9) Infancy and Childhood Flashcards
During which childhood periods are weight gain extremely rapid?
- During the first year of life
- During the adolescent growth spurt
What are growth charts used for?
To analyze length and weight measurements
How are growth charts used?
- They are NOT diagnostic
- They are used in concert with other information to assess general health
How do breastfed infants at 3 to 4 months compare to bottle-fed infants in terms of weight and height?
- Similar height
- Breastfed infants have a lower weight
- Natural differences
Do growth charts apply to all children in terms of race and ethnicity?
- Yes, these differences are relatively minor on growth
- Health and environmental influences have a greater influence on growth
What are the three eating developmental patterns?
1) Nursing Period
2) Transitional Period
3) Modified Adult Period
When does the nursing period occur?
During the first four to six months
What is the nursing period characterized by?
Breast milk and/or infant formula forms the complete source of nutrition for the infant
When does the transitional period occur?
From six to 10 months
What is the transitional period characterized by?
The introduction of semi-solid foods with high milk consumption
When does the modified adult occur?
After 10 months
What is the modified adult period characterized by?
The infant may consume most adult-type foods with modifications (e.g. cutting into smaller pieces)
Exclusive breastfeeding is recommended for how many months?
6 months
Until when is cow’s milk not recommended to be consumed?
Until the first year
What type of cow’s milk is recommended for young infants (above 9 months)? Until when?
- Full-fat (3.25%) at a maximum quantity of 750 mL per day
- Until after the child reaches 2 years of age
Why is low-fat milk not recommended for children under the age of two?
Lower in energy, vitamin and EFA content
How does the distribution of energy-yielding macronutrients differ between human milk and infant formula?
They are similar
How does the distribution of energy-yielding macronutrients differ between human milk and the recommended adult diet?
- Breast milk: 55% fat
- Adult diet: 30% fat
What are the associated risks with under-dilution of formula?
May increase the risk of dehydration and metabolic acidosis
How may under-dilution of formula increase the risk of dehydration and metabolic acidosis?
- An excess of protein and solutes are provided to the infant
- Results in hypernatremia and an increased strain on the kidneys
What kind of water must be used to make formula? How is it obtained?
- Sterile water (pathogen-free)
- Brought to a rolling-boil for 2 minutes
Should infant formula be microwaved?
No, as it results in hot spots in the milk, which may cause burns
What is Nursing Bottle Syndrome?
- Results when an infant is put to bed with bottles containing fluids other than water
- Milk or juice pools in the infant’s mouth while sleeping, resulting in severe dental caries
Which vitamins are deficient in goat’s milk?
- Folic acid
- Vitamin B6
- Vitamin B12
How does the protein content of goat’s milk compare to breast milk or formula? What is the effect?
- Higher in protein
- Increases the risk of dehydration and higher renal solute load (strain on kidneys)
How does the calcium and phosphorus content of goat’s milk compare to breast milk or formula? What is the effect?
- Low calcium to phosphorus ratio
- Increases the risk of hyperphosphatemia tetany
How does the energy content of plant-based beverages compare to breast milk or formula? What is the effect?
- Low-energy density
- Results in failure to thrive and infant malnutrition
Which vitamin is deficient in plant-based beverages?
Vitamin D
How does the manganese content of plant-based beverages compare to breast milk or formula? What is the effect?
- Higher than the UL for manganese
- Increases the risk of neurotoxicity and learning disabilities
How may a mother realize whether the infant is given enough milk?
- Observe their child’s behaviour
- Observe the contents within the child’s diaper
Which diaper observations may a mother make?
- The number of wet diapers
- The number of soiled diapers
- The colour of the stool
What is Beikost? When is it recommended?
- The introduction of solid foods alongside breast milk or formula
- At 4 to 6 months
What characteristics allow Beikost to commence at 4 to 6 months?
- The teeth have developed
- The infant has the ability to swallow solid foods
- The baby’s energy requirements now exceed the quantity of breast milk alone
What are indications of readiness for Beikost?
- Doubling of the infant’s weight
- Remaining hungry after consuming 32 ounces of formula
- Remaining hungry 4 hours after the consumption of 8 ounces of formula
- Sitting with support
- Controlling head movements
What are risks associated with the introduction of solid foods too early?
