Midterm 2 - Nutrition Through Life
fiber during infancy
- 6-12 months: fiber-containing foods may be gradually introduced to infants until they consume 5 g of fiber per day - sources of fiber for infants include whole-grain cereals, green vegetables, and legumes
The Growth Reference Charts
- Developed by the CDC - describe how certain children grew in a particular place and time - charts for infants from birth to 36 months of age, and ages 2 to 20 years
how sick babies are fed
- Feeding methods: selected based on projected length of time the infant will need to achieve successful bottle or breastfeeding - Enteral, parenteral, gavage, and gastrostomy and jejunostomy feeding
Key questions regarding infancy
- How often does your baby feed? How long? - How does your baby behave during and after a feeding? - Has your baby had any other fluids from a bottle? - How many wet diapers and stools does your baby have every day?
developmental lactase deficiency
- Preterm infants < 34 weeks gestational age - Lactose still beneficial & lactase produced soon
Rooting: newborn reflex
- When a baby's cheek is stroked, baby turns head toward the cheek that was stroked and opens mouth - helps a baby find the nipple
primary lactose intolerance
- ability to synthesize lactase decreases w/ age - "lactase nonpersistence" normal - rates depend on dairy products consumed regularly in a geographic area > ~ 2% in N Europe > ~ 100% in Asia
food allergies in infants
- about 6-8% of children under 4 years old have allergies - absorption of intact proteins in the basis - common symptoms: wheezing or skin rashes - guidelines recommend breast milk for infants considered at risk
infant mortality
- an estimate of the number of infant deaths, which occur within the first year of life, for every 1,000 live births - used as an indicator of the health and well-being of a nation - U.S. ranked below other wealthy countries - top 3 causes: birth defects, LBW/preterm births, and sudden infant death syndrome (SIDS) - infant mortality reported in the U.S. was 5.96 per 1,000 live births - nutrition is a key factor in infant mortality
Early childhood caries (ECC): linked to feeding practices
- avoid high-frequency consumption of sugar - limit use of bedtime bottle - avoid frequent breastfeeding after first tooth - bottle wean between 12-18 months - brush or wipe emerging teeth
Palmar: newborn reflex
- baby grasps an object placed in the palm of his/her hand - precursor to voluntary grasping
Stepping: newborn reflex
- baby is held upright by an adult and is then moved - precursor to voluntary walking forward; begins to step rhythmically
Sucking: newborn reflex
- baby sucks when an object is placed in mouth - permits feeding
Moro: newborn reflex
- baby throws arms out and then inward (if embracing) - may help a baby cling to the mother in response to loud noise or when baby's head falls
withdrawal: newborn reflex
- baby withdraws foot when the sole is pricked with a pin - protects a baby from unpleasant stimulation
Blink: newborn reflex
- baby's eyes close in response to bright light or loud noise - protects their eyes
Babinski: newborn reflex
- baby's toes fan out when the sole of the foot is stroked - perhaps a remnant of evolution from heel to toe
hydrolyzed formulas
- better GI tolerance, but . . poor acceptance by infant due to bitter taste and recommended if allergy confirmed - fully hydrolyzed --> amino acids, peptides (alimentum) - partially hydrolyzed --> allergen perhaps still present (nutramigen)
fluids for infant feeding
- breast milk or formula provide adequate water for healthy infants the first six months - fluid needs during illness are of concern because dehydration is a common response to illness in infancy - juice is not needed to meet fluid needs
vegetarian diets during infancy
- can support normal growth and development in infants when well planned to meet their nutritional needs - more restrictive vegan and macrobiotic diets may increase risk for nutrient deficiencies - DHA content in breast milk is lower in vegetarian mothers than non-vegetarian mothers - when infants of vegan mothers are exclusively breastfed, mothers should pay particular attention to protein, omega-3 essential fatty acids, iron, calcium, and vitamin D and vitamin B12 intake
Constipation during infancy
- changes in the frequency, size, consistency, or easiness of passing stool - more frequent in formula-fed infants - often occurs for a short duration
interpretation of growth data: newborn health
- charts show: weight for age and length & head circumference and length for age - warning signs: no increase in weight or length & continued decline or rapid increase in weight, length, or head circumference percentile;
protein during infancy
- determined as grams/kg body weight - needs change with growth/development - 0-6 months: 1.2 grams/kg - 7-12 months 1.5 grams/kg or 11 grams/day
