638 Pediatric Nutrition - apps.pharmacy.wisc.edu · FORMULA PREPARATION PEARLS •Sterilize water...
Transcript of 638 Pediatric Nutrition - apps.pharmacy.wisc.edu · FORMULA PREPARATION PEARLS •Sterilize water...
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N O N P R E S C R I P T I O N P R O D U C T S & S E L F - C A R E , 6 3 8C A L L E Y P A U L S O N , D P H - 4
PEDIATRIC NUTRITION & NUTRITION SUPPLEMENTS
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OBJECTIVES
• By the end of this module, students will be able to:• Describe nutritional needs of full-term infants • Calculate maintenance fluid requirements for full-term
infants• Compare and contrast different infant nutrition sources
based on health benefits and infant condition • Summarize proper preparation and sanitization techniques
for infant feeds• Assess use of nutritional supplements in pediatric patients • Evaluate and recommend when it is appropriate to refer an
infant to their primary care provider
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PEDIATRIC PATIENTS DIFFER FROM ADULTS
• Body composition• Develops over first few years of life• Vast differences at each stage
• Organ Maturation• Liver, kidneys, gut, lungs
• Functional/Mechanical Maturation• Swallowing, gastric functionality, volume
consumed, feeding fatigue, voiding control
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BASIC NUTRITIONAL REQUIREMENTS
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BASIC NUTRITIONAL REQUIREMENTS
• Dietary components:• Carbohydrates, protein, and lipids• What’s missing? • Fiber Do not need fiber for the first 12 months
of life
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BASIC NUTRITIONAL REQUIREMENTS
• Carbohydrates• 40-50% of energy needs• Lactose from milk• Exception – ketogenic diet
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BASIC NUTRITIONAL REQUIREMENTS
• Protein• Contains essential amino acids (aa)• Taurine, a cysteine a.a. derivative, is important for
membrane integrity • Deficiency affects: sight, hearing, fat absorption• Present in human breast milk• Supplemented in infant formula
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BASIC NUTRITIONAL REQUIREMENTS
• Lipids (9cal/g)• 50% of non-protein energy
from 0-12 months • Age 2-5 yo: Decreases to 20-
30% of caloric energy intake• Essential Polyunsaturated
Fatty Acids (PUFAs)• Linoleic acid
docosahecaenoic acid (DHA)• Linolenic acid arachadonic
acid (ARA)• Should always be supplemented
in formula
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BASIC FLUID REQUIREMENTS
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BASIC FLUID REQUIREMENTS
• Differ for premature and full-term infants
• Full-term daily maintenance
• Ex: Baby Seamus weighs 21.6 kg
First 10 kg 100 mL/kg Second 10 kg 50 mL/kgEach additional kg thereafter 20 mL/kg
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BASIC FLUID REQUIREMENTS EXAMPLE
• Ex: Baby Seamus weighs 21.6 kg
First 10 kg 100 mL/kg Second 10 kg 50 mL/kgEach additional kg thereafter 20 mL/kg
0-10 kg 1000mL10-20 kg 500mL21-21.6 kg 32mLTotal daily fluid requirement =1532mL
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INFANT NUTRITION SOURCES
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NUTRITION SOURCES AT BIRTH
• Mom’s breast milk!• Best option
• Formula• Wide variety• 2nd best option when breast milk is not an option
• Cow milk• Not recommended• Low in iron, too high in protein, variable fat content
• Goat milk• Not recommended• Low in iron, vitamin D, and folate
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BREAST MILK
• Healthy People 2020 Goals:• 84% of infants breast-fed at birth• 61% at 6 months old• 34% at 12 months old• 2006 data: 74% at birth (including single feed); 44% at 6
months; 23% at 12 months
• American Academy of Pediatrics• Recommends breast feeding through 12 months old
• Factors linked to not breast-feeding:• Poor; poorly educated; unmarried
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IMPORTANCE OF BREAST FEEDING
• Best nutritional source for infants• Composition changes as the child grows• Composition even changes throughout a single
feeding
• Decreases infant’s risk of infections• Immunoglobulins passed from mother to child• Many other proposed benefits
• Bonus: Increases mother-child bonding
Andreas NJ, Kampmann B, Mehring le-doare K. Human breast milk: A review on its composition and bioactivity. Early Hum Dev. 2015;91(11):629-635.
