INFANT FORMULA

INFANT FORMULAINFANT FORMULA

ESPGANESPGAN (European Society for Paediatric (European Society for Paediatric Gastroenterology and Nutrition)Gastroenterology and Nutrition)::Cow`s milk is forbiden in infant`s nutrition during the Cow`s milk is forbiden in infant`s nutrition during the first year of lifefirst year of life

For this reason they have been created milk powder For this reason they have been created milk powder preparations with a composition similar to human preparations with a composition similar to human milk = milk formulas.milk = milk formulas.


1. Start Formulas (0-6 months)2. Follow - up Formulas: - 6 to 12 months; - 1-3 years (junior formula); - hypoallergenic formula (HA);3. Special formulas: - for premature infants; - low lactose / lactose free (source of protein is cow milk / soybean); - height energy, low sodium formula.


Start FormulaStart Formula:: source of protein is cow milk,, used until the age of 6 monthused until the age of 6 month,, NAN 1, Lactogen 1, Humana 1, Milumil 1, Aptamil NAN 1, Lactogen 1, Humana 1, Milumil 1, Aptamil 1, Similac, Vitalact1, Similac, Vitalact etc. etc.

Follow –up FormulaFollow –up Formula:: source of protein is cow milk,, used fromused from 6 month to 1 year 6 month to 1 year,, NAN 2, Lactogen 2, Humana 2, Milumil 2 şi 3, NAN 2, Lactogen 2, Humana 2, Milumil 2 şi 3, VitalactVitalact..

Start FormulasStart Formulas

Follow –up FormulasFollow –up Formulas


Junior Formula (Lait de croissance)Junior Formula (Lait de croissance):: used between used between 1-3 years1-3 years NAN 1+, NAN 2+, Milumil Junior, Humana JuniorNAN 1+, NAN 2+, Milumil Junior, Humana Junior..

Hypoallergenic Formula (HA)Hypoallergenic Formula (HA):: source of protein: extensive hydrolyzed cow milk proteins used in infants with personal or family history for used in infants with personal or family history for allergies allergies NAN HA, Milumil HANAN HA, Milumil HA..

Junior FormulaJunior Formula

Hypoallergenic FormulaHypoallergenic Formula

Infant formulaInfant formula

Preterm infant FormulaPreterm infant Formula:: -adequated to their special needs- higher protein content- smaller amounts of lactose- easily assimilated fat (MCTs - Medium Chain Triglycerides)- amount of calcium and phosphorus almost double- higher vitamin content than standard formulas

PreNAN, Aptamil Prematil, Humana 0, BIOPrePreNAN, Aptamil Prematil, Humana 0, BIOPre etc. etc.

Preterm infant formulaPreterm infant formula


Human milk fortifiersHuman milk fortifiers:: - - recommended for VLBW and ELBW preterm infants, - increase human milk caloric value, - used only under medical supervision - extensively hydrolyzed protein mixtures, - easily assimilated carbohydrates, - contain no fat, - Nestle FM85, Aptamil FMS.

Human milk fortifiersHuman milk fortifiers


Low lactose /lactose free formulaLow lactose /lactose free formula::- for the new - born babies and infants with lactose - for the new - born babies and infants with lactose intolerance,intolerance,- carbohydrate source: glucose polymer / starch- carbohydrate source: glucose polymer / starch- source of protein: enzymatically hydrolyzed cow milk - source of protein: enzymatically hydrolyzed cow milk protein (protein (Alfare,AltheraAlfare,Althera) or unchanged cow milk protein ) or unchanged cow milk protein ( (Milupa HN 25Milupa HN 25))- rich in MCTs. - rich in MCTs.

Low lactose /lactose free formulaLow lactose /lactose free formula


Lactose free soy formulaLactose free soy formula:: used in: used in:

secondary lactose intolerance , secondary lactose intolerance , cow milk protein allergycow milk protein allergy,,

Milupa SOM, Milupa PregominMilupa SOM, Milupa Pregomin..

