INFANT NUTRITION

Food and its presentation extremely Food and its presentation extremely important during baby’s important during baby’s first yearfirst year

First year period of most First year period of most rapid growthrapid growth Requirement Requirement 100kcal/kg/day100kcal/kg/day. . Ideal infant diet is Ideal infant diet is breast milkbreast milk

High nutrition containing High nutrition containing easily easily digestibledigestible proteins, carbohydrates, proteins, carbohydrates, vitamins, mineral, and water.vitamins, mineral, and water.

FormulaFormula is a poor substitute that carries is a poor substitute that carries health risks including higher rates of health risks including higher rates of infectioninfection; ; inadequateinadequate nutrition and nutrition and obesityobesity

Nutritional Requirements of the Infant

Iron-fortified cereal is usually started at about 6 months.

Vitamin K supplement is routinely given shortly after birth.

Infants should not be given an excess of vitamin A or D.

3

Bottle Feeding

The infant should be cuddled and held in an upright position.He should be burped.Formulas are developed so that they are similar to human milk in nutrient and kcal values however the best formula is inferior to breast milk.Synthetic milk made from soybeans may be used for sensitive or allergic infants. However long term health problems may arise from exclusive soy milk formula

Bottle Feeding

Sterile water must be used to mix formula.Infants under one year should not be given cow’s milk.Consistent temperature should be used.Once an infant has started a feeding any left over formula (or breast milk given in a bottle) must be discarded and not saved for the next feeding

Improper water to powered formula may lead to kidney problems and/or malnutrition

Supplementary Foods

Cow’s milk under 1yr may cause:

Gastrointestinal blood lossProtein in cow’s milk and formula causing reaction on small bowel mucosa

Iron deficiency anemiaLow iron content and GI bleed

Excessive Renal Solute LoadImmature kidneys difficulty handling protein, phosphorous

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Burping a Baby

7

Regurgitation: most prominent Regurgitation: most prominent presenting symptompresenting symptom

©Copyright Science Press Internet Services

Symptoms of infantile reflux esophagitisSymptoms of infantile reflux esophagitis

©Copyright Science Press Internet Services

Normal esophageal mucosa erosive esophagitis

Methods

Infants with recurrent regurgitation and without other symptoms were fed alternately with thickened and non-thickened identical formula. Documentation of GER episodes during the study was performed by simultaneous impedance measurement and pH monitoring.

Thickened feedingThickened feeding has a significant has a significant effect on the effect on the reduction of reduction of regurgitationregurgitation frequency and amount frequency and amount in otherwise healthy infants. in otherwise healthy infants.

This effect is caused by a reduction This effect is caused by a reduction in the number of nonacid in the number of nonacid (pH >4)(pH >4) GER episodes, but also because of a GER episodes, but also because of a decrease of decrease of mean refluxmean reflux height height reached in the esophagus. reached in the esophagus.

However, the occurrence of However, the occurrence of acid acid GER is not reduced. GER is not reduced.

Thickening of formula feedings with Thickening of formula feedings with carob beancarob bean gum is an gum is an efficient efficient therapytherapy for uncomplicated GER in for uncomplicated GER in infants.infants.

NOVALAC NOVALAC ARAR

For regurgitating For regurgitating infantsinfants

Thickens in the stomach,Thickens in the stomach, smooth in the feeding bottle smooth in the feeding bottle

thickened with specially treated corn starch (99% amylopectin) highly digestible

synergy between starch and casein thick at gastric pH, but not at a neutral pH (viscosity 50 at pH 6.5 vs 200 Cp at pH =3.5)

homogeneous curd

Novalac AR Novalac AR

viscosityviscosity

0

50

100

150

200

pH 6,5 pH 3,5

vis

co

sit

y (C

p)

In the stomachIn the stomachIn the feeding In the feeding bottle bottle

Novalac AR does not Novalac AR does not slow down gastric slow down gastric

emptyingemptying

Medium chain triglycerids

Low osmolarity

Adapted caloric content

Why not using rice Why not using rice starch?starch?

less interesting thickening properties20% amylose low digestibility

NOVALAC ACNOVALAC AC

What What causes causes colics?colics?

colics are multifactorial : physiological, psychological

colics are related to gas production

Where does this gas come from?

Physiological lactase defficiency

excess of lactose is fermented by colonic bacteria

Lactose content of Lactose content of different formulaedifferent formulae

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Standardformula

intestinalcapacity ofabsorption

Novalac AC

Minimum amount authorized by EU regulation

What would be What would be the best the best

solution ?solution ?

A FORMULA WITH

The benefits of lactose at the duodenal level for minerals absorption

Little or no lactose at the colon level to avoid its inconvenience

There is no point replacing lactose fermentation by other starch derivative fermentation :

the excess of lactose must be replaced by an easily & fully digestible starch derivatives

BUT

STARCH DERIVATIVES

SPECIAL TREATMENT TO REDUCE THE RESISTANT

STARCH (AMYLOSE) CONTENT

< 1% AMYLOSE

GOOD DIGESTIBILITY = LESS OR NO FERMENTATION

For the comfort of For the comfort of colicky infantscolicky infants

Novalac Novalac ACAC

NOVALAC IT...NOVALAC IT...

waters the stools

moistens the rectum

… … to improve the intestinal transit of to improve the intestinal transit of infants. infants.

increases the bacterial mass

does not delay the gastric emptying