chapter 13
Nutrition during Lactation
A nursing mother produces about 25 ounces of milk a day -Energy cost: Producing milk costs a woman almost 500 calories per day above her regular need. •To meet this energy need, the woman is advised to eat an extra 330 calories of food each day. The other 170 calories can be drawn from the fat stores she accumulated during pregnancy •Fluid needs approx. 13 cups fluid/d to prevent dehydration •Nutritional deprivation of the mother reduces the quantity more than the quality of her milk. •Generally, infants with a strong family history of food allergies benefit from breastfeeding •Gradual weight loss (1 pound per week) is safe and does not reduce milk output. Too large an energy deficit, especially soon after birth, will inhibit lactation.
Risk Factors for Neural Tube Defects
A pregnancy affected by a neural tube defect can occur in any woman, but these factors make it more likely: A personal or family history of a pregnancy affected by a neural tube defect. Maternal diabetes. Maternal use of certain antiseizure medications. Mutations in folate-related enzymes. Maternal obesity.
Alcohol crosses the placenta freely and is directly toxic: -•Can halt the delivery of oxygen through the umbilical cord•A few minutes of alcohol exposure during fetal brain growth can exert a major detrimental effect•Interferes with placental transport of nutrients to the fetus and can cause malnutrition in the mother•Before fertilization, damage can be caused to the ovum or sperm in the mother- or father-to-be, leading to abnormalities in the child
A sudden dose of alcohol can halt the delivery of oxygen through the umbilical cord. The fetal brain and nervous system are extremely vulnerable to a deficit of oxygen or glucose, and alcohol causes both by disrupting placental functioning. Alcohol slows cell division, reducing the number of cells produced and inflicting abnormalities on those that are produced and all of their progeny. During the first month of pregnancy, the fetal brain is growing at the rate of 100,000 new brain cells a minute. Even a few minutes of alcohol exposure during this critical period can exert a major detrimental effect. Alcohol interferes with placental transport of nutrients to the fetus and can cause malnutrition in the mother; then all of malnutrition's harmful effects compound the effects of the alcohol. Before fertilization, alcohol can damage the ovum or sperm in the mother- or father-to-be, leading to abnormalities in the child.
underweight pregnancy
A woman who begins her pregnancy underweight and who fails to gain sufficiently during pregnancy is very likely to bear a baby with a dangerously low birthweight must gain weight before pregnancy A low-birthweight baby, defined as one who weighs less than pounds (2,500 grams), is nearly 40 times more likely to die in the first year of life than a normal-weight baby. Low birthweight is also associated with low adult IQ and other brain impairments, short stature, and educational disadvantages. Nutrient deficiency coupled with low birthweight is the underlying cause of more than half of all the deaths worldwide of children under 5 years of age. In the United States, the infant mortality rate in 2013 was just under 6.0 deaths per 1,000 live births.
formula feeding
Acceptable alternative to breastfeeding-made to copy breast milk composition as much as possible. •Meets all the energy and nutrient requirements for healthy, full-term infants during the first 6 months of life •Special formulas: available for infants with special conditions (soy, hydrolyzed protein, lactose-free) •Transition to cow's milk only after one year of age-composition very different. •Once the baby is obtaining ~2/3 of calories from a balanced diet (after 12 months of age), reduced-fat or low-fat cow's milk (in the context of an overall diet that supplies 30 percent of calories from fat) is an acceptable and recommended beverage.
Describe the roles of nutrition before and during pregnancy.
