Chapter 7 = nutrition across lifespan (pregnancy and infant)

DRI vitamins pregnancy

- most needed still vitamin A especially if lactating -vitamin K need doesnt change from 90 mch -vitamin C need increase 3rd highest -folate second highest specifically high when pregnant 600 mcg -calcium need remains the same 1000 mg

joint commission national quality measures for perinatal care measures

-exclusive breast milk feeding during newborn's entire hospitalization -exclusive breast milk feeding during newborn's entire hospitalization consider mom's choice -rationale for measure exclusive breast milk feed for firs t6 months of neonatal life

advantages of breastfeeding

-incidence of otitis media (ear infection), type 1 and 2 DM, obesity, leukemia, lymphoma, GI and resp diroders reduced. due to transfer of antibodies from mom to infant -carbohydrates, proteins, fats in breast milk are predigested for ready absorption -breast milk is high in omega 3 fatty acids -breast milk low sodium -iron,zinc, magnesium found in breast milk highly absorbable -calcium absorption enhanced, calcium to phosphorus ratio 2:1 -risk allergies reduced -maternal infant bonding promoted

infant grows ___ per month in height

1 inch per month in height during first 6 months and 1/2 inch per month during second 6 months

DRI protein during pregnancy

1.1 g/kg per day protein essential for rapid tissue growth of maternal and fetal structures, amniotic fluid and extra volume.

first trimester weight gain recommended

1.1 to 4.4 lbs

newborn should nurse up to ___ min per breast

15 to 20 min per breast but avoid educating clients regarding expected duration of feedings, clients educated on how to evluaate when newborn has completed feeding by noting slowing of newborn suckling, sofetened breast or sleeping

second and third trimesters weight gain recommended

2 to 4 lb/month normal weight client (BMI 18.5-24.9) = 1lb/week total 25 to 35 lb underweight client (BMI< 18.5) = just more than 1lb/weel 28 to 40 lb overweight client (BMI 25-29.) = 0.66 lb/week total 15 to 25 lb obese client (BMI >30) = 0.5 ln/weel total 11 to 20 pounds

protein should comprise of ___ total daily calorie intake for pregnant women

20% of total daily calorie intake

fat limited to ___ total daily calorie intake for pregnant women

30% of total daily caloric intake

infant should not drink more than

32 oz formula per 24 hr period unless directed by provider

daily increase of ___ calories recommended during second trimester of pregnaancy

340 calories

solid foods should not be introduced before

4 to 6 months of age due to risk of food allergies and stress of immature kidneys introduction of solid foods after 6 months of age

increase of ____ calories during third trimester of pregnancy

452 calories

appropriate weight gain infant

5 to 7 oz per week during first 5 to 6 months

if breastfeeding is eliminated before

5-6 months, a bottle should be provided for infant's sucking needs substitute cup for one feeding period at a time over 5-7 days

new foods introduced one at a time over

5-7 day period to observe for indications of allergy or intolerance, which can include fussiness, rash, upper respiratory distress, vomiting, diarrhea, or constipation. order of introduction of new foods is no longer considered important, and meat may be introduced first due to its iron and zinc content

carbs comprise ____ calorie intake total daily pregnant women

50% total daily calorie intake, ensuring adequate carb intake allow protein to be spared and vailable for synthesis of fetal tissue

iron fortified formula is recommended for at least first

6 months of life or until infant consumes adequate solid food. after 6 months formula without added iron might be indicated

exclusive breastfeeding for first __ mo of life

6 months of life, followed by breastfeeding with introduction of complementary foods until at least 12 months of age, then continuation of breastfeeding for as long as mother and infant desire

recommends that infants receive breast milk for ___

6 to 12 months of age (exclusive breast feeding)

infant can be ready for three meals per day with three snacks by

8 months age

iron pregnancy

DRI increases 50%, to support increase maternal blood volume and provide iron for fetal liver storage iron obtained from dairy products, meats especially red meats consuming foods high in vitamin C aids in absorption of iron, pregnant women take supplement of 27 mg iron daily

clinical findings of lactose intolerance

abdominal distention, flatus, occasional diarrhea soy based or casein hydrolysate formulas can be prescribed as alternative formulas for infants who are lactose intolerant

