Infant Feeds

Question 1

What are the different phases of childhood?

Answer 1

• Neonate
  
  • <4 weeks
• Infant
  
  • <12 months
• Toddler
  
  • 1-2 years
• Pre-school
  
  • 2-5 years
• School age
• Teenager/adolescent

Question 2

What factors lead the growth in the following phases:

• infant
• child
• pubertal

Answer 2

• Infant
  
  • Nutrition led
• Child
  
  • Growth hormone led
• Pubertal
  
  • Sex hormone led

Question 3

What is birth size and weight impacted by?

Answer 3

• Maternal size
• Placental function
• Gestation
  
  • 95% of weight between 20-40 weeks
  • 10-16% of body weight as fat

Question 4

What is the size of the average term infant?

Answer 4

3.3kg

Question 5

What is energy required for?

Answer 5

• Physical activity
• Thermogenesis
• Tissue maintained
• Growth

Question 6

Why are children at risk of inadequate nutrition?

Answer 6

• Characteristic feature is need to fuel both rapid growth and maintenance
  
  • Infants can become rapidly malnourished
  • Dependent on carer
  • High demands for growth and maintenance
    
    • Infants 100kcal and 2g protein/kg/day
    • Adults 35kcal and 1g/kg/day
  • Low stores (fat and protein)

Question 7

What is the average weight gain in g/week for:

• 0 to 3 month old
• 3 to 6 month old
• 6 to 9 month old
• 9 to 12 month old

Answer 7

• 0 to 3 months
  
  • 200g
• 3 to 6 months
  
  • 150g
• 6 to 9 months
  
  • 100g
• 9 to 12 months
  
  • 50 to 75

Question 8

By when does a baby double its weight, and then triple?

Answer 8

Babies double weight by 6 months and triple by 1 year:

• After 1 year, about 2kg and 5cm/year until puberty

Question 9

What is growth monitred by?

Answer 9

Growth charts

Question 10

How much calories and protein per day do:

• children require
• adults require

Answer 10

• Infants 100kcal and 2g protein/kg/day
• Adults 35kcal and 1g/kg/day

Question 11

Why is weight maintenance for children like an adult losing weight?

Answer 11

With children, weight maintenance is like adults losing weight, as they should be growing

Question 12

Why is breast feeding the best form of feed?

Answer 12

• Well tolerated
• Less allergenic
• Low renal solute lead
• Calcium, phosphate, iron, fatty acids
• Improves cognitive development
• Reduces risk of infection
  
  • Macrophages and lymphocytes
  • Interferon, lactoferrin, lysozyme
  • Bifidus factor

Question 13

Compare and contrast breast milk and formula?

Answer 13

Question 14

When is breast feeding recommended until?

Answer 14

• Exclusively breast feeding to around 6 months
• From 6 months, complementary breast feeding alongside solids is supported

Question 15

What are some of the principles of UNICEF baby friendly “ten steps”?

Answer 15

• Written breast feeding policies communicated with staff
• Train all health care staff to implement policies
• Inform all pregnant woman about the benefits of breast feeding
• Help mothers initiate breastfeeding within a half hour of birth
• Show mothers how to breast feed

Question 16

What are standard formula milks prepared from?

Answer 16

Cow milk

Question 17

What does specialised formula exist for?

Answer 17

• Specialised formulas exist for cow milk protein allergy
  
  • Nutrient dense
  • Disease specific

Question 18

When is cow milk not suitable as the main drink before and why?

Answer 18

Cows milk not suitable as main drink until 1 year as they contain no iron

Question 19

What are some examples of available formula milk?