Growth Standard Charts
- developed by the WHO - established for children ages 0 to 5 - describes the growth of healthy children in optimal conditions
preparing infant for drinking from a cup
- developmental readiness for a cup begins at 6-8 months - wean to a cup at 12-18 months - first portion from cup is typically 1-2 oz - drop in total fluids consumed may result in constipation
sodium during infancy
- essential mineral - needed for fluid maintenance - requirements: 120 mg from birth-5 months & 200 mg from 6-12 months (based on the amount of sodium found in breastmilk)
vitamin D during infancy
- fat soluble - required for bone mineralization and proper calcium and phosphorous utilization in blood - exclusively breastfed infants need supplementation (400 IU/day) - deficiency can lead to rickets
Digestive system development in infants
- fetus swallows amniotic fluid which stimulates intestinal maturation and growth - at birth, the healthy newborn can digest fats, protein, and simple sugars - common problems include colgastroesophageal reflux (GER), diarrhea, and constipation - the infant GI tract is fully developed around 6 months - gut microbiome develops before birth and impacts health in later years (breastfeeding and GI issues can impact microbiome)
protein requirements for preterm infants
- first 6 months: 1.52 grams/kg body weight - 7 to 12 months: 1.2 g/kg bodyweight - form of protein: hydrolyzed protein or single amino acid-based formulas
carbohydrates during infancy
- glucose is imperative for proper growth/development - without adequate supply, growth stunting can occur
nutrition for infants with special care needs
- health conditions in infants interfere with growth and developments (most resolve; some persist) - nutrition plays an important role in: preventing illness, maintaining health, & treating conditions in infancy
mucosal barrier in the newborn
- high pH in the stomach - leaky intestinal barrier - immature slgA system
the importance of infant feeding position
- improper positioning may cause choking, discomfort, and ear infections - position young bottle-fed infants in a semi-upright position - spoon-feeding should be with infant seated back and feet supported - adults feeding infants should be directly in front of infant making eye contact
lactose intolerance during infancy
- inability to digest lactose - characterized by cramps, nausea, pain, and alternating diarrhea and constipation - uncommon in infancy and tends to be overestimated
energy needs vary for preterm infants
- increased calories required for infections, fever, difficulty breathing, temperature regulation, and recovery from surgery - decreased calories recommended for spina bifida or down syndrome - AAP: 105-130 cal/kg - European society for gastroenterology and nutrition: 110-135 cal/k
recommendations for development of infant feeding skills
- infant should not be overly tired or hungry - use small spoon with shallow bowl - allow mouth to open and tongue to extend - place spoon on front of tongue with slight downward pressure - avoid scraping spoon on infant's gums - place feeding to allow infant to swallow - first meals may be in small volume
development of infant feeding skills
- infants are born with innate reflexes and ability to regulate food intake - eating schedule should be dictated by the infant - cluster feeding may occur and is most common during the even and in young infants
Iron during infancy
- infants are born with iron stores reflective of maternal stores - by 6 months, a breastfed infant needs an additional iron source - formula-fed infants should receive iron fortified formula - iron deficiency can cause irreversible behavioral and brain function abnormalities
- complementary feeding for infants
- infants can swallow pureed foods at 6 months - 6-8 months: infants can swallow very soft, lumpy foods - 9-12 months: many foods are appropriate for infants at this age
motor and cognitive development in infants
- infants gain control of their head and neck first - next they gain control of their middles, followed by the legs - energy needs increase with increased movement - spoon feeding is appropriate when baby can sit and has head and neck control
influence of food preferences on feeding behavior for infants
- infants have been exposed to flavors while in utero - flavor of breast milk is influenced by diet - infants have genetic, unlearned preference for sweet and salty tastes, and rejection of sour and bitter tastes
soy based formulas
- lactose free - vegetarian - supplementation --> goal of matching human milk and cow milk based formulas
energy needs during infancy
- need more energy per bodyweight than any other time during life - relative to size, needs are twice that of an adult -most infants require 100 kcal/kg body weight - needs change with age - distribution of calories in infancy: 40-50% from fats, 7-11% from protein, and the remainder for carbohydrates - fat in the diet is essential to meet needs
