WEEK 3: Dietetics: Infant feeding Flashcards
Children need food of appropriate _____ and _____ for optimal growth and development.
Children need food of appropriate quantity and quality for optimal growth and development.
Nutritional Vulnerability of Infants and Children.
1. Low nutritional stores
2. High nutritional demands for growth
4months -
1 year -
3 years -
3. Rapid neuronal development
At birth –
1year -
- Low nutritional stores
- High nutritional demands for growth
4months -30% energy intake
1 year - 5%
3 years - 2% - Rapid neuronal development
At birth –brain accounts for 2/3 BMR
1year - 50%
State the Long-term outcome of early nutritional deficiency.
State diseases children can have in adult life due to nutrient deficiency.
- Affect linear growth/mental development.
- Diseases in adult life
*Coronary heart disease
*Stroke
*Non-insulin dependent diabetes mellitus
*Hypertension
*Chronic airway obstruction
Describe the RELATION OF MATERNAL & FETAL NUTRITION.
*Maternal diet ultimate source of fetal nutrients as evidenced by distinctly lower average birth weight among babies in low-income than from high-income groups
*With poor maternal diet, less fat & protein storage in fetus, less vitamin A & iron storage in fetal liver & less Ca +2 deposition in fetal skeleton
*Poor maternal diet also increases incidence of abortions, stillbirths & developmental abnormalities in fetus
*Whatever physical, biochemical, physiologic & behavioral defects due to poor maternal diet intensified during neonatal period
AT BIRTH & NEONATAL PERIOD
*After birth when infant can safely tolerate enteral nutrition judged by____________
State the benefits of breastfeeding at birth.
Most infants can start breast-feeding immediately almost always within how many hours?
An infants’ stomach emptying varies from how many hours or more during a day?
*After birth when infant can safely tolerate enteral nutrition judged by normal activity, alertness, suck & cry, feedings started
*To maintain normal metabolism during transition from fetal to extrauterine life
*To promote maternal-infant bonding
*To decrease risks of hypoglycemia, hyperkalemia, hyperbilirubinemia & azotemia.
Azotemia is a medical condition characterized by elevated levels of nitrogen-containing compounds, such as urea and creatinine, in the blood.
*Most infants can start breast-feeding immediately almost always within 1–4 hr
*An infant’s stomach’s emptying time varies from 1–4 hr or more during a single day
General guidelines for infant feeding.
Fill in the blanks.
By end of 1st week, most healthy infants will be taking how much volume /feeding and want how many feedings/24 hr?
By end of 1st month, how many % of infants will have established a suitable & reasonably regular schedule.
Most will wake for a middle-of-the-night feeding until ______of age though some will never desire this feeding while others continue it beyond_________of age.
Between _______________of age, many infants will lose interest in the late evening feeding.
By ___________ of age, most will be satisfied with 3 meals/day plus snacks.
Not all infants conform to these general guidelines.
By end of 1 st wk, most healthy infants will be taking 60–90 ml/feeding and want 6–9 feedings/24 hr
By end of 1 st month, >90% of infants will have established a suitable & reasonably regular schedule
Most will wake for a middle-of-the-night feeding until 3–6 wks. of age though some will never desire this feeding while others continue it beyond 3–6 wk. of age.
Between 4–8 mo. of age, many infants will lose interest in the late evening feeding.
By 9–12 mo. of age, most will be satisfied with 3 meals/day plus snacks.
Not all infants conform to these general guidelines.
State 5 REASONS FOR AN INFANT’S CRY OTHER THAN HUNGER
*May not be receiving enough milk
*May have discomfort such as uncomfortable clothing, colic or “gas”, wet diapers or feeling hot or cold
*To gain sufficient or additional attention
*Simply need to be held
*Sick infants (uninterested in food and continue to cry even when held)
How long is usually recommended for breastfeeding?
What is the WHO recommendation?
Breast feeding
*First 4-6 months - exclusive
Can continue up to 3 years (WHO)
What are the recommendations for weaning?
If breast milk is inadequate or if mother has to go for work may start at 4 months
If not start at 6 months
State the advantages of breastfeeding.
*Biological fluid
*Freely available
*Clean
*Immune boost for the baby via passive immunity via IgA
BREAST STRUCTURE
Each breast has how many lobes of milk-producing glandular tissue?
Each lobe is made up of many smaller _______.
Special channels called ducts run from these lobes.
