EXAM 2

protein Adequate intake/RDA for infants

0-6 months = 1.2 grams/kg 7-12 months = 1.5 grams/kg or 11 grams/day

toddlers

1-3 y/o, rapid increase in gross and fine motor skills

Appropriate for gestational age (AGA)

10-85 percentile

pre-school age

3-5 y/o, increasing autonomy, broader social circumstances, increasing language skills, expanding behavior control

full term infant

37-42 weeks, 2500-3800 grams or 5.5-8.5 lbs

Distribution of calories in infancy

40-50% from fat 7-11% from protein Remainder from carbs

Primary lactose intolerance

Ability to synthesize lactase decreases in childhood and adulthood, "Lactase non persistence" is normal, variation in age of expression (infant to adult), depends on the amount of dairy products in diets of people in geographic area, occurrence: ~2% in Northern Europe and ~100% in Asia

Food allergies in infants

About six to eight percent of children under four years old have allergies, absorption of intact proteins is the basis, common symptoms are wheezing or skin rashes, guidelines recommend breast milk for infants considered at risk

organizations creating recommendations for infants

Academy of pediatrics, National Academy of Medicine, Academy of Nutrition and Dietetics, European Society of Pediatric Gastroenterology/Hepatology/Nutrition Committee on Nutrition

Normal growth and development: Toddlers

Average gain of 8 ounces per month and grow .4 inches

Normal Growth and Development: birth-12 months

Average infant triples birth weight

Intrauterine growth retardation (IUGR)

Baby in uterus, growth is slower than it should be

Hydrolyzed formulas

Better GI tolerance, poor acceptance by infant (bitter taste), high cost, recommended if allergy is confirmed

Assessing Newborn Health

Birthweight and gestational age as outcome measures

What to feed preterm infants

Breast milk is the recommended source of nutrition when initiating enteral feeds, when not available/contraindicated preterm infant formulas are available, Soy formulas not recommended for preterm infants < 1800 g

infant Fluids

Breast milk or formula provide adequate water for healthy infants the first 6 months, fluid needs during illness are of concern because dehydration is common response to illness in infancy, juice is not needed to meet fluid needs

Vegetarian diets in infants

Can support normal growth and development in infants when well planned to meet their nutritional needs (more restrictive vegan and macrobiotic diets may increase risk for nutrient deficiencies), DHA content in breastmilk is lower in vegetarian mothers than non-vegetarian mothers

The growth reference charts (developed by CDC)

Describe how certain children grew in a particular time and place, charts for infants from birth-36 months of age and ages 2-20 y/o

infant protein needs

Determined as grams/kg body weight, needs change with growth/development

Nutrition risks to development

Developmental delay: range of symptoms reflecting slow development (feeding difficulties/need for enteral parenteral feedings/altered growth/drug nutrient interactions), not all infants with developmental delay have developmental disabilities that continue into childhood

Preparing for drinking from a cup

Developmental readiness for a cup begins at 6-8 months, wean to a cup at 12-18 months, first portion from a cup is typically 1-2 ounces, drop in total fluids consumed may result in constipation

Considerations for Families of Infants with Special Healthcare Needs

Emotional impact of having sick newborn may be overwhelming to parents, healthcare providers must be sensitive to parents' emotional needs

infant sodium needs

Essential mineral needed for fluid maintenance, requirements: 120 mg from birth to 5 months and 200 mg for 6-12 months, based on the amount of sodium found in breastmilk

Growth standard charts (developed by WHO)

Established for children 0-5 y/o, describe the growth of healthy children in optimal conditions

Allergy (High Risk Infant)

Family history of allergy → infant risk One parent = 35% risk Both parents = 58% risk Both parents with same clinical disease (asthma or eczema) = 78% risk

