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Feed That Baby!. Kathryn Camp, MS, RD, CSP Assistant Professor of Pediatrics USUHS Pediatric Nutritionist, WRAMC. Infant Nutrition. The interplay of meeting nutritional demands and developmental milestones 100kcal/kg/day; 2.2 g pro/kg/day Breastmilk or Iron fortified formulas.

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feed that baby

Feed That Baby!

Kathryn Camp, MS, RD, CSP

Assistant Professor of Pediatrics

USUHS

Pediatric Nutritionist, WRAMC

infant nutrition
Infant Nutrition
  • The interplay of meeting nutritional demands and developmental milestones
  • 100kcal/kg/day; 2.2 g pro/kg/day
  • Breastmilk or Iron fortified formulas
breastmilk
Breastmilk
  • Four stages of composition
    • Colostrum: fat and calories; protein/vit/min
    • Transitional milk
    • Mature milk
    • Extended lactation
  • Hindmilk vs foremilk
  • Needs of lactating women
    • additional 500 calories, 12-15grams of protein
breastmilk composition
Breastmilk Composition
  • Energy- 20cal/oz, variable within a feeding
    • 50% fat, 40% carbohydrate, 10% protein
  • Fat
    • Palmitic, linoleic, oleic
    • EFA--linolenic and linoleic
    • Docosahexaenoic and arachidonic acids
  • Carbohydrate
    • Lactose (glucose + galactose)
  • Protein
    • 70% whey and 30% casein
composition cont
Composition cont:
  • Immunological factors
    • anti-inflammatory
      • -protect against atopy
    • anitmicrobial
      • Secretory IgA
    • immunomodulating
      • cytokines
aap recommendations breastfeeding
AAP Recommendations Breastfeeding
  • Exclusive breast feeding during the first 4-6 months
  • Continuation of breast feeding for the 2nd 6 months as optimum source of nutrition
advantages of breastfeeding
Advantages of Breastfeeding

INFANT:

  • Superior nutritional composition
  • Immunologic properties
  • Decreased immune mediated dz
  • Improved cognitive ability
  • Protective against childhood obesity
advantages cont
Advantages Cont:

MOTHER/SOCIETY:

  • Enhanced maternal-infant bonding
  • Reduced risk of ovarian and breast cancer and osteoporosis
  • Safest in disaster and poverty settings
  • Lower cost (including paraphernalia)
  • Increased convenience
barriers to breastfeeding
Barriers to Breastfeeding
  • Sore nipples and engorgement
  • Concern for hyperbilirubinemia
  • Maternal fatigue
  • Return to work
  • Concern for milk supply vs infant needs
    • Unnecessary formula supplementation
signs of adequate breastmilk
Signs of Adequate Breastmilk
  • Feeding 8-10 times per day
  • Rhythmic suck and audible swallows
  • Number of wet diapers
  • Number of bowel movements
  • Infant behavior
  • Weight and physical exam
expressed milk
Expressed Milk
  • Clean hands and equipment
  • Safe for 8-10 hrs at room temp
  • Up to 8 days in coldest part of refrigerator
  • 4-6 months in self-defrosting freezer
  • Up to 1 year in deep freezer
  • Defrost in refrigerator overnight
  • Never microwave or refreeze
indications for use of infant formulas
Indications for Use of Infant Formulas
  • Maternal conditions
    • do not wish to or cannot provide BM
    • infection with organisms transmitted in BM
    • chemotherapy, certain medications or drugs
  • Infant conditions
    • inborn errors of metabolism
    • failure to gain weight despite breastfeeding intervention
slide18

Question:A 2 month old infant is brought to you with failure to thrive. The mother reports she is breast-feeding the child every 6 hours but the child only sucks for 5 minutes before falling asleep. The mother also reports that she is very anxious. What will be your advice to her?Answers follow

slide19
stop breast-feeding immediately and switch to the bottle
  • offer the breast more frequently to build up the milk supply
  • encourage the infant to suck longer to empty the breast
  • offer the breast first then use a bottle if the child is still hungry
  • try and relax when nursing the baby
  • offer information on breast-feeding support groups such as Nursing Mothers Assoc
infant formulas1
Infant Formulas
  • Four main categories of formulas:
    • Standard formula (cow’s milk)
      • Enfamil, Similac
    • Soy
      • Isomil, Prosobee
    • Protein hydrolysates
      • Pregestimil, Alimentum, Nutramigen
    • Purified amino acid based
      • Neocate
standard formulas
Breastmilk

