ntr 315 exam 2

How does breast milk compare to infant formula (cow) in protein, carbohydrates, and fats? What are the advantages of breast milk compared to formula?

*Breast Milk* -Higher in fat (55%) -7% protein (casein 40% and whey 60%) -38% CHO *Infant Formula Cow Milk* -49% fat -Formula is slightly higher in protein (9%) (casein and 40% whey) & 42% CHO *Soy Formula* -Highest in protein (12%) Cow and soy doesn't have immunological factors like breast milk

Describe the risks/conditions associated with prematurity

*Heart* -Patent Ductus Anteriosis - basically babies have a hole in their heart and if they are born prematurely then that hold may stay open >The duct is open that allows the baby's blood to flow to the lungs before birth *Gastrointestinal* -Necrotising Enterocolitis - condition with damage or inflammation to a section of the intestine -Gastroesophageal Reflux - acid of the stomach moving up the esophagus, makes them not want to eat / they associate pain with eating and will likely lead to feeding problems *Lung* -Respiratory Distress - the lungs are the last organs to develop so they have respiratory distress (common in most babies born at 37 weeks or less) *Central Nervous System* -Cerebral Palsy - affects motor function; many of the neurological conditions and causes associated with cerebral palsy are closely linked to preterm delivery. Preterm babies also have an increased rate of infection, another significant risk factor for cerebral palsy. Caused by not getting enough oxygen to the brain -Mental retardation -Learning disabilities *Eyes* -Poor vision *Bones* -Osteopenia - low bone density, which in turn leads to low nutrients stores, and brain issues

What are the recommendations for energy, protein, and fat during infancy? How do these recommendations compare to adult recommendations

*Infants* -50% of total kcal should come from fat -1.5g/kg body weight of protein -About 100 kcal per kg of body weight *Adults* -No more than 35% of total kcal should come from fat -0.8-1.0 g/kg protein -40 kcal/kg of body weight

Under what conditions would a preterm infant be fed by the following feeding modalities?

*Parenteral (IV)* -Peripheral vein - short term; used if the child just needs some extra fluids -TPN (central) - long term; does through the peripheral vein and is routed to the heart, can deliver a lot of nutrients long term; does to the heart; can also go to the umbilical line (IV) used if child is having problems digesting in GI tract *Enteral (tube feedings)* -Gavage (shorter term) >Nasal gastric: goes through nose to stomach >Oro gastric: goes mouth to stomach (more common) -Gastrostomy (G tube) - put to stomach and deliver breast milk through port. After TPN. Port into stomach through belly for long term feeding -Transpyloric feeding - does past pyloric valve that separates stomach and intestines -> directly to intestines. Used particularly for kids with GERD >Bottle feeding / breast feeding: if they've developed the sucking reflex then they can be fed fortified breast milk or preterm formula

Why has the US seen an increase in preterm births in the past 25 years?

-1 in 8 births is preterm (2nd highest in the world -Older mothers (getting pregnant later in life) -Infertile couples using fertility drugs end up with multiple fetuses -Really hard to sustain a pregnancy with so many babies -C section - can be pretty inaccurate about estimating the gestational age of the child

Compare the protein recommendations of infant, toddlers, and preschoolers

-3-4 g/kg for preterm infants -1.5 g/kg for infants -1.1 g/kg for toddler -0.95 g/kg for preschoolers

What is the average length of gestation for a full-term pregnancy? At how many weeks gestation is a newborn considered to be preterm? At how many weeks gestation is a newborn considered to be post term?

-40 weeks is considered full term -Below 37 weeks is preterm -Over 42 weeks is considered post term -Normal is considered 37 to 42 weeks

Why would a preterm infant younger than 26 weeks be fed a formula that is lactose-free?

-A baby doesn't develop the lactase enzyme until 35 weeks -They have decreased digestive enzymes -Sucrose develops at 27 weeks and lactase develops at 35

At what age is it appropriate to serve low-fat or fat-free cow's milk? Why?

-Age 2 -They need all that extra fat for brain development from 0-2 years old -After that, you can serve lower % fat milk, but you cannot feed them milk until they are 1 -They can have whole milk from 1-2 years old and can switch to low fat at 2 years

What are appropriate / inappropriate foods and textures for an infant during the first year of development?

-Appropriate: single ingredient food, iron fortified cereals, pureed (strained) meats, strained fruits and vegetables -Inappropriate: cow's milk, any food that can cause choking, honey, very salt and sweet foods, excessive juice

What is colic and how long does it generally last?

-Babies cries at least 3 times a day, 3 times a week, for 3 months -Colic is when a baby, for no apparent reason, is really fussy and cries for hours at a time, often at the same time everyday -Starts 2-6 weeks after birth will last from 12-16 weeks

What are some of the causes associated with low birth weight?

