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Infant Formula

Infant Formula. Mónica Riojas, MD LSU Pediatrics. Principles of Infant Feeding. Energy Requirements: kcal/kg/d 0-12 mo: 100-120 1-3 yr: 90-100 4-6 yr: 80-90 7-10 yr: 70-75 15+ yr: 45-50 .

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Infant Formula

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  1. Infant Formula Mónica Riojas, MD LSU Pediatrics

  2. Principles of Infant Feeding Energy Requirements: kcal/kg/d • 0-12 mo: 100-120 • 1-3 yr: 90-100 • 4-6 yr: 80-90 • 7-10 yr: 70-75 • 15+ yr: 45-50

  3. Principles of Infant Feedings Formula fed infants feed every 3-4 hrs. Feedings/day 0-3 Months: 6-8 4-6 Months: 5-7 6-8 Months: 4-6 9-12 Months: 3-5

  4. Principles of Infant Feeding Average Volume of Milk per Feeding • 1st wk: 1-2 oz • 2-4 wks: 2-3 oz • 1-2 mo: 4-5 oz • 3-4 mo: 5-6 oz • 5-6 mo : 7-8 oz • By 12 mo of age, the average child should be taking an average of 24 oz/d.

  5. INFANT STOMACH CAPACITY

  6. Infant Formula Indications As substitute for human milk in infants for whom BF is medically contraindicated. As supplement for BF infants who do not gain weight adequately. As a substitute or supplement for human milk whose mother chooses not to BF or not to do it exclusively.

  7. Distribution of Kcals

  8. Question • Which of the following statements about infant nutrition is true? • Human milk contains more casein than infant formulas. • Infants who receive increased whey protein have been shown to grow better than those who receive primarily casein. • Iron is absorbed better from cow milk formulas than from human milk. • Lactose-free formulas result in decreased absorption of calcium. • There are no apparent negative effects from the addition of DHA and ARA to formulas.

  9. Differences Between Types of Milk

  10. Benefits of Whey Protein Promotes more rapid gastric emptying. Consists of soluble proteins that are easily digested. Lines the GI tract and plays a role in host defense.

  11. Question • Is iron supplementation required at birth? • No • When should you start iron supplementation? • All babies (including breastfed) should receive supplementation in their food (iron-fortified cereal) by 6 months of age. • In FT infants, iron stores become depleted by 4-6 months of age.

  12. Dietary Recommendations IRON Pre-term: 2 mg/kg/d at 1-12 mo Full-term: 1 mg/kg/d at 4-6 mo Iron Fortified Formula: 12 mg/L Cow’s milk has 0.5mg/L of iron.

  13. Dietary Recommendations VITAMIN D • 400 IU/d Who should receive Vitamin D? • All BF infants, unless they are weaned to at least 1000 ml/d (33 oz) of Vit. D fortified formula. • Formula fed infants ingesting ≤ 1000 ml/d of Vit. D fortified formula. • Children/adolescents who get no sun light, ≤ 1 L of Vit. D fortified milk, no MVI.

  14. Infant Formulas • Premature Formulas • Standard Formulas • Special Formulas

  15. Standard Formulas COMPOSITION • Protein • Whey (β lacto-globulin) & Casein • Whey predominant (60:40), Casein predominant (20:80), or 100% whey • Fat • Vegetable oils • Coconut: Saturated, short & MCFA • Palm oil: Saturated & LCFA • Safflower, corn & soy: LCFA, DHA & ARA • Carbohydrate • Lactose

  16. Standard Infant Formulas Provide 20 cal/oz PRESENTATIONS: Powder Concentrated Liquid Ready to Feed

  17. Preparation of Infant Formula POWDER Add 1 scoop powder to 2 oz of water CONCENTRATED LIQUID Mix 1 oz concentrated liquid and 1 oz water 13 oz can READY TO FEED Hospital use: 2 and 3 oz bottles 32 oz container Expensive

  18. Preparation of Infant Formula What type of water should be mixed with the formula? • Tap: safe, may boil x 1 min. • Distilled water with fluoride. • Well: boil 10 min. Give fluoride. • Warm, cold or room temperature.

  19. Cow Milk/Standard Formulas Designed to meet the nutritional needs of the term and near-term infant. Enfamil Premium Newborn & Infant Similac Advance Store Brands

  20. Cow Milk/Standard Formulas

  21. New Infant Formula Features Prebiotics • Nondigestible short-chain carbohydrates that stimulate growth and function of specific species of bacteria. • Increases concentration of lactobacillus and bifidobacterium. • Used to treat chronic diarrhea. • Beneficial to atopic children. Probiotics • Live microorganisms that survive digestion and colonize the colon. Organic • No pesticides or synthetic fertilizer used. • No hormones or antibiotics used.

