Infant feeding 2

Infant feeding

Dr.Noor Sameer Yahya
2019

Formula feedingCow milk is the base of most formulas

Formula processing
Commercial milk formulas are modified from cows milk base and their protein and minerals level are reduced nearer to those of human milk thus decreasing osmolality and renal excretion load
,the saturated fat of cows milk is replaced with some unsaturated vegetable fatty acids ,
iron and vitamins are added (fortified ),because both human &cow milk are deficient with these two important elements .
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Types of formula

1.cow’s milk-based formula
is suitable for most healthy full-term infants and is recommended (from birth - 12 months),which are powdered ,evaporated milk .
all modern infant formulas ,contain reduced protein and electrolyte levels and have added iron and vitamins (including A, B group, c, d, e and k and other nutrients

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2-Soy based formula
Soy protein–based formulas on the market are all free of cow's milk protein and lactose and provide 67 kcal/dL.
They meet the vitamin, mineral, and electrolyte guidelines from the AAP and the FDA for feeding term infants,
indications include
galactosemia
hereditary lactase deficiency,
documented secondary lactose intolerance occurs for the breast-fed infant,

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3-Hydrolysed formula

which is cow’s milk-based formula that has been processed to break down most of the proteins into smaller particles, may modify the development of allergic disease.

4-Extensively hydrolyzed formulas

are the preferred formulas for infants intolerant to cow's milk or soy proteins. These formulas are lactose free and can include medium-chain triglycerides, making them useful in infants with gastrointestinal malabsorption due to cystic fibrosis, short gut syndrome, and prolonged diarrhea
5.Amino Acid Formulas
Amino acid formulas are peptide-free formulas that contain mixtures of essential and nonessential amino acids. They are specifically designed for infants with dairy protein allergy who failed to thrive on extensively hydrolyzed protein formulas

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6-Ready to drink’ formulas products are available in aseptically packed glass bottles for hospital use only or in aseptically packed tetra packs for domestic use. the liquid formula needs to be poured into a sterilised bottle and can be warmed in the bottle if desired, just before feeding.


7-Goat milk formula cause folic acid deficiency

8-Special milk formula as low electrolyte formula used for congestive heart failure or low a.a formula as low phenyl alanine formula in patients with phenyl ketonurea
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Preparing infant formula

1.Always wash hands before preparing formula and ensure that formula is prepared in a clean area
2.Use sterilized bottles, teats,
3.Boil fresh tap water and allow it to cool until lukewarm – to cool to a safe temperature &allow the water to sit for at least 30 minutes
4.Ideally prepare only one bottle of formula at a time, just before feeding
5.Add water to the bottle first, then powder

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6.Always measure the amount of powder using the scoop provided in the can, as scoop sizes vary between different formula(1scoop+1oz)
7.Keep the scoop in the can when not in use – do not wash the scoop as this can introduce moisture into the tin if not dried adequately
8.Place the teat and cap on the bottle and shake it until the powder dissolves
9.Test the temperature of the milk with a few drops on the inside of your wrist
10.A feed should take no longer than 1 hour – any formula that has been at room temperature for longer than 1 hour should be discarded
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Sterilization methods
Sterilization by boiling
1-Wash bottles, teats and caps in hot soapy water with a bottle/ teat brush before sterilization

2-Place utensils, including bottles, teats and caps in a large saucepan on the back burner of the stove

3-Cover utensils with water, making sure to eliminate all air bubbles from the bottle

4-Bring water to the boil and boil for 5 minutes. Turn off – do not allow it to boil dry

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5-Allow the equipment to cool in the saucepan until it is hand hot and then remove it – be very careful if children are present .
6-Store equipment that is not being used straight away in a clean container in the fridge Boil all equipment within 24 hours of use

7-No.of bottles should be =No. of feeds +1

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Good bottle-feeding practice

-always checking the temperature of the formula before feeding & the amount of milk flow from the teat(it should be drop by drop).
-holding, cuddling and talking to (if it is not too distracting) the infant while feeding and responding to infant cues .
-not leaving an infant to feed on their own (i.e. with the bottle propped) – the milk may flow too quickly and cause the infant to splutter or chock.
-putting an infant to sleep while drinking from a bottle – as well as the risk of choking this increases the risk of ear infection and dental caries.


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How much milk?

Bottle fed infants up to 6 months require about 150 ml/kg( 5oz /kg) body weight each day to meet their nutrient needs.

some will require more (up to 200 ml/kg), others less

Plenty of wet nappies (six or more per day), consistent (but not excessive) weight gain, and a thriving, active infant indicate that all is well.
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Introducing solid foods

appetite and nutritional requirements are no longer satisfied by breast milk or infant formula alone
stores of several nutrients – for example, iron and zinc – are often falling in exclusively milk-fed infants (both breast & formula )
feeding behaviour has progressed from sucking to biting (most infants are chewing by 7–9 months and can manage finger foods at 8 months)
the tongue-extrusion reflex has disappeared and the infant’s increasing ability to sit without support allows greater manipulation of food before swallowing, so that thicker foods can be managed
the digestive system has matured and the infant is able to digest starches
most infants have developed an interest in their environment, which prompts a willingness to accept new textures and flavours
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Important principle for solid food introduction