-Being premature, using drugs, and smoking -Fertility drugs, multiple pregnancy, caesarean sections, advancing age of first-time moms, preeclampsia (high blood pressure), eclampsia (seizure), HTN, chronic diseases, poor maternal nutrition, substance abuse and tobacco use, stress

What vitamin supplements/fortified foods are recommended for breast fed versus formula fed infants (0-1 year old)?

-Breast fed infants: vitamin D, fluoride, and iron supplementation -Formula fed: need fluoride and iron supplementation, but doesn't need vitamin D since formula has it already -Both types of infants only need B12 supplementation if the mother is a vegan, and both need vitamin K at birth to prevent bleeding

At what age does an infant generally crawl? At what age does an infant generally walk?

-Crawls at 8-10 months -Walks at 10-12 months

Why is infant diarrhea a serious problem that needs immediate attention?

-Diarrhea is caused by an infection or feeding intolerance; cannot get the nutrients the infant needs -Can be very serious because the baby can lose a lot of water and electrolytes

What foods typically cause choking in infants?

-Hotdogs (not until they're 3) -Nuts such almonds -Grapes -Raisins -Cut meats that are coarse -Hard raw veggies -Popcorn -Peanut butter

At what age should an infant start solid foods? Why?

-However, by ages 4 months 6 months, most babies are ready to begin eating solid foods as complement to breast-feeding or formula-feeding -It's during this time that babies typically stop using their tongues to push food out of their mouths and begin to develop the coordination to move solid food from the front of the mouth to the back for swallowing -Their iron stores deplete by 6 months -Solid food can also help normal flora develop

What are the changes of survival for an infant born before 25 weeks compared to an infant born after 27 weeks gestation?

-Infant born at 24 weeks has 40-70% chance to survive and after 27 weeks the infants has a 90% or greater -1% survival if 22 weeks or lower

Why are fluid needs so high in preterm infants?

-Insensible water loss which is when they lose water through the skin and the respiratory system (and they have a high respiration rate) -Normal babies lose 10% and preterm lose 15%

What are the risk factors of lead poisoning? What are some sources of lead in the environment and how is lead poisoning prevented?

-Iron Deficiency / Calcium Deficiency >They all bind the same binding proteins, when you have less of iron and calcium then you could have a worse case of lead toxicity because it has a better chance to bind to these binding proteins >Effect on development >Cognitive / behavioral >Decreased growth >Central nervous system is affected *Treatment* -Removed lead from environment like the old paint from houses -Routine screenings to make sure the child hasn't been exposed -Chelation therapy for high exposures, this will bind the lead and take it out of the body

Many toddlers and preschoolers do not meet recommendations for iron, vitamin D and calcium. Describe diseases / symptoms associated with these nutrient deficiencies

-Iron deficiency - low growth rate -Vitamin D - rickets, bone formation -Calcium - low bone mass, osteoporosis, abnormal heart rhythm

What are the concerns with feeding large amounts of juice to infants?

-It is very caloric; can contribute to dental cavities -Can also cause diarrhea and has a lot of sugar alcohols like sobitol

What type of formula(s) is (are) appropriate for following conditions? Why?

-Lactose intolerance - lactose-free formula = term infant formula without lactose -Cow's milk allergy - soy formulas or protein hydrolysates -Feeding intolerance to protein - protein hydrolysates or elemental formula (give hydrolysate first, and give elemental formula if hydrolysates are not tolerated) -Prematurity - premature formula (hospital use) and premature discharge formula (home use) -Galactosemia - soy formulas

What are the energy/protein recommendations for premature infants (per kilogram (kg) body weight compared to healthy full-term infants?

-Needs for preterm and LBW infants >Energy ~120 kcal / kg / day ~(full term is usually about 100) >Fats ~50% of calories generally -About the same fat levels as full term >Fluid -Increased needs for fluids because of thin skin and high respiration rate ~Needs 135-200 mL per kg ~(full term needs about 100 mL)

Based on the recommended kilocalories for an infant, what are the approximate daily kilocalories recommended for 4 moth-old who weighs 10 pounds?

-Notes say about 100 kcal/kg of body weight -If you weigh 10 lb, that would be about 4.5 kg so the infant would need about 450 kcal

What are the criteria used to determine if a preterm infant is ready to go home from the hospital?

-Regulate body temperature -Breathe independently -Weigh > 1800 grams (4 lbs) -Enteral / oral feedings tolerated -Adequate kilocalories and nutrients -Gaining weight

If an older infant became iron deficient what are some possible causes? What are the symptoms of iron deficiency?

