Lecture 10 - Complementary Feeding

Question 1

what is complementary feeding defined as

Answer 1

the process starting when breast milk alone is no longer sufficient to meet nutritional requirements, and therefore other foods and liquids are needed along with the breast milk or formula

Question 2

what is another word for complementary feeding

Answer 2

weaning

Question 3

when is complementary feeding recommended

Answer 3

around 6 months of age

Question 4

what allows newborns to be ready to feed

Answer 4

they are born with reflexes that prepare them to feed

such as : rooting, mouthing, head turning, gagging, swallowing and coordinate breath and swallow

Question 5

baby must show all of these signs to be ready to start solids, what are they

Answer 5

• baby is around 6 months of age
• baby can hold their head up
• baby sits when well supported
• baby opens their mouth as food approaches
• baby can keep food in their mouth and then swallow it, instead of pushing the food out
• baby shows signs of biting and chewing

Question 6

what are the risks of early introduction (<5 months) to complementary feeding

Answer 6

increased risk of :

• eczema and food allergies
• respiratory disease
• gut infection
• diarrhoea and dehydration
• impaired iron absorption and iron deficiency
• malnutrition due to decrease in milk energy and inadequate complementary foods

Question 7

what are the risks of late introduction of complementary feeding

Answer 7

increased risk :
- iron deficiency

• feeding difficulties
• growth faltering
• other micronutrient deficiencies
• development of food allergies

Question 8

on average the first teeth being to erupt when the baby is :

Answer 8

around 6 to 9 months old

Question 9

the full set of 20 deciduous teeth has usually erupted into the mouth by what age

Answer 9

around 3 years of age

Question 10

do infants need teeth to eat food

Answer 10

no they do not

Question 11

what is the progression of texture of food for infants

Answer 11

pureed

mashed

chopped

family foods

Question 12

what is recommended about moving through the texture of foods with infants

Answer 12

move through the stages quickly, if you stay on pureed food to long you could miss critical period

Question 13

what is the texture and development stage of a head up baby (0-6months)

Answer 13

suck, swallow, extrusion reflex

• move liquid only from front to back of mouth

Question 14

what is the reflex and texture of food for a supported sitter baby (6-7 months)

Answer 14

being able to move the tongue from side to side without moving the head

• smooth, running puree

Question 15

what is the texture of food like for an independent sitter (7-8 months)

Answer 15

thick puree, small soft lumps or mashed

Question 16

what is the texture of food like for a crawler (8-12 months)

Answer 16

chew and swallow soft mashed, minced, grated, chopped foods

Question 17

what is the texture of food like for a infant beginning to walk (12-24 months)

Answer 17

family foods, maybe different shapes but similar to what the family eats

Question 18

Prolonged use of purée foods (> 9 months) and introduction of lumpy foods later than 10 months is associated:

Answer 18

• feeding difficulties (commonly refusal) in older children
• low intake of nutrient rich foods

Question 19

what is responsive feeding ( how should children be feed and what to do if they refuse)

Answer 19

• sensitive to hunger and satiety cues
• feed slowly and patiently encourage children to eat but do not force them
• if child refuses food, experiment with different food combinations, tastes, textures and methods of encouragement

Question 20

signs a baby is hungry

Answer 20

• opening mouth and turning head from side to side
• fussing and leaning toward the breast or food
• increasing physical movements that become agitated / excited
• crying in a distressed intense way
• asking for or pointing at foods

Question 21

signs a baby is full

Answer 21

• pushing or arcing away, pushing food or plate away
• turning head away or shaking head to communicate ‘no more’
• spitting out food
• using words like “all done” or “get down”
• becoming distracted and more interested in what is going on around them

Question 22

what are the foods first recommendations

Answer 22

iron rich and then also vegetables and fruit

Question 23

what are good choices for iron rich first foods

Answer 23

cooked pureed meat, chicken and fish

baby rice cereal : iron fortified cereal mixed with water, breast milk or formula

cooked and mashed plant based proteins

Question 24

what are the conflicts on baby rice

Answer 24

• some nutritionists do not recommend baby rice as it is processed
• unsupported concerns on inadequate salivary amylase
• unsupported concerns about high arsenic

