Life Cycle Nutrition: Chapter 8 - Infant Nutrition
What is infant mortality? What are the major cause and other causes? What the resources and prevention programs to combat infant mortality? Whom do they assist most?
-Infant mortality is when an infant dies within its 1st year of life. -Major causes of this are congenital malformations, a low birth weight (LESS than 2500 g or 5.5 lbs.), preterm births, sudden infant deaths, maternal complications, and unintended injuries. -Resources and preventions that combat with infant mortality are Medicaid, Child Health Initiatives Program (CHIP), Early Periodic Screening, Detection, and Treatment Program (EPSDT), WIC and CDC (Nutrition Surveillance Program), and Bright Futures. -These programs mostly assist with those who are having or have poor social and economic statuses, not enought access to health care or medical interventions, are pregnant as a teenage, whether or not they have access to abortion services, and if they fail from prevention of preterm & low birth weight babies.
What is the difference between full term and preterm infants?
A full term infant is 38 - 42 weeks at birth (88% of all USA infants are this) while a preterm infant is LESS than 37 weeks at birth. The typical full term weight of a baby is 2500-3800 g (5.5 to 8.5 lbs.) and their typical height is 47-54 cm (18.5 to 21.5 in).
What are acceptable fluids for an infant vs. not acceptable fluids, why?
Acceptable fluids for an infant are breast milk or formula since this and all fluid forms contribute to water intake. Additional plain water is needed in hot, humid climates and Pedialyte and sports drinks can provide electrolytes but are lower in calories when compared to formula or breast milk. This may result in weight loss when overusage occurs. Not acceptable fluids are juices for infants below the ages of 6 months since it can give them dental caries and possibly start to rot their teeth when lying down on bed. They may also get too excited before bedtime and not fall asleep. Furthermore, colas and teas are to be avoided since they contribute to a LOWER QUALITY of Nutritional Intakes.
When does the introduction to solid foods occur? Which solid foods are and aren't appropriate for infants to try? What are the infant's physical signs for readiness in solid foods?
At 6 months, offer small portions of semisoft food on a spoon in a shallow bowl once or twice a day. If the baby can't extend their tongue out past their lower lip, then they aren't ready to be spoon fed. Foods appropriate for the the infant are iron-fortified baby cereal, fruits and vegetables (though, only ONE new food should be offered once every 2-3 days), and commercial baby foods at 6 months of age. (not necessary but provide sanitary and convenient choices). They are all pureed and very soft and lumpy food products. At 9-12 months, the baby can then start eating soft mashed table foods such as applesauce, yogurt, cooked hot cereal, and Cheerios. Foods NOT appropriate for the baby due to choking hazards are hot dogs, popcorn, potato chips, peanuts, peanut butter chucks, raisins, whole grapes, stringy meats, gum & gummy-textured candy, hard candy or jelly beans, hard fruits or vegetables, and hard lumpy food products. These under chewed foods can obstruct the airways in the baby's lungs and their eating skills aren't fully developed yet. Developmental readiness begins 6-8 months.
What are the differences between Breast milk, cow-based and soy based formulas, and cow's milk?
Breast milk = 7% protein calories, 38% carbohydrate calories, and 55% fat calories. IT is recommended that exclusive breast feeding is done in the 1st 6 months and continuing onto the 1st year of life. This should be done immediately after giving birth since infants less than 6 months of age are NOT allowed any other liquids or foods except for this and formula. Their growth rate and health status will indicate the adequacy of the baby's intake since it is more than the VOLUME of breast milk or formula. Each standard infant formula provides 20 kcal/fl. oz. Cow based formula = 9-12% protein calories, 41-43% carbohydrate calories, and 48-50% fat calories. Soy based formula = 11-13% protein calories, 39-45% carbohydrate calories, and 45-49% fat calories. Soy formula usage isn't recommended for managing infantile colic. Lactose free and hydrolyzed formulas are better for infants who are unable to breastfeed or have cow's milk formula. Cow's milk = Iron deficiency anemia can develop when it is introduced too soon in infancy. This anemic deficiency is linked to GI blood loss, Low absorption rates of calcium & phosphorus, iron-rich foods being displaced, and it may be introduced to the baby's diet only because infant formula is very expensive nowadays.
What is colic? Does it ever go away and if so when? What is the cause? How is it treated?
