INFANT FEEDING
DR. MOHAMMAD F. IBRAHEEMDEPARTMENT OF PEDIATRICS
(2)
Objectives
Formula feeding and typesWeaning
First year feeding problems
Over feeding
Regurgitation
Colic
Constipation
• Formula Feeding
• Most women make their feeding choices for their infant early in pregnancy.• The usual intake to allow a weight gain of 25-30 g/day will be 140-200 ml/kg/day in the first 3 mo of life.
• But after that, the rate of weight gain declines.
Vomiting and spitting up are common, and when weight gain and general well-being are noted, no change in formula is necessary.
In addition to complementary foods introduced between 4 and 6 mo. of age, continued breast-feeding or the use of infant formula for the entire 1st year of life should be encouraged.
1-COW’S MILK PROTEIN–BASED FORMULAS
The protein concentration varying from 1.45 to 1.6 g/dl, considerably higher than in mature breast milk (~1 g/dl).The predominant whey protein is β-globulin in bovine milk
and α-lactalbumin in human milk.
Plant or a mixture of plant and animal oils are the source of fat in infant formulas.
Lactose is the major carbohydrate in mother’s milk and in
standard cow’s milk–based infant formulas for term infants.
2-SOY FORMULAS
Free of cow’s milk protein and lactose and provide 67 kcal/dl.The protein is a soy isolate supplemented with l-methionine, l-carnitine, and taurine to provide a protein content of 2.45-2.8 g per 100 kcal or 1.65-1.9 g/dL.
indications :- A- galactosemia.
B-hereditary lactase deficiency.
C-situations in which a vegetarian diet is preferred.
3-PROTEIN HYDROLYSATE FORMULA
may be partially hydrolyzed, containing oligopeptides with amolecular weight of <5000 d, or extensively hydrolyzed, containing
peptides with a molecular weight <3000 d.
Indications :-
1- infants intolerant to cow’s milk or soy proteins.
2-gastrointestinal malabsorption due to cystic fibrosis, short gut syndrome, and prolonged diarrhea.
e.g. Nutramigen. Pregestemil. Aptamil pepti.
4-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.
Whole cow’s milk is not recommended under one year of age because :
1-Intolerance occurs.2-Increase incidence of iron def. anemia.
3-Contains more solutes that the kidneys of small babies can not cope with.
Weaning
Weaning is the process of gradually introducing a mammal infant to what will be its adult diet and withdrawing the supply of its mother's milk.When's the best time to start weaning?
The AAP recommends exclusive breast-feeding for the first six months after birth — and breast-feeding in combination with solids foods until at least age 1.Extended breast-feeding is recommended as the mother and her baby wish to continue.
Still, when to start weaning your child is a personal decision.Whenever the mother choose to start weaning her baby from the breast, stay focused on her child's needs as well as her own.
Resist comparing your situation with that of other families
Are there certain times when it wouldn't be smart to start weaning?
Consider delaying weaning if:Concerned about allergens.
might prevent or delay eczema, cow's milk allergy, and wheezing in early childhood.
The child isn't feeling well.
If the child is ill or teething, postpone weaning until he or she is feeling better.
A major change has occurred at home. Avoid initiating weaning during a time of major change at home. If the family has recently moved or the child care situation has changed, for example, postpone weaning until a less stressful time.
What's the best way to begin weaning?
When you start the weaning process, take it slow. — over the course of weeks or months —will cause milk supply to gradually diminish and prevent discomfort caused by engorgement.
(treated by applying cold compresses to the breasts to help decrease swelling and discomfort).
Keep in mind that children tend to be more attached to the first and last feedings of the day, when the need for comfort is greater.
These feedings might be the last ones your child drops. As a result, it might be easier to drop a midday breast-feeding session first.
After a lunch of solid food, your child might become interested in an activity and naturally give up this session.
Once you've successfully dropped one feeding, you can start working on dropping another.
You might also choose to wean the baby from breast milk during the day but continue breast-feeding at night.Remember, it's up to the mom and her child.
First year feeding problems:
Under feeding:
It is suggestive by crying ,restlessness & failure to gain wt. adequately despite complete emptying of
the breast or the
bottle.
It is also result from
the failure to take
sufficient quantities
of food even when
offered.
The child will not gain wt. and actually he will lose wt. and become Marasmic ( looks as an old man and loose the muscle bulk . Constipation, failure to sleep, irritability, and excessive crying are to be expected).
The child will be def. in vit. A,B,C,D; Fe. Def. anemia & protein def. also .
