EXAM 2
protein Adequate intake/RDA for infants
0-6 months = 1.2 grams/kg 7-12 months = 1.5 grams/kg or 11 grams/day
toddlers
1-3 y/o, rapid increase in gross and fine motor skills
Appropriate for gestational age (AGA)
10-85 percentile
pre-school age
3-5 y/o, increasing autonomy, broader social circumstances, increasing language skills, expanding behavior control
full term infant
37-42 weeks, 2500-3800 grams or 5.5-8.5 lbs
Distribution of calories in infancy
40-50% from fat 7-11% from protein Remainder from carbs
Primary lactose intolerance
Ability to synthesize lactase decreases in childhood and adulthood, "Lactase non persistence" is normal, variation in age of expression (infant to adult), depends on the amount of dairy products in diets of people in geographic area, occurrence: ~2% in Northern Europe and ~100% in Asia
Food allergies in infants
About six to eight percent of children under four years old have allergies, absorption of intact proteins is the basis, common symptoms are wheezing or skin rashes, guidelines recommend breast milk for infants considered at risk
organizations creating recommendations for infants
Academy of pediatrics, National Academy of Medicine, Academy of Nutrition and Dietetics, European Society of Pediatric Gastroenterology/Hepatology/Nutrition Committee on Nutrition
Normal growth and development: Toddlers
Average gain of 8 ounces per month and grow .4 inches
Normal Growth and Development: birth-12 months
Average infant triples birth weight
Intrauterine growth retardation (IUGR)
Baby in uterus, growth is slower than it should be
Hydrolyzed formulas
Better GI tolerance, poor acceptance by infant (bitter taste), high cost, recommended if allergy is confirmed
Assessing Newborn Health
Birthweight and gestational age as outcome measures
What to feed preterm infants
Breast milk is the recommended source of nutrition when initiating enteral feeds, when not available/contraindicated preterm infant formulas are available, Soy formulas not recommended for preterm infants < 1800 g
infant Fluids
Breast milk or formula provide adequate water for healthy infants the first 6 months, fluid needs during illness are of concern because dehydration is common response to illness in infancy, juice is not needed to meet fluid needs
Vegetarian diets in infants
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 breastmilk is lower in vegetarian mothers than non-vegetarian mothers
The growth reference charts (developed by CDC)
Describe how certain children grew in a particular time and place, charts for infants from birth-36 months of age and ages 2-20 y/o
infant protein needs
Determined as grams/kg body weight, needs change with growth/development
Nutrition risks to development
Developmental delay: range of symptoms reflecting slow development (feeding difficulties/need for enteral parenteral feedings/altered growth/drug nutrient interactions), not all infants with developmental delay have developmental disabilities that continue into childhood
Preparing 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 a cup is typically 1-2 ounces, drop in total fluids consumed may result in constipation
Considerations for Families of Infants with Special Healthcare Needs
Emotional impact of having sick newborn may be overwhelming to parents, healthcare providers must be sensitive to parents' emotional needs
infant sodium needs
Essential mineral needed for fluid maintenance, requirements: 120 mg from birth to 5 months and 200 mg for 6-12 months, based on the amount of sodium found in breastmilk
Growth standard charts (developed by WHO)
Established for children 0-5 y/o, describe the growth of healthy children in optimal conditions
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% risk
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)
infant Digestive system development
Fetus swallows amniotic fluid which stimulates intestinal maturation and growth, at birth the healthy newborn can digest fats/protein/simple sugars, common problems include col gastroesophageal reflux (GER)/diarrhea/constipation, the infant GI tract is fully developed around 6 months, gut microbiome develops before birth and impacts health in later years (breastfeeding impacts microbiome, GI issues can impact overall gut health/microbiome)
preterm Protein requirements
First 6 months: 1.52 g/kg body weight, 7-12 months:1.2 g/kg (Hydrolyzed protein or single amino acid-based formulas)
Feeding problem interventions
Frequent growth assessment, Monitor fluid and food intake, Adjust feeding frequency/volume/concentration, Adjust feeding timing, Assess feeding position, Increase nutrient density, Parent education, Observe infant-caregiver interactions, Consider developmental abilities
infant fiber needs
From 6-12 months fiber containing foods may be gradually introduced to infants until they consume 5 g/day, sources of fiber for infants include: whole grain cereals/green vegetables/legumes
infant carb needs
Glucose is imperative for proper growth/development, without adequate supply growth stunting can occur
infant growth interpretation
Growth charts, biochemical indicators, body composition, head circumference, evidence based practice treatment guidelines, medication assessment
Mucosal Barriers in The Neonate (Newborn)
High pH in the stomach, leaky intestinal barriers
Key questions regarding infants
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?
