Exam 3 Chapter 7, 8, 9
What is the cost of a human milk bank prescription?
$3-5 per oz (very expensive)
What are the signed and symptoms of candidiasis for mommy?
'twinges' or burning in the nipple that persist after feeding; Nipples appear red/shiny
Edna is a 3.5 month old, full term infant who weighs 13 lbs and 14 oz and is 24.5 inches long. What are Edna's daily protein requirements?
(13 lbs* 454g) + (14 oz *28.4g)= (5902 g) + (398g)= 6300g= 6.3 kg; OR; 14 oz/16 oz in a lbs= ).875 lbs therefore Edna weighs 13.875 lbs/2.2= 6.3 kg infants from 0-6 mo's need 1.52 g/kg/d; 6.3kg* 1.52g= 9.6 g/d about 10 g
Ethan is an 11 month old infant who was born full term, without complications, weighs 21 lbs 8 oz and is 29.2 inches long. What are Ethan's daily energy requirements?
(21 lbs* 454g)+(8 oz* 28.4g)= (9534g)+(227g)= 9761g=9.8kg; infant ages 6-12 mo's= 98kcals/kg/d; 9.8g* 98 kcals= 960 kcals
How long can breast milk be kept in the freezer, chest?
-4F 6-12 months
What is the DRI for fluoride 0-6 months and 6-12 months?
0-6 months= 0.1 mg/d; 6- 12 months= 0.5 mg/d
454.4 g= ____________ kg
0.4544 kg
What is the patter of weight gain that is wanted for all infants in oz?
0.5 - 1 oz per day
What is the energy content of human milk for preterm infants?
0.58-0.70 kcal.mL
How long can breast milk be kept in the freezer, separate door?
0F 3-6 months
At ____________ raw veggies that are steamed can be started.
1 year
What are common nutritional problems and concerns with infants?
1) Failure to thrive (FTT) 2) Colic 3) Iron-deficiency anemia 4) GI Problems: Diarrhea & Constipation 5) Early Childhood Cares (ECC) 6) Food allergies/intolerances 7) Lactose intolerance
Describe the challenges in feeding VLBW or ELBW infants.
1) Fatigue/decreased arousal 2) Low tolerance of volume 3) "Disorganized feeding" 4) Status post respirator dependency (stress response)
In addition to growth charts, what methods can you use to assess an infant with special needs' growth?
1) Growth charts for specific diagnoses 2) Biochemical indicators (Fe, Pro, electrolytes) 3) Body composition 4) Head circumference 5) Consider medications that impact growth 6) Treatment guidelines or published protocols to set outcome goals instead of standard growth charts.
What are the protein needs of an infant age 6 months to 12 months?
1.2 g/kg/day from 6 to 12 months
What are the protein needs of an infant age brith to 6 months?
1.52 g/kg/day from birth to 6 months
What are the protein requirements for a healthy infant?
1.52- 2.2 g/kg/d
You determine Mark's energy requirements to be 1020 kcal's/day. What volume of mature breast milk per day would Mark need to consume to meet his needs?
1020 kcals/ 0.65 kcals/ml= 1569 mL
If an infant needs decreased calories due to Spina Bifida or Down syndrome is _____ kcal's/day
108
Healthy infants 0-6 mo's need how many kcal's/day?
108 kcals/day
How many Kcals/kg/day is typical for an infant in the ages of birth to 6 months?
108 kcals/kg/ day (80 to 120)
What is the recommendation for iron in infants 7-12 months?
11 mg
What is the daily energy needs range according to the European Society for Gastroenterology and Nutrition (ESGN) for very preterm?
110-135 kcal/kg/day
If an infant needs increased calories due to very-pre term or infection or body burning more is ________ kcal's/day.
120
What are the daily energy needs according to the American Academy of Pediatrics (AAP) recommendations for very preterm?
120 kcal/kg/d for very preterm infants
How many Kcals/ oz do baby food fruits provide?
14-20 kcals/oz
Emma is a 4 month old, formula fed infant who was born full term, weighs 14.5 lbs, and is 22.5 inches long. What are Emma's daily energy needs?
14.5lbs= 6.6kg; energy for 0-6 mo's= 108 kcal's/kg/d; 6.6kg * 108 kcals= 713 kcals/d
1 lb = _____ oz
16 oz
Only one new food over_____days w/ ______ days b/t new foods.
2-3; 4-5
How many times a way do infants poop?
2-6 times per day
Standard infant formula provides ___ kcal/fl oz
20
Human milk provides ________ kcals/oz or ______ kcal/ml
20-22; 0.65
Wendy is a 9 month old, full term infant who is formula fed. Her length is 29.7 inches and her weight is 20.6 lbs. What are Wendy's protein requirements per day?
20.6 lbs/ 2.2+ 9.4 kg Infants 6-12 months need 1.6 g/kg/d; 9.4 kg* 1.2g= 11g
Preterm formula provides ________ kcal/fl oz
22-24
What is typical birth weight in grams?
2500- 3800 g
1 oz = ________ g
28.4 g
What are the preterm or recovery from illness protein requirements for an infant?
3.0-3.5 g/kg/d
When is peak maternal plasma and breast milk alcohol levels reached?
30 to 60 minutes after alcohol consumption and 60 to 90 minutes when taken with food. As alcohol clears from a mother's blood, it clears from her milk. (the highest, so has to wait even longer than that to breastfeed)
What is desirable birth weight in grams?
3500-4500 g
A Pre- term infant is considered to be before ________ weeks gestation.
37
A early- term infant is considered to be _______to ________ weeks gestation.
37-38
A full- term infant is considered to be _______to ________ weeks gestation.
39-40
How long can breast milk be kept in the refrigerator?
39F for 5 days
Infants should not consume more than ______ oz of 100% fruit juice per day?
4
When to the infants reflexes start to fade?
4 to 6 weeks
How do you calculate gestation adjusted age?
40 weeks- how long was in gestation= weeks/4= months then take those months minus 9 months total= gestation adjusted age
Louisa is 10 months old but was born at 28 weeks gestation. What is Louisa's gestation-adjusted age?
