Pediatric Nutrition - PowerPoint PPT Presentation

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Pediatric Nutrition

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... human milk using manual expression or pump and given by bottle/tube ... skim milk is inappropriate in the first 2 years of life. Transition to Solid Foods ... – PowerPoint PPT presentation

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Title: Pediatric Nutrition


1
Pediatric Nutrition
  • The first two years
  • Joan Brennan
  • Clinical Dietitian

2
Early Recommendations
  • Breastfeeding and Human Milk
  • exclusive human milk feeding for first 4-6 months
    of life
  • breastfeeding may continue until two years of age
    and beyond
  • vitamin D supplementation of 400 IU to all human
    milk fed infants from birth until diet provides a
    source of vitamin D

3
Human Milk Feeding
  • either by breast or as expressed human milk using
    manual expression or pump and given by
    bottle/tube
  • various pumps available
  • manual vs. electric
  • electric most efficient and effective best one
    is rental from pharmacy
  • may take 7-10 days to establish breastfeeding
  • frequent feedings will help establish milk supply
  • number of wet diapers in a 24 hour period good
    indicator of whether baby is getting enough
  • supplemental formula may obstruct establishment
    breastfeeding

4
Infant Formulas
  • when an informed mother chooses not to
    breastfeed, commercial infant formulas are the
    most acceptable alternative to human milk
  • nutrient content of iron-fortified infant formula
    is designed to meet the nutritional needs of
    healthy term infants until 12 months of age
  • composition, processing, packaging, labeling are
    regulated under the Canadian Food and Drug
    Regulations

5
Infant Formula - Cows Milk Based
  • designed for most preterm infants gt 2000g and
    healthy term infants with no family history of
    allergy
  • designed to resemble human milk in nutrient
    composition and digestibility
  • available low in iron or as iron-fortified
  • iron-fortified recommended until 9-12 months of
    age and consuming a variety of foods
  • Eg Enfamil A, Similac Advance

6
Infant Formula - Follow-up
  • designed for infants in the second six months of
    life who are eating solid foods
  • more appropriate quantities and forms of
    nutrients compared to cows milk
  • lower renal solute load
  • iron-fortified
  • not superior to starter formulas
  • eg Next Step, Follow-up

7
Infant Formula - Lactose-free, cows milk based
  • suitable for infants with lactose intolerance
  • primary lactose intolerance due to congenital
    lactase deficiency (rare)
  • secondary due to acute gastroenteritis or chronic
    conditions
  • glucose polymers from corn syrup are substituted
    for the lactose
  • eg Enfalac Lactose-free

8
Infant Formula - Soy
  • soy protein and glucose and/or sucrose have been
    substituted for milk protein and lactose only
    available iron-fortified
  • approximately 40 of infants allergic to milk
    will also be allergic to soy
  • not suitable for use in children with a family
    history of allergy
  • suitable for infants with galactosemia or vegan
    lifestyle

9
Infant Formula - Protein Hydrolysate
  • Two types available in Canada
  • less extensively hydrolyzed
  • eg Good Start
  • for use in infants at risk for atopy
  • extensively hydrolyzed (casein-based)
  • eg Nutramigen
  • for infants at high risk for allergy to cows
    milk or soy protein

10
Infant Formula - Specialized
  • designed for infants with disorders of digestion,
    absorption and/or metabolism of protein, fat or
    carbohydrate
  • expensive, less palatable, for use under
    supervision of a health care practitioner
  • eg Pregestimil, Neocate, Alimentum, Portagen

11
Infant Formula - Distribution of Energy
12
Transition to Cows Milk
  • pasteurized whole cows milk may be introduced
    between 9-12 months of age and continued
    throughout the second year of life
  • partly skimmed milk (1 and 2) is not routinely
    recommended in the first 2 years of life
  • skim milk is inappropriate in the first 2 years
    of life

13
Transition to Solid Foods
  • infants between 4 and 6 months of age are
    physiologically and developmentally ready for new
    foods, textures and modes of feeding
  • infants intestinal track is relatively permeable
    and may predispose the infant to absorb foreign
    proteins resulting in an allergic reaction
  • introduction of single foods makes it easier to
    identify allergen

14
Transition to Solid Foods
  • single grains such as rice, barley and oat
    cereals offered first before mixed cereals
  • little nutritional or developmental benefit
    associated with practice of adding infants
    cereals or other pureed foods to bottles
    containing formula
  • introducing solids should support developmental
    readiness to progress from sucking to spoon
    feeding

15
Transition to Solid Foods
  • critical learning period where texture should be
    introduced (6-10 months) or it becomes more
    difficult with increasing age
  • important to encourage transition from pureed
    foods to finger foods and table foods
  • by 1 year, a variety of foods should be consumed
    with less dependency on milk as major source of
    nutrition

16
Other Highlights
  • iron-containing foods such as iron-fortified
    cereals are recommended as the first foods
  • fruit juice intake should be limited to avoid
    interfering with the intake of nutrient
    containing foods and fluids
  • soy (except soy formula), rice or other
    vegetarian beverages, whether or not they are
    fortified, are inappropriate alternatives to
    human milk, formula or pasteurized whole cows
    milk in the first two years

17
Other Highlights
  • dietary fat restriction during the first 2 years
    of life is not recommended as it may compromise
    the intake of energy and EFA and affect growth
    and development
  • to prevent infant botulism, honey should not be
    used in infants under 1 year
  • to prevent nursing bottle syndrome, infants
    should not be fed using a propped bottle

18
Gastroenteritis
  • mild to moderate dehydration may be managed with
    an oral electrolyte solution and early refeeding
  • for infants who are breastfed, continue
    breastfeeding while supplementing fluid intake
    with an oral electrolyte solution
  • there is no justification to recommend a lactose
    free formula for routine feeding after a bout of
    gastroenteritis

19
Constipation
  • parents should be educated about the wide
    variation in normal bowel function in infants and
    toddlers
  • no evidence to support infants on iron-fortified
    formula are more constipated
  • often seen with transition to whole cows milk
    when done too quickly
  • transition with half formula/human milk feedings
    and half whole cows milk minimizes complications
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