Replacement Feeding

Question 1

What is the recommended first choice of feed for infants?

Answer 1

Breastmilk is the recommended first choice of feed for infants due to its numerous health benefits for both the baby and the mother.

Question 2

When might replacement feeding (formula feeding) be necessary?

Answer 2

Replacement feeding, or formula feeding, may be necessary in certain circumstances where breastfeeding is not feasible or safe, such as when the mother is unable to breastfeed or if there are medical reasons prohibiting breastfeeding.

Question 3

What is the importance of educating parents about the risks associated with formula feeding?

Answer 3

t is crucial to educate parents about the risks associated with formula feeding to ensure they make informed decisions about infant feeding. This includes understanding potential health implications for the baby and the mother.

Question 4

What should be considered when assessing the family’s ability to safely formula feed?

Answer 4

When considering formula feeding, it is essential to assess the family’s ability to safely prepare and provide formula, including access to clean water, proper sanitation, and sufficient resources to afford formula and feeding equipment.

Question 5

Why is it important to promote and support breastfeeding despite the availability of formula feeding?

Answer 5

Breastfeeding offers unparalleled health benefits for both infants and mothers. Therefore, every effort must be made to promote and support breastfeeding, while also acknowledging and addressing situations where formula feeding becomes necessary

Question 6

The following conditions must be met for safe replacement feeding at home:

Answer 6

Safe water and sanitation assured.
* Reliably provide sufficient infant formula for 12 months.
* Prepare infant formula freshly and cleanly with every feed.
* Exclusively give infant formula for the first 6 months of a infant’s life.
* Supportive family.
* Access to health care that offers comprehensive child health services.

Question 7

What is the primary basis for most formula feeds?

Answer 7

Most formula feeds are primarily based on cow’s milk, which undergoes various alterations to approximate the composition of breast milk.

Question 8

Can cow’s milk be modified to perfectly replicate breast milk?

Answer 8

No, despite modifications, cow’s milk cannot fully replicate the unique properties of breast milk.

Question 9

What forms are available for formula feeds?

Answer 9

Formula feeds are available in two main forms: as powder, which needs to be mixed with water before feeding, and as ready-to-feed preparations, which require no additional preparation.

Question 10

What is the aim of altering cow’s milk in formula feeds?

Answer 10

The aim of altering cow’s milk in formula feeds is to approximate the nutritional composition of breast milk as closely as possible to support infant growth and development.

Question 11

Why is it emphasized that no modification of cow’s milk can fully reproduce breast milk?

Answer 11

It is important to emphasize that no modification of cow’s milk can fully reproduce breast milk to highlight the unique and irreplaceable nutritional and immunological benefits provided by breast milk.

Question 12

Consider the
following when deciding on which formula to use:

Answer 12

• Standard term formula are suitable for term or larger preterm infants.
• Preterm formulas for infants under 35 weeks (or less than 2000-2500g).
• Specialised formula i.e. amino-acid based or hydrolyzed formula may be needed
  in malabsorption or allergy. Nutrient dense formula can be considered in infants
  who are growth faltering.
• Socioeconomic status of the family.
• Local availability of the milk products

Question 13

When is cow’s milk considered suitable for infants?

Answer 13

Cow’s milk is not suitable for newborn infants but can be introduced as a beverage after 12 months of age

Question 14

Why is cow’s milk not recommended for newborn infants?

Answer 14

Cow’s milk is not recommended for newborn infants because it lacks essential nutrients in the proper proportions needed for infant growth and development. Additionally, cow’s milk can be difficult for infants to digest and may increase the risk of certain health issues such as iron deficiency anemia and gastrointestinal discomfort.

Question 15

What are the nutritional concerns regarding cow’s milk for infants?

Answer 15

Cow’s milk contains higher levels of protein and minerals such as sodium and potassium, which can strain a newborn infant’s immature kidneys and may lead to dehydration or electrolyte imbalances. Additionally, cow’s milk lacks adequate amounts of certain essential nutrients like iron and vitamin E needed for optimal infant growth and development.

Question 16

Fluid requirements in term infants

Answer 16

Day 1 – 60 ml/kg
Day 2 – 75 ml/kg
Day 3 – 96 ml/kg
Day 4 – 132 ml/kg
Day 5 – 150 ml/kg

Continue at 150ml/kg thereafter for the first month of life.

Question 17

What is the recommended starting feed volume for preterm infants weighing less than 1500g on day 1 of life?

Answer 17

For preterm infants weighing less than 1500g, the recommended starting feed volume on day 1 of life is 24ml/kg.

Question 18

How should feed volumes be increased for preterm infants in the neonatal period?

Answer 18

Feed volumes for preterm infants should be increased by 30-40ml/kg per day. This gradual increase helps support the infant’s nutritional needs and growth.

