ia_gov_sa · guide · processed · 3 chunks
مجموعه الشعبان
Council of Health Insurance
Specialized Infant formulas
Clinical Practice Guideline Tool
First step : ALWAYS encourage breastfeeding
الجمعيه السعوديه
لطب الاسره والمنطقه
Saudi Society of Family and Community Medicine
If mother is unable to breastfeed or prefers formula, a standard formula (iron fortified) is suggested
- No data to support one formula over another
Most term infants need a standard formulas. These formulas are modeled after breast milk and contain 20 kcal per ounce (0.67 kcal /ml). Their carbohydrate source is lactose, and they contain cow's milk protein.
Common Indications for use of Non standard formula include GERD, infantile colic, lactose intolerance and Milk protein allergy
GERD
Infant with Suspicion of GERD
History and Physical Exam
Presence of Alarm signs
No
Continue breastfeeding
Consider Anti Reflux measures
Avoid Overfeeding, Thicken feeds (infant with emesis)
Not Improved
Reevaluate
Consider other Dx
Continue AR measures
Breastfed infants : elimination of
cow's milk in maternal diet
Formula fed infant :
Consider 2-4 weeks of Partially/
hydrolyzed or amino acid based
formula
Not Improved
Reevaluate
consider other Dx
Referral to Pediatric GI
Referral not Possible
Continue management (up to 1
year) and discuss milk protein
reintroduction at follow up
Consider 4-8 week trial of acid
suppression then wean if
symptoms improved
Anti reflux formulas reduce daily emesis and regurgitation in infants, but have not been shown to improve growth or development
Gastroesophageal reflux [GER]
a normal physiologic process that occurs in healthy infants
Gastroesophageal
reflux disease (GERD)
when the reflux episodes are associated with complications such as esophagitis or poor weight gain
Symptoms : Postprandial emesis associated with poor weight
gain, irritability, cough, recurrent stridor, hoarseness, sleep disturbances etc
Dx : Clinical diagnosis,
diagnostic testing is not needed
if symptoms do not impact
growth or development.
Anti reflux measures
Avoid tobacco smoke exposure
Avoid overfeeding
Anti reflux positioning
Poor Weight gain
Weight less than the \( 2^{nd} \) percentile for gestation-corrected age and sex when plotted on an appropriate growth chart and decreased velocity of weight gain that is disproportionate to growth in length
Do not consider weight gain to be poor among children growing along a curve with a normal interval growth rate, even if their weight is \( <2^{nd} \) percentile
Milk protein allergy
Symptoms : Gastrointestinal symptoms (diarrhea with or without blood) associated with extra GI manifestations ex: Eczema (most common presentation), wheezing, family hx of atopy
Dx : History and physical examination, implementing diet diary
Hypoallergenic formula is effective for the treatment of milk protein allergy and the prevention of atopic disease.
In breastfed babies with cow milk protein allergy, mother need to eliminate all dairy product or any food containing dairy
Suggested formula :
Trial of Hypoallergenic formulas contain extensively hydrolyzed proteins for 4-8 weeks if improve continue to 4-6 months
Lactose intolerance
Congenital lactase deficiency : onset : birth , extremely rare
GI Referral
Primary lactase deficiency : primary lactase deficiency ,usually develops in childhood , lactose free diet suggested
Secondary lactase deficiency :
Onset : Common, occurs after small bowel injury; transient following gastroenteritis, chemotherapy, etc.
Dx : History and physical examination
Symptoms :Flatulence, fussiness, emesis, diarrhea
Children with diarrheal illnesses who have no or only mild dehydration
Persistent diarrhea (diarrhea lasting more than 14 days)
(indicate mucosal injury)
or severe dehydration
Continue breastfeeding or standard (lactose-containing) formula
In Breastfed: Continue Breast feeding
In formula fed :Trial of Lactose-free formulas (4-6 weeks)
If no improvement after trial of lactose free formulas refer to pediatric GI
Infantile colic
A self-limited and benign functional disorder of paroxysmal uncontrollable crying and fussiness in otherwise healthy infants <3 months old without obvious cause
Dx : Wessel criteria for definition of infantile colic is based on amount and duration of crying
>3 hours/day
>3 days/week
>3 weeks duration
Changes to the feeding technique and/or experimenting with a number of techniques to soothe the infant
not responding to first line-interventions
One-week trial of an extensive hydrolysate infant formula Up to 3-4 months
The response to formula usually occurs within 48 hours
The original formula is resumed if there is no change in the infant's symptoms Hydrolysate formula may be continued if there is a decrease in crying/fussiness.
References:
-O'Connor, N., 2021. Infant Formula. [online] Aafp.org. Available at: <https://www.aafp.org/afp/2009/0401/p565.html> [Accessed 6 September 2021].
- Pediatrics.aapplications.org. 2021. [online] Available at:
<https://pediatrics.aappublications.org/content/pediatrics/118/3/1279.full.pdf> [Accessed 6 September 2021].
Pediatrics, 2000. Hypoallergenic Infant Formulas. 106(2), pp.346-349.
- Aafp.org. 2021. [online] Available at: <https://www.aafp.org/afp/2004/0815/afp20040815p735.pdf> [Accessed 6 September 2021].
- Naspghan.org. 2021. [online] Available at: <https://www.naspghan.org/files/documents/pdfs/position-papers/PedGERD%20Summary%20FINAL.pdf> [Accessed 6 September 2021].
- Who.int. 2021. WHO and UNICEF issue new guidance to promote breastfeeding in health facilities globally. [online] Available at: <https://www.who.int/news/item/11-04-2018-who-and-unicef-issue-new-guidance-to-promote-breastfeeding-in-health-facilities-globally> [Accessed 6 September 2021].