fluoride supplements can be required if an

adequate level is not supplied by water supply

fish pregnancy

advisories regarding fish and shellfish consumption during pregnancy due to risk of mercury levels, mercury toxic to developing fetal brain tissue

cow's milk should not be introduced into diet until

after 1 year of age cuz protein and mineral content stress the immature kidney, a young infant cannot fully digest protein and fat contained in cow's milk

never allow child to take a bottle to bed

as this promotes dental caries

lactose intolerance increased prevalence in

asian, native american, african, latino, mediterranean descent

avoid consuming ____ in breastfeeding

avoid consuming freshwater fish or alcohol and limit caffeine

semisolid foods should not be introduced before ___ months of age

before 4 months of age to coincide with development of head control, ability to sit, back and forth motion of tongue

early fetal development occurs

before woman might realize she is pregnant

instruct mother to begin ___ of her breast or use electric breast pump

begin manual expression of her breast or use electric breast pump if infant is unable to breastfeed due to prematurity or respiratory distress do not take medications unless prescribed by provider

birth to 4 months food

breast milk (until 6 months) or formula (at 4 months)

formula feeding used in place of

breastfeeding as occasional supplement to breastfeeding or when exclusively breastfed infants are weaned before 12 months of age

colic techniques to help

burp infant in upright position swaddling, carrying infant, rocking, repetitive soft sound can soothe infant most infants grow and gain weight despite colic ensure parent colic is transient and does not indicate more serious problems or lack of parental ability

caffeine pregnancy

caffeine crosses placenta and can affect movement and heart rate of fetus, moderate (less than 300 mg/day does not appear harmful)

diarrhea

characterized by passage of more than three loose, watery stools over a 24 hour -overfeeding and food intolerances are common causes of osmotic diarrhea -infectious diarrhea in infant is commonly caused by rotavirus -breastfed infants continue nursing -formula fed infants do not require diluted formulas/special formulas

nausea and constipation pregnancy

common -for nausea eat dry crackers or toast, avoid alcohol, caffeine, fats, spieces. avoid drinking fluids with meals, don't take meds to control nausea w/o provider -constipation - increase fluid at least 8 cups per day, include extra fiber in diet (veggies/fruits/whole grains)

12 months food

cow's milk, eggs, cheese

failure to thrive

defined as inadequate gains in weight, and height in comparison to established growth development norms -assess clinical findings of congenital defects, CNS disorders, partial intestinal obstruction -monitor swallow/sucking problems -identify feeding patterns especially concerning preparion of formulas -observe for psychosocial problems, parent infant bonding, abuse/neglect -provide supportive nutritional guidance, high calorie/protein diet -provide supportive parenting guidance

maternal nutritional demands increased for

development of placenta, enlargement of uterus, formation of amniotic fluid, icnrease in blood volume, preparation of breasts for lactation

weaning

developmentally infant is ready for weaning from breast or bottle to a cup between 5-8 months of age. infant might not be ready to wean from bottle or breast until 12 to 14 months of age

birth weight ___ by 4-6 months and ____ by 1 year of age

double by 4-6 months and triples by 1 year of age need for calories and nutrients is high to suppor trapid rate of growth

head circumference increases rapidly during first ___ months

during first 6 months at rate of 0.6 inches per month, rate slows to 0.5 cm/ month for months 6 to 12 by 1 year head size should increase 3%, reflective of growth of nervous system

hold infant durign feedings with head slightly

elevated to facilitate passage or formula into stomach. tilt bottle to maintain formula in nipple and prevent swallowing of air do not prop bottle or put an infant to bed with bottle. this practice promotes tooth decay.

mothers milk supply is

equal to demand of infant infant will empty breast within 5-10 min, but might need to continue to suck to meet comfort needs

frequent feedings

every 2 hour indicated, and manual expression of milk to initiate flow can be needed if it has been 4 hr and infant has not breastfed, mother should awaken infant for feeding

expressed breastmilk

every effort made to encourage mothers to express breast milk for supplementation if extra fluids or calories are required -expressed milk can be refrigerated in sterile bottles or storage bags and labeled with date and time, milk was expressed. maintained in fridge for 10 days or frozen in sterile containers for 6 months

iron fortified rice cereal should be offered

first wheat cereals should not be introduced until after first year, do not put cereal in infant's bottle

iron fortified infant cereal is

first solid food introduced as gestational iron stores begin to deplete aorund 4 months of age

