Infant FeedingMyrna D.C. San Pedro, MD, FPPS

ARTIFICIAL FEEDING

Isocaloric.Isocaloric. Infant formulas or breast milk substitutes Infant formulas or breast milk substitutes contain about 20 kcal/oz like breast milk.contain about 20 kcal/oz like breast milk.

Caloric requirements.Caloric requirements. The average caloric The average caloric requirement of a FT infant is about 80-120 kcal/kg requirement of a FT infant is about 80-120 kcal/kg during the 1during the 1stst few months of life & 100 kcal/kg by 1 few months of life & 100 kcal/kg by 1 yr.yr.

Fluid requirements.Fluid requirements. During the 1 During the 1stst 6 months of life, 6 months of life, about 130-190 ml/kg/day. As a rule, the infant about 130-190 ml/kg/day. As a rule, the infant regulates his or her own fluid requirement provided regulates his or her own fluid requirement provided adequate amounts mostly from orange juice & other adequate amounts mostly from orange juice & other foods or water offered. foods or water offered.

Number of feedings daily.Number of feedings daily. For the 1 For the 1stst month or 2, month or 2, feedings are throughout 24-hr period, 3-5 hrs interval, feedings are throughout 24-hr period, 3-5 hrs interval, so about 8 feedings a day. As quantity increases, so about 8 feedings a day. As quantity increases, number of feedings decrease adjusting to family number of feedings decrease adjusting to family pattern of daytime activity & by 9-12 months most pattern of daytime activity & by 9-12 months most infants are satisfied with 3 meals a day.infants are satisfied with 3 meals a day.

MILK FORMULAS

Certified Milk.Certified Milk. After drawing milk, it is cooled to 70 After drawing milk, it is cooled to 7000 C immediately & kept at this temperature till delivery.C immediately & kept at this temperature till delivery.a.a. Eliminates bovine tuberculosis, typhoid & other Eliminates bovine tuberculosis, typhoid & other

salmonella, dysentery, streptococcus & salmonella, dysentery, streptococcus & staphylococcusstaphylococcus

Pasteurized Milk.Pasteurized Milk. Heating milk at 63 Heating milk at 63oo C for 30 min or C for 30 min or for 15 sec at 72for 15 sec at 72oo C followed by rapid cooling to 65 C followed by rapid cooling to 65oo C. C.a.a. Destroys all pathogenic bacteria but only 99% of Destroys all pathogenic bacteria but only 99% of

saprophytessaprophytesb.b. Destroys 20% of vitamin C & 10% of thiamineDestroys 20% of vitamin C & 10% of thiaminec.c. Standards range from 5,000-10,000/ml to 50,000 Standards range from 5,000-10,000/ml to 50,000

non-pathogenic bacteria/mlnon-pathogenic bacteria/mld.d. Should be kept at 10Should be kept at 10oo C & do not use after 48 hrs C & do not use after 48 hrse.e. Only fresh milk pasteurizedOnly fresh milk pasteurized

MILK FORMULAS Homogenized Milk.Homogenized Milk. Processing of milk so that fat Processing of milk so that fat

globules are broken down into a fine emulsion by globules are broken down into a fine emulsion by passing milk through a fine aperture at high pressure passing milk through a fine aperture at high pressure at pasteurization temperature.at pasteurization temperature.a.a. The fine emulsion will prevent creaming & renders The fine emulsion will prevent creaming & renders

fat more easily assimilatedfat more easily assimilatedb.b. Also the method used to incorporate vitamin D in Also the method used to incorporate vitamin D in

milkmilk Evaporated Milk.Evaporated Milk. Cow’s milk vaporized at 55-60 Cow’s milk vaporized at 55-60oo C to C to

about 50% of its volume, homogenized, sealed in cans about 50% of its volume, homogenized, sealed in cans & autoclaved at 116& autoclaved at 116oo C for some time to destroy spores C for some time to destroy sporesa.a. Process can damage quality of proteinProcess can damage quality of proteinb.b. If can unopened, can keep for months without If can unopened, can keep for months without

refrigerationrefrigerationc.c. Lactalbumin less allergenic Lactalbumin less allergenic d.d. 30 ml or 1 fl oz = 40 kcal30 ml or 1 fl oz = 40 kcal

