2Principles of Infant Feeding Energy Requirements: kcal/kg/d0-12 mo:1-3 yr:4-6 yr:7-10 yr:15+ yr:
3Principles of Infant Feedings Formula fed infants feed every 3-4 hrs.Feedings/day0-3 Months:4-6 Months:6-8 Months:9-12 Months:By 4 mo, the baby is being introduced to solids, these are bottles only. Infants c feeding difficulties eat more freq. or more volume.3
4Principles of Infant Feeding Average Volume of Milk per Feeding1st wk: oz2-4 wks: oz1-2 mo: oz3-4 mo: oz5-6 mo : ozBy 12 mo of age, the average child should be taking an average of 24 oz/d.
6Infant Formula Indications As substitute for human milk in infants for whom BF is medically contraindicated.As supplement for BF infants who do not gain weight adequately.As a substitute or supplement for human milk whose mother chooses not to BF or not to do it exclusively.
7Distribution of Kcals Breastmilk Formula % Protein 6 9 % Fat 52 48 % Carbohydrate42
8QuestionWhich of the following statements about infant nutrition is true?Human milk contains more casein than infant formulas.Infants who receive increased whey protein have been shown to grow better than those who receive primarily casein.Iron is absorbed better from cow milk formulas than from human milk.Lactose-free formulas result in decreased absorption of calcium.There are no apparent negative effects from the addition of DHA and ARA to formulas.
9Differences Between Types of Milk BreastmilkStandard Cow FormulaCow MilkCalories20 kcal/oz19 kcal/ozProtein0.9 g/dL1.4 g/dL3.5 g/dLMinerals (Ca, P, Fe)LowerHigherIron AbsorptionBetterWorseTerribleVit. ABCSameVit. DEKRenal SoluteWhey:Casein Protein Ratio70:30Varies, but not better than human milk20:80
10Benefits of Whey Protein Promotes more rapid gastric emptying.Consists of soluble proteins that are easily digested.Lines the GI tract and plays a role in host defense.
11Question Is iron supplementation required at birth? NoWhen should you start iron supplementation?All babies (including breastfed) should receive supplementation in their food (iron-fortified cereal) by 6 months of age.In FT infants, iron stores become depleted by 4-6 months of age.
12Dietary Recommendations IRONPre-term: 2 mg/kg/d at 1-12 moFull-term: 1 mg/kg/d at 4-6 moIron Fortified Formula: 12 mg/LCow’s milk has 0.5mg/L of iron.
13Dietary Recommendations VITAMIN D400 IU/dWho should receive Vitamin D?All BF infants, unless they are weaned to at least 1000 ml/d (33 oz) of Vit. D fortified formula.Formula fed infants ingesting ≤ 1000 ml/d of Vit. D fortified formula.Children/adolescents who get no sun light, ≤ 1 L of Vit. D fortified milk, no MVI.
16Standard Formulas COMPOSITION Protein Whey (β lacto-globulin) & Casein Whey predominant (60:40), Casein predominant (20:80), or 100% wheyFatVegetable oilsCoconut: Saturated, short & MCFAPalm oil: Saturated & LCFASafflower, corn & soy: LCFA, DHA & ARACarbohydrateLactose
17Standard Infant Formulas Provide 20 cal/ozPRESENTATIONS:PowderConcentrated LiquidReady to Feed
18Preparation of Infant Formula POWDERAdd 1 scoop powder to 2 oz of waterCONCENTRATED LIQUIDMix 1 oz concentrated liquid and 1 oz water13 oz canREADY TO FEEDHospital use: 2 and 3 oz bottles32 oz containerExpensiveCareful reconst. Important forexact concentration. Powder increase volumen
19Preparation of Infant Formula What type of water should be mixed with the formula?Tap: safe, may boil x 1 min.Distilled water with fluoride.Well: boil 10 min. Give fluoride.Warm, cold or room temperature.
20Cow Milk/Standard Formulas Designed to meet the nutritional needs of the term and near-term infant.Enfamil Premium Newborn & InfantSimilac AdvanceStore BrandsSMA withdraw from SE area20
21Cow Milk/Standard Formulas Enfamil NB has Vit D 400 IU in 27 oz, SA has lutein good for eye health doesn’t contain palmein oil=improved calcium absorption
22New Infant Formula Features PrebioticsNondigestible short-chain carbohydrates that stimulate growth and function of specific species of bacteria.Increases concentration of lactobacillus and bifidobacterium.Used to treat chronic diarrhea.Beneficial to atopic children.ProbioticsLive microorganisms that survive digestion and colonize the colon.OrganicNo pesticides or synthetic fertilizer used.No hormones or antibiotics used.
