FAQs
1. Do you have some tips to help mothers settle an infant with colic symptoms?
There are a number of steps a parent can take to help settle their colicky baby:
1. The movement of taking their baby for a walk or a drive, may help settle him
2. Give the baby a warm bath and swaddle him in a warm blanket.
3. Some gentle massage on the baby’s back, chest and stomach can help
4. To prevent the baby from being over-stimulated. Busy, noisy places should be avoided, especially late afternoon and evening.
5. TV off and lights lowered. Calming the baby with soft music, a running fan or clothes dryer may be helpful.
6. For bottle-fed babies Cow&Gate Comfort First Infant Milk is clinically proven to help alleviate symptoms of colic* provide link to product information
For a full list of settling tips, advice and information for parents, copies of our ‘Comforting your colicky baby booklet’ can be ordered on the resources section of the website.
*Savino et al., Reduction of crying episodes owing to infantile colic: a randomised controlled study on the efficacy of a new formula. EJCN 2006; doi:10.1038/sj.ejcn.1602457.
2. When would you advise to move to a formula suitable for a hungrier baby?
The Food Safety Authority of Ireland recommend that the infant who is not breastfed should be given a whey-dominant formula (i.e. Cow&Gate First Infant Milk for newborn) as the most appropriate breastmilk substitute from birth until 12 months. The protein in this infant milk has been altered to reflect the composition of the whey:casein fraction in breastmilk. Should infants continue to be hungry after a milk feed, it is advised to increase both the frequency and volume of the milk feed before moving onto a casein dominant formula to take into account growth spurts which occur regularly in the early weeks. If the Infant is still not satisfied, parents should contact their HCP to enquire about moving onto a casein dominant feed such as Cow&Gate infant milk for hungrier babies.
3. Are there any benefits in moving to a casein based formula?
A casein dominant infant formula such as Cow&Gate infant milk for hungrier babies also fully complies with the same EU compositional guidelines for infant milk formula. The protein fraction in a casein dominant formula is based on 80% casein and 20% whey, maintaining its similarity to cows’ milk. It is specially designed to help satisfy hungrier bottlefed babies as the casein sits in the infant’s stomach for longer. It may also delay the early introduction of solids which are not recommended until at least 17 weeks. Research shows that by 4 months, 72% of Irish Infants are using a casein based formula*. Research has shown that 23% of Irish infants were weaned onto solid food before the age of 12 weeks†.
Cow&Gate infant milk for hungrier babies contains Cow&Gate's prebiotic oligosaccharides which have been proven to reduce chest infections, ear infections, antibiotic use, eczema1,2. Also, contains nucleotides to support growth and a good Ca:P ratio to support development of teeth and bones.
* Twomey A et al., Feeding infants – an investment in the future. Ir Med J 2000; 93(8):248-250
†Tarrant et al., Determinants of early introduction to solid foods in a sample of healthy term infants. Proc Nut Soc. 2007; AOC 54A.1. Arslanoglu S et al. J nutr 2007; 137: 2420-2424. 2. Arslanoglu S et al. J Nutr 2008; 138(6): 1091-5.
4. What is the safest way to prepare a bottlefeed?
If using powdered infant formula, it is best practice to prepare each feed from fresh. Please refer to our bottle feeding guide in the resources section of the website for information on how to correctly make up a bottle using powdered infant milk. Alternatively, convenient ready-to-feed tetra packs are available for most standard formula milks.
5. What is the bottlefeeding guidance for travelling on short or long journeys?
For journeys less than 2 hours in total: The Food Safety Authority of Ireland and Safefood recommend that parents/guardians use ready-to-feed tetra packs. However, if they are not available, it is recommended that before the journey the feed should be prepared as normal, then cooled quickly and placed in a fridge at 5°C or below. Just before leaving the home, the cold feed is to be removed from the fridge and placed in an insulated cool bag with ice packs. On arrival, place the feed in a fridge as soon as possible. Feed then to be re-warmed when needed.
