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INFANT FORMULA. ESPGAN (European Society for Paediatric Gastroenterology and Nutrition): Cow`s milk is forbiden in infant`s nutrition during the first.

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Presentation on theme: "INFANT FORMULA. ESPGAN (European Society for Paediatric Gastroenterology and Nutrition): Cow`s milk is forbiden in infant`s nutrition during the first."— Presentation transcript:

1 INFANT FORMULA

2 ESPGAN (European Society for Paediatric Gastroenterology and Nutrition): Cow`s milk is forbiden in infant`s nutrition during the first year of life For this reason they have been created milk powder preparations with a composition similar to human milk = milk formulas.

3 INFANT FORMULA 1. Start Formulas (0-6 months) 2. Follow - up Formulas: - 6 to 12 months; - 1-3 years (junior formula); - hypoallergenic formula (HA); 3. Special formulas: - for premature infants; - low lactose / lactose free (source of protein is cow milk / soybean); - height energy, low sodium formula.

4 INFANT FORMULA Start Formula: ,  source of protein is cow milk,  used until the age of 6 month,  NAN 1, Lactogen 1, Humana 1, Milumil 1, Aptamil 1, Similac, Vitalact etc. Follow –up Formula: ,  source of protein is cow milk,  used from 6 month to 1 year,  NAN 2, Lactogen 2, Humana 2, Milumil 2 şi 3, Vitalact.

5 Start Formulas

6

7 Follow –up Formulas

8

9 INFANT FORMULA Junior Formula (Lait de croissance):  used between 1-3 years  NAN 1+, NAN 2+, Milumil Junior, Humana Junior. Hypoallergenic Formula (HA): Hypoallergenic Formula (HA):   source of protein: extensive hydrolyzed cow milk proteins  used in infants with personal or family history for allergies  NAN HA, Milumil HA.

10 Junior Formula

11 Hypoallergenic Formula

12 Infant formula Preterm infant Formula: - - adequated to their special needs - higher protein content - smaller amounts of lactose - easily assimilated fat (MCTs - Medium Chain Triglycerides) - amount of calcium and phosphorus almost double - higher vitamin content than standard formulas PreNAN, Aptamil Prematil, Humana 0, BIOPre etc. PreNAN, Aptamil Prematil, Humana 0, BIOPre etc.

13 Preterm infant formula

14 Infant formula Human milk fortifiers: - - recommended for VLBW and ELBW preterm infants, - increase human milk caloric value, - used only under medical supervision - extensively hydrolyzed protein mixtures, - easily assimilated carbohydrates, - contain no fat, - Nestle FM85, Aptamil FMS.

15 Human milk fortifiers

16 Infant formula Low lactose /lactose free formula: - for the new - born babies and infants with lactose intolerance, - carbohydrate source: glucose polymer / starch - source of protein: enzymatically hydrolyzed cow milk protein (Alfare,Althera) or unchanged cow milk protein (Milupa HN 25) - rich in MCTs.

17 Low lactose /lactose free formula

18 Infant formula Lactose free soy formula:  used in: secondary lactose intolerance, secondary lactose intolerance, cow milk protein allergy, cow milk protein allergy,  Milupa SOM, Milupa Pregomin.

19 Lactose free soy formula

20 Infant formula Probiotics: - live bacteria, viable, resistant to gastric acid, bifidobacterias nonpathogenic, usually producing lactic acid - favor the multiplication of bacteria in the colon - bifidobacterias and lactobacilli.

21 Infant formula Probiotics Roles: - stabilizing effect of intestinal barrier function - protection against food / environmental antigens. - stimulates the production of Ig As and mucus, - attenuates inflammatory responses induced by pathogens.

22 Infant formula Probiotics. Effects on the “distance“: - osteoporosis prevention; - colon cancer prevention; - prevention of inflammatory bowel disease; - effects on lipid metabolism.

23 Infant formula Prebiotics (oligosaccharides and disaccharides): carbohydrate food`s components which are not digested and absorbed in the proximal colic digestive tract → fermentation substrate → stimulates bifidobacterias proliferation.

24 Infant formula Prebiotics Roles: - modulate immune function; - compete for receptors with pathogens; - selectively stimulate and enhance a limited number of endogenous beneficial bacterial species, resident in the colon, producing antimicrobial substances.

25 Infant formula Prebiotics Effects: - multiplication of lactobacillus flora and faecal Effects: - multiplication of lactobacillus flora and faecal fermentizing type; - improve bowel function; - increase the resistance against digestive pathogens; - systemic immune response modulation; - reduce the risk of allergies; - reduce the risk of colon cancer; - reduce serum cholesterol and lipids; - increase the bioavailability of the colon; - increase the bone mineralization.

26 Infant formula Long Chain Polyunsaturated Fatty Acids - L.C.P.U.F.A. Major sources: microalgae fungal and marine oils egg yolk.

