Infant Care

Question 1

Why is folic acid imporant during pregancy

Answer 1

• reduces incidence of neural tube defects -> spina bifida, anencyphaly, encephalocele
• the neural tube forms in the few weeks of pregancy and closes by week 6, before many women know they are pregnancy

*recommended that any women child bearing age take folic acid supplement

Question 2

When to start/stop taking folic acid

Answer 2

• multivitamin with folic acid shoudl be initiated 3 months before pregnancy
• multivitamin should eb continued throughout pregnancy and continues for 4-6 weeks after pregnancy and as long as breastfeeding

*evidence is strongest in early stages to promote neural tube development but also helps suport cells in growth so should continue during preg

Question 3

How much folic acid should be taken

Answer 3

*depends on history of both female and male partner

1. Low risk
   
   • no personal history for NTD or folic acid sensitive birth defects
   • multivitamin with 0.4-1mg folic acid
   • take 0.4-1mg folic acid
2. Moderate
   
   • Personal histroy of folate sensitive anomalies
   • family history for NTD (not personal)
   • diabetes Type 1 or II 9in female partner)
   • teratogenic medications by folate inhibition
     
     • ex if female on anti-seizure meds
   • GI malabsorption that reduces RBC folate
     
     • female has chrons
   • take 1 mg FA until 12 w gestation, then 0.4-1mg
3. High
   
   • personal NTD history
   • previous NTD pregnancy
   • need 4-5mg FA daily for 1st 12 weeks, then multivitamin 0.4-1 mg
   • * 12 weeks before and 12 weeks after preg

Question 4

iron during pregnancy

Answer 4

• extra iron needed to support growth of baby and due to extra blood volume
• recommended amount 27mg daily
• found in most prenatal vitamina

*some cant tolerate in 1st trimester due to N/V, thats okay but must start in 2nd trim

• anemiia may develop during pregnancy

Question 5

How much weight should be gained durign pregnancy

Answer 5

*based on BMI

Less than 18.5………………12.5 to 18 kg (28 to 40 lb)

Between 18.5 and 24.9…….11.5 to 16 kg (25 to 35 lb)

Between 25 and 29.9………….7 to 11.5 kg (15 to 25 lb)

More than 30…………………..5 to 9 kg (11 to 20 lb)

*these lead to fewer complications (preterm birth, gestational diabetes, low or high birth weight)

• minimiz weight gain in first trimester

Question 6

eating during pregnancy

Answer 6

• eat small amounts of food often -> 3x meals plus 3 snacks
• extra calories not needed in 1st trim
• in 2nd and 3rd trimester -> 2-3 extra food servings (an extra 340-450 cal/day)

Question 7

foods to avoid during pregnancy

Answer 7

1. Caffeine
   
   • up to 300 mg/day appears safe
   • does not increase miscarriage isk ro likelihood or preterm birth
2. Fish
   
   • avoid large fish due to mercury content (shark, swordfish)
   • shrimp, canned light tuna, salmon, pollock and catfish can be eaten in small amounts (1-2x/week)
3. Listeriosis
   
   • can cause miscarriage, still birth
   • avoid unpasteurized milk, soft cheeses, raw/undercooked meat
   • heat prepared meets (weiners,deli meats) until steaming

Question 8

Nutrition for mother during breastfeeding

Answer 8

• extra 500 calories/day
• planty of water (minimum 8 glasses, drink each time you breastfeed)
• calcium 1000mg/day (dietary and supplemental resources)

Question 9

recomendations for why to breastfeed

Answer 9

• breast milk is best food for baby
• perfect mis of nutrients
• contains antibodies/immune factors to prevent illness
• easy for baby to digest (less constipation/diarrhea)

Recommendation: exclusive breastfeeding for first 6 months, can continue until 2 yo and beyond

• introduce other foods around 6 months

Question 10

Breastfeeding benefits for baby and mother

Answer 10

• Baby
  
  • reduced incidence of illness
    
    • diarrhea, otitis media, respiratory infections, asthma
• Mother
  
  • reduced postpartum bleeding
  • weight loss
  • reduced risk of breast/ovarian cancer
  • improved bone health

Question 11

what is colostrum

Answer 11

• first milk prduced when baby is bron
• thick, yellowish

rich in proteins (including antibodies_ and other nutrients

• changes to breastmilk ~72 hours (breasts feel full)

Question 12

foremilk vs hindmilk

Answer 12

• Foremilk: released at beginning of feeding; watery, satisfies thirst

Hindmilk: released as feeding continues; rich, fatty, satisfies hunger, provides calroies

