Rourke Baby Record- Nutrition extra tips

Question 1

Breastfeeding decreases risk of what 3 things

Answer 1

• SIDS
• Diarrhea
• Ear/lung infections

Question 2

What does the hand expression of breastmilk help

Answer 2

helps with production

Also:
* Soften the areola to help infant latch
* Lessen the discomfort of engorged breasts, whether breastfeeding is continued or not
* Be used as an alternative to a breast pump

• Hand expression in the first hour after birth and continuing after each feeding helps to establish a good milk supply, even when breastfeeding is going well. Families
  can provide breastmilk by cup or spoon while infant learns to breastfeed effectively.

Question 3

For formula feeding what types of formula should be avoided

Answer 3

homemade ones

Homemade infant formula, including those made with evaporated milk, are not safe alternatives to commercial infant formula as they can cause severe malnutrition and potential fatal illness

Infant formulas typically contain iron- 0.4mg-1.3mg/100ml

Question 4

Is skin to skin still important when feeding formula

Answer 4

yes

Question 5

Are follow-up infant formulas (e.g., 6 months plus) superior to standard infant formulas (e.g., 0 month plus)?

Answer 5

no

Question 6

What is the best formula

Answer 6

cows milk based

soy next

Question 7

Is sterilzing needed for bottles when formula feeding

Answer 7

yes until age 6 months

Question 8

What is safe water to mix with formula

Answer 8

tap, bottled, regularly tested well water

avoid carbonated and mineral water

Ready to feed formulas need no mixing and are safest

Question 9

How long can formula be stored in fridge or on counter

Answer 9

fridge 24 hours
counter 2 hours

Question 10

What are signs of iron deficiency in infants

4

Answer 10

• pallor
• poor appetite
• irritabiity
• slowed growth

Question 11

What is needed to know about infant and child consumption of fish

Answer 11

some fish contain higher levels mercury

fresh/frozen tuna, shark, swordfish, escolar, marlin, orange roughy, and canned albacore
(white) tuna

amount fed should be restricted

Question 12

What should children be fed in terms of fish

Answer 12

2 servings/week of low mercury fish

Question 13

Can you give goat milk to a child with cows milk allergy

Answer 13

no- similar protein structure

Common food allergens in Canada are: eggs, milk, mustard, peanuts, crustaceans and molluscs, fish, sesame seeds, soy, sulphites, tree nuts, wheat and triticale

Question 14

If a child is upright, attentive, and fed approriate textures what is their risk of choking compared to adults

Answer 14

same risk

Question 15

Is gagging the same as choking in infants

Answer 15

no- natural relfex to prevent choking

Question 16

What are high risk choking foods

Answer 16

• hard small round items like candies
• smooth or stick
• bones
• toothpicks/skewers

AVOID TIL AGE 4

• Avoid hard, small and round, or smooth and sticky, solid foods including: hard candies, cough drops, gum, popcorn, marshmallows, whole nuts, seeds, fish with
  bones and snacks using toothpicks or skewers for children younger than 4 years.

Reduce the risk of choking by dicing or cutting lengthwise hot dogs or sausages, grating raw carrots or hard fruits such as apples, removing pits from fruits,
chopping grapes, thinly spreading nut butters on crackers or toast, and finely chopping foods that are fibrous or stringy in texture such as celery, pineapple or
oranges.

Question 17

Is baby led weaning the gold standard for food introduction

Answer 17

no- use infant feeding cues

• Baby-led weaning (BLW) is a method of introducing solid foods to infants. There is no agreed upon definition for BLW and there is no conclusive high-quality
  evidence to support BLW over other methods of feeding.43 Common components of BLW include the following:
  o Infants are encouraged to self-feed family finger foods rather than being spoon-fed by someone else, therefore avoiding pureed foods.43
  o Food is offered in many shapes and sizes that infants can easily handle.
• Concerns of BLW may include:
  o Low iron and low energy intake due to the limited variety of iron-rich foods that babies can feed themselves. Closely monitor the infant’s growth and advise
  parents to provide iron-rich foods at every meal.43
  o Risk for choking due to developmental readiness to self-feed whole foods. Provide information to parents on how to safely prepare foods and to avoid choking
  hazards to help minimize risk.43

