Nutrition and Supplements in Infancy: from the necessary to the ...

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Nutrition and Supplements in Infancy: from the necessary to the ...

Nutrition and Supplements in

Infancy: from the necessary to

the detrimental

Haya Hamade MD MPH


Objectives

• Remember the principles and importance of nutrition in the first

year of life

• Understand the different sources of milk and their indications

• Recommend appropriate supplements and complementary

solid foods

• Give evidence‐based recommendations on nutrition and

colic/probiotics/LCPUFA‐formula

• Become fervent breastfeeding advocates


Relevance

• Critical period

• Early deficits lead to long term negative outcomes

• Effective child health intervention


Requirements

• Term:


Milk: Breast is best


Milk: Breast is best

• Dynamic

• Composition

• Benefits

• Contraindications: myths and facts


Milk: breast is best

• When to start

• Frequency

• When to stop


Milk: breastmilk substitute

• Why formulas pale in comparison

( Breastfeeding counselling: A training course. Geneva, World

Health Organization, 1993 (WHO/CDR/93.6)).

Protein

Human milk Animal milks Infant formula

correct amount, easy

to digest

too much, difficult to

digest

partly corrected

Fat

enough essential fatty

acids, lipase to digest

lacks essential fatty

acids, no lipase

no lipase

Water enough extra needed may need extra

Anti-infective

properties

present absent absent


Milk: Breastmilk substitute

• Standard formula


Milk: Breastmilk substitute

• Soy formula

• yes: galactosemia/congenital lactase

deficiency/vegetarian

• No: colic/milk protein allergy/preterm

• Maybe: acute gastroenteritis


Milk: Breastmilk substitute

• LF (lactose‐free) formula

• Yes: “true” lactose intolerance

• No: healthy term newborns

• Maybe: acute gastroenteritis


Milk: Breastmilk substitute

• AR (“anti‐reflux”) formula

• Yes: GERD

• No: healthy term newborns

• Maybe: mild GERD (“happy spitter”)


Milk: Breastmilk substitute

• HA (“hypoallergenic”) formula

• Yes: cow milk protein allergy

• No: high risk prophylaxis (partially hydrolyzed)

• Maybe: colic


Milk: Breastmilk substitute

• Preterm formula

• Yes: 2kg)


Milk: Breastmilk substitute

• LCPUFA formulas


Mineral and Vitamins: Vit D

• Risk

• New guidelines for prevention: 400IU/day

Wagner et al 2008. Prevention of rickets and Vitamin D

Deficiency in Infants, Children and Adolescents.

Pediatrics

• What form?

• When to stop?


Minerals and Vitamins: Iron

• Risk: ID/ADA

• Prevention: AAP 2010 guidelines

• Term/Breastfed: yes

• Term/Formula‐fed: maybe

• Preterm/Breastfed: yes

• Preterm/Formula‐fed: maybe

Robert D. Baker et al. Diagnosis and Prevention of Iron

Deficiency and Iron‐Deficiency Anemia in Infants and Young

Children (0 ‐3 Years of Age). Pediatrics; originally published

online October 5, 2010;


Minerals and Vitamins: Fluoride

• Prevention of caries

• Systemic and Topical

• Risk of enamel fluorosis


Fluoride


Fluoride

• New 2010 ADA guidelines

• Risk assessment approach

• CAT


Minerals and Vitamins: Special

case

• Vegetarian/vegan breastfeeding mothers

• Possible nutritional deficiencies

• Management


Solid foods

• When? Developmentally ready

• What? Flexible but avoid certain foods

• How? One food at a time


Foods to avoid

• Honey: botulism

• Round hard foods (nuts/grapes): choking

• Cow’s milk: IDA

• Juices: malnutrition/caries/GI

• ?Peanut/fish/tree nuts/egg: allergies

• Artificial sweeteners/raw meat/coffee/alcohol/carbonated

beverages/spices: no comment


Colic

• 2 recent (2011) systematic reviews (Perry at al and Hall

et al)

• What doesn’t work

• What could work

• Bottom line


Intelligence in bottle?

• LCPUFA‐supplemented formulas (DHA/AA)


Intelligence in a bottle?

• Term infants‐Cochrane review 2008 (Simmer et al)

• Preterm infants‐Cochrane review 2011 (Schulzke et al)

• All infants: Individual meta‐analysis 2010 (Beyerlein et

al)


Probiotics

• Definition

• Examples

• Mechanism of action

• Formula supplementation?


Probiotics

• 2 recent position papers

• Routine use in formula

• What works: AVD

• What could work: colic/AAD

• What is controversial: NEC


• Questions?

Thank you

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