  22. Premature Infant Formulas • For LBW and Premature Infants • Increased energy requirement: 120 kcal/kg/d • Preterm formulas should always be discontinued before hospital discharge. • Increased intake with age → excess intake of vitamins/minerals

  23. Composition of Premature Infant Formula • 20, 22, 24 kcal/oz • Increased protein: whey predominant • 60% whey:40% casein • Breastmilk - 70% whey:30% casein • Increased calcium & phosphorus • Contain AA: cysteine and taurine • Lactose + glucose polymers • MCT • Increased Vitamins & Minerals

  24. Premature Infant Formulas • Enfamil Premature 20 cal • Enfamil Premature 24 cal • Similac Special Care Advance 20 cal • Similac Special Care Advance 24 cal • Good Start Premature 24 cal

  25. Premature Infant Formulas

  26. Transitional Formulas • 22 kcal/oz INDICATIONS • Infants 34 WGA or 1,800-2,000 g • How long should infants be on transitional formulas? • 6 to 9 months of age

  27. Transitional Formulas Enfamil Enfacare Similac Expert Care Neosure

  28. Transition Formula

  29. Question • What type of milk would you recommend a breastfeeding infant that develops “rash and hives” while eating yogurt and cream cheese, and tolerates foods such as eggs and bread without any problems? • Trial of Soy Milk–Based Formula • If no improvement switch to an extensively hydrolyzed or AA-based formula

  30. Soy Protein Formulas • Lactose Free • Contain higher concentrations of protein, AA, calcium, phosphorus, zinc and iron. Primary Carbohydrate • Glucose polymers from corn syrup solids or maltodextrin

  31. Soy Protein Formulas INDICATIONS • Galactosemia • Congenital Lactase Deficiency • Post-diarrhea lactose intolerance • Strict vegetarian family

  32. Soy Protein Formulas NOT RECOMMENDED FOR • Preterm infants with BW ≤ 1800 g. • Do not meet requirements for calcium and phosphorus. • Prevention of colic or allergy • Infants with cow milk protein-induced enterocolitis (non-IgE allergic enterocolitis) • 30% of infants with milk protein allergy also have soy protein allergy.

  33. Soy Protein Formulas • Enfamil ProSobee • Similac Sensitive • Store Brand Soy Infant Formula

  34. Soy Protein-Based Formulas

  35. Modified Cow Milk Protein or Soy-Based Formulas Carbohydrate • Reduced lactose or lactose-free carbohydrate blends Protein • Partially hydrolyzed whey and soy proteins Other • Thickeners (rice cereal) • Soy fiber • Prebiotics

  36. Modified Cow Milk Protein or Soy-Based Formulas INDICATIONS • Infants recovering from diarrhea • Infants with colic • Infants with GER • NOT for infants with galactosemia • NOT for cow milk formula intolerance

  37. Special Indications GER Enfamil AR Similac Sensitive for Spit up Diarrhea and fussiness Similac Expert Care for Diarrhea Enfamil Gentlease Similac Sensitive Fussiness and Gas Specialty-metabolic formulas Similac PM 60/40

  38. Modified Cow or Soy Milk-Based Formulas

  39. Modified Cow or Soy Milk-Based Formulas

  40. Modified Cow or Soy Milk-Based Formulas

  41. Modified Cow or Soy Milk-Based Formulas

  42. Question • A mother brings her 1 month old infant to clinic because of a 1 week history of “bloody streaks in stool” and fussiness. Mom was breastfeeding for the first 3 weeks of life, then switched to a cow milk-based formula 1 week ago. What formula should you recommend? • Protein Hydrolysate Formula

  43. Extensively Hydrolyzed Formulas Made for infants who are unable to digest or tolerate formulas containing intact cow milk protein. Lactose free Protein Extensively hydrolyzed casein Partially hydrolyzed whey Carbohydrate Glucose polymers and/or sucrose Fat Content Vegetable oils LCT/MCT from safflower and soy

  44. Extensively Hydrolyzed Formulas INDICATIONS • Cow milk and soy protein allergy • Malabsorption syndromes • Cystic fibrosis • Biliary Atresia • Short gut syndrome • Pancreatic insufficiency • Protein calorie malnutrition • Autoimmune diseases/immunodeficiency syndromes

  45. Question • Hydrolysate formulas are MOST often used in the management of: • Celiac disease • Cow milk protein allergy • Cystic fibrosis • GER • Lactose intolerance

  46. Extensively Hydrolyzed Formulas • Nutramigen • Pregestemil • Similac Expert Care Alimentum

  47. Extensively Hydrolyzed Formulas

  48. Amino Acid Based Formulas • Intolerance to intact or hydrolyzed protein. Protein • Free Amino Acids Carbohydrate • Glucose polymers

  49. Amino Acid Based Formulas INDICATIONS • Cow Milk Protein Allergy • Eosinophilic GI disorders • Atopic diseases • Severe food allergy • Asthma • Eczema

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