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Infant Feeding 2014Infant Feeding 2014
Resident Nutrition Education Resident Nutrition Education SessionSession
2-19-2014 2-19-2014
ObjectivesObjectives
Increase skills at recommending foods and Increase skills at recommending foods and formulas for infantsformulas for infants
Increase skills at recommending Increase skills at recommending substitutes for possible feeding intolerancesubstitutes for possible feeding intolerance
Increase awareness of resources that can Increase awareness of resources that can help with infant feedinghelp with infant feeding
Calorie Needs for Infants/ToddlersCalorie Needs for Infants/Toddlers
Infants Infants 0 to 5 months : 108 kcals/kg / estimate 0 to 5 months : 108 kcals/kg / estimate
650/day650/day• Most formulas 20 kcals/oz.Most formulas 20 kcals/oz.
6 to 12 months:96 kcals/kg/ estimate 850/day6 to 12 months:96 kcals/kg/ estimate 850/day ChildrenChildren
1 to 3:102kcals/kg/estimate 1,300/day 1 to 3:102kcals/kg/estimate 1,300/day 4 to 6: 90 kcals/kg/ estimate 1,800/day 4 to 6: 90 kcals/kg/ estimate 1,800/day 7 to 10: 70 kcals/kg/ estimate 2,000/day 7 to 10: 70 kcals/kg/ estimate 2,000/day
1st month1st month
8 to 12 feedings per day8 to 12 feedings per day watch for signs of hunger not the clockwatch for signs of hunger not the clock frequent feedings help build mom’s supplyfrequent feedings help build mom’s supply On demand bottle feeding not clockOn demand bottle feeding not clock
greater or equal to 6 wet diapers per day greater or equal to 6 wet diapers per day sign baby is drinking enough sign baby is drinking enough
check weight to monitor feeding progresscheck weight to monitor feeding progress
Weight gain rateWeight gain rate
4 to 8 ounces per week for the first 6 4 to 8 ounces per week for the first 6 monthsmonths
1 LB every 2 weeks1 LB every 2 weeks
Monitoring Feeding ProgressMonitoring Feeding Progress
Weight checks main way to assess if Weight checks main way to assess if intake is adequateintake is adequate breastfed babies should be checked several breastfed babies should be checked several
days after discharge since there is not days after discharge since there is not another good way to monitor intakeanother good way to monitor intake
some initial weight loss is normalsome initial weight loss is normal >8% of birth weight lost is excessive>8% of birth weight lost is excessive should pass their birth weight by 10 to 14 should pass their birth weight by 10 to 14
daysdays
Monitoring eliminationMonitoring elimination
Number, size, color of stooling and voiding Number, size, color of stooling and voiding is another way to tell if breastfed infants is another way to tell if breastfed infants are getting adequate calories are getting adequate calories
colorless, dilute, urine, 6 to 8x per daycolorless, dilute, urine, 6 to 8x per day urate crystals look like brick dust, may be urate crystals look like brick dust, may be
present in first few days but abnormal if present in first few days but abnormal if detected any other timedetected any other time
4th-5th day, stools-small, yellow curds x 44th-5th day, stools-small, yellow curds x 4
Formula feedingFormula feeding
Ready to feed formulas-no water addedReady to feed formulas-no water added liquid or powered concentrate-mix with liquid or powered concentrate-mix with
water, standard 1 oz. formula with 1 oz. water, standard 1 oz. formula with 1 oz. water=20 calories per oz.water=20 calories per oz.
