NUTRITION CH 12

Which of the following is best barometer of nutritional status? a. BMI b. bone growth c. length d. weight

bone growth

Formula Preparation

1. Clean all necessary equipment and wash hands before preparing formula. 2. Read formula label and dilute formula exactly as recommended by the manufacturer. 3. Use cold tap water for preparation of concentrated or powdered formula, unless directed otherwise by physician or nurse. 4. Never heat formula in a microwave oven. 5. Discard unused prepared formula after 2 hours.

An infant with stunted growth, edema, skin sores, and discoloration of dark hair to red or blond has which type of malnutrition?

kwashiokor

Should a parent be alarmed if their child displays these eating behaviors? • Wanting foods plain, with no sauces and not mixed together • Varying interest and lack of interest in food, with appetites that go up and down • Food jags—eating only a few foods day after day or week after week until the next food jag starts

no, these changes are considered normal for the preschool child

Toddlers

▶ 1 to 3 years old ▶ Energy and protein needs are high compared with adult needs ▶ Wide range of energy needs ◦ Velocity of growth ◦ Level of physical activity ▶ Muscle mass, bone structure, and other body tissues continue to grow rapidly ◦ Require an adequate dietary supply of protein, minerals, and vitamins ▶ Daily intake of 19 g of fiber is recommended to prevent constipation

Adolescence Physical Growth - Body Composition

▶ 12 to 18 years old ▶ The final growth spurt of childhood ◦ Increasing body size ◦ Development of sex characteristics ▶ Girls ◦ More subcutaneous fat in the abdominal area ◦ Pelvis widens ◦ Increase hip size ▶ Boys ◦ Increased muscle mass ◦ Long-bone growth

Preschool-Aged Children

▶ 3 to 5 years old ▶ Physical growth and appetite continue in spurts ▶ Food jags are common ▶ Group eating ◦ Significant means of socialization ◦ Food preferences trend toward what the group is eating ▶ A healthy eating habits developed during this time set the stage for eating behaviors throughout childhood

School-Aged Children

▶ 5 to 12 years old ▶ Generally slow and irregular growth rate ▶ Girl's development usually bypasses that of boys ▶ Parental food habits have the most influence on a child's eating behavior ▶ Screen time ◦ High-risk television behaviors are correlated to long-term negative effects on food habits and risk for obesity ▶ Peer food habits ▶ School environment

Anorexia Nervosa

▶ A serious, potentially life threatening eating disorder that is characterized by self-starvation ▶ Self-starvation can lead to deficiencies in essential nutrients and energy required for the human body to function normally

Nutritional Requirements for Growth Protein Needs

▶ As a child gets older and the growth rate slows, the protein requirements per kilogram of body weight gradually decline ▶ The protein requirements of an infant for the first 6 months of life: ◦ 1.52 g/kg ▶ The protein needs of a fully grown adult: ◦ 0.8 g/kg

Feeding for Mature Infants Breast Milk

▶ Breast milk is the ideal first food for infants ▶ When mothers are away from their infant for several hours ◦ May use manual expression or a breast pump ◦ Breast milk can be stored and frozen in sealed plastic baby bottle liners for later use

Feeding for Mature Infants Summary Guidelines

▶ Breastfeeding should be continued for at least the first full year of life ◦ It should be supplemented with a vitamin K shot at birth and daily vitamin D drops ▶ Iron-fortified formula should be used for any infant who is not breastfeeding ▶ Water and juice are unnecessary for breastfed infants during the first 6 months of life ▶ Solid foods may be introduced at approximately 6 months of age ▶ Whole cow's milk may be introduced at the end of the first year ◦ Reduced-fat or fat-free cow's milk is not recommended until after the age of 2 years ▶ Allergens (e.g., wheat, egg white, citrus juice, nuts) should not be given as the first solid foods ◦ Should be introduced soon after traditional solid foods are tolerated ▶ Honey should not be given to an infant who is younger than 1 year old ◦ Botulism spores ▶ Foods with a high risk for choking and aspiration should not be given to infants ◦ Hot dogs, nuts, grapes, carrots, popcorn, cherries, peanut butter, round candy

Feeding for Mature Infants Weaning

▶ By 6 to 9 months of age ▶ As increasing amounts of other foods are introduced

Nutritional Requirements for Growth Calcium

▶ Calcium needs are critical during the most rapid growth periods of infancy through adolescence ▶ Infancy: mineralization of the skeleton, bone growth, and formation of teeth ▶ Approximately 40% of adult peak bone mineral density is deposited during the short period of adolescence ▶ Calcium absorption, calcium deposition in bone, and calcium retention ◦ Peak just before puberty

Bulimia Nervosa

▶ Characterized by repeated episodes of binge eating and purging ▶ Binge eating: a consumption of a quantity of food that is large in size for the person and the amount of time ▶ Purging: compensatory behavior used to prevent weight gain. Methods include vomiting, laxative or diuretic abuse, enemas, fasting and excessive exercise

Growth and Development Childhood

▶ Childhood growth rate slows and becomes irregular ▶ Growth occurs in small spurts ▶ Appetites usually taper off during periodic plateaus