23Premature Infant Formulas For LBW and Premature InfantsIncreased energy requirement: 120 kcal/kg/dPreterm formulas should always be discontinued before hospital discharge.Increased intake with age → excess intake of vitamins/mineralsShow stomach size23
24Composition of Premature Infant Formula 20, 22, 24 kcal/ozIncreased protein: whey predominant60% whey:40% caseinBreastmilk - 70% whey:30% caseinIncreased calcium & phosphorusContain AA: cysteine and taurineLactose + glucose polymersMCTIncreased Vitamins & MineralsHigher caloric density, more readily absorbed lipids, greater protein content, AA deficient in preemies and important for brain development,24
25Premature Infant Formulas Enfamil Premature 20 calEnfamil Premature 24 calSimilac Special Care Advance 20 calSimilac Special Care Advance 24 calGood Start Premature 24 cal
30QuestionWhat type of milk would you recommend a breastfeeding infant that develops “rash and hives” while eating yogurt and cream cheese, and tolerates foods such as eggs and bread without any problems?Trial of Soy Milk–Based FormulaIf no improvement switch to an extensively hydrolyzed or AA-based formulaMilk protein allergy, IgE mediated reaction
31Soy Protein Formulas Lactose Free Contain higher concentrations of protein, AA, calcium, phosphorus, zinc and iron.Primary CarbohydrateGlucose polymers from corn syrup solids or maltodextrin
32Soy Protein Formulas INDICATIONS Galactosemia Congenital Lactase DeficiencyPost-diarrhea lactose intoleranceStrict vegetarian family
33Soy Protein Formulas NOT RECOMMENDED FOR Preterm infants with BW ≤ 1800 g.Do not meet requirements for calcium and phosphorus.Prevention of colic or allergyInfants with cow milk protein-induced enterocolitis (non-IgE allergic enterocolitis)30% of infants with milk protein allergy also have soy protein allergy.
34Soy Protein Formulas Enfamil ProSobee Similac Sensitive Store Brand Soy Infant Formula
36Modified Cow Milk Protein or Soy-Based Formulas CarbohydrateReduced lactose or lactose-free carbohydrate blendsProteinPartially hydrolyzed whey and soy proteinsOtherThickeners (rice cereal)Soy fiberPrebiotics
37Modified Cow Milk Protein or Soy-Based Formulas INDICATIONSInfants recovering from diarrheaInfants with colicInfants with GERNOT for infants with galactosemiaNOT for cow milk formula intolerance
38Special Indications GER Enfamil AR Similac Sensitive for Spit up Diarrhea and fussinessSimilac Expert Care for DiarrheaEnfamil GentleaseSimilac Sensitive Fussiness and GasSpecialty-metabolic formulasSimilac PM 60/40
39Modified Cow or Soy Milk-Based Formulas Gentleease: milk based powder with iron, partially broken down proteins
43QuestionA mother brings her 1 month old infant to clinic because of a 1 week history of “bloody streaks in stool” and fussiness. Mom was breastfeeding for the first 3 weeks of life, then switched to a cow milk-based formula 1 week ago. What formula should you recommend?Protein Hydrolysate FormulaChild has milk protein intolerance, non-IgE mediated. Usually begins at 2 weeks of age-2 mo.
44Extensively Hydrolyzed Formulas Made for infants who are unable to digest or tolerate formulas containing intact cow milk protein.Lactose freeProteinExtensively hydrolyzed caseinPartially hydrolyzed wheyCarbohydrateGlucose polymers and/or sucroseFat ContentVegetable oilsLCT/MCT from safflower and soy
45Extensively Hydrolyzed Formulas INDICATIONSCow milk and soy protein allergyMalabsorption syndromesCystic fibrosisBiliary AtresiaShort gut syndromePancreatic insufficiencyProtein calorie malnutritionAutoimmune diseases/immunodeficiency syndromes
46QuestionHydrolysate formulas are MOST often used in the management of:Celiac diseaseCow milk protein allergyCystic fibrosisGERLactose intolerance
47Extensively Hydrolyzed Formulas NutramigenPregestemilSimilac Expert Care Alimentum
56QuestionA 4 month old male is at clinic for his well child check. On questioning of his diet, mom states he drinks whole milk, orange juice, ravioli, and cheetos puffs. How do you counsel on appropriate dietary recommendations for his age?
57Cow’s Milk Introduce until 12 months of age!!!! Low iron content. May increase fecal blood loss in some infants.May cause hypocalcemia.High protein and electrolyte content → high renal solute.Lower caloric content (19 cal/oz)
58Principles of Infant Feeding Number of Meals a Day0-3 mo: bottles4-6 mo: 5 bottles + 1 solid meal6-8 mo: 4 bottles + 2 solid meals9-12 mo: 3 bottles + 3 solid meals
59Infant Nutrition: Solid foods CerealStrained VegetableStrained MeatsStrained fruitsTable FoodJuices and dessertsVitamins and Minerals
60Solid Foods Introduce at 4-6 months age Has good head control No extrusion reflexSits with supportHas doubled birth weightSeems hungry after 32 oz milk
61QuestionWhat is the MOST likely outcome of introducing solid foods at an age of ≤ 3 months?Accelerates the development of oral motor skillsHelps the infant sleep through the nightIncreases the risk of food allergiesIncreases the risk of GERIncreases the risk of GI infections
62Solid Food Introduce rice cereal first. Advance to single vegetables. Add one food at a time.Feed same for 3-5 days.Combination dinners last.
63Infant Nutrition 0-4 mo: 100% total calories from milk 6-8 mo: 65% calories from milk33% calories from solids.9-12 mo: 50/50 milk and solids
64Solid foods Strained Food Stage 1 Foods: 2.5 oz jar, 4-5 mo
66Infant Nutrition CEREALS First solid introduced at 4-6 months of age Iron FortifiedProvides 15 calories per TbspFull serving: 4 Tbsp + 4 oz formula or breastmilkDO NOT ADD IN BOTTLE!!!!!!!!Thickened feedings for severe GER