Lecture 10: Complementary Feeding Flashcards
What is complementary feeding?
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
What are other commonly used terms for complementary feeding?
‘weaning’ ‘introduction to solids’
What are complementary foods called?
‘solids’ ‘solid foods’
When is the recommendation to start complementary feeding?
Around 6 months of age
What does texture, variety and flavour positively influence?
Introduction of motor development, enhancing cognitive development
What reflexes are newborns born with for feeding?
Rooting, mouthing, head turning, gagging, swallowing and coordinate breath and swallow
What are the signs that a baby is ready to start solids?
- 6 months
- Hold head up
- Sits when supported
- Opens mouth
- Keep food in mouth
- Can swallow food
- Biting and chewing
What are the risks of early introduction to complementary feeding? (<5 months)
- Eczema
- Food allergies
- Respiratory disease
- Gut infection
- Diarrhoea
- Dehydration
How does early introduction to complementary feeding influence iron? (<5 months)
Impaired iron absorption and iron deficiency
What are the risks of late introduction to complementary feeding? (>7 months)
- Iron deficiency
- Feeding difficulties
- Growth faltering
- Micronutrient deficiencies
- Food allergies
What percent of NZ babies are introduced to complementary foods at or before 5 months?
60%
What percent of NZ babies are introduced to complementary foods at or after 6 months?
40%
When do the first teeth begin to erupt?
Around 6-9 months
When has the full set of 20 deciduous teeth usually erupted in the mouth?
By 3 years of age
Are teeth necessary for an infant to start complementary feeding?
Not necessary - they have strong gums
What is the progression of textures in order?
- Pureed
- Mashed
- Chopped
- Family foods
What time period is pureed food generally introduced? What movements are they doing?
Supported sitter (6-7 mo)
What time period is mashed food generally introduced? What movements are they doing?
Independent sitter (7-8 mo)
What time period is chopped food generally introduced? What movements are they doing?
Crawler (8-12 mo)
What time period is family food generally introduced? What movements are they doing?
Beginning to walk (12-24 mo)
What is prolonged use of pureed foods and introduction of lumpy foods later than 10 months associated with?
- Feeding difficulties (commonly refusal)
- Low intake of nutrient rich foods
Why do infants need to be given textured foods?
To develop chewing skills and tongue movements
What is the WHO recommendation for complementary feeding schedules at 6-8 months of age?
- Milk given before food
- CF 2-3 times per day
- 200kcal/d of food
What is the WHO recommendation for complementary feeding schedules at 9-11 months of age?
- CF 3 times per day
- 1-2 nutritious snacks
- approx. 686kcal/day
- Milk given after food
What does responsive feeding involve?
- Being sensitive to hunger and satiety cues
- Feed slowly and patiently
- Encourage not force
What to do if a child refuses food?
Experiment with different food combinations, tastes, textures and methods of encouragement
Feeding time is period of…
Learning and love through talking and eye contact
What are signs a baby is hungry?
- Opening mouth
- Turning head side to side
- Leaning towards
- Agitated/excited
- Distressed/crying
- Asking for or pointing
What are signs a baby is full?
- Pushing/arching away
- Turning head away
- Spitting out food
- Using words
- Distracted
What are the MOH recommendations for serving sizes?
Not given - focus is on growth, development, varied food intake and choice
What should the first foods babies are introduced to be?
Iron-rich foods
What are examples of iron rich foods for 6 month year olds?
- Cooked pureed meat
- Baby rice cereal (fortified)
What are the concerns about baby rice?
- Is processed
- Not enough salivary amylase (this is not true)
Why is iron deficiency prevalent in infancy?
- High requirement
- Iron stores begin to run low
What infants are at most risk of iron deficiency?
- Low intake of ‘high iron’ foods
- Low birth weight (<2500g)
- Pre-term infants (<37 wks)
- Low SES
In a NZ study, how many infants had suboptimal iron stores aged 7-10 months?