27 Infant formula L.C.P.U.F.A. Roles: - major structural components of cell membranes (phospholipids); - promote brain and retina development; - confer protective antiallergic; - immune system development.

28 Infant formula Nucleotides (cytidine, uridine, adenosine, guanosine) Roles: - precursors of nucleic acids; - constituent of enzymes; - cellular energy source; - growth and differentiation of gastrointestinal tract; - antidiarrhea protection; - immune system development.

29 Infant formula Established intestinal microflora during the first 2 years of life determines the position and profile of intestinal adaptation for life, thus having a significant impact on the development of diseases: allergies, asthma, gastro-intestinal diseases.

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31 Disadvantages of bottle feeding Strict rules to reduce the risk of infection: - fresh preparation at every meal; - discard any unused quantity of the remaining milk; - strict hygiene; - in hospitals - guidelines (protocols) written for preparation and handling, with strict control of preparation and handling, with strict control of compliance.

32 Weaning foods

33 Definition: foods introduced in infant`s diet after the age of 4 – 6 month - progressive process (it takes several months); - purpose: food supplementation (caloric and quality); - will be started at age 4 months to bottle fed infants; - may be delayed until the age of 6 months in breast fed infants.

34 Weaning foods Principles: - diet should be balanced and rational; - introducing a new food will be made only when the infant is healthy; - first food introduced is individualized depending on the specifics of development in infants: - appropriate weight for age → vegetable soup or fruit puree; - weight deficit → diet enriched in protein;

35 Weaning foods - - caloric value of newly introduced food (meal) must be greater than that which is removed from the diet; - introduction of new food will be progressive →20- 30g/day at each meal, reducing the same amount of milk, up to completely replace the milk at that meal with the new food; - newly introduced food will be administrated with a spoon;

36 Weaning foods - should be introduced one new food per week - at the same meal - should be introduced one new food per week - at the same meal - can be combined more food but only after testing each one tolerance; - - in case digestive disorders (vomiting and / or diarrhea) occur, the new food is interrupted and then resumed occur, the new food is interrupted and then resumed after a few days to normalize intestinal transit; - we use second stage of age infant formula;

37 Weaning foods - polysaccharides (starch) will be introduced into the diet with priority over sugar; - until the age of 6-7 months will not provide gluten - polysaccharides (starch) will be introduced into the diet with priority over sugar; - until the age of 6-7 months will not provide gluten flour but only those of rice, corn; - will avoid rare and abundant lunch which: ■ increased lipid synthesis from carbohydrates ■ increased fat deposition ■ increase the biosynthesis→ cholesterol and triglycerides ■ causes gastric hypertrophy ■ increase the intestinal absorption surface ■ cause changes in liver enzymes.

38 Weaning foods - number of meals per day will be determined by age, hunger - satiation sensation and infant`s weight; - the infant will not be forced to consume the entire meal offered (risk of "opposition "); - generalization of a food that is received with pleasure at all meals disrupt the nutritional balance of the infant; - hydration between meals is made with sweetened - hydration between meals is made with sweetened liquids (tea, boiled and cooled water);

39 Weaning foods - if the weaning chart is correct, we should not - if the weaning chart is correct, we should not supplement infant’s diet with vitamins; - from the age of 7-8 months self-supply should be encouraged; - weaning foods will be mashed until the first teeth appear and crushed after that age; - the best criterion of weaning success is tracking - the best criterion of weaning success is tracking infant`s growth curves and development.

40 Weaning foods

41 Foods used: 1. Vegetables: carrots, potatoes, parsley, spinach, lettuce, zucchini, red peppers, green beans; as soups and puree. Industrial products (simple vegetables / cereals with added vegetables, meat or fish) may be used after the age of 6-8 months, depending on composition.

42 Vegetables, rice and turkey puree Patatoes, carrots, cicken puree

43 Weaning foods Infant cereal: - are introduced from the age of 4-6 months - important source of calories and fiber to regulate bowel movements - fortified with vitamins, calcium and iron - bacteriological secured - bacteriological secured - gluten-free - for infants aged 4-6 months - with gluten - for infants aged > 6 months.

44 Weaning foods

45 Biscuits: after 6 months of age, in combination with fruit puree. White bread: after the age of 8 months Pasta (noodles) from the age of 8 months, boiled in soup.

46 Weaning foods Fruits: apples, peaches, bananas, - juices, purees and compotes. Forbidden during the first year of life: fruits with small seeds (raspberries, strawberries, fruits with small seeds (raspberries, strawberries, blueberries, blackberries, kiwi) with strong allergy action.

47 Three fruits juice with vitamin C Fruits puree

48 Weaning food Cottage cheese: from the sixth month of life, 20-30g each day, mixed with rice, soup, mashed vegetables or fruits. Cow cheese (unsalted): from 8-9 months of age, mixed with porridge / Pasta (pudding). Fermented cheese: after 1 year of age.

49 Weaning food Egg Yolk: boiled for 5 minutes after the age of 4-5 months, 2-3 times / week mixed with soup or mashed vegetables. White: not given until the age of 1 year because it causes allergies.