Colic is a sudden onset of irritability, fussiness or crying. The episodes may appear at the same time each day for the same duration. However, it usually disappears at the 3rd or 4th month of age. There is an unknown cause to it but it may have something to do with an upset GI tract and how the infant is being fed with practice. Treatment for this is rocking, swaddling, or other soothing methods to calm the baby down, position them for better eating, and pat their back so that they burp and relieve gas.
Nutrition Intervention for Risk reduction: What is Early Head Start? What types of programs does Early Head Start assist families with coordinating? What are newborn screening programs? Four are discussed in your book. Briefly, explain each one
Early Head Start Program Works with families at risk such as drug abuse, infants with disabilities, or teenage mothers Model program: Newborn Screening Phenylketonuria, galactosemia, hypothyroidism, or sickle-cell disease
What is iron deficiency anemia? How common is it during infancy?
Even though it is less common in infants than in toddlers and it is more common in low-income families, it is the iron stores in the infant and they reflect on the mother's diet on how her iron stores are doing.
Food Allergies and Food Intolerances: How long does it take the infant's immune system to develop? Why is it difficult to determine if it is an allergy, sensitivity, or intolerance? What is the prevalence of allergies that develop during infancy? How might an infant develop a food allergy? How is it confirmed? What are the common symptoms? What is the treatment for a suspected protein intolerance? What is recommended for infants whose family has a known history of food allergies/intolerances? When allergy foods are restricted, what two factors should be considered?
Exclusive breastfeeding for ≥4 months protects against allergies, dermatitis & wheezing. It takes an infant a few years to fully develop their immune system and GI tract. It is difficult to determine an allergy, sensitivity, or intolerance since only about 6-8% of children less than 4 yrs. old have allergies that begin in infancy. They aren't confirmed in lab tests until after infancy. Common symptoms for this is wheezing and skin rashes. Development of food allergies influenced by numerous factors: genetics, duration of breastfeeding, time of introduction of other foods, maternal smoking, air pollution, exposure to infectious disease, maternal diet and immune systems. No scientific evidence shows gassy foods in mother's diet produce gas in infant Low-allergen maternal diet associated with reduction in distressed behavior (colic) Allergenic foods eliminated were cow's milk, eggs, peanuts, tree nuts, wheat, soy, & fish Food Allergies and Intolerances After illness, the intestinal lining becomes inflamed and it allows protein fragments to be absorbed. These protein fragments are hypothesized to trigger a reaction against the "foreign protein fragment" and absorption of intact proteins causes allergic reactions. Treatment for suspected protein intolerance is a formula with hydrolyzed proteins that has enzymatically digested protein or single AA. They can be expensive and older infants might not like the flavor. Also, those with a known family history of allergy/intolerance can decrease this risk by breast feeding with NO soy infant formula and post pone the introduction of "Allergy Foods" of wheat, eggs, and peanut butter food products. Restriction of "allergy foods" may decrease nutritional adequacy and reinforce rejecting behaviors regarding food and variety.
Cross cultural considerations and vegetarian/vegan diets: What are harmful cultural practices? What factors should be considered regarding assistance programs and counseling families on infant feeding practices? Based on the type of diet (vegetarian, vegan, macrobiotic, & restrictive), which infants might have their growth effected? What supplements should the breast-fed vegan baby receive? What assessments should be conducted for these babies? What are the risks for the vegetarian/vegan baby when considering food allergies?
Harmful cultural practices are baby foods that do not reflect on ethnic diversity and they harm it by pre-chewing meats and giving infant meats. Infants will be the ones to have their growth statuses effected the most. Cultural considerations may impact willingness to participate in assistance programs since everyone must be mindful of dignity and practice respect and sensitivity towards others. Supplements that infants might take if they are being veganly breast fed are Vitamin D, Vitamin B12, and possibly iron and zinc. Periodic assessments conducted are the food & nutrient intakes and the growth & health statuses. Risks when considering food allergies for a vegan baby are soy, wheat, and nuts.
What is lactose intolerance? What are the symptoms? How common is it? Lactose intolerance can be confused with two conditions, what are they? What is the treatment for lactose intolerance?
Lactose intolerance is the Inability to digest the disaccharide lactose and it is a deficiency in the Lactase enzyme. The symptoms and characterizations of this are cramps, nausea, pain and alternating diarrhea and constipation. Lactose intolerance in uncommon and tends to be overestimated. It can be easy to confuse it with colic and GI infections can interfere with lactose digestion. Lactose free formulas are available Modified corn starch or sucrose
What is Physical Growth Assessment? Why is it important to measure growth accurately? How are measurement errors avoided? What type of growth charts are utilized and why?
