kept in a covered container in the fridge for how long
up to 48 hours
why should a baby never be left alone to eat
choking is silent
what are the characteristics of gagging
- watering eyes
- pushing tongue forward out of mouth
- retching movement to bring food forward
- may vomit
- loud / dramatic
what are the characteristics of choking
- may cough or gasp as trying to get air
- may go silent
- may make a struggling sound or raspy whisper
- silent
what are the foods that you should be aware of that could cause choking
- small hard foods
- small round foods
- foods with skins or leaves
- compressible food
- thick pastes
- fibrous or stringy foods
what are the main reasons that cows milk should not be given as a drink until infants are older than 12 months
- concentration and bioavailability of iron is low
- may displace other solid foods, reducing nutrient intake
- may cause gastrointestinal blood loss
- high renal solute load
what is the issue with cows milk and renal solute load
the high mineral concentration compared to human milk is hard on the kidneys and infants have immature kidneys
when is cows milk ok for babies
when in food,
it just the high concentrations or high doses that cause issues
what is the concern with baby food pouches
adverse health outcomes (such as decay, obesity, motor development) with pouch “suckling”
what are dietitian concerns about baby food pouches
the infant cannot see, touch or smell pouch contents (this is important for exposure to foods)
what is the nutritional intake of babies who have baby food pouches like
nutrient intakes are similar to infants who do not consume baby food pouches, additionally no difference in iron status but slightly higher intakes of total sugars