calorie goal 108 kcals/kgcalorie goal 108 kcals/kg do not added cereals, solids, honey, corn do not added cereals, solids, honey, corn
syrupsyrup Easy flow nipples increase consumptionEasy flow nipples increase consumption
allergiesallergies
1 to 3% infants have allergy to cow’s milk 1 to 3% infants have allergy to cow’s milk proteinprotein
10 to 14 days 10 to 14 days for allergic response to for allergic response to occur after exposure to allergenoccur after exposure to allergen
severity of signs vary-emesis, bloody severity of signs vary-emesis, bloody stools, dermatitis, anaphylactic shock,stools, dermatitis, anaphylactic shock,
Feeding challengeFeeding challenge
If allergies suspected change formula for 2 If allergies suspected change formula for 2 to 4 weeksto 4 weeks
use a hypo-allergenic formula, then switch to use a hypo-allergenic formula, then switch to previous formulaprevious formula
monitor reactionsmonitor reactions may want to do under your supervision if may want to do under your supervision if
reactions were severereactions were severe WIC NEEDS MD ORDER/DIAGNOSESWIC NEEDS MD ORDER/DIAGNOSES
For special formulasFor special formulas
Formula TypesFormula Types
Standard milk based formulaStandard milk based formula soy-based non-milk based, lactose free, soy-based non-milk based, lactose free,
lactofreelactofree hypercaloric hypercaloric Hypoallergenic formulas-NeocateHypoallergenic formulas-Neocate
See handout for brand names/categoriesSee handout for brand names/categories
Nutrition care manualNutrition care manual
https://www.nutritioncaremanual.org/formulary.cfm
Formula Types Formula Types Formula recipes to adjust caloriesFormula recipes to adjust calories Infant Feeding guidesInfant Feeding guides
Formula feeding basicsFormula feeding basics
Prepare only amount of formula baby will Prepare only amount of formula baby will drink at one timedrink at one time
discard any unused formula to avoid discard any unused formula to avoid foodborne illnessfoodborne illness
keep all supplies cleankeep all supplies clean refrigerate prepared or open formularefrigerate prepared or open formula check for these steps if GI distress occurscheck for these steps if GI distress occurs
Formula feeding problemsFormula feeding problems
Colicky -switch to hypoallergenic formula Colicky -switch to hypoallergenic formula for several monthsfor several months
discourage bottle proppingdiscourage bottle propping
Vitamin/ mineral supplementsVitamin/ mineral supplements
Fluoride supplements at 6 months if local Fluoride supplements at 6 months if local water supply does not contain fluoride or water supply does not contain fluoride or bottled water usedbottled water used
if exclusively breast fed, start Vit. D 400 IU if exclusively breast fed, start Vit. D 400 IU at birthat birth
iron-start iron fortified cereals at 6 monthiron-start iron fortified cereals at 6 month
Breast fed babies supplementsBreast fed babies supplements
Neonate has adequate iron stores for first Neonate has adequate iron stores for first 4 months, bioavailability of iron in 4 months, bioavailability of iron in breastmilk high, supplements not usually breastmilk high, supplements not usually given until after 6 months, if even thengiven until after 6 months, if even then
Strict vegetarian moms should take B12 Strict vegetarian moms should take B12 supplementssupplements
Feeding schedulesFeeding schedules
Use resources to reinforce feeding Use resources to reinforce feeding schedule schedule schedules should review amts., types, motor schedules should review amts., types, motor
skills needed, temperatures, preparation, food skills needed, temperatures, preparation, food safety, and healthy feeding relationship safety, and healthy feeding relationship between infant and caretakerbetween infant and caretaker
Never FORCE feedings, or force baby to Never FORCE feedings, or force baby to eat all of containereat all of container
ResourcesResources
Feeding schedules that can be Feeding schedules that can be downloaded from WIC program websites downloaded from WIC program websites or infant feeding companiesor infant feeding companies
reviews physical, developmental changes reviews physical, developmental changes and foods that would work with different and foods that would work with different changeschanges
reviews their foods for each step: 1, 2, 3reviews their foods for each step: 1, 2, 3 Nutrition Care ManualNutrition Care Manual
Focus on Mindful Eating in InfantsFocus on Mindful Eating in Infants
Habits start young, avoid being over or Habits start young, avoid being over or undernourished as infant or adultundernourished as infant or adult
Turn off TVTurn off TV Focus on eating and hungerFocus on eating and hunger
Establish meal times and routineEstablish meal times and routine Avoid Multi-tasking and rushing feedingsAvoid Multi-tasking and rushing feedings Put away toysPut away toys Make eye contact with infantMake eye contact with infant
0 to 4 months0 to 4 months
Breast feeding or iron fortified formulas Breast feeding or iron fortified formulas only for the first 4 to 6 monthsonly for the first 4 to 6 months
nursing 8 to 12 times per day, normal at nursing 8 to 12 times per day, normal at first, reduce to about 4 to 6 times by 4 first, reduce to about 4 to 6 times by 4 months (depends of growth patterns)months (depends of growth patterns)
formula-6 to 8 feedings, 2 to 5 oz. per formula-6 to 8 feedings, 2 to 5 oz. per feeding, with age number of feedings feeding, with age number of feedings decrease, amount increase to 6 to 8 oz.decrease, amount increase to 6 to 8 oz.
