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Fifth stage
Pediatrics
Lec-
Dr.Athl
/ /2016
Infant Nutrition
Objectives :
1. To know about nutritional requirements for optimal growth & well being in infancy.
2. For better understanding of breast feeding regarding mechanism of lactation,
composition, adequacy, advantages, preparation of the lactating mother, problems
encountered,& contraindications.
3. Comparison between breast milk and cow’s milk regarding composition, nutritional
outcome, complications,& preparation of formula.
4. Special formulas like soy protein, lactose free,& hypoallergenic formulas.
5. Weaning.
Good nutrition is essential for:
1. Survival
2. Physical growth
3. Mental development
4. Health and well-being
:
Nutritional requirements
Age dependent (the younger the child the higher their energy needs per kilogram body
weight). Generally the average term baby needs in the first year of life :
Fluid 100-150 ml/kg /day
Calories 100 -120 kCal/kg/day
Protein 1.5-2 g/kg/day
Na 1.5 mmol/kg/day
K 3 mmol/kg/day
Premature babies may have increased needs regarding water, energy, protein, and bone
minerals to deal with their rapid growth.
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Breast feeding :
World Health Organization (WHO) strongly advocates breast-feeding as the preferred
feeding for all infants. The success of breast-feeding initiation and continuation depends on
multiple factors, such as education of mother, hospital breast-feeding practices and policies,
routine and timely follow-up care, and family support .The WHO recommends exclusive
breast-feeding for the first 6 months of life
.
Six months is the recommended age for the introduction of solid foods for infants.
Breastfeeding (and/or breast milk substitutes, if used) should continue beyond the first six
months, along with appropriate types and amounts of solid foods
Contribution of Breast-feeding to Health:
1. Infectious and allergic disease:
Human milk feeding decreases the incidence and severity of diarrhea, respiratory
illnesses, otitis media, bacteremia, bacterial meningitis, and necrotizing enterocolitis
Anti infective properties: Macrophages, lymphocytes and polymorphs, Secretory
IgA, Lysozyme, Lactoferrin (an iron containing growth factor that enhances the
growth of lactobacilli which create acidic medium that inhibits the growth of E.coli.)
& anti-viral agents .
Decreased atopic diseases and infantile colic compared to formula fed
2. Breast-feeding and cardiovascular health :
Meta-analyses have shown that breast-fed infants in industrialized countries have
lower plasma cholesterol in adult life, lower systolic blood pressure, and are less
obese.
3. Breast-feeding and neurological development:
There are beneficial effects of feeding preterm infants with human milk on long-term
neurodevelopment (IQ) in preterm infants.
Breast feeding strengthen the psychososial mother-infant relationship.
4. Maternal benefits:
Decreased risk of postpartum hemorrhages, more rapid uterine involution Longer
period of amenorrhea, and decreased postpartum depression.
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There is an association between a long lactation and a significant reduction of hypertension,
hyperlipidemia, cardiovascular disease, and diabetes in the mother. Cumulative lactation of
more than 12 months also correlates with reduced risk of ovarian and breast cancer.
Adequacy of milk intake :
Urine output: a well-hydrated infant voids six to eight times a day. Each voiding should
soak, not merely moisten, a diaper, and urine should be colorless.
Stool : By 5 to 7 days, loose yellow stools should be passed at least four times a day.
Growth: Rate of weight gain provides the most objective
indicator of adequate milk intake.
Let down reflex:
Breast milk production& secretion:
Prolactin released in response to sucking drives milk synthesis.
Oxytocine released in response to sucking stimulate the “let-down reflex”.
Colostrum :
1. For 2-4 days post delivery.
2. Contains more sodium
3. High in vit A and vit K
4. More protein & IgA than mature milk
5. Less fat and carbohydrate
6. Colostrum is followed by transitional milk
7. Mature breast milk is established by 4th week
Common breastfeeding problems:
Breast tenderness, engorgement, and cracked nipples are
the most common problems
encountered by breastfeeding
mothers.
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Engorgement :
One of the most common causes of lactation failure, should receive prompt attention because
milk supply can decrease quickly if the breasts are not adequately emptied. Applying
warm or cold compresses to the breasts before nursing and hand expression or pumping of
some milk can provide relief to the mother and make the areola easier to grasp by the infant.
Nipple tenderness :
Severe nipple pain and cracking usually indicate improper latch-on. Proper sucking should
include the areola as well.
Treatment include proper positioning of baby.
Additional measures include:
1. exposing the nipples to air.
2. Applying pure lanoline emollient .
3. Avoiding soaps and shampoos for cleaning.
4. Frequent changing of nursing pads.
5. Nursing more frequently by proper position of the baby.
Problems that may be encountered in breast fed babies:
Vitamin K deficiency
Hypernatremia at end of first week in babies due to insufficiency.
Breastfeeding jaundice (in the first week)& Breast milk jaundice .
Contraindications :
1. hiv (in western countries)& hepatitis b in the mother
2. maternal malnutrition.
3. puerperal psychosis
4. severe maternal infections ( typhoid,tuberculosis, sepsis,).
5. breast cancer
6. substance abuse
7. inborn errors of metabolism (examples: pku, galactosemia, lactose intolerance).
8. maternal drugs : the following drugs may be contraindication to breast feeding:
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Maternal Drugs:
°Absolute contraindications: ° Relative contraindications:
Sulfonamides
Breast feeding is not contraindicated in mastitis.
Breast milk substitutes:
Infant formulas (modified cows milk) are suitable from birth and are usually
based on cows milk (unmodified = ↑(Na, protein& phosphate)).
Whey based milks are usually first choice if not breast feeding.
Casein based milks are suggested for more hungry babies.
Soya infant milks (for especial indications).
Follow on formulas: higher iron content than cows milk.
Specialised formulas for those who are preterm or have medical conditions
(lactose free, phenylalanine free).
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Soy protein formulas: ( isomil, nursoy…).
Similar to cows milk but protein derived from soya with lactose replaced with other
carbohydrates (glucose syrups)
Indicated in Galactosemia, Lactose intolerance,& Cows milk allergy.
Soya milks contain phytoestrogens which have been shown to have an
immunosuppressive effect in rodents. So it should be used only when strictly indicated
and no proper substitute exists .
Hypoallergenic formulas :
These formulas are made of protein hydrolysate . the carbohydrate is supplied as glucose and
the lipids are provided as medium chain triglycerides (eg. Pregestemil).
Used mainly for children with cows milk protein allergy.
Weaning :
WHO recommends introduction of solid foods at around 6 months of age
75% introduced solid foods by 5 months of age; not following the guidelines.
Why introduce solid foods at six months?
1. infants need more iron and other nutrients than milk.
2. at 6 months infants can spoon-feed (upper lip moving down, chew, use the tongue to
move the food from front to back).
3. development of eye-hand co-ordination (finger foods).
4. introducing solids early before sufficient development of the neuro-muscular co-
ordination or before the gut and kidneys have matured risk of infections and
development of allergies (eczema, asthma).