40-28= 12 weeks/4= 3 months 9 months- 3 months= 6 months old
A later-term infant is considered to be ________ weeks gestation.
41
A post term infant is considered to be ________ weeks gestation.
42
1 lb = _________ g
454.4 g
What is the typical length of an infant in cm?
47-54 cm
What are the protein requirements for a ELBW infant?
4g/kg
New foods may have to be introduced________ times before a child will accept them.
5-10
How long can breast milk be kept in an insulated cooler bag?
5-39F for 24 hours
Suzie is a 5lbs 8 ounce very-preterm infant. What are her daily energy needs according to the American Academy of Pediatrics (AAP) recommendations? What is her daily energy needs range according to the European Society for Gastroenterology and Nutrition (ESGN)?
5.5lbs/2.2=2.5kg 2.5*120= 300kcals/day 2.5*110= 250 2.5*135= 338 range 250-338 kcals/day
How many grams of fat should Suzie (infant from #5) be provided based on the AAP's recommendations for energy? Discuss the fat requirements for infants at risk.
5.5lbs/2.2=2.5kg 2.5*120= 300kcals/day 55%*300= 165kcals/ 9= 18.3g
Calculate the protein needs for Lizzy, a 5 lbs 5 oz (LBW), preterm infant who is recovering from and illness. What physical sign is an indication of adequate protein intake?
5/16=0.3+5 5.3lbs/2.2= 2.4kg 2.4*3= 7.2g Pro/day 2.5*3.5= 8.4g Pro/day head circumference growth
Breast milk contains about ______ calories from fat.
55%
How long can breast milk be kept in the freezer compartment of a refrigerator (no door)?
5F for 2 weeks
After birth, how long does it take for the GI tract to Mature?
6 months
When does table food start to be introduced for a toddler?
6 months
The recommended age for beginning the weaning process for an infant from the breast or bottle to a cup is between __________ months.
6 to 8
Ron's wife left him home alone with their 4 month old child Richie. Ron's wife left freshly expressed breast milk on the counter at 1 pm for Ron to feed to Richie when he awoke from his nap. How many hours can the freshly expressed breastmilk be left at room temperature and still be considered safe for Ron to feed to Richie?
6-8 hours at less than or equal to 78 degrees F
When are vegetables introduced?
6-8 months
Johnny is 4 months old, weighs 15.2 lbs and is 23.4 inches long. What are Johnny's protein needs? How many kcals from protein does Johnny need? If Johnny needs 745 kcals/day, what % of total kcals does Johnny need from protein?
6.9kg; 1.52*6.9= 10.46g/day; 10.46*4= 41.8 kcal/day; 41.8/745 *100= 5.6%
What is the AI for an infant 0-6 months for CHO? (g)
60 g/d
How many Kcals does mature breast milk contain per 100mL?
67kcals/ 100 mL
Calculate the calorie needs for Joey, 0-6 mo, a 7lb 4 oz infant with Down syndrome.
7+(4/16)= 7.25/2.2= 3.3kg 3.3kg*108= 356 kcal/day upper needs
How many Kcals/oz do baby food veggies provide?
9- 19 kcal/ oz
When is lead screening done in infants?
9-12 mo's- earlier (at 6 mo's) if familial history
When should nuts be introduced to infants?
9-12 months old
Isabelle is 9 months old, weighs 21.5 lbs and is 27.9 inches long. What are Isabelle's energy needs? Approximately how many mL of mature human breast milk would Isabelle have to consume to meet her energy needs?
9.8kg about 960 kcal's/day and 1432 mL mature breast milk (about 6 cups)
Isabelle is 9 months old, weighs 21.5 lbs and is 27.9 inches long. What are Isabelle's protein needs? How many kcals from protein does Isabelle need? If Isabelle needs 960 kcals/day, what % of total kcals does Isabelle need from protein?
9.8kg; 1.2* 9.8= 11.8g/day; 11.8*4= 47 kcal's/day; 47/960*100= 4.59%
When spoon-feeding an infant should be seated at a ____________________ with back and feet supported.
90 degree angle
What is the AI for an infant 7-12 months for CHO? (g)
95 g/d
How many Kcals/kg/day is typical for an infant in the ages 6 months to 12 months?
98 kcal/kg/day
Healthy infants 6-12 mo's need how many kcal's/day?
98 kcals/day
What are infants critical periods of development? (don't name times)
A fixed period of time in which certain behaviors or developments emerge which is necessary for sequential behaviors or developments
What is the AI for vitamin D from birth to one year?
AI= 400 IU/day (10 mcg)
What does IUGR represent?
All infants who's growth is restricted SGA; dSGA and pSGA
What plot is considered normal or healthy on growth chart?
Any plot b/t the 2nd percentile and the 98th percentile is considered "normal".
Name what the following acronym stands for: AGA
Appropriate for gestational age
When should the choice to breastfeed be discussed?
BEFORE birth, during prenatal care
What are the estimated minimum requirements of sodium for 0-6 and 7-12 months?
Birth - 6 mo's: 120 mg/day; 7-12 mo's: 370 mg/d
What to feed a VLBW or severe pre term infant?
Breast milk Human-milk fortifier Preterm infant formulas Vary in caloric content MCT oil (medium chain triglyceride) Whey protein
_________________________________ provide adequate water for healthy infants up to 6 months.
Breast milk or formula
Briefly define the genetic disorders. Disorders sensitive to high-dose vitamins
Cannot have B12 therefore meat
What causes colic?
Cause unknown but associated with GI upset, infant feeding practices
Name the 6 most common pediatric food allergies. What are the possible reasons for allergy preventive effects of breastfeeding?
Cow's milk, wheat, eggs, peanuts, soybeans, and tree nuts. The possible reasons for allergy preventative effects of breastfeeding include low content of allergens, transfer of maternal immunity, long-chain fatty acids and IGA in breastmilk protect against inflammation and infections, regulation of infant immunity, influence on gut microbial flora.
