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Formula Formula Feeding of Feeding of
InfantsInfants
Formula Formula Feeding of Feeding of
InfantsInfantsBy Nykytyuk SBy Nykytyuk S
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Formula Feeding• - It is a child's diet of infancy, in
which she did not receive human milk or its amount is less than 20% of the food and staple food are artificial mixtures.
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There is an agreement among healthcare professionals, infant food manufacturers and mothers that breastfeeding is the best choice for feeding infants during their first four to six months of life
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There are several reasons There are several reasons why a mother may not why a mother may not breastfeed her baby:breastfeed her baby: 1. Medical or other health reasons
may prevent a mother from breastfeeding.
2. The baby with special requirements may not tolerate breast milk.
3. Some social or psychological reasons can make it more difficult to breastfeed exclusively.
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The absolute The absolute contraindications to contraindications to
breast-feedingbreast-feeding
1. Hypergalactosaemia. 2. Phenylketonuria [PKU].3. Lactose intolerance.
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Medical contraindications Medical contraindications to breast-feeding to breast-feeding
connected with motherconnected with mother1. Decompensated chronic diseases like
blood circulation insufficiency, kidney or liver problems, respiratory insufficiency of III grade, HIV-infection, etc.
2. Psychical disorders as epilepsy, schizophrenia, depressive phychosis, postpartum psychosis.
3. Taking certain medications (See tables 1, 2).
4.4. SubstSubstance-abuse (drugs, alcohol, marijuana, cocainecocaine, heroin, ets)(See table 3).
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Table 1. Drugs that are Table 1. Drugs that are contraindicated during breast-feedingcontraindicated during breast-feeding
No. Drug Reported sign or symptom in infant
or effect on lactation
1. Bromocriptine Supresses lactation
2. Cocaine Cocaine intoxication
3.Cyclophos-phamide
Possible immune supression; unknown effect on growth or association with carcinogenesis; neutropenia
4. Cyclosporine
Possible immune supression; unknown effect on growth or association with carcinogenesis
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5. Doxopubicin Possible immune supression; unknown unknown effect on growth or association with with carcinogenesis
6. Ergotamine Vomiting, diarrhea, convulsions (doseses used in migraine medication)
7. Lithium ⅓ to ½ therapeutic blood concentration in infants
8.Methotrexate
Possible immune supression; unknown effect on growth or association with carcinogenesis; neutropenia
9.Phencyclidine (PCP)
Potent hallucinogen
10.10. Phenindione Phenindione Anticoagulant; increased prothrombin and nd partial thromboplastin time in infant
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Table 2. Table 2. Drugs that have caused Drugs that have caused significant effects on some nursing significant effects on some nursing
infants and should be given to infants and should be given to nursing mothers with cautionnursing mothers with caution
No. DrugReported sign or symptom in infant or
effect on lactation
1.Aspirin (salicylates)
Metabolic acidosis (dose related); may affect platelet function; hemorrhagic rashrash
2. Clemastine Drowsiness, irritability, refusal to feed,feed, high-pitched cry, neck stiffness
3.Phenolbarbitol
Sedation; infantile spasms after weaning weaning from milk containing phenolbarbitol, methemoglobinemia
4.4. PrimidonePrimidone Sedation; feeding problems
5.5. SulfasalazineSulfasalazine Bloody diarrhea
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Table 3. Drugs of abuse that areare contraindicated
during breast-feedingdingNo. Drug
Reported sign or symptom in infant or effect on lactation
1.
Amphetamine
Irritability, poor sleep pattern
2.
Cocaine Cocaine intoxication
3.
Heroin Irritability, Heroin intoxication
4.
Nicotine (smoking)
Shock, vomiting, diarrhea, rapidid heart rate, restlessness; decreased milk production
55..
PhencyclidinPhencyclidinee
Potent hallucinogen
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Other reasons why a Other reasons why a mother may not mother may not breastfeed her baby:breastfeed her baby:• Working outside the home makes it
more difficult to breastfeed exclusively, especially if there is no support at her workplace for her to either bring her baby or to express and store her milk.
