Nutrition, energy needs, and feeding patterns throughout the lifespan
Milk supply is adequate if 1. 2. 3.
1. infant gains weight and length 2. has frequent stools 3. 6-8 wet diapers/day
For hyperbilirubinemia, encourage ___ - ______ feedings per day of human milk or formula to promote ________ and intestinal mobility.
9-12 hydration
SGA (small) AGA (appropriate) LGA (large)
<10th percentile birth weight for gestational age 10th-90th percentile >90th percentile
Supplements calcium
<18 = 1300 mg >18 = 1000 mgs
AI (grams/day) 1. Alpha-linolenic acid - Men = - Female = 2. linolenic acid - Men = - Female =
AI (grams/day) 1. Alpha-linolenic acid - Men = 1.6 - Female = 1.1 2. linolenic acid - Men = 17 - Female = 12
FTT may result from
Acute or chronic illness, restricted diet, poor appetite, lack of fiber leading to chronic constipation, diminished intake
exclusive breastfeeding for first ___ months. Then supplemented by weaning foods for at least up to ______ months.
first 6 months 12 months
6-8 months of age add large finger foods (teething biscuits) than can be secured with a
palmar grasp
Gravida refers to:
pregancy
colostrum has more ______, ______ and _______ than mature milk.
protein, less fat and cho has antibodies yellowish transparent fluid secreted from the breast during 1st few days; meets infants needs during the 1st week
Maternal hormones from pituitary: 1. prolactin stimulates _____ __________. 2. oxytocin __________
1. prolactin = stimulates milk production 2. oxytocin = moves milk through ducts
Elderly should be encouraged to have
- Folate rich foods - supplements of b6 and b12 may be needed
Weight gain pace _____#/month first 3 months _____#/week thereafter
1# 1#
Supplements during pregnancy linolenic acid
1.4g/day linolenic acid (300 mg DHA; 1.3 g/day during lactation needed for development of fetal nervous system
Calcium for males and females ages 9-13
1300 mg AI
Athletes need water during physical activity: _______ ounces of water for every _____# body weight loss.
16 ounces 1 pound
calories during lactation 1st 6 months = 6-12 months =
1st 6 months = +330 6-12 months = +400 kcals
No whole cows milk during the
1st year of life
BMI for age percentiles start at age
2
Measure supine length until what age
2 years of age supine length (lying down)
Normal birth weight low birth weight (LBW) very low birth weight (VLBW) extremely low birth weight (ELBW)
2,500-4,000 grams <2,500 grams (<5.5#) <1,500 grams (<3.3#) <1,000 grams
Weight for Age used for birth-24 months and ___-______ years of age.
2-20 5th-95th
Human milk = ______ calories/ounce
20
2002 RDA Protein 1-3 years = 4-8 years = 9-13 years =
2002 RDA Protein 1-3 years = 13 grams 4-8 years = 19 grams 9-13 years = 34 grams
2002 RDA Protein Males 14-18 years = Females 14-18 years =
2002 RDA Protein Males 14-18 years = 52 grams Females 14-18 years = 46 grams
Growth usually does not deviate by more than
25 percentile points from the established pattern of growth *look for change in rate of growth as a potential risk
Elderly fluid needs
25-30 ml/kg
Limit fruit juice to how many ounces up to age 6
4 oz
Normal gestation is ____ weeks.
40
Breast-fed infants need ___________ vitamin D from birth and _______ mg fluoride/day after 6 months of age if water contains inadequate fluoride.
400IU .25 mg/day
Adulthood CHO = Fat = Protein =
45-65% cho 20-35% fat 10-35% protein
0-6 months weight length 7-12 months weight length
6 kg (13#) 24" (60 cm) 9 kg (20#) 28" (71 cm)
Muscle glycogen depleted in 2-3 hours of continuous exercise at ____-_____%.