- Morbidity due to diarrhea and food allergies
- Undernutrition (decrease in maternal milk production)
- Allergies (maybe diabetes)
- Choking
What is a psychological effect that may occur from introducing solid foods too early?
- Extrusion reflex (infant rejects the hard object in the mouth)
- Results in an adversary relationship between the mother and infant
What are risks associated with the introduction of solid foods too late?
- Growth faltering
- A decrease in immune protection
- Feeding aversion
- Undernutrition (exclusive breastfeeding may become inadequate)
Which nutrient deficiencies are at-risk when solid foods are introduced too early?
- Energy
- Protein
- Iron
- Zinc
- Vitamin A
- Vitamin D
When may an infant hold a bottle by themself?
9 months
What are five infant feeding issues?
1) Nitrites
2) Allergies
3) Fruit juices, deli meats, salts, sugar, harmful lipids
4) Sorbitol-containing juices
5) Infant colic
Which foods are recommended to avoid prior to 4 or 5 months because they contain nitrites? How may they be used, if need be?
- Spinach
- Collards
- Carrots
- Beets
- Turnips
- If used, they must be boiled and the water must be discarded
What are the effects of nitrites in infants younger than 4 to 5 months?
- These foods oxidize hemoglobin, producing methemoglobin
- Results in a decreased oxygen availability to tissues
Which form of hemoglobin does methemoglobin contain?
- Ferric, rather than the ferrous form
- Decreased oxygen availability
What is recommended to analyze for allergies in infants?
Wait three days after the introduction of a new food to allow for the identification of the allergenic food
75% of allergies arise from which foods?
- Cow’s milk
- Egg whites
- Peanuts
What are health risks associated with the consumption of fruit juices?
- Interferes with other nutrient-containing foods
- The baby feels satiated, and no longer desires nutrient-rich foods
- Prolonged contact with teeth may lead to dental caries
Which juices are preferable in infants below 6 months, if fruit juice must be consumed?
Grape juice
Which type of juice may cause allergies?
Orange juice
Which types of juice contain excessive amounts of sorbitol?
- Apple
- Pear
- Peach
- Plum
Which foods are recommended to be avoided in infants?
- Deli meats
- Smoked or raw fish
- Larger game fish
- Soft tofu
- Salt
- All forms of sugar
- Sugar substitutes
- Fats and oils containing harmful lipids
Why is soft tofu not recommended to be consumed in infants?
- High water
- Low protein
- Low iron
What is sorbitol? How is it related to infants?
- Derivative of glucose (reduced alcohol)
- Infants have a limited capacity to absorb sorbitol
What occurs if sorbitol-containing foods are introduced too early?
- The baby is incapable of absorbing the sorbitol, which reaches the colon intact
- Exerts an osmotic effect, resulting in diarrhea
How is infant colic associated with carbohydrate malabsorption?
- Fruit juices containing sorbitol and/or a high fructose to glucose ratio
- Produce an excess of hydrogen gas, resulting in abdominal pain
The infant’s first solid foods should be rich in _______.
iron
When should iron-rich foods be given to infants?
- At 6 months
- Twice a day
What are examples of iron-rich foods?
- Iron-enriched baby cereal
- Meat and poultry
- Fish
- Tofu
- Legumes
- Eggs
In general, during the infancy period, if _____ and _____ needs are met, it is very likely that the needs for micronutrients are met as well.
protein
energy
If exclusive breastfeeding is continued after 6 months, the baby would be provided with sufficient ______, but there would be a lack in ______.
protein
energy
How may the introduction of solid foods be accomplished?
- Well-cooked purees
- 3 to 5 mL at a time
When should vegetables be served? When should fruits be served?
- Vegetables: lunch or supper
- Fruit: breakfast or dessert
Infants above a year of age should consume a maximum of what quantity of fruit juice? How should it be served?
- 125 to 175 mL
- Served in a bottle
- Pasteurized
- No added sugar
What occurs from the ingestion of cow’s milk in infants below a year of age?
Intestinal bleeding
Which foods must be present in the diet when cow’s milk is introduced?
