Feed That Baby!

1
Feed That Baby!

• Kathryn Camp, MS, RD, CSP
• Assistant Professor of Pediatrics
• USUHS
• Pediatric Nutritionist, WRAMC

2
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

3
(No Transcript)
4
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

5
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

6
(No Transcript)
7
Composition cont

• Immunological factors
• anti-inflammatory
• -protect against atopy
• anitmicrobial
• Secretory IgA
• immunomodulating
• cytokines

8
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

9
What Are the Advantages of Breastfeeding?
10
Advantages of Breastfeeding

• INFANT
• Superior nutritional composition
• Immunologic properties
• Decreased immune mediated dz
• Improved cognitive ability
• Protective against childhood obesity

11
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

12
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

13
(No Transcript)
14
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

15
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

16
Under What Circumstances Would You Recommend
Using Formula?
17
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

18
QuestionA 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
19

• 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

20
Infant Formulas
21
Infant Formulas

• Four main categories of formulas
• Standard formula (cows milk)
• Enfamil, Similac
• Soy
• Isomil, Prosobee
• Protein hydrolysates
• Pregestimil, Alimentum, Nutramigen
• Purified amino acid based
• Neocate

22
Standard Formulas

• Breastmilk
• 20cal/oz
• Human milk fat
• Lactose
• wheycasein 7030
• Iron 0.3mg/L
• Vitamin D 21 IU/L
• Renal solute load 91

• Enfamil/Similac
• 20cal/oz
• Soy, coconut, sunflower, palm
• Lactose
• 6040, 1882
• Iron 12mg/L
• Vitamin D 405 IU/L
• Renal solute load 130s

23
Soy Formulas

• Breastmilk
• 20cal/oz
• Human milk fat
• Lactose
• wheycasein 7030
• Iron 0.3mg/L
• Vitamin D 21IU/L
• Renal solute load 91

• Isomil/Prosobee
• 20cal/oz
• palm olein, soy,coconut,sunflower
• Corn syrup/sucrose
• Proteinsoy isolate and L-methionine
• Iron 12mg/L
• Vitamin D 405 IU/L
• Renal solute load 150s

24
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

25
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

26
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

27
Protein Hydrolysates

• 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

• Breastmilk
• 20cal/oz
• Human milk fat
• Lactose
• 70whey 30casein
• Iron 0.3mg/L
• Vit D 21 IU/L
• Renal solute load 91

28
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

29
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

30
Vitamins Minerals (cont)

• Iron supplementation
• Recommended for BF infants by 4-6mo
• Infant cereal/iron drops
• Fluoride supplementation
• Recommended for those infants gt6months who live
  in areas where water supply contains lt0.3ppm of
  fluoride
• Bottled, well water, or RTF formulas

31
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

32
Progression of Solids

• Need for solids
• Feedings
• 4-6 months-infant rice cereal
• 7 months- strained vegetables/fruits
• 8-10 months- juices and meats
• gt9-10 months- finger foods

33
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 cows milk
• GI blood loss
• Poor source of vitamins C E as well as
  essential FA

34
(No Transcript)
35
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