Prevention of Food Allergy
Identify high risk infants, breastfeed exclusively for 4-6 months, hypoallergenic formula (completely hydrolyzed), include potential allergens in infants diet after 6 months, probiotics have some positive research
Importance of feeding position
Improper positioning may cause choking/discomfort/ear infections, position young bottle fed infants in a semi upright position, spoon feeding should be infant seated with back and feet supported, adults feeding infants should be directly in front of infant making eye contact
Lactose intolerance in infants
Inability to digest lactose, characterized by cramps/nausea/pain/alternating diarrhea and constipation, uncommon in infancy and tends to be overestimated, undigested unabsorbed lactose in intestine → bacteria utilize for growth (abdominal pain/diarrhea/nausea/flatulence/bloating)
Infant Mortality
Infant mortality rate is 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, US ranked below other wealthy nations, Infant mortality reported in the US was 5.96 per 1,000 liver births in 2014, nutrition is a key factor in infant mortality
feeding condition recommendations
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 infants gums, pace feeding to allow infant to swallow, first meals may be small in volume
infant eating skills
Infants are born with innate reflexes and ability to regulate food intake, need to coordinate sucking/swallowing/breathing, inherent preference for sweet taste At 4-6 weeks reflexes fade and infants begins to purposely signal wants and needs
infant iron needs
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
Infants can swallow pureed foods at 6 months, at 6-8 months infants can swallow very soft lumpy foods, by 8-10 months infants can eat soft mashed foods, many foods are appropriate for infants who are 9-12 months
infant motor and cognitive development
Infants first gain control of their head and neck...hen middle...followed by legs, motor development tends to move from center to peripheral, energy needs increase with increased movement, spoon feeding appropriate when baby can sit and has head and neck control
Influence of food preference on feeding behavior
Infants have been exposed to flavors while in utero, flavor of breast milk is influenced by mother's diet, infants have genetic unlearned preference for sweet and salty tastes and rejection to sour/bitter tastes
Nutrition Services
Infants who were born preterm or with special health care needs may qualify for nutrition-related services and programs (early Intervention Programs funded through the IDEA-Part C, Early Head Start, WIC, State Children with Special Health Care Needs programs)
Severe Preterm Birth and Nutrition
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
Soy protein based formula
Lactose free and vegetarian, supplementation = goal of matching human milk and cow's milk-based formulas
Challenges in feeding preterm infants
Lethargy, Low tolerance of volume, Stress responses connected to feeding
Immature sIgA system
More permeable, uptake of relatively intact proteins (antigen absorbed), I&E allergy observed, closure in about 3-4 months
growth warning signs
No increase in weight or length, continued decline or rapid increase in weight/length/head circumference
Colic
No specific cause, defined by the "rule of three"
infant fluoride needs
Not an essential nutrient, helps to create stronger teeth, DRI = 0.1 mg/day for infants younger than 6 months and 0.5 mg/day for 7-12 months, special circumstances may require fluoride supplementation
preterm food safety
Preterm babies have immature immunological systems (more susceptible to infection), every effort should be made to ensure feedings meet food safety requirements
Developmental lactase deficiency
Preterm infants < 34 weeks gestational age, lactose still beneficial, lactase produced soon
preterm Vit and Minerals
Preterm infants have higher iron needs, human-milk fortifiers provide additional calories and nutrients, preterm infant formulas provide similar amounts of macronutrients and micronutrients as fortified breast milk
Nutrition plays an important role in:
Preventing illness, maintaining health, treating conditions in infancy
Avoidance of Allergies (Mucosal Barrier)
Proteolytic enzymes (stomach/small Intestine) + Bile acids and other enzymes + pH changes + mucus layer + tight junctions between epithelial cells + secretory IgA system
preterm fat needs
Provide 45-55 percent calories, ow-fat diets are not recommended, medium-chain triglycerides (MCT) do not require bile for absorption and are a routine source of fat in preterm infant formula
Congenital lactose intolerance
Rare → requires lactose-free formula
Secondary lactose intolerance
Results from injury to small intestine (lactase synthesized/released at the tips of the villi), very common in infants, usually no restriction needed
Feeding Problems in infants
Seen in 40-45 percent of VLBW infants, feeding problems may cause frustration to families, term infants can be introduced to complementary foods at six months of age, an infant born at 32 weeks gestation would be ready for complementary foods at eight months of age
factors that impact infant Cognitive development
Severe acute malnutrition, chronic undernutrition, iron deficiency anemia, iodine deficiency, environmental interactions