Adequate nutrition before pregnancy establishes physical readiness and nutrient stores to support placental and fetal growth. Both underweight and overweight women should strive for appropriate body weights before pregnancy. Newborns who weigh less than pounds face greater health risks than normal-weight babies. Implantation, fetal development, and critical period development depend on maternal nutrition status. The effects of malnutrition during critical periods are irreversible. Pregnancy brings physiological adjustments that demand increased intakes of energy and nutrients. A balanced nutrient-dense diet is essential for meeting nutrient needs. Folate and vitamin play key roles in cell replication and are needed in large amounts during pregnancy. Folate plays an important role in preventing neural tube defects. Choline is needed for normal development of the fetus's brain and spinal cord. Adequate vitamin D and calcium are indispensable for normal fetal bone development. Iron supplements are recommended for pregnant women. Zinc is needed for protein synthesis and cell development during pregnancy. Physicians routinely recommend daily prenatal multivitamin-mineral supplements for pregnant women. Prenatal supplements are most likely to benefit women who do not eat adequately, who are carrying twins or triplets, or who smoke cigarettes, drink alcohol, or abuse drugs. Participation in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during pregnancy can reduce iron deficiency, infant mortality, low birthweight, and maternal and newborn medical costs. Food assistance programs such as WIC can provide nutritious food for pregnant women of limited financial means. Appropriate weight gain is essential for a healthy pregnancy. Weight gain recommendations are influenced by the pre-pregnancy body mass index (BMI) and number of fetuses in the pregnancy. Physically fit women can continue physical activity throughout pregnancy but should choose activities wisely. Pregnant women should avoid sports in which they might fall or be hit and should not become overheated or dehydrated. Pregnant teenage girls have extraordinarily high nutrient needs and an increased likelihood of problem pregnancies. Adequate nutrition and appropriate weight gain for pregnant teenagers can substantially improve outcomes for mothers and infants. Food cravings usually do not reflect physiological needs, and some may interfere with nutrition. Nausea arises from normal hormonal changes of pregnancy. Smoking during pregnancy delivers toxins to the fetus, damages DNA, restricts fetal growth, and limits the delivery of oxygen and nutrients and the removal of wastes. Smoking and other drugs, contaminants such as mercury, foodborne illnesses, large supplemental doses of nutrients, weight-loss diets, and excessive use of artificial sweeteners and caffeine should be avoided during pregnancy.
Summarize the evidence against alcohol intake during pregnancy.
Alcohol crosses the placenta and is directly toxic to the fetus. Alcohol limits oxygen delivery to the fetus, slows cell division, and reduces the number of cells organs produce. The severe birth defects of fetal alcohol syndrome arise from damage to the fetus by alcohol. Lesser conditions, alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD), also arise from alcohol use in pregnancy. Alcohol's damaging effects on the fetus are dose dependent, becoming greater as the dose increases. Abstinence from alcohol in pregnancy is critical to preventing irreversible damage to the fetus.
Identify nutrition practices that promote an infant's well-being.
An infant's birthweight doubles by about five months of age and triples by one year. Infants' rapid growth and development depend on adequate nutrient supplies, including water from breast milk or formula. With the exception of vitamin D, breast milk provides all the nutrients a healthy infant needs for the first four months of life. Breast milk offers the infant unsurpassed protection against infection—including antiviral agents, anti-inflammatory agents, antibacterial agents, and infection inhibitors. Infant formulas are designed to resemble breast milk in nutrient composition. After the baby's first birthday, reduced-fat or low-fat cow's milk can replace formula. At six months, an infant may be ready to try some solid foods. By one year, the child should be eating foods from all food groups. The early feeding of the infant lays the foundation for lifelong eating habits. The most important single measure to undertake during the first year is to encourage eating habits that will support continued normal weight as the child grows.
Feeding the Infant
Babies grow faster 1st year of life than ever again. •Growth directly reflects nutrition status •Basal metabolic rate high-rapid metabolism •Infants require about 100kcal/kg •Adults mostly around 30kcal/kg •Vitamins •Water
physical activity and sleep
Benefits of physical activity-•Better cardiovascular profile•Recommendation: 60 minutes per day Adequate sleep-Less likely to be obese
Early Childhood Influences on Obesity
Calories, family influence, snacking •Little physical activity, too much "screen time"•Food advertising to children•Television •Internet "advergames"
Describe the challenges associated with childhood obesity.
