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

3. 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

4. Calorie Needs for Infants/Toddlers  Infants 0 to 5 months : 108 kcals/kg / estimate 650/day 0 to 5 months : 108 kcals/kg / estimate 650/day Most formulas 20 kcals/oz.Most formulas 20 kcals/oz. 6 to 12 months:96 kcals/kg/ estimate 850/day 6 to 12 months:96 kcals/kg/ estimate 850/day  Children 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

5. 1st month  8 to 12 feedings per day watch for signs of hunger not the clock watch for signs of hunger not the clock frequent feedings help build mom’s supply frequent feedings help build mom’s supply On demand bottle feeding not clock 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

6. Weight gain rate  4 to 8 ounces per week for the first 6 months  1 LB every 2 weeks

7. 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 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 some 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 days should pass their birth weight by 10 to 14 days

8. 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

9. 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

10. 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,

11. 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 For special formulas

12. Formula Types  Standard milk based formula  soy-based non-milk based, lactose free, lactofree  hypercaloric  Hypoallergenic formulas-Neocate  See handout for brand names/categories

13. Nutrition care manual  https://www.nutritioncaremanual.org/formu lary.cfm https://www.nutritioncaremanual.org/formu lary.cfm https://www.nutritioncaremanual.org/formu lary.cfm  Formula Types  Formula recipes to adjust calories  Infant Feeding guides

14. 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

15. Formula feeding problems  Colicky -switch to hypoallergenic formula for several months  discourage bottle propping

16. 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

17. 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

18. 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 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

19. 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

20. 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 Focus on eating and hunger  Establish meal times and routine  Avoid Multi-tasking and rushing feedings  Put away toys  Make eye contact with infant

21. 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.

22. Shopping for baby foods  First step  Second step  Third step

23. 6 months 6 months  Solids can be stated when birth weight has doubled Do not eat out of jars, put small serving in separate bowl Do not eat out of jars, put small serving in separate bowl Rice cereal usually first, only 1 to 2 spoonfuls Rice cereal usually first, only 1 to 2 spoonfuls  Juice at 6 mo.: Only 4 to 6 oz. per day From cup not bottle 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 start solids if infant nurses 8 or more times per day, or consumes more than 32 oz. formula per day

24. 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

25. 9 to 12 months  Add strained or finely chopped meats only 1 new meat a week 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.

26. 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

27. 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.