• Choosing not to breastfeed for personal reasons, either from the birth of the baby or after breastfeeding for a short while, is a mother's prerogative.
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Recommendations for Working Women:
• The mother who goes back to work can usually continue breast-feeding without problems. The milk supply adjusts itself to the demand. If the mother is working at least 8 hours a day, it is sometimes prudent to pump the breasts once during her work day in order to stay comfortable and maintain a good milk supply. Each woman is different in what is required to maintain a supply. Some women can work for a long time without pumping and without compromising the supply. Others have a supplya supply that is more responsive to decreased feeds.feeds. A woman will rarely “dry up” becayse she hasshe has returned to work.
• Working mothersWorking mothers, however, can easily breast-breast-feed part-time andfeed part-time and formula-feed part-time.
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Breast pumps and storage of milk
• Hand expression is superior if the mother can learn the technique.
• Several pumps are available if the mother is unable to express by hand.
• It is good if the woman can borrow a pump from a friend before she decides which pump to purchase. Another alternative is to rent an electric pump.
• Milk should be stored in clean containers andand immediately refrigerated or frozen. – If refrigerated, it will stay good for 48 hours. – If frozen at 0°F, it wiil keep for months.
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Individual feeding
• Breast feeding solves this problem in the best possible way. Every child has it’s individual peculiarities of food corrections’ and adds’ assimilation, that need to be taken into account during the design of child’s ration.
• Appropriate physical, mental and psychological development of child is a criteria of food’s adequacy.
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Female’s milk – is a unique combination of nutrients,
complex biological system, which conducts plastic, energetic and immuno-modulating functions
• Colostrum – is a sticky yellow liquid, which fills up the alveolus during the last trimester of pregnancy and is being produced during the next 3-4 month after the birth of the child
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Chemical peculiarities of colostrum:
• Contains in 4-5 times more proteins than mature milk;
• In 2-10 times more vitamine A and carotine;• In 2-3 times more vitamine C;• Contains big amount of secretological Ig A;• Composition of colostrum is close to the
composition of tissues of a new-born child: proteins are identical to the proteins of blood; lipids are enriched with olein acid, contain big amount of phospholipids; sugar is represented by lactose; high amounts of mineral salts.
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Advantages of breast feeding:
ChildChild MotherMother FamilyFamily
Prophylactic of infectious Prophylactic of infectious and allergic illnessesand allergic illnesses
Prevention of post-Prevention of post-pregnancy complicationspregnancy complications Economic advantagesEconomic advantages
Prophylactic of illnesses Prophylactic of illnesses of digestive and of digestive and endocrine systemsendocrine systems
Prevention of unwanted Prevention of unwanted pregnancy during the 4-pregnancy during the 4-6 month after the birth 6 month after the birth of the childof the child
Healthy childHealthy child
Provision of physiologic Provision of physiologic developmentdevelopment
Preservation of Preservation of reproductive healthreproductive health
High index of intellectual High index of intellectual developmentdevelopment
Prophylactic of cancer Prophylactic of cancer illnessesillnesses Psychoemotional unityPsychoemotional unity
Healthy societyHealthy society
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Recommendations for mother’s diet:
• To drink approximately 64 oz of fluids per day.
• The nursing mother requires an additional 500 calories and 20-30 g of protein a day.
• She has to take her prenatal vitamins with iron.
• The mother need not to avoid certain foods unless she observes consistent increased fussfussiness in the baby in association with the mother ingestion such foods.
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Foods commonly Foods commonly incriminated:incriminated:
• Garlic• Onions• Cabbage• Chocolate• Great quantities of caffeine.Nursing mother may drink small amounts
of alcohol: a glass of sherry or wine may be beneficial in late afternoon if she is having let-down reflex problems.
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Common problems encountered with brest-
feeding• Poor Let-Down (Milk ejection
reflex)• Poor Weight Gain• Mastitis• Cracked Nipples• Jaundice From Breast- Feeding
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Artificial feedingArtificial feeding
• This is the feeding of infant when he gets cow’s or buffalo’s milk or formula from first days till 4th to 6th month of his life.