Answer 19

• Pre-term formula
  
  • Typically higher in protein (2g vs 1.5g) and higher calorie (80kcal vs 67kcal) / 100ml
• Nutrient dense formula
  
  • 100kcal/100ml
• Cows milk protein allergy
• Disease specific

Question 20

Describe the normal feeding pattern (volume, times per day, suggested milk intake per day) for:

• up to 2 weeks
• 2 weeks to 2 months
• 2 to 3 months
• 3 to 5 months
• 6 months
• 7 to 9 months
• 10 to 12 months

Question 21

Cow’s milk protein allergy - epidemiology

Answer 21

• Most common allergy in infants

Question 22

Cow’s milk allergy - management

Answer 22

• Nutramigen
  
  • First line feed of choice
• Amino acid based feed
  
  • Second line based feed
  • Indications – severe colitis/enteropathy breast milk

Question 23

What is the first and second line feeds for cow milk protein allergy?

Answer 23

• Nutramigen
  
  • First line feed of choice
• Amino acid based feed
  
  • Second line based feed
  • Indications – severe colitis/enteropathy breast milk

Question 24

At what age do babies begin the milk ladder?

Answer 24

When babies reach one year begin milk ladder:

• Slowly introduce more dairy into diet

Question 25

What are indications for lactose free milks?

Answer 25

* Lactose intolerance

Question 26

What can lactose intolerance be secondary to?

Answer 26

Can occur primary or secondary, due to: * Short lived conditions such as post-gastroenteritis

Question 27

What are possible complications of soya milk usage?

Answer 27

They are high in phytoestrogens, complications: * Which can be concerning in infants under 6 months * Cross reactivity with cows milk

Question 28

What are indications for soya milk?

Answer 28

* Milk allergy when hydrolysed formula refused * Vegan families, if not breast fed * Consider for children \> 1 year still on milk free diet

Question 29

What are some non-formula milks other than cow milk?

Answer 29

* Soya milk * Lactose free milk * Rice milk * Not advice for children under 5 years * Goats and sheeps milk * Not suitable for under 1^st * Many children react * Oat and nut milk * Organic versions * Are not calcium fortified

Question 30

How do organic/unsweetended versions of cow milk compare in calories and calcium to cow milk?

Answer 30

Full fat cows milk: * 65kcal/100ml and 120mg calcium/100ml * Organic/unsweetened milk substitutes low in calories * Organic milks have no calcium supplemented

Question 31

How much calcium fortified milk is required to meet calcium requirements?

Answer 31

Need 400-500ml of calcium fortified milk to meet calcium requirements: * Supplement if \<500ml calcium fortified substitute * Alliance calcium liquid or if \>3 years calcium softies * Breast feeding mums Accrete or Cacit D3

Question 32

When should a calcium supplement be given?

Answer 32

* Supplement if \<500ml calcium fortified substitute * Alliance calcium liquid or if \>3 years calcium softies * Breast feeding mums Accrete or Cacit D3

Question 33

When do solids start getting used?

Answer 33

Used in complementary feeding in the transition from milk to mixed diet: * Nutritional and developmental changes Starts around 6 months of age (17-26 weeks): * Look for signs of readiness * Head control, interest in food

Question 34

What are signs of readiness to try solids?

Answer 34

* Head control, interest in food

Question 35

Why introduce solids to a babies diet?

Answer 35

* Milk alone inadequate * Encourage tongue and jaw movements in preparation for speech and social interactions * Neophobia * To reject novel or unknown foods in childhood, increase acceptance by repeatedly offering a variety of foods * Common

Question 36

What is neophobia?

Answer 36

* Neophobia * To reject novel or unknown foods in childhood, increase acceptance by repeatedly offering a variety of foods * Common

Question 37

What is weaning?

Answer 37

Weaning = introducing babies to solid food

Question 38

What should you wait until before you start weaning?

Answer 38

Wait until they can support there own head

Question 39

What solids can be given to babies of the following ages: - 17 weeks to 6 months - around 6 months - 6 to 9 months - 9 to 12 months - 12 months - 18 months

Answer 39

Question 40

Why is vitamin D often low?

Answer 40

* Dark skinned children at risk * Diet is a poor source, most comes from the sun

Question 41

How much vitamin D should be given as supplement for: - birth to 1 year - everyone over 1 year

Answer 41

* Birth to 1 year * 8.5-10ug * Not required if infant formula \>500ml * Everyone over 1 year * 10ug

Question 42

What are the different kinds of reflux?