Physical Growth Assessment is when newborn grow faster than any other time in life. Their growth reflects their nutritional adequacy, health status, and economic & environmental adequacy. Being that there is a wide range of normal growth within infants, calibrated scales & recumbent length measurement board are required for accurate measures. Measurement errors can be avoided by having the baby lay as still as possible with no added weight or length as this can mess up their growth records. Eyes looking straight up, no bent hips or knees, heels measured with feet flat against the foot board, and the head circumference at widest part of head will get the best measurement of the infant. The types of growth charts used is the 2006 WHO CDC growth chart because for infants anywhere from 0 - 24 months old, it measures their weight-for-age, length-for-age, weight-for-length, and head circumference for age. The more times a baby is measured and their growth is plotted, it will be more likely their growth patterns will be more distinct. -Underweight Weight-for-age <3rd percentile -Stunted Length-for-age <3rd percentile -Wasted Weight-for-length <3rd percentile -Risk of overweight Weight-for-length >85th percentile -Overweight Weight-for-length >97th percentile -Obese Weight-for-length >99.9th percentile
What is SGA, AGA, LGA, and IUGR?
SGA = Small for gestational age AGA = Appropriate for gestational age LGA = Large for gestational age --> The newborn is GREATER than the 90th% percentile for their weight and age. IUGR = Intrauterine Growth Retardation --> The newborn here was LESS than the 10th% percentile for their weight and age.
What are the 8 major reflexes found in newborns? What are the 16 gross motor skills? What are the 6 sub-stage sensorimotor stages of development?
The 8 major reflexes in newborns are as follows: 1. Babinski --> A baby's toes fan out when foot sole is stroked. 2. Blink --> Baby's eyes close to bright lights or loud noises. 3. Moro --> Throwing your arms out and then inward (as if embracing) 4. Palmar --> Grasping an object when placed in the palm of the hand. 5. Rooting --> Stroking a baby's cheek and its head turns towards the stroked cheek and opens its mouth. 6. Stepping --> Baby is held upright by an adult and then moved. 7. Sucking --> Sucking on an object when placed in the mouth. 8. Withdrawal --> A baby withdrawing its foot when its sole is pricked with a pin. The 16 gross motor skills are as followed: 0. Fetal posture - 0 months 1. Chin up - 1 month 2. Chest up - 2 months 3. Reach and miss - 3 months 4. Sit with support - 4 months 5. Sit on lap; grasp object - 5 months 6. Sit on high chair; grasp dangling object - 6 months 7. Sit alone - 7 months 8. Stand with help - 8 months 9. Stand behind furniture - 9 months 10. Creep (crawl on the ground) - 10 months 11. Walk when led - 11 months 12. Pull to stand by furniture - 12 months 13. Climb stair steps - 13 months 14. Stand alone - 14 months 15. Walk alone -15 months The 6 sub-stages of the sensorimotor development stages are as follows: 1. At 0-1 months old, the reflexes become coordinated and the baby can suck on the nipple. 2. At 1-4 months old, the primary circular reactions start appearing in the baby as they learn their first reaction from sucking its own thumb. 3. At 4-8 months old, the secondary circular reactions come out and the infant explores the world around them as they shake a toy to hear it rattle. 4. At 8-12 months old, the means-end sequencing of schemes is seen here and the baby has intentional behavior now as they move obstacles in order to reach for a toy. 5. At 12-18 months old, the teritary circular reactions are developing in the baby's mind as they experiment with different toy sounds as they shake and hear the noises they make. 6. At 18-24 months old, symbolic processing is shown in the baby's language, gesture, and pretend play as they pretend to eat their food with their pretend fork.
Diarrhea and Constipation: What are the causes of diarrhea and constipation?
The causes of diarrhea & constipation are viral and bacterial infections, food intolerances, and changes in fluid intakes.
What is the development of infant feeding skills? Review associations with the feeding experience such as positive/pleasant reactions to eating vs. negative/unpleasant reactions to eating. Be able to apply this knowledge to situations.