23%:
- Depleted (9%)
- Deficiency (11%)
- IDA (3%)
What are the consequences of iron deficiency?
- Decreased immunity
- Altered intestinal function
- Impaired cognitive, social and socio-emotional development
What are the consequences of IDA?
- Fatigue
- May see effects on intellectual and motor performance
Other than iron rich foods, what should the other first foods of complementary feeding be?
Vegetables in fruit
What are the benefits of vegetables and fruit as first foods?
- Important nutrients (vitamins, minerals, fibre)
- Variety of colours
- Improves immunity, digestion, decreased obesity
How should vegetables and fruit be kept safe to eat?
Fresh, washed in clean water, frozen or canned
How many exposures can it take before acceptance?
8-15 positive exposures
What is an exposure?
Any sight, touch, smell, taste
When are infants first exposed to flavours?
In utero and via BM
What are infants preferences for taste?
Sweet tastes - just like BM
How are preferences learned?
Through exposure
Why is a variety of foods from each of the groups important?
- Adequate essential nutrients
- Growth and development
- Healthy taste preferences
What fluids should infants have before 12 months of age?
- BM or formula
- Water
What fluids are not recommended for infants? (before 12 months)
- Fruit juice/cordials
- Soft drinks
- Caffeine-containing drinks
- Herbal tea
- Alcohol
How should infants food be prepared?
Do not add salt, soy sauce, sugar, honey or artificial sweeteners
What are the rules for honey and infants?
No honey before 12 months
Why should honey not be given before 12 months?
It can cause infant botulism caused by the toxin clostridium - also survives cooking temperatures
Why is food safety so important for infants?
Immature guts are susceptible to food borne illnesses
What are some food safety tips for cooking for infants?
- 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
What does gagging sound like?
Loud/dramatic
What does choking sound like?
Silent
What are the signs of gagging?
- Watering eyes
- Pushing tongue forward out of mouth
- Retching movement to bring food forward
- May vomit
What are the signs of choking?
- Cough or gasp as trying to get air
- May go silent
- Struggling sounds or raspy whispers
How do we minimise the risk of food-related choking?
- Sit while eating
- Someone always present
- Match food to ability
- Alter texture
- Remove high risk parts of food
- Learn choking first aid
What foods are most likely to cause choking?
- Small hard foods
- Small round foods
- Food with skin or leaves
- Compressible food
- Thick pastes
- Fibrous or stringy foods
When should cows milk be given to drink for infants?
Older than 12 months
Why should cows milk not be given before one year?
- Low bioavailability/concentration of iron
- GI blood loss
- High renal solute load
- Displace other foods
What are the 5 major proteins in cows milk?
- B-lactoglobulin
- Bovine gammaglobulin
- Casein
- A-lactalbumin
- Bovine serum albumin
Why can infants not handle the high renal solute load of cows milk?
Immature kidneys
How can infants handle increased renal solute load?
Take in adequate fluid
Is cows milk in food ok?
Yes; it is just the high concentration and high doses that are problematic
What should be done when a baby is unwell?
- Consider intake over week not daily
- Keep hydration high
- Regular offering of BM and water
- Small portions of soft foods (easy to swallow)
What are the general concerns surrounded baby food pouches?
- Tooth decay
- Obesity
- Poor motor development
What are dietitian’s concerns with baby food pouches?
Cannot see, touch or smell pouch contents - bad exposure
What is the reality of baby food pouches vs obesity?
They do not contribute large amounts of energy or impact weight gain
What do infants with cow’s milk protein allergy use?
Specialised medical formula
What does infant formula for special dietary/medical use require?
Requires being extensively hydrolysed
Why is specialised dietary formula extensively hydrolysed?
To break down the cows milk protein structure for digestibility
What is specialised dietary formula treated with to break down most of the cows milk protein?
Enzymes
Where can specialised dietary formula be purchased from?
Can often be purchased over the counter without prescription - this is to change under proposal P1028
Why not soy formula for cows milk allergy?
Generally a high cross reactivity between milk and soy
