Chapter 19: Infant and Child Nutrition

failure to thrive (FTT)

- about 5-10% infants and children do not grow as expected - can have specific medical cause (heart issue, infection) - 80% have no apparent disease - poverty, food insecurity; poor parent-infant interactions, parent inexperience with infant feeding - infants need: physical contact, eye contact, proper nutrition without restrictions

vitamin D

- all infants and children should consume 400 IU/day - supplements for breastfed infants, formula-fed infants who consume less than a quart/day

nursing bottle syndrome

- baby bottle tooth decay/ early childhood caries - seen in bottle-fed infants: liquid pools in babies' mouths; high CHO fluids provide acid and sugar for bacteria to grow - offer breast milk, formula, water, offered in a sippy cup at 6 months - drink from cup by 1 year; wean from bottle by 18 months - wipe gums regularly, start brushing as teeth appear

over- and underfeeding

- overfeeding increases number of andipose cells - underfeeding may affect organ development - unwise to restrict diet

vitamin K

- routinely given as injection at birth - intestinal bacteria then begin to synthesize

- build to a variety of foods - pay attention to infant's appetite - avoid overfeeding or underfeeding - infants need fat - choose fruits, vegetables, grains - do not overdo high-fiber foods - sugars and sodium in moderation - choose foods containing iron, zinc, and calcium

AAP Infant Dietary Guidelines

- 70% teenagers report trying alcohol once - 22% report binge drinking - exposure reduces brain mass in area involved in decision-making, learning, and memory - abuse in adolescence predicts of use in adulthood - should not be viewed as normal part of growing up - consequences can be longstanding and devastating - physical, emotional, and intellectual; effects of alcohol on the liver, brain, and cardiovascular system can start early

alcohol abuse among teens

growth charts, head circumference, over- and underfeeding

assessment of growth

head circumference

brain growth is fastest in infancy (assessment of growth)

- vital to maximize bone mass during childhood and adolescence - periods of rapid bone growth and mineralization - dairy - up to 2 years, whole milk for extra fat, energy; after 2 years, reduced fat or fat-free - plant milks and fortified orange juice are alternatives

calcium (toddlers and preschool children)

- needed to maximize bone mineralization - less than 10% of adolescent girls and 25% of boys meet calcium intake recommendations (1300 mg/day) - 1 in 5 children deficient in vitamin D - 3 servings/day of dairy or nondairy alternative

calcium and vitamin D (teenager)

- highest energy needs per unit of body weight (EER) - rapid growth and high metabolic rate - ~700 kcal/day for a 6 month old child: 46 kcal/lb, compared to 16 kcal/lb for 20 year old woman - breast milk, formula provide sufficient kcals up to 6 months

calorie needs (infants)

- age 0-6 months: 60 grams/day - age 7-12 months: 95 grams/day - based on typical intake of human milk by breastfed infants plus introduction of solid foods at 6 months - no AI for fiber < 2 years - work up to ~5 g/day between 6 months and 1 year

carbohydrate needs (infants)

- AAP advises limit of 100 mg/day - excessive caffeine intake affects neurological and cardiovascular development, sleep patterns - caffeine poisoning from energy drinks

curb caffeine intake

- high rate of infant mortality compared to other countries - more cases of obesity - more cases of type 2 diabetes - less physical activity, more screen time - more consumption of soft drinks and energy drinks - intake of fruits, vegetables, whole grain short of recommendations

current status of child health

- cardiovascular disease: abnormal blood lipids in 1 of 5 youths 12 to 19 years old, AAP recommends screening at around age 9-11, earlier if at risk - alarming increase of type 2 diabetes: 85% overweight at diagnosis; if overweight or obese and at risk, screen every 2 years - weight management control: diet and exercise

early signs of chronic disease

- growth is an indicator of nutritional status ( short term: weight, long term: length) - eating poor diet during stages of infancy or childhood hampers cell division - smaller in size (height and weight) - adequate diet later won't compensate for lost growth (!!!)

