Nutrition During Infancy, Childhood, and Adolescence (Sherpath Module 11)

A nurse is discussing an infant's diet and what to expect in the first year of life with a new set of parents. Which pieces of information about an infant's diet and nutrition should the nurse include in the education that is the most accurate? Select all that apply.

'Be sure not to give your infant any honey for the first year of life.' 'Solid foods can be introduced when the extrusion reflex disappears.' 'You should avoid foods like popcorn and grapes until your infant is older.'

A parent asks, 'How can I get my child to like new foods?' What is the nurse's most appropriate response?

'Children need 10 to 20 attempts with a food before accepting it.'

The parent of a preschool child states, 'For the last four days, my child will eat nothing but crackers and refuses anything else that I have offered.' What is the nurse's best response?

'This is normal behavior for a preschool-aged child.'

The mother of a 6-month-old infant who is exclusively breastfed asks, 'Do I have to give my baby iron-fortified foods?' What is the nurse's most appropriate response?

'Yes; your baby now requires more iron.'

Which is a common risk for a toddler who consumes an excessive amount of cow's milk in place of meals and snacks?

Iron deficiency anemia Rationale: Although milk is a source of several important nutrients, it is a poor source of iron. The toddler who consumes excessive amounts of cow's milk in place of meals and snacks is at risk for iron deficiency anemia. Infants and children are innately capable of recognizing satiety and self-regulating energy balance when offered a healthy diet, so they are less at risk for obesity. In pediatrics, the term 'failure to thrive' is used to describe infants, children, or adolescents who do not grow and develop normally. Food insecurity occurs when there is a limited or uncertain availability of nutritionally adequate and safe foods or there is a limited or uncertain ability to acquire acceptable foods in socially acceptable ways.

The nurse is helping a group of adolescents reduce their risk of osteoporosis later in life. Which interventions does the nurse recommend to reduce this risk? Select all that apply.

Join the track team. Limit sodium intake. Consume an adequate amount of calcium.

A young adolescent has developed secondary amenorrhea from heavy participation in athletic sports. What does the nurse understand about the risks of secondary amenorrhea?

Low estrogen levels may reduce bone density. Rationale: Female adolescents who participate in athletic training may develop secondary amenorrhea related to low estrogen levels that may reduce bone density. Amenorrhea is a lack of menses, so excessive bleeding is not a concern. Sports can enhance energy metabolism and tissue development. Fluid loss causing dehydration is not directly related to secondary amenorrhea.

Which are important nutritional factors regarding life-long bone health that the nurse should consider when counseling adolescent girls about dietary intake? Select all that apply.

Lower sodium intake Increased calcium intake Participating in weight-bearing physical activity

What is the best parental intervention when a child refuses to eat a vegetable at mealtime?

Offer a fruit

The nurse is looking for ways to reduce obesity in adolescents. How can the nurse promote healthy eating in the school cafeteria?

Offer nonfood rewards for healthy choices in the vending machines.

In order to provide the best nutrition for the infant, the nurse understands that the premature infant or small-for-gestational-age infant has to overcome which challenges with feeding? Select all that apply.

Poor sucking reflex Small gastric capacity Difficulty in swallowing Rationale: A poor sucking reflex, small gastric capacity, and difficulty in swallowing may present challenges in feeding in the premature infant or small-for-gestational-age infant. The premature infant or small-for-gestational-age infant is challenged with decreased, not increased, intestinal motility that could present a challenge in feeding. The premature infant or small-for gestational-age infant is challenged with an increase, not decrease, in nutrient requirements for catch-up growth.

An adolescent is complaining of headaches and feeling tired all the time. The nurse suspects the adolescent has iron deficiency anemia. What foods does the nurse recommend the adolescent reduce?

Potatoes and whole grains Rationale: Potatoes and whole grains are good sources of iron to replenish red blood cells if the adolescent is anemic. Bananas, apples, peaches, and berries are nutritious but do not offer as much iron. Starchy baked goods are also not a major source of iron.

Which stages of growth and development involve irregular periods of growth? Select all that apply.

Preschoolers Toddlers School-aged children Rationale: Toddlers, preschoolers, and school-aged children experience slow and irregular growth. During these periods, their energy needs are less per kilogram of body weight, but they require well-balanced diets for continued growth and health. Newborns and infants experience rapid, steady growth.

Which factors greatly influence an adolescent's eating pattern? Select all that apply.

Rapid growth Peer pressure Self-consciousness

Which is a consequence of childhood obesity?

