infant nutrition eseminar powerpoint - infant nutrition eseminar.ppt created date 5/28/2010 2:38:09...

Infant nutrition

Claire WilliamsonNutrition ScientistSarah Schenker

Nutrition Scientist1st June 2010

© British Nutrition Foundation 2010

Overview

• Breastfeeding- Benefits of breastfeeding for baby/mother- Healthy eating while breastfeeding

• Bottle feeding- Different types of formula

• Weaning- When to start weaning?- Initial stages of weaning- Later stages of weaning- Drinks- Allergy advice- Supplements


Breastfeeding

• Breastfeeding is considered to be theoptimal method of infant feeding.

• Exclusive breastfeeding is recommendedworldwide for first 6 months of life (WHO recommendations)

• The UK still has one of the lowest breastfeeding rates in Europe:

- One week - 45% of mothers exclusively breastfeeding- 6 weeks - 21% - 4 months – 7% - 6 months – proportion negligible(Infant Feeding Survey 2007)


Composition of breast milk

• Contains over 300 different components• Provides all the energy and nutrients that the baby

needs• Contains growth factors and immunological

components – help protect against infection• Composition changes as baby grows and develops• Colostrum produced in first few days – high in

antibodies Milk then becomes more dilute – baby takes larger volumes

• Composition also changes during a feed – starts more concentrated (richer in energy and nutrients) and then becomes more dilute


Benefits of breastfeeding – for baby• Breast milk provides the ideal combination of nutrients to meet the

baby’s needs - composition automatically changes as the baby grows and develops.

• Provides an array of protective factors – e.g. growth factors and immunoglobulins.

• Exclusive breastfeeding for at least 3 months associated with a lower incidence/severity of gastroenteritis, ear infection and respiratory infection.

• Increasing evidence that breastfeeding associated with a lower risk of obesity and cardiovascular risk factors in later life.

• May protect against some immune-related diseases in later life e.g. diabetes, coeliac disease (although further research is needed).

• May also protect against allergic disease (although research findings have been inconsistent).


Benefits of breastfeeding – for mother

• Associated with a decreased riskof breast cancer and also possiblyovarian cancer in later life.

• Associated with a decreased riskof osteoporosis and hip fractures in the post-menopausal period.

• Aids more rapid post-partum weight loss and return of post-partum uterine tone.


Bottle feeding

• If a mother is unable to breastfeed, or chooses not to, then infant formula should be given as an alternative.

• Strict criteria on the composition of formula and permitted ingredients are set out by the European Commission.

• The vitamin and mineral content of different formula brands is very similar, although many differ in the source of protein or addition of novel ingredients.


Infant formula – protein content

• Breast milk is predominantly whey protein based (60% whey, 40% casein) and therefore first formulas contain a higher proportion of whey.

• Some formulas developed ‘for hungrier babies’ – contain slightly more protein and predominantly casein based.

• Protein content of formula thought to contribute to the different growth patterns found between breastfed/bottle fed infants.

• Protein content of some brands being reduced – bring closer to breastmilk.

• Long-term effects of protein content of formula currently being studied.


Infant formula – other components

Long- chain PUFAs:• Breast milk contains both omega-3 and omega-6 long-chain

polyunsaturated fatty acids (PUFAs) – required for development of the brain, nervous system and retina.

• Now added to many brands of formula (as AA and DHA)

Prebiotics:• Breast milk contains a number of prebiotics (oligosaccharides)

– act as a substrate for the ‘good bacteria’ in the baby’s digestive system.

• Fructo-oligosaccharides (FOS) and galacto-oligosaccharides (GOS) now added to a number of formula brands.

• Studies show these are effective in helping achieve a gut flora similar to bottle fed babies.


Weaning

• Weaning is a gradual process that should start at around 6 months and continues into the baby’s first year.

• At around 6 months, stores of some nutrients (e.g. iron) start to run out and therefore additional sources are needed.

• WHO recommends exclusive breastfeeding until 6 months of age.

• The timing of introduction of solids should take into account individual baby’s development as this can vary widely.

• There are approximately 3 stages of weaning.


When to start weaning?• Dept of Health recommends introduction of solids at about 6

months, but no earlier than 17 weeks (DH 2004).

• Ongoing debate regarding the ideal weaning age and some parents may choose to start weaning before 6 months of age.

• Weaning should not be delayed beyond 6 months, as can lead to later feeding problems and reduced acceptance of foods later on.

• Signs that a baby may be ready for weaning:- starts to show an interest in food;- is able to sit up (may still need support);- wants to chew and put objects in mouth;- is able to reach and grab accurately;- still seems hungry after a milk feed.