Lactose free soy formulaLactose free soy formula


Probiotics:- live bacteria, viable, resistant to gastric acid,

nonpathogenic, usually producing lactic acid

- favor the multiplication of bacteria in the colon - bifidobacteriasbifidobacterias and lactobacilli.


ProbioticsProbiotics

Roles: - stabilizing effect of intestinal barrier function - protection against food / environmental antigens

- stimulates the production of Ig As and mucus, - attenuates inflammatory responses inducedby pathogens..

Infant formulaInfant formulaProbioticsProbiotics

Effects on the “distance“: - osteoporosis prevention; - colon cancer prevention; - prevention of inflammatory bowel disease; - effects on lipid metabolism..


Prebiotics (oligosaccharides and disaccharides):

carbohydrate food`s components which are not digested and absorbed in the proximal colic digestive tract →fermentation substrate → stimulates bifidobacterias proliferation.

Infant formulaInfant formulaPrebioticsPrebiotics

Roles: - modulate immune function; - compete for receptors with pathogens; - selectively stimulate and enhance a limited number

of endogenous beneficial bacterial species, resident in the colon, producing antimicrobial substances.

Infant formulaInfant formulaPrebioticsPrebiotics

EffectsEffects:: - multiplication of lactobacillus flora and faecal - multiplication of lactobacillus flora and faecal fermentizing type;fermentizing type; - improve bowel function; - improve bowel function; - increase the resistance against digestive pathogens; - increase the resistance against digestive pathogens; - systemic immune response modulation; - systemic immune response modulation; - reduce the risk of allergies; - reduce the risk of allergies; - reduce the risk of colon cancer; - reduce the risk of colon cancer; - reduce serum cholesterol and lipids; - reduce serum cholesterol and lipids; - increase the bioavailability of the colon; - increase the bioavailability of the colon; - increase the bone mineralization. - increase the bone mineralization.


Long Chain Polyunsaturated Fatty Acids Long Chain Polyunsaturated Fatty Acids - L.C.P.U.F.A.- L.C.P.U.F.A.

Major sources: microalgae fungal and marine oils egg yolk.

Infant formulaInfant formula L.C.P.U.F.A.L.C.P.U.F.A.

Roles:- major structural components of cell membranes

(phospholipids);- promote brain and retina development;- confer protective antiallergic;- immune system development.


Nucleotides (cytidine, uridine, adenosine, guanosine)

Roles: - precursors of nucleic acids; - constituent of enzymes; - cellular energy source; - growth and differentiation of gastrointestinal tract; - antidiarrhea protection; - immune system development.


Established intestinal microflora during the first 2 years of life determines the position and profile of intestinal adaptation for life, thus having a significant impact on the development of diseases: allergies, asthma, gastro-intestinal diseases.

Disadvantages of bottle feedingDisadvantages of bottle feeding

Strict rulesStrict rules to reduce the risk of infection: to reduce the risk of infection: - fresh preparation at every meal; - fresh preparation at every meal; - discard any unused quantity of the remaining milk; - discard any unused quantity of the remaining milk; - strict hygiene; - strict hygiene; - in hospitals - guidelines (protocols) written for - in hospitals - guidelines (protocols) written for

preparation and handling, with strict control of preparation and handling, with strict control of

compliance.compliance.

Weaning foodsWeaning foods


DefiniDefinitiontion:: foods introduced in infant`s diet after the foods introduced in infant`s diet after the age of 4 – 6 monthage of 4 – 6 month

- progressive process (it takes several months);- progressive process (it takes several months);- purpose: food supplementation (caloric and quality);- purpose: food supplementation (caloric and quality);- will be started at age 4 months to bottle fed infants;- will be started at age 4 months to bottle fed infants;- may be delayed until the age of 6 months in breast fed - may be delayed until the age of 6 months in breast fed infants. infants.