Social Discrimination Rationale: A consequence of childhood obesity includes the psychosocial risk factor of social discrimination. Genetics can be a contributing factor for obesity,not a result of it. Cognitive delay, not obesity, may occur due to a nutritional deficiency, an environmental exposure, or other risk factors. Physical inactivity is a contributing behavioral factor for obesity, not a result of it.

In order to support rapid growth during the first three years of life, how many kilocalories per kilogram of body weight per day is required?

80 to 120 kcal/kg/d

Which group has the highest risk for inadequate nutrient intake?

Adolescent females

What is the safest method for introducing highly allergenic foods into the diet of infants and children?

Introduce them after traditional foods have been introduced

What is the most effective way to avoid an allergic disease when introducing a new food?

Introducing a new food every three to five days

A nurse is using the World Health Organization growth chart for infant girls. The parent of the infant asks the nurse what the measurements will indicate for her daughter. What response by the nurse is the most accurate regarding the interpretation of the growth chart measurements?

The percentile will help us follow your daughter's physical growth rate compared with other infant girls of her weight and length.' Rationale: The statement by the nurse that the percentile will help follow the infant's physical growth rate compared to other infant girls is correct because growth charts allow the health care provider to compare the growth rate to other healthy infants. The statement by the nurse that the percentile will indicate how tall the infant will be as an adult is incorrect because growth charts do not predict adult height. The statement by the nurse that the percentile will help to follow the infant's physical growth rate compared with other infants of her weight and length is incorrect because the infant is compared with other infants of the same sex, not all infants. The statement by the nurse that the percentile will indicate how tall the infant is compared to other healthy and well-nourished infants of her length and height is incorrect because the infant is compared with other infants of the same sex, not all infants.

A nurse is performing a nutrition assessment on an infant and is preparing to weigh the infant. What else is recommended for weighing an infant for growth chart measurements? Select all that apply.

Using a digital infant scale Using a balance-beam scale Weighing the infant in the nude

Which groups are at the highest risk for being overweight? Select all that apply.

Non-Hispanic girls Mexican American boys

What role do carbohydrates play in the energy and growth of a child?

Preferred energy source Rationale: Carbohydrates are the preferred energy source of total calories in the body. Carbohydrates also spare protein so that it may be used for the vital task of growth instead of being burned as energy. Fat is a backup energy source; it provides the essential fatty acids necessary for growth. Calcium influences bone development. Protein supplies essential amino acids for tissue growth and maintenance.

A nurse is educating new parents on introducing solid foods to their infant's diet. What statements made by the parents indicate that the infant is ready for solid food to be introduced into the diet? Select all that apply.

'Our infant can hold her head up all on her own.' 'Whenever I am preparing her bottle, she reaches for it.' 'She weighed 8 lb when she was born, and now she is over 20 lb.' 'When I have tried to feed her solid food, she opens her mouth as I am giving it to her.'

An adolescent asks the nurse if taking a calcium supplement instead of eating and drinking calcium sources is sufficient. What is the nurse's best response?

'Supplemental calcium does not contribute as much to bone density as dietary calcium.'

A nurse is teaching a new mother about breastfeeding. Which statement by the nurse regarding breastfeeding is the most accurate?

'The breast should be offered 10-12 times per 24 hours in the first several weeks.'

A nurse is educating a new mother on introducing iron-fortified solid foods to her infant's diet. At approximately what age are infants ready for the introduction of solid foods?

6 months Rationale: Age is one of the basic indicators of readiness for solid foods, and at approximately 6 months of age, an infant can have iron-fortified solid foods added to the basic diet of breast milk. At 4 months, it is too early for an infant to have iron-fortified solid foods, and it is safe for infants to have them prior to 8 and 10 months.

An adolescent is concerned about experiencing profound body changes. What does the nurse share with this adolescent to reduce her fears?

'Individuals in your age group experience major changes in size, weight, and nutritional needs.'

An adolescent is learning about body changes in this period of time. Which patient statement should the nurse clarify?

'Males develop subcutaneous fat before females.'

Adolescents have an increased need for calcium to develop bone mass. Which calcium requirement should the nurse include in an adolescent's plan of care?

1000 mg/day Rationale: The recommended calcium for adolescents is 1300 mg/day. Intake below this amount (800 mg/day or 1000 mg/day) would be inadequate. Intake above this amount (2000 mg/day) would be excessive.

A nurse is helping an adolescent prepare the appropriate nutrients for menu planning. If the adolescent weighs 100 lb, how many calories daily should come from the protein? Round your answer to one decimal place.

145.6 kcal

Which adolescents does the nurse know are at a higher risk for obesity? Select all that apply.

16-year-old on the speech team 14-year-old who plays video games after school 15-year-old who comes home every day to an empty house

A nurse is interpreting weight-for-length percentile ranks for infant boys on the World Health Organization's growth chart for infant boys. Which infant is most at risk for nutrition-related problems?