Childhood obesity increases a child's risk for chronic diseases during both childhood and into adulthood. These health concerns include: abnormal blood lipids; high blood pressure; elevated insulin and the development of type 2 diabetes; changes in the heart structure; and the development of heart disease, asthma and breathing difficulties, and fatty liver.
choline, vit D, Iron, calcium
Choline: vital for the structural integrity of cell membranes, the synthesis of an important neurotransmitter, and the metabolism of lipids. Pregnancy DRI 450mg/d •Vitamin D & calcium: building skeleton •Calcium absorption doubles during pregnancy •Vitamin D required for calcium absorption -calcium, phosphorus, and magnesium—are in great demand during pregnancy. -Severe maternal vitamin D deficiency interferes with normal calcium metabolism and, in rare cases, may cause the vitamin D-deficiency disease rickets in a newborn -adequate sun is enough -In the final weeks of pregnancy, more than 300 milligrams of calcium a day are transferred to the fetus. -the USDA Eating Patterns suggest consuming three cups per day of fat-free or low-fat milk or the equivalent in milk products -Less preferred is a daily supplement of 600 milligrams of calcium. •Iron: Increased blood volume in pregnancy. High blood losses during delivery. Anemic women higher risk for LBW infants & preterm births -Choose foods that supply heme iron (meat, fish, and poultry), which is most readily absorbed. Choose additional iron sources, such as eggs, vegetables, and legumes. Along with foods rich in iron, choose foods that enhance its absorption, such as vitamin C-rich fruits and vegetables. -Iron supplements are recommended for pregnant women.
Hypertension
Chronic hypertension: In pregnant women, hypertension that is present and documented before pregnancy; in women whose prepregnancy blood pressure is unknown, the presence of sustained hypertension before 20 weeks of gestation •Present after pregnancy as well •Gestational hypertension: High blood pressure that develops in the second half of pregnancy and usually resolves after childbirth Hypertension•Chronic: present before and remains after pregnancy •Gestational: usually resolves after birth •Risks: heart attack, stroke, LBW, preterm birth, and separation of the placenta from the uterus •Preeclampsia: HBP and protein in urine •Preeclampsia affects almost all of the mother's organs—the circulatory system, liver, kidneys, and brain. Can progress to seizures-->eclampsia. Maternal mortality during pregnancy is rare in developed countries, but eclampsia is one of the most common causes
cravings
Cravings and aversions are common r/t hormone-induced changes and sensitivities •Do not reflect physiological needs •Pica: eating nonfood items such as laundry starch, clay, soil, or ice •"Morning" sickness: hormonal changes, typically peaks 9 weeks •Heartburn or indigestion: pregnancy alters muscle tone, growing fetus crowds intestinal organs
Fetal Alcohol Syndrome
Drinking alcohol during pregnancy threatens the fetus with irreversible brain damage, growth restriction, mental retardation, facial abnormalities, vision abnormalities, and many more health problems—a spectrum of symptoms known as fetal alcohol spectrum disorders, or FASD. -A more severe form is fetal alcohol syndrome (F A S): The cluster of symptoms including brain damage, growth restriction, mental retardation, and facial abnormalities seen in an infant or child
fathers to be
Fathers-to-be are also wise to examine their eating and drinking habits. For example, leading a sedentary lifestyle and consuming too few fruit and vegetables may affect men's fertility (and the fertility of their children), and men who drink too much alcohol or encounter other toxins in the weeks before conception can sustain damage to their sperm's genetic material
List five feeding guidelines that encourage normal eating behaviors and autonomy in the child.
Feeding guidelines that foster normal eating behaviors include: discouraging unacceptable behavior, letting young children explore and enjoy food, not forcing food on children, providing nutritious options and letting children choose which ones they eat, and limiting sweets.
Warning Signs of Preeclampsia
Hypertension Protein in the urine Upper abdominal pain Severe and constant headaches Swelling, especially of the face Dizziness Blurred vision Sudden weight gain (1 lb/day)
Increased Nutrient Needs for each trimester
In the first trimester, a pregnant woman needs no additional energy, but her energy needs rise as pregnancy progresses. She requires an additional 340 daily calories during the second trimester and an extra 450 calories each day during the third trimester A woman can easily meet the need for extra calories by selecting more nutrient-dense foods from the five food groups. Ample carbohydrate (ideally, 175 grams or more per day and certainly no less than 135 grams) -fuel the fetal brain and spare the protein needed for fetal growth The protein DRI during pregnancy calls for 25 grams per day more than for nonpregnant women, but most U.S. women need no additional protein-rich foods, because they already consume plenty of meats, seafood, poultry and eggs. Low-fat milk and milk products provide protein, calcium, vitamin D, and other nutrients. The essential fatty acids, however, are particularly important to the growth and development of the fetus. The brain is composed mainly of lipid material and depends heavily on long-chain omega-3 and omega-6 fatty acids for its growth, function, and structure. Fish consumption during pregnancy provides a rich source of omega-3 fatty acids and improves brain development and cognition in infants.
