Breastfed and/or infant formula fed and solids
This document is part of the ACI Diet Specifications for Paediatric Inpatients. It is not to be used for patient education.
Aim
To identify patients who are breastfed and/or infant formula fed as well as on a solid diet so that an age-appropriate diet can be ordered.
Characteristics
Breastfed and/or infant formula and solids intake.
Indications
All patients being breastfed and/or infant formula fed and feeding on solids.
This diet is used in conjunction with a diet selected to provide solids appropriate for age and stage of development of feeding skills.
May be combined with a therapeutic diet for dietary restriction or special requirements.
Nutritional adequacy
Nutritionally adequate. Both breast milk and/or infant formula and solids are required for nutritional adequacy. Selection of appropriate diet code is required in addition to this code. The proportion of contribution of breast milk/infant formula towards nutrition will vary individually according to age, feeding patterns and developmental stage. The provision of a hospital environment conducive to breastfeeding will assist in maintaining usual breastfeeding patterns, e.g. rooming in.
Precautions
Breastfeeding is the best source of nutrition for infants in their first year of life. WHO recommendations are for exclusive breastfeeding for 6 months and for continuation of breastfeeding until the age of 2 years or beyond. To optimise effective breastfeeding during hospital admission, the maternal diet needs to be adequate; and an environment conducive to breastfeeding needs to be provided. Facilities for expressing and access to a lactation consultant may be of benefit.
From 6 months, complementary solids need to be introduced to meet nutrient needs, however these may be introduced from 4 months if indicated developmentally. Iron containing solids are particularly important from 6 months onwards as foetal iron stores are diminished. Major sources of iron include iron fortified infant cereals and red meat.
Permission should be sought from a parent/guardian before giving infant formula, particularly for breastfed infants or infants fed expressed breast milk.
To ensure safety and hygiene, formula must be prepared using sterile/cool, boiled water and sterilised equipment and bottles in a dedicated formula preparation room if possible according to Food Safety Standards.
Infants may be given fruit puree/gel if required as a mode of administering medications as prescribed by a physician, where that medication cannot be modified or given in a liquid form.
Note: Preterm infants should not be given thickener.
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | As per age and/or other paediatric diet order | - |
| Sauces, gravies | As per age and/or other paediatric diet order | - |
| Starchy vegetables/pasta/rice | As per age and/or other paediatric diet order | - |
| Vegetables | As per age and/or other paediatric diet order | - |
| Soups | As per age and/or other paediatric diet order | - |
| Sandwiches | As per age and/or other paediatric diet order | - |
| Salads, dressings | As per age and/or other paediatric diet order | - |
| Breads, cereals | As per age and/or other paediatric diet order | - |
| Spreads | As per age and/or other paediatric diet order | - |
| Hot breakfast choices | As per age and/or other paediatric diet order | - |
| Fruit | As per age and/or other paediatric diet order | - |
| Yoghurt | As per age and/or other paediatric diet order | - |
| Desserts | As per age and/or other paediatric diet order | - |
| Milk and cheese | As per age and/or other paediatric diet order | - |
| Beverages | As per age and/or other paediatric diet order | - |
| Biscuits | As per age and/or other paediatric diet order | - |
| Miscellaneous | As per age and/or other paediatric diet order Starch based, locust bean (carob bean) gum and guar gum thickeners for thickening EBM or formula for term infants only | Xanthan gum based thickeners for thickening EBM or formula |
References
- Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
- Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
- Dietitians Association of Australia. 2009. Nutrition Manual 8th ed. Canberra: DAA.
- American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
- NHMRC 2003 Dietary Guidelines for Children and Adolescents in Australia.
- Sydney Children’s Hospital Network factsheets on Breastfeeding, Breastfeeding – Is it for me?, Baby’s first foods and Preparation of Infant Formula
- Australian Breastfeeding Association.
- National Health and Medical Research Council. Infant Feeding Guidelines for Health Workers.
- WHO/UNICEF. Protecting, Promoting and Supporting Breastfeeding: The special role of maternity services. A joint World Health Organisation/UNICEF statement. 1989. Geneva, Switzerland.
- WHO. International Code of Marketing of Breastmilk Substitutes. 1981. Geneva, Switzerland.
- Shaw V and Lawson M. Clinical Paediatric Dietetics. 3rd Edition. 2007. Blackwell Publishing.
- NSW Ministry of Health. Breastfeeding in NSW: Promotion, protection and support. 2011.
- Australasian Society for Clinical Immunology and Allergy, 2008. Infant feeding advice.
- Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, Fleischer Michaelsen K, Moreno L, Puntis J, Rigo J, Shamir R, Szajewska S, Turck D, van Goudoever J. 2008. Medical Position Paper – Complementary Feeding: A Commentary by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition 46:99-110.
- Food Standards Code FSANZ.
- Abrams S.A. American Academy of Pediatrics Jun 3, 2011; DOI: 10.1542/aapnews.20110603-1. Be cautious in using thickening agents for preemies.