60-80%
protein during pregnancy, and lactation ____ grams during second half of pregnancy
71 grams
BMI for age percentiles <5th 5th-84th 85th-94th >95th
<5th = underweight 5th-84th = healthy weight 85th-94th = overweight >95th or BMI >30 = obese
Adulthood RDA Protein >19 years Male = >19 years Female =
Adulthood RDA Protein >19 years Male = 56 grams >19 years Female = 46 grams
Composition human vs cow milk protein % cho % fat %
Human milk protein % = 7% cho % = 38% fat % = 55% -(more lactalbumin)* Cow milk protein % = 20% cho % = 30% fat % = 50%
Sodium AI 19-50 years Men and women = NaCl =
Sodium AI 19-50 years Men and women = 1.5 g/day NaCl = 3.8 g
Stature/length for age is used for 1. ___-____ month recumbent length 2. __-___ years height
Stature/length for age is used for 1. 0-24 month recumbent length 2. 2-20 years height
Sunken fontanel may be due to
dehydration or protein malnutrition
American Academy of Pediatrics has growth charts to assess children with ________ ________ no longer relfect the population and should not be used.
down syndrome
Creatine supplements do not enhance
endurance (not helpful for marathon runners or soccer players)
At risk weight gain
failure to gain 4#/month in last half of pregnancy <16 or >35 years old <12 months between pregnancies
FTT
failure to thrive
During low-moderate intensity aerobic activity (long duration, steady pace) (endurance training), ______ is a significant energy source.
fat
Low fat and non fat milks are inappropriate during the first ____ years of life
first 2 years of life
Minimum recommended Hbg and Hct levels during pregnancy
hemoglobin = 11 g/dl hematocrit = 33%
hemoglobin: newborn 6-23 months hematocrit: newborn
hemoglobin: newborn = 16.5 - 19.5 6-23 months = 10.0+ hematocrit: newborn = 49-54%
_________ needs are the same for boys and girls until age 10.
iron
Pregnant adolescent are at high risk and need extra
iron, calcium, zinc
one of the major reasons for large discrepancies in growth patterns is _______ ________ in _______________.
one of the major reasons for large discrepancies in growth patterns is HUMAN ERROR in measurement.
9-12 months of age add small finger foods (dry cereal) as what develops?
pincer grasp (thumb and forefinger)
Avoid excess intake of what vitamin during pregnancy
preform vitamin A (Supplements >5000IU)
Neonate, birth to month can absorb whole, intact ________
protein
During prolonged exercise, reliance on CHO to provide _________ for continued lipid oxidation.
pyruvate
Avoid what fish during pregnancy
shark swordfish king mackerel limit albacore and raw fish
Mary is a preschool teacher and is planning a picnic for the children's end-of-the-school-year party. Which of the following foods would be the best for Mary to bring? A. Hot dogs B. Strawberries C. Grapes D. Milk
B. strawberries bring food that does not commonly cause choking or allergic reactions most common choking: tough meats, hot dogs, nuts, grapes, hard candies, popcorn, and peanut butter Cow's milk protein is the most common single allergen for infants most common allergies: milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat
By 2 years, birth weight should be __________ and length should be increased by _____%.
By 2 years, birth weight should be quadrupled and length should be increased by 75%.
By 4th-5th month, birth weight should be ___________; by one year, birth weight should be _________ and length should increase by ____%.
By 4th-5th month, birth weight should be doubled; by one year, birth weight should be tripled and length should increase by 50%.
Growth charts for other special needs are based on relatively small populations. If used, use them along with the ______ or _____ growth charts.
CDC WHO
Exercise above 60-65% maximal oxygen uptake ______ is needed as a fuel source
CHO
For those who cannot tolerate cows milk-based or soy products use formulas made from
Casein hydrolysate (pregestimil)
Childhood 1-3 growth rate ________ 4-6 growth in ________ 7-10 growth _______
Childhood 1. 1-3 growth rate slows (food serving sizes 2-4 oz, 2-4T) 2. 4-6 growth in spurts 3. 7-10 growth slows
Symptoms of lead poisoning
Irritability, lethargy, anorexia, vomiting, diarrhea, and anemia
Athlete Hydration Before Exercise
Limited research indicates 10 ml/kg of high Na containing beverages (164 mEq/L) prior to activity 1 - 4 hrs long. May enhance maintenance of body core temp in mod-highly trained males 23 - 46 yrs old
Newborns initially lose ___% of birth weight; This should be regained by ____-____ days.