18-month-old boy in the second percentile

The nurse is preparing to take anthropometric measurements on an infant. The nurse is weighing the infant using an infant scale. Which recorded weight is most appropriate to plot on the growth chart?

18.7 lb (8.52 kg) Rationale: The nurse should record the weight 8.52 kg because infant weight should be recorded to the nearest 0.01 kg. Recording 8.5 kg is only to the nearest 0.1 kg. The nurse should not record the weight as 8524 g, because it is standard to use kilograms rather than grams. Recording three decimal places, as in 8.524 kg, is unnecessary.

What does the Food and Nutrition Board recommend to prevent constipation in toddlers (1 to 3 years old)?

19 g of fiber per day Rationale: The Food and Nutrition Board recommends 19 g of fiber per day for toddlers to prevent constipation. Decreasing dairy consumption and increasing water, vegetables, and fruit are not specifically recommended by the Food and Nutrition Board to prevent constipation at this age.

Approximately what percentage of adult peak bone mineral density is deposited during adolescence?

40% Rationale:Approximately 40% of adult peak bone mineral density is deposited during adolescence. The amount 30% is too low, and the amounts 50% and 60% are too high.

The nurse is determining the ideal protein intake for a healthy adolescent patient. If the patient weighs 120 lb, what is the ideal protein intake? Round your answer to one decimal place.

43.6 g

A nurse is plotting anthropometric measurements for a 6-month-old infant girl on a growth chart for weight-for-length percentile rank. At a previous visit, the infant was in the 90th percentile rank for weight-for-length. The infant does not have any medical history and the parent reports a diet consistent with the last visit. At the current visit, which percentile rank does the nurse recognize as a normal progression of growth and development?

90th percentile

What is the best method for parents to promote a healthy weight and reduce the risk of obesity among adolescents?

Lead by example

A nurse is preparing to take measurements on an infant to plot on a growth chart. Growth charts are used as guides to follow an individual's pattern of physical growth in relation to the standard growth curves of healthy children. Which measurements does the nurse need to take in order to use the World Health Organization's (WHO) growth chart for infants? Select all that apply.

Length Weight Head circumference

Which pieces of evidence-based research does the nurse know to be true regarding nutritional differences between Caucasian and African American adolescents? Select all that apply.

African American adolescents retain more calcium at all intake levels compared to Caucasian adolescents. African American adolescents have higher levels of parathyroid hormone compared to Caucasian adolescents. Caucasian adolescents have higher urinary excretion of calcium compared to African American adolescents.

How will the majority of the caloric intake for a 5-year-old child be spent?

Basal metabolism Rationale:The majority of the caloric intake for a 5-year-old child is spent on basal metabolism (50%). Tissue growth accounts for 12%, fecal loss for 8%, and physical activity for 25%.

A nurse is educating a new mother on nutrition requirements for the newborn. Which type of nutrition is most beneficial to the newborn?

Breast Milk Rationale: Breast milk is the ideal first food for infants, and it is the primary recommendation of pediatricians and dietitians. Cow's milk should never be given to an infant in the first year of life. A human milk fortifier is only used as a supplement to breast milk. Breast milk substitute is an acceptable alternative to breast milk, but research has shown that many mothers do not adhere to the recommended safety precautions when preparing infant formula.

Which change in a toddler most requires an adequate dietary supply of protein, minerals, and vitamins?

Muscle development

The school nurse is educating classroom teachers on reducing the overall weight of adolescents. What is the most supportive action the teachers can take for the students?

Encourage healthy lifestyles starting with choices in foods.

Which factors place an infant at risk for failure to thrive? Select all that apply.

Endocrine disease Intestinal obstruction Diluted ready-to-feed formula

A nurse is obtaining anthropometric measurements on an infant to record on a growth chart. The next measurement to be taken is the length of the infant, and the nurse is using a recumbent length board. What are the requirements for a recumbent measure? Select all that apply.

Fixed headboard Infant placed supine Soles of feet vertical

A new father asks the nurse why solid foods cannot be introduced before 6 months of age or before the infant shows signs of readiness. When responding to the infant's father, what potential risks in introducing solid food too early should the nurse include? Select all that apply.

Food allergies Excessive kcal intake Gastrointestinal upset

The school nurse is checking the school menu to ensure protein intake is optimal for the adolescent students. Which guideline for protein intake meets the adolescent's daily needs to maintain nitrogen reserves?

Girls require 46 g/day; boys require 52 g/day

A parent is having difficulty providing healthy meals for a busy adolescent. Which recommendations can the nurse make to promote healthy eating at home? Select all that apply.