MILK FORMULAS

Condensed Milk.Condensed Milk. Cow’s milk to which 45 % cane Cow’s milk to which 45 % cane sugar addedsugar addeda.a. Carbohydrate content 60% when diluted 1:4Carbohydrate content 60% when diluted 1:4b.b. Percentage composition of proteins 1.6 %, fat 1.6 %, Percentage composition of proteins 1.6 %, fat 1.6 %,

carbohydrate 11 % & minerals 0.36 %carbohydrate 11 % & minerals 0.36 %c.c. Used only for a short period of time if high caloric Used only for a short period of time if high caloric

formula needed since nutritionally “out of balance”formula needed since nutritionally “out of balance”d.d. Less fat soluble vitamins & vitamin CLess fat soluble vitamins & vitamin C

Dried MilkDried Milk. Prepared by spraying whole or pasteurized . Prepared by spraying whole or pasteurized milk into a hot chamber at a very high speed so that milk into a hot chamber at a very high speed so that water is volatized immediately or by freeze-dryingwater is volatized immediately or by freeze-dryinga.a. Fine curds produced because protein alteredFine curds produced because protein alteredb.b. Vitamin C not affectedVitamin C not affected

MILK FORMULAS Skimmed Dried Milk.Skimmed Dried Milk. Fat removed before milk is dried Fat removed before milk is dried

so that fat content is only 0.05 %so that fat content is only 0.05 %a.a. Half-skimmed dried milk has fat content of 1.5 %Half-skimmed dried milk has fat content of 1.5 %b.b. Useful for fat intolerance, diarrhea or some prematuresUseful for fat intolerance, diarrhea or some prematures

Fermented Milk.Fermented Milk. Acidity of sour milk responsible for Acidity of sour milk responsible for changing of the casein curdschanging of the casein curdsa.a. Buttermilk.Buttermilk. Milk that has been allowed to turn sour by Milk that has been allowed to turn sour by

nature & its fat removed by churning; since frequently nature & its fat removed by churning; since frequently contaminated, sterile skimmed milk is inoculated with contaminated, sterile skimmed milk is inoculated with some lactic-acid producing organisms (some lactic-acid producing organisms (Lactobacillus Lactobacillus acidophilus, L. bulgaricus, or Streptococcus lacticusacidophilus, L. bulgaricus, or Streptococcus lacticus))

b.b. Fermented Whole milk.Fermented Whole milk. After inoculation, milk is After inoculation, milk is incubated at 27-30incubated at 27-30o o C for 6-12 hrs after which it is C for 6-12 hrs after which it is refrigerated for several daysrefrigerated for several days

c.c. Protein Milk. Protein Milk. Introduced by Finkelstein for treatment Introduced by Finkelstein for treatment of diarrheasof diarrheas

MILK FORMULAS

Acid Milk.Acid Milk. Prepared by addition of dilute mineral Prepared by addition of dilute mineral or organic acids to the milk, such as lactic acid or organic acids to the milk, such as lactic acid milk popularized by Marriottmilk popularized by Marriotta.a. Overcomes buffer value of cow’s milkOvercomes buffer value of cow’s milkb.b. Bactericidal effect in stomach & duodenumBactericidal effect in stomach & duodenumc.c. May cause acidosis in infantsMay cause acidosis in infants

Filled Milk.Filled Milk. Fat content of whole milk is replaced Fat content of whole milk is replaced by vegetable oil, coconut oil & corn oil & this by vegetable oil, coconut oil & corn oil & this increases the amount of saturated fatty acidsincreases the amount of saturated fatty acids

Recombined Milk.Recombined Milk. Separated non-aqueous Separated non-aqueous ingredients mixed together with or without water, ingredients mixed together with or without water, e.g. in condensed milk recombination, butterfat & e.g. in condensed milk recombination, butterfat & non-fat milk solids are put together againnon-fat milk solids are put together again

MILK FORMULAS

Reconstituted Milk.Reconstituted Milk. Remaking of any Remaking of any milk product to approximate the milk product to approximate the composition of fresh cow’s milk, hence, for composition of fresh cow’s milk, hence, for powdered milk, all that is needed is waterpowdered milk, all that is needed is water

