Infant Feeding, Immunizations, and Patient (parent) Education

Objectives
Infant Feeding

The role of the physician in infant nutrition is largely one of "educator" and "advocate." The body of knowledge that surrounds infant and childhood nutrition is a growing and changing one. If one looks at the history of this area over the past 50 years, it becomes apparent that we have revolved back to the practices of the 1920s and before, at least in the areas of introduction of solid foods and breast feeding. This trend is the result of several factors:

As a result, you will sometimes find yourself advocating a particular feeding regime against a wall of resistance from grandparents, mothers-in-law, aunts and, at times, physicians. It then becomes necessary for you to provide sufficient information and support to enable parents to understand why and how your plan is preferrable. This can be accomplished by the information you supply plus involvement of the parent in the patient education classes available in the Clinic.

The scope of information on infant nutrition that applies to this Clinic will cover two areas: Prenatal Nutrition and Infant Feeding Periods.

Prenatal Nutrition

As you follow OB patients, it is important to consider that, over the past 15 years, we have learned that smoking, alcohol consumption, drug ingestion, and excess caffeine, as well as the nutrition of the mother before and during preg-nancy, all affect fetal growth and development. Expectant mothers should be apprised of these dangers. Certain specific deficiencies in pregnant women can affect the fetus. The most common is iron, but zinc, calcium, and vitamin deficiencies may also adversely affect fetal growth. Similarly, inadequate intake of calories and protein, especially in females underweight at the beginning of pregnancy, can produce small-for-date babies.

The view that the fetus is relatively protected from nutritional deficiencies of the mother by its ability to "parasitize" maternal stores is no longer the predominant one. Your patients can benefit from dietary counsel during the course of their prenatal follow-up.

This is also a good time to discuss breast or formula feeding. The many advantages of breast feeding were referred to earlier in this discussion, and the tables and reference readings in your handout will give you additional information. It is important to recognize that this is the parents' decision - the information we supply enables them to make an informed decision.

 

Infant Feeding Periods

This second area becomes important as you follow infants for "well-baby care." The feeding guide in this section provides specific recommendations. In order to understand the rationale behind these recommendations, it is best to consider infant feeding periods in 3 overlapping stages: (1) the nursing period, (2) the transitional period, and (3) the modified adult period.

It is possible to recommend feeding schedules that are tailored to the individual baby, if one considers all of these areas.

Immunizations

The importance of immunizations in children has been adequately reviewed. The current schedule is included in this section for your review and reference. Two points are worth emphasizing for your work in this Clinic:

Contraindications to Pertussis Vaccine Contraindications to MMR Contraindications to Varicella Vaccine

Reference Reading

Pediatric Annals, Vol. 10, No. 11, November 1981, "Nutrition."

Pediatrics, Vol. 65, No. 6, June 1980, "Feeding Supplemental Foods to Infants."

Clinical Pediatrics, Vol. 21, No. 6, June 1982, "Fetal Alcohol Syndrome."

Family Physician, Vol. 24, No. 1, July 1981, "Human Milk and Breast Feeding."

1991 American Academy of Pediatrics Red Book.

 

T. Davis, MD
updated 8/30/05


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