What advice can you offer a mother who is experiencing letdown failure?
Destress; play soothing music that she can focus on while nursing; Have a partner rub his/her knuckles down her spine; Try different nursing positions; Get out of the house- Most babies enjoy a walk.; Arrange for some time alone (a few hours); Switch from caffeinated to decaffeinated beverages and water for a few weeks.
Laurel is a preterm infant born at 35 weeks gestation. What are the nutritional/health benefits of breastfeeding Laurel?
Ease of protein digestion, fat absorption, and improved lactose digestion. The known health and developmental benefits include better visual acuity, greater motor and mental development at 1.5 years of age, greater verbal intelligence quotient at 7-8 years of age, and a lower incidence of serious infectious diseases.
What does the infant;s style or patterns of behavior include?
Emotional reactions to new situations; Activity level; Sociability
Carol, a new breast feeding mother, goes to the mall shopping with her friends. She is gone longer than planned and is not able to nurse her baby or pump until she returns 5 hours later. What is the most likely problem Carol will have?
Engorgement
What are the 2 types of nutrition support?
Enteral—nutrients delivered directly to GI tract Parenteral—nutrients delivered directly to the bloodstream
T/F Adding baby cereal to a 7 month old infant's formula and offering it to him/her via a bottle is an appropriate recommendation given to mother's to help their baby sleep through the night.
False
T/F Breastfeeding mother are encouraged to rub vaseline on their nipples to prevent sore nipples.
False
T/F Dehydration is not common in infants.
False
T/F Exposing a 7 month old infant to a wide variety of new foods at meals throughout the week is recommended to enhance the infants food habits later in life.
False
T/F Herbal remedies are regulated by the FDA.
False
T/F Infants should be in vigorous structured exercise programs.
False
T/F Lactating mothers who abuse drugs should still breastfeed because the breastmilk benefits out ways the drugs.
False
T/F Sizes of commercial, jarred baby food are determined by age-appropriate portion sizes.
False
T/F The American Academy of Pediatrics recommends limiting an infants scream time to no more than 1 hour per day..
False
T/F The Babinski reflex is an automatic response that is important to an infant's nutritional intake.
False
T/F The main obstacle to nursing multiples is milk supply/
False
T/F The vast majority of women experience significant problems with breastfeeding.
False
T/F Women who have flat or inverted nipples can not successfully breastfeed.
False
T/F Infants can have some solid food starting at 4 months.
False, NO solid food before 6 months
T/F Use of the BMI-for-age growth chart is recommended for children younger than age two years at this time.
False, NOT recommended
T/F At the age of 5 months, infants can no longer meet their nutrient needs through breast milk and must begin to supplement their nutritional intake with smooth textured foods such as iron fortified cereal.
False, at 6 months
T/F Women should stop breast feeding when she has Mastitis.
False, it is important to keep the milk flowing through
T/F Whole, reduced-fat or skim cow's milk can be used in infancy to supplement human breast milk.
False; No cow's milk until after age 1 because it is linked to iron deficiency and the proteins are different can kill child
___________ of infants with special health care needs should be considered (not just the infant)
Families
Several herbs have been traditionally used to affect milk production. Identify 3 herbs that promote milk production and are considered safe/compatible for use by breastfeeding mothers.
Fenugreek, Goat's-Rue, Milk/Blessed Thistle
What are the keys to building a plentiful milk supply when breastfeeding multiple infants? How would you assess if the infants were receiving adequate nutrition?
Frequency and effectiveness. To assess if infants are receiving adequate nutrition, one can analyze how often a mother nurses, how long the nursing lasts, if the baby is latching on and/or suckling properly, etc.
What are some common problems that simply reflect the immaturity of the infant's GI tract?
Gastroesophageal reflux (GER); Diarrhea; Constipation; Colic
________________ are the standard tool for interpreting infant and child growth.
Growth Charts
What foods should not be given to infants especially those less than 1 years old because of choking hazards?
Hot dogs; Popcorn, potato chips; Peanuts, chunks of peanut butter; Raisins, whole grapes; Stringy meats; Gum & gummy-textured candy, hard candy or jelly beans; Hard fruits or vegetables
What are the 3 primary questions that must be addressed with high risk infants?
How is the baby growing? Is the diet providing all required nutrients? How is the family coping?
What are the guidelines for the storage of human milk freshly expressed into a closed container for home use?
Human milk freshly expressed into a sanitized, closed container can be kept at 78 degrees F or lower for 6-8 hours, at 39 degrees or lower for 3-5 days, 2 weeks in a freezer compartment inside a refrigerator, 3-6 months in the freezer section of a refrigerator with a separate door, or 6-12 months in a deep freezer at 0 degrees
What does early onset/breast-nonfeeding jaundice result from? What is the recommended management/treatment of this condition?
Inadequate feeding; results from reduced volume of milk transfer to the infant limited caloric intake and producing a state of partial starvation. The recommended management/treatment of this condition is to encourage mothers to nurse frequently about 8-10 x per day, avoid BM supplementation if possible, monitor serum bilirubin daily as outpatient, and try to increase milk volume.
What are the signed and symptoms of candidiasis for baby?
Infant has oral white patches
Maggie would like to breastfeed her son who was delivered at 37 weeks gestation. What risks does this place the infant at? What is your advice for Maggie?
Infant may have subtle immaturity that makes establishing breastfeeding difficult and places him at risk for insufficient milk intake, hypoglycemia, jaundice, and poor weight gain. He may also have cardiorespiratory instability, poor temperature control, lower glycogen and fat stores, an immature immune system and poorly coordinated suck-swallow coordination. Maggie should have a specific feeding plan including a plan to wake a sleepy infant every 2-4 hours to avoid the near-term breastfeeding cascade. If John is not sucking vigorously, Maggie should pump after each feeding attempt or at least every 3 hours to build the milk supply
What is infant sensorimotor development?
Interaction b/t biological and environmental systems that causes awareness
What is sensorimotor development in an infant influenced by?