How sick babies are fed

Feeding methods selected based on projected length of time the infant will need to achieve successful bottle or breastfeeding (enteral, parenteral, gavage, and gastrostomy and jejunostomy feeding)

infant Digestive system development

Fetus swallows amniotic fluid which stimulates intestinal maturation and growth, at birth the healthy newborn can digest fats/protein/simple sugars, common problems include col gastroesophageal reflux (GER)/diarrhea/constipation, the infant GI tract is fully developed around 6 months, gut microbiome develops before birth and impacts health in later years (breastfeeding impacts microbiome, GI issues can impact overall gut health/microbiome)

preterm Protein requirements

First 6 months: 1.52 g/kg body weight, 7-12 months:1.2 g/kg (Hydrolyzed protein or single amino acid-based formulas)

Feeding problem interventions

Frequent growth assessment, Monitor fluid and food intake, Adjust feeding frequency/volume/concentration, Adjust feeding timing, Assess feeding position, Increase nutrient density, Parent education, Observe infant-caregiver interactions, Consider developmental abilities

infant fiber needs

From 6-12 months fiber containing foods may be gradually introduced to infants until they consume 5 g/day, sources of fiber for infants include: whole grain cereals/green vegetables/legumes

infant carb needs

Glucose is imperative for proper growth/development, without adequate supply growth stunting can occur

infant growth interpretation

Growth charts, biochemical indicators, body composition, head circumference, evidence based practice treatment guidelines, medication assessment

Mucosal Barriers in The Neonate (Newborn)

High pH in the stomach, leaky intestinal barriers

Key questions regarding infants

How often does your baby feed?how long? how does your baby behave during and after a feeding? has your baby had any other fluids from a bottle? how many wet diapers and stools does your baby have every day?

Prevention of Food Allergy

Identify high risk infants, breastfeed exclusively for 4-6 months, hypoallergenic formula (completely hydrolyzed), include potential allergens in infants diet after 6 months, probiotics have some positive research

Importance of feeding position

Improper positioning may cause choking/discomfort/ear infections, position young bottle fed infants in a semi upright position, spoon feeding should be infant seated with back and feet supported, adults feeding infants should be directly in front of infant making eye contact

Lactose intolerance in infants

Inability to digest lactose, characterized by cramps/nausea/pain/alternating diarrhea and constipation, uncommon in infancy and tends to be overestimated, undigested unabsorbed lactose in intestine → bacteria utilize for growth (abdominal pain/diarrhea/nausea/flatulence/bloating)

Infant Mortality

Infant mortality rate is an estimate of the number of infant deaths, which occur within the first year of life for every 1,000 live births, used as an indicator of the health and well-being of a nation, US ranked below other wealthy nations, Infant mortality reported in the US was 5.96 per 1,000 liver births in 2014, nutrition is a key factor in infant mortality

feeding condition recommendations

Infant should not be overly tired or hungry, use small spoon with shallow bowl, allow mouth to open and tongue to extend, place spoon on front of tongue with slight downward pressure, avoid scraping spoon on infants gums, pace feeding to allow infant to swallow, first meals may be small in volume

infant eating skills

Infants are born with innate reflexes and ability to regulate food intake, need to coordinate sucking/swallowing/breathing, inherent preference for sweet taste At 4-6 weeks reflexes fade and infants begins to purposely signal wants and needs

infant iron needs

Infants are born with iron stores reflective of maternal stores, by 6 months a breastfed infant needs an additional iron source, formula fed infants should receive iron fortified formula, iron deficiency can cause irreversible behavioral and brain function abnormalities

Complementary feeding

Infants can swallow pureed foods at 6 months, at 6-8 months infants can swallow very soft lumpy foods, by 8-10 months infants can eat soft mashed foods, many foods are appropriate for infants who are 9-12 months

infant motor and cognitive development

Infants first gain control of their head and neck...hen middle...followed by legs, motor development tends to move from center to peripheral, energy needs increase with increased movement, spoon feeding appropriate when baby can sit and has head and neck control

