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Paeds > Paediatric Feeds > Flashcards

Paediatric Feeds Flashcards

1
Q

Why is breastmilk best (4)

A

Immunologic factors
Tropic to GIT
Easily absorbed
Well tolerated by premature babies

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2
Q

Breastmilk composition (3)

A

Protein - 80% whey, 20% casein (easily digested + low renal load)
CHO - mainly lactose
Fat - LCT

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3
Q

Reasons behind BM composition

A
  • Comp. Changes as baby gets older.
  • Low protein- modest amount of nitrogen load for immature kidneys.
  • Protein - mostly lactalbumin (whey protein - forms soft, easily digested curd.)
  • More than 100 major milk oligosaccharides - protective properties against respiratory and enteric diseases.
  • Relatively low Na content - fluid requirements met while RSL is kept low.
  • Minerals - largely protein bound & balanced for bioavailability.
  • Ca:P - 2:1 - ideal for Ca absorption
  • Limited amount of Zn and Fe - highly absorbable.
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4
Q

Colostrum vs milk (3 each)

A

Colostrum
- high concentrations of proteins (protective immunoglobulins, lysosomes and lactoferrin)
- High concentrations of Na and Cl
- low concentrations of casein, lactose, K, citrate, Ca and P.

Mature milk
- comes in around 5 days after birth
-Increase in lipid & casein, lactose, K, citrate, Ca and P.
-Decrease in total protein, Na and Cl

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5
Q

Breastfeeding volumes

A
  • first BF (within 60min post birth) 0-5ml colostrum
  • 1st 24hrs after birth: 7-123ml of colostrum (babies having between 3-8 feeding sessions)
  • 2-6 days after birth (5-10 feeding sessions): 395-868ml
  • by 1 month, intake 750-800ml

Milk production of an exclusively bf mom 710-803ml/d

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6
Q

Breastfeeding benefits for infant (11)

A
  1. Optimal nutrition for infant
  2. Strong bonding with mother
  3. Safe, fresh milk
  4. Enhances immune system
  5. Decreased risk for acute otitis,edit, non-specific GE, severe LRTIs and asthma
  6. Protection against allergies and intolerances
  7. Promotion of correct development of teeth and jaw.
  8. Associations with higher IQ and school performance through adolescence.
  9. Decreased risk of chronic diseases ( DM type 1 & 2, hot, obesity, heart disease, hypercholesterolaemia and childhood leukaemia.
  10. Deceased risk for SIDS
  11. Decreased risks for infant morbidity and mortality.
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7
Q

Breastfeeding benefits for mothers (10)

A
  1. Strong bonding with infant
  2. Increased energy expenditure- faster return to pre- pregnancy weight
  3. Faster shrinkage of uterus.
  4. Decreased postpartum bleeding and delays menstrual cycle.
  5. Decreased risk for chronic disease (DM2, breast and ovarian cancer)
  6. Improved bone density and decreased risk of hip fractures.
  7. Decreased risk of postpartum depression
  8. Enhances self-esteem in the maternal role
  9. Saves time from preparing and mixing formula
  10. Money saved both on formula and increased medical expenses associated with formula feeding
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8
Q

Ten steps to successful breastfeeding (WHO & UNICEF 1989)

A
  1. Have a written breastfeeding policies that is routinely communicated to all healthcare staff.
  2. Train all staff in skills necessary to implement policy
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within a half-hour of birth.
  5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
  6. Give newborninfants no food or drink other than breast milk unless medically indicated.
  7. Practise rooming in -allow mothers and infants to remain together -24 hrs/d.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
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9
Q

Regulation R991. (5)

A

Enforcing WHO Code for marketing Breastmilk substitutes (BMS)

Prohibits advertising any BMS for infants <1yr

No picture on BMS tins which depicts an infant

Prohibits advertising of bottle teats and pacifiers

No “specials” allowed on BMS

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10
Q

Sources of Macronutrients in Infant Formulas - cows milk

A

Protein → casein & whey
CHO → lactose
Fat - Palm, say, coconut, safflower, sunflower

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11
Q

Sources of Macronutrients in Infant Formulas → cow’s milk - lactose-free

A

Protein → casein, whey
Cho → corn syrup solids (glucose)
fat → Palm, soy, coconut

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12
Q

Sources of Macronutrients in Infant Formulas - soy

A

Protein → soy
Cho → corn syrup (glucose), sucrose
Fat → Palm, soy & coconut

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13
Q

Sources of Macronutrients in Infant Formulas - extensively hydrolysed

A

Protein → peptides & amino acids
Cho → corn syrup solids (glucose), modified corn starch, sucrose
Fat → Palm, soy, coconut, safflower, sunflower, MCT