For longer journeys: The Food Safety Authority of Ireland and Safefood recommend that parents/guardians use ready-to-feed tetra packs. Alternatively, the safest option is to bring the powder and prepare a feed from fresh. If the parent/guardian will not be able to boil water when out, they should fill a thermos flask with boiling water to bring with them. Fill the flask and seal it, the water will stay above 70°C for several hours. This can then be used to make up a feed when needed. Flasks are to be washed and rinsed with boiling water before being filled with the boiling water that will be used to make up the feed.
6. What is the recent advice regarding Vitamin D supplementation for bottlefed Infants?
Vitamin D deficiency has emerged as a public health problem in Ireland and in children can lead to rickets. The Food Safety Authority of Ireland and the Department of Health recommend that all babies in Ireland receive a Vitamin D supplement of 200IU (5µgs) each day from birth to 12 months, regardless of the method of feeding. However, if bottle-fed or partially breastfed (and taking greater than 500mls formula per day) a Vitamin D3 only supplement should be used rather than a multivitamin, to avoid the upper tolerable intake levels for Vitamin A being exceeded. For Infants taking less than 500mls per day, it is advised to supplement using 0.3mls Abidec every day.
7. Is a lactose free formula effective in reducing general colic symptoms?
For general colic symptoms a lactose free formula is not necessary. Lactose is important as it enhances the absorption of calcium essential for a baby’s developing bones and teeth.
In some cases after a spell of gastroenteritis an infant may develop temporary lactose intolerance. In this case the short-term use of a lactose free formula may be helpful, but will only be needed for approximately 6-8 weeks. Lactose free
formulas must be used under medical supervision.
8. Are goat's or soya milk suitable alternatives for infants with intolerances or allergies?
Goat’s milk is not recommended as a suitable alternative for infants with intolerances or allergies. The protein in goat’s milk does not comply with EU or Irish regulations governing infant milk formulas. Furthermore, the protein in Goat’s milk is similar to that in cow’s milk, which is also not recommended by the Department of Health and Children as a main milk drink in the first year and therefore, an infant with an intolerance/allergy to cow’s milk protein is very likely to have the same symptoms following ingestion of the protein in goat’s milk.
Soya formula is no longer the first line treatment for infants with cows’ milk allergy, especially less than 6 months. Soya formula should only be given to infants with cows’ milk protein intolerance/allergy who refuse to take an extensively hydrolysed formula such as Cow&Gate Pepti First infant milk. Soya formula can also be used if Infant has galactosaemia or follows a vegan diet.
9. What is the latest guidance for infants with allergies to cows’ milk?
New guidelines have been developed for the management and diagnosis of cows’ milk protein allergy (CMPA) in infants1. Separate guidelines are available for breast-fed and formula-fed infants.
BREAST-FED INFANTS:
Suspicion of mild to moderate CMPA in breastfed Infants:
Mother to continue breastfeeding but start an elimination diet, (no cow’s milk protein for 2-4 weeks). Mother is to take a Calcium supplement and exclude egg.
If there is an improvement: Re-Introduce cow’s milk protein.
If symptoms do not reappear: Reintroduce egg and monitor.
If symptoms reappear: Maintain elimination diet in mother.
If there is no improvement: Resume normal diet in mother and/or consider other diagnosis. Continue breastfeeding
Suspicion of severe CMPA in breastfed Infants: Referral to Paediatric Specialist for diagnosis & treatment. Start elimination diet in mother with Calcium supplement and no cow’s milk protein.
FORMULA-FED INFANTS
Suspicion of mild to moderate CMPA in formula-fed Infants:
Start an elimination diet using an extensively hydrolysed formula (eHF) as FIRST CHOICE e.g. Cow&Gate Pepti First Infant Milk – click here for more information.
If there is an improvement: An open challenge with cows’ milk formula under clinical observation should be carried out.
If symptoms do not reappear: Resume cows' milk protein in diet and monitor
If symptoms reappear: Maintain cows' milk protein elimination diet until 9-12 months or at least 6 months.
If there is no improvement: Start an elimination diet with an amino acid formula or resume cows' milk protein in the diet.