infant reflexes that prepare them to successful feeding
- need to coordinate sucking, swallowing, and breathing - inherent preferences for sweet tastes - at 4-6 weeks, reflexes fade; infant begins to purposely signal wants and needs
water during infancy
- needs typically met via breastmilk/formula - excessive intake can be harmful - infants should be monitored for dehydration
colic
- no specific cause - defined by the "rule of three": crying for more than 3 hours per day, for more than 3 days per week, and for more than 3 weeks in an infant who is well fed and otherwise healthy - possibly helpful: probiotics, breastfeeding mothers removing bananas from diet, consuming protein-rich foods, grapes, lemons, and potatoes
fluoride during infancy
- not an essential nutrient - helps to create stronger teeth - DRI: 0.1 mg/day for infants younger than 6 months & 0.5 mg/day for infants 7-12 months - special circumstances may require fluoride supplementation
severe preterm birth and nutrition
- nutrition in early infancy plays a key role in immediate neonatal survival, growth, neurodevelopment, and a conditioning factor for long-term health - provision of adequate energy and nutrients to the very preterm infant requires parenteral nutrition support, followed by. slow transition to enteral feeding
vitamins and minerals requirements for preterm infants
- preterm infants have higher iron needs - human-milk fortifiers provide similar amounts of macronutrients and micronutrients as fortified breast milk
fat requirements for preterm infants
- provide 45-55% calories - low-fat diets: not recommended - medium-chain triglycerides (MCT): do not require bile for absorption, and are a routine source of fat in preterm infant formula
developmental delay
- range of symptoms reflecting slow development in infants with special health care needs - feeding difficulties/need for enteral or parenteral feedings - altered growth - drug-nutrient interactions - not all infants with developmental delay have developmental disabilities that continue into childhood
feeding in early infancy
- recommendation: exclusive breast feeding for first six months and continuation to one year - infant formulas are manufactured to closely resemble human milk; however, numerous components cannot be replicated - growth and health status are better indicators of dietary adequacy than volume of breast milk or formula alone
types of formula (if not breastfed)
- regular: iron-fortified for 12 months (cow's milk-based & soy-protein-based) - hydrolyzed formulas
factors that impact cognitive, motor, and socio-emotional development in infants
- severe, acute malnutrition - chronic undernutrition - iron deficiency anemia - iodine deficiency - environmental interactions
infancy and dietary intake
- stomach capacity on day 1 = 5-7 mL (shooter marble) - stomach capacity on day 3 = 22-27 mL (ping pong ball) - stomach capacity on day 10 = 60-81 mL (XL chicken egg)
interpretation of growth in infants with special health care needs
- strong emphasis is placed on growth as a sign of improving health in small and sick infants - changes in growth rate are associated with the frequency of illness, hospitalizations, and medical history
cow's milk-based formula
- the American Academy of Pediatrics (AAP) recommends cow milk formula of fortification if breastfeeding is not an option - most similar to breast milk - good balance of protein, carbohydrates, and fat
diarrhea during infancy
- three or more loose watery stools per day or a stool volume greater than ten grams per kilogram of body weight - may result in infections, food intolerance, changes in fluid intake, or excessive fruit juice intake - concentrate on adequate hydration/avoidance of dehydration
lead during infancy
- toxicity can interrupt brain development, slow growth, and interfere with calcium and iron absorption - can be found in water and paint - infants can be exposed if caregivers carry home lead dust
lipids during infancy
- triglycerides are the major energy source in human milk - infants need at least 20 grams of fat per day - human milk provides essential fatty acids (ARA, EPA, DHA)
introduction of complimentary foods for infants
- typically appropriate around 6 months - signs of readiness include moving tongue from side to side, keeping the head upright, and sitting with little support
cues for feeding readiness in infants
- watching food being opened in anticipation of eating - tight fists or reaching for spoon - displeasure if feeding too slow or stops temporarily - playing with food or spoon - slowing intake, turning away, refusal, or spitting out food when full
prevention of food allergy
-Identify high risk infants -Breast-feed exclusively for 4-6 months -Hypoallergenic formula (completely hydrolyzed) -Include potential allergens in infant's diet after 6 months -Probiotics - some positive research
