Nutrition and Growth

Question 1

Benefits to the Baby for Breast Feeding

Answer 1

A:-Allergic disease risk decreases: asthma& allergies 
D: -Diabetes risk decreases
O: -Obesity risk decreases
N: -Neurodevelopmental improvement
I: -Infections reduced
S: -Stronger attachment
etc.....
-All of these benefits are magnified in the preterm infant

Question 2

Benefits to the Mother

Answer 2

B: -Bonding which is augmented through release of hormones when nursing.
E: -Easier and faster recover from birthing.
C: -Cancer rates reduced
N: -Natural contraceptive
H:-Heart Disease decrease
D: Diabetes Reduction

Question 3

Contraindications for Breast Feeding

Answer 3

BAD BREASTS:
B-Hepatitis B
A-Anti-thyroid meds
D-Disease/ STIs: HIV and HSV lesions on breast
B-Bad bugs: CMV (preemie) and TB
R-Radioactive meds and chemotherapy
E-Errors of metabolism: Galactosemia, PKU, Urea cycle defects in the baby
A-Anti-giardia meds (Flagyl)
S-Sulfonamides
T-Tetracycline

Question 4

Questions in Determining Effective Breast Feeding

Answer 4

• How often is the baby nursing?
• For how long?
• Is mom’s milk in? Milk surge usu day 3-5
• Is the baby latching on well?
• How many wet diapers in the past 24 hours?
• How many stools in the past 24 hours?

Question 5

Physical Evaluation in Determining Effective Breast Feeding

Answer 5

• Calculate the weight loss
• Evaluate for signs of dehydration
• Evaluate for ankyloglossia; baby may require frenotomy
• Evaluate the suck
• If possible observe the child breast feeding

Question 6

Extra Help in Regards to Breast Feeding

Answer 6

• Schedule an appointment with a lactation consultant
• La Leche League
• Close follow up
• www.kellymom.com
• www.llli.org

Question 7

Formula Selection:

Answer 7

Cow’s Milk Protein Formula, Soy Formula, Partial Hydrolysate Formula, Hydrolysate Formula

Question 8

Cow’s Milk Protein Formula

Answer 8

• 80% of formula sold
• Sugar is lactose
• Iron fortified
• Most now fortified with DHA and ARA (thought to be important for brain and eye development)
• Many now with probiotics

Question 9

Examples of Cow’s Milk Protein Formula

Answer 9

Similac, Enfamil, Store brands

Question 10

When Do We Recommend Cows Milk?

Answer 10

NO COW’S MILK BEFORE 1 YEAR!! Can lead to iron deficiency d/t Low concentration of iron; esp when drinking too much; 20-24 ounces per day.

• Higher protein, sodium, potassium and chloride leads to higher renal loading
• Limited essential fatty acids, Vit E, zinc
• They can however have milk products such as yogurt and cheese.

Question 11

Soy Formula

Answer 11

• Made from Soy protein; carbohydrate is sucrose or glucose
• Usually not indicated for true milk protein allergy as up to 50% also allergic to soy protein
• No evidence that it reduces colic
• Per AAP few indications over cow’s milk formula except galactosemia

Question 12

Examples of Soy Formula

Answer 12

Prosobee (enfamil), isomil (similac), good start soy

Question 13

Partial Hydrolysate Formula

Answer 13

-Easier to digest but not indicated for protein allergy/intolerance. Often touted for fussy or gassy infants.

Question 14

Examples of Partial Hydrolysate Formula

Answer 14

Good Start, Enfamil Gentlease

Question 15

Hydrolysate Formula

Answer 15

Proteins broken down. For milk protein allergy.

Question 16

Examples of Hydrolysate Formula

Answer 16

Nutramigen, Alimentum

Question 17

Other Formulas:

Answer 17

AR: added rice marketed for babies who spit up a lot

Premature babies: neosure (similac) and enfacare (enfamil) - 22kcal/oz

Question 18

Elemental Formula

Answer 18

Protein broken down to amino acid level. Severe food allergies. Other medical conditions such as short bowel syndrome, malabsorption, eosinophilic esophagitis.

Question 19

Examples of Elemental Formula

Answer 19

Elecare, Neocate, Puramino (Nutramigen AA)

Question 20

Signs Baby is Ready for Solids

Answer 20

• Able to hold head up and sit comfortably
• Loss of extrusion reflex
• Opens his mouth when food comes his way
• Usually has at least doubled in weight
• Usually taking about 32oz of milk per day

Question 21

What do you Feed a Baby when they are ready for Solid Foods?

Answer 21

• Single grain cereals
• Pureed veggies
• Pureed fruits
• Pureed meats
• 1 new food every 4-5 days
• Once baby is able to sit up and can grab foods and bring the to their mouth they can get finger foods

Question 22

Vitamins for Infants

Answer 22

• Starting at birth – 400 IU vitamin D daily for breast fed infants
• Breast feeding moms should take their prenatal vitamin and vegetarian moms may need an extra vitamin B supplement
• Iron –1mg/kg/d starting at 4 months until iron rich roods are introduced
• Flouride – after 6 months, once baby has teeth; paint on and leave
• Other deficiencies: Vit D (rickets), Zinc (Perioral Dermatitis), Protein & Calories (Kwashiorkor , Marasmus)

Question 23

Failure to Thrive

Answer 23

• FTT: growth faltering in infants and young children
• wt curve has fallen by 2 major percentile lines from a previously established growth rate
• Wt/L decreases below the 2nd percentile
• Weight less than 80 percent of ideal weight-for-age
• Most common cause is inadequate dietary intake (termed non-organic).
• HUGE array of organic causes

Question 24

FTT: Assessment

Answer 24

• At every well check, we measure and trend weight, length, HC and look for trends
• Complete History and Physical
• What does the baby eat? How much? How often?
• How is the formula prepared?
• PMH and FHx can be very important. Small parents have small babies!

Question 25

FTT: Treatment

Answer 25

• If non-organic, you need to get more calories in; may increase the calories in the formula or supplement with protein shakes in older kids
• If organic, you need to identify and treat the underlying cause: EASIER SAID THAN DONE!!