Principles:- diet should be balanced and rational;- introducing a new food will be made only when the infant is healthy;- first food introduced is individualized depending on the specifics of development in infants: - appropriate weight for age → vegetable soup or fruit puree; - weight deficit → diet enriched in protein;


- caloric value of newly introduced food (meal) must be greater than that which is removed from the diet;

- introduction of new food will be progressive →20-30g/day at each meal, reducing the same amount of milk, up to completely replace the milk at that meal with the new food;

- newly introduced food will be administrated with a spoon;


- - should be introduced one new food per week - at the should be introduced one new food per week - at the same meal same meal

-can be combined more food but only after testing each can be combined more food but only after testing each one tolerance;one tolerance;-

- in case digestive disorders (vomiting and / or diarrhea) - in case digestive disorders (vomiting and / or diarrhea) occur, the new food is interrupted and then resumed occur, the new food is interrupted and then resumed after a few days to normalize intestinal transit;after a few days to normalize intestinal transit;

- we use second stage of age infant formula;- we use second stage of age infant formula;


- - polysaccharides (starch)polysaccharides (starch) will will be introduced into the be introduced into the diet with priority over sugar;diet with priority over sugar;- until the age of 6-7 months will not provide gluten - until the age of 6-7 months will not provide gluten flour but only those of rice, corn;flour but only those of rice, corn;- will avoid rare and abundant lunch which:- will avoid rare and abundant lunch which:■ increased lipid synthesis from carbohydrates■ increased lipid synthesis from carbohydrates■ increased fat deposition■ increased fat deposition■ increase the biosynthesis→ cholesterol and triglycerides■ increase the biosynthesis→ cholesterol and triglycerides■ causes gastric hypertrophy■ causes gastric hypertrophy■ increase the intestinal absorption surface■ increase the intestinal absorption surface■ cause changes in liver enzymes. ■ cause changes in liver enzymes.


-number of meals per day will be determined by number of meals per day will be determined by age, hunger - satiation sensation and infant`s weight;age, hunger - satiation sensation and infant`s weight;

- the infant will not be forced to consume the - the infant will not be forced to consume the entire meal offered (risk of "opposition ");entire meal offered (risk of "opposition ");

- generalization of a food that is - generalization of a food that is received with pleasure at all meals disrupt the received with pleasure at all meals disrupt the nutritional balance of the infant;nutritional balance of the infant;

- hydration between meals is made with sweetened - hydration between meals is made with sweetened liquids (tea, boiled and cooled water);liquids (tea, boiled and cooled water);


- if the weaning chart is correct, we should not - if the weaning chart is correct, we should not supplement infant’s diet with vitamins;supplement infant’s diet with vitamins;

- from the age of 7-8 months self-supply should - from the age of 7-8 months self-supply should be encouraged;be encouraged;

- weaning foods will be mashed until the first teeth - weaning foods will be mashed until the first teeth appear and crushed after that age;appear and crushed after that age;

- the best criterion of weaning success is tracking - the best criterion of weaning success is tracking infant`s growth curves and development.infant`s growth curves and development.


Foods used:

1. Vegetables: carrots, potatoes, parsley, spinach, lettuce, zucchini, red peppers, green beans; as soups and puree.

Industrial products (simple vegetables / cereals with added vegetables, meat or fish) may be used after the age of 6-8 months, depending on composition.

Vegetables, rice and turkey puree

Patatoes, carrots, cicken puree


Infant cerealInfant cereal::- are introduced from the age of 4-6 months- are introduced from the age of 4-6 months

- important source of calories and fiber to regulate bowel - important source of calories and fiber to regulate bowel movementsmovements

- fortified with vitamins, calcium and iron- fortified with vitamins, calcium and iron

-bacteriological secured bacteriological secured

- gluten-free - for infants aged 4-6 months- gluten-free - for infants aged 4-6 months- with gluten - for infants aged > 6 months.- with gluten - for infants aged > 6 months.


BiscuitsBiscuits: after 6 months of age, in combination : after 6 months of age, in combination with fruit puree.with fruit puree.

