Nutrition and Growth Flashcards
Benefits to the Baby for Breast Feeding
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
Benefits to the Mother
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
Contraindications for Breast Feeding
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
Questions in Determining Effective Breast Feeding
- 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?
Physical Evaluation in Determining Effective Breast Feeding
- 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
Extra Help in Regards to Breast Feeding
- Schedule an appointment with a lactation consultant
- La Leche League
- Close follow up
- www.kellymom.com
- www.llli.org
Formula Selection:
Cow’s Milk Protein Formula, Soy Formula, Partial Hydrolysate Formula, Hydrolysate Formula
Cow’s Milk Protein Formula
- 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
Examples of Cow’s Milk Protein Formula
Similac, Enfamil, Store brands
When Do We Recommend Cows Milk?
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.
Soy Formula
- 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
Examples of Soy Formula
Prosobee (enfamil), isomil (similac), good start soy
Partial Hydrolysate Formula
-Easier to digest but not indicated for protein allergy/intolerance. Often touted for fussy or gassy infants.
Examples of Partial Hydrolysate Formula
Good Start, Enfamil Gentlease
Hydrolysate Formula
Proteins broken down. For milk protein allergy.
Examples of Hydrolysate Formula
Nutramigen, Alimentum
Other Formulas:
AR: added rice marketed for babies who spit up a lot
Premature babies: neosure (similac) and enfacare (enfamil) - 22kcal/oz
Elemental Formula
Protein broken down to amino acid level. Severe food allergies. Other medical conditions such as short bowel syndrome, malabsorption, eosinophilic esophagitis.
Examples of Elemental Formula
Elecare, Neocate, Puramino (Nutramigen AA)
Signs Baby is Ready for Solids
- 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
What do you Feed a Baby when they are ready for Solid Foods?
- 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
Vitamins for Infants
- 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)
Failure to Thrive
- 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
FTT: Assessment
- 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!
FTT: Treatment
- 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!!