Question 19

At what rate should feed volumes be increased until reaching the target volume for preterm infants?

Answer 19

Feed volumes for preterm infants should be increased until reaching 150-200ml/kg. This rate of increase ensures adequate nutrition and supports optimal growth.

Question 20

How should feed volumes be adjusted for preterm infants considering the nutritional content of feeds and infant growth?

Answer 20

Feed volumes should be adjusted according to the nutritional content of feeds, as preterm formulae vary in calorie and protein content. Additionally, feed volumes should be monitored and adjusted based on the infant’s growth to ensure they are receiving adequate nutrition.

Question 21

Why is it important to gradually increase feed volumes for preterm infants?

Answer 21

Gradually increasing feed volumes for preterm infants helps minimize the risk of feeding intolerance and supports optimal growth and development. This approach allows the infant’s gastrointestinal system to adapt to increasing volumes of feeds while ensuring adequate nutrition.

Question 22

What is the energy content (kcal) per 100 ml of breast milk and most modified and partially modified milk?

Answer 22

Breast milk and most modified and partially modified milk contain 67 kcal/100 ml.

Question 23

What is the energy content (kcal) per 100 ml of special preterm formulas?

Answer 23

Special preterm formulas contain 80-85 kcal/100ml.

Question 24

What are the recommended daily requirements of energy intake for preterm infants?

Answer 24

The recommended daily requirements for preterm infants range from 110–135 kcal/kg/24 hours.

Question 25

What are the recommended daily requirements of energy intake for term infants?

Answer 25

The recommended daily requirements for term infants range from 100–115 kcal/kg/24 hours.

Question 26

How can the required energy intake be achieved for infants using formula feeding?

Answer 26

By using the appropriate volume of correctly mixed formula, infants can receive the required energy intake according to their actual body weight and the energy content of the formula.

Question 27

What is an important consideration regarding powdered infant formula?

Answer 27

Powdered infant formula is not sterile and may contain pathogens, posing risks if improperly prepared, handled, or used.

Question 28

Why is it crucial to inform caregivers about the potential risks associated with powdered infant formula?

Answer 28

Caregivers need to be aware of the potential risks associated with inappropriate preparation, handling, and use of powdered infant formula, as it can lead to serious illness in infants.

Question 29

Why is it necessary to check the reconstitution methods of various formula brands before educating caregivers?

Answer 29

Different brands of powdered infant formula may have varying reconstitution methods (e.g., different ratios of water to powdered formula), necessitating verification of preparation methods before educating caregivers to ensure proper formula preparation.

Question 30

What feeding method should caregivers be encouraged to use at home, and why?

Answer 30

Caregivers should be encouraged to cup feed their infants at home, as bottles and teats are difficult to clean and can increase the risk of infants developing diarrhea due to contamination.

Question 31

How can caregivers mitigate the risks associated with using powdered infant formula?

Answer 31

: Caregivers can mitigate risks by following proper preparation, handling, and feeding practices, including using sterile water, measuring formula accurately, preparing formula immediately before feeding, and cup feeding instead of using bottles and teats. Additionally, caregivers should be vigilant about hygiene and sanitation during formula preparation and feeding.

Question 32

Frequency of feeding in term infants

Answer 32

demand feed or 3-hourly feeds to start with i.e. 8 feeds a day

Question 33

Frequency of feeding in pre-term infants

Answer 33

: 2 or 3-hourly feeds i.e. 8-12 feeds per day

Question 34

What feeding approach is recommended for infants?

Answer 34

Infants should be allowed to feed on demand, rather than being encouraged to “finish every feed.”

Question 35

Why is it important to allow infants to feed on demand?

Answer 35

Allowing infants to feed on demand supports their natural feeding cues and helps regulate their appetite, fostering healthy eating habits and growth.

Question 36

What should be ensured while allowing infants to feed on demand?

Answer 36

It is important to ensure nutritional adequacy, particularly in preterm infants transitioning from tube or cup feeding to breastfeeding.

Question 37

What feeding methods might be necessary for preterm infants transitioning to breastfeeding?

Answer 37

Preterm infants transitioning to breastfeeding may require nasogastric tube or cup feeds initially, depending on their clinical condition and gestational age. Expressed breast milk is typically used for these feeds.

Question 38

How does allowing infants to feed on demand support their development?

Answer 38

Allowing infants to feed on demand supports their physiological and emotional needs, promotes bonding between the infant and caregiver, and facilitates optimal growth and development.

Question 39

When should preterm infants, regardless of feeding method, be given a multivitamin supplement?

Answer 39

Preterm infants, whether breastfed or formula fed, should be given a multivitamin supplement. Typically, multivitamin drops are started daily when full volume feeds are reached and continued until solids are introduced

Question 40

What is the rationale behind giving preterm infants a multivitamin supplement?

