RESUMEN
The aim of this case report was to identify the optimal point to start oral feeding in order to help a preterm infant successfully pass through the transitional feeding period. Because all preterm infants must go through a transitional feeding period, going through this period successfully is very important. This case report described a nursing experience related to caring for a low-birth-weight preterm infant who showed hunger cues before feeding at around 31gestational weeks during the tube-feeding period. An assessment revealed that the preterm infant did not exhibit good sucking, breathing, and swallowing coordination. Therefore, we decided to design a nursing care plan to help the preterm infant transition smoothly from tube feeding to oral feeding. The nursing care period was from September 21st to November 2th, 2017. The care processes included: 1) the oral stimulation phase: provision of oral stimulation to increase oral motor function, 2) the oral feeding training phase: use of the Preterm Oral Feeding Readiness Scale (POFRAS) assessment tool to assess feeding readiness before oral feeding, 3) use of a cue-based approach to decide the starting and stopping points, and, finally, 4) the transition to the demand feeding phase. As the preterm infant grew, the body weight and feeding amount both increased positively and without complications. This experience may serve as a model for developing clinical guidelines for a cue-based feeding approach for preterm infants during the transitional feeding period.
Asunto(s)
Señales (Psicología) , Métodos de Alimentación , Recien Nacido Prematuro , Deglución , Nutrición Enteral , Humanos , Recién NacidoRESUMEN
Given the lifelong associations between infant diet and weight, understanding maternal transitional infant feeding decisions can assist efforts to establish healthy eating habits early in life. Feeding experiences were explored using semi-structured interviews with 15 first-time mothers who were selected based on their concerns about their infants' weight in an infant feeding survey. Thematic synthesis of the interview transcripts identified three main themes: (1) Expectations of a "responsible mother", (2) Trusting oneself and trust in others, and (3) From stress to successful feeding. Dominant social ideals of motherhood and infant behaviour influenced feeding practices, some of which are associated with obesity. Judgments of mothers' infant feeding practices and infant size alongside feeding and weight gain 'checklists' undermines maternal transitional feeding knowledge. Family-centred, non-judgmental guidance from peers, family members and health professionals would better support mothers to navigate the day-to-day reality of feeding and caring for an infant throughout the first year of life that is based on achievable personal goals rather than societal ideals.
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Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Madres/educación , Destete , Peso Corporal , Lactancia Materna , Dieta Saludable , Femenino , Conductas Relacionadas con la Salud , Humanos , Lactante , Conducta del Lactante , Encuestas Nutricionales , Obesidad/prevención & control , Investigación Cualitativa , Encuestas y CuestionariosRESUMEN
Evidence supports the establishment of healthy feeding practices early in life to promote lifelong healthy eating patterns protective against chronic disease such as obesity. Current early childhood obesity prevention interventions are built on extant understandings of how feeding practices relate to infant's cues of hunger and satiety. Further insights regarding factors that influence feeding behaviors in early life may improve program designs and outcomes. Four electronic databases were searched for peer-reviewed qualitative studies published between 2000 to 2014 with transitional infant feeding practice rationale from developed countries. Reporting transparency and potential bias was assessed using the Consolidated Criteria for Reporting Qualitative Research quality checklist. Thematic synthesis of 23 manuscripts identified three themes (and six sub-themes): Theme 1. Infant (physical cues and behavioural cues) focuses on the perceived signs of readiness to start solids and the feeding to influence growth and "health happiness." Theme 2. Mother (coping strategies and knowledge and skills) focuses on the early survival of the infant and the family and the feeding to satisfy hunger and influence infant contentment, and sleep. Theme 3. Community (pressure and inconsistent advice) highlights the importance of generational feeding and how conflicting feeding advice led many mothers to adopt valued familial or culturally established practices. Overall, mothers were pivotal to feeding decisions. Satisfying infant's needs to reach "good mothering" status as measured by societal expectations was highly valued but lacked consideration of nutrition, obesity, and long term health. Maternal interpretation of healthy infant feeding and successful parenting need attention when developing strategies to support new families.