White breadWhite bread: after the age of 8 months : after the age of 8 months

Pasta (noodles)Pasta (noodles) from the age of 8 months, boiled in from the age of 8 months, boiled in soup. soup.


FruitsFruits:: apples, peaches, bananas, apples, peaches, bananas, - juices, purees and compotes. - juices, purees and compotes.

Forbidden during the first year of lifeForbidden during the first year of life:: fruits with small seeds (raspberries, strawberries, fruits with small seeds (raspberries, strawberries, blueberries, blackberries, kiwi) with strong allergy blueberries, blackberries, kiwi) with strong allergy action.action.

Three fruits juice with vitamin C

Fruits puree

Weaning foodWeaning food

Cottage cheeseCottage cheese:: from the sixth month of life, 20-30g each day, from the sixth month of life, 20-30g each day, mixed with rice, soup, mashed vegetables or fruits. mixed with rice, soup, mashed vegetables or fruits.

Cow cheeseCow cheese (unsalted): (unsalted): from 8-9 months of age, from 8-9 months of age, mixed with porridge / Pasta (pudding). mixed with porridge / Pasta (pudding).

Fermented cheeseFermented cheese: after 1 year of age.: after 1 year of age.


EggEggYolkYolk:: boiled for 5 minutes boiled for 5 minutes after the age of 4-5 months, 2-3 times / week after the age of 4-5 months, 2-3 times / week mixed with soup or mashed vegetables. mixed with soup or mashed vegetables.

WhiteWhite: not given until the age of 1 year because it : not given until the age of 1 year because it causes allergies.causes allergies.


LiverLiver (chicken / beef) (chicken / beef) after the age of 6 months after the age of 6 months 20 - 30g/day, in vegetable soup / puree, on days when 20 - 30g/day, in vegetable soup / puree, on days when

no egg or meat are used.no egg or meat are used.

MeatMeat (chicken / beef) (chicken / beef) after the 5 month of life after the 5 month of life cooked, chopped very fine, place 20 -30g/day in cooked, chopped very fine, place 20 -30g/day in

vegetable soup or vegetable puree. vegetable soup or vegetable puree.


FishFish:: → after the age of 1 year because of food allergy risk → after the age of 1 year because of food allergy risk

can be given after the age of 8 months as industrial can be given after the age of 8 months as industrial

preparations.preparations. YogurtYogurt::from the age of 7 monthsfrom the age of 7 months

Sour CreamSour Cream: from 7-8 months of age.: from 7-8 months of age.

Toddler`s nutritionToddler`s nutrition


PrinciplesPrinciples::

- presented aesthetically- presented aesthetically

- menu composed according to the degree of - menu composed according to the degree of development and child preferencesdevelopment and child preferences

- will avoid over nutrition with carbohydrates (dental caries)- will avoid over nutrition with carbohydrates (dental caries)

- lean pork - after the age of 2 years- lean pork - after the age of 2 years


PrinciplesPrinciples::- mutton / lamb meat are not recommended - mutton / lamb meat are not recommended (harder to digest)(harder to digest)

- avoid bottle feeding - avoid bottle feeding

- one meal per day will be served along - one meal per day will be served along with the whole familywith the whole family

- child will receive three meals and two snacks.- child will receive three meals and two snacks.

Toddler`s nutritionToddler`s nutrition Liquid requirementsLiquid requirements: 125 ml / kg / day.: 125 ml / kg / day.

proteinprotein = 2.5 to 3 g / kg / day; = 2.5 to 3 g / kg / day;fatfat = 4.5 g / kg / day; = 4.5 g / kg / day;carbohydratecarbohydrate = 10.12 g / kg / day. = 10.12 g / kg / day.

Calorie needsCalorie needs: 80-100 kcal / kg / day.: 80-100 kcal / kg / day.

Cow's milk should not exceed Cow's milk should not exceed 500 ml / day.500 ml / day.