Have a variety of washed and chopped vegetables ready to eat in the refrigerator. Prepare meals and leave a plate to warm if the adolescent is unable to eat with the family. Add vegetables to cooked foods to increase the daily amount consumed. Provide opportunities for the adolescent to share in food preparation.

An adolescent has a body mass index (BMI) over 30. Which health concerns should the nurse discuss with the adolescent and parents? Select all that apply.

Hypertension Type 2 diabetes Hyperlipidemia

Why do infants require more water per unit of body weight than adults do? Select all that apply.

Infants have a higher metabolic rate. Infants have a larger proportional body surface. A greater percentage of an infant's total body weight is composed of water. Infants are more susceptible to volume depletion. Rationale: Infants require more water per unit of body weight than adults because they have a higher metabolic rate, a larger proportional body surface, a greater percentage of total body weight composed of water, and they are more susceptible to volume depletion. A larger portion of the increased fluid is needed in the infants' extracellular, not intracellular, spaces.

A new mother of a 4-month-old girl reports to the nurse, 'I was afraid that she would become overweight with all of the fat that is in breast milk. I started to give her low-fat cow's milk instead.' What are some of the negative effects of low-fat cow's milk to infants less than 1 year of age that the nurse will explain to the mother? Select all that apply.

Insufficient linoleic acid Specific form of eczema Insufficient energy to support growth requirements Rationale: Low-fat milk does not provide a sufficient amount of linoleic acid, which is the essential fatty acid needed for growth and development of body tissues found in the fat portion of milk. A specific form of eczema has been observed in infants deficient in linoleic acid. Low-fat and nonfat milks do not provide sufficient energy, which leads the infant to consume increased volumes of milk and excessive proteins. Cow's milk is a poor source of vitamin C, so the infant would not consume excessive vitamin C. Cow's milk does not provide sufficient energy to support growth requirements, so the infant would not consume insufficient volumes of milk and excessive protein, because she would need to consume more.

What two vitamins are recognized by the American Academy of Pediatrics as potentially necessary in supplemental form for infants?

K and D Rationale: The two vitamins that are recognized by the American Academy of Pediatrics as potentially necessary in supplemental form for infants are vitamins K and D. Vitamin K is critical for blood clotting; a major contributor to the daily supply of vitamin K is provided by bacterial production in the gut. Because infants are born without bacterial flora, their vitamin K synthesis and stores are minimal. There is a concern for a high prevalence of vitamin D deficiency and low levels of vitamin D in breast milk; this is why vitamin D also may be necessary in supplemental form. Infants are not deficient in vitamins C and A. Pregnant women may require folate, but infants do not. Infants do not require supplemental iron and vitamin B.

The nurse understands that an infant dramatically changes in growth and development during the first 12 months of life. Which is most accurate regarding an infant's expected growth in the first year of life?

Triple birth weight and increase length by 50% Rationale:During the first year of life, and infant is expected to triple his or her birth weight and increase in length by 50%. Tripling his or her birth weight and increasing in length by 25% is not enough of an increase in length. Doubling his or her birth weight and increasing length by 25% is not enough of an increase in weight or length. Doubling his or her birth weight and increasing its length by 50% is less than the expected tripling of weight during the first year of life.

A new African American mother has chosen to breastfeed her infant. What supplement should her breast-fed infant receive to prevent the development of rickets?

Vitamin D Rationale:Breast milk may not supply adequate vitamin D to prevent the development of rickets and this is critical for African American mothers who are less able to initiate the synthesis of vitamin D in their skin. Iron, calcium, and vitamin K deficiencies do not cause rickets.

An adolescent has been getting sick frequently with colds and infections. Which foods rich in vitamin A can the nurse recommend to improve immune system function? Select all that apply.

Walnuts Potatoes Spinach Beans

A nurse has plotted anthropometric measurements on the World Health Organization's (WHO) growth chart for infant girls. The infant currently weighs 18.5 lb (8.4 kg) and measures 31.5 in (80 cm) long. The nurse interprets that the infant is in the second weight-for-length percentile. Which statement by the nurse is the most accurate?

With her measurements, we need to ask more questions to identify any nutrition-related problems.'

The nurse is preparing to take height, weight, and head circumference measurements on an infant boy. Which growth chart is most appropriate for this patient?

World Health Organization growth chart for boys

A nurse is educating a new mother on introducing solid foods to her infant's diet. What statement by the nurse is the most accurate regarding the introduction of solid foods to an infant's diet?

You should give one new food at a time in a small amount, about five to seven days apart, prior to the milk feeding.