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Classification of artificial feeding
• Not adapted: sweet and sour - 2, 3,4.Adapted: high adapted (special), adapted (baseline), following (partially adapted).Treatment: with pre-and probiotics, antireflux to malovahovyh children, for the treatment of anemia, antiallergic.
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Formula milks• Formula milks are humanized, i.e.,
they come very close to the composition of breast milk.
• However, they are more expensive, so cow’s or buffalo’s milk are quite often used.
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Размещение бар-кода
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T 125 -140 O.
Ultrapasterisation
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ТERMOLISATION
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Characteristic of milk for artificial feeding
• This cow's milk that meets the following requirements:Contains not less than 35 g / l fat, 40-45 g / l of sugar;Has acidity of not more than 20 degrees Turner;Lets not less than 85 g / L solids;Does not contain pathogenic and putrefactive bacteria;The total number of bacteria does not exceed 50 000 in 1 ml;Title coliform 1:10;Used for making baby milk.
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Composition of cow’s milk versus breast milk.
(in 100 ml)
Human milkHuman milk Cow’s milkCow’s milk
Calories 67 67
Water 87 % 87 %
Carbohydrate 7.4 % 4.4 %
Lactose Lactose isomerisomer
β-lactose α-lactose
FatFat 3.5 %3.5 % 3.5 %3.5 %
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Human milkHuman milk Cow’s milkCow’s milk
Protein 1.5 % 3.5 %
Lactalbumin:Casein ratio
60 : 40 20 : 80
SodiumSodium 15 mg60 mg
(4 times)
Phosphorus Phosphorus 15 mg90 mg
(6 times)
Calcium Calcium 30 mg120 mg (4 times)
Iron Iron 0.5 mg 0.1 mg
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Other advantages of breast milk versus cow’s
milk:• Breast milk is available all the time and is
practically free from pathogenic bacteria.• It needs no time for preparation• It is available at the optimum temperature.• It contains antibodies as IgG and IgA and and
protects against certain infections such as protects against certain infections such as E.ColiE.Coli, cholera, polio, tetanus, measles etc. , cholera, polio, tetanus, measles etc. IgA antibodies prevent the microorganisms IgA antibodies prevent the microorganisms to adhere the intestinal mucosa and to adhere the intestinal mucosa and provide local GIT immunity.provide local GIT immunity.
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• β-lactose is called Bifidus factor, which promotes the growth of lactobacillus and helps to lower the gut pH, thus inhibiting the growth of E.Coli and yeasts.E.Coli and yeasts.
• Breast milk contains lactoferrin (an iron-binding whey protein), which inhibits bacterial growth by depriving them of iron, which is necessary for growth.
• Breast milk contains cystine and tyrosine, which are not synthesized by infants but they are essential for proper growth and development.
• Breast milk contains taurine that is Breast milk contains taurine that is synthesized in inadequate amounts in synthesized in inadequate amounts in infants. It is important for normal infants. It is important for normal differentiation of CNS.differentiation of CNS.
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• Breast milk contains nonspecific factors of immune difence: lisozyme, macrofagocytes, neutrofiles, lymphocytes, complement system.
• There are 5 times more essential fatty acids (polyunsaturated: arachidonic, docosahexacnoic, linoleic, and α-linolenic) in breasts milk than in cow’s milk.
• Breast milk contains ferments (lipase, lactase) and mothers hormones.
• Breast milk is ‘species specific’ and therefore allergy to breast milk is rare.
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Dilution of Cow’s Milk:Child’s Age Cow’s Milk Water
First 10 days 1 part 2 parts
10 to 20 days
1 part 1 part
Up to 2 mo 2 parts 1 part
• If dilution of cow’s milk is required, add 1 TSF of sugar to each ounce of water (5 %) – isocaloric formula)
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Benefits concoctions in a dilution of milk over
water: • Contribute to the creation of colloidal
milk because casein clots more easily digested;Some (buckwheat) with a membership of amino acids;With the broth in the child coming polysaccharides, which reduces fermentation;Conjee has protective properties;Slightly increased caloric mixture.