obese women pregnancy
Infants born to obese women are likely to be large for gestational age, weighing more than 9 pounds at birth. Problems associated with a high birthweight include a difficult labor and delivery, birth trauma, and cesarean section. Consequently, these babies have a greater risk of poor health and death than infants of normal weight. Infants of obese mothers also may be likely to be born with neural tube defects. Obese women themselves are likely to suffer gestational diabetes, hypertension, and complications during and infections and hemorrhage after the birth. In addition, both overweight and obese women have a greater risk of giving birth to infants with heart defects and other abnormalities Maternal obesity increases a child's risk of obesity, heart disease, type 2 diabetes, and asthma throughout life
Tips for Successful Breastfeeding
Learn about the benefits of breastfeeding. Initiate breastfeeding within 1 hour of birth. Ask a health-care professional to explain how to breastfeed and how to maintain lactation. Give newborn infants no food or drink other than breast milk unless medically indicated. Breastfeed on demand. Offer no artificial nipples or pacifiers to breastfeeding infants. Find support groups, books, or websites that help troubleshoot breastfeeding problems.
when not to breastfeed
Many substances impair maternal milk production, or enter breast milk and interfere with infant development •Alcohol and illicit drugs: alcohol concentration peak within one hour after consumption •Illicit drug users should not breastfeed •Tobacco: Lactating women who smoke tobacco produce less milk, and milk of lower fat content •Caffeine: Excess caffeine can make a breastfed infant jittery and wakeful. As during pregnancy, caffeine consumption should be moderate when breastfeeding •Medications: Danger levels vary - consult physician •Environmental: the many benefits of breastfeeding far outweigh any small risk from environmental hazards in the United States
Tips for Relieving Common Discomforts of Pregnancy To alleviate the nausea of pregnancy:
On waking, get up slowly. Eat dry toast or crackers. Chew gum or suck hard candies. Eat small, frequent meals whenever hunger strikes. Avoid foods with offensive odors. To prevent or alleviate constipation: Eat foods high in fiber. Exercise daily. Drink at least 8 cups of liquids a day. Respond promptly to the urge to defecate. Use laxatives only as prescribed by a physician. To prevent or relieve heartburn: Relax and eat slowly. Chew food thoroughly. Eat small, frequent meals. Drink liquids between meals. Avoid spicy or greasy foods. Sit up while eating. Wait an hour after eating before lying down. Wait 2 hours after eating before exercising.
breastmilk
Pediatricians may prescribe supplements containing vitamin D, iron, and fluoride Contains antiviral agents, anti-inflammatory agents, antibacterial agents, and infection inhibitors. Colostrum produced 1st few days, provides maternal antibodies that inactivate harmful bacteria within the infant's digestive tract before they can start infections Breastfed infants have fewer allergic reactions such as asthma, wheezing, and skin rash The risk of SIDS is lower among breastfed infants .The DHA in breast milk and the feeding process itself, benefits the infant's development.