Treatment :
Treatment of underfeeding includes:-a- Increasing nutrient intake.
b-Correcting any deficiencies of vitamins and/or minerals.
c-And instructing the caregiver in the art and practice of infant feeding.
d- If an underlying systemic disease, child abuse or neglect, or a psychologic problem is responsible, specific management of that disorder is necessary
Over feeding:
Which is either quantitative or qualitative .
Regurgitation & vomiting are the major symptoms.
*diet high in fat --delay
gastric emptying—distention
&discomfort- inc. wt.
*diet high in CHO—
fermentation in int.—
distention &flatulence—
inc. wt.
In both cases there will be deficiency of protein, ess.A.A.,vits.& minerals.
*Too high calories esp.in the first two weeks
of life will cause loose
stool(osmotic diarrhea).
Regurgitation:
Definition: Return of small amounts of swallowed food during or shortly after feeding; within limitit is normal and
called(Posseting)
which occurs
During the first
6 mon. of life.
Colic:
Definition: It is a complex of paroxysmal abdominal pain presumably of intestinal origin. It is of unknown cause.But recent studies
suggest that it has
some relation to
irritable bowel
syndrome in adults
of the same family.
It is common in babies and called (3 months colic), there will be an unexplained irritability & severe crying, it occurs usually in the afternoon.
Careful physical exam.
to exclude other causes
of colic as:
Intussusception,
Strangulated hernia,
Otitis media,
pyelonephritis,….etc.
Factors that play part in colic:-
Hunger---crying---swallowing air--- vicious cycle.Increase CHO in the diet -----fermentation ----distention----colic.
Allergy to cow milk.
Treatment:
1-Holding the infant upright or prone across the lap or on a hot water bottle or heating pad occasionally helps.2- Passage of flatus or fecal material spontaneously or with expulsion
of a suppository or enema
sometimes affords relief.
3-Carminatives before feedings
are ineffective in preventing
the attacks.
4-Sedation is occasionally
indicated for a prolonged
attack.
5-If other measures fail, both the child and the parent may be sedated for a period.
6- In extreme cases, temporary hospitalization of theinfant, often with no
more than a change
in the feeding routine
and a period of rest
for the parent, may
help.
7- Prevention of attacks should be sought by improving feeding techniques, including :-
a-“Burping.”b- Providing a stable emotional environment.
c- Identifying possibly allergenic foods in the infant's or nursing mother's diet.
d- And avoiding underfeeding or overfeeding.
Although it is not serious, colic can be particularly disturbing for the parents as well as the infant. Thus, a supportive and sympathetic physician can be particularly helpful,
even if attacks do not
resolve immediately.
The fact that the
condition rarely persists
beyond 3 mo. of age
should be reassuring.
CONSTIPATION
Constipation is infrequent bowel movements or difficult passage of stools.
Obstipation
Is intractable constipation.Constipation is practically unknown in breast-fed infants receiving an adequate amount
of milk and is
rare in formula-fed
infants receiving an
adequate intake.
The consistency of the stool, not its frequency, is the basis for diagnosis. Most infants have 1 or more stools daily, but
some occasionally
have a stool of normal
consistency at
intervals of up
to 36–48 hr.
Whenever constipation or obstipation is present from birth or shortly after birth, a rectal examination should be performed. Tight or spastic anal sphincters may occasionally be responsible for obstipation, and finger dilation is
frequently corrective.
spastic anal sphincters may
occasionally be responsible
If irritation is alleviated,
healing usually occurs
quickly.
Aganglionic megacolon may be manifested by constipation in early infancy; the absence of stool in the rectum on digital
examination suggests
this possibility, but
further diagnostic
work-up is indicated .
Constipation may be caused by :-
An insufficient amount of food or fluid.diets that are too high in protein or deficient in bulk. Simply increasing the amount of fluid or sugar in the formula may be corrective during
the 1st few months of life.
After this age, better results
are obtained by adding or
increasing the intakes of cereal,
vegetables, and fruits.
Prune juice (½–1 oz) may be helpful, but adding foods with some bulk is usually more effective. Milk of magnesia may be given in doses of 1–2 tsp,
but should be reserved
for unresponsive or
severe constipation.
Enemas and suppositories
should never be more
than temporary measures.
Summary
There are different types of formula feeding which includes: - 1-ordinary formulas. 2- formulas prepared for special purpose .Weaning (u) begin between 4-6 mo.
Under feeding & overfeeding should be avoided
Differentiation between pathol. From non-pathol. throw up.
Colics in the first 3mo. Of life is very common non pathol. Problems.
Constipation should be managed properly.
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