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d) Engorgement
Pg. 478
Because you know that this client had a cesarean and is being discharged today, she is most likely on postpartum day 3 or 4, when engorgement is most common. Although mastitis, nipple thrush, or a plugged duct may happen during this time, they more commonly occur after 2 weeks postpartum. Also, mastitis, thrush, and a plugged duct are usually unilateral, and this client's symptoms are bilateral. Hard, warm, and tender breasts on the third or fourth day with normal vital signs are most likely the result of engorgement.
Allergenic foods
Honey or corn syrup (contains Clostridium botulinum)
Highly seasoned foods
Excessive formula or breast milk
Foods that tend to cause choking
Cow's milk
Excessive apple or pear juice
The following are several foods and practices to avoid when feeding an infant:
Excessive infant formula or human milk. After 6 months of age, solid foods should play an increasing role in satisfying an infant's growing appetite. Age-appropriate solid foods
provide necessary calories and iron, plus they help the infant to develop motor skills. About 24 to 32 ounces (¾ to 1 liter) of human milk or formula daily is ideal after 6 months, with complementary foods supplying the rest of the infant's energy needs.
Foods that tend to cause choking. Foods that are round or oval in shape, larger than a half inch in diameter, or of a soft or sticky texture can easily get lodged in a child's throat. These foods include hot dogs, hard or gummy candies, whole
nuts, grapes, coarsely cut meats, raw carrots, popcorn, and large bites of nut butters. Caregivers should not allow younger children to gobble snack foods during playtime and should supervise all meals.
Potential food allergens before 4 months of age. Cow's milk, egg whites, peanuts, tree nuts, soy, and wheat are responsible for 90% of food allergies in childhood. For the first six months of life, energy and nutrient needs of most infants can be met with exclusive breastfeeding or infant
formula. If any solid foods are introduced before 4 months of age (not recommended), they should be iron-fortified rice or oat cereals, puréed meats, vegetables, or fruits.
Cow's milk, especially low-fat or fat-free cow's milk. The AAP strongly urges parents not to give reduced-fat or fat-free milk to children under age 2. Before age 2, the amount of this milk needed to meet energy needs would supply too many minerals, which could overwhelm the kidneys. Limiting fat intake might also hinder
nervous system development. Beyond 2 years of age, children can drink reduced-fat, 1%, or fat-free milk because by this age, they are consuming enough solid foods to meet calorie and fat requirements.
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Goat's milk. Although perceived by some to pose lower risk for food allergies, goat's milk is low in folate, iron, vitamin C, and vitamin D and should not be used as a source of nourishment for infants.
Excessive fruit juice. The fructose and sorbitol contained in some fruit
juices, especially apple and pear juices, can lead to diarrhea because they are slowly absorbed. Also, if fruit juice or related drink products are replacing formula or milk in the dietary pattern, the infant may not be receiving adequate calories, calcium, or other nutrients essential for proper growth. Studies have shown a link between excessive amounts of fruit juice and failure to thrive, GI tract complications, obesity, short stature, and poor dental health. Fruit juice (even 100% fruit
juice) is not recommended at all for infants. See Sections 19.4 and 19.5 for age-specific recommendations.
Food safety hazards. The immune system is still maturing during infancy and early childhood, so it is important to avoid potential sources of foodborne illness (review Chapter 17). For example, raw (unpasteurized) milk or soft cheeses (e.g., queso fresco) may be contaminated with bacteria or viruses. Meat, poultry, eggs, and seafood should be cooked to proper temperatures. In addition,
honey may contain spores of Clostridium botulinum, which can lead to the potentially fatal foodborne illness known as botulism. Safe food handling starts with proper handwashing.
Excessive nutrient supplementation. Supplemental vitamins or minerals that provide more than 100% of the RDA or AI for age can increase the risk for nutrient toxicities. Consult a pediatrician or registered dietitian nutritionist before giving dietary supplements to an infant.