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INFANT NUTRITION

INFANT NUTRITION. Sinéad Feehan Department of Nutrition & Dietetics A.M.N.C.H. August 2009. Overview. Assessing growth Requirements Breastfeeding Formula Feeding Introducing Solid Foods Iron & Vitamin D. Normal Growth: Weight. Normal birth weight 3.5kg Regain birth weight by 2 weeks

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INFANT NUTRITION

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  1. INFANT NUTRITION Sinéad Feehan Department of Nutrition & Dietetics A.M.N.C.H. August 2009

  2. Overview • Assessing growth • Requirements • Breastfeeding • Formula Feeding • Introducing Solid Foods • Iron & Vitamin D

  3. Normal Growth: Weight • Normal birth weight 3.5kg • Regain birth weight by 2 weeks • Expected gain • 200g per week for 1st 3 months • 150g per week for 2nd 3 months • 100g per week for 3rd 3 months • 50-75g per week for 4th 3 months • NB standardisation of measurements

  4. Normal Growth : Length • Normal birth length 50cm • Expected growth • 1st year 25cm • 2nd year 12cm • 3rd year onwards 10-6cm per year until puberty • Supine length until age 2

  5. Normal Growth: OFC • Normal head circ at birth 35cm • >0.5cm per week (48cm by 1 yr) • Reflects brain growth • Above eyes, upright, looking straight ahead

  6. Centile Charts • Various charts available • Calculate age in weeks • <37/40: correct until 2 years • Weight at 4-8 weeks predictive • View growth in relation to normal population

  7. Reference Nutrient Intakes

  8. WHO RECOMMENDATION • Exclusively Breastfeed for 6 months • Continue to breastfeed after that, in combination with appropriate complementary foods, until the age of 2 years or beyond • WHO guidelines have been accepted and endorsed by the DOHC

  9. Breastfeeding Benefits • Immunological:Breastfed babies are at lower risk of infection. • Nutritional:Easy to digest, optimal blend of nutrients, low risk of contamination. • Psycho/social:Bonding, pain relief, maternal confidence & empowerment. • Financial:Milk is always available: shorter hospital stay.

  10. Benefits • Optimal nutrition for human infant • Correct nutrient composition – macro/micronutrients • Nutritionally complete until 6 mths • Immunological advantages • Macrophages: lysozymes and lactoferrin • Lymphocytes: interferon and IgA • Bifidus factor • Antibodies • Anti-trypsin factor

  11. Possible Contra-indications • Medications • IV Drug Abuse • HIV • Galactosaemia, Alactasia Note: Very low birth weight/premature, can be fed expressed breast milk

  12. Colostrum • Protein rich – Arginine & Tryptophan • Essential fatty acids • Vitamins (A, D & B12) and minerals • Frequent suckling – increases hormone production (Prolactin & Oxytocin) which increases milk production

  13. Mature Breast Milk • Fore milk & hind milk • Less protein, more fat and energy • Antibodies & anti-infective agents • Digestive enzymes – lipase and amylase • Vitamins, minerals and trace elements • High bioavailability of nutrients • 67 -70 kcals/100mls

  14. Formula Feeding • Approved formulae – nutritionally complete • No immunological/enzymic properties • Cows milk based, modified to mimic the nutrient profile of mature breast milk • Provide 65-69 Kcals / 100mls • Demand feed: 150 – 200mls/kg/day

  15. Standard Products • Whey based/ first milks • Cow & Gate First Infant Milk • Farley’s First Milk • Milupa Aptamil First Infant Milk • SMA First Infant Milk • Caesin based/ “milk for hungrier babies” • Cow & Gate Second Infant Milk • Farley’s Second Milk • Milupa Aptamil Extra Hungry • SMA Extra Hungry

  16. Follow-on Formulae • Follow-on milks • Cow & Gate Follow-on Milk • Farley’s Follow-on Milk • Milupa Aptamil Follow-on Milk • SMA Follow-on Milk • Marketed for babies > 6 months • Higher Energy, Iron & Vitamin D than term formulae

  17. Specialised Formula (Non-Px) • Anti-regurgitation Formula • Enfamil AR • SMA Staydown • Not effective with ant-acid medications • Lactose-free Formula • Enfamil 0-Lac • SMA LF • Glucose syrup instead of lactose • Lactose intolerance usually transient - avoid prolonged use

  18. Special Formula (Non-Px) • Soya milks • Farley’s Soya Formula • SMA Wysoy • Lower biological value • Limited clinical indications – Galactosaemia • Not indicated in colic, lactose intolerance, CMPI • Contra-indicated under 6 months (BDA)