If CMPA symptoms persist, maintain cows' milk protein elimination diet until 9-12 months or at least 6 months. Then repeat challenge.
Suspicion of severe CMPA in formula-fed infants: Start an elimination diet using amino acid formula for a minimum of 2-4 wks and refer to a Paediatric specialist
If there is an improvement: Refer to Paediatric specialist diagnostic procedures
If there is no improvement: Refer to Paediatric specialist challenge
Cow&Gate’s Pepti range of extensively hydrolysed formula, proven to significantly improve symptoms of CMPA2, more information can be found in the product section of the website.
1. Vandenplas et al., Guidelines for the diagnosis and management of cows' milk protein allergy in infants. Arch Dis Child 2007; 92(10):902-908.
2. Verwimp et al., Symptomatology and growth in infants with cows' milk protein intolerance using two different whey-protein hydrolysate based formulas in a Primary Health Care setting. EJCN. 1995; 49(Suppl1):S39-48.Pregnancy
Are omega fats important during pregnancy?
The Department of Health and Children outline the importance of omega 3 & 6 fatty acids in the diet of pregnant women as they are important for the development of baby's brain, eyes and nervous system. Good sources of fatty acids include oily fish, such as herring, mackerel, salmon, sardines and trout. White fish sources such as cod and whiting. Some vegetable oils, such as rapeseed (canola), flaxseed, linseed and walnut. The Department of Health and Children recommend 3 daily servings of meat, fish, eggs and alternatives during pregnancy. They also advise that pregnant women eat 1 portion of oily fish each week (portion:piece of fish weighing 90g (3oz). If it is not possible to include oily fish, try other sources of omega-3 and omega-6 such as meat, chicken, eggs, seeds (sunflower, safflower, sesame), vegetables, fortified breakfast cereals and wholegrain breads. Pregnant women must also take 1 portion of white fish, such as cod, haddock or whiting) each week.
Docosahexanoic acid (DHA) is an important omega 3 fatty acid during pregnancy. It has been estimated that the brain alone accumulates 67mg DHA in the third trimester of pregnancy which is required for normal brain development and function.
Although there are no national recommended dietary allowances (RDAs) for DHA supplementation during pregnancy at present, the dietary inclusion of good sources of omega-3 fatty acids is recommended. Furthemore, the International Society for the Study of Fatty Acids and Lipids recommends greater than or equal to 0.3g of DHA daily for pregnant women (Simopoulos et al., 1999)
If pregnant women find it difficult to meet their weekly dietary requirements for omega-3 fatty acids, it is recommended they seek more advice from their healthcare professional as supplementation maybe required to supply the important omega-3 fatty acids they need to ensure the development of baby's brain, eyes and nervous system.
Reference:
1. Simopoulos AP, Leaf A, Salem N Jr (1999). J Am Coll Nutr. Oct; 18(5):487-9.
Toddlers
1. When is the earliest time that solid food can be introduced?
The Department of Health and Children recommend that parents who have exclusively breastfed their infant should commence weaning at 6 months; therefore the advice for these parents is that this process should move relatively quickly from baby rice and puréed fruits and vegetables onto finger foods and more mashed textures. For babies that are bottlefed, weaning can start anytime between 4 months and 6 months at which stage gentle flavours and gluten free foods, like baby rice, should be offered. Spoonfeeds should not be given to infants <17 weeks as their renal and gastrointestinal systems are not ready to cope with anything other than breastmilk or infant milk formula before then. Some research also shows early introduction of spoonfeeds can increase their risk of infections and food allergy†.
Suggestions which may help:
1. Give advice on why solid foods should not be introduced before 17 weeks
2. Suggest increasing the milk volume at each feed, or the duration of the feed if breastfeeding
3. Suggest increasing the frequency of feeds
4. If bottlefeeding, suggest changing to a casein dominant milk click here for more information
†Department of Health. Infant Feeding Recommendations. 2003. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_40971 97 [accessed August 2008].