Weaning – stage 1• Initial aim - to get baby used to the sensation of food in the

mouth that is not ‘free-flowing’.

• Sensitive time for development of taste so try to introduce a wide range of different foods and tastes.

- Start with pureed foods (e.g. fruit and vegetables), mixed with a little milk (breast or formula).

- Offer a few teaspoons once a day – increase the amount offered gradually.

- Babies still meeting most of their nutritional requirements from their milk.

• Foods to avoid before 6 months:- foods containing wheat/gluten (e.g. pasta, bread, cereals);- eggs;- fish and shellfish;- soft and unpasteurised cheeses.


Weaning - stage 2 (around 7–9 months)• Infants can now be introduced to a wider range of foods,

textures and tastes.

• Foods offered can now include:- Purees of vegetables and beans/lentils/chicken/other types of

meat;- Bread, rice and pasta;- Full fat dairy foods e.g. yogurt and fromage frais;- Full fat milk can be used in cooking (or with breakfast cereals).

• Soft finger foods should also be given at this stage to help encourage babies to feed themselves – some babies prefer foods they can hold e.g. pieces of fruit, sticks of vegetables (cooked), pieces of toast.

• Solid foods should gradually start to replace milk feeds, but babies should still be given breast/formula milk as the main drink up to 12 months of age.


Weaning – stage 3(around 9-12 months)

• By this stage, babies should be having three meals a day, in addition to healthy snacks.

• Foods should be chopped, mashed or minced and include:- starchy foods e.g. bread, rice, pasta, potatoes - fruit and vegetables – can now be given raw or cooked and served with meals or as finger foods;- milk and dairy products (full fat);- soft-cooked meat, fish, eggs (well cooked) or pulses (beans, lentils).

• Important that infants are given lumpier foods at this stage to encourage chewing (even if they don’t yet have any teeth).

• Finger foods are great for helping babies to learn to feed themselves.


Weaning - drinks

• Babies should still be given breast or formula milk as the main drink up to 12 months (at least 500-600 ml formula per day).

• Water is the best alternative to milk as a drink.

• Which milk?- cow’s milk not suitable as a main drink until 12 months.- after 12 months, whole milk can be given as a main drink (and should replace formula milk).- whole milk can be used in cooking before 12 months and added to breakfast cereals.- from 2 years, semi-skimmed milk can gradually be introduced, as long as the child is eating and growing well.- skimmed milk or 1% milk isn't suitable for children under 5 years - not enough energy and vitamin A.


Weaning – what to avoid• Salt – babies under one year should have less than 1g of salt

per day as their kidneys cannot cope with very much salt. Foods prepared at home should have no salt added.

• Sugar – frequently consuming sugar-containing foods and drinks can lead to tooth decay and may encourage a sweet tooth.

• Honey – honey should not be given to babies under one year because there is a risk it can contain bacteria that can cause infant botulism.

• Shark, marlin and swordfish – should not be given to babies because of the high levels of mercury they can contain.

• Raw eggs – eggs should be cooked until the white and yolk are solid. Avoid any foods containing raw or partially cooked eggs.

• Whole nuts - should not be given to children under age 5 because of the risk of choking.


What about allergies?

Common foods that cause allergies include milk, eggs, soya, wheat (and other cereals containing gluten e.g. rye, barley, oats), nuts, seeds, fish and shellfish.

Food allergies are more likely to develop if there is a family history of atopy – increased risk of allergies such as asthma, eczema, hay fever or food allergies.

It is a good idea to introduce foods that have the potential to cause allergic reactions gradually, one at a time. This should be after 6 months of age.

Advice on peanut allergy has recently changed – latest research shows no clear evidence that avoiding peanuts helps to reduce the risk of peanut allergy.

If child thought to be at risk of peanut allergy – consult GP, health visitor or allergy specialist before giving peanuts for the first time.


What about supplements?

• Department of Health recommends that breastfed infants should be given a supplement providing vitamins A, C and D (in the form of liquid drops) from the age of 6 months.

• Infants receiving at least 500ml of infant formula per day do not need these vitamin drops since the vitamins are already added to the formula.

• Vitamin drops including vitamins A, C and D are available for some young children through the Healthy Start scheme.Visit: http://www.healthystart.nhs.uk


For further information, go to:

www.nutrition.org.uk

www.foodafactoflife.org.uk

BNF is grateful for financial support from the Agricultural and Horticultural Development Board

to enable us to develop these eSeminars.


infant nutrition eseminar powerpoint - infant nutrition eseminar.ppt created date 5/28/2010 2:38:09...

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