Question 25

what are the unsupported concerns about inadequate salivary amylase

Answer 25

they were worried that the starch would cause GI concerns for the baby, however at 6 months babies have adult level functioning salivary amylase

Question 26

iron deficiency is prevalent in infancy is due to

Answer 26

high requirement - high growth rate iron stores received in utero begin to run low

Question 27

what infants are most at risk of iron deficiency

Answer 27

- low intake of "high iron" foods - low birth weight (<2,500g) - pre term infants because they do not gain those additional iron stores in the past couples weeks - low socioeconomic status / food insecure

Question 28

what are the consequences of iron deficiency for infants

Answer 28

- altered intestinal function - impaired cognitive, social and socio-emotional development

Question 29

what are the consequences of iron deficiency anaemia for infants

Answer 29

- fatigue / decreased activity - sustained IDA may be associated with irreversible and detrimental effects on intellectual and motor performance

Question 30

prevention of iron deficiency

Answer 30

- food based (foods first) approach - unknown risk of iron supplementation for healthy young children - however, iron supplementation required for some infants

Question 31

what is the first foods approach (vegetables and fruit)

Answer 31

- provide important nutrients : vitamins, minerals, fibre - fresh, washed in clean water, frozen or canned

Question 32

early childhood intakes of vegetables and fruit improves what

Answer 32

improves immunity, aids digestion, decreases risk of obesity

Question 33

what is repeated exposure of vegetables important for

Answer 33

important for acceptance from the infant as they are used to the sweetness of breastmilk and vegetables are often bitter tasting

Question 34

how many exposures to a food can it take for acceptance

Answer 34

8-15 exposures

Question 35

what are ways of exposing children to food

Answer 35

see, touch, smell, taste - providing the food in different forms may help with exposure

Question 36

what liquids should infants be ok to have

Answer 36

only breast milk, formula and water

Question 37

what are the guidelines with preparing foods for infants and why

Answer 37

do not add salt, soy sauce, sugar, honey or artificial sweeteners, they have very sensitive taste buds

Question 38

honey should be avoided for what age infants

Answer 38

< 12 months

Question 39

why should honey be avoided in infants

Answer 39

can cause infant botulism caused by the toxin Clostridium botulinum

Question 40

equipment must be sterilised for infants until what age

Answer 40

6 months

Question 41

Home-prepared and commercial infant foods can be kept in a covered container in the fridge for how long

Answer 41

up to 48 hours

Question 42

why should a baby never be left alone to eat

Answer 42

choking is silent

Question 43

what are the characteristics of gagging

Answer 43

- watering eyes - pushing tongue forward out of mouth - retching movement to bring food forward - may vomit - loud / dramatic

Question 44

what are the characteristics of choking

Answer 44

- may cough or gasp as trying to get air - may go silent - may make a struggling sound or raspy whisper - silent

Question 45

what are the foods that you should be aware of that could cause choking

Answer 45

- small hard foods - small round foods - foods with skins or leaves - compressible food - thick pastes - fibrous or stringy foods

Question 46

what are the main reasons that cows milk should not be given as a drink until infants are older than 12 months

Answer 46

- concentration and bioavailability of iron is low - may displace other solid foods, reducing nutrient intake - may cause gastrointestinal blood loss - high renal solute load

Question 47

what is the issue with cows milk and renal solute load

Answer 47

the high mineral concentration compared to human milk is hard on the kidneys and infants have immature kidneys

Question 48

when is cows milk ok for babies

Answer 48

when in food, it just the high concentrations or high doses that cause issues

Question 49

what is the concern with baby food pouches

Answer 49

adverse health outcomes (such as decay, obesity, motor development) with pouch "suckling"

Question 50

what are dietitian concerns about baby food pouches

Answer 50

the infant cannot see, touch or smell pouch contents (this is important for exposure to foods)

Question 51

what is the nutritional intake of babies who have baby food pouches like

Answer 51

nutrient intakes are similar to infants who do not consume baby food pouches, additionally no difference in iron status but slightly higher intakes of total sugars