Influence of food preference on feeding behavior

Infants have been exposed to flavors while in utero, flavor of breast milk is influenced by mother's diet, infants have genetic unlearned preference for sweet and salty tastes and rejection to sour/bitter tastes

Nutrition Services

Infants who were born preterm or with special health care needs may qualify for nutrition-related services and programs (early Intervention Programs funded through the IDEA-Part C, Early Head Start, WIC, State Children with Special Health Care Needs programs)

Severe Preterm Birth and Nutrition

Key role in immediate neonatal survival/growth/neurodevelopment and a conditioning factor for long-term health, provision of adequate energy and nutrients to the very preterm infant requires parenteral nutrition support followed by slow transition to enteral feeding

Soy protein based formula

Lactose free and vegetarian, supplementation = goal of matching human milk and cow's milk-based formulas

Challenges in feeding preterm infants

Lethargy, Low tolerance of volume, Stress responses connected to feeding

Immature sIgA system

More permeable, uptake of relatively intact proteins (antigen absorbed), I&E allergy observed, closure in about 3-4 months

growth warning signs

No increase in weight or length, continued decline or rapid increase in weight/length/head circumference

Colic

No specific cause, defined by the "rule of three"

infant fluoride needs

Not an essential nutrient, helps to create stronger teeth, DRI = 0.1 mg/day for infants younger than 6 months and 0.5 mg/day for 7-12 months, special circumstances may require fluoride supplementation

preterm food safety

Preterm babies have immature immunological systems (more susceptible to infection), every effort should be made to ensure feedings meet food safety requirements

Developmental lactase deficiency

Preterm infants < 34 weeks gestational age, lactose still beneficial, lactase produced soon

preterm Vit and Minerals

Preterm infants have higher iron needs, human-milk fortifiers provide additional calories and nutrients, preterm infant formulas provide similar amounts of macronutrients and micronutrients as fortified breast milk

Nutrition plays an important role in:

Preventing illness, maintaining health, treating conditions in infancy

Avoidance of Allergies (Mucosal Barrier)

Proteolytic enzymes (stomach/small Intestine) + Bile acids and other enzymes + pH changes + mucus layer + tight junctions between epithelial cells + secretory IgA system

preterm fat needs

Provide 45-55 percent calories, ow-fat diets are not recommended, medium-chain triglycerides (MCT) do not require bile for absorption and are a routine source of fat in preterm infant formula

Congenital lactose intolerance

Rare → requires lactose-free formula

Secondary lactose intolerance

Results from injury to small intestine (lactase synthesized/released at the tips of the villi), very common in infants, usually no restriction needed

Feeding Problems in infants

Seen in 40-45 percent of VLBW infants, feeding problems may cause frustration to families, term infants can be introduced to complementary foods at six months of age, an infant born at 32 weeks gestation would be ready for complementary foods at eight months of age

factors that impact infant Cognitive development

Severe acute malnutrition, chronic undernutrition, iron deficiency anemia, iodine deficiency, environmental interactions

Infants with genetic disorders

Small subset of congenital anomalies: phenylketonuria, Galactosemia, Urea cycle disorders, Fat-related and carbohydrate-related disorders, Disorders sensitive to high-dose vitamins, Renal genetic disorders

Infants with Congenital Abnormalities and Chronic Illness

Some infants are born at term but require neonatal intensive care (cardiac/genetic/chromosomal conditions)

growth and health

Strong emphasis is placed on growth as a sign of improving health in small and sick infants, changes in growth rate are associated with the frequency of illness/hospitalizations/medical history

Corrected age

Subtract gestational age at birth from 40 weeks

cow's milk based formula

The american academy of pediatrics recommends cow milk formula of iron-fortification if breastfeeding is not an option, most similar to breastmilk Good balance of protein/carbs/fat

infants and lead

Toxicity can interrupt brain development/slow growth/interfere with calcium and iron absorption, can be found in water and paint, infants can be exposed if caregivers carry home lead dust

infant lipid needs

Triglycerides are the major energy source in human milk, infants need at least 30 grams of fat per day, human milk provides essential fatty acids (ARA, EPA, DHA)

Introduction of complementary foods

Typically appropriate around 6 months, signs of readiness include moving the tongue from side to side/keeping the head upright/sitting with little support, solids offered via spoon = total of 1-2 tablespoons should be offered

Growth in preterm infants

Variety of growth charts (Fenton preterm growth charts and Olsen intrauterine growth charts), certain concepts impact assessment (body composition)

Cues for feeding readiness

Watching food being opened in anticipation of eating, tight fists or reaching for spoon, displeasure if feeding is too slow or stops, playing with food or spoon, slowing intake/turning away/refusal/spitting out food when full

infant water needs

Water needs typically met via breast milk/formula, excessive intake can be harmful, infants should be monitored for dehydration

growth charts show

Weight for age and length, length and head circumference for age

Large for gestational age (LGA)

above 90th percentile

Partially hydrolyzed

allergen perhaps still present

Fully hydrolyzed

amino acids and peptides

preterm infant

before 37 weeks less than 2500 grams

Top 3 causes of infant mortality

birth defects, LBW/preterm birth, and sudden infant death syndrome (SIDS)

Constipation in infants

changes in the frequency/size/consistency/ease of passing stool, more frequent in formula-fed infants, often occurs for a short duration

rule of 3 (colic)

crying for more than 3 hours per day, for more than 3 days per week, and for more than 3 weeks in an infant who is well fed and otherwise healthy

infant nutrition recommendation

exclusive breastfeeding for first 6 months and continuation to one year, infant formulas are manufactured to closely resemble human milk but numerous components cannot be replicated, growth and health status are better indicators of dietary adequacy than volume of breast milk or formula alone

newborn growth assessment

gestational age, birthweight, length, and head circumference

Human milk

gold standard for nutrient content

infant energy needs

infants need more energy per body weight than any other time in life, related to size needs are twice that of an adult, most infants require 100 kcal/kg body weight, needs change with age, fat is essential to meet needs

Health conditions in infants

interfere with growth and development, most problems resolve some persist

small for gestational age (SGA)

less than 10th percentile

Early childhood caries (ECC)

linked to feeding practices Feeding techniques to reduce caries: avoid high-frequency consumption of sugar, limit the use of bedtime bottle, avoid frequent breastfeeding after first tooth, bottle wean between 12 and 18 months, see a dentist by 12 months, brush or wipe emerging teeth

Major Food Allergens

milk, Eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans

breastmilk of vegan mothers

mothers should pay particular attention to protein, omega-3 fatty acids, iron, calcium, and vitD and VitB12 intake

preterm energy needs

needs vary, Increased calories required for infections/fever/difficulty breathing/temperature regulation/recovery from surgery, decreased calories recommended for spina bifida or Down syndrome, AAP: 105-130 cal/kg, European Society for Gastroenterology and Nutrition: 110-135 cal/kg

Types of lactose intolerance

primary, secondary, congenital, developmental

possibly helps colic

probiotics, breastfeeding mothers removing bananas from diet, consuming protein-rich foods, grapes, lemons, and potatoes

types of formula

regular (cow's milk based or soy protein based) and hydrolyzed formulas (fully and partially hydrolyzed)

infant VitD needs

required for bone mineralization and proper calcium and phosphorus utilization in blood, exclusively breastfed infants need supplementation (400 IU/day) deficiency can lead to rickets

Eating schedule

should be dictated by infant, cluster feeding may occur and is most common during the evening and in young infants

Diarrhea in infants

three or more loose watery stools per day or a stool volume greater than 10 g/kg of body weight, may result infections/food intolerance/changes in fluid intake/excessive fruit juice intake, concentrate on adequate hydration/avoidance of dehydration

extremely low birthweight

under 1000 grams

very low birthweight

under 1500 grams

low birthweight

under 2500 grams