Answer 42

* GOR * Effortless passage of gastric contents into oesophagus with or without regurgitation and vomiting * GORD * When the reflux of gastric contents causes troublesome symptoms and/or complications

Question 43

What is GOR and GORD?

Answer 43

* GOR * Effortless passage of gastric contents into oesophagus with or without regurgitation and vomiting * GORD * When the reflux of gastric contents causes troublesome symptoms and/or complications

Question 44

GOR - epidemiology | (how common, age)

Answer 44

* Vomiting common in babies * Peaks at 3-4 months

Question 45

DOR - management

Answer 45

* Reassurance over natural course * Advice on feeding, check if overfed * No specific treatment * Thickened formula * Infant Gaviscon sachets * Carobel * If no improvement * Trial or milk free diet

Question 46

What are examples of thickended formulas that can be given for GOR?

Answer 46

* Thickened formula * Infant Gaviscon sachets * Carobel

Question 47

What are red flag signs for reflux?

Answer 47

* Weight loss or poor weight gain * Recurrent or bilious vomiting * GI bleeding * Persisting diarrhoea * Dysphagia * Stridor/cough/hoarseness

Question 48

Who are high risk groups of reflux?

Answer 48

* Preterm babies * Neurological impairment * Chronic respiratory illness * Anatomical * Genetic disorders such as down syndrome

Question 49

GORD - treatment

Answer 49

* Acid suppression * Reduced gastric acid may increase risk of pneumonia, gastroenteritis and candidiasis * Trial of milk free diet * Continuous NG/jejunal feeds * Consideration of anti-reflux surgery * Drug therapy * Gaviscon liquid – 1^st line * H2 receptor antagonist (Ranitidine) * Proton pump inhibitors (Omeprazole/Lansoprazole) * Pro-kinetics (Domperidone to promote gastric emptying, or low dose erythromycin) * Only short term * Anti-histamine (Alimemazine)

Question 50

What drug therapy can be used for GORD?

Answer 50

* Gaviscon liquid – 1^st line * H2 receptor antagonist (Ranitidine) * Proton pump inhibitors (Omeprazole/Lansoprazole) * Pro-kinetics (Domperidone to promote gastric emptying, or low dose erythromycin) * Only short term * Anti-histamine (Alimemazine)

Question 51

What are the normal crying times for: - 0 to 6 weeks - 10 to 12 weeks

Question 52

What are common issues that cause feeding problems?

Answer 52

* In bread fed baby * Functional lactose overdose * All babies * Cows milk protein allergy * Psychosocial issues * Maternal health issues * Colic

Question 53

What is colic?

Answer 53

Inconsolable crying in a baby: * \<3 months of age, \>3 hours/day, \>3 days/week * For at least a week No red flag symptoms

Question 54

What is the criteria to be colic?

Answer 54

Inconsolable crying in a baby: * \<3 months of age, \>3 hours/day, \>3 days/week * For at least a week

Question 55

Colic - treatment

Answer 55

* Explanation and reassurance * Probiotics * Trial of cows milk protein avoidance * Lactase drops * Anti spasmodics

Question 56

Iron deficiency - aetiology

Answer 56

* Breast fed/pre term * Cow’s milk * Not fortified with iron like formula * Too much juice * No structure to meals/snacks * Constipation

Question 57

Iron deficiency - epidemiology | (how common)

Answer 57

* Most common deficiency in the world

Question 58

Iron is particularly important for development of what organ?

Answer 58

Iron important for brain development, periods of peak brain development: * Neonatal period * 6 months to 3 years

Question 59

When are periods of peak brain development?

Answer 59

* Neonatal period * 6 months to 3 years

Question 60

What are examples of nutritional issues beyond infancy: - toddler and pre-school - school age - adolescent

Answer 60

* Toddler and pre-school * Picky eaters/excess milk * Dependent on carer * Frequent illness * School age * Learning to be independent * Chronic disease * Obesity * Adolescent * Independent * Puberty * Eating disorders