diabetes
Poorly controlled type 1 or type 2 diabetes -->severe hypoglycemia or hyperglycemia, preterm labor, & pregnancy-related hypertension. •Infants may be large (LGA) & may suffer physical and mental abnormalities and respiratory distress. •Gestational diabetes usually resolves after the birth, but some women develop diabetes (usually type 2) later in life, especially if they are overweight.•At 1st prenatal visit: all women with BMI ≥25 and have one or more additional risk factors for type 2 diabetes are screened for GDM •All other pregnant women are tested for glucose tolerance at 24 to 28 weeks of gestation. Pregnant women with unmanaged type 1 or type 2 diabetes may experience: •Severe hypoglycemia or hyperglycemia •Preterm labor •Pregnancy-related hypertension •Infants of such women may: •Be large •Suffer physical and mental abnormalities •Suffer other complications such as respiratory distress
lactation-A nursing mother produces about 25 ounces of milk a day
Prepare before birth •Read books •Consult a certified lactation consultant •Learn about nutritional requirements •In rare cases, women produce too little milk to nourish their infants adequately. Severe consequences, including infant dehydration, malnutrition, and brain damage, can occur if the condition goes undetected for long. •Early warning signs of insufficient milk are dry diapers (a well-fed infant wets about six to eight diapers a day) and infrequent bowel movements.
lactation
Prepare before birth•Read books•Consult a certified lactation consultant•Learn about nutritional requirements •In rare cases, women produce too little milk to nourish their infants adequately. Severe consequences, including infant dehydration, malnutrition, and brain damage, can occur if the condition goes undetected for long. •Early warning signs of insufficient milk are dry diapers (a well-fed infant wets about six to eight diapers a day) and infrequent bowel movements.
High-Risk Pregnancy Factors
Prepregnancy BMI either <18.5 or ≥25 Insufficient or excessive pregnancy weight gain Nutrient deficiencies or toxicities; eating disorders Poverty, lack of family support, low level of education, limited food availability Smoking, alcohol, or other drug use Age, especially 15 years or younger or 35 years or older Many previous pregnancies (3 or more in mothers younger than age 20; 4 or more in mothers age 20 or older) Short or long intervals between pregnancies (<18 months or >59 months) Previous history of problems such as low- or high-birthweight infants Twins or triplets Pregnancy-related hypertension or gestational diabetes Diabetes; heart, respiratory, or kidney disease; genetic disorders; special diets and medications
folate and b12
Roles in cell reproduction, so increased need during pregnancy •Folate: 600 mcg/d to prevent neural tube defects (tube doesn't close properly). 3,000 US pregnancies/year affected •Anencephaly: the upper end of the neural tube fails to close. Consequently, the brain is either missing or fails to develop. brain missing or not developed, often miscarry •Spina bifida: spinal cord doesn't close, can be external-produces paralysis in varying degrees, depending on the extent of spinal cord damage. Mild cases may not be noticed. Moderate cases may involve curvature of the spine, muscle weakness, mental handicaps, and other ills; severe cases can result in death. •To reduce the risk of neural tube defects, women who are capable of becoming pregnant are advised to obtain 400 micrograms of folic acid daily from supplements, fortified foods, or both, in addition to eating folate-rich foods. •Grain enrichment with folate has decreased incidence of NTD •Vitamin B12 Assists folate with manufacture of new cells. In animal foods, vegans need supplements.
Cautions for the Pregnant Woman; smoking
Smoking can kill otherwise heathy fetus or newborn. Smoking during pregnancy can damage fetal DNA, which could lead to develops It slows fetal growth, can reduce brain size, and may impair the intellectual and behavioral development of the child later in life. increased risk SIDS. -Constituents of cigarette smoke, such as nicotine, carbon monoxide, arsenic, and cyanide, are toxic to a fetus. Smoking during pregnancy can damage fetal DNA, and can lead to developmental defects or diseases such as cancer. -It slows fetal growth, can reduce brain size, and may impair the intellectual and behavioral development of a child later in life. Smoking during pregnancy damages fetal blood vessels, an effect that is still apparent at the age of 5 years. -Fetal growth restriction Preterm birth Low birthweight Premature separation of the placenta Miscarriage Stillbirth Sudden infant death syndrome Congenital malformations
physical activity
Staying active improves the fitness of the mother-to-be, facilitates labor, helps to prevent or manage gestational diabetes, and reduces psychological stress. Active women report fewer discomforts throughout their pregnancies and are more likely to meet weight gain recommendations. •Consult physician first based on individual health and fitness. •Sensible low-impact activities recommended. •Prevent dehydration•Prevent high internal temperature
breastfeeding-With the exception of vitamin D, breast milk provides all the nutrients healthy infants need for the first 4 months of life. Breast milk offers infants unsurpassed protection against infection—including antiviral agents, anti-inflammatory agents, antibacterial agents, and infection inhibitors.
