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HUNT243 > Lecture 10: Complementary Feeding > Flashcards

Lecture 10: Complementary Feeding Flashcards

1
Q

What is complementary feeding?

A

The process starting when BM alone is no longer sufficient to meet nutritional needs, and therefore other foods and liquids are needed along with BM, or formula

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2
Q

What are other commonly used terms for complementary feeding?

A

‘weaning’ ‘introduction to solids’

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3
Q

What are complementary foods called?

A

‘solids’ ‘solid foods’

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4
Q

When is the recommendation to start complementary feeding?

A

Around 6 months of age

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5
Q

What does texture, variety and flavour positively influence?

A

Introduction of motor development, enhancing cognitive development

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6
Q

What reflexes are newborns born with for feeding?

A

Rooting, mouthing, head turning, gagging, swallowing and coordinate breath and swallow

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7
Q

What are the signs that a baby is ready to start solids?

A
  • 6 months
  • Hold head up
  • Sits when supported
  • Opens mouth
  • Keep food in mouth
  • Can swallow food
  • Biting and chewing
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8
Q

What are the risks of early introduction to complementary feeding? (<5 months)

A
  • Eczema
  • Food allergies
  • Respiratory disease
  • Gut infection
  • Diarrhoea
  • Dehydration
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9
Q

How does early introduction to complementary feeding influence iron? (<5 months)

A

Impaired iron absorption and iron deficiency

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10
Q

What are the risks of late introduction to complementary feeding? (>7 months)

A
  • Iron deficiency
  • Feeding difficulties
  • Growth faltering
  • Micronutrient deficiencies
  • Food allergies
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11
Q

What percent of NZ babies are introduced to complementary foods at or before 5 months?

A

60%

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12
Q

What percent of NZ babies are introduced to complementary foods at or after 6 months?

A

40%

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13
Q

When do the first teeth begin to erupt?

A

Around 6-9 months

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14
Q

When has the full set of 20 deciduous teeth usually erupted in the mouth?

A

By 3 years of age

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15
Q

Are teeth necessary for an infant to start complementary feeding?

A

Not necessary - they have strong gums

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16
Q

What is the progression of textures in order?

A
  1. Pureed
  2. Mashed
  3. Chopped
  4. Family foods
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17
Q

What time period is pureed food generally introduced? What movements are they doing?

A

Supported sitter (6-7 mo)

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18
Q

What time period is mashed food generally introduced? What movements are they doing?

A

Independent sitter (7-8 mo)

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19
Q

What time period is chopped food generally introduced? What movements are they doing?

A

Crawler (8-12 mo)

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20
Q

What time period is family food generally introduced? What movements are they doing?

A

Beginning to walk (12-24 mo)

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21
Q

What is prolonged use of pureed foods and introduction of lumpy foods later than 10 months associated with?

A
  • Feeding difficulties (commonly refusal)
  • Low intake of nutrient rich foods
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22
Q

Why do infants need to be given textured foods?

A

To develop chewing skills and tongue movements

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23
Q

What is the WHO recommendation for complementary feeding schedules at 6-8 months of age?

A
  • Milk given before food
  • CF 2-3 times per day
  • 200kcal/d of food
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24
Q

What is the WHO recommendation for complementary feeding schedules at 9-11 months of age?

A
  • CF 3 times per day
  • 1-2 nutritious snacks
  • approx. 686kcal/day
  • Milk given after food
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25
Q

What does responsive feeding involve?

A
  • Being sensitive to hunger and satiety cues
  • Feed slowly and patiently
  • Encourage not force
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26
Q

What to do if a child refuses food?

A

Experiment with different food combinations, tastes, textures and methods of encouragement

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27
Q

Feeding time is period of…

A

Learning and love through talking and eye contact

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28
Q

What are signs a baby is hungry?

A
  • Opening mouth
  • Turning head side to side
  • Leaning towards
  • Agitated/excited
  • Distressed/crying
  • Asking for or pointing
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29
Q

What are signs a baby is full?

A
  • Pushing/arching away
  • Turning head away
  • Spitting out food
  • Using words
  • Distracted
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30
Q

What are the MOH recommendations for serving sizes?

A

Not given - focus is on growth, development, varied food intake and choice

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31
Q

What should the first foods babies are introduced to be?

A

Iron-rich foods

32
Q

What are examples of iron rich foods for 6 month year olds?

A
  • Cooked pureed meat
  • Baby rice cereal (fortified)
33
Q

What are the concerns about baby rice?

A
  • Is processed
  • Not enough salivary amylase (this is not true)
34
Q

Why is iron deficiency prevalent in infancy?

A
  • High requirement
  • Iron stores begin to run low
35
Q

What infants are at most risk of iron deficiency?

A
  • Low intake of ‘high iron’ foods
  • Low birth weight (<2500g)
  • Pre-term infants (<37 wks)
  • Low SES
36
Q

In a NZ study, how many infants had suboptimal iron stores aged 7-10 months?

A

23%:
- Depleted (9%)
- Deficiency (11%)
- IDA (3%)

37
Q

What are the consequences of iron deficiency?