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14
Q

Sources of Macronutrients in Infant Formulas (amino-acid based / completely hydrolysed/ elemental)

A

Protein → amino acids
Cho → corn syrup solids (glucose)
Fat → soy, coconut, safflower, MCT

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15
Q

Cow’s milk formulas

A

Infacare
lactogen
Nan pelargon
Melegi Nurture

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16
Q

Soy based formula

A

Isomil
Infasoy

17
Q

Lactose-free cow’s milk based formula

A

Nan lactose free
s-26LF gold
(not appropriate for galactosaemia

18
Q

Hydrolysed protein formula

A

Similac Alimentum
Alfaré
Nutricia Pepticate
Novalac Allernova smooth

19
Q

Amino-acid based formulas

A

Nutricia neocate LCP
Nutricia neocate junior
Novalac Aminova

20
Q

Preterm infant formula

A

Pre Nan

21
Q

Energy & protein dense formula

A

Infatrini
Used for fluid restriction, cardiac patient & catch-up growth
100kcal/100ml
2.6g protein/ 100ml

22
Q

Monogen

A
  • Low fat
  • nutritionally complete
  • contains whey protein, Cho, fat [low in LCTs (16%) & high in MCTs (84%)]

Indications:
Hyperlipoproteinaemiatype I
Long chain fatty acid oxidation defects (LCFADs)
Intestinal lymphangiectasia
Chylothorax
Intractable malabsorption with steatorrhoea

Per 100ml
74kcal, 12g CHO & 2.1.g fat, 2.2g prot

Dilution= 1:30ml water

23
Q

Ketocal

A
  • Very high fat (73%), low CHO
  • Milk proteins, supplemented with amino acids, fat , CHO, vitamins, minerals & trace elements
    -1:5 dilution = 20g in 80ml water to make 100ml(146kcal)
    -1:7 dilution = 20g in 120ml water = 140ml

100ml provides:
146kcal
3.1g prot
0.6g CHO

Energy distribution:
Protein8.2%
Carbohydrate3.1%
Fiber1.5%
Fat (LCT 100%)88.7%

  • Classical (4:1) ketogenic diet
    •Intractable epilepsy
24
Q

Carbohydrate-free formula

A
  • Either soy protein or hydrolysed protein
  • CHO malabsorption
  • CHO source: glucose or fructose must be added to these formulas
  • CHO generally started at 2-3% wt/vol & is increased as tolerated to make a 20kcal/25ml formula
25
Q

Energivit

A

A protein-free powder containing carbohydrate, fat, vitamins, minerals and trace elements.
•
Per 100ml:
–74kcal
–0g protein
–10g CHO
–3.75g fat
95% LCT and 4.5% MCT per 100g

Recommended concentration is 15% w/v (weight for volume)
Osmolality is 190 mOsm/kg H20 (at 15% wt/vol)

Indications:

For infants and children requiring additional energy, vitamins, minerals and trace elements or who are following a protein restricted diet.

May be used as part of a modular feed in conjunction with an appropriate nitrogen source (i.e. protein, peptide, or amino acids)

Can be used as a protein free formula in the short term, for example as an emergency regime or when awaiting diagnosis

26
Q

Kindergen

A

Nutritionally complete , unflavoured

Whey protein (cows’ milk),carbohydrate, fat, vitamins, minerals and trace elements with modified levels of phosphorus and electrolytes.

25.1 kcal per 5gr scoop

Low levels of potassium, chloride, calcium, phosphorus and vitamin A

Fibre Free

Halaal & Kosher

Indications
For the dietary management of chronic renal failure and where peritoneal rapid overnight dialysis (PROD) or continuous cycling

27
Q

Prethickened Formulas

A

Use associated with decreased symptoms of :

Regurgitation & vomiting in infants with GOR

Not more effective at reducing reflux symptoms than std formulas thickened with cornstarch or rice cereal.

Nutrients in prethickened formulas are not displaced by additives.

Prethickened formulas flow freely through a std nipple

Formulas show benefits & are well tolerated.
–
E.g. Nan AR

28
Q

Stabilisation formula for SAM:

A

F75

For stabilisation feeding
Low in prot, lactose, iron and sodium

WHO recipe per 100ml:
75kcal
0.9g prot(60% whey; 40% casein)
13g CHO (0.8g lactose)
2g fat
0g fibre
10mg sodium
0.01mg iron

Specially formulated for children with severe acute malnutrition (SAM) only
Not suitable for well-nourished children
Not for parenteral administration

29
Q

Catch-up formulas for SAM

A

F100

Catch-up phase
High in energy and protein

Per 100ml:
100kcal
2.8g prot(20%whey; 80% casein)
9g CHO (4,7g lactose)
5.9fg fat
0g fibre
30mg sodium

Not for <6 months old

Paeds (20 decks)

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