Answer 40

Preterm infants have increased nutritional needs due to their immature systems and may require additional vitamins and minerals to support their growth and development.

Question 41

When is it recommended to start iron supplementation in preterm infants?

Answer 41

Iron supplementation should be started from 1 month of age in preterm infants to prevent later iron deficiency anemia, as they have increased iron needs and may be at higher risk of iron deficiency.

Question 42

Why is iron supplementation important for preterm infants?

Answer 42

Iron supplementation is important for preterm infants to prevent iron deficiency anemia, which can have long-term consequences on their cognitive and motor development.

Question 43

What considerations should be made when giving supplements to preterm infants?

Answer 43

When giving supplements to preterm infants, it’s important to follow healthcare provider recommendations and monitor for any signs of intolerance or adverse reactions. Additionally, ensuring appropriate dosage and administration methods is crucial for their safety and effectiveness.

Question 44

At what age is the introduction of complementary foods generally not recommended for the general population?

Answer 44

The introduction of complementary foods is generally not recommended before 6 months of age for the general population.

Question 45

Are these recommendations applicable to special groups such as preterm infants?

Answer 45

No, these recommendations are not intended for special groups such as preterm infants. Individual recommendations must be made based on the infant’s development, including positioning, behavior, and oral skills.

Question 46

What approach is suggested for introducing complementary foods to infants?

Answer 46

It is recommended to introduce small amounts of iron-rich foods, one at a time, starting with cereals, pureed fruits, and vegetables.

Question 47

How should the introduction of complementary foods progress?

Answer 47

The introduction of complementary foods should gradually progress to a full mixed diet, incorporating a variety of foods to ensure adequate nutrition and development.

Question 48

What factors should be considered when introducing complementary foods to infants?

Answer 48

When introducing complementary foods, factors such as the infant’s readiness, developmental milestones, and individual preferences should be considered. Additionally, attention should be paid to ensuring that iron-rich foods are included in the diet to support healthy growth and development.

Question 49

What are helpful signs indicating appropriate feeding and growth in infants?

Answer 49

A helpful sign is when the infant is content after a feed, coupled with a satisfactory weight gain as per the growth chart.

Question 50

What steps should be taken if an infant is experiencing failure to thrive?

Answer 50

If an infant is failing to thrive, several steps should be taken:

1. Examine the infant to exclude any underlying diseases or medical conditions.
2. Assess the adequacy of milk intake and the infant’s energy and protein intake.
3. Exclude abnormal losses, such as vomiting or diarrhea, as well as factors like infection, acidosis, metabolic disturbances, or congenital or acquired conditions that could contribute to poor growth.

Question 51

Why is it important to examine an infant experiencing failure to thrive?

Answer 51

It is crucial to examine the infant to identify and exclude any underlying diseases or medical conditions that may be contributing to the failure to thrive.

Question 52

What factors should be considered when assessing the adequacy of milk intake?

Answer 52

When assessing the adequacy of milk intake, factors such as the frequency and duration of feeds, feeding patterns, and signs of satiety or hunger should be considered.

Question 53

Why is satisfactory weight gain an important indicator of infant health and nutrition?

Answer 53

Satisfactory weight gain is an important indicator of infant health and nutrition as it reflects proper growth and development, indicating that the infant is receiving adequate nutrition for their needs.

Question 54

Why is cup feeding preferable to bottle feeding?

Answer 54

Cup feeding is preferable to bottle feeding because a cup is far easier to clean, reducing the risk of bacterial contamination and promoting better hygiene.

Question 55

What is the recommended feeding duration for infants?

Answer 55

No normal infants should be fed for longer than 20 minutes to prevent overfeeding and promote healthy feeding habits.

Question 56

What advice should be given regarding the cleanliness of cups, bottles, and teats?

Answer 56

It is important to thoroughly clean cups, bottles, and teats after each use using hot, soapy water and a bottle brush to remove any milk residue. Rinse thoroughly and air dry to prevent bacterial growth.

Question 57

How should sterilization of feeding equipment be performed?

Answer 57

Feeding equipment such as cups, bottles, and teats should be sterilized before first use and then regularly thereafter. This can be done by boiling the equipment in water for at least 5 minutes or using a sterilizer according to manufacturer instructions.

Question 58

What are the recommendations for the storage of reconstituted milk and feeding temperature?

Answer 58

Reconstituted milk should be stored in a clean, covered container in the refrigerator and used within 24 hours. Before feeding, milk should be warmed to body temperature by placing the container in warm water, ensuring it is not too hot for the infant.

Question 59

What common mistakes should mothers be warned about regarding infant feeding?

Answer 59

Mothers should be warned about common mistakes such as making feeds too strong or too weak, as this can affect the infant’s nutrition and health. It is also important to educate mothers about the difference between thirst and hunger cues in infants to avoid overfeeding.