The AAP and the Academy of Nutrition and Dietetics recommend exclusive breastfeeding for 6 months and breastfeeding with complementary foods for at least 12 months as an optimal feeding pattern for infants Excels as source of nutrients•Conveys immune factors, which both protect against infection and inform baby's body about the outside environment•Energy-nutrient balance very different than for adults; breast milk lower in protein and higher in fat.•Vitamins and minerals balanced except vitamin D, may need supplements Benefits of Breastfeeding For Infants: Provides the appropriate composition and balance of nutrients. Provides hormones that promote physiological development. Improves cognitive development. Protects against a variety of infections. May protect against some chronic diseases, such as diabetes and hypertension, later in life. Protects against food allergies. Reduces the risk of sudden infant death syndrome. For Mothers: Contracts the uterus. Delays the return of regular ovulation, thus lengthening birth intervals. (It is not, however, a dependable method of contraception.) Conserves iron stores (by prolonging amenorrhea). May protect against breast and ovarian cancer. Other: Saves on doctor visits for infant illness. Saves costs of formulas, bottles, brushes, etc. Is an environmentally sustainable option.
ideal weight gain
The ideal weight-gain pattern for a woman who begins pregnancy at a healthy weight is pounds during the first trimester and 1 pound per week thereafter. If a woman gains more than is recommended early in pregnancy, she should not restrict her energy intake later on to lose weight. A sudden, large weight gain is a danger signal, however, because it may indicate the onset of preeclampsia The weight a pregnant woman gains is nearly all lean tissue: the placenta, uterus, blood, milk-producing glands, and the fetus itself The fat she gains is needed later to support lactation.
Explain how nutrition supports lactation.
The lactating woman needs extra fluid and adequate energy and nutrients for milk production. Malnutrition diminishes the quantity of the milk without altering quality. Moderate weight loss during lactation does not adversely affect the quality or quantity of breast milk. Breastfeeding is not advised if the mother's milk is contaminated with alcohol, drugs, or environmental pollutants. Most ordinary infections such as colds have no effect on breastfeeding infants, but HIV/AIDS may be transmitted through milk.
the events of pregnancy
The newly fertilized ovum is called a zygote. It begins as a single cell and rapidly divides into many cells during the days after fertilization Implantation: uterine wall within two weeks **malnutrition can lead to failure at this point, and neural tube defects •Embryo is Fetus at eight weeks: complete CNS, beating heart, fully formed digestive system, well-defined fingers and toes, and the beginnings of facial features•Fetal period: last 7 months of gestation; grows 50x heavier & 20x longer •Gestation: 40 weeks, 3 trimesters
teen pregnancy
U.S. teen birthrate is still one of highest among industrialized nations. In 2016, more than 209,000 infants were born to teenaged U.S. mothers Special case of intense nutrient needs •Many teens enter pregnancy with deficiencies of vitamin B12 and D, folate, iron, and calcium that can impair fetal growth •Less likely to receive prenatal care & more likely to smoke-->low birthweight and infant death •Rates of stillbirths, preterm births, and low-birthweight infants are high when either parent is a teen Pregnant teenage girls have extraordinarily high nutrient needs and an increased likelihood of problem pregnancies. Adequate nutrition and appropriate weight gain for pregnant teenagers can substantially improve outcomes for mothers and infants.
Choice of Infant Foods
Variety, balance, and moderation •Foods to omit•Baby desserts•Sugar alcohols•Salted canned foods•Honey •Milk anemia: too much cows milk replaces iron-rich foods
zinc, prenantal supplements
Zinc: protein synthesis and cell development; abundant in protein-rich foods such as shellfish, meat, and nuts. •Prenatal supplements: typically provide more folate, iron, and calcium than regular supplements. Women with poor diets need them urgently, as do women in these high-risk groups: women carrying twins or triplets and women who smoke cigarettes, drink alcohol, or abuse drugs -Zinc is needed for protein synthesis and cell development during pregnancy.
