Weaning

Protein

-bmilk/formula -bioavailability factors -not too high(over rapid growth)

9-12 mths

-chew minced/chopped -spoon self feeding

Skills 4-6mths

-food from spoon -front to back of mouth -tick purée/mash

Vegiterian planning

-protein Omega 3 Iron Zinc Iodene Calcium Vitamin D/B12

When and how

1-2tsp(plastic weaning spoon) Never in bottle Pre/post milk

Foods to avoid

1. 6mths- gluten shellfish citrus 2. 6-9mths eggs 3. Salt/sugar limit from 1 yr 4. Cow milk honey pate soft/blue cheese 1yr 5. Bran or nuts 5 yrs

Nutritional reasons for weaning

1. Additional nutrients/energy 2. Iron and zinc stores depleted

Factors influencing early weaning

1. Fam /friends/health profs 2. Not satisfied 3. Knowledge 4. Exciting/interesting 5. Development/maturity sign

Why is it too early

1. Gag reflex 2. Reject flavour/texture 3. No bite/chew 4. More prone to allergies 5. GI infection 6. Obesity 7. Renal solute load

Why not too early

1. Immature renal/GI 2. GI permeable (foreign proteins provoke immune sensation) 3. Gut prone to diarrhoea (unable to digest and absorb)

Problems with weaning too late

1. Iron/zinc used at 6mths 2. Low vit D- low ca absorption 3. Milk vols too low 4. Oro- motor /speech 5. Picky later

Skills 6-9mths

1. Move/chew soft lumps 2. Self feed 3. Cup sipping

Signs to start weaning

1. Not satisfied (more than 1 week) 2. Wake more regularly at night 3. Interest/watching 4. Chew/dribble 5. Things in mouth 6. Sitting unsupported

Neophobia stages

1. Sight -1 taste 14mths 2. Peak 20mths 3. Diminish 8 yrs -parents influence

First food criteria

1. Small amount 2. Smooth (digestion) 3. Bland (less reaction) 4. GF (till 6 mths) Cereal/fruit purée

Developmental reasons

1. Speech 2. Mouth-tounge coord 3. Fine motor/hand-eye coord 4. Gross motor 4. Social 5. Harder to wean later

7-10 months

Cubed tofu and pasteurised cheese

WHO REView- 4 or 6 months?

No difference in growth and no benefits in solids

Conditions for food

No salt No sugar Not home prepped(fat/protein) No fruit juice under 6mths

Pasteurised milk

Not before 12 mths (some for mash )

Parents worry food is bland

Not bland to babies

Fibre

Not high due to small tummy -small amounts for vitB and constipation -helps healthy choices later

Follow on milk timing

Not till 6 months -not necessary

Skimmed

Not under 5 yrs

Spoon responses and times

Opening mouth - 2w to 9mths Clear spoon (7mth-24mth)

Timing and consequences

Over 3mth, under 6-7mths -coeliac or type 1

Weaning definition

Period of gradual reduction in freq and vol of bmilk/formula -start with cfeeding -result in diet pattern similar to family by 2 years

Energy density foods

Priority due to small tummies -fruit and veg have micros -no high sugar/salt

What to couple it with

Protective function with breast milk -increase weekly

What is gluten

Protein in wheat, rye , barley , oats -food antigen with an immunological trigger

Interventions

Red meat Chicken leg Baked beans Fortified food Dried fruit Leafy veg -no tea(tannins) -supps

Ireland's issues

Red meat intro too late 2/3 using commercial foods Ante-natal advice/parents

GI tract at 4 months

Requires a switch from high fat milk to a higher carb diet

Flavour

Savoury /bitter needed -commercial products dangerous Mom's amniotic Fluid flavoured