-Seen in mothers who were deficient -Babies who are not fed solid foods early enough since breast milk isn't sufficient in iron stores -High cow milk consumption -Babies who are born prematurely- more than three weeks before their due date- or have a low birth weight -Babies who drink cow's milk before age 1 -Breast-fed babies who aren't given complementary foods containing iron after age 6 months -Babies who drink formula that isn't fortified with iron -Children ages 1 to 5 who drink more than 24 ounces (710 mL) of cow's milk, goat's milk or soy milk a day -Children who have certain health conditions, such as chronic infections or restricted diets -Children ages 1 to 5 have been exposed to lead *Symptoms of Fe Deficiency*: -Irritable -Fatigued -Growth Restriction -Iron deficiency also causes impairment of growth, impaired motor development, and affects mental growth

At what age is it appropriate to serve cow's milk to infants? Why?

-Should wait to feed cow's milk until they are 12 months old -Reasons: protein and sodium content are too high; could develop an allergy to milk if they're not ready to digest it yet; very low in iron that is also not very bioavailable (this can cause them to develop iron deficiency anemia)

Describe the growth rate of toddlers and preschoolers as compared to infants

-The highest rate of growth is within the first year, then growth slows down, but is still on rise, just not as much as it would be in infancy -Growth rate established by 2 years of age

During infancy, what nutrients are needed in significantly higher amounts compared to adults, pound for pound?

-Vitamin A, D, E, and C as well as Iodine (and maybe Calcium) -Magnesium, iron and B6 are the only ones higher for adults

80% of preterm infants are born within the range of ________ week gestation

32 to 37 weeks

At what gestational age does the sucking reflex develop

32-34 weeks gestational age

The American Academy of Pediatrics recently came out with a new recommendation for iron supplementation in breast fed infants. At what age should iron supplementation begin in these infants?

4 months

An infant's birth weight would be considered healthy between what percentiles on a CDC growth curve?

5th and 85th percentile

How long does it generally take for a preterm infant born at a VLBW (28-32 weeks gestation) to catch up growth to a full term infant?

About 2 years

At ages 4-6 the BMI growth curve for age gradually rises from its low point. What is this rise called and why does it happen?

Adiposity rebound

In what ethnic population do we see vitamin D deficiency in young children?

African American and Hispanics are also affected

According to the American Academy of Pediatrics, what is the recommended fiber intake for a toddler who is 30 pounds and 2 years old? (2.2 lb = 1 kg)

Age + 5g = # of g/day

Low Birth Weight

Any birthweight under 5.5 lbs (32-37 weeks)

Extremely Low Birth Weight

Any weight under 2 pounds (22-28 weeks)

What is BMI for age and how is it used?

BMI for age for the child is used to compare to the average BMI for the child's age based on the other kids in the US. BMI for age is used to figure out if the child is overweight or obese or of normal weight. Not used to adults because they have stopped growing.

Underweight

BMI-for-age <5th

Overweight

BMI-for-age =>85th and <95th

Obesity

BMI-for-age =>95th

Why is vitamin K given as a single dose at birth?

Babies have very little vitamin K in their bodies at birth. Vitamin K does not cross the placenta to the developing baby, and the gut does not have any bacteria to make vitamin K before birth. After birth, there is little vitamin vitamin K in breast milk and breastfed babies can be low in vitamin K for several days. Vitamin K is also given to discourage excessive bleeding, by helping with forming blood clots

Joey is 12 1/2 months old and was born at 26 weeks gestation. He is 9 kg in weight and 71 cm in length. Using the growth chart below, plot Joey's weight and length for his corrected age. Is Joey's growth adequate for his corrected age?

Corrected Age = Chronological Age - Months Preterm x=12.5 - ((40-26)/4) = 9 months is corrected age Normal gestation is 40 weeks 40-26=14 weeks 50-14=36 weeks = 9 months

During early infancy, how often does an infant generally want to nurse or bottle feed?

Every 2-3 hrs

The American Academy of Pediatric recommends that a mother breastfeed her child for how long?

Exclusively for 6 months and to continue for at least 12 months

If an infant's growth declines more than 2 major percentile lines on a CDC growth chart and is plotted near or below the lowest percentile for weight and length, what condition would you suspect?

Failure to thrive: failure to gain weight as expected, often accompanied by poor height growth

What are the risk associated with enteral feedings?

Feeding intolerance aspiration, and Necrotizing enterocolitis (NEC)

What is the rooting reflex?

For example, your baby is born with a "rooting" reflex that prompts her/him to turn her/his head toward your hand if you stroke her cheek or mouth. This helps her/him find the nipple at feeding time. At first she'll/he'll root from side to side, turning her/his head toward the nipple and then away in decreasing arcs. But by about three weeks she'll/he'll simply turn her/his head and move her/his mouth into position to suck

Describe growth rate / BMR during infancy. By how much does an infant's length and weight increase during infancy?