growth in preterm infants
-Variety of growth charts •Fenton preterm infant growth charts •Olsen intrauterine growth charts -Certain concepts impact assessment •Body composition
symptoms of an allergy to Cow's milk
-frequent spitting up -vomiting -colic-like symptoms, which may include excessive crying and irritability after feedings -diarrhea -blood in stool -lack of weight gain -hives -a scaly skin rash -coughing or wheezing -watery eyes and stuffy nose -trouble breathing and swelling of mouth and throat -anaphylaxis, a life-threatening allergic reaction
maturation of mucosal barrier
-immature mucosa = more permeable --> uptake of relatively intact proteins --> antigen absorbed --> IgE and allergy - closure in about 3-4 months
special conditions in infants
-preterm infants -severe preterm births -infants with congenital abnormalities and chronic illness
secondary lactose intolerance
-results from injury to small intestine -lactase synthesized/released at the tips of villi -very common in infants -usually no lactose restriction is needed
birthweight and gestational age: full-term infants
37 to 42 weeks: weight 2500-3800 grams (five and a half to eight and a half pounds)
undigested unabsorbed lactose in intestine
Bacteria utilize for growth - Abdominal pain - Diarrhea - Nausea - Flatulence and/or bloating
congenital lactose intolerance
Rare --> requires lactose-free formula
Appropriate for gestational age (AGA)
Weight, length, and head circumference are between the 10th and 89th percentiles for gestational age.
small for gestational age (SGA)
Weight, length, and head circumference is below the 10th percentile for gestational age.
Birthweight and gestational age: preterm infants
before 37 weeks - low birthweight: under 2500 grams - very low birthweight: under 1500 grams - extremely low birthweight: under 1000 grams
Feeding: potential nutrition problems in infants with special health care needs
disruption of the delivery of nutrients as a result of: - altered structure or function of the mouth, oral cavity, or GI tract - disrupted interaction or response to cues between the infant and caregiver - difficulty with achieving or maintaining adequate positioning when feeding - lengthy duration or increased energy expenditure with feedings
Allergy - high risk infant
family history of allergy --> infant risk - one parent --> 35% risk - both parents --> 58% risk - both parents with same clinical disease (asthma or eczema) --> 78%
intrauterine growth retardation (IUGR)
fetal undergrowth from any cause, resulting in a disproportionality in weight, length, or weight-for-length percentiles for gestational age
nutritional adequacy: potential nutrition problems in infants with special health care needs
increased or decreased energy needs, altered nutritional requirements, vitamins minerals and cofactors required in higher or lower amounts
growth reflects nutritional status for most infants
interpretation methods: - growth charts - biochemical indicators - body composition - head circumference - evidence-based practice treatment guidelines - medication assessment
major food allergens (FDA)
milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans
Reach and miss
newborn gross motor skill at 3 months
sit with support
newborn gross motor skill at 4 months
sit on lap, grasp object
newborn gross motor skill at 5 months
sit on high chair, grasp dangling objects
newborn gross motor skill at 6 months
Stand with help
newborn gross motor skill at eight months
walk when led
newborn gross motor skill at eleven months
walk alone
newborn gross motor skill at fifteen months
stand alone
newborn gross motor skill at fourteen months
stand holding furniture
newborn gross motor skill at nine months
chin up
newborn gross motor skill at one month
sit alone
newborn gross motor skill at seven months
creep/crawl
newborn gross motor skill at ten months
climb stair steps
newborn gross motor skill at thirteen months
pull to stand by furniture
newborn gross motor skill at twelve months
chest up
newborn gross motor skill at two months
fetal position
newborn gross motor skill at zero months
energy and nutrient needs for preterm infants
preterm infants and infants with special health care needs and/or developmental delay: - nutrient requirements for high-risk infants with health conditions are base4d on the recommendations for healthy infants - specific nutrients may be adjusted higher or lower based on the health condition
Growth: potential nutrition problems in infants with special health care needs
slow rate of weight gain, accelerated rate of weight gain, slow linear growth, disproportionate weight for length
corrected age
subtract gestational age at birth from 40 weeks
Large for gestational age (LGA)
weight, length, and head circumference is above the 90th percentile for gestational age.