Infant Feeding

1. Infant Feeding Myrna D.C. San Pedro, MD, FPPS

2. 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.

3. 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

4. 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. Cow’s 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

5. MILK FORMULAS • Condensed Milk. Cow’s milk to which 45 % cane sugar added • Carbohydrate content 60% when diluted 1:4 • 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

6. 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

7. 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 cow’s 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

8. MILK FORMULAS • Reconstituted Milk. Remaking of any milk product to approximate the composition of fresh cow’s 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

9. 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 cow’s milk allergy • Powdered Protein. For prematures or debilitated infants or those with diarrhea

10. NOT RECOMMENDED FOR INFANTS • Whole Cow’s 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 • Goat’s Milk • Just as antigenic as cow’s 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

11. 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

12. 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

13. 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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