A
  • Decreased immunity
  • Altered intestinal function
  • Impaired cognitive, social and socio-emotional development
38
Q

What are the consequences of IDA?

A
  • Fatigue
  • May see effects on intellectual and motor performance
39
Q

Other than iron rich foods, what should the other first foods of complementary feeding be?

A

Vegetables in fruit

40
Q

What are the benefits of vegetables and fruit as first foods?

A
  • Important nutrients (vitamins, minerals, fibre)
  • Variety of colours
  • Improves immunity, digestion, decreased obesity
41
Q

How should vegetables and fruit be kept safe to eat?

A

Fresh, washed in clean water, frozen or canned

42
Q

How many exposures can it take before acceptance?

A

8-15 positive exposures

43
Q

What is an exposure?

A

Any sight, touch, smell, taste

44
Q

When are infants first exposed to flavours?

A

In utero and via BM

45
Q

What are infants preferences for taste?

A

Sweet tastes - just like BM

46
Q

How are preferences learned?

A

Through exposure

47
Q

Why is a variety of foods from each of the groups important?

A
  • Adequate essential nutrients
  • Growth and development
  • Healthy taste preferences
48
Q

What fluids should infants have before 12 months of age?

A
  • BM or formula
  • Water
49
Q

What fluids are not recommended for infants? (before 12 months)

A
  • Fruit juice/cordials
  • Soft drinks
  • Caffeine-containing drinks
  • Herbal tea
  • Alcohol
50
Q

How should infants food be prepared?

A

Do not add salt, soy sauce, sugar, honey or artificial sweeteners

51
Q

What are the rules for honey and infants?

A

No honey before 12 months

52
Q

Why should honey not be given before 12 months?

A

It can cause infant botulism caused by the toxin clostridium - also survives cooking temperatures

53
Q

Why is food safety so important for infants?

A

Immature guts are susceptible to food borne illnesses

54
Q

What are some food safety tips for cooking for infants?

A
  • Wash hands
  • Wash equipment
  • Sterilize equipment until 6 months
  • Food kept in covered in container in fridge for up to 48 hours
  • Throw out unconsumed food
  • Throw out if been sitting at room temp for >2 hours
55
Q

What does gagging sound like?

A

Loud/dramatic

56
Q

What does choking sound like?

A

Silent

57
Q

What are the signs of gagging?

A
  • Watering eyes
  • Pushing tongue forward out of mouth
  • Retching movement to bring food forward
  • May vomit
58
Q

What are the signs of choking?

A
  • Cough or gasp as trying to get air
  • May go silent
  • Struggling sounds or raspy whispers
59
Q

How do we minimise the risk of food-related choking?

A
  • Sit while eating
  • Someone always present
  • Match food to ability
  • Alter texture
  • Remove high risk parts of food
  • Learn choking first aid
60
Q

What foods are most likely to cause choking?

A
  • Small hard foods
  • Small round foods
  • Food with skin or leaves
  • Compressible food
  • Thick pastes
  • Fibrous or stringy foods
61
Q

When should cows milk be given to drink for infants?

A

Older than 12 months

62
Q

Why should cows milk not be given before one year?

A
  • Low bioavailability/concentration of iron
  • GI blood loss
  • High renal solute load
  • Displace other foods
63
Q

What are the 5 major proteins in cows milk?

A
  • B-lactoglobulin
  • Bovine gammaglobulin
  • Casein
  • A-lactalbumin
  • Bovine serum albumin
64
Q

Why can infants not handle the high renal solute load of cows milk?

A

Immature kidneys

65
Q

How can infants handle increased renal solute load?

A

Take in adequate fluid

66
Q

Is cows milk in food ok?

A

Yes; it is just the high concentration and high doses that are problematic

67
Q

What should be done when a baby is unwell?

A
  • Consider intake over week not daily
  • Keep hydration high
  • Regular offering of BM and water
  • Small portions of soft foods (easy to swallow)
68
Q

What are the general concerns surrounded baby food pouches?

A
  • Tooth decay
  • Obesity
  • Poor motor development
69
Q

What are dietitian’s concerns with baby food pouches?

A

Cannot see, touch or smell pouch contents - bad exposure

70
Q

What is the reality of baby food pouches vs obesity?

A

They do not contribute large amounts of energy or impact weight gain

71
Q

What do infants with cow’s milk protein allergy use?

A

Specialised medical formula

72
Q

What does infant formula for special dietary/medical use require?

A

Requires being extensively hydrolysed

73
Q

Why is specialised dietary formula extensively hydrolysed?

A

To break down the cows milk protein structure for digestibility

74
Q

What is specialised dietary formula treated with to break down most of the cows milk protein?

A

Enzymes

75
Q

Where can specialised dietary formula be purchased from?

A

Can often be purchased over the counter without prescription - this is to change under proposal P1028

76
Q

Why not soy formula for cows milk allergy?

A

Generally a high cross reactivity between milk and soy

HUNT243 (11 decks)

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