2. What are the most appropriate first foods to introduce?
Infants’ first foods should be of a pureed and soft runny consistency without lumps. It is advised to introduce one new food at a time. The most appropriate first foods include baby rice, vegetables such as carrots, butternut squash, sweet potato and fruits such as banana, pear and apple. It is generally accepted that vegetables should be introduced before fruit so infants will accept vegetables more readily later on. Simply boil or steam the vegetables or fruits and then purée or mashthrough a metal sieve using a fork. Some of baby’s usual milk can be added to thin the mixture if required. Parents should be guided by their infants’ appetite. So, it is advisable that infants get used to any food before starting another. Start off with one teaspoon of food, gradually increasing to 2-3. After this, it will be possible to put different foods and flavours together. There are 4 different stages during the weaning process.
Go to our weaning section to find out how to progress from first foods and onto stage 2!
3. What is the dietary guidance for the introduction of allergenic foods such as gluten to infants?
Currently the Department of Health and Children recommends delaying the introduction of potentially allergenic foods until the age of six months1.
However, the Department of Health and Children in Ireland are currently reviewing new expert recommendations on the introduction of allergenic foods and gluten. In 2008 an ESPGHAN Committee on Nutrition published a position paper on complementary feeding2. The recommendations stated that there was no evidence to support the delayed introduction of potentially allergenic foods (wheat, dairy foods, eggs, fish, nuts, soya, shellfish and citrus fruits) and that these foods can be introduced from 4 months and gluten should be introduced no later than 7 months. Such foods should be introduced one by one with some time between, so that the baby can be monitored for an adverse reaction. These new expert recommendations have not been enforced in Ireland to date.
1. Health promotion unit, Department of Health and Children. Starting to spoon-feed your baby 2005; available online at www.healthpromotion.ie.
2. Agostoni et al., Complementary Feeding: A Commentary by the ESPGHAN Committee on Nutrition. JlPediatric Gastroenterology and Nutrition 2008; 46:99–110
4. What are the best dietary sources of iron for growing Toddlers?
Infants are born with a good supply of iron which becomes depleted by 6 months. Therefore, from then, it will be important to include iron rich foods in the diet such as meat (especially red meat), eggs, baked beans, dark green leafy vegetables, lentils, iron-fortified Cow&Gate GUM and breakfast cereals. When infants reach the age of 1, their requirements for iron increase significantly. Toddlers need 8mg iron every day, nearly the same amount as an adult man. Meeting those high iron needs can be challenging for parents.
Toddlers who consistently fail to meet their iron needs can develop symptoms of anaemia which include a poor appetite, irritability, and a slower rate of growth and brain development. Cow&Gate Growing Up Milk, which in combination with a balanced diet can be helpful to improve a toddler’s overall nutrient intake and make a significant contribution to the overall iron content of their diet.
For more information on how to improve a toddlers' iron intake follow the link to Toddler Nutrition
5. What should I recommend for parents of fussy eaters?
This is a question that comes up frequently and can be a genuine concern for parents, considering their infants were great eaters before they reached the toddler years.
Tips for fussy eating:
- Food refusal is a normal part of a toddler’s development. Refusing a food may not always mean that he doesn’t like it, parents need to be reassured that it is normal and explain that they may have to offer the food over ten times before he decides that he likes it!
- Advise parents not to let their toddler fill up on drinks in between meals particularly cordials, squashes and fruit juice as this can suppress their appetite, leaving no room for solid food. Aim for about six drinks per day in a beaker or cup. Water is best between meals.
- Parents should not force their toddler to eat; this can result in a permanent dislike of that food. When it becomes clear that he’s not going to eat it, take the plate away without commenting. Next time offer a different food from the same food group.
- Suggest parents limit all possible distractions at mealtimes, e.g. turn off the television! Toddlers can only concentrate on one thing at a time, having a TV on in the background can be very distracting and make mealtimes more difficult.
- Praising the toddler when he eats well is important, this will help him to enjoy meal times. Parents should avoid making a fuss when he refuses food, as frustrating as it is, it is important for them, try to stay calm. Some toddlers may refuse food as a way to get their parents attention.