Asunto(s)
Lactancia Materna , Dieta , Fenómenos Fisiologicos Nutricionales Maternos , Animales , Desarrollo Infantil , Estudios de Evaluación como Asunto , Femenino , Humanos , Lactante , Leche , Relaciones Madre-Hijo , Responsabilidad Parental , Obesidad Infantil/prevención & control , DesteteRESUMEN
OBJECTIVES: Determining nutritional development in wild primates is difficult through observations because confirming dietary intake is challenging. Physiological measures are needed to determine the relative contributions of maternal milk and other foods at different ages, and time of weaning. We used fecal stable carbon and nitrogen isotopes (δ13 C, δ15 N) and fecal nitrogen concentrations (%N) from wild chimpanzees at Ngogo, Uganda, to derive physiological dietary indicators during the transition from total reliance on maternal milk to adult foods after weaning. MATERIALS AND METHODS: We analyzed 560 fecal samples collected non-invasively from 48 infants, their mothers, and 6 juvenile siblings. Most infant and juvenile samples (90%) were matched to samples collected from mothers on the same day. Isotopic assessments were compared with observations of nursing and feeding. RESULTS: Infants ≤1 year old showed average δ15 N, δ13 C and %N ratios that were 2.0, 0.8 and 1.3% greater than their mothers, respectively, interpreted as trophic level effects. Although data collected on newborns were few, results suggest that solid foods were consumed within 2-5 months after birth. Trophic level differences decreased steadily after 1 year, which indicates a decreasing relative contribution of milk to the diet. Isotopic results indicated infants were weaned by 4.5 years old-more than a year earlier than observations of nipple contacts ceased, which revealed the occurrence of "comfort nursing." Juvenile isotopic signatures indicate no nursing overlap between siblings. DISCUSSION: Our results resemble the stable isotope differences of human babies. This study contributes to a model of chimpanzee nutritional development required to understand early life history patterns in hominins.
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Animales Lactantes/fisiología , Isótopos de Carbono/análisis , Heces/química , Conducta Alimentaria/fisiología , Isótopos de Nitrógeno/análisis , Pan troglodytes/fisiología , Animales , Antropología Física , Uganda , DesteteRESUMEN
Infant dietary patterns tend to be insufficient sources of fruits, vegetables, and fiber, as well as excessive in salt, added sugars, and overall energy. Despite the serious long-term health risks associated with suboptimal fruit and vegetable intake, a large percentage of infants and toddlers in the U.S. do not consume any fruits or vegetables on a daily basis. Since not all fruits and vegetables are nutritionally similar, guidance on the optimal selection of fruits and vegetables should emphasize those with the greatest potential for nutrition and health benefits. A challenge is that the most popularly consumed fruits for this age group (i.e., apples, pears, bananas, grapes, strawberries) do not closely fit the current general recommendations since they tend to be overly sweet and/or high in sugar. Unsaturated oil-containing fruits such as avocados are nutritionally unique among fruits in that they are lower in sugar and higher in fiber and monounsaturated fatty acids than most other fruits, and they also have the proper consistency and texture for first foods with a neutral flavor spectrum. Taken together, avocados show promise for helping to meet the dietary needs of infants and toddlers, and should be considered for inclusion in future dietary recommendations for complementary and transitional feeding.
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Desarrollo Infantil , Dieta Saludable , Medicina Basada en la Evidencia , Frutas , Fenómenos Fisiológicos Nutricionales del Lactante , Persea , Preferencias Alimentarias , Frutas/química , Humanos , Lactante , Política Nutricional , Valor Nutritivo , Persea/químicaRESUMEN
BACKGROUND: Dysphagia is often a comorbidity in patients who require a tracheostomy, yet little is known about patterns of oral intake commencement in tracheostomized patients, or how patterns may vary depending on the clinical population and/or reason for tracheostomy insertion. AIMS: To document patterns of clinical management around the commencement of oral intake throughout hospital admission and along the decannulation pathway in patients with a new tracheostomy, and to examine the nature of variability across multiple clinical populations. METHODS & PROCEDURES: A 12-month retrospective review of 126 patients who had undergone an acute tracheostomy was conducted. Within the cohort, patients were further classified into eight clinical populations representing specialty areas within the tertiary referral centre. Data were collected on timing of milestones and patterns of clinical management related to oral and enteral feeding and decannulation. Relationships between temporal variables were calculated, in addition to descriptive analysis of the overall cohort and by clinical population. OUTCOMES & RESULTS: Median temporal markers of patient progression post-tracheostomy insertion for the cohort were: continuous cuff deflation after 7.5 days, commencement of oral intake after 10.5 days, decannulation after 15 days and cessation of enteral nutrition (EN) after 17 days. However, considerable individual variation and differences between clinical populations was observed. Overall, 86% of the cohort returned to oral intake, although 25% were discharged with EN via a gastrostomy. A total of 86% of the group were decannulated by hospital discharge. Oral intake was introduced at every stage of the decannulation pathway, including prior to cuff deflation, but the majority of patients commenced diet/fluids following cuff deflation or with an uncuffed tube in situ, and most patients who ceased EN did so following decannulation. Commencement of oral intake was evenly split between the intensive care unit (ICU) and the wards. Increased time to commencement of oral intake correlated with increased time to decannulation (r = .805, p = .001), and increased time to decannulation correlated with increased hospital length of stay (r = .687, p = .006). Whilst cohort patterns were observed within the heterogeneous group, sub-analysis revealed distinct patterns of oral intake management across the different clinical populations. CONCLUSIONS & IMPLICATIONS: The data provide benchmarks enabling comparison by overall cohort as well as by specialist clinical populations, each with differing reasons for tracheostomy insertion. The data would suggest that tracheostomy patients should not be looked upon as a singular cohort; rather, evaluation of factors with specific attention made to underlying aetiology and individual clinical presentation is essential.