- Daily iron-rich foods
- Vegetables
- Fruits
Which types of infants below the age of two should be served skim, 1% or 2% cow’s milk?
They should ONLY be served full-fat milk (3.25%)
Which attitudes are infants required to develop by the age of two years old? (2)
1) Develop a sense of taste and acceptance to enjoy different foods
2) Attitudes and practices that form the basis for lifelong health-promoting eating patterns
When should the introduction of new foods occur during a meal?
At the beginning of a meal
Which foods are better liked: crunchy foods or overcooked foods?
Crunchy foods
What is the portion size for the introduction of new foods based on?
1 tablespoon per year of age
How should a child be forced to clean their plate?
- They should never be forced to clean their plate
- New foods should not be forced on the child
Which foods should be avoided to prevent choking below the age of three?
- Hard, small, round, smooth and sticky solid foods
- Whole nuts, popcorn, grapes, large berries, peanut butter, marshmallows, ice cubes, and hot dogs in chunks
Apart from food choice, how may a parent prevent choking in their young child?
- Supervise during eating
- Prevent running/playing while eating
- Remove bones from meat or fish
- Remove fruit cores and pits
- Cut grapes into quarters
Which foods should be avoided due to the risk of botulinum spores?
- Honey
- Corn syrup
What are the risks of botulinum spores?
- They are resistant to pasteurization
- They can germinate in the GI tract, causing a toxic effect
What are the effects of botulinum spores in children?
- Decreased feeding
- Weakness
- Respiratory distress
- Constipation
What is the most preventable nutritional deficiency in children in North America?
Iron deficiency anemia
Iron deficiency anemia is associated with excessive exposure/intake of which substances? (2)
1) Excessive cow’s milk intake
2) Excessive exposure to lead
What is the maximal quantity of cow’s milk that is recommended for infants? Why?
- 2-3 cups per day
- Cow’s milk displaces iron-rich foods
Which factors may contribute to the increased risk of iron deficiency anemia in young children?
- Rapid growth during the first two years of life requires a higher hemoglobin mass
- Children have difficulty chewing meats (less heme iron)
What are symptoms of iron deficiency anemia?
- Lack of energy
- Poor appetite
- Irritability
- Difficulty concentrating
- Slow weight gain
- Recurrent infections
The ingestion of which vitamin should be increased to aid in the absorption of iron?
Vitamin C
What type of anemia does iron deficiency lead to?
Hypochromic microcytic anemia
How does iron deficiency anemia affect the absorption of elements?
Increases the absorption of other elements (e.g. lead and cadmium)
What is DMT1?
- Divalent metal transporter 1
- The common iron-lead transporter contained in the GI tract
How does iron deficiency anemia lead to lead toxicity?
- Lead is taken up by iron absorption machinery, blocking iron through competitive inhibition
- Lead interferes with important iron-dependent metabolic pathways (e.g. heme biosynthesis)
What are sources of lead?
- Diet
- Air
- Drinking water
- Ingestion of paint chips
Which deficiencies increase the absorption of lead?
- Iron
- Calcium
What are the nutrition recommendations in terms of dietary fat in preschool and childhood?
Nutritious food choices should NOT be eliminated or restricted because of fat content
What are the nutrition recommendations in terms of dietary fat during early adolescence?
Emphasize energy intake adequate to sustain growth with a gradual lowering of fat intake
What are the nutrition recommendations in terms of dietary fat once linear growth has stopped?
Fat intake as currently recommended is appropriate
Children consuming a low-fat diet are at an increased risk of which micronutrient deficiencies?
- Calcium
- Zinc
- Vitamin A
- Riboflavin
What is the major risk of excessively low-fat diets in children?
Growth stunting
What are the effects of decreasing the meat intake in a child?
- Higher fiber intake from complex carbohydrates
- Decreasing quantity of animal protein
- Decrease in essential mineral bioavailability
The risk of _____ deficiency increases with plant-food intake, affecting linear growth.
zinc
A survey in Quebec among 5 to 18 year old children suggested that the nutrient that is most frequently insufficient is _______.
calcium
What is the most common complaint among parents?
Feeding problems
What are characteristics of feeding problems?