8 to 10 months food

fish, poultry

PKU diet

foods low in phenylalanine, foods high in protein (fish, poultry, meat, eggs, nuts, dairy products) must be avoided due to high phenylalanine levels no meat/dairy more fruits veggies

bottles of mixed formula or open cans of liquid formula require refrigeration. do not use if

formula has been left at room temp for 2 hour or longer, do not reuse partially emptied bottles of formula.

lactating women increase in daily caloric intake

if client is breastfeeding during postpartum period, additional dailiy intake of 330 calories during first 6 months, additional daily intake 400 calories during second 6 months

breastfeed new born offered breast

immediately after birth and frequently thereafter, should be 8-12 feedings in 24 hour period

constipation

inability or difficulty to evacuate bowels -not common problem for breastfed infants -caused by formula is too concentrated or inadequate carb intake -stress importance of accurate dilution of formula -adherence to recommended amount of formula intake for age

lactose intolerance

inability to digest significant amounts of lactose (predominant sugar of milk) and is due to inadequate lactase (enzyme that digests lactose into glucose and galactose)

instruct mother to demand feed infant and assess hunger cues

include rooting, suckling on hands and fingers and rapid eye mvoement, crying is late indicator of hunger

4 to 6 months food

iron fortified cereal

nighttime feeding are

last to disappear

dehydration clinical findings

listlessness, sunken eyes, sunken fontanels, decreased tears, dry mucous membranes, decreased urine output contact provider for signs of dehydration, vomit, bloody stools, high fever, change in mental status, refusal to take liquids occur

maternal phenylketonuria (PKU)

maternal genetic disease which high levels of phenylalanine pose danger to fetus -important for client to start PKU diet at least 3 months prior to pregnancy and continue diet throughout pregnancy important to prevent fetal complications (intellectual disability, behavioral problems) foods high in protein avoided

delay introduction of

milk, eggs, wheat and citrus foods that can lead to allergic reactions in susceptible infants do not give peanuts or peanut butter due to risk of severe alelrgic reaction

colic - breastfeeding

mothers should continue nursing but limit caffeine and nicotine intake eliminate cruciferous vegetables (cauliflower, broccoli, brussel sprouts), cow's milk, onion and chocolate

mild diarrhea can require

no specific interventions -check with provider for any diet modifications -treatment begin at home with oral rehydration solutions. after each loose stool 8 oz solution given. sports drinks contraindicated

colic signs

persistent crying lasting 3 hr or longer per day cause of colic is unknown, occurs in late afternoon. more than 3 days per week for more than 3 weeks. crying accompanied by tense abdomen and legs drawn up to belly resolves by 3 months of age

folic acid intake pregnancy

recommended 600 mcg/day of folic acid. lactating clients 500 mcg/day necessary for neurological development of fetus and prevent birth defects, essential for maternal RBC formation. food source sinclude green leafy veggies, enriched grains and orange juice

appropriate finger foods for infants include

ripe bananas, toast strips, graham crackers, cheese cubes, noodles, peeled chunks of apples, epars, peaches

donor milk considerations

should be made in consultation with provider with proper screening for safety of milk and depend on infant's age/health

thaw milk in refrigerator

stored for 24 hr after thawing, defrosting or heating in microwave not recommended cuz high heat destroys some of milk antibodies and burn infant's oral mucosa do not refreeze thawed milk

9 to 12 months food

table foods (cooked, chopped, unseasoned)

by 9 months of age infant should be ablel to eat

table foods that are cooked, chopped, unseasoned. do not feed baby honey due to risk of botulism

commercial infant formulas providean alternative to breast milk

they are modified from cow's milk to provide comparable nutrients. however breast milk is far superior to any formula and even more crucial for premature infant

6 to 8 months food

veggies, fruits, strained meats

indicators for readiness include

voluntary control of head and trunk, hunger less than 4 hr after vigorous nursing or intake of 8 oz of formula and interest of infant

first 6 months infants should receive no

water or formula except in cases of medical indication and parent informed choice

vegetarian diets pregnancy

well balanced veggie diets that include dairy products can provide all nutritional requirements