Transcript Infant Nutrition

Infant Feeding 2014
Resident Nutrition Education
Session
2-19-2014
Objectives
 Increase
skills at recommending foods and
formulas for infants
 Increase skills at recommending
substitutes for possible feeding intolerance
 Increase awareness of resources that can
help with infant feeding
Calorie Needs for Infants/Toddlers
 Infants

0 to 5 months : 108 kcals/kg / estimate
650/day
• Most formulas 20 kcals/oz.

6 to 12 months:96 kcals/kg/ estimate 850/day
 Children
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

1 to 3:102kcals/kg/estimate 1,300/day
4 to 6: 90 kcals/kg/ estimate 1,800/day
7 to 10: 70 kcals/kg/ estimate 2,000/day
1st month
8
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to 12 feedings per day
watch for signs of hunger not the clock
frequent feedings help build mom’s supply
On demand bottle feeding not clock
 greater
or equal to 6 wet diapers per day
sign baby is drinking enough
 check weight to monitor feeding progress
Weight gain rate
4
to 8 ounces per week for the first 6
months
 1 LB every 2 weeks
Monitoring Feeding Progress
 Weight
checks main way to assess if
intake is adequate




breastfed babies should be checked several
days after discharge since there is not
another good way to monitor intake
some initial weight loss is normal
>8% of birth weight lost is excessive
should pass their birth weight by 10 to 14
days
Monitoring elimination
 Number,
size, color of stooling and voiding
is another way to tell if breastfed infants
are getting adequate calories
 colorless, dilute, urine, 6 to 8x per day
 urate crystals look like brick dust, may be
present in first few days but abnormal if
detected any other time
 4th-5th day, stools-small, yellow curds x 4
Formula feeding
 Ready
to feed formulas-no water added
 liquid or powered concentrate-mix with
water, standard 1 oz. formula with 1 oz.
water=20 calories per oz.
 calorie goal 108 kcals/kg
 do not added cereals, solids, honey, corn
syrup
 Easy flow nipples increase consumption
allergies
1
to 3% infants have allergy to cow’s milk
protein
 10 to 14 days for allergic response to
occur after exposure to allergen
 severity of signs vary-emesis, bloody
stools, dermatitis, anaphylactic shock,
Feeding challenge
 If
allergies suspected change formula for
2 to 4 weeks
 use a hypo-allergenic formula, then switch
to previous formula
 monitor reactions
 may want to do under your supervision if
reactions were severe
 WIC NEEDS MD ORDER/DIAGNOSES

For special formulas
Formula Types
 Standard
milk based formula
 soy-based non-milk based, lactose free,
lactofree
 hypercaloric
 Hypoallergenic formulas-Neocate
 See
handout for brand names/categories
Nutrition care manual
 https://www.nutritioncaremanual.org/formu
lary.cfm
 Formula
Types
 Formula recipes to adjust calories
 Infant Feeding guides
Formula feeding basics
 Prepare
only amount of formula baby will
drink at one time
 discard any unused formula to avoid
foodborne illness
 keep all supplies clean
 refrigerate prepared or open formula
 check for these steps if GI distress occurs
Formula feeding problems
 Colicky
-switch to hypoallergenic formula
for several months
 discourage bottle propping
Vitamin/ mineral supplements
 Fluoride
supplements at 6 months if local
water supply does not contain fluoride or
bottled water used
 if exclusively breast fed, start Vit. D 400 IU
at birth
 iron-start iron fortified cereals at 6 month
Breast fed babies supplements
 Neonate
has adequate iron stores for first
4 months, bioavailability of iron in
breastmilk high, supplements not usually
given until after 6 months, if even then
 Strict
vegetarian moms should take B12
supplements
Feeding schedules
 Use
resources to reinforce feeding
schedule

schedules should review amts., types, motor
skills needed, temperatures, preparation, food
safety, and healthy feeding relationship
between infant and caretaker
 Never
FORCE feedings, or force baby to
eat all of container
Resources
 Feeding
schedules that can be
downloaded from WIC program websites
or infant feeding companies
 reviews physical, developmental changes
and foods that would work with different
changes
 reviews their foods for each step: 1, 2, 3
 Nutrition Care Manual
Focus on Mindful Eating in Infants

Habits start young, avoid being over or
undernourished as infant or adult
 Turn off TV


Focus on eating and hunger
Establish meal times and routine
 Avoid Multi-tasking and rushing feedings
 Put away toys
 Make eye contact with infant
0 to 4 months
 Breast
feeding or iron fortified formulas
only for the first 4 to 6 months
 nursing 8 to 12 times per day, normal at
first, reduce to about 4 to 6 times by 4
months (depends of growth patterns)
 formula-6 to 8 feedings, 2 to 5 oz. per
feeding, with age number of feedings
decrease, amount increase to 6 to 8 oz.
Shopping for baby foods
 First
step
 Second step
 Third step
6 months

Solids can be stated when birth weight has doubled
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Do not eat out of jars, put small serving in separate bowl
Rice cereal usually first, only 1 to 2 spoonfuls
Juice at 6 mo.: Only 4 to 6 oz. per day
 From cup not bottle
OR start solids when they drink 8 oz. of formula in a
sitting and are hungry in less than 4 hours
 start solids if infant nurses 8 or more times per day, or
consumes more than 32 oz. formula per day
6 to 9 months
 Start
veggies first
 Add strained fruits, vegetables, and juices,
only 1 new food every 7 days
 usual serving is 2 to 3 T. 2 times/day
 Only 2 ounces baby juice from cup
 only 30 to 32 oz. of formula or 3 to 5
feedings
9 to 12 months

Add strained or finely chopped meats

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only 1 new meat a week
egg yolks only
plain toast and crackers added once teeth are
present
cheese, cottage cheese, yogurt, can be added
but not cow’s milk
soft chopped vegetables and fruits
formula or breast milk 25 to 30oz., 3 to 4
nursings.
1 to 2 years
 Add
whole milk at 1 year
 add egg whites at 1 year
 avoid foods that may cause choking: hot
dogs, sausages, popcorn, nuts, round
candy, uncooked vegetables, apple
chunks, grapes, nuts, seeds, peanut butter
 wait for full set of teeth for above foods
Special problems
 Nursing
bottle caries-can be caused by
sleeping with bottle of juice, formula or
breast milk
 water recommended if bottle is needed at
bedtime
 extra water only needed if newborn is at
high risk for dehydration: heat, humidity,
diarrhea, etc.