12 mths

Self feeding Cup with 2 hands Eat family foods

8mths

Sit unsupported 1st teeth Swallow big food blouses Can sit up

Food 4-6 mths

Smooth purée Mash

Under 4 months neuromuscular control

Suckling liquid Head/neck/back control weak Gag extrusion reflex

Sources

Supp 5mg/day Oily fish Liver Eggs Fortified cereal/margarine

Important foods to replace meat start of weaning

Tofu legumes soy yoghurt egg-yolk cottage cheese TVP mince

6 steps to eating

Tolerates Interacts Smells Touch Taste Eat

Cows milk

Too much p+ and ca2+ -renal waste overload

First feeding tounge control

Tounge protruding looks like they don't like smooth food -easier when sucking pads disappear

Salt recommended and consequences

Under 12mtbs- not over 1g -high bp later on if too much

What is too early How many do it

Under 17mths -70%

Infant formula as cfood

Unhelpful and confusing

Juice

Unnecessary due to dental caries -must be diluted , only at meals -too much may displace milk

What compliments iron

Vitamin C

High sugar consequences

Weight gain Negative food patterns Carcinogenic potential

Weight and length first 12 months

Weight: double 4 months Triple 12 Length: double 12 months

Good source but danger

Yogurt and cheese must be pasteurised -may have listeria monocytogens

Milk when weaning

Continue -bmilk on demand -formula 6-9mths 3/4 a day 600-800mls 9-12mths max 600 mls

Main reason we wean 4-6 mths

Need to get used to food before they really need it , and they're most willing 4-6mths

Unpasteurised

Never

Causes of anaemia

Cows milk before 12 mths Early weaning Prolonged milk diet Lack of iron/vit c Unaware

4-6 mths

Munching reflex(tounge flexibility) Gag weakened Eats some solids

Need for vitamin C

Collagen formation Iron absorption

Suckling and swallowing development

14-15w gestation -breathing co-ordination at birth -adapt to milk flow types

Holding spoon with no spills

15-18mths

Open cup age

19mths

When to bottle wean

1yr

Proportion of fat in diet and when it should differ

25% -if poorly feeding or infected -reduced before 3 yrs

When to wean premes

5-8 mths after uncorrected age

History

50s- 6w 60+70s - 4 mths WHO 2003- 6mths (maybe 4-6mth)

Semi skimmed

After 2 yrs if all other requirements met

Complementary feeding definition

All liquid semi -solid and solid foods other than bmilk and formula fed when weaning

Caution around

Allergies or exma- alert GP -try once to spot reaction

Learning taste starting point

Amniotic fluid (inborn preferences)

Sources vit c

Berries Oranges Peppers Brocolli

Why iron is low

Bmilk low iron as bacteria would feed and thrive on it leading to GI infection

Iron importance

Brain development Anaemia

Function vit D

Calcium absorption -rickets

Chewing at 6 months

Can coordinate Lumpy solids Gums hard

Weaning AKA

Cfeeding Transitional feeding -progression from f/b only to full mixed diet

How to reach omega 3 needs

DHA higher in breast milk Oily fish- 30-60g/week from 7 mths due to drop when weaning

Gag reflex

Evolutionary -USUALLY declines with PRACTICE -less common if weaned right -many vomit

Diets

Fruitarian, raw, paleo, macrobiotic not recommended

Sweetening

Fruits not sugar or honey

Function of vit A

Growth Skin Eyes Immunity

Why this time gap

Gut/immune immaturity Larger portions when older leads to stronger antigenic effect

Food 9-12mth

Hard finger food Minced/chopped

How energy requirements measured

Henry/oxford eqns

Details on energy expenditure

Higher in formula until 1 yr No exercise factor till 12 mths

Preferences for sugar

Innate and genetic - parental and postnatal influences

Weaning principle

Kid decides how much, parent decides what

Lumpy foods

Later than 10 mths - problems with fruit /veg , impediments, nutrient deficiency

EBF till 6 months

Less GI/respiratory issues

Sources vit C

Liver Oily fish Whole milk Cheese Carotenes

Vegan diet problems

Low energy/protein/iron/zinc/calcium

Food 6-9mths

Mash/soft lumps Soft finger foods Liquids in cup/beaker