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Advances in nutritional modifications of infant
formulas• Proteins: their amount is adopted to the
needs of infant’s organism. Almoust all formulas contain whey:casein ratio as 60:40 and adopted amino acid content.
Amino acid Breast milk
Cow’s milk
“Vitalact” “Similac”
Valine Valine 8.2 %
6.6 4.6 % 6.8 %
Lysine Lysine 10.9
57.8 9.7 % 8.4 %
Trypto-Trypto-phan phan
2.29 1.4 2.4 % 1.4 %
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• Fats: long-chain polyunsaturated fatty acids are added in amounts similar to those in human milk. Infants fed these formulas or human milk have higher tissue concentrations of long-chain polyunsaturated fatty acids and reportedly have better visual acuity than do infants fed nonsupplemented formulas.
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Carbohydrates:• Carbohydrates: they are presented
by β-lactose, sakcharose, dextrin-maltose, which improve the growth of Bifidum-bacteria. The total quantity of carbohydrates in formulas is 7.5 %
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• Nucleotides and their related productsucts play key roles in many biological processes. Although nucleotides can be be synthesized endogertously, they are considered "conditionally essential." Nucleotide concentrations in human milk are higher than in unsupplemented cow milk-based formulas, and studies in animals and human infants suggest that dietary nucleotides play a role in the development of the gasgastrointestinal and immune systems
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Vitamins and mineralsBreast milk
Cow’s milk
Fortified formulas
•Vitamin E
0.63 mg%
0.18 0.4-0.6
•Vitamin C
4.2 mg% 1.5 4.5-5.0
•Potassium
55 mg% 140 70-95
•Selenium 15 to 20
µg/L 2 to 8 µg/L
11 to 15 µg/L
•OsmolalitOsmolality y
260 mosm/L
420 mosm/L
320 mosm/L
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• For infants 0 to 12 months
• Whey proteins:casein = 60:40
• Close to breast milk spectrum of amino acids
• Contains taurine.• Milk fats – 74 % and
plant fats – 26 %• Linoleic : α-linolenic
ratio is optimal for absorption 9.9:1
• Osmolality is equal 270 mosm/L
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• The level of proteins is 2.2 %
• Whey proteins:casein = 40:60
• Inriched with bifidum-bacteria
• Fortified with vitamins
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• Biologically hydrolyzed casein and and whey proteins
• Biologically hydrolyzed lactose
• Iron fortified (0.8 mg/100 ml)
• Contains Bifidobacterium Lactis 2107/1 g
-6 : -3 = 7.9:1• Osmolality 270
mosm/L
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Humana
Humana-pre 90 мl
from 0 till 3 monthс
Humana-pre 450 мl.
from 0 till 3 month
Humana pre (300) g.
От 0 till 3 month
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Basic formulas• is adapted for all food ingredients
dry milk mixture as close to breast milk for food, biological value and osmolarity. They contain all the necessary food applications (taurine, L-carnitine, lecithin, etc.) that are particularly important for child development.
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Lactosae-free
• Diarea syndrom different etiology
пребиотик
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For infants with• Hypergalactosaemi
a • Lactose intolerance• Strong allergy to
cow’s milk proteins• Vegetarian babies
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Next• - A mixture that is recommended
for children older than 6 months;This is partly adapted mixture prepared without added protein and whey. Food and energy value of these mixtures is higher than the baseline, except they contain lactose, sucrose and starch.
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The need for baby's first year of life in food
ingredients per 1 kg of body weight when artificial feeding
• Adapted mix: 0 - 6 months - 3.0 g protein; Fats - 6,5-6,0 g carbohydrates - 12-14 g; 12.7 months - proteins - 3.5 g fat - 5,5-5,0 g; Carbohydrates - 12-14 g;
• Not adapted mixture: 0 - 6 months - protein 3.5 g, fat - 5,5-5,0 g carbohydrates - 12-14 g; 12.7 months - proteins - 4,0 g, fats - 5,5 g, carbohydrates - 13g.