- Diarrhea
- Constipation
- Colic
- Refusal to eat
How may certain feeding problems be induced by parents?
- High-anxiety
- Ill health of the mother
- Breastfeeding issues
What is the refusal to eat associated with at 2 years old?
- Behavioral problems
- Failure to thrive
- Impaired growth
- Recurrent infections
What are the effects of feeding problems at 4 years old?
- May experience catch-up growth
- May still have feeding difficulties and hyperactivity
What characteristics allow for the differential diagnosis of feeding problems?
- No weight gain or weight loss for over a month
- No underlying medical or mental conditions
- Not lacking available food
- Condition emerges before 6th birthday
Define failure to thrive.
- Downward deviation from age and gender norms
- Characterized by stunting or wasting
Is failure to thrive a disease or a disorder?
- It is NEITHER
- It is a sign of undernourishment
What are organic causes?
Related to a medical or physical disease
What are non-organic causes?
Causes that are external to the individual
What is failure to thrive associated with in terms of developmental outcomes?
- Delayed motor skills
- Delayed language acquisition
- Delayed social skills
Provide examples of organic causes of failure to thrive.
- Congenital heart defect
- Malabsorption syndrome
- Anemia
- Renal issues
Provide examples of non-organic causes of failure to thrive.
- Abnormal development and behavior
- Distorted caregiver-child relationship
- Deprived background (not enough food)
- High-income parents with distorted health beliefs
Which conditions may cause a child to ingest too little food?
- Pre-maturity
- Developmental delays
- Autism
- Cystic fibrosis
- Chronic liver disease
- Celiac disease
Up to 80% of children with growth failure exhibit no ______________.
apparent growth-inhibiting disorder
Failure to thrive before a year of age results in a high risk of ___________.
cognitive delay
__% of children display general behavioral problems and issues specifically related to eating.
50
What are the three general patterns of failure to thrive? (3)
1) Low head circumference as well as height and weight below the 5th percentile
2) Normal head circumference, impaired weight, but normal height
3) Normal head circumference, impaired weight, and greatly lower height
Which general pattern of failure to thrive is associated with intellectually handicapped children?
Low head circumference as well as height and weight below the 5th percentile
What may be the cause of failure to thrive characterized by low head circumference as well as height and weight below the 5th percentile?
Mechanical feeding difficulties (e.g. extrusion response)
What is the likely cause of failure to thrive characterized by normal head circumference, impaired weight, but normal height?
- Malabsorption or endocrine disorders
- Poor utilization of calories and energy
- E.g. cystic fibrosis, milk intolerance, allergy, parasites
What is the likely cause of failure to thrive characterized by normal head circumference, impaired weight, and greatly lower height?
- Malnutrition due to poverty or infant behavioral problems
- Insufficient macrobiotics
Which macrobiotics may be limited in failure to thrive characterized by normal head circumference, impaired weight, and greatly lower height?
- Vitamin D
- Iron
- Vitamin B12
- Protein
- Calories
What is the treatment for extreme failure to thrive, resulting in hospitalization?
- The administration of 150% of the normal caloric requirement for catch-up growth
- Individualized medical and social support
What is stunting?
Short height for age
What is wasting?
Low weight for height
What are indicators of failure to thrive?
- Consistently low weight percentile
- Rapid drop in weight percentile
What is the first indicator that varies during malnourishment?
- Decrease in weight from the baseline
- Decrease in weight occurs PRIOR to a decrease in height
What does a rapid decrease in weight indicate? What does a decrease in height gain indicate?
- Decrease in weight (acute malnutrition)
- Decrease in height gain (severe malnutrition)
What does a decrease in both height and weight indicate?
Primary disorder of growth
What are developmental and behavioural issues of undernourished children?
- Lose interest in their surroundings
- Don’t make eye contact
- Become fussy
- May not reach developmental milestones (e.g. talking, walking)
How may infections lead to undernourishment?
- Increase the rate at which nutrients are used
- Decrease appetite
What is an example of a simultaneous organic and non-organic cause of failure to thrive?
- Severe gastrointestinal reflux
- Infant and caregiver become frustrated
Children who develop failure to thrive below the age of one are at a high risk of what?
Cognitive delay, particularly concerning verbal and math skills