*make sure feeing last several minutes to get hindmilk

Question 13

When should you breastfeed? How to determine if baby is getting enough

Answer 13

• feed on demand, whenever baby is hungry
• usually every 2-3 hours at first, (8-12 x/day)
• feed more foten during growth spurts

Baby getting enough is: 6 of more wet diapers/day, stools are soft yellow and seedy, and there is weight gain

Question 14

describe cow based infant formula

Answer 14

• most common
• can have added DHA/arachadonic acid (omega 3/6 fatty acids), probiotics, lower iron

*lower iron formulas not recommended, advertised bc formula can cause decrease in contipation

Question 15

Decribe lactose free cow milk based formulas

Answer 15

• lactose is replaced with maltodextrin and sucrose
• used for congenital lactse deficiency (rare)
• parents purchase this is suspect gassiness/fussiness is due to lactose intolerance

*lactose is ipmortant in mineral absorptiona nd bacterial colonization, so a switch should not be amde without careful consideratoin

• may be useful after a bout of diarrhea (temporary lactose intolerance)

Question 16

descrie soy protein isolate-based formuals

Answer 16

• free of cows milk protein and lactose
• iron fortified
• Recommended for galactosemia or congenital lactase deficiency

– Can also be used if vegetarian diet is desired

– Potential cross-reactivity with milk protein allergy, use with caution

*not recommended is have an allergy to cows mlk form

Question 17

describe hydrolyzed protein infant formula

Answer 17

– Extensively hydrolyzed

– proteins are heat-treated and enzymatically hydrolyzed into peptide chains and free amino acids

• Ex. Nutramigen
• Used for infants with intolerance to intact cow milk protein and soy protein
• Also may be beneficial in infants with malabsorptive disease
• Lactose free

Expensive, less palatable

* Partially hydrolyzed formulas also available: Less expensive, more palatable than extensively hydrolyzed formulas

* Marketed to relieve gas, fussiness

Question 18

describe amino acid infant formula

Answer 18

• AKA “elemental” formulas

– Contain free amino acids

– Used in infants with severe milk protein hypersensitivity

– Also used for infants with malabsorptionassociated diseases who have persistent symptoms with a partially hydrolyzed formula

Question 19

what other types of formulas exist

Answer 19

Formulas for premature infants

– Pre-thickened formulas • For treatment of regurgitation, vomiting

– Follow-up formulas for 6-24 months: Contain more protein, minerals, vitamins & Usually less expensive

Question 20

What are the forms on infant formula

Answer 20

Powder: most common and least expensive

Concentrated liq: prepared by diluting with equal amount of water, intermediate cost

Ready to use liquid: most expensive, does not require any preparation, can be purchased in ready to use bottles

Question 21

iron supplementation in infants

Answer 21

* soemtimes needed

• babies bronw with reserve of iron: transferred from mother in last trimester
• supplementation needed in low birthweight infants (ex: preterm, small for gestational age)
• stores are deplated after 4-6 months in breast fed babies:

*introduce iron rich foods at ~6 months

-use using formula, want to use an iron foritfied formula

*iron deficiancy can impact cognitive development

Question 22

Vitamin D supplementation in infants

Answer 22

Breastfed babies require vitamin D supplementation

– Usually 400 IU per day

– May need more in northern communities

Formula-fed babies usually do not need vitamin D supplementation

*– Already present in formula

Exception: northern communities

Question 23

When to introduce solid foods to infants

Answer 23

• ~6 months
• breast milk or formula no longer adequate for growing needs
• When is baby ready?
  
  • Seems hungry earlier than usual
  • Can sit up without support, and has good control of his neck muscles
  • Holds food in his mouth without pushing it out on his tongue right away
  • Shows interest in food when others are eating, and opens his mouth when he sees food coming his way
  • Can let you know he doesn’t want food by leaning back or turning his head away.

Question 24

what should be first foods for an infant

Answer 24

* source of iron

• Most common: single-grain iron-fortified infant cereal (ex. rice, barley, oat or wheat cereal)

– Alternatives: • Pureed meat, poultry, cooked egg yolk and well cooked legumes (beans, lentils, chick peas) are also good sources of iron

– Start with small amount (~1tsp), liquid consistency

* Introduce new foods one at a time, 3-5 days apart to identify allergic reactions

Question 25

foods to avoid in infants

Answer 25

Sugary drinks or foods, such as candies, soda/pop or energy drinks.

– Honey to babies under 1 year old, as there is a risk of infant botulism (food poisoning).

Question 26

when to introduce allergens

Answer 26

ex peanuts and eggs

• do not delay
• delayed introduction can increase allergy development