I found 2 handouts from my "formula lectures" in med school. There are no
references.They are not a joke.  I was really tested on this.I wonder what
made me save these. This is what I really was given a lecture on. I hope it
gives all of you some insight to medical school education reguarding infant
nutrition. They are about 7 years old. I hope someone is lurking from
Augusta, Georgia that can tell us that this has all changed?






     Pediatric formula

1. formula can be grouped according to protein type:
Cow's Milk-enfamil,similac,SMA,gerber's.carnation,advance,lactofree
soy based-prosobee,isomil,nursoy,soyalac
Protein hydrolasate-Progestamil,nutramagin,alimentum

2. all cow's milk formula have lactose as it's sugar except lactose free.

3.soy based formulas are lactosee free. Prosobee is also sucrose free.There
is a new soy based isomil DF that is intended for short periods of time for
diarrhes.(DF stands for diarrhea formula) it has fiber to help decrease
diarrhea.

4. The cow's protein can be furthur divided by the % of the protein being
whey(the watery protein fraction) or casein(the curd or solid portion) It is
felt that whey might be easier to absorb.Since breast milk is 60%
whey/40%casein,the formula companies are attempting to mimic breast milk.
60/40- breast milk,enfamil,SMA,similac C,PM60/40

78%casein/22%whey similac,gerbers(old enfamil)

No studies conclusively decide on whether the% makes a difference

5. signs of lactose intolerance are increased gas,watery stools that burn
the buttocks(lactic acid),and an infant that appears colcky after feeds.

Most infants are not totally deficient of the lactase enzyme, but become
deficient of the lactase enzyme, but becomes symptomatic as certain loads
are reached. The black population appears to have an increased incidence of
this. With a bad gastoenteritis, with profuse diarrhea, the infant may
become temporarily deficient of the lactase enzyme and needs switching to a
lactose free formula.


     SOME FEEDING PEARLS

1. NEVER EXCEED 32OZ/DAY OF FORMULA. ONCE THIS IS REACHED AND NOT
SATISFIED,IT IS TIME TO START SOLIDS AND A GRADUAL DECREASE TO 24 OZ/DAY.
THIS USUALLY OCCURS AROUND4-6 MONTHS OF AGE.PPROGRESSION OF SOLIDS- CEREALS,
YELLOW VEGETABLES,MEATS,FRUITS

ONE NEW THING  AT A TIME.ADDD NEW ITEM EVERY 4-5 DAYS.AVOID THE FOLLOWING
UNTIL 9 MONTHS(ALLERGIC POTENTIAL)--CITRUS,CHOCOLATE,STRAWBERRIES,EGG
WHITES,SHELL FISH,TOMATOES,NUTS

2.IRON IS BLAMED FOR EVERYTHING-COLIC,CONSTIPATIONAND DIARRHEA
3.THE TERM CONSTIPATION IS OVERUSED. SOME INFANTS DO NOT HAVE A STOOL
EVERYDAY. THEY MAY GO EVERY 3RD DAY WITH A SOFT PASTY STOOL.OTHERS WILL GO 3
TIMES A DAY. THER IS A WIDE VARITION OF NORMAL.

4. ALL INFANTS DRAW THEIR LEGS UP,TURN RED FACED AND MAKE NOISES WHILE
PASSING A STOOL. THIS IS NORMAL!!THEY DO NOT HAVE THE HELP OF GRAVITY AND
VALSALVA AND USE ABDOMNAL MUSCULATURE.IT WOULD BE THE SAME FOR AN ADULT IF
THEY LAY FLAT ON THEIR BACK AND ATTEMPT A BOWEL MOVEMENT.THIS BRINGS A LOT
OF MOTHERS TO TH ER THINKING THEIR CHILD IS CONSTIPATED AND WANT IT FIXED.

5.NEVER USE PEDIALYTE/CLEAR LIQUIDS LONGER THAN 4-5 HOURS OR YOU WILL STARVE
AN INFANT. AS SOON AS THE INFANT CAN TOLERATE 1/2 OUNCE OF PEDIALYTE, SWITCH
TO 1/2 OUNCE OF FORMULA.THE KEY IS SMALL AND FREQUENT FEEDS.DONOT DISTEND
THE STOMACH OR IT WILL PROMOTE VOMITING OR INCREASED GASTROCOLIC REFLUX AND
MORE DIARRHEA.

6. DO NOT FEEL YOU HAVE TO DO SOMETHING B/C OF DIARRHEA OR VOMITING. A 6
MONTH OLD WITH 2-3 LOOSE STOOLS PROBABLY NEEDS NO TREATMENT.

7.BE WARY OF USING MEDICINE TO STOP DIARRHEA OR VOMITING. MOST TIMES, ALL
ONE NEEDS TO DO IS GIVE A FEW HOURS OF BOWEL RESTANDD THEN SMALL FREQUENT
FEEDS.

8.CONSIDER ISOMIL DF FOR BAD DIARRHEA.IT IS ISOMIL WITH FIBER ADDED TO HELP
SLOW DOOWN THE THE DIARRHEA. ONLY COMES IN READY MADE CANS. MEANT FOR A
SHORT COURSE OF TREATMENT(1 WEEK).

Very sorry to share these horrible lecture outlines with you,
Denise Punger MD FAAFP
Florida
http://doctor.medscape.com/denisepungermd

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