Shopping for baby foodsShopping for baby foods
First stepFirst step Second stepSecond step Third stepThird step
6 months6 months
Solids can be stated when birth weight has doubledSolids can be stated when birth weight has doubled Do not eat out of jars, put small serving in separate bowlDo not eat out of jars, put small serving in separate bowl Rice cereal usually first, only 1 to 2 spoonfulsRice cereal usually first, only 1 to 2 spoonfuls
Juice at 6 mo.: Only 4 to 6 oz. per dayJuice at 6 mo.: Only 4 to 6 oz. per day From cup not bottleFrom cup not bottle
OR start solids when they drink 8 oz. of formula in a OR start solids when they drink 8 oz. of formula in a sitting and are hungry in less than 4 hourssitting and are hungry in less than 4 hours start solids if infant nurses 8 or more times per day, or start solids if infant nurses 8 or more times per day, or
consumes more than 32 oz. formula per dayconsumes more than 32 oz. formula per day
6 to 9 months6 to 9 months
Start veggies firstStart veggies first Add strained fruits, vegetables, and juices, Add strained fruits, vegetables, and juices,
only 1 new food every 7 daysonly 1 new food every 7 days usual serving is 2 to 3 T. 2 times/dayusual serving is 2 to 3 T. 2 times/day Only 2 ounces baby juice from cupOnly 2 ounces baby juice from cup only 30 to 32 oz. of formula or 3 to 5 only 30 to 32 oz. of formula or 3 to 5
feedingsfeedings
9 to 12 months9 to 12 months
Add strained or finely chopped meatsAdd strained or finely chopped meats only 1 new meat a weekonly 1 new meat a week
egg yolks onlyegg yolks only plain toast and crackers added once teeth are plain toast and crackers added once teeth are
presentpresent cheese, cottage cheese, yogurt, can be added cheese, cottage cheese, yogurt, can be added
but not cow’s milkbut not cow’s milk soft chopped vegetables and fruitssoft chopped vegetables and fruits formula or breast milk 25 to 30oz., 3 to 4 formula or breast milk 25 to 30oz., 3 to 4
nursings.nursings.
1 to 2 years1 to 2 years
Add whole milk at 1 yearAdd whole milk at 1 year add egg whites at 1 yearadd egg whites at 1 year avoid foods that may cause choking: hot avoid foods that may cause choking: hot
dogs, sausages, popcorn, nuts, round dogs, sausages, popcorn, nuts, round candy, uncooked vegetables, apple candy, uncooked vegetables, apple chunks, grapes, nuts, seeds, peanut butterchunks, grapes, nuts, seeds, peanut butter
wait for full set of teeth for above foodswait for full set of teeth for above foods
Special problemsSpecial problems
Nursing bottle caries-can be caused by Nursing bottle caries-can be caused by sleeping with bottle of juice, formula or sleeping with bottle of juice, formula or breast milkbreast milk
water recommended if bottle is needed at water recommended if bottle is needed at bedtimebedtime
extra water only needed if newborn is at extra water only needed if newborn is at high risk for dehydration: heat, humidity, high risk for dehydration: heat, humidity, diarrhea, etc.diarrhea, etc.