Newborns initially lose 6% of birth weight; This should be regained by 10-14 days.
Weight for Age a. NOT used to classify _______/_______ weight. b. ________ ________ marker of growth; affected by _________ nutritional stress or illness c. CANNOT distinguish between __________ and ___________ because it does not include height. d. further evaluation needed if below 5th or above the 95th percentile.
Weight for Age a. NOT used to classify UNDER/OVER weight. b. SHORT TERM marker of growth; affected by ACUTE nutritional stress or illness c. CANNOT distinguish between STUNTING and WASTING because it does not include height. d. further evaluation needed if below 5th or above the 95th percentile.
Weight for length/stature (5th-95th) a. identifies ______/_______ nutrition, or within normal limits b. detects _______ _______ changes in nutritional status c. used to distinguish between ___________ and __________. d. <5th may reflect _______ _________ or __________; >95th may mean _______- ___________.
Weight for length/stature a. identifies under/over nutrition, or within normal limits b. detects SHORT TERM changes in nutritional status c. used to distinguish between STUNTING and WASTING. d. <5th may reflect acute illness or wasting; >95th may mean over-nutrition.
Most dietary deficiencies in children seen when
adolescence, final growth spurt
stature/length for age a. defines shortness/tallness b. reflects _______ _______ nutritional status; determines extent of stunting c. affected by _____ _______ nutritional stress or _________ _____________. d. <5th = _______ ___________
stature/length for age a. defines shortness/tallness b. reflects LONG TERM nutritional status; determines extent of stunting c. affected by LONG TERM nutritional stress or CHRONIC ILLNESS. d. <5th = SHORT STATURE
Carb loading/glycogen loading
stores 2-3x the normal amount of muscle glycogen
Normal gestation = 40 weeks corrected, or adjusted, age corrects for the baby's prematurity and is calculated by....
subtracting the # or weeks premature from the chronological age. Actual age - weeks premature = corrected or adjusted age A baby is born 29 weeks gestation. Actual age = 7 months; corrected age??? 28 weeks (actual age) - 11 weeks (premature) = 17 weeks (corrected age)
BFHI
global effort to increase incidence and duration of breastfeeding (measurable outcomes) - hospital must show it implements ten steps to successful breastfeeding - requires multidisciplinary team
progesterone
hormone that develops placenta after implantation
Unconjugated bilirubin levels elevate within first week of life as a result of increased breakdown of _______ or decreased ______ ________.
hyperbilirubinemia RBC intestinal mobility
At 4-6 months when sitting posture can be sustained and extrusion reflex diminishes begin with
iron-fortified cereal (rice), then strained veggies or fruit
An infant born at _____ weeks is 12 weeks premature. Four months after birth, the growth parameters of him at _____ weeks can be compared with those of a _____ month old infant born at term.
28 weeks = 12 weeks premature four months after birth, growth parameters of him at 28 weeks can be compared with those of a one month infant born at term. 4 months chronologic age - 3 month correction factor = 1 month adjusted age
Weight gain guidelines for pregnancy BMI <18.5 = BMI 18.5-24.9 = BMI 25-29.9 = BMI >30 =
28-40# (underweight) 25-35# (normal) 15-25# (overweight) 11-20# (obese) *target is to at least achieve lower limit *Black and very young women: strive to achieve upper end to reduce risk
Calories during pregnancy 2nd trimester = 3rd trimester =
2nd trimester = +340 calories 3rd trimester = +452 calories
Measure head circumference or (OCF ____ _____ _________) until how many years of age
3 years of age OCF = occipital frontal circumference
Supplements ferrous sulfate folic acid
30mgs during 2nd and 3rd trimesters (taken between meals, not with milk, tea, or coffee) Folic acid 400 mcg (added to 200 from foods = 600)
Fluid needs in adults
35 ml/kg or 1 ml/calorie ingested
BMI for age percentiles is _____ and ______ specific
age and sex
How many minutes of physical activity for children
at least 60 minutes.day
A diet high in antioxidants (5) may delay development of cataracts.
beta-carotene selenium Vitamin C Vitamin E resveratrol
Weight for length/stature is used for birth-24 months and young children aged ___-____.