Spaces around the lobules and ducts are filled with fatty & connective tissue stroma that determines the size.
Nipple skin contains many nerves, oil & sweat secreting glands.
The actual milk-producing structures nearly the same in all
Each breast has 15 to 20 lobes of milk-producing glandular tissue.
Each lobe is made up of many smaller lobules.
University of Western Australia’s Human Lactation Research Group, with Medela, investigated the lactating breast using sophisticated ultrasound & research results overturned 160 years of received wisdom concerning the female breast.
What has changed regarding the breast structure?
*Ducts branch closer to the nipple
*Lactiferous sinuses do not exist
*Glandular tissue is found closer to the nipple
*Subcutaneous fat is minimal at the base of the nipple.
Describe the physiology of lactation.
*Nipple stimulation from baby’s breast sucking
*Message sent to spinal cord, then brain
*Increased prolactin levels released by anterior pituitary for milk production
*Increased oxytocin levels released by posterior pituitary for milk ejection reflex
State 6 factors influencing composition of milk.
*Time of day - Fat content highest early in the day & lowest at night
*Mother’s diet - Milk usually light blue but the more fat the more yellowish
*Mother’s emotional state - milk ejection reflex often absent or erratic during periods of pain, fatigue, or emotional distress
*Whether fore or hind milk -. “Fore” milk, 1st milk expressed is clear, thin & bluish reflecting low fat & high-water content but “Hind” milk or end milk is thick & creamy white reflecting higher fat content.
*Drugs - Atropine, opium, lead, iodides, barbiturates, sulfonamides, INH & some antibiotics may be found in milk after prolonged use or in maximum doses
*Smoking
State 4 factors used to determine adequacy of breastfeeding or breastmilk.
*If infant is satisfied after each nursing period
*Contented and sleeps 2-4 hours between feedings.
*Regularly and adequately gaining weight
*The “let-down” or milk ejection reflex in the mother is an important sign
Describe changes in the composition of breastmilk with time.
Fore milk - Contain more proteins, lactose &
other nutrients
Hind milk – More fat (energy): more whitish
Describe how to establish breast-feeding.
- Initiation - within the first 1/2 to one hour of life
- Exclusive breastfeeding for 1st 6 months
Infants receive only breast milk and no other liquids or solids not even water, except vitamins or mineral supplements. - Breastfeeding on demand
as often as the child wants, day and night. - bottles, teats or pacifiers not recommended
- Technique of breast feeding
*Skin to skin contact
*Positioning
*Feed till emptying of one breast
How long is colostrum released for?
How much is released per day?
Describe the contents and characteristics of colostrum.
First 2-4 days
10-40ml
*Yellow fluid
*More protein (95% Globulins and IgA)
*Less fat and sugar
*More vitamins esp. Vit A
*More salt (Sodium and chloride ions)
*Alkaline pH 7.7
How long is transitional milk released for?
How much is released per day?
Describe the contents and characteristics of transitional milk.
From Day 4-10 to 1 month
Increases to less than 600ml
*Fall in protein
*Decreasing in cells/ mm3 and concentration of immunoglobulins
*Gradual increase in fat and lactose
*Sodium, chloride and potassium ions decrease
*Calcium and phosphate ions constant
How long is mature milk released for?
How much is released per day?
Describe the contents and characteristics of mature milk.
By the end of first month of lactation.
About 600ml in 1st month and to 800ml in the 6 months
Falls to 25-400ml in the second year.
*About 5% fat, 1.1% protein and 7% lactose
*pH 6.8-7.4 average=7
Outline 5 factors for assessment of the adequacy of milk.
*Growth (weight gain)
*Satisfaction (Sleeping after meals)
*Urine output /Bowel movements
*Pins and needles sensation of the breast
*Secretion of milk from the contra lateral breast while feeding
Breastmilk has Anti-infective properties.
State the 4 humoral factors of breastmilk and their function.
Humoral
*Secretory IgA
– Mucosal protection
*Bifidus factor
– Promotes growth of Lactobacillus bifidus
-Low pH inhibit growth of GI pathogens
*Lysozyme – Bacteriolytic enzyme
*Lactoferrin – Inhibit growth of E-coli
State the cellular Anti-infective properties of breastmilk.
*Macrophages
*Lymphocytes
-Delayed hypersensitivity (T-cells)
-IgA secretion (B-cells)
Breastmilk has high protein quality.
What is its whey: casein ratio?
60:40
