Page 125 - MHF-FeedingMinds-final.indd
P. 125
116 4.3 Common Feeding Problems in Infancy
when infants change from breastfeeding to If conservative management with diet fails to
formula feeding or from a whey-dominant resolve constipation, then the infant should be
formula to a casein-dominant formula referred for further medical opinion.
●● over-concentrating of the infant formula Food Hypersensitivity (Food
Allergy and Food Intolerance)
●● inadequate fluid intake, including underfeeding
About 2–5 per cent of infants are sensitive to
●● cow’s milk protein intolerance. certain foods, but many more parents suspect that
a food is causing problems for their infant (Venter
Constipation may also begin with weaning onto et al. 2006).
solid food.
The foods that most commonly cause problems are
Management of constipation milk, eggs, soya, fish, wheat and peanuts. Many infants
in formula-fed infants grow out of it by 12 months so it is important that the
condition is monitored carefully to ensure special
●● Fluid intake: Ask parents to keep a feed diary for diets are not continued for longer than necessary.
2–3 days. Check the volume of feed given/kg
actual body weight/24 hours against Symptoms
recommended intake (see page 96).
Symptoms of immediate-onset allergy may occur
●● Check that the infant formula is being made up up to one hour after food ingestion and include
according to the manufacturer’s instructions skin manifestations (urticaria, itching, rash),
and not being over-concentrated or under- vomiting, angioedema and anaphylaxis. Delayed-
concentrated. onset reactions are harder to diagnose and may not
manifest until hours or days after the ingestion of
●● Casein-dominant milks can be more the offending food. Possible symptoms include
constipating than whey-dominant milks so a eczema, chronic diarrhoea, colic/abdominal pain
change from casein-dominant to and faltering growth.
whey-dominant formula may help.
Diagnosis
●● Changing to a modified formula for minor
digestive problems may help as the fats in these The gold standard test is the placebo-controlled
formula are different to standard formulas double-blind food challenge. In clinical practice,
(Moro et al. 2002, Schmelzle et al. 2003). however, open challenges are usually performed
where parents and practitioners know what is in
●● A two-week trial of a hydrolysed protein or the food. Food challenges are an integral part of
amino acid-based formula will indicate if the diagnosis in order to:
cause is cow’s milk protein intolerance.
●● detect a specific food which causes symptoms –
●● Additional drinks of cooled boiled water can be a positive result confirms the need to exclude
offered in between milk feeds and particularly that food from the diet; or
in hot weather.
●● prove that a specific food is not responsible – an
If the infant is being weaned then check that a absence of symptoms confirms that a restricted
balanced weaning diet including fruit, vegetables diet is not needed.
and cereals are being offered. More wholegrain
cereals can be offered such as porridge or wheat- Once diagnosed, a food causing symptoms should
based breakfast cereals (e.g. Weetabix or be excluded.
Shreddies). However, bran should not be given to
infants. Also check that drinks or water are being
offered with meals.