  19. Prescribable Specialised Formulae • Nutrient dense • SMA High Energy, Infatrini • Hydrolysed • Pepti-Junior, Pepdite, Nutramigen 1 and 2, Pregestimil, Nutrilon Pepti, Prejomin, MCT Pepdite • Elemental • Neocate • LBW/ Premature • Nutriprem 1 and 2, SMA Gold Prem, BM Fortifier • Disease specific • Caprilon, Kindergen, Galactomin 17 and 19, Monogen, Locasol

  20. Volumes • Feed on demand • Initially small frequent feeds • Volumes increase, frequency decreases • Example • 4 week old infant weighing 4.3kg • Fluid requirement 150mls/kg = 645mls/day 80mls 3 hourly x 8 or 95mls 3.5 hourly x 7 or 110mls 4 hourly x 6 All suitable, baby dictates, don’t restrict hungry baby

  21. Formulae :Possible Problems • Over-concentration • Hypernatraemia and dehydration • Inappropriate calorie density • Over-dilution • Excess volume • Vomiting and hyponatraemia • FTT and malnutrition • HygieneSafefood: “How to prepare your babys bottle feed”

  22. Weaning • Solid food should be introduced at 6 mths • ? Not before 4 months: -milk meets all nutrient requirements -immature GIT & limited renal capacity -Poor neuromuscular co-ordination • ? by 6 months: -increasing energy & nutrient needs -decreased body stores : Fe & Zn -aids chewing & speech development -food refusal less likely

  23. Weaning cont’d • First foods (6mths): - puree fruit, veg, rice/ gluten-free cereals - puree meat/chicken/fish - offer variety of tastes & textures • Next foods: -introduce wheat, gluten, eggs*,citrus fruit-don’t add salt or sugar -more lumpier/mashed consistency -introduce finger foods- include iron-rich foods

  24. Weaning cont’d • Cow’s milk not as drink before 1 year • Potential allergens • No evidence to delay introduction • Eggs – well cooked after 6 months • Nuts – avoid whole until 5 years; fhx avoid for 3 years • Gluten • Currently > 6 months • Literature 4 – 7 months, gradual intro while BF • Vegetarian • Ensure 500mls of BM/ formula • Vegan • Not recommended

  25. Suitable Drinks • Breast milk / formula & water only • Unmodified cows, goats, sheeps milk unsuitable • Juice – not required but not before 6 mths and not in quantities > 120-180mls per day. Offer diluted. • Tea, aerated drinks, mineral waters, coffee : unsuitable • No additions to bottles • Encourage cup from 6 months • Discourage bottle from 1 year • NB dental care

  26. Current Practices:Tarrant et al 2006 • 23% of infants weaned to solids <12 weeks • 9% <10 weeks • 10% at 6 months crisps/choc/biscuits >4/week • 6% add solids to bottles • 31% add gravy to weaning foods • 16% add sugar to weaning foods • 5% add salt to weaning foods

  27. Current Practices:Tarrant et al 2006 (contd.) • 4% have tea/lemonade/cola at 6 months • 2% have these drinks regularly • 6% have >180ml juice per day at 6 months • 4% have sugar water as a drink at 6 months • 20% mothers avoid meat in weaning diets

  28. By 1 year…. • Eat family meals • Wide range of textures and tastes • Approx 1 pint cow’s milk per day • Drinking from cup not bottle

  29. Common feeding problems • FALTERING GROWTH • IRON DEFICIENCY ANAEMIA • VITAMIN D DEFICIENCY & RICKETTS

  30. Faltering Growth • Downward deviation in weight across 2 or more centiles from the max centile achieved at 4-8 weeks for a period of a month or more • Possible Causes: -inadequate dietary intake -malabsorption/excessive losses -increased nutrient requirements -inability to utilise nutrients, e.g. metabolic conditions-psychological problems, e.g. poor parenting skills

  31. Faltering Growth : Management • Increase feed volume, if inadequate • Consider Nasogastric feeding • Supplement feeds to increase energy density • Aim For: 130 - 150 Kcals/Kg • 3 - 4.5g protein/Kg

  32. Iron Deficiency Anaemia • Definition: Hb < 11g/dl, Ferritin < 10microg • Symptoms include - apathy, poor appetite, poor growth, psychomotor delay • Possible causes are prematurity and inadequate weaning diet • Inhibitors of iron are tannins, phytic acid, phosphoproteins • Prevention = Breast milk/Fe fortified formula Weaning foods rich in haem iron Adequate vitamin C

  33. Vitamin D • Re-emergance of rickets • Low vitamin D levels in normal population • Risk factors • Latitude, lack of sunlight exposure • Pigmented skin • Poor maternal status • Prolonged breastfeeding, poor weaning diets • FSAI recommend 5μg daily for all infants • Await policy…….

  34. Infant Nutrition • Breast/Formula feed up to One year old • Introduce solids from 6 months • Include iron-rich foods in weaning diet • Offer variety of tastes & textures • Encourage drinking from a cup from 6-8 months

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