Transcript Infant Feeding

Infant Feeding
Myrna D.C. San Pedro, MD, FPPS
ARTIFICIAL FEEDING
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Isocaloric. Infant formulas or breast milk substitutes
contain about 20 kcal/oz like breast milk.
Caloric requirements. The average caloric
requirement of a FT infant is about 80-120 kcal/kg
during the 1st few months of life & 100 kcal/kg by 1 yr.
Fluid requirements. During the 1st 6 months of life,
about 130-190 ml/kg/day. As a rule, the infant regulates
his or her own fluid requirement provided adequate
amounts mostly from orange juice & other foods or
water offered.
Number of feedings daily. For the 1st month or 2,
feedings are throughout 24-hr period, 3-5 hrs interval,
so about 8 feedings a day. As quantity increases,
number of feedings decrease adjusting to family pattern
of daytime activity & by 9-12 months most infants are
satisfied with 3 meals a day.
MILK FORMULAS
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Certified Milk. After drawing milk, it is cooled to 700 C
immediately & kept at this temperature till delivery.
a. Eliminates bovine tuberculosis, typhoid & other
salmonella, dysentery, streptococcus & staphylococcus
Pasteurized Milk. Heating milk at 63o C for 30 min or for
15 sec at 72o C followed by rapid cooling to 65o C.
a. Destroys all pathogenic bacteria but only 99% of
saprophytes
b. Destroys 20% of vitamin C & 10% of thiamine
c. Standards range from 5,000-10,000/ml to 50,000 nonpathogenic bacteria/ml
d. Should be kept at 10o C & do not use after 48 hrs
e. Only fresh milk pasteurized
MILK FORMULAS
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Homogenized Milk. Processing of milk so that fat
globules are broken down into a fine emulsion by passing
milk through a fine aperture at high pressure at
pasteurization temperature.
a. The fine emulsion will prevent creaming & renders fat
more easily assimilated
b. Also the method used to incorporate vitamin D in milk
Evaporated Milk. Cow’s milk vaporized at 55-60o C to
about 50% of its volume, homogenized, sealed in cans &
autoclaved at 116o C for some time to destroy spores
a. Process can damage quality of protein
b. If can unopened, can keep for months without
refrigeration
c. Lactalbumin less allergenic
d. 30 ml or 1 fl oz = 40 kcal
MILK FORMULAS
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Condensed Milk. Cow’s milk to which 45 % cane
sugar added
a. Carbohydrate content 60% when diluted 1:4
b. Percentage composition of proteins 1.6 %, fat 1.6 %,
carbohydrate 11 % & minerals 0.36 %
c. Used only for a short period of time if high caloric
formula needed since nutritionally “out of balance”
d. Less fat soluble vitamins & vitamin C
Dried Milk. Prepared by spraying whole or pasteurized
milk into a hot chamber at a very high speed so that
water is volatized immediately or by freeze-drying
a. Fine curds produced because protein altered
b. Vitamin C not affected
MILK FORMULAS
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Skimmed Dried Milk. Fat removed before milk is dried so
that fat content is only 0.05 %
a. Half-skimmed dried milk has fat content of 1.5 %
b. Useful for fat intolerance, diarrhea or some prematures
Fermented Milk. Acidity of sour milk responsible for
changing of the casein curds
a. Buttermilk. Milk that has been allowed to turn sour by
nature & its fat removed by churning; since frequently
contaminated, sterile skimmed milk is inoculated with
some lactic-acid producing organisms (Lactobacillus
acidophilus, L. bulgaricus, or Streptococcus lacticus)
b. Fermented Whole milk. After inoculation, milk is
incubated at 27-30o C for 6-12 hrs after which it is
refrigerated for several days
c. Protein Milk. Introduced by Finkelstein for treatment
of diarrheas
MILK FORMULAS
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Acid Milk. Prepared by addition of dilute mineral
or organic acids to the milk, such as lactic acid milk
popularized by Marriott
a. Overcomes buffer value of cow’s milk
b. Bactericidal effect in stomach & duodenum
c. May cause acidosis in infants
Filled Milk. Fat content of whole milk is replaced
by vegetable oil, coconut oil & corn oil & this
increases the amount of saturated fatty acids
Recombined Milk. Separated non-aqueous
ingredients mixed together with or without water,
e.g. in condensed milk recombination, butterfat &
non-fat milk solids are put together again
MILK FORMULAS
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Reconstituted Milk. Remaking of any milk
product to approximate the composition of
fresh cow’s milk, hence, for powdered milk,
all that is needed is water
Follow-on Milk Formulas. Food intended
for use as a liquid part of the weaning diet
for the infant from the 6th month onwards &
for children between 12-36 months of age
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c.
Questions raised about the high protein content
Risk of hypernatremic dehydration due to high
potential renal solute load
However, beneficial in places where
supplementary foods are low in protein
MILK FORMULAS
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Special Milk Formulas. Where either the
carbohydrate, protein, fat or all these
components have been altered to address
specific needs
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b.
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Phenylalanine-free. Milk formula for
phenylketonuria
Lactose-free Formulas. For lactose
intolerance or galactosemia
Soy formulas/Protein Hydrolysates. For
infants with cow’s milk allergy
Powdered Protein. For prematures or
debilitated infants or those with diarrhea
NOT RECOMMENDED FOR
INFANTS
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Whole Cow’s Milk
a. Protein content much higher than in breast milk,
21 % versus 7-16 %, thus, increasing solute load
b. Low in iron & use may result in occult blood loss
in stools
Skimmed Milk & Low Fat Milk
a. Very low fat content
b. Deficient in vitamin C & iron
Goat’s Milk
a. Just as antigenic as cow’s milk
b. High protein content may result in an increased
renal solute load
c. Deficient in folic acid & iron
d. Carbohydrate content only 25 % versus 35-65 %
in breast milk
WEANING
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The process of introducing any non-milk food
into the infant diet, irrespective of whether or
not breast or bottle feeding continues
Introduction of solids usually done at about 4-6
months of age because:
a. Milk supply may no longer meet the energy
requirements for growth
b. Vitamin & mineral deficiencies may begin to
develop in the fully breastfed infant
c. The infant exhibits developmental readiness
DEVELOPMENTAL READINESS
FOR WEANING
Better head control
 Better oral motor coordination
 Intestinal tract better able to handle
foreign proteins
 Kidneys better able to tolerate
increased protein loads
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WEANING FOODS
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Initial weaning foods are usually cereals, pureed
fruits & vegetables
When the infant shows “gumming” or develops
chewing motions, usually at 6-8 months of age,
chewable biscuits & succulent solids may be
introduced
Ground fresh beef, liver or strained canned meats
may be given initially by 6 months of age
Egg white, chicken & similar highly antigenic foods
should be introduced with caution during the
second 6 months to observe for & minimize allergic
manifestations
Lifelong dietary habits may become established at
weaning period, hence, excessive salt & sugar
intake should be discouraged
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