birth - 24 months 2-5 years of age
the elderly often lack__ and ___ due to decreased absorption as a result of decreased HCL
calcium and iron
0-6 months calories protein water fat
calories = 520 (Female); 570 (Male) protein = RDA 9.1 gram water = 125-155 ml/kg (based on age) fat = minimum of 30 grams/day
7-12 months calories protein water fat
calories = 676 (Female); 743 (Male) protein = 11 g (2.5-3g/kg/day) water = 1.5 ml/kg fat = minimum of 30 grams/day
Use WHO growth charts from ______ to _________ Use CDC growth charts from ___-_____ years of age.
- Use WHO growth charts from birth to 2 years of age - Use CDC growth charts from 2-20 years of age
Adequate Intake (AI) Total Fiber Adults under 50 years: Men = Female = Adults over 50 years: Men = Female =
Adequate Intake (AI) Total Fiber Adults under 50 years: Men = 38 grams Female = 25 grams Adults over 50 years: Men = 30 grams Female = 21 grams
Elderly (based on US Census Bureau) - Young old = - Aged = - Oldest old =
Elderly (based on US Census Bureau) - Young old = 65-74 years - Aged = 75-84 years - Oldest old = 85 years and up
At rest and during normal activities what is the primary energy source?
Fats = 80-90% cho = 5-18% protein = 2-5%
Fluid AI >19 years old Men = Women =
Fluid AI >19 years old Men = 3.7 L/day Women = 2.7 L/day
For the elderly, __________ needs decrease, _______ needs remain the same (___ gram/kg)
For the elderly, calorie needs decrease, protein needs remain the same (1 gram/kg)
In elderly there is constipation due to ___________ __________ _________ and Decreased HCl secretion in the stomach.
In elderly there is constipation due to decreased gastric motility and decreased HCl secretion in the stomach.
Infant formula a. 20 calories/ounce; need 2 1/2oz/lb/day b. has more ________, more ______ than human milk; but lacks antibodies c. Vitamin ____ requirement is met if infant receives at least 1 _______ of standard (vitamin ___ fortified) infant formula daily. d. formula fed infants only need fluoride (.25 mg/day) as supplement after 6 months if water supply is inadequate (<0.3 ppm) e. unmodified cow's milk in formula = inappropriate; tough hard curd; hard to ________; less ________; increased renal solute load f. Dried whey has _____% lactose; casein hydrolysate does not have lactose g. iron-fortified formula is recommended for all infants on formula
Infant formula a. 20 calories/ounce; need 2 1/2oz/lb/day b. has more protein, more iron than human milk; but lacks antibodies c. Vitamin D requirement is met if infant receives at least 1 quart of standard (vitamin D fortified) infant formula daily. d. formula fed infants only need fluoride (.25 mg/day) as supplement after 6 months if water supply is inadequate (<0.3 ppm) e. unmodified cow's milk in formula = inappropriate; tough hard curd; hard to digest; less EFA; increased renal solute load f. Dried whey has 73% lactose; casein hydrolysate does not have lactose g. iron-fortified formula is recommended for all infants on formula
Athlete Hydration During Exercise: continuous endurance physical activity of 1-4 hrs
rehydration beverages provided in a volume that equals.... - volume of 100% fluid lost during mod-vigorous activity plus - 5.5 - 15% CHO - 55 - 164 mEq Na ---> More effective in maintaining hydration in mod/high humidity compared to non CHO electrolyte solutions
Restore hydration in adults 19 years old AFTER continuous endurance physical activity of 1-2 hours induration
rehydration beverages provided in a volume that equals.... - 100-150% of fluid lost during exercise - 6-7.6% CHO - 57.5-1150 mg/dl sodium --> all more effective in improving hydration and endurance capacity than non-CHO electrolyte solutions
By around 6 months of age add one serving of ______-______ rich foods to enhance iron absorption from nonheme sources.
vitamin C
Adverse effects of carb loading, glycogen loading
weakness, bloating, dizziness, soreness
This growth chart is NOT used to classify under/over weight; it also CANNOT distinguish between stunting and wasting because it does not include height.
weight for age