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WHEN TO AVOID BREAST FEEDING
• Mother with HIV• Risk of transmission to nursing infant• However, benefit outweighs risk of HIV in underdeveloped
countries
• Mother taking harmful medications• Many medications pass through the breast milk• Avoid feeds vs. dose after feeding/pumping
• Helpful resources• Lactmed: <toxnet.nlm.nih.gov>• National Breastfeeding Helpline: 800-994-9662
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INFANT FORMULAS
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INFANT FORMULAS
• Special formulations for different populations:• Pre-mature, newborn,
infant/toddler, and specific disease states
• Various compositions:• Milk-based, soy protein, or
casein hydrolysate-based• Ready-to-feed, concentrated
liquid, powder• Therapeutic, standard, fortified
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CONDITION SPECIFIC FORMULAS
Gastric Reflux (GERD) Enfamil A.R., Similac Sensitive
Cystic Fibrosis EleCare, Pregestimil LIPIL, Similac Expert Care Alimentum
Lactose Intolerance Enfamil ProSobee, Similac Sensitive, Similac Sensitive IsomilSoy
Allergy/sensitivity to cow milk or soy protein
EleCare, Neocate Infant, Nutramigen LIPIL, NutramiginAA LIPIL, Pregestimil, Similac Expert Care Alimentum
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FORMULA CONSIDERATIONS
• Manufactured to be sterile• Reminder: still requires sterile
preparation by caregiver
• Standard caloric density: 20 kcal/ounce• 1.5mL of water for each kcal
• Formulas can be fortified to be more concentrated!
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FEED SCHEDULE
• Dependent on size, age, food source, and baby• Smaller babies feed more often, but a smaller volume
• Important to avoid over and under-feeding
• There are no hard numbers for recommendations!
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FORMULA PREPARATION
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FORMULA PREPARATION PEARLS
• Wash hands before handling feeding materials
• To sterilize feeding materials:• Start with cold tap water• Place materials into water, bring to a rolling boil, hold for 5
minutes • Remove materials from water and allow to dry
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FORMULA PREPARATION PEARLS
• Sterilize water for formula mixture• Bring to a rolling boil for 1-2 minutes then allow to cool
• Formulas• Wash the container with hot water and soap, then
rinse• Shake formula (unnecessary for powder forms)• Mix appropriate amounts of sterilized water and
formula
• Prepare feed and give to baby• Test temperature!
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BEYOND USE DATE
Liquid Formula
• Liquid concentrate• Refrigerated
• 48 hrs
• Ready-to-use• Refrigerated
• 48 hrs
Powdered Formula
• Unused, reconstituted liquid• Refrigerated
• 48 hrs
• Unused powder• Non-refrigerated
• 1 month
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MICROWAVES FOR PREPARATION
• Not recommended
• Safe utilization:• Remove lid prior to microwaving• 4 oz of milk per cycle –
• Never frozen milk water-bath prior• 4 or 8 oz of formula
• Duration:• 4 oz = 30 sec• 8 oz = 45 sec
• Invert 10 times after each heating• Test temperature!
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PEDIATRIC NUTRITIONAL SUPPLEMENTS
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VITAMIN & MINERAL SUPPLEMENTATION
• Multivitamin and mineral supplementation is generally unnecessary for full-term infants
• Some infants at risk for deficiencies requiring supplementation of:• Vitamin D• Iron
• Supplementation should always be discussed with the physician first!
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VITAMIN & MINERAL SUPPLEMENTATION
• Fluoride• Reduces dental decay
• Supplementation not recommended:• birth to 6 months
• Supplementation may be recommended:• 6 months to 6 years of age when drinking water is
inadequately fluorinated and lack fluoride from other sources
• PCP may recommend supplementation when fluoride intake is inadequate
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WHEN TO REFERINFANTS NOT APPROPRIATE FOR SELF -CARE
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WHEN TO REFER
• Vomiting/Diarrhea• Green• Projectile• Day 3
• Bloody stool
• Dehydration• S/sx: limp, lethargic, lacking tears• Fewer wet diapers, dark urine
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C A L L E Y P A U L S O N , D P H - 4C M P A U L S O N 2 @ W I S C . E D U
QUESTIONS?