Question 18

FYI

Responsive Feeding and the Division of Responsibility
* The development of healthy eating skills is a shared responsibility:
o Birth to 6 months - Parents decide what milk source to provide. The infant, with infant-led or on-cue feeding, decides when, where and how much they are
fed.
o 6 months and older - Parents provide a selection of nutritious food and milk source and are beginning to be responsible for when and where the infant is fed
(e.g. parent chooses when/where solids are offered, infant chooses when to breastfeed). The infant decides whether to eat and how much to eat
o By 12 months - Parents take over the responsibility for when and where the child is fed by providing regular meals and snacks. Parents need to trust the
child’s ability to decide how much to eat and whether to eat
* In a non-controlling, non-coercive environment, healthy children have the and ability to self-regulate the amount of food and energy consumed.
* Fluctuations in
intake are normal and to be expected, as children have appetites that are appropriate for their age and growth rate.
* Children will eat less on some days and more on other days
* Pressuring children positively or negatively will not help them eat more or less of certain foods. Pressure or praise may lead to negative attitudes about eating and poor eating habits
* Pressuring or coercion may have short-term benefits but will make feeding more challenging and eating less rewarding.
o Positive pressure includes offering rewards, bribes (“if you eat your peas, you can have dessert”), praise (“you are a good girl for eating the peas”) or
reminding a child to eat a certain food.
o Negative pressure includes prodding, scolding, punishment, pleading, coercing (“clean your plate”)16 or using excessive verbal encouragement (“come on,
you’ve tried it before”).
* Children do not have the cognition to understand the health properties or impacts of food, therefore food should not be classified as “healthy” or “unhealthy.”
* Use plain language to describe food by calling foods by their name (ex. calling a cookie a cookie, not a ‘treat’). Foods can be described in neutral terms (i.e. the
strawberry is red, the soup is hot).

Question 19

fyi

Eating together as a family provides the child with a pleasurable, social experience and the opportunity to develop healthy eating habits and learn skills through imitation.
* Early childhood food experiences are critical to the development of food preferences and eating behaviours.
* Plan 3 meals and 2-3 snacks per day, scheduled 2.5 to 3 hours apart. Structure and routine for eating is important
* Allow about 20 minutes for children to stay at the table. When mealtime is over, remove the food
* Recommend avoiding distractions such as toys, books or screens during mealtimes
* Parents play a role in a child’s acceptance of a wider variety of foods.8 Children are more likely to try and enjoy a variety of foods when they are offered the same
foods the rest of the family are eating.
* Reassure parents that it is common to offer a new food more than 10 times before a child will accept it. Continue to keep offering these foods and wait for the child
to try it on their own.

Question 20

fyi

Vegetarian and Vegan Eating
* When vegetarian and/or vegan diets are well-planned, they can meet nutritional needs.
* Children are at higher risk of being low in vitamin B12, iron, zinc, calcium, vitamin D, and omega-3 fatty acids, especially in vegan diets.48
* Vegetarian diets may be lower in calories and may need extra sources of energy, including, soy products, avocado, soy and canola oils, nuts and nut butters.48
* Offer commercial soy-based formula for vegan children under 24 months of age who are not breastfed.8
* Refer client to a registered dietitian if the child is vegan or does not include milk or egg products in their diet.4
Plant-Based Beverages
* Plant-based beverages are made from legumes (soy, pea), nuts (almond, cashew, coconut, macadamia), seeds (flax, hemp) or grains (oat, rice).23
* Store-bought plant-based beverages may be fortified. Homemade plant-based beverages are not fortified and are void of important nutrients.23
* They are not equivalent to breastmilk, infant formula or 3.25% MF cow’s milk due to the lower protein, fat and calories and may not meet the needs for appropriate
growth and development.23
* For families wanting to offer a plant-based option, a commercial soy-based infant formula should be provided as a main milk source to a non-breastfed child under
24 months of age.8
Pediatric Nutrition Guidelines for Health Professionals (Birth to Six Years) 20
© Ontario Public Health Dietitians, 2024
* If a child is 24 months of age or older, if a plant-based beverage is consumed, parents are advised to select an unsweetened option that is labelled as “fortified” and
contains the following per 250 mL23
○ At least 6 g of protein,
○ At least 23% Daily Value (300 mg) of calcium,
○ At least 10% Daily Value (80 IU or 2 mcg) of vitamin D,
○ Less than 15% Daily Value (15 g) of sugar.
Note: The marketplace is changing. A plant-based beverage with a nutrient profile equivalent to 3.25% MF cow’s milk may be an alternative to 3.25% MF cow’s milk
starting at 9-12 months of age. Consider referral to a registered dietitian.

Question 21

What is ankyloglossia

Answer 21

tongue tie

Question 22

What is a tongue tie

Answer 22

congenital anomalym of abnormally short lingual frenulum

Question 23

What does a tongue tie cause

Answer 23

can restrict tongue tip mobility

can result in feeding issues

most infants with tongue tie are asymptomatic

Question 24

What is done if the tongue tie is causing feeding issues

Answer 24

frenotomy- surgical division of lingual frenulum

Question 25

what supplement do breastfeeding mothers need to take

Answer 25

400-600IU Vit D daily

Question 26

Is gastroesophageal reflux (GE) common in infants

Answer 26

yes - this is spitting up after feeds

Question 27

When does GE reflux peak and decrease

Answer 27

peaks around 3-4 months of age, rare after 1 year

Question 28

what can be done to decrease GE reflux

Answer 28

• thickened feeds
• switch to soy formula ?intolerance if formula fed
• if breastfed mom cut out cows milk protein

Question 29

Should infants be sat up to sleep or put on stomach to decrease GE reflux

Answer 29

no- high risk SIDS. Should be on back flat

Also PPIs etc should not be routinely used untill evidence of esophageal erosion