Toddler`s nutritionToddler`s nutritionBreakfastBreakfast::- 250 ml cow milk - 250 ml cow milk - bread with butter, jam / honey- bread with butter, jam / honey- cottage cheese, eggs, lean ham.- cottage cheese, eggs, lean ham.

LunchLunch (most important): (most important):- vegetables or meat soup; - vegetables or meat soup; - mashed vegetables with minced chicken / beef (~ 50g) - mashed vegetables with minced chicken / beef (~ 50g) (meatballs, minced meat croquette, roll) with sauce or(meatballs, minced meat croquette, roll) with sauce orgarnish of vegetables;garnish of vegetables;- dessert: compote, homemade cakes.- dessert: compote, homemade cakes.

At the At the endend of the meal: 100-150 ml of water. of the meal: 100-150 ml of water.


DinnerDinner::- pudding, vegetable salads, scrambled eggs, cheese - pudding, vegetable salads, scrambled eggs, cheese dumplings,dumplings,- 250 ml milk / yogurt and bread / biscuits.- 250 ml milk / yogurt and bread / biscuits.

Two snacksTwo snacks (at 10 a.m. and 5 p.m.): fruits. (at 10 a.m. and 5 p.m.): fruits.

Forced administration of food is due to psychogenic Forced administration of food is due to psychogenic anorexia, common in families with spoiled children.anorexia, common in families with spoiled children.

Forbidden foods in Toddler`s nutritionForbidden foods in Toddler`s nutrition

- - foods that may cause aspirationfoods that may cause aspiration: nuts, fruits with : nuts, fruits with seeds, seeds, popcorn, fries, raw celery,seeds, seeds, popcorn, fries, raw celery,fish with bones, candy;fish with bones, candy;

- - sweetssweets: cakes with cream, sugar cereals, soft : cakes with cream, sugar cereals, soft drinks with artificial fruit flavors;drinks with artificial fruit flavors;

Forbidden foods in Toddler`s nutritionForbidden foods in Toddler`s nutrition

- - indigestible foodindigestible food: sausages, mutton, venison fried or : sausages, mutton, venison fried or

preserved, condiments;preserved, condiments;

- peas, beans, cabbage can be inserted in the diet after - peas, beans, cabbage can be inserted in the diet after

age 2;age 2;

- alcohol, coffee, tea or cola. - alcohol, coffee, tea or cola.

Nutrition for 4 – 7 years old childNutrition for 4 – 7 years old child


PrinciplesPrinciples:: - 3 meals and two snacks; - 3 meals and two snacks;

- cow's milk: maximum 500 ml / day;- cow's milk: maximum 500 ml / day;

- fruits and vegetables: raw (salads) / prepared;- fruits and vegetables: raw (salads) / prepared;

- meat: 75 g daily;- meat: 75 g daily;

- egg: 3-4 times / week- egg: 3-4 times / week;;


PrinciplesPrinciples:: - whole bread: max 150-200 g / day; - whole bread: max 150-200 g / day;

- water and sweets: at the end of the meal so as not - water and sweets: at the end of the meal so as not to affect appetite;to affect appetite;

- child will eat at the table with the family;- child will eat at the table with the family;

- good learning skills: washing hands before - good learning skills: washing hands before eating, brushing teeth.eating, brushing teeth.

Nutrition for 7 - 15 years old childNutrition for 7 - 15 years old child


Diet similar to that of adult;Diet similar to that of adult;

3 meals and 1-2 snacks per day;3 meals and 1-2 snacks per day;

breakfast: important because it is before school hours;breakfast: important because it is before school hours;

food: fresh, sufficient quantity, high biological value;food: fresh, sufficient quantity, high biological value;


AdolescentsAdolescents: :

- frequently adopt a diet low in energy content, low in- frequently adopt a diet low in energy content, low in

vitamins (A, C, D) and minerals (Calcium, Magnesium,vitamins (A, C, D) and minerals (Calcium, Magnesium,

Iron);Iron);

- fast food should be avoided (increases the risk- fast food should be avoided (increases the risk

of obesity).of obesity).

INFANT FORMULA

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