50 Weaning food Liver (chicken / beef) after the age of 6 months 20 - 30g/day, in vegetable soup / puree, on days when Liver (chicken / beef) after the age of 6 months 20 - 30g/day, in vegetable soup / puree, on days when no egg or meat are used. Meat (chicken / beef) after the 5 month of life cooked, chopped very fine, place 20 -30g/day in no egg or meat are used. Meat (chicken / beef) after the 5 month of life cooked, chopped very fine, place 20 -30g/day in vegetable soup or vegetable puree.

51 Weaning food Fish: → after the age of 1 year because of food allergy risk can be given after the age of 8 months as industrial can be given after the age of 8 months as industrial preparations. Yogurt: from the age of 7 months Sour Cream: from 7-8 months of age.

52 Toddler`s nutrition

53 Principles: - presented aesthetically - presented aesthetically - menu composed according to the degree of - menu composed according to the degree of development and child preferences - will avoid over nutrition with carbohydrates (dental caries) - will avoid over nutrition with carbohydrates (dental caries) - lean pork - after the age of 2 years - lean pork - after the age of 2 years

54 Toddler`s nutrition Principles: - mutton / lamb meat are not recommended (harder to digest) - avoid bottle feeding - avoid bottle feeding - one meal per day will be served along - one meal per day will be served along with the whole family - child will receive three meals and two snacks. - child will receive three meals and two snacks.

55 Toddler`s nutrition Liquid requirements: 125 ml / kg / day. protein = 2.5 to 3 g / kg / day; fat = 4.5 g / kg / day; carbohydrate = 10.12 g / kg / day. Calorie needs: 80-100 kcal / kg / day. Cow's milk should not exceed 500 ml / day. Liquid requirements: 125 ml / kg / day. protein = 2.5 to 3 g / kg / day; fat = 4.5 g / kg / day; carbohydrate = 10.12 g / kg / day. Calorie needs: 80-100 kcal / kg / day. Cow's milk should not exceed 500 ml / day.

56 Toddler`s nutrition Breakfast: - 250 ml cow milk Breakfast: - 250 ml cow milk - bread with butter, jam / honey - cottage cheese, eggs, lean ham. Lunch (most important): - vegetables or meat soup; Lunch (most important): - vegetables or meat soup; - mashed vegetables with minced chicken / beef (~ 50g) - mashed vegetables with minced chicken / beef (~ 50g) (meatballs, minced meat croquette, roll) with sauce or garnish of vegetables; - dessert: compote, homemade cakes. At the end of the meal: 100-150 ml of water.

57 Toddler`s nutrition Dinner: - pudding, vegetable salads, scrambled eggs, cheese dumplings, - 250 ml milk / yogurt and bread / biscuits. Two snacks (at 10 a.m. and 5 p.m.): fruits. Forced administration of food is due to psychogenic Two snacks (at 10 a.m. and 5 p.m.): fruits. Forced administration of food is due to psychogenic anorexia, common in families with spoiled children.

58 Forbidden foods in Toddler`s nutrition - foods that may cause aspiration: nuts, fruits with seeds, seeds, popcorn, fries, raw celery, fish with bones, candy; - sweets: cakes with cream, sugar cereals, soft drinks with artificial fruit flavors;

59 Forbidden foods in Toddler`s nutrition - indigestible food: sausages, mutton, venison fried or - indigestible food: sausages, mutton, venison fried or preserved, condiments; - peas, beans, cabbage can be inserted in the diet after - peas, beans, cabbage can be inserted in the diet after age 2; - alcohol, coffee, tea or cola.

60 Nutrition for 4 – 7 years old child

61 Principles: - 3 meals and two snacks; - cow's milk: maximum 500 ml / day; - fruits and vegetables: raw (salads) / prepared; - meat: 75 g daily; - egg: 3-4 times / week; - egg: 3-4 times / week;

62 Nutrition for 4 – 7 years old child Principles: - whole bread: max 150-200 g / day; - water and sweets: at the end of the meal so as not to affect appetite; - water and sweets: at the end of the meal so as not to affect appetite; - child will eat at the table with the family; - child will eat at the table with the family; - good learning skills: washing hands before eating, brushing teeth. - good learning skills: washing hands before eating, brushing teeth.

63 Nutrition for 7 - 15 years old child

64 Diet similar to that of adult; Diet similar to that of adult; 3 meals and 1-2 snacks per day; 3 meals and 1-2 snacks per day; breakfast: important because it is before school hours; breakfast: important because it is before school hours; food: fresh, sufficient quantity, high biological value; food: fresh, sufficient quantity, high biological value;

65 Nutrition for 7 - 15 years old child Adolescents: Adolescents: - frequently adopt a diet low in energy content, low in vitamins (A, C, D) and minerals (Calcium, Magnesium, Iron); - fast food should be avoided (increases the risk of obesity).


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