Infant Nutrition: Colic, Diarrhea, and Constipation

• Key questions to ask regarding infants include feeding frequency and duration, behavior during and after feeding, other fluids consumed from a bottle, and the number of wet diapers and stools per day.

Common Nutritional Issues and Concerns

• Colic has no specific cause.
• Colic is defined by the "rule of three": crying for more than 3 hours a day, more than 3 days a week, for over 3 weeks in a well-fed, otherwise healthy infant.
• Probiotics, breastfeeding mothers removing bananas from their diet, and consuming protein-rich foods, grapes, lemons, and potatoes may be helpful for colic.
• Diarrhea is indicated by three or more loose, watery stools per day or a stool volume exceeding 10 grams per kilogram of body weight, which can be caused by infections, food intolerance, changes in fluid intake or excessive juice.
• With diarrhea, ensure adequate hydration.
• Constipation involves changes in stool frequency, size, consistency, or ease of passing, is more common in formula-fed infants, and is often short in duration.
• Early Childhood Caries (ECC) is linked to feeding practices.
• Feeding techniques to reduce caries includes avoiding high-frequency sugar consumption, limiting bedtime bottles, avoiding frequent breastfeeding after the first tooth emerges, bottle weaning between 12 and 18 months, dentist visits by 12 months, and brushing emerging teeth.
• Lactose intolerance involves the inability to digest lactose, and is characterized by cramps, nausea, pain, alternating diarrhea and constipation, and is uncommon in infancy and often overestimated.
• Types of lactose intolerance include primary, secondary, congenital and developmental lactase deficiency.
• In primary lactose intolerance, lactase synthesis decreases with age and depends on dairy consumption, most common.
• In secondary lactose intolerance, small intestine injury may cause lactase synthesis/release issues, often seen in infants, usually needs no lactose restrictions.
• Congenital lactose intolerance is rare and requires lactose-free formula.
• With developmental lactase deficiency, preterm infants less than 34 weeks gestational age benefit from lactose that is produced soon after birth.
• 6 to 8 % of children under four years old have food allergies.
• Food allergies are based on the absorption of intact proteins, and common symptoms include wheezing or skin rashes.
• Breast milk is recommended for infants considered at risk for allergies.

Avoidance of Allergy and Mucosal Barrier

• Proteolytic enzymes, bile acids, pH changes, mucus layer, tight junctions between epithelial cells, and secretory IgA system support the avoidance of allergy.
• Neonates have a high stomach pH.
• Neonates have leaky intestinal barriers and immature slgA systems.
• Closure of the mucosal barrier occurs in about 3-4 months.
• Immature mucosa is more permeable, leading to increased uptake of intact proteins, with antigen absorbed, IgE and allergy.

Allergy and High-Risk Infants

• Family history of allergy increases infant risk.
• One parent with allergies gives the infant a 35% risk.
• Both parents give the infant a 58% risk.
• Both parents with the same clinical disease (asthma or eczema) gives the infant a 78% risk.
• Major food allergens recognized by the FDA are milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybeans.
• Symptoms of an allergy to cow's milk include frequent spitting up, vomiting, colic-like symptoms, diarrhea, blood in stool, lack of weight gain, hives, scaly skin rash, coughing or wheezing, watery eyes and stuffy nose, trouble breathing, and anaphylaxis.
• Food allergies can be prevented by identifying high-risk infants, exclusive breastfeeding for 4-6 months, using hypoallergenic formulas, and including potential allergens in the infant's diet after 6 months, and probiotics.
• Well-planned vegetarian diets can support normal infant growth and development.
• More restrictive vegan/macrobiotic diets may increase the risk of nutrient deficiencies.
• DHA content in breast milk is lower in vegetarian mothers.
• Vegan mothers who exclusively breastfeed should pay attention to their protein, essential omega-3 fatty acids, iron, calcium, vitamin D and B12 intake.

Nutrition for Infants with Special Healthcare Needs

• Health conditions interfere with growth and development.
• Most related problems resolve while some persist.
• Nutrition is important for preventing illness, maintaining health, and treating conditions in infancy.
• Nutrition-related risks to development include developmental delay, feeding difficulties, altered growth patterns, and drug-nutrient interactions.
• Not all infants experiencing developmental delays will develop disabilities that continue into childhood.

Growth of Infants at Risk and Interpretation

• Growth reflects nutritional status.
• Interpretation methods include growth charts, biochemical indicators, body composition, head circumference, evidence-based practice treatment guidelines, and medication assessment.
• Growth charts include fenton preterm infant growth charts and olsen intrauterine growth charts.
• Certain assessment factors impact body composition.
• Corrected age is found by subtracting gestational age at birth from 40 weeks.
• Emphasis is placed on growth as a sign of health improvement in small and sick infants.
• Changes in growth rates are associated with frequency of illness, hospitalizations, and medical history.

Special Conditions and Meeting Nutritional Needs

• Special conditions include preterm infants, severe preterm birth, and infants with congenital abnormalities and chronic illnesses.
• Energy and nutrient needs for preterm infants and those with developmental delays are based on recommendations for healthy infants.
• Specific nutrients may be adjusted based on health conditions.
• Energy needs vary, increased calories should be available for infections, fever, difficulty breathing, temperature regulation, or surgery; decreased calories are recommended for spina bifida or Down syndrome.
• AAP recommends 105-130 cal/kg.
• European Society for Gastroenterology and Nutrition recommends 110-135 cal/kg.
• Protein requirements are 1.52 grams per kg of body weight for the first six months, and 1.2 g/kg from 7 to 12 months.
• Hydrolyzed protein or single amino acid-based formulas are acceptable.
• Fats should provide 45-55% of calories.
• Low-fat diets are not recommended.
• Medium-chain triglycerides (MCT) do not require bile for absorption and provide routine fat in preterm formula.
• Preterm infants also need higher iron needs
• Human milk fortifiers provide additional calories and nutrients.
• Preterm infant formulas have macronutrients and micronutrients similar to fortified breast milk.

Severe Preterm Birth

• Nutrition plays a key role in survival, growth, neurodevelopment, and conditioning for long-term health.
• Very preterm infants need parenteral nutrition support and a slow transition to enteral feeding to get adequate energy and nutrients.
• Feeding methods are based on the time the infant needs to achieve successful bottle or breastfeeding.
• Enteral feeding can be achieved through gavage, gastrostomy and jejunostomy feeding.
• Parenteral feeding is intravenous feeding.
• Preterm babies have immature immunological systems and are more susceptible to infection.
• Ensure food safety requirements are met.
• Breast milk is recommended when initiating enteral feeds.
• When breast milk is unavailable or contraindicated, preterm infant formulas are an option.
• Challenges in feeding preterm infants include lethargy, low tolerance of volume, and stress responses.
• Soy formulas not recommended for preterm infants under 1800 g.
• VLBW infants present feeding problems around 40-45% of the time that may cause frustration to families.
• Term infants can be introduced to complementary foods at six months, while an infant born at 32 weeks gestation may be ready for complementary foods at eight months.

Nutritional Interventions

• Interventions for feeding problems include frequent growth assessment, monitoring fluid and food intake, adjusting feeding frequency, volume, or concentration, assess feeding position, increase nutrient density, parent education, observing infant-caregiver interactions, and considering developmental abilities.
• Emotional impact of caring for a sick newborn can be overwhelming to parents, so healthcare providers must be sensitive to parents' emotional needs.
• Infants born preterm or with special healthcare needs can qualify for nutrition-related services and programs.
• Early Intervention Programs, Early Head Start, WIC, and State Children with Special Health Care Needs programs may be available.