Growth triples during the first year of life -Infant weight triples -Length increases by 50% (doubles) -Head circumference by 30% *Weight*: Your infant will double his birth weight by the time he is 6 months old. He iwll triple his birth weight by the time he is 1 year old. He will gain about 1 to 2 pounds per month. *Length*: Your infant will grow about 1 inch per month for the first 6 months of life. He will grow 1/2 inch per month between 6 months and 1 year of age. He should be 2 times longer than his birth length by the time he is 10 to 12 months old. Most of his growth will happen in his trunk (mid-section). *Head size*: Your infant's head will grow about 1/2 inch every month for the first 6 months. His head will grow 1/4 inch per month between 6 months and 1 year of age. His head should measure close to 17 inches around by the time he is 1 year of age

What are some hunger cues for young babies?

Hand in mouth, sucking motion, body movements, sounds, cries or fusses

What variables are used to calculate the energy needs (Estimated Energy Requirement - DRI) for preschool children?

Height, weight, age, gender, activity level

Honey should not be fed to infants who are under 12 months of age. Why?

Honey contains botulism spores that the baby cannot digest as well as an adult can and it is therefore dangerous to the infant

What are the benefits of enteral feeding compared to parenteral feeding?

Improve nutrient intake and GIT maturation, reduce jaundice, full-volume feedings tolerated earlier

Large for Gestational Age

Infants about the 90th percentile in birth weight

Healthy Birth Weight

Infants are usually born 5.5 lbs to 8.5 lbs and are in between the 10th and 90th percentile (32-42 weeks)

Describe the dip in BMI for age growth curve from ages 2-4. What does this dip indicate?

It represent growth of height, from 2-4 you grow a lot and weight does't necessarily grow accordingly to height so that causes a dip

Hyperbilirubinemia results from an immaturity of what organ system? What is a physical sign of hyperbilirubinemia?

Jaundice is a condition that makes a newborn's skin and the white part of the eyes look yellow. It happens because there is too much bilirubin in the baby's blood (hyperbilirubinemia). Bilirubin is a substance that is made when the body breaks down old red blood cells. It is an immaturity of the liver.

Small for Gestational Age

Less than 10th percentile

Very Low Birth Weight

Less than 3 and 1/3 lbs (28-32 weeks)

How do you know if an infant is ready to eat solid foods?

No extrusion reflex, opens mouth for spoon, can sit with minimal support

What physical measurements are taken to measure growth in toddlers 2 years of age?

Recumbent length and weight

What physical measurements are taken at each routine doctor's visit to assess growth of an infant?

Recumbent length, weight, and head circumference

High Birth Weight

Review says HBW includes post-term and large for gestational age (may it's greater than 8.5 lbs)

Why is protein added to soy formula?

Soy protein are deficient in some amino acids that babies need. Soy proteins aren't readily digested as proteins from breast milk, so they add more protein to the soy formula to increase changes of absorption

What DRI standard is used for expressing nutrient recommendations in infants?

The 2005 Dietary Guidelines for Americans the needs of children aged 2 and older- not infants. Recommendations for infants are from the Dietary Reference Intakes (DRI), which are based on research over decades on infant growth and health and from professional groups such as the National Academy of Medicine, the American Dietetic Association

All preterm infants have Respiratory Distress Syndrome. Why?

The lungs are the last organs to develop and if they have the left womb before they are ready then that would be likely to the something that hasn't fully developed yet

A child can meet his/her vitamin D needs by means other than foods or supplements. How?

The sun

Risks for nutrient deficiencies are high in preterm infants. Why?

They may not have gotten enough nutrients from the mother since they left the womb early; they also have low bone density which is where minerals are stored

What is the extrusion reflex?

This is when they'll push any food placed on their tongue out the front of their mouth. This is completely normal, and doesn't mean they don't like their food- it just means they're capable of swallowing it yet. Somewhere between four and six months the extrusion reflex should disappear, and it's from this point that you can look at giving your baby new types of food

Joey is 10 weeks old and was born at 26 weeks gestation. He is 2.4 kg in weight and 46 cm in length. Using the growth chart below, plot Joey's weight and length for his corrected gestational age. Is Joey's growth adequate for his corrected gestational age?

When it is counting weeks gestation (when they are really young), you add the age to the weeks gestation before birth (he was born at 26 weeks and is 10 weeks old as he is 36 weeks), but when you are dealing with older children, you use the formula she gave us: Corrected Age = Chronological Age - Months Preterm) to see the child's growth in comparison to other children

When feeding an infant it is recommended that you introduce new foods one food at a time over a 2-4 day period. Why?

You want to go slowly to check for allergies and intolerances