Critical Periods
he fetus's heart and brain are well developed at 14 weeks; the lungs, 10 weeks later. Therefore, early malnutrition impairs the heart and brain; later malnutrition impairs the lungs. -The effects of malnutrition during critical periods of pregnancy are seen in defects of the nervous system of the embryo (explained later), in a child's poor dental health, and in an adolescent's and adult's vulnerability to infections and possibly higher risks of diabetes, hypertension, stroke, or heart disease. The effects of malnutrition during critical periods are irreversible: abundant and nourishing food, fed after the critical time, cannot remedy harm already done.
Development of Type 2 Diabetes
linked with obesity-Native American, African, Asian, or Hispanic ethnicity increases risk -Often lack any symptoms of diabetes -Telltale signs often undetected in children
The nationwide Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Supplemental Nutrition Assistance Program (SNAP)-formerly food stamps
provides vouchers redeemable for nutritious foods, along with nutrition education and referrals to health and social services, for low-income pregnant and lactating women and their children. -Food assistance programs such as WIC can provide nutritious food for pregnant women of limited financial means. Participation in WIC during pregnancy can reduce iron deficiency, infant mortality, low birthweight, and maternal and newborn medical costs. WIC-sponsored foods include baby foods, eggs, dried and canned beans and peas, tuna fish, peanut butter, fruit and vegetables and their juices, iron-fortified cereals, milk and cheese, soy-based beverages and tofu, whole-wheat bread, and other whole-grain products. WIC encourages breastfeeding and offers incentives to mothers who feed their infants breast milk. For infants given infant formula, WIC also provides iron-fortified formula.
mealtimes with infants
•Develops sense of autonomy •Feeding guidelines •Discourage unacceptable behavior •Let young children explore and enjoy food •Don't force food on children •Provide nutritious foods •Limit sweets •Don't turn dining table into a battleground
looking ahead
•First year of life lays the foundation for future health •Encourage healthy eating habits •Avoid concentrated sweets •Encourage physical activity •Don't use food for reward, punishment, or comfort •Nursing bottle syndrome: prolonged sucking displaces normal jaw line and favors bacterial growth and tooth decay
An Infant's First Solid Foods
•Infants are often developmentally ready to accept some solid foods between 4 and 6 months of age •Must be able to manage physically & metabolically. •Nutrient needs: Iron, zinc, and vitamin C •Physical readiness: offering by spoon develops swallowing ability •8 months to a year, a baby can sit up, can handle finger foods, and begins to teethe. At that time, hard crackers and other finger foods may be introduced to promote the development of manual dexterity and control of the jaw muscles. Choking big risk!! •Monitor allergic reactions by introducing single-ingredient foods one at a time
other cautions
••Medications, drugs and herbal supplements not prescribed by a physician may be unsafe and should not be taken. O T C drugs and medication must be prescribed by a physician•Herbal supplements have not been tested for safety or effectiveness during pregnancy and must be avoided Drugs of abuse easily cross the placenta and impair fetal growth and development •Consumption results in cases of preterm births, low-birthweight infants, and sudden infant deaths •Environmental contaminants such as lead may lead to low-birthweight infants with delayed mental and psychomotor development •Exposure to mercury: Harm caused to the developing fetal brain and nervous system •Nevertheless, consumption of fish is recommended •Foodborne illnesses can leave a pregnant woman exhausted and dangerously dehydrated •Vomiting and diarrhea •Pregnant women are more likely than others to contract listeriosis •A serious foodborne infection caused by the bacterium Listeria monocytogenes, which is found in soil and water •Can cause miscarriage, stillbirth, or severe brain or other infections in fetuses and newborns •Can be avoided by following safe practices Vitamin-mineral overdoses are toxic•Vitamin A in excess may cause malformations of the cranial nervous system in the fetus•Restrictive dieting can be hazardous •Some diets may lack nutrients vital to fetal growth •Sugar substitutes are acceptable if used within F D A guidelines •Caffeine in small amounts is allowed•one cup of coffee