Interactions with the environment; Adequate energy,protein/nutrients (short and long term); Stimulation of social and emotional growth; Genetics
What does lead in infants do?
Interferes w/ iron and Ca absorption; Causing slow growth and short stature
Name what the following acronym stands for: IUGR
Intrauterine Growth Retardation/ Restriction
Jack is at the 90th percentile for weight and the 75th percentile for length for his age. How would you interpret this data?
Jack weighs more than 90% and is longer than 75% of all the boys his age
What is the recommendation of caffeine in lactating mothers?
Less than 750 mL /d (25 oz) of coffee/day
Lucy's length for age growth chart states that Lucy is between the 2nd and 5th percentile for age at birth. What does this mean?
Lucy is longer than than 2-5% of girls her same age at birth
What is large head size called?
Macrocephaly
Female or male infants have less of a problem with Jaundice.
Male
What is the name of the bacterial infection of the breast most commonly found in breastfeeding women? What are the signs and symptoms (s/s) of this infection?
Mastitis. May result from: sore and cracked nipples, blood borne source of bacterial infection, missing a feeding resulting in engorgement, then plugged duct may precipitate engorgement. S/s: painful, enlarged, hard area in the breast; possible fever and flu-like symptoms.
_____________________________ beneficial to very low brith weight VLBW and extremely low brith weight ELBW infants because of low pancreatic and liver enzymes which are needed to digest Long-chain Triglycerides LCT
Medium-chain triglycerides (MCT)
Why should breastfeeding women avoid certain fish?
Mercury levels
What is small head size called?
Microcephaly
Which of the following herbs is considered "safe" to use during lactation and may even be used to promote milk production? St. John's wort; Echinacea; Foxglove; Feverfew; Milk/Blessed Thistle
Milk/Blessed Thistle
What are the 5 types of enteral tube feeding?
Nasogastric (NG)- nose Oral-gastric (OG)- mouth Transpyloric- below stomach Gastrostomy- into stomach Jejunostomy- into jejum
Should lactating women with HIV and Aides breast feed?
No
Why is whole milk recommended for 1 year old infants?
No low fat milk before the age of 2 because restriction may jeopardize normal growth and brain development
What are the recommendations for lead in infants?
No recommendations; May be toxic
How is hyper lactation treated?
Nurse baby on one side only and express for comfort on the other; Cabbage leaves may be used to decrease production
_____________________ is more important than specific percentile and provides a better picture.
Pattern of growth
How can dehydration in an infant be corrected?
Pedialyte
______________________ assessment in very important in identifying health issues and nutritional inadequacy.
Physical growth
What is the difference between the two types of Jaundice?
Physiological (normal) Jaundice- begins after day 1 ; and Pathological Jaundice- begins wishing 1st day and rises
What are the two types of Jaundice?
Physiological (normal) Jaundice; and Pathological Jaundice
Briefly define the genetic disorders. Renal
Poly cystic kidney disease
Christie is a breastfeeding mother who asks you if alcohol can be eliminated from her breast milk by pumping immediately after drinking a few glasses of wine. What would you tell her?
Pumping immediately after consuming alcohol does NOT facilitate the elimination of alcohol from the milk; No, the alcohol will still be in the breast milk and will clear from the milk as soon as it clears from the blood stream: roughly 3 hours per drink for a 120-pound woman
What are some recommendations to relieve colic?
Rocking, swaddling, or bathing or any method of relaxing the baby; Proper positioning at feeding; Burping the baby often to relive gas; Make connections b/t mom's diet and colic of nursing and make corrections; Change infant formula
Fran is a breastfeeding mother who needs to use a specific medication. What should you tell her?
Schedule doses carefully around nursing sessions; try a short-acting form of the medication; use an inhalant or topical application of medication instead; evaluate the infant
When does engorgement happen to mom?
Sleepy baby, sore nipples, baby-mom separation
Name what the following acronym stands for: SGA. What umbrella term is it under?
Small for Gestational Age; IUGR
What herb is commonly consumed for depression and is not good for the baby while lactating?
St. John's wort; bc may reduce milk supply
What is encephalopathy?
Swelling of the brain a form of jaundice; Kernicterus is a form of this in which brain damage is caused
What is your best reference when determining breast feeding drugs?
TOXNET Lact Med online data base (not PDR, Physician's Desk Reference)
What is colic?
The sudden onset of irritability, fussiness or crying for more than 3 hours for more than 3 days a week for 3 weeks
What is the purpose of human milk banks? Which infants are most likely to received banked milk? How is human milk for human milk banks stored?
To provide human milk to infants who cannot be breastfed by their mothers. Premature and sick infants are most likely to receive banked milk. The milk is carefully pasteurized to kill pathogens and preserve nutrients. It is then stored frozen and in rigid plastic containers in order to keep the composition of the milk stable.
T/F A child typically requires special health care because they have/had a metabolic/genetic disorder, birth defect, trauma, infection, exposure to drugs/alcohol or was born pre-term.
True
T/F American Academy of Pediatrics recommends NO screen time at all.
True
T/F Babies born vaginally have a better micro-biome than c-scetion babies.
True
T/F Breastfeeding provides protection for allergic diseases in infants.
True
T/F Children with special health care needs are infants, children or adolescents with or at risk for a physical or developmental disability, or with a chronic medical condition.
True
T/F Children with special healthcare needs are infants, children or adolescents with, or at risk for, a physical or developmental disability, or with a chronic medical condition
True
T/F Feeding is not only about nutrition, it is also about the development of skills (social, motor, muscular)
True
T/F First foods may appear to be rejected due to immature tongue movement resulting in underfeeding.
True
T/F Food preference from infancy sets stage for lifelong food habits.
True
T/F Infants can have vegetarian diets and still be healthy.
True
T/F Infants may "outgrow" a lactose intolerance.
True
T/F It is better to smoke and breastfeed than to smoke and not breastfeed.
True
T/F Jenny is currently receiving ABT for mastitis. Jenny should continue to nurse her baby.
True
T/F Small exposures of allergies may help a baby to protect against allergen later in life.
