Infant Formulas Demystified (Part 2) and Infant Feeding

Posted on February 1st, 2013 by Denise | No Comments

Infant Formulas Demystified (Part 2)

and Infant Feeding

By

Denise Koonce OTR

Those of you who know me know my favorite age group to treat are infants.  I love‘em!  Unfortunately, many times this age group will have oral motor deficits and working on feeding becomes one of the main goals of both the parent and therapist.  When I am holding an infant in my arms and we are working on feeding, I have every ounce of my being engaged.  I am concentrating very hard on every aspect of that infant while we become one for about 20 minutes. Together we work to coordinate absolutely every suck, swallow and breath in order to safely, efficiently, and effectively ingest 10-30 cc of formula.  Once it is down I do everything I can to try and help the infant keep it down.  After the infant has worked so hard to take in such a small amount of nutrition, it makes you want to insure you are providing them with the best possible situation so their effort is not wasted.  This to me is one of the most rewarding aspects of being a therapist.  Last week I tried to provide a skeleton version of infant formula and give a foundation for further feeding information.  Now that the foundation has been laid we can begin to build and add structure to the world of infant feeding. 

Many of the patients we see in therapy for feeding are or were infants who were unable to breast feed at birth and therefore receive their nutrition from a formula.  They can receive it either by mouth or enterally by NG tube or Mickey button and sometimes by both.  They may have been born premature or have a medical reason as to why they were unable to initiate breast feeding.  The infants in these categories are generally discharged from the hospital on a specific formula for medical and/or dietary reasons.  The dietary reasons could be for increased weight gain without increasing volume, adding fatty acids, or adding a thickening agent.   The medical reasons could include physical anomalies, cardiac, renal, or respiratory issues but the most prevalent reasons are failure to thrive and gastrointestinal issues such as reflux, omaphalocele, malabsorption, and short gut syndrome, just to name a few.     

Due to the complexity of the infants with these and other medical diagnoses there is a tremendous amount of information that needs to go into the decision making process with feeding.  There are several factors that have to be evaluated and considered beyond what formula is being used.  Here are some questions you can ask ,the parent or caregiver, in order to assist with that decision making process:  why are they on a specific formula, is it in powder or liquid form, who prescribed or recommended it, what feeding schedule is the infant on, how much formula are they taking by mouth, in what time period, what bottle and nipple are being used, if powder formula is used do they make a large batch or an individual serving, do they allow the bubbles to settle first before feeding,  what temperature is the water they are using to mix the formula, what kcal/per oz is being mixed, how much if any is the infant spitting up, and when are they spitting up in relation to the feed, is the spit up curdled or liquid, how often are they stooling and what is the consistency, etc.  These are only some of the questions you can ask which will provide additional information and insight therefore providing direction on how to proceed with the infants feeding plan.   

Join me next week and we will continue to answer why these questions are relative and important and how their answers affect your decisions as a therapist.  If you have questions are thoughts regarding infant formula please share them with us.

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