On 12/13/2014 10:34 AM, Maureen MINCHIN wrote:
> There's no basis for the 500mL; it's formula that should be no more than that by 12 months so that the child eats other food. I am seeing children drinking a litre, up to two, and not eating.
/*Besides the absurdity of measuring the breast milk the baby receives
at the breast, we are also dealing with the basic math problem - meaning
the problem with math itself. *//*
*//*Let's do simple calculations - 500 cc is 2-2.5 cups (or bottles) of
fluids that is not too much actually. The average for a kid at this age
would be about 750 cc. Again, everything will depend on the individual
situation. Also, it will depend on what family would consider "fluid"
and "drinking". Had families requesting interventions, multivitamins and
medications increasing appetite for kids who would not eat anything
during the day drinking only water. On further questioning (sometimes -
further interrogations) it will turn out that the kid would EAT 2-3
bottles (the same 500-750cc) of buttermilk with soft cheese and cereal
per night (to say nothing about cookies and milk during the day).
Grrr... */
> As for iron fortification: if the child has a good supplementary diet the worry is likely to be that fortified cereals provide iron in excess, and that this negatively affects cognitive development increases oxidative risks which may include promoting cancer, and assists pathogens.
/*Iron supplementation of the exclusively breastfed baby is an issue in
its own that should not be taken out of the context. While I do agree
with Maureen's comments here, I have to admit that iron deficiency is
real and it can hurt the kid as much (if not worse) as iron overload
would. Especially if the most nutrition is still coming from the breast
milk for this kid, I would definitely recommend supplementation of the
mother. 10 mo old baby is exactly at the period of life when his iron
reserves are on the low side and evaluation for possible anemia is
recommended (at least in United States such screening is mandated). I
prefer to check both complete blood count and iron levels, as some times
one can have "anemia" (read - low hemoglobin levels) with mild
hereditary anemia traits, that are not always picked up on the neonatal
screening at birth. Evaluating indexes and comparing that picture with
several iron studies will give the better understanding of the situation
and thus- prevent both under treating and overdosing this particular
kid. I did try to find any formal recommendation for anemia screening
in Norway, only finding some articles of very small studies and that's it.
I also have to chime in on the premises of cereal as a first food and
the baby food vs family foods in general. The concept of the baby foods
comes from the idea that babies are not made to eat adult food and thus
have to have something entirely different and special made for them.
This concept works when parents have horrible diet either by adversity
(extreme poverty) or by choice (poor eating habits). But provision of
baby foods either by cooking separate meals or by using manufactured
staff in boxes, cans and tubes can have a significant adverse effect on
the family nutrition in general and on the kid's nutrition in
particular. By relying on "special baby foods" and thus by not
addressing infant nutrition as a part of the family nutrition from the
very beginning of PREGNANCY we are losing the opportunity to provide
family with nutritional skills that they will carry on through the
pregnancy, lactation, and thereafter. The demand to cook separately for
the child (like it is done in areas where I came) puts additional
financial and organizational burden on the family and pushes parents to
turn to the dark side of manufactured "baby foods".
Which brings us to the concept of cereals as a first food, which is a
not good thing all together *//*/*high carbohydrate overload and its
intrinsic sweetness*/. No matter what will be written on the box
(including "organic", "whole grain", "gluten free". "iron fortified" and
so on) processed food is a processed food is a processed food and we
should be advocating against it as much as possible, at least to the
reliable families that can and that are interested in proper nutrition
for parents and kids. For families that consider re-fried beans from
Taco Bell take out (equivalent of McDonald's) as a vegetable, definitely
manufactured baby foods, including the cereals, will be a much better
choice. But as I can assume, that was not a situation in Rachel's case. */
> Has the PHN been talking to a formula rep and got the 500ml there, assumed breastmilk the same as formula?
/*Again, even formula reps would not give you the 500 cc volume, but
keep in mind that most of the artificial milks manufacturers are also in
the baby food and (no comment about it) in the toddler foods business too.*/
> Anyway, how is she to measure the 500ml when breastfeeding. DUH. Just offer three meals, 2 snacks as WHO suggests, and let baby decide what to eat. Good literature on complementary foods on WHO website and also First Steps Nutrition Trust in the UK.
*/
/**/Exactly. And using words "complimentary foods" or "family foods" is
extremely important./**/
/**/Unfortunately many health care providers (physicians, nurses and
educators) are still being taught in terms of "baby foods" as the only
nutrition for infants and toddkers, "jars" as a measure of the volume
and "stages" as a measure of the texture :(./**/
/**/
/**/For Rachel - I would treat this situation as a great educational
opportunity both for the mother, for the PHN (was it a public health
nurse?) and for the community in general./**/
/**/What about compiling the cookbook with the local family friendly
recipes that would satisfy (with some minor alterations for texture and
spiciness) the whole family - parents, older kids and babies? /**/
/**/Having pediatricians, dieticians, lactation consultants and PHNs on
a selection committee would create such an avenue for open discussion
and thus - an opportunity for a change./**/
/**/
/**/Alla /*
--
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine
Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Education Initiative
NJ Chapter Breastfeeding Co-Coordinator, American Academy of Pediatrics
Satellite Symposia Sub-Committee Chair, Academy of Breastfeeding Medicine
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