Infant Feeding

Chapter 56 Infant Feeding



Edelveis R.M. Clapp, DO




Speaking Intelligently


As pediatricians we encourage mothers to breastfeed, and we provide support with counseling, weight checks, and recommendation of lactation consultants when needed. It is important to recognize that not all mothers will be willing or able to breastfeed. Successful breastfeeding is a learning curve for both mother and infant, and ultimately some parents may choose formula feeding. It is important to be supportive and encourage families to make the decision that best works for their lives, whether it be breastfeeding or formula feeding. As the pediatrician, you are the person who helps shape and guide the parents’ view on infant nutrition, and they will look to you for advice. It is important to be well informed and to stay current with American Academy of Pediatrics (AAP) recommendations.



Medical Knowledge and Patient Care


Feeding an infant can be very confusing, especially for first-time parents. The AAP recommends exclusive breastfeeding for the first 6 months of life with continuation until 12 months, or as long as mother and child mutually desire.1,2 For those who choose not to breastfeed, cow’s milk–based formula is an acceptable alternative. At birth, 70% of infants are breastfed. By 6 months only one third are breastfed.3 The pediatrician should be able to counsel about both breastfeeding and formula feeding, and guide parents to provide optimal nutrition.



Breast Milk Composition


Breast milk provides optimal infant nutrition. Its composition is 70% whey and 30% casein, compared with cow’s milk, which is 18% whey and 82% casein.1,2 Whey proteins are more easily digested in that they are more resistant to precipitation in stomach acid, and this promotes gastric emptying. Whey proteins such as lactoferrin, lysozyme, and secretory immunoglobulin A are involved in host defense.1 Human milk also contains oligosaccharides, nucleotides, cellular components, and growth factors that enhance the newborn’s immune system.


Lipids provide approximately 50% of the total calories, and human milk is high in essential fatty acids. Derivatives of these play important roles in neural and retinal function.


The major carbohydrate is lactose, which is hydrolyzed to glucose and galactose by lactase in the small intestine. Lactose that passes to the distal small intestine promotes proliferation of lactobacilli, which serves to suppress growth of more pathogenic bacteria and promote calcium and phosphorous absorption.2


Human milk contains many micronutrients, minerals and vitamins that promote optimal growth and development. However, there is little biologically active vitamin D in breast milk. Infants who are exclusively breastfed require 400 international units per day of vitamin D to be started soon after birth to prevent vitamin D deficiency and rickets.4


There are numerous advantages to breastfeeding:


• It is relatively low cost. Lactating mothers must optimize their caloric intake and eat a well-balanced varied diet that includes foods rich in calcium, zinc, magnesium, vitamin B6, and folate.

• Breast milk is always available, requires no preparation, and is specifically tailored for human nutrition.

• Breastfeeding is associated with a lower incidence of allergies, otitis media, gastroenteritis, pneumonia, bacteremia, and meningitis during the first year of life.3

• Advantages to mother include faster weight loss because breastfeeding metabolizes an additional 500 calories per day. It also promotes involution of the uterus.


Contraindications to Breastfeeding



• Maternal infections are generally not a contraindication to breastfeeding. Two exceptions are infection with human immunodeficiency virus (HIV) in the United States and a maternal herpesvirus outbreak with lesions on the breast.5

• Drugs that are contraindicated in lactation include cimetidine, cyclophosphamide, ergotamine, and thiouracil.6 In most cases, there is a reasonable substitute for these medications that is not contraindicated in breastfeeding.

• Some drugs (e.g., those used for radiology studies) require temporary cessation of breastfeeding.

• Some inborn errors of metabolism, such as galactosemia, are contraindications to breastfeeding.


Formula


Breast milk is the standard upon which infant formula composition is based. Infant formula must meet the minimum requirements of nutrients without exceeding the maximum recommended for each nutrient required for normal growth and development.2


Iron-fortified cow’s milk–based formulas are an excellent feeding alternative. Nutritional studies comparing breastfed and formula-fed infants show little to no differences. Iron-fortified formula can be used:


• As a substitute for nonbreastfed infants
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Jul 18, 2016 | Posted by in PEDIATRICS | Comments Off on Infant Feeding

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