effects of undernutrition

- 30 grams/day - 15% of total fat should be essential fatty acids; DHA, arachidonic acid supplied by human milk, formula - vital to nervous system development (brain, eyes) - half of the energy supplied by breast milk and formula comes from fat - restriction of fat intake not advised under 2 years

fat needs (infants)

- burp after each 1-2 oz. consumed - spitting up is normal - watch for signs of fullness: turning head away, falling asleep, being inattentive, playful - do not put baby to bed with bottle - observing infant needs and cues can: assure calorie needs are being met, foster trust and responsiveness, help child develop habit of respecting internal cues of hunger, satiety

feeding technique

3 cups per day

fluid needs of infant

- cow's milk not tolerated by infants under 12 months - formulas: must follow strict quality control guidelines, fortified with vitamins and minerals (except fluoride) - cow's milk base formula: contains lactose/sucrose, casein, whey, and vegetable oils - hydrolyzed protein formula if allergies to milk and soy - transition formulas

formula feeding

growth charts

height and weight correspond to a percentile - 50th percentile if considered average (assessment of growth)

- build on what they know - pair new food with familiar food - enlist child in selection, preparation - use sectional plate - keep it crunchy, keep flavor mild - finger foods are fun - serve challenging food first - dinner table not a battle ground - no nagging, forcing, bribing - don't bribe with sweets or desserts

improving acceptance of nutritious foods

- introduce one food at a time - check for intolerance, wait 7 days before introducing new food - iron-fortified cereals (rice) - strained vegetables, then fruits, then meats - use baby-sized spoon with long handle - hold infant comfortably on lap, be calm, casual - expect only 2-3 bites at first

introducing solid food

- ~10% of teens have low iron stores or iron deficiency anemia - leads to fatigue and decreased concentration - lean meats, fortified grains - menstruating teenage girls may need multivitamin with iron

iron (teenager)

- iron deficiency anemia most likely between 6-24 months: poor oxygen supply to cells: decreased stamina, compromised learning ability - iron-fortified cereals, lean meats - avoid over-consumption of milk

iron (toddlers and preschool children)

increases 50% by end of first year

length of growing infant

iron stores depleted by 4-6 months of age - iron-fortified formula for bottle-fed infants - iron supplementation for breastfed infants until solid foods introduced introduction of iron-containing solid foods ~ 6 months - fluoride supplement after 6 months if not provided by tap water, toothpaste, food - zinc and iodide - supplied by breast milk or formula

mineral needs (infants)

iron, calcium, sodium

nutrients of concern (toddlers and preschool children)

- calcium, vitamin D, iron

nutrients of concerns (teenager)

- start the day with breakfast: reduces risk of obesity, nutrient shortfalls, fortified breakfast cereals typically best source of iron, vitamin A, and folic acid for children ages 2 to 18 - choose healthy fats: shift from full fat dairy and meat to low fat dairy, fish, lean meat, plant oils - avoid sugary drinks: choose water, low- or fat-free milk; replace 100% fruit juices with whole fruits

nutrition priorities

- smaller portions of high fat/sugar foods (40% of teens eat fast food daily) - larger servings of: low-fat dairy, lean meats, vegetables and fruits, whole gains - stress importance of nutrition on physical performance and fitness

nutrition recommendations for teens

- since 1970s, overweight and obesity more than tripled - mroe than 1/3 US school children classified as overweight or obese - about 40% of obese children and about 80% of obese adolescents become obese adults - causes of childhood obesity: genetic factors account for only 1/3 of individual differences in weight, excessive caloric intake, sedentary activity, physical activity decreases as screen time increases

overweight and obesity (toddlers and preschool children)

- 9-11 grams/day (based on age) - half should be from essential amino acids - breast milk, formula provide sufficient protein - high protein diet - stress on kidneys, excess nitrogen and minerals exceed abilities of immature kidneys

protein needs (infants)