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Energy needs of the child by artificial
feeding • When feeding
vysokoadaptovanymy formula - the same as in breast feeding;When fed infant formula - 5% higher than breastfeeding;When feeding not adapted formula - 10% higher than in breastfed.
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• For premature and low-birth-weight (less than 2500 g) babies
• Proteins – 2.3 %• Whey : casein ratio =
70:30• Proteins are particly
hydrolyzed (oligopeptids)
• Contains lysine, cystine, tryptophan, L-histidine, and taurine.
• Polyunsaturated fatty acids (arachidonic, docosahexacnoic, linoleic, and α-linolenic) are present
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• For ‘hungry’ babies• For infants with
often regurgitation• Contains 77 % of
casein• Iron, Iodine, Vit. D,
A, E and C enriched.
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• It doesn’t containtain lactose
• Only whey proteins are present, 20 % of them are amino acids
• Contains nucleotides and selen
• Iron and Iodine fortified
• Contains taurine, inositol, L-karnitine.
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• NAN H.A.1• NAN H.A.2• For children with
strong family allergy• Contains 100 % of
whey proteins, which are hydrolyzed to oligopeptids (80 %) and aminoacids (20 %)
•Alfaré• Hypoallergenic
elemental diet for children with malarbsorption syndrome, diarrhea, for tube feeding
• Contains hydrolyzed whey proteins: 80 % of oligopeptids and 20 % of aminoacids
• Hydrolyzed lactose• Short-chain fatty
acids
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Other commercial infant formulas
Formula Protein source
Carbohy-drate s.
Fat source
For full-term and premature infants with no special nutritional requirements
SMA SMA (Wyeth)(Wyeth)
Nonfat cow's milk, reduced mineral whey: whey/casein ratio: 60:40
Lactose Oleo, coconut, oleic (saf-flower) and soy oils
Enfamil Enfamil (Mead (Mead Johnson)Johnson)
Nonfat cow's milk, deminer-alized whey: whev/casein ratio: 60:40
Lactose Soy, coconut oils
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Similac (Ross)
Nonfat cow's milk; whey/ casein ratio: 18:82
Lactose Soy and coconut oils, mono- and diglycerides
Baby formula (Gerber)
Nonfat cow's milk; whey/ casein ratio: 18:82
Lactose Soy
FOR MILK PROTEIN-SENSITIVE INFANTS (‘MILK ALLERGY’), LACTOSE INTOLERANCE,
GALACTOSEMIA
Prosobee Prosobee (Mead (Mead Johnson)Johnson)
Soy protein isolate Corn syrup solids. Lactose and sucrose free
Soy and coconut oils
Isomil Isomil (Ross)(Ross)
Soy protein isolate Corn svrup, sucrose Lactose free
Soy and coconut oils
Nursoy Nursoy (Wyeth)(Wyeth)
Soy protein isolate
Sucrose (liquid formula). Corn syrup solids (powdered formula)
Oleo, coconut, oleic, and soy
oils
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FOR INFANTS WITH MALABSORPTION SYNDROME
RCF (Ross Carbohydrate Free) (Ross)
Soy protein isolate
Soy and coconut oils
Portagen (Mead Johnson)
Sodium caseinate
Corn syrup solids, sucrose, lactose
MCT (coconut source) and corn oil
Pregestimil (Mead Johnson)
Casein hydrolysate and L-amino acids
Corn syrup solids, modified tapioca starch
Corn oil, MCT For infants with disaccha-ridase deficiencies, malabsorption svndromes, cystic fibrosis.
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Specialty formulasFormula
(manufacturer)Indication for use Comments
Lonalac (Mead
Johnson) Powder
For children with congestive
cardiac failure, who require
reduced sodium intake.
For long-term management,
additional sodium must be given.
Supplement with vitamins C and D and iron. Na = 1 mEq/L
Similac PM 60/ 40 (Ross)
Powder
For newborns predisposed to
hypocal-cemia and infants with impaired renal, digestive, and
cardio-vascular functions.
