Paediatrics: Milk feeding

Milk feeding

Methods

·  Bottle.

·  Tube feeding (if too ill/immature to suck).

·  Naso/oro-gastic tube.

·  Silastic naso-jejunal tube (severe gastro-oesophageal reflux (GOR), aspiration, or recurrent apnoeas).

·  Gastrostomy (if required long term, older children).

Breastfeeding

Breast feeding is a learned skill for both mother and baby. Establishing feeding can take time, and it is vital that good support is available (breast feeding advisors or midwifes with appropriate training).

Advantages

·  fall Maternal post partum haemorrhage.

·   Mild maternal contraceptive effect.

·   rise Bonding.

·  fall Maternal breast cancer risk.

·   Cheap.

·   fall Infant mortality (less relevant in developed world).

·   fall GI and respiratory infection rate.

·   fall Later autoimmune disease incidence (e.g. type I diabetes mellitus, atopic diseases).

·   rise later IQ.

Problems

·  Cracked/sore nipples.

·  Maternal anxiety (breast fed babies can gain weight slower than their bottle-fed couterparts—give reassurance and support).

·  Small risk of hypernatraemic dehydration if low milk intake (suspect if weight loss >10%).

Contraindications

·  +ve maternal HIV status (in developed countries).

·  Certain maternal medications (e.g. amiodarone).

·  Maternal herpes zoster over breast.

·  Infantile galactosaemia or phenylketonuria (PKU).

·  Primary lactose intolerance (very rare).

Expressed breast milk (EBM)

Usually mother’s own breast milk, but some units have donor breast milk banks which can be of value, particularly in extreme preterm infants.

EBM is usually used to establish feeding in preterm infants, but is also useful when top-up feeds are required, if mother and baby are separated for any reason, or if there are other maternal problems e.g. cracked/sore nipples or breast engorgement.

Once expressed, can refrigerate and use within 24–48hr, or freeze and use for up to 3mths.

Formula milk

Normal volume required is 150mL/kg/day.

Advantages

·Paternal involvement.

·Milk intake determined.

Problems

·Constipation.

·Oral thrush.

·  Milk bezoars.

Trophic feeding (gut-priming)

The term describes practice of feeding small milk volumes (0.5–1mL/kg/hr of EBM) to enhance gut structure and function in infants too ill or immature to tolerate substantive milk feeds. Evidence suggests that in the preterm infant it improves GI motility and function, as well as achieving clinical outcomes of ‘rise’ weight gain, ‘rise’ head growth, ‘fall’ infection risk, and improved later milk tolerance.