Nutrition Problems During Childhood Obesity - Recommendations

▶ Choose specific meal times ▶ Provide a wide variety of nutrient-dense foods rather than "junk" foods ▶ Offer an age-appropriate portion size ▶ Limit nonnutritive snacking and the use of juice or sweetened beverages ▶ Encourage children to regulate their own food intake based on intuitive eating principles ▶ Have regular family meals to promote social interaction and to role mode healthy food-related behavior ▶ Limit screen time ▶ Make physical activity a daily family affair

Feeding for Mature Infants Breast Milk Substitute

▶ Choosing a commercial infant formula ◦ Milk allergy or intolerance: Soy-based formula ◦ Allergic to cow's milk and soy-based formulas: amino acid-based formula ▶ Preparing the formula ◦ Manufacturer's instructions ◦ Refrigerate until use ◦ Bottles should be heated in a bowl of warm water (not in a microwave) ▶ Feeding the formula ◦ Never prop the bottle or leave the baby alone to feed ◦ It allows milk to pool in the mouth - choking, earache, or baby bottle tooth decay

Feeding for Mature Infants Cow's Milk

▶ Cow's milk is not recommended during the first year of life ▶ Unmodified cow's milk is not suitable for infants ◦ Too heavy a load of solutes for the infant's GI tract and renal system ▶ Children between the ages of 1 and 2 years ◦ Should not be fed reduced-fat cow's milk (e.g., skim or low-fat milk) ⚫ Insufficient energy ⚫ Lacks linoleic acid (essential fatty acid for growth found in the fat portion of the milk)

Nutritional Requirements for Growth Iron

▶ Essential for hemoglobin formation and cognitive development ▶ Infants of mothers with iron-deficiency anemia during gestation are at risk for iron-deficiency anemia at birth ▶ Iron content of breast milk is highly absorbable and fully meets the needs of an infant for the first 6 months of life ▶ Infants who are not breastfed need an iron-fortified breast milk substitute

Nutritional Requirements for Growth Water Requirements

▶ Infants required more water per unit of body weight than adults ◦ A greater percentage of the infant's total body weight is composed of water ◦ A larger proportion of the infant's total body water is in the extracellular spaces ◦ Infants have a larger proportional body surface area and metabolic rate ▶ In 1 day, an infant generally consumes amount of water that is equivalent to 10 - 15% of his/her body weight

When to Introduce Solid Food

▶ Introduce solid food at 6 months ◦ Tongue movement allows swallowing ◦ Muscle development allows infant to sit up ◦ Digestive system and kidneys have matured ◦ Less likely to develop food allergies ◦ Iron-fortified cereals are well tolerated

Feeding for Mature Infants Solid Food Additions

▶ Iron-fortified solid foods should be added at approximately 6 months of age ▶ The American Academy of Pediatrics note other signs of readiness ◦ Can the infant hold his or her head up? ◦ Does the infant open his/her mouth in anticipation of food coming his/her way? ◦ Can the infant move the food from the spoon to his/her throat to swallow? ◦ Is the infant large enough?

Premature Infants Physiologic Delays

▶ More body water, less protein, and fewer mineral stores ▶ Little subcutaneous fat to maintain body temperature ▶ Poorly calcified bones ▶ Incomplete nerve and muscle development - sucking reflexes weak or absent ▶ Limited ability for digestion, absorption, and renal function ▶ Immature liver ◦ Lack developed metabolic enzyme systems or adequate iron stores

Growth and Development Infancy

▶ Most infants double their birth weight by 6 months and they triple it by 12-15 months of age ▶ Infants generally increase their birth length by 50% during the first year and double it by 4 years of age

Adolescence Physical Growth - Bone Mineral Density

▶ Reach its peak velocity of accumulation during the preadolescent years (≈ 8 years old) through about age 20 ▶ Linear growth reaches its peak ◦ Female: 16 years of age ◦ Male: 21 years of age ▶ Balanced diet with calcium containing dairy or dairy substitutes ▶ Recommended calcium intake: 1300 mg/day ▶ Even when supplemented with calcium, bone mineral density does not reach the same level as those who consume naturally high calcium diet

Milk Content for Premature Infants

▶ The American Academy of Pediatric recommends normal feeding of breast milk to premature and other high-risk infants ▶ Mothers of preterm infants produce milk that is significantly higher in energy, carbohydrates, protein, and fat to meet the elevated needs of preterm infants

Nutritional Requirements for Growth Vitamin Supplements

▶ The American Academy of Pediatrics recognizes only 2 vitamins that are potentially needed in supplemental form ◦ Vitamin K ◦ Vitamin D ▶ Nearly all infants born in the U.S. and Canada receive a one-time prophylactic injection of 1 mg of vitamin K at birth ▶ It is recommended that breastfed infants receive oral vitamin D drops (400 IU) beginning at hospital discharge

Growth and Development Adolescence

▶ The onset of puberty begins the second stage of rapid growth ▶ Levels of growth hormone and sex hormones rise ▶ Long bones grow quickly ▶ Sex characteristics develop ▶ Fat and muscle mass increase significantly

The total daily caloric intake of an average 5-year-old child is spent in the following way

◦ Basal metabolism: 50% ◦ Physical activity: 25% ◦ Tissue growth: 12% ◦ Fecal loss: 8% ◦ Thermic effect of food: 5%