- If the toddler enjoys going over to his friends or cousins house for tea, suggest to parents that they ask a friend/relative to include a food on the menu that he refuses to eat. If he sees others eating and enjoying it, he will be more likely to want to try it. But do not to attempt to try this if the other children are likely to reject it too.
- Toddlers love messy meal times when they are allowed to feed themselves. Parents shouldn’t spoon-feed just to avoid a mess. Let him pick the food up rather than trying to spoon it into his mouth. Toddlers like having control of feeding themselves. Make meal times fun! Involve the toddler in simple preparation and cooking of food. Using a cookie cutter to cut pizza or bread into fun shapes, can make them more interesting. He will become familiar with new foods and more likely to try new things.
There are also a number of considerations to take into account if you are presented with this:
6. How much milk should a toddler consume?
Toddlers need between 300-500mls of milk every day. Drinking milk is still very important but the consumption of large volumes should be discouraged as they can fill up on too much milk, reducing their appetite for solid foods. Remember, cows' milk is very low in iron which can result in infants not meeting their Iron RDA. A simple solution would be to replace cows' milk with 2 beakers of Cow&Gate GUM which will provide a toddler with over half his required Iron RDA in conjunction with a nutritionally balanced diet.
Is toddler still teething?Babies can begin to teethe as early as 4 months, however you may not see any appear until 7 months, so it is quite normal for the eruption of the 20 baby teeth to continue into the toddler years. With the eruption of these teeth, some babies and toddlers may experience symptoms such as discomfort, irritability, cheek flushing and drooling. Some tips for managing these symptoms during these years could include feeding them cooler foods which can soothe their sore gums such as cold full fat yogurts with fruit purées or cucumber pieces which have been stored in the fridge. Harder foods may also help, as it gives baby something to bite down on, to help the teeth come through. It is extremely important to ensure toddlers are able to cope with these differing consistencies. It is possible that some toddlers may experience more severe and persistent teething symptoms which may need more specialised advice to help alleviate symptoms. In this instance, healthcare professional advice can be sought.
How to clean a children's teeth?
Once teeth have appeared, it is important that they are cleaned every day with a soft brush, soft washcloth or just water. This reduces the risk of the development of tooth decay or dental caries. The use of flouride toothpaste is not advised before the age of two years as babies and small children are unable to spit it out of their mouth. After two years, a pea sized amount of toothpaste can be used. Flouirde is beneficial in the prevention of dental caries and tooth decay.
Feeding cooler foods can soothe sore gums (e.g. cold yogurts and fruit purée or cucumber pieces stored in the fridge.
Harder foods may also help, as it gives baby something to bit down on, to help the teeth come through.7. What is the best dietary advice for getting the balance right during the toddler years?
To enable a toddler to get a balanced diet, they must eat a variety of foods, in the right proportions. The food pyramid for toddlers 1-3 years should be used as a guide to getting the correct number of servings of the different food groups. Toddlers need around 2-3 small meals and 2-3 snacks each day to provide a variety of nutrients needed for healthy growth and development.
Drinks are also important, aim for up to 6 cups of fluid each day. Water is best between meals. Toddlers need between 300-500mls of milk every day. Drinking milk is still very important but the consumption of large volumes should be discouraged as they can fill up on too much milk, reducing their appetite for solid foods. Pure fruit juice is a good source of vitamin C but should be well diluted (1 part juice to 4/5 parts water) and given with meals, the vitamin C will help with the absorption of iron from foods.Parents can assess their toddler’s diet using the Cow&Gate Start Healthy Calculator which can be accessed in the interactive tools section of both the consumer and HCP website. To use the tool you simply enter all the food and drink that the toddler has had in a day and their actual intake will be compared to the recommended toddler food pyramid. Parents will be given plenty of advice and information on how to improve their toddler’s intake, to help them to achieve a healthy balanced diet.
Health promotion unit, Department of Health and Children. Food and Nutrition Guidelines for Pre-school Services. 2004; available online at www.dohc.ie/publications/preschool_guidelines.html