infant feeding 2014

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Infant Feeding 2014 Infant Feeding 2014 Resident Nutrition Resident Nutrition Education Session Education Session 2-19-2014 2-19-2014

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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. - PowerPoint PPT Presentation

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Page 1: Infant Feeding 2014

Infant Feeding 2014Infant Feeding 2014

Resident Nutrition Education Resident Nutrition Education SessionSession

2-19-2014 2-19-2014

Page 2: Infant Feeding 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

Page 3: Infant Feeding 2014

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

Page 4: Infant Feeding 2014

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

Page 5: Infant Feeding 2014

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

Page 6: Infant Feeding 2014

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

Page 7: Infant Feeding 2014

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

Page 8: Infant Feeding 2014

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

Page 9: Infant Feeding 2014

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,

Page 10: Infant Feeding 2014

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

Page 11: Infant Feeding 2014

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

Page 12: Infant Feeding 2014

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

Page 13: Infant Feeding 2014

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

Page 14: Infant Feeding 2014

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

Page 15: Infant Feeding 2014

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

Page 16: Infant Feeding 2014

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

Page 17: Infant Feeding 2014

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

Page 18: Infant Feeding 2014

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

Page 19: Infant Feeding 2014

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

Page 20: Infant Feeding 2014

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.

Page 21: Infant Feeding 2014

Shopping for baby foodsShopping for baby foods

First stepFirst step Second stepSecond step Third stepThird step

Page 22: Infant Feeding 2014

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

Page 23: Infant Feeding 2014

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

Page 24: Infant Feeding 2014

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.

Page 25: Infant Feeding 2014

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

Page 26: Infant Feeding 2014

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.