Follow-on Milk Formulas.Follow-on Milk Formulas. Food intended Food intended for use as a liquid part of the weaning diet for use as a liquid part of the weaning diet for the infant from the 6for the infant from the 6thth month onwards & month onwards & for children between 12-36 months of agefor children between 12-36 months of agea.a. Questions raised about the high protein contentQuestions raised about the high protein contentb.b. Risk of hypernatremic dehydration due to high Risk of hypernatremic dehydration due to high

potential renal solute loadpotential renal solute loadc.c. However, beneficial in places where However, beneficial in places where

supplementary foods are low in proteinsupplementary foods are low in protein

MILK FORMULAS

Special Milk Formulas.Special Milk Formulas. Where either Where either the carbohydrate, protein, fat or all the carbohydrate, protein, fat or all these components have been altered these components have been altered to address specific needsto address specific needs

a.a. Phenylalanine-free.Phenylalanine-free. Milk formula for Milk formula for phenylketonuriaphenylketonuria

b.b. Lactose-free Formulas.Lactose-free Formulas. For lactose For lactose intolerance or galactosemiaintolerance or galactosemia

c.c. Soy formulas/Protein Hydrolysates.Soy formulas/Protein Hydrolysates. For infants with cow’s milk allergyFor infants with cow’s milk allergy

d.d. Powdered Protein.Powdered Protein. For prematures or For prematures or debilitated infants or those with diarrheadebilitated infants or those with diarrhea

NOT RECOMMENDED FOR INFANTS

Whole Cow’s MilkWhole Cow’s Milka.a. Protein content much higher than in breast Protein content much higher than in breast

milk, 21 % versus 7-16 %, thus, increasing milk, 21 % versus 7-16 %, thus, increasing solute loadsolute load

b.b. Low in iron & use may result in occult blood Low in iron & use may result in occult blood loss in stoolsloss in stools

Skimmed Milk & Low Fat MilkSkimmed Milk & Low Fat Milka.a. Very low fat contentVery low fat contentb.b. Deficient in vitamin C & ironDeficient in vitamin C & iron

Goat’s MilkGoat’s Milka.a. Just as antigenic as cow’s milkJust as antigenic as cow’s milkb.b. High protein content may result in an High protein content may result in an

increased renal solute loadincreased renal solute loadc.c. Deficient in folic acid & ironDeficient in folic acid & irond.d. Carbohydrate content only 25 % versus 35-65 Carbohydrate content only 25 % versus 35-65

% in breast milk% in breast milk

WEANING

The process of introducing any non-milk food The process of introducing any non-milk food into the infant diet, irrespective of whether or into the infant diet, irrespective of whether or not breast or bottle feeding continuesnot breast or bottle feeding continues

Introduction of solids usually done at about Introduction of solids usually done at about 4-4-6 months of age6 months of age because: because:

a.a. Milk supply may no longer meet the energy Milk supply may no longer meet the energy requirements for growthrequirements for growth

b.b. Vitamin & mineral deficiencies may begin Vitamin & mineral deficiencies may begin to develop in the fully breastfed infantto develop in the fully breastfed infant

c.c. The infant exhibits developmental The infant exhibits developmental readinessreadiness

DEVELOPMENTAL READINESS FOR WEANING

Better head controlBetter head control Better oral motor coordinationBetter oral motor coordination Intestinal tract better able to Intestinal tract better able to

handle foreign proteinshandle foreign proteins Kidneys better able to tolerate Kidneys better able to tolerate

increased protein loadsincreased protein loads

WEANING FOODS

Initial weaning foods are usually cereals, pureed Initial weaning foods are usually cereals, pureed fruits & vegetablesfruits & vegetables

When the infant shows “gumming” or develops When the infant shows “gumming” or develops chewing motions, usually at 6-8 months of age, chewing motions, usually at 6-8 months of age, chewable biscuits & succulent solids may be chewable biscuits & succulent solids may be introducedintroduced

Ground fresh beef, liver or strained canned Ground fresh beef, liver or strained canned meats may be given initially by 6 months of agemeats may be given initially by 6 months of age

Egg white, chicken & similar highly antigenic Egg white, chicken & similar highly antigenic foods should be introduced with caution during foods should be introduced with caution during the second 6 months to observe for & minimize the second 6 months to observe for & minimize allergic manifestationsallergic manifestations

Lifelong dietary habits may become established Lifelong dietary habits may become established at weaning period, hence, excessive salt & at weaning period, hence, excessive salt & sugar intake should be discouragedsugar intake should be discouraged

SMILE SMILE it’s contagious!it’s contagious!