20cal/oz

Human milk fat

Lactose

whey:casein 70:30

Iron 0.3mg/L

Vitamin D 21 IU/L

Renal solute load 91

Enfamil/Similac

20cal/oz

Soy, coconut, sunflower, palm

Lactose

60:40, 18:82

Iron 12mg/L

Vitamin D 405 IU/L

Renal solute load 130s

Standard Formulas
soy formulas
Breastmilk

20cal/oz

Human milk fat

Lactose

whey:casein 70:30

Iron 0.3mg/L

Vitamin D 21IU/L

Renal solute load 91

Isomil/Prosobee

20cal/oz

palm olein, soy,coconut,sunflower

Corn syrup/sucrose

Protein=soy isolate and L-methionine

Iron 12mg/L

Vitamin D 405 IU/L

Renal solute load 150s

Soy Formulas
soy formulas1
Soy Formulas
  • Not appropriate for preterm infants/CF
    • Aluminum content, risk of osteopenia, growth concerns
  • Indications for use
    • Milk protein intolerance
    • Lactose intolerance (rare)
    • Galactosemia
    • Vegetarian diet
milk protein allergy
Milk Protein Allergy
  • Not lactose intolerance!!
  • Onset first 4 months of life
  • Sxs: diarrhea, heme +, vomiting, rashes, respiratory sxs, systemic rxn
  • Tx- elimination of milk protein until 1-2yrs of age at which time it is reintroduced
  • 50-60% infants will also have allergy to soy
lactose intolerance
Lactose Intolerance
  • Two types of lactose intolerance
    • Primary congenital lactase deficiency (RARE)
    • Secondary lactase deficiency s/p acute gastritis
      • Soy and Lactose free formulas (Lactofree) can be used short term but there is little justification
protein hydrolysates
Breastmilk

20cal/oz

Human milk fat

Lactose

70%whey 30%casein

Iron 0.3mg/L

Vit D 21 IU/L

Renal solute load 91

Pregestimil

20cal/oz

MCT, safflower, soy

Sucrose, corn starch

*Casein Hydrolysate-nonantigenic peptides

Iron 12mg/L

Vitamin D 405 IU/L

Renal solute load 170s

Protein Hydrolysates
question
QUESTION
  • Which formula should these infants have?
    • Infant with galactosemia
    • Infant with multiple food allergies
    • Healthy term infant
    • Infant with decreased pancreatic lipase and bile salts
vitamin and mineral needs
Vitamin and Mineral Needs
  • Vitamin K IM x1 for all newborns
    • Prevents hemorrhagic disease of the newborn
    • Low stores at birth and sterile gut
  • Vitamin D supplementation
    • Exclusively BF infants at risk
      • Fat malabsorption, dark skinned, low exposure to sunlight
      • Adequate sunlight
      • Dose 400IU/day
vitamins minerals cont
Vitamins & Minerals (cont)
  • Iron supplementation
    • Recommended for BF infants by 4-6mo
    • Infant cereal/iron drops
  • Fluoride supplementation
    • Recommended for those infants >6months who live in areas where water supply contains <0.3ppm of fluoride
    • Bottled, well water, or RTF formulas
introduction of solids
Introduction of solids
  • Readiness- physical and social factors
    • extrusion reflex disappears
    • can hold head up, sit independently, and maintain balance while using hands to reach/grasp
    • Can show desire for food as well as disinterest in food or satiety
    • Doubles BW and weighs at least 13lbs
    • Seems hungry after 8-10 BF/day or drinks more than 32oz of formula/day
    • Typical age 4-6months
progression of solids
Progression of Solids
  • Need for solids
  • Feedings
    • 4-6 months-infant rice cereal
    • 7 months- strained vegetables/fruits
    • 8-10 months- juices and meats
    • >9-10 months- finger foods
whole milk
Whole Milk
  • NOT BEFORE 12 MONTHS
  • Risks of early introduction
    • Increased risk of milk protein allergy and GI bleed secondary to GI immaturity
    • Development of iron deficiency
      • Low stores by 4-6mo
      • Low bioavailability of iron in cow’s milk
      • GI blood loss
    • Poor source of vitamins C & E as well as essential FA
question1
QUESTION
  • A 5mo infant weighing 6kg consumes 4oz of Similac q 3 hours during the day to total 6 bottles and sleeps through the night. No solids. Is this adequate?
  • What is the total calorie intake?
  • 480 calories/day
  • How many kcal/kg?
  • 80 kcal/kg
  • How many calories does the infant need?
  • Around 600