Low calcium, potassium, and
phosphorus. Relatively low
solute load. Na — 7 mEq/L
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Lofenalac (Mead Johnson)
For infants and children with phenylketonuria.
111 mg phenylalanine per quart of formula
Phenyl-free (Mead Johnson)
For children over 1 year of age with phenylketonuria.
Phenylalanine free. Permits increased supplementation with normal foods.
PKU 1 (Milupa) For infants with phenylketonuria (Available as PKU 2 for children over 1 year of age.)
Phenylalanine- and fat-free. Contains vitamins,minerals, and trace elements
Low Methionine Diet Powder (Product 3200K) (MeadJohnson)
For infants with homocystinuria
Nutritionally complete, but requires monito-ring of amino acid levels
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65
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Developmental milestones Developmental milestones associated with feedingassociated with feeding
Age (months) Development• Birth
– Has sucking, rooting, and swallowing reflexes;– Feels hunger and indicates desire for food by crying; – Expresses satiety by falling asleep
• 1 - Has strong extrusion reflex• 3-4
– Extrusion reflex is fading; – Begins to develop hand-eye coordination
• 4-5 - Can approximate lips to the rim of a cup• 5-6 - Can use fingers to feed self a cracker• 6-7
– Chews and bites; Chews and bites; – May hold own bottle, but may not drink from it May hold own bottle, but may not drink from it
(prefers for it to be held)(prefers for it to be held)
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• 7-9– Refuses food by keeping lips closed; has taste
preferences;preferences;– Holds a spoon and plays with it during Holds a spoon and plays with it during
feeding; feeding; – May drink from a straw; May drink from a straw; – Drinks from a cup with assistanceDrinks from a cup with assistance
• 9-12– Picks up small morsels of food (finger foods)
and feeds self– Holds own bottle and drinks from it– Drinks from a household cup without
assistance but spills some– Uses a spoon with much spilling
• 12-18– Drools less– Drinks well from a household cup, but may
drop it when finished– Holds cup with both hands
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• 24– Can use a straw– Chews food with mouth closed and shifts food in
mouth– Distinguishes between finger and spoon foods– Holds small glass in one hand; replaces glass
without dropping
• 36– Spills small amount from spoon– Begins to use fork; holds it in fist – Uses adult pattern of chewing, which involves rotary
action of jaw
• 48– Rarely spills when using spoon– Serves self finger foods – Eats with fork held with fingers
• 5454 Uses fork in preference to spoon
• 7272 Spreads with knife
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Principles of artificial feeding:
• Careful and precise execution of technique preparation of mixtures;Move baby to bottle-feeding should not be too fast;Diet remains free (in children before the introduction of complementary foods 6-7 times a day, after the introduction of complementary foods - 5 times a day); foods should be given with a spoon;Introduction of complementary foods for children who are bottle-fed vysokoadaptovanymy mixtures do not differ from those in children with breastfeeding
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Calculations approximate volume of food in children during the first 10 days of
life: • 70 or 80 x n, where n-day life of
the newborn (formula Finkelstein);2% of body weight at birth x n, where n-day life of the child (formula Zaitseva);
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Caloric methodsCaloric methods
On the first six mounth-120 - 115 ccal/kg daily,On the next six mounth - 115 - 110 ccal|kg daily .
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Daily volume of milk (volume Daily volume of milk (volume method)method)
Age of child Part from the weight of body
2 weak- 2 mounth 1/5
2 mounth-4 mounth 1/6
4 mounth– 6 mounth 1/7
6 mounth and more 1 l
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Criteria for evaluating the effectiveness of artificial
feeding: • The general condition of the child: characterization
health, emotional state;Development of static and locomotor functions;Condition of the skin and mucous membranes;Development of subcutaneous fat basis;Turgor pressure;Condition muscular and skeletal systems; Functional status of the digestive system and other internal organs;The growth;Dynamics of body weight;Incidence;Laboratory parameters: hemoglobin, erythrocyte count, results scatological examinations, urinalysis.
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Thank you for attention!