Infant Feeding

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Infant Feeding

• Myrna D.C. San Pedro, MD, FPPS

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ARTIFICIAL FEEDING

• 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.

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MILK FORMULAS

• Certified Milk. After drawing milk, it is cooled
  to 700 C immediately kept at this temperature
  till delivery.
• 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.
• Destroys all pathogenic bacteria but only 99 of
  saprophytes
• Destroys 20 of vitamin C 10 of thiamine
• Standards range from 5,000-10,000/ml to 50,000
  non-pathogenic bacteria/ml
• Should be kept at 10o C do not use after 48 hrs
• Only fresh milk pasteurized

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MILK FORMULAS

• 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.
• The fine emulsion will prevent creaming renders
  fat more easily assimilated
• Also the method used to incorporate vitamin D in
  milk
• Evaporated Milk. Cows 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
• Process can damage quality of protein
• If can unopened, can keep for months without
  refrigeration
• Lactalbumin less allergenic
• 30 ml or 1 fl oz 40 kcal

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MILK FORMULAS

• Condensed Milk. Cows milk to which 45 cane
  sugar added
• Carbohydrate content 60 when diluted 14
• Percentage composition of proteins 1.6 , fat 1.6
  , carbohydrate 11 minerals 0.36
• Used only for a short period of time if high
  caloric formula needed since nutritionally out
  of balance
• 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
• Fine curds produced because protein altered
• Vitamin C not affected

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MILK FORMULAS

• Skimmed Dried Milk. Fat removed before milk is
  dried so that fat content is only 0.05
• Half-skimmed dried milk has fat content of 1.5
• Useful for fat intolerance, diarrhea or some
  prematures
• Fermented Milk. Acidity of sour milk responsible
  for changing of the casein curds
• 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)
• Fermented Whole milk. After inoculation, milk is
  incubated at 27-30o C for 6-12 hrs after which it
  is refrigerated for several days
• Protein Milk. Introduced by Finkelstein for
  treatment of diarrheas

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MILK FORMULAS

• Acid Milk. Prepared by addition of dilute mineral
  or organic acids to the milk, such as lactic acid
  milk popularized by Marriott
• Overcomes buffer value of cows milk
• Bactericidal effect in stomach duodenum
• 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

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MILK FORMULAS

• Reconstituted Milk. Remaking of any milk product
  to approximate the composition of fresh cows
  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
• 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

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MILK FORMULAS

• Special Milk Formulas. Where either the
  carbohydrate, protein, fat or all these
  components have been altered to address specific
  needs
• Phenylalanine-free. Milk formula for
  phenylketonuria
• Lactose-free Formulas. For lactose intolerance or
  galactosemia
• Soy formulas/Protein Hydrolysates. For infants
  with cows milk allergy
• Powdered Protein. For prematures or debilitated
  infants or those with diarrhea

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NOT RECOMMENDED FOR INFANTS

• Whole Cows Milk
• Protein content much higher than in breast milk,
  21 versus 7-16 , thus, increasing solute load
• Low in iron use may result in occult blood loss
  in stools
• Skimmed Milk Low Fat Milk
• Very low fat content
• Deficient in vitamin C iron
• Goats Milk
• Just as antigenic as cows milk
• High protein content may result in an increased
  renal solute load
• Deficient in folic acid iron
• Carbohydrate content only 25 versus 35-65 in
  breast milk

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WEANING

• 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
• Milk supply may no longer meet the energy
  requirements for growth
• Vitamin mineral deficiencies may begin to
  develop in the fully breastfed infant
• The infant exhibits developmental readiness

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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

• 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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