Child and infant nutrition

Question 1

Nutrition in infancy

Answer 1

• Infancy= 1st year
• High nutritional requirements
  
  • Birth weight doubled at 6 months & tripled at 1yr
  • Length increases by 50% in 1st year
• Optimal nutrition is important due to
  
  • Low nutritional stores
  • Rapid growth & development
  • Immature body systems
  • Effect on long term health

Question 2

Infant nutritional requirements

Answer 2

Question 3

Average feeding patterns

Answer 3

• Demand feeding is recommended
• Infants over 2.5kg- 8 feeds 3 hourly
• Infants over 3.5kg - 6 feeds 4 hourly
• Infants over 4k- 5 feeds 4 hourly (night feed dropped)
• Once solids established usually have 3-4 larger feeds per day

Question 4

Average weight gain

Answer 4

• Weight loss in 1st 5-7 days of life
• If >10% needs further assessment

Question 5

Growth charts

Answer 5

• Allow comparison between a child’s measurements and normal range of measurements
• Weighted at birth, 2 weeks, 6-8 week check, at immunisation and if there are weight concerns
• Would need further assessment if
  
  • Weight crossed 2 centile spaces
  • Weight was below 0.4th centile or above 99.6th centile
  • If there was more than 2 centiles difference between weight and length centiles

Question 6

Choices: infant nutrition

Breast v formula

Question 7

Breastfeeding

Advantages of breast feeding to infants

Answer 7

• Ideal nutritional composition, high bioavailability
• Protective- reduced infection, allergic disease
• Psychological/bounding benefits
• Long term health benefits

Question 8

Breast feeding

Advantages of breast feeding to mother

Answer 8

• Inexpensive & convenient
• Psychological/bonding benefits
• Faster uterine contraction & loss of pregnancy wgt
• Long term health benefits

Question 9

Initiating and supporting breastfeeding

Answer 9

• First feed soon after birth/skin to skin contact
• Good positioning and attachment
• Baby-led/ demand feeding, no treats, dummies or othe oral diet
• Support- health visitor, national childbirth trust, midwives

Question 10

Infant feeding survey

Answer 10

• 1 in 3 mothers still breastfeeding at 6 months in