Infants with genetic disorders
Small subset of congenital anomalies: phenylketonuria, Galactosemia, Urea cycle disorders, Fat-related and carbohydrate-related disorders, Disorders sensitive to high-dose vitamins, Renal genetic disorders
Infants with Congenital Abnormalities and Chronic Illness
Some infants are born at term but require neonatal intensive care (cardiac/genetic/chromosomal conditions)
growth and health
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/medical history
Corrected age
Subtract gestational age at birth from 40 weeks
cow's milk based formula
The american academy of pediatrics recommends cow milk formula of iron-fortification if breastfeeding is not an option, most similar to breastmilk Good balance of protein/carbs/fat
infants and lead
Toxicity can interrupt brain development/slow growth/interfere with calcium and iron absorption, can be found in water and paint, infants can be exposed if caregivers carry home lead dust
infant lipid needs
Triglycerides are the major energy source in human milk, infants need at least 30 grams of fat per day, human milk provides essential fatty acids (ARA, EPA, DHA)
Introduction of complementary foods
Typically appropriate around 6 months, signs of readiness include moving the tongue from side to side/keeping the head upright/sitting with little support, solids offered via spoon = total of 1-2 tablespoons should be offered
Growth in preterm infants
Variety of growth charts (Fenton preterm growth charts and Olsen intrauterine growth charts), certain concepts impact assessment (body composition)
Cues for feeding readiness
Watching food being opened in anticipation of eating, tight fists or reaching for spoon, displeasure if feeding is too slow or stops, playing with food or spoon, slowing intake/turning away/refusal/spitting out food when full
infant water needs
Water needs typically met via breast milk/formula, excessive intake can be harmful, infants should be monitored for dehydration
growth charts show
Weight for age and length, length and head circumference for age
Large for gestational age (LGA)
above 90th percentile
Partially hydrolyzed
allergen perhaps still present
Fully hydrolyzed
amino acids and peptides
preterm infant
before 37 weeks less than 2500 grams
Top 3 causes of infant mortality
birth defects, LBW/preterm birth, and sudden infant death syndrome (SIDS)
Constipation in infants
changes in the frequency/size/consistency/ease of passing stool, more frequent in formula-fed infants, often occurs for a short duration
rule of 3 (colic)
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
infant nutrition recommendation
exclusive breastfeeding for first 6 months and continuation to one year, infant formulas are manufactured to closely resemble human milk but numerous components cannot be replicated, growth and health status are better indicators of dietary adequacy than volume of breast milk or formula alone
newborn growth assessment
gestational age, birthweight, length, and head circumference
Human milk
gold standard for nutrient content
infant energy needs
infants need more energy per body weight than any other time in life, related to size needs are twice that of an adult, most infants require 100 kcal/kg body weight, needs change with age, fat is essential to meet needs
Health conditions in infants
interfere with growth and development, most problems resolve some persist
small for gestational age (SGA)
less than 10th percentile
Early childhood caries (ECC)
linked to feeding practices Feeding techniques to reduce caries: avoid high-frequency consumption of sugar, limit the use of bedtime bottle, avoid frequent breastfeeding after first tooth, bottle wean between 12 and 18 months, see a dentist by 12 months, brush or wipe emerging teeth
Major Food Allergens
milk, Eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans
breastmilk of vegan mothers
mothers should pay particular attention to protein, omega-3 fatty acids, iron, calcium, and vitD and VitB12 intake
preterm energy needs
needs vary, Increased calories required for infections/fever/difficulty breathing/temperature regulation/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/kg
Types of lactose intolerance
primary, secondary, congenital, developmental
possibly helps colic
probiotics, breastfeeding mothers removing bananas from diet, consuming protein-rich foods, grapes, lemons, and potatoes
types of formula
regular (cow's milk based or soy protein based) and hydrolyzed formulas (fully and partially hydrolyzed)
infant VitD needs
required for bone mineralization and proper calcium and phosphorus utilization in blood, exclusively breastfed infants need supplementation (400 IU/day) deficiency can lead to rickets
Eating schedule
should be dictated by infant, cluster feeding may occur and is most common during the evening and in young infants
Diarrhea in infants
three or more loose watery stools per day or a stool volume greater than 10 g/kg of body weight, may result infections/food intolerance/changes in fluid intake/excessive fruit juice intake, concentrate on adequate hydration/avoidance of dehydration
extremely low birthweight
under 1000 grams
very low birthweight
under 1500 grams
low birthweight
under 2500 grams