1.the introduction of solid foods at around 4- 6 months
2.Introduce 1 food at a time
3. Energy density should exceed that of breast milk
4.Should start with iron-containing foods, including iron-enriched infant cereals, pureed meat, poultry and fish (all sources of haem iron) and legumes.
5.Vegetables, fruits, and dairy products such as full-fat yoghurt, cheese and custard can then be added.
6.small, hard pieces of food should be avoided as they can cause choking ,
7.Salt should not be added to food, as infant kidneys are immature and unable to excrete excess salt.
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8. Frequent consumption of added sugars is associated with increased risk of dental caries Infants given salty or very sweet foods may also acquire a taste for them, resulting in poor food choices later in life

9.Zinc intake should be encouraged with foods such as meat, dairy products, wheat, and rice

10.Phytate intake should be low to enhance mineral absorption

11.Fluoride is an essential nutrient, being part of the structure of bones and teeth. areas where the water supply is not fluoridated, an inadequate intake of fluoride by infants and the general community poses a public health problem however excessive exposure to fluoride results in dental fluorosis so given after 6mon.
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12. Food offered should be an appropriate texture and consistency for the infant’s developmental stage:
by 8 months most infants can manage ‘finger foods’
by 12 months, infants can have nutritious choices from the foods eaten by the rest of the family and should be consuming a wide variety of foods.


13. At the proper age, encourage a cup rather than a bottle
The WHO states ‘If you live in an area where sanitation and clean water are a problem, cup-feeding is a safer option than bottle feeding . This is because the teats and screw tops of bottles are more difficult to clean and can trap harmful bacteria.
Feeding cups containing formula or breast milk should continue to be sterilized up to 12 months
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14. Breast milk should continue to 12 mo, formula or cow's milk is then substituted

15. consumption of nutrient-poor foods with high levels of fat/ saturated fat, sugar, and/or salt (e.g. cakes, biscuits, confectionery and potato chips) should be avoided or limited

16. Food safety :

 Attention to food hygiene is very important when preparing foods for infants and children To prevent salmonella poisoning, cook all eggs thoroughly (i.e. until the white is completely set and yolk begins to thicken) and do not use uncooked products containing raw eggs, such as home-made ice cream or mayonnaise
 Reduce the transfer of cariogenic bacteria from carer to infant by avoiding inappropriate feeding practices such as sharing spoons and other utensils

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Infants with a family history of allergy

There is little evidence that delaying introducing solid foods beyond 6 months reduces the risk of allergy. some suggestion reveals that delaying introducing foods may increase (rather than decrease) allergy.
So egg, peanuts, nuts, wheat, cow’s milk and fish should be avoided to prevent food allergy or eczema in infants (with siblings who already have allergies to these foods)
Treatment of proven food allergies involves avoiding foods known to cause symptoms.
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Foods not suitable for infants or that should be used with care

Nuts and other hard food
Foods with a high risk of choking such as whole nuts, seeds, raw carrot, and chunks of apple should be avoided for the first 3 years as their size and/or consistency increases the risk of inhalation and choking.
However nut pastes can be offered to infants from around 6 months of age.
Honey
Honey can contain the spores of Clostridium botulinum, and should not be given to infants aged under 12 months
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Non-milk beverages
exclusively breastfed infants do not require additional fluids up to 6 months of age.
For formula-fed infants, cooled boiled tap water may be used if additional fluids are needed.

Caffeinated and sugar-sweetened drinks

tea contains tannins and other compounds that bind iron and other minerals, thereby reducing their bioavailability. As well, sugar is often added to tea, increasing the risk of dental caries. For these reasons, tea is not recommended as a drink for infants

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Fruit juice and fruit drink

-juice is not appropriate in treating dehydration or managing diarrhea
-excessive juice consumption may be associated with malnutrition (over nutrition and under nutrition) and with It can cause variety of gastrointestinal symptoms including diarrhea, flatulence, abdominal distention, and dental caries.
-infants should not be given juice at bedtime
-fruit juice should be limited to 120–180 ml/per day for children aged over 12 months.
-children should be encouraged to eat whole fruits to meet their recommended daily fruit intake
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Problems associated with earlier introduction of solid food

1.if less time is spent on the breast, maternal milk production may decline because of reduced stimulation and under- nutrition may result in extreme cases
2.If solid foods are introduced while the tongue-extrusion reflex is still strong, the infant will reject the spoon (ahard object ) the mother might then feel that the infant is rejecting the food, when in fact he or she is rejecting the object in the mouth
3.exposure to pathogens present in foods can cause increased rates of diarrheal diseases.
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Problems associated with later introduction of solid foods
1.growth can alter because breast milk or infant formula alone is insufficient after 6 months
2.immune protection can be compromised
3.micronutrient deficiencies, especially of iron and zinc, can develop as iron stores are likely to become depleted
4.There is an association with increased risk of developing allergic syndromes
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