Paediatric gastroenterology - liver + infant nutrition (part 2 of lecture 2)

Question 1

Be aware of the range of clinical manifestation of food intolerance and cow’s milk allergy

Understand the approach to children with faltering growth, undernutrition and obesity

Know the key types of infant feeds and when they might be used.

Answer 1

Main differences between breast and formula feeding

Know the principles underlying the UNICEF ‘Baby Friendly’ programme

Use clinical and dietary history taking to make effective assessments and assess progress.

Question 2

Growth is primarily led by what in the following

• infant
• child
• puberty

Answer 2

Nutrition

Growth hormone

Sex steroids

Question 3

Average weight gain at

• 0-3 months
• 3-6 months
• 6-9 months
• 9-12 months

Answer 3

200g
150g
100g
50g

Question 4

Main differences between breast and formula feeding

Answer 4

Breast

• allows bonding
• PERFECT nutrition
• less allergenic (low antigen load)
• passive immunity –> develops baby’s active immunity
• develops baby’s gut mucosa
• reduced infection risk

Formula

• NEAR PERFECT nutrition
• NO ANTI-INFECTION PROPERTIES
• risk of contamination
• no spread of blood borne virus/drugs from mum to baby
• high antigen load
• ACCURATE feed volumes
• provides vit K
• reduced risk of jaundice

Question 5

Know the principles underlying the UNICEF ‘Baby Friendly’ programme

Answer 5

1. Have a written breast-feeding policy- routinely communicated to all staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits/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 newborn infants no food and drink other than breast milk, unless medically indicated.
7. Practise rooming-in - allow mothers+ infants to remain together - 24h/day
8. Encourage breast-feeding on demand.
9. Give no artificial teats, pacifiers (dummies) to breastfeeding infants.
10. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.

Question 6

Are all formulas cows milk based

Answer 6

Yes

Question 7

Milk is the exclusive food babies have for a minimum of how many months

Answer 7

6

Question 8

Cow’s milk (that adults drink) cannot be a child’s main drink until they’re age 1 because …

Answer 8

It contains no iron (but formula does)

Question 9

If have cow’s milk protein allergy, what types of formula can be given instead?

Answer 9

1st line - extensively hydrolysed protein feeds
–> e.g. nutramigen LGG, aptamil pepti

2nd line - amino acid based milks
–> e.g. alfamino

Question 10

Lactose free milks are given to those lactose tolerant (RARE IN BABIES, MORE IN OLDER IN CHILDREN)

Is lactose intolerance allergy mediated?

Answer 10

No, they just can’t absorb lactose

Question 11

Can soya milks be given to those with cow’s milk protein allergy?

Answer 11

No

-because soya commonly has cross reactivity with cow’s milk allergy so will probably be allergic to soya too

Question 12

Alternatives to non-formula milks (ONLY WHEN AGE >1)

Answer 12

Rice milk (but not for <5)
Goat’s milk (not for <1)
Oat/nut milks

Question 13

How many ml of full fat cow’s milk do children need to meet calcium requirements a day?

How many ml of calcium fortified milk (e.g. oat, soya) do children need to meet calcium requirements a day?

Answer 13

350ml

400-500ml

Question 14

Weaning (i.e. adding solids) starts at what age

Answer 14

6 months