The development of infant feeding skills are the reflexes they are born with where they have rooting, mouthing, head turning, gagging, swallowing, and the coordination of breathing and swallowing. This would be their food intake regulatory mechanism. Self-regulation of feeding is mediated by the pleasure of feeling full and having an inherent preference for sweet tasty foods. This is key to having successful feeding experiences. However, pain and discomfort (GER and constipation) can replace pleasure with discomforting eating habits. It can set up cycles of negative and frustrating eating associations for the parents whenever their child has a mealtime behavioral problem.
What are the Energy and Nutrient Needs of infants? Know how to calculate calories and protein needs based on age of the infant. What are the fat requirements during infancy? What are the other nutrients and non-nutrients during infancy?
The energy and nutrient needs of an infant are the HIGHEST per pound than during any other life cycle portion of their lives. Recommendations for infants are from the Dietary Reference Intakes (DRI), National Academy of Medicine, AAP, the Academy of Nutrition and Dietetics, the European Society of Pediatric Gastroenterology, and Hepatology, & Nutrition Committee on Nutrition. They also need energy, protein, fat, metabolic rate, and calorie needs. Energy in calories is 108 kcal/kd/day from birth to 6 months. (The range is from 80 - 120.) Protein needs are 2.2 g/kg/day. Energy in calories is 98 kcal/kg/day from 7 - 12 months. Protein needs are 1.6 g/kg/day. Look at the weight-for-age and length-for-age percentile chart and look for the pounds of the individual and switch it over to kg. Once you've got that, dependent on how old the infant, multiply the appropriate energy and proteins needs to them and that's your answer. Fat requirements during infancy aren't recommending any specific intake levels. The fat calories that they get from being breastfed are 55%. Fat needs in cholesterol are important for gonad, brain, liver, muscle, and heart development since breast milk is easily digestable and usable in short-chain and medium-chain fatty acids than long-chain fatty acids which is found in infant formulas. It provides essential fatty acids (DHA & EPA) and infants can't fast from food for too long because they use up their carb and fat energy sources quickly. Other nutrients needed for the infant are 0.1 - 0.5 mg/day of fluoride dependent on their age, Vitamin D at 400 IU/day, Sodium for 120-200 mg/day, Iron is at 11 mg for infants ages 7-12 months, there aren't any recommendations for fiber, and then no lead whatsoever since it may be toxic.
When should an infant begin weaning from breast/bottle? When should an infant begin drinking from a cup? Why an open cup?
The infant should start weaning from the breast and bottle at 6 months of age and should be offered water or juice. After that, they should start drinking from a 1-2 oz. cup at 12 to 24 months of age. Starting to drink from an open cup with help with their advanced stages of mouth and tongue skills and speech development.
What are risk factors for developing iron deficiency anemia? What are the long-term consequences? What is the treatment for breast fed babies and infant formula fed babies?
The risk factors for developing iron deficiency anemia is if the infant had a low birth weight, elevated lead intakes, and are under the nutrition standards of what they should be getting. The long-term consequences of this are learning delays. Treatment for this consists of iron supplements and iron-fortified cereals at 6 months and Iron-fortified formula at 15 mg/liter of iron.
What increases the risk of developing baby bottle caries and ear infections? How can baby bottle caries and ear infections be prevented?
They are both linked to feeding practices esp. at night time. Formulas, juices, or other high-carb beverages at bedtime and during sleep can cause less swallowing and pooling of fluids pool in the mouth and it makes this a perfect way for bacteria in the mouth to feed on and cause tooth decay. Likewise, shorter and more vertical ear tubes are under a different pressure while sucking on a bottle and the liquid doesn't fully drain from the ear tubes. When an infant lying on his/her back Liquid buildup in tubes increases the risk of infection. To prevent this, limit the use of bedtime bottle, offer juice in cup, only give water bottles at bedtime, and examine and clean emerging teeth.
What factors decrease the risk of constipation? Should high fiber foods be recommended for constipation? Why? What are the general recommendations for diarrhea?
To avoid the risk of the infant becoming constipated, they should be getting adequate fluids, avoid medications UNLESS it is prescribed for them, and avoid soybean based formulas since it might make them more constipated than whole cow milk formula. High fiber foods are NOT recommended to infants since they are a CHOKING HAZARD. Excessive fruit juice intake can cause diarrhea in older infants, so it is recommended that they feed on their usual diet of breast milk and formula while having diarrhea since it can lead to serious dehydration.