- American Academy of Pediatrics recommends introducing solid foods at about 6 months of age - not physically mature enough earlier; add to, not replace human milk or formula - general readiness signs: reaching about 13 pounds, consuming more than 32 oz. formula/day or breastfeeding more than 8 to 10 times/day, little relationship between solid food and sleeping through night

readiness for solid foods

1. nutritional needs - need additional calories, replenish iron stores 2. physiological capabilities - more mature digestive system, increased kidney function 3. physical ability - disappearance of extrusion reflex, better head and neck control, ability to sit up 4. allergy prevention - leaky gut until 4-6 months

readiness for solid foods - developmental factors

- smaller stomach capacity - 6 small meals vs. 3 large meals - do not overeat - means of getting attention - children will never starve themselves - offer 2 to 3 nutrient-dense options: peanut butter and apple, cheese and whole wheat crackers

redefine snacking

- physical activity guidelines recommendation: 60+ minutes of moderate-to-vigorous physical activity daily - American Academy of Pediatrics: limit screen time to 14 hours per week - limit high-calorie foods, sugared soft drinks, and whole milk - include more vitamins- and mineral-dense foods and healthy snacks - weight loss generally not necessary: if needed should be gradual

reversing trends for overweight and obesity

- survey of US schoolchildren showed: (40% ate no vegetables, except for potatoes or tomato sauce, 20% ate no fruit, less than 20% consume adequate calcium) - use MyPlate for diet planning (limit SFAs and sodium, increase in serving size as child ages) - schools support sound nutrition (2010 Healthy Hunger - Free Kids Act, school lunch provides at least 1/3 of DRI, nutrition condition)

school-age children

- toddlers consume ~1000 mg/day more than needed - reduce sodium intake by: limiting salt added during cooking, limiting processed foods, fast foods, rinsing canned vegetables

sodium (toddlers and preschool children)

- supplements generally not necessary - focus on good food choices: whole-grain breads and cereals, fruits and vegetables, low-fat milk and milk products - use of fortified cereals - look for cereal with 50% DV for iron, 25% DV for zinc - potential for accidental overdose

supplements? (toddlers and preschool children)

- rapid growth rate - weight (doubles by 4-6 months, triples by 1 year) - length (increases 50% by end of first year) - nutrients needed to support proper growth: calories, protein, calcium, iron, zinc, and other nutrients - inadequate nutrition (including fat) can inhibit growth - overnutrition more prevalent in North America

the growing infant

rapid growth spurt - between ages 10-13 in girls, 12-15 in boys - girls gain ~10 inches, boys gain ~12 inches - girls gain fat and lean tissue, boys gain lean tissue - increase in appetite - peer pressure - greater responsibility for food choices - don't think often about long-term health

the teenager

- slowing of growth rate ( 4.5-6.6 lb. average weight gain per year, 3-4 inch average height gain per year) - reduction in appetite - "picky eating", choose nutrient dense foods, a 2 year old needs ~100 kcal/day - promote good eating habits and physical activity

toddlers and preschool children

- drop in GROWTH rate -> loss of appetite - built-in feeding mechanism - more interested in playing, exploring than eating - eating is a way to express independence, autonomy, test boundaries - wary of new tastes, more sensitive taste buds than adults - influenced by food temperatures, appearance, texture, taste - typical serving size = 1 Tbsp./year of age for most foods - may take 10 or more exposures until a food is acceptable

understanding "picky eating"

- vitamin K - vitamin D - vitamin B-12 supplements for breastfed infants of vegan moms

vitamin needs (infants)

- fluid needs ~ 3 cups per day, via breast milk or formula - under normal conditions additional water is not necessary or recommended < 6 months - hyponatremia - babies are easily dehydrated - can damage kidneys, use fluid-replacement formulas containing electrolytes, per physician

water (infancy)

- doubles by 4-6 months - triples by 1 year

weight of growing infant

- excessive formula or human milk - foods that tend to cause choking - potential food allergens before 6 months of age - cow's milk, especially low-fat or fat-free - goat's milk, too low in some nutrients - fruit juice (per AAP 2017 guidelines) - food safety hazards (ex- raw milk, soft cheeses, undercooked meat, honey) - excessive nutrient supplementation

what not to feed an infant