True
T/F The classifications that are used for children under two do not include the terms "overweight" and "obese".
True
T/F The growth pattern of exclusively breastfed infants differs from formula-fed infants.
True
T/F The infant can get a yeast infection, candidiasis, in his/her mouth from the pacifier it can pass it to mommy though breastfeeding.
True
T/F The terms "overweight" and "obese" are used exclusively to describe children 2 to 20 with BMI-for-age between the 85th - 95th percentiles (overweight) and ≥ 95th percentile (obese)
True
T/F Smoking while breastfeeding is better for the baby than smoking and not breastfeeding.
True, because the baby still gets all the other benefits of breastfeeding out way all the negative effects
T/F Breastfeeding twins, triplets & quadruplets is possible.
True, but mommy needs lots of support
Infants often have condition that reflect the immaturity of the gastrointestinal (GI) tract, which include all the following except: Urinary tract infections; colic; constipation; gastroesophageal reflex (GER); unexplained diarrhea
Urinary tract infections
_________ has their own growth charts that use z-scores to determine nutritional/growth/developmental adequacy.
WHO
What is the treatment for hyperactive let down?
Wait for the milk flow to slow down before putting the infant to the breast
A breastfeeding mother presents with a candidiasis (yeast) infection at her nipple area and relays that she keeps developing and being treated for these infections. What is the first question you ask her?
Was your infant simultaneously treated for the infection?
Extremely Low Birthweight (ELBW)
Weighing <1000 g (< 2lbs 3oz)
Very Low Birthweight (VLBW)
Weighing <1500 g (<3 lbs 5oz)
Low-Birthweight (LBW)
Weighing <2500 g (<5 lbs 8oz)
What factors influence calorie needs in an infant, requiring us to use a range?
Weight and growth rate; Sleep/wake cycle; Temperature and climate; Physical activity; Metabolic response to food; Health status/recovery from illness
In breastfeeding women, do most medications taken by the mother get excreted in breast milk? What are the steps to minimize the effects of maternal medication?
Yes. a) Avoid long-acting forms. b.) Schedule doses carefully. c) Evaluate infant. d) Choose the drug that produces the least amount in the milk.
What does failure to thrive (FTT) mean?
a diagnosis that shows inadequate weight or length grains or inadequate head circumference gains; not meeting developmental milestones
What is bilirubin?
a fat-soluble byproduct of red blood cell destruction; more red blood cells during fetus; excreted through the poop and also converted to water soluble when exposed to UV light
What is Pedialyte?
a sports drinks provide electrolytes but lower in calories than formula or breast milk about 3 kcal's/oz compared to 20-22 kcal's/oz
Describe neonatal jaundice, its incidence rate and the serum bilirubin level that will result in jaundice. Identify 1 Major, 1 Minor and 1 decreased risk factor for severe hyperbilirubinemia
a yellow discoloring of the skin caused by too much bilirubin in the blood. It is fairly common and considered a benign condition that resolves on its own or with minimal intervention. Jaundice will occur with serum bilirubin levels exceeding 5 to 7 mg/dl. One major risk factor: jaundice being observed within the first 24 hours of life. One minor risk factor: male gender.
What is motor development in infants and where is it?
ability to control voluntary muscles from the top down
Johnny is 4 months old, weighs 15.2 lbs and is 23.4 inches long. What are Johnny's energy needs? Approximately how many mL of mature human breast milk would Johnny have to consume to meet his energy needs?
about 745 kcal's/day 1110 mL mature breast milk (about 5 cups)
What two things are very important when assessing growth of a child or infant?
accuracy and consistency
When can babies have cows milk and what kind?
after the age of 1 and only whole milk
Which of the following is a warning sign indicating growth problems in infants? plateau in weight gain for more than one month; all of the choices indicate growth problems in infants; drop in weight without regain within a few weeks; lack of height gain; plateau in head circumference gain for more than one month
all of the choices indicate growth problems in infants
How is candidiasis treated?
anti yeast cream on the breast for mommy and oral medication for baby depending on how bad
Debbie is a mom with a newborn. She called a nurse practitioner to report that one of her breasts was painful, enlarged and had a red area. In order to distinguish between two common conditions, what additional information would the practitioner want?
any flu like symptoms?, gradual or sudden onset?, fever?, where is the pain?
Energy needs during infancy____________________________ of body wt than at any other time.
are higher per kg
When feeding problems are identified in infancy, what nutrition interventions should be considered?
assess growth, monitor intake, make adjustments in feeding frequency/ timing/ position, nutrient density, parent education, observe parent-infant interactions, consider developmental abilities
An infant who has been ill has been on a respirator since birth. He is now 6 months old and ready to start solids, although he does not like it when a spoon is placed in his mouth. What might be the cause of this?
associating the spoon with discomfort, critical period for mouth exploration or near-muscular development missed due to respirator, not yet ready
How long can breast milk be kept on the counter?
at room temperature 77F for 6-8 hours
Where is head circumference measured?
at widest part of head
What was early childhood caries originally called?
baby bottle carries
Why cant a baby have honey?
because it can carry botchilsum
In a typical growing infant there is an increase in __________________________________________.
both weight and length EVERY month
Adequate nutrition is required for normal growth and development; especially _______________________.
brain development
What is mode of feeding?
breastfeeding or formula
Sonia comes to you in desperation, her son Greg has colic and she is at her wit's end about what to do to help him. What is your advice?
burp Greg often, discuss Sonia's diet and make connections between her intake and Greg's colic, propter positioning while feeding, swaddle and rock Greg
How are babies unlatched correctly if the baby is not unlatching?
by the mom releasing the suction by putting her finger in the babies mouth and rubbing its lips to release the suction
How do you avoid measurement errors when accurately measuring growth in infants?
calibrated measuring equipment, zero out scale, infant is nude or clean dipper, correct positioning (anatomical position), head circumference measured at widest part of head
What causes failure to thrive?
calorie deficit
What is the most common type of yeast infection for any person including breastfeeding women?
candidiasis
Briefly define the genetic disorders. Galactosemia
cannot break down glactose so babies cannot have breast milk
Briefly define the genetic disorders. Fat-related disorders
cannot metabolism long chain fatty acids
What is breast milk jaundice?
caused by breast milk; Onset later (after 3rd day) treatment is to stop breast feeing for 12-24 hours
Growth Charts assess measurements over time which identify__________________ and _______________________.
change in growth rate; need for intervention
What is constipation in an infant?
changes in the frequency, size, consistency, or easy of passing stool
At 9-12 months what soft table foods are offered at this time?
cheerios, applesauce, mashed potatoes
What are early childhood caries?
child cavities from milk sitting in milk over night, juice, frequent breast feeding
What age group does the CDC recommend to use the WHO growth standard charts?
children 0 - 24 months of age. (0-2 yo)
What is the second most common nutritional problem in infants?
colic
How do you prevent a plugged duct?
completely empty the breast
Stacie is petite, small breasted first time mother who is infested in breastfeeding her baby; however, she is concerned about not being able to produce enough milk (let down failure and low milk supply) for her baby. What information would you share with Stacie to help her maintain adequate milk production?
completely empty your breasts at each feeding, either by nursing or pumping; relax and decrease stress; breastfeed or pump frequently; ensure adequate nutrition (greater than or equal to 1500 kcal's/day) and hydration (pale yellow urine)
What foods are considered unsafe for infants to consume?
concentrated sweets, sugar alcohols, honey
What is your advice for Sally, a breastfeeding women who habitually consumes caffeine?
consumption, like any other nutrient should be consumed in moderation. Most infants can tolerate the equivalent of 5 or less 5 ounce cups of coffee a day, or less than 750 ml per day. But some infants are more sensitive and it is up to the mother to determine if symptoms of: hyperactive, fussy, and wakefulness are due to caffeine intake d/t the maternal diet.
What type of fruit should infants eat at or after 6 months?
cooked and pureed with no sugar added
How is protein offered to a 6 to 8 month old infant?
cooked egg, pureed meats
What type of vegetables can infants eat at 6 to 8 months?
cooked, strained and pureed with no added salt (NAS)
Wanda is a breastfeeding mother suffering from significant postpartum depression. What should you be most concerned about regarding her infant son James?
delayed cognitive development from decreased stimulation
Hyperbilirubinemia in newborns is caused by _________________.
destruction of aged red blood cells
Monitoring an infant's nutritional status requires an understanding of their overall _________________.
development
What conditions/situations does and infant require increased calorie needs?
difficulty breathing, temperature regulation, infections, fever, very-preterm, recovery after surgery
Name what the following acronym stands for: dSGA
disproportionately small for gestational age
How do you change lbs to kg?
divide by 2.2
The vast majority of women (do or do not) experience significant problems during breastfeeding
do not
Newborns ___________ birth weight by 4-6 mos and ___________ it by 1 yr.
double; triple
How is candidiasis prevented?
dry breast, sanitize pacifier
Lower birth wt is related to ____________________________________________________________________.
earlier delivery, more complications, and a lower chance of survival
What nutrition interventions are recommended for management of early onset/breast non feeding jaundice in infants?
early and frequent breastfeeding
What are the two types of Jaundice in the breastfed infant?
early breast-nonfeeing; not eating enough and Late breastmilk jaundice- caused by breast milk (hold off on breast milk for a few days)
What is the difference between engorgement and plugged duct?
engorgement is in both breast while plugged duct is normally just one duct in one breast
Which ones is more long term enteral feeding or parenteral feeding?
enteral feeding
Besides food and nutrition what else influences the infant?
environment
Breast milk: AAP & The Academy of Nutrition and Dietetics recommend __________________________________________________________________.
exclusive breast feeding for 1st 6 months & continuation to 1 yr
It is important for a mother to have a varied diet wile breast feeding because it __________________________________________________________.
exposes breast fed baby to more flavors
What is the treatment of engorgement?
express the milk, warm shower, cold compress, cabbage leaves
Infants who are fed breastmilk typically growth _________ in the first 3 months and then _____________ from 3 months to 12 months.
faster; slower
What vitamins should be supplemented for exclusively breastfeed infants?
fluoride, iron, vitamin B12, Vitamin D (if vegan)
What can too much fluoride cause in infants?
fluorosis
An infants prefers vegetables or fruits, why?
fruits because they are sweet
Briefly define the genetic disorders. Carbohydrate disorder
glycogen storage disease
When is an infant considered LGA in lbs and grams?
greater than or equal to 10 lbs or 4500 g
What is the single most useful tool for defining health and nutritional status?
growth assessment
How are patterns of growth assessed in infants?
growth charts
What will happen if there is insufficient amounts of CHO in an infants diet?
growth will plateau
Infants with a length-for-age < 2nd percentile are classified as ______________________.
having short stature.
The development of motor control starts with _________________________________.
head and trunk control, then lower legs
What is a protein-sparing diet?
high carbohydrates, to protein is not used for energy but used for other things in the body
Infants with a weight-for-length > 98th percentile are classified as _____________________________.
high weight-for-length.
What is the difference between hyperactive let down and hyperlactation?
hyperactive let down is increased flow while hyper lactation is increased milk volume not necessarily flow
A mother who is experiencing ___________________________ would be concerned about her infant choking on the milk or gulping to keep up with the flow resulting in gas pains and a fussy infant.
hyperactive letdown
Where does engorgement happen?
in both breasts, overfilled with milk resulting in generalized pain
The first step in correcting failure to thrive in infants is
increase calorie and protein intake
What is the first step of nutrition intervention for failure to thrive?
increase energy (kcals) and protein intake
When is energy per kg of body wt highest during the life cycle of a human?
infancy
How much would you expect Anthony to weigh at 1 year of age if he was born full term at 7lbs 4 oz; assuming Anthony had a typical pattern of growth?
infants double in size at 4 to 6 months and triple in size at 1 year; 7 lbs* 3= 21 lbs; 4 oz* 3= 12 oz
What infants need vitamin D supplementation?
infants that are exclusively breastfed infants and those not exposed to sunlight
What is otitis media?
infection of babies inner ear
What is important about infant's fat intake?
intake should NOT be limited before 2 years of age as restriction may jeopardize normal growth and brain development
Under nutrition of what micronutrient can delay infant stages of development?
iron
What is never included in a human milk fortifier?
iron
What type of cereal should infants eat at or after 6 months?
iron fortified rice cereal
The first food (other than breast milk or formula) to be given to an infant should be
iron-fortified cereal
Fat restriction (is or is not) recommended b/c fat provides satiety and long-term energy.
is not
Does Intrauterine Growth Predict Outside Growth?
it depends on intrauterine environment (nutrition), fetal origins errors, unknown factors such as air pollution or other toxins
What information should you obtain from your breastfeeding client who is taking an herbal remedy? What should you do w/ this information?
it is important to check the contents. Important information would include its name, a list of all of the ingredients, the names of the plants or other components (include Latin names if possible), details of preparation, and the amount consumed. With this information, using reliable herbal information or the regional poison control center, it is possible to identify the potentially harmful pharmacological and toxicological ingredients.
Newborn health status is assessed by a number of indicators of growth and development taken right after birth, which include all the following Except: birthweight; length; knee to ankle length; head circumference
knee to ankle length
Name what the following acronym stands for: LGA
large for gestational age
Infants__________ food preferences based on experiences with foods.
learn
A very pre- term infant is considered to be _________________________ weeks gestation.
less than or equal to 34
Good feeding practice to limit early childhood caries include all the following EXCEPT: Offering only water in a bottle to sleep with; examining and cleaning emerging baby teeth on a regular basis; seeing a dentist by 12 months; letting the baby have juice in a bottle throughout the day to have as desired; avoiding frequent breastfeeding after first tooth
letting the baby have juice in a bottle throughout the day to have as desired
Name the steps to manage nipple pain. __________
letting the breasts air dry after nursing, rubbing expressed milk or all-purpose ointment (not petroleum based) on nipples, and using warm compresses on sore nipples.
Why is dehydration common in infants?
limited ability to signal thirst, vomiting and diarrhea can cause dehydration, dehydration is difficult to detect in infants
Describe a plugged duct. What is the best method to prevent/cure a plugged duct?
localized blockage of milk in one breast resulting from milk stasis (milk remaining in the ducts). Treatment: gentle massage, warm compresses, and complete emptying of the breast. Women should consider changing nursing positions to facilitate emptying the breast. If plugging occurs repeatedly, a gentle manual massage before nursing often results in the plug being expelled.
What is the most common reason women stop breast feeding?
low milk supply; perceived
Infants with a weight-for-length < 2nd percentile are classified as ___________________________.
low weight-for-length.
The most important step to prevent sore nipples is to _____________.
make sure the baby is positioned properly
When measuring growth in infants, you should do all the following EXCEPT ______ to avoid measurement errors. use measurement equipment that has been recently calibrated; make sure that neither hips nor knees are bent; confirm the scale is on zero before starting; measure the heel with the foot flat against a foot board; make sure the infant keeps his/her full diaper on to keep surfaces clean
make sure the infant keeps his/her full diaper on to keep surfaces clean
What is the difference in the composition of milk from women who deliver preterm infants as compared to women who deliver full term infants?
milk is higher in protein, slightly lower in lactose, and higher in energy content (0.58-0.70 kcal/mL) compared to full term milk. Pre term infants also require more nutrients that are not provided by human milk and may require a fortifier of vitamins D, C, E, B2, Ca, P, Zn & Pro.
What is the minimum amount go Kcals/d a lactating woman must have to avoid low milk supply?
more than 1500 kcal's/day
An infant that is very active is more developed in the _________ and __________ categories.
motor and muscle
What is the recommendation of nursing mothers and marijuana and why?
none, THC is 8 fold in concentration in milk compared to mom's plasma
When discussing children with special healthcare needs it is important to avoid terms such as _____________.
normal, abnormal and diet
How should cereal be presented to an infant at or after 6 months?
not in a bottle, from a spoon to developmental growth of eating off spoon
What is non-feeding jaundice?
nursing infrequently or inefficiently Early onset jaundice (about 2-5 days old)
Recommendation for introducing a baby to food on a spoon inclusion all of the following Except: offer a large variety of foods for him/her to choose from; time the first spoon-feeding experiences for when the baby is not overly tired; keep the spoon level and do not scrape foods into the baby's mouth; place the bowl of the spoon on the tongue with slight downward pressure; give the baby time to open his or her mouth and extend the tongue towards food
offer a large variety of foods for him/her to choose from
How do you offer new foods?
only 1 new food at a time and offer it over 2-3 days w/ 4-5 days b/t new foods
What is an intolerance?
only GI tract upset
What are the types of failure to thrive?
organic- a medical illness; non-organic- no identifiable medical cause (too much water mixed into foods decreasing calorie intake);
Briefly define the genetic disorders. Bone genetic disorders
osteogenesis imperfecta
What are the health risks for infants posed by having a mother who smokes?
otitis media, exacerbations of asthma, respiratory infections, and gastrointestinal dysregulation such as GERD or colic. Tobacco smoking also increases the exposure of infants to organochloride pesticides, PCBs and hexachlorobenzene
If all else fails what medication is given for the treatment of let down failure?
oxytocin in the form of a nasal spray
Briefly define the genetic disorders. maple syrup urine disease
pee smells like syrup, body can not break down branched chain amino acids
Briefly define the genetic disorders. phenylketonuria
phenylaine cannot be broken down
What can early weaning result in?
plateau in weight, and/or constipation
What are the common causes of nipple pain?
poor positioning of the infant at the breast, improper release of suction after a feed, infection (thrush or staphylococcus aureus), pumping with too much suction, a problem with the infant's suck, dermatologic abnormalities, breast care/proper cleaning may also contribute.
Name what the following acronym stands for: pSGA
proportionately small for gestational age
What is nutrition support?
provision of nutrients by methods other than consuming regular foods/beverages
If mom who is breastfeeding, wants to have a glass of wine at dinner what should she do?
pump before you go so that you have clean milk to give the baby the you get home, them pump and dump after dinner
______ is an unsafe dos to give to one-year old infants
raisins
What is the most common reason for cessation of breastfeeding?
real or perceived insufficient milk supply
What is an allergy?
related to protein leached into blood stream causing a reaction; fully system shutdown
When should breastfeeding be initiated?
right after birth
What parental role is very important?
role modeling
What position should a young infant be bottle-fed?
semi-upright so not in the crib
What if a mother suspects a correlation b/t her diet and the baby's colic?
she should keep a food diary with notes on the baby's symptoms and behavior
How does alcohol on the lactation effect the baby?
sleepy, uncomfortable, affects odor and taste of milk
What are some cues for infants to stop feeding table food?
slow intake, turing away, refusal, or spitting out food
Infants who are fed formula typically growth _________ in the first 3 months and then _____________ from 3 months to 12 months.
slower; faster
At 6 months what is offered? How often?
small portions (1-2 Tbs) of semisoft food on a spoon 1-2 times each day
Briefly define the genetic disorders. Urea cycle disorders
something wrong with protein metabolism
What are some reasons lactating women get mastitis?
sore and cracked nipples, infection, engorment, plugged duct, tight fitting clothes
Name the common conditions that breastfeeding women experience. __________
sore, flat, or inverted nipples, letdown failure, hyperactive letdown, hyperlactation, engorgement, plugged duct, mastitis, low milk supply, and yeast infection (candidiasis).
What conditions/situations does and infant require decreased calorie needs?
spina bifida or down syndrome
Which of the following would not be a cue an infant might give when signaling that he/she is hungry and ready to eat? Showing excitement by clenching his/her fists; Showing irritation if the feeding pace is too slow; spitting out food on the floor; watching the food be opened
spitting out food on the floor
All of the following are recommended treatments for plugged ducts EXCEPT ______? Apply warm compresses; change nursing positions; take one tablespoon per day of lecithin; gently massage the affected breast; stop breastfeeding until you see a health care provider
stop breastfeeding until you see a health care provider
Infants have inherent preference for _________ taste and dislike of ________ flavors.
sweet, bitter
What is muscle development in an infant?
the ability to sit up from central to peripheral
What should a breastfeeding mother who is experiencing hyperactive letdown be concerned about?
the infant may be overwhelmed by the volume of the milk and the infant may choke or gulp to keep up with the flow. When the infant gulps, the infant takes in air, develops gas pain, and then becomes fussy.
What are the draw backs of commercial baby foods?
the jars could be mistaken for a serving size, no cultural options, squeeze pouches do not meet developmental stage, sometimes things are added or not, watch calories
What is a Z-score in ration to the WHO growth chart?
the number of standard deviation from the mean; 1= mild malnutrition, 2= moderate malnutrition, 3= severe malnutrition
What is weaning?
the slow discontinuation of breastfeeding or bottle feeding and substitution of food for breast milk or infant formula
What is the main obstacle of breastfeeding twins, triplets or quadruplets?
the time & fatigue of mother b/c feedings could be at >15 times per day
What are the recommendation for fiber in infants?
there are none
What happens if critical periods in infancy are missed?
there may be difficulty later on
Are "Sippy cups" good?
they are okay but they delay the development of drinking from cup and can mess up teeth, pallet, speech
What is diarrhea in an infant?
three or more loose, watery stools per day or a stool volume greater than 10 grams per kilogram of body weight
When working with an infant what is the role of the Dietitian?
to assess nutritional status of newborn but also educate the parents
Why would a baby with Jaundice be put under a UV lamp?
to convert the fat-soluble bilirubin to water soluble so it can be peed out
What is the goal of weight gain in infants?
to provide enough kcal's/d to promote a 15g or 0.5oz gain per day
What is the danger to the baby if the mom has hyper lactation?
too much foremilk and not enough hind milk which causes spitting up, poor weight gain, choking, gas, difficulty maintaining latch
A possible cause of non-organic failure to thrive in infants is?
too much water is added when mixing infant formula
If a mommy has a choice of taking a medication orally or topically and is breast feeding which should she choose?
topical application
In grams, what is considered a Extremely low brith weight?
under 1000 g
In grams, what is considered a very low brith weight?
under 1500 g
In grams, what is considered a low brith weight?
under 2500 g
What is hyperbilirubinemia?
very high amounts of bilirubin
Which 3 main groups of infants require in-depth nutritional assessments?
very pre-term infants; infants born with birth defects; infants at risk for chronic health problems
Infants who are born _______________, ______________, and ___________________ face more health risks than infants who are born at ______ weeks or later.
very pre-term, pre-term and early-term; 39
What type of fruit can infants eat at 8 to 10 months?
very soft fruits like peaches or pears can be cut up
Supplementation of what vitamin should be given at birth to exclusively breastfed infants and those not exposed to sunlight?
vitamin D
What are some cues for infants readiness for feeding table food?
watching food being open, tight fists, reaching for spoon, playing with food or spoon (still interested)
Between 6-8 months what liquids should/can be offered to infant?
water or juice but only 4 oz/day
What are the nutritional concerns for infants with Down Syndrome?
weak facial muscles causes feeding difficulty, overweight common, low amount go movement, constipation
Potential nutrition problems in infants with special health care needs include all of the following EXCEPT: difficulty achieving or maintaining adequate positioning when feeding; weight gain that follows a channel/curve on the weight for age growth chart; decreased energy needs; accelerated rate of weight gain
weight gain that follows a channel/curve on the weight for age growth chart
How could more problems with breast feeding could be prevented?
with adequate, consistent, and individualized prenatal breastfeeding education & support from health care professionals both in the hospital (during initiation) and after discharge (for continued breastfeeding)
What is Jaundice?
yellowing of the skin due to immature liver causing high bilirubin
After __________of age, infants are better equipped to 'communicate' with parents about their hunger.
~6 mo's
