Transcript PREPARATE DE LAPTE PRAF

INFANT FORMULA
ESPGAN
(European
Society
for
Paediatric
Gastroenterology and Nutrition):
Cow`s milk is forbiden in infant`s nutrition during the
first year of life
For this reason they have been created milk powder
preparations with a composition similar to human
milk = milk formulas.
INFANT FORMULA
1. Start Formulas (0-6 months)
2. Follow - up Formulas:
- 6 to 12 months;
- 1-3 years (junior formula);
- hypoallergenic formula (HA);
3. Special formulas:
- for premature infants;
- low lactose / lactose free (source of protein is cow
milk / soybean);
- height energy, low sodium formula.
INFANT FORMULA
Start Formula:
 source of protein is cow milk,
 used until the age of 6 month,
 NAN 1, Lactogen 1, Humana 1, Milumil 1, Aptamil
1, Similac, Vitalact etc.
Follow –up Formula:
 source of protein is cow milk,
 used from 6 month to 1 year,
 NAN 2, Lactogen 2, Humana 2, Milumil 2 şi 3,
Vitalact.
Start Formulas
Start Formulas
Follow –up Formulas
Follow –up Formulas
INFANT FORMULA
Junior Formula (Lait de croissance):
 used between 1-3 years
 NAN 1+, NAN 2+, Milumil Junior, Humana Junior.
Hypoallergenic Formula (HA):
 source of protein: extensive hydrolyzed cow milk
proteins
 used in infants with personal or family history for
allergies
 NAN HA, Milumil HA.
Junior Formula
Hypoallergenic Formula
Infant formula
Preterm infant Formula:
-adequated
to their special needs
- higher protein content
- smaller amounts of lactose
- easily assimilated fat (MCTs - Medium Chain
Triglycerides)
- amount of calcium and phosphorus almost double
- higher vitamin content than standard formulas
PreNAN, Aptamil Prematil, Humana 0, BIOPre etc.
Preterm infant formula
Infant formula
Human milk fortifiers:
- recommended for VLBW and ELBW preterm infants,
- increase human milk caloric value,
- used only under medical supervision
- extensively hydrolyzed protein mixtures,
- easily assimilated carbohydrates,
- contain no fat,
- Nestle FM85, Aptamil FMS.
Human milk fortifiers
Infant formula
Low lactose /lactose free formula:
- for the new - born babies and infants with lactose
intolerance,
- carbohydrate source: glucose polymer / starch
- source of protein: enzymatically hydrolyzed cow milk
protein (Alfare,Althera) or unchanged cow milk
protein (Milupa HN 25)
- rich in MCTs.
Low lactose /lactose free formula
Infant formula
Lactose free soy formula:
 used in:
 secondary lactose intolerance ,
 cow milk protein allergy,
 Milupa SOM, Milupa Pregomin.
Lactose free soy formula
Infant formula
Probiotics:
- live bacteria, viable, resistant to gastric acid,
nonpathogenic, usually producing lactic acid
- favor the multiplication of bacteria in the colon bifidobacterias and lactobacilli.
Infant formula
Probiotics
Roles:
- stabilizing effect of intestinal barrier function
- protection against food / environmental
antigens
- stimulates the production of Ig As and mucus,
- attenuates inflammatory responses induced
by pathogens.
Infant formula
Probiotics
Effects on the “distance“:
- osteoporosis prevention;
- colon cancer prevention;
- prevention of inflammatory bowel disease;
- effects on lipid metabolism.
Infant formula
Prebiotics (oligosaccharides and disaccharides):
carbohydrate food`s components which are not digested
and absorbed in the proximal colic digestive tract →
fermentation substrate → stimulates bifidobacterias
proliferation.
Infant formula
Prebiotics
Roles:
- modulate immune function;
- compete for receptors with pathogens;
- selectively stimulate and enhance a limited number
of endogenous beneficial bacterial species, resident in
the colon, producing antimicrobial substances.
Infant formula
Prebiotics
Effects:
- multiplication of lactobacillus flora and faecal
fermentizing type;
- improve bowel function;
- increase the resistance against digestive pathogens;
- systemic immune response modulation;
- reduce the risk of allergies;
- reduce the risk of colon cancer;
- reduce serum cholesterol and lipids;
- increase the bioavailability of the colon;
- increase the bone mineralization.
Infant formula
Long Chain Polyunsaturated Fatty Acids
- L.C.P.U.F.A.
Major sources:
microalgae
fungal and marine oils
egg yolk.
Infant formula
L.C.P.U.F.A.
Roles:
- major structural components of cell membranes
(phospholipids);
- promote brain and retina development;
- confer protective antiallergic;
- immune system development.
Infant formula
Nucleotides
(cytidine, uridine, adenosine, guanosine)
Roles:
- precursors of nucleic acids;
- constituent of enzymes;
- cellular energy source;
- growth and differentiation of gastrointestinal tract;
- antidiarrhea protection;
- immune system development.
Infant formula
Established intestinal microflora during the first 2
years of life determines the position and profile
of intestinal adaptation for life, thus having a significant
impact on the development of diseases: allergies,
asthma, gastro-intestinal diseases.
Disadvantages of bottle feeding
Strict rules to reduce the risk of infection:
- fresh preparation at every meal;
- discard any unused quantity of the remaining milk;
- strict hygiene;
- in hospitals - guidelines (protocols) written for
preparation and handling, with strict control of
compliance.
Weaning foods
Weaning foods
Definition: foods introduced in infant`s diet after the
age of 4 – 6 month
- progressive process (it takes several months);
- purpose: food supplementation (caloric and quality);
- will be started at age 4 months to bottle fed infants;
- may be delayed until the age of 6 months in breast fed
infants.
Weaning foods
Principles:
- diet should be balanced and rational;
- introducing a new food will be made only when the
infant is healthy;
- first food introduced is individualized depending on
the specifics of development in infants:
- appropriate weight for age → vegetable
soup or fruit puree;
- weight deficit → diet enriched in protein;
Weaning foods
-
caloric value of newly introduced food (meal)
must be greater than that which is removed from
the diet;
- introduction of new food will be progressive →2030g/day at each meal, reducing the same amount
of milk, up to completely replace the milk at that
meal with the new food;
- newly introduced food will be administrated with a
spoon;
Weaning foods
- should
be introduced one new food per week - at the
same meal
-can
be combined more food but only after testing each
one tolerance;
-
- in case digestive disorders (vomiting and / or diarrhea)
occur, the new food is interrupted and then resumed
after a few days to normalize intestinal transit;
- we use second stage of age infant formula;
Weaning foods
- polysaccharides (starch) will be introduced into the
diet with priority over sugar;
- until the age of 6-7 months will not provide gluten
flour but only those of rice, corn;
- will avoid rare and abundant lunch which:
■ increased lipid synthesis from carbohydrates
■ increased fat deposition
■ increase the biosynthesis→ cholesterol and triglycerides
■ causes gastric hypertrophy
■ increase the intestinal absorption surface
■ cause changes in liver enzymes.
Weaning foods
-number
of meals per day will be determined by
age, hunger - satiation sensation and infant`s weight;
- the infant will not be forced to consume the
entire meal offered (risk of "opposition ");
- generalization of a food that is
received with pleasure at all meals disrupt the
nutritional balance of the infant;
- hydration between meals is made with sweetened
liquids (tea, boiled and cooled water);
Weaning foods
- if the weaning chart is correct, we should not
supplement infant’s diet with vitamins;
- from the age of 7-8 months self-supply should
be encouraged;
- weaning foods will be mashed until the first teeth
appear and crushed after that age;
- the best criterion of weaning success is tracking
infant`s growth curves and development.
Weaning foods
Weaning foods
Foods used:
1. Vegetables: carrots, potatoes, parsley, spinach,
lettuce, zucchini, red peppers, green beans;
as soups and puree.
Industrial products (simple vegetables / cereals with
added vegetables, meat or fish) may be used after the
age of 6-8 months, depending on composition.
Vegetables, rice and
turkey puree
Patatoes, carrots,
cicken puree
Weaning foods
Infant cereal:
- are introduced from the age of 4-6 months
- important source of calories and fiber to
regulate bowel movements
- fortified with vitamins, calcium and iron
-
bacteriological secured
- gluten-free - for infants aged 4-6 months
- with gluten - for infants aged > 6 months.
Weaning foods
Weaning foods
Biscuits: after 6 months of age, in combination
with fruit puree.
White bread: after the age of 8 months
Pasta (noodles) from the age of 8 months, boiled in
soup.
Weaning foods
Fruits:
apples, peaches, bananas,
- juices, purees and compotes.
Forbidden during the first year of life:
fruits with small seeds (raspberries, strawberries,
blueberries, blackberries, kiwi) with strong allergy
action.
Three fruits juice
with vitamin C
Fruits puree
Weaning food
Cottage cheese:
from the sixth month of life, 20-30g each day,
mixed with rice, soup, mashed vegetables or fruits.
Cow cheese (unsalted):
from 8-9 months of age,
mixed with porridge / Pasta (pudding).
Fermented cheese: after 1 year of age.
Weaning food
Egg
Yolk:
boiled for 5 minutes
after the age of 4-5 months, 2-3 times / week
mixed with soup or mashed vegetables.
White: not given until the age of 1 year because it
causes allergies.
Weaning food
Liver (chicken / beef)
after the age of 6 months
20 - 30g/day, in vegetable soup / puree, on days when
no egg or meat are used.
Meat (chicken / beef)
after the 5 month of life
cooked, chopped very fine, place 20 -30g/day in
vegetable soup or vegetable puree.
Weaning food
Fish:
→ after the age of 1 year because of food allergy risk
can be given after the age of 8 months as industrial
preparations.
Yogurt:
from the age of 7 months
Sour Cream: from 7-8 months of age.
Toddler`s nutrition
Toddler`s nutrition
Principles:
- presented aesthetically
- menu composed according to the degree of
development and child preferences
- will avoid over nutrition with carbohydrates (dental caries)
- lean pork - after the age of 2 years
Toddler`s nutrition
Principles:
- mutton / lamb meat are not recommended
(harder to digest)
- avoid bottle feeding
- one meal per day will be served along
with the whole family
- child will receive three meals and two snacks.
Toddler`s nutrition
Liquid requirements: 125 ml / kg / day.
protein = 2.5 to 3 g / kg / day;
fat = 4.5 g / kg / day;
carbohydrate = 10.12 g / kg / day.
Calorie needs: 80-100 kcal / kg / day.
Cow's milk should not exceed 500 ml / day.
Toddler`s nutrition
Breakfast:
- 250 ml cow milk
- bread with butter, jam / honey
- cottage cheese, eggs, lean ham.
Lunch (most important):
- vegetables or meat soup;
- mashed vegetables with minced chicken / beef (~ 50g)
(meatballs, minced meat croquette, roll) with sauce or
garnish of vegetables;
- dessert: compote, homemade cakes.
At the end of the meal: 100-150 ml of water.
Toddler`s nutrition
Dinner:
- pudding, vegetable salads, scrambled eggs, cheese
dumplings,
- 250 ml milk / yogurt and bread / biscuits.
Two snacks (at 10 a.m. and 5 p.m.): fruits.
Forced administration of food is due to psychogenic
anorexia, common in families with spoiled children.
Forbidden foods in Toddler`s nutrition
- foods that may cause aspiration: nuts, fruits with
seeds, seeds, popcorn, fries, raw celery,
fish with bones, candy;
- sweets: cakes with cream, sugar cereals, soft
drinks with artificial fruit flavors;
Forbidden foods in Toddler`s nutrition
- indigestible food: sausages, mutton, venison fried or
preserved, condiments;
- peas, beans, cabbage can be inserted in the diet after
age 2;
- alcohol, coffee, tea or cola.
Nutrition for 4 – 7 years old child
Nutrition for 4 – 7 years old child
Principles:
- 3 meals and two snacks;
- cow's milk: maximum 500 ml / day;
- fruits and vegetables: raw (salads) / prepared;
- meat: 75 g daily;
- egg: 3-4 times / week;
Nutrition for 4 – 7 years old child
Principles:
- whole bread: max 150-200 g / day;
- water and sweets: at the end of the meal so as not
to affect appetite;
- child will eat at the table with the family;
- good learning skills: washing hands before
eating, brushing teeth.
Nutrition for 7 - 15 years old child
Nutrition for 7 - 15 years old child
Diet similar to that of adult;
3 meals and 1-2 snacks per day;
breakfast: important because it is before school hours;
food: fresh, sufficient quantity, high biological value;
Nutrition for 7 - 15 years old child
Adolescents:
- frequently adopt a diet low in energy content, low in
vitamins (A, C, D) and minerals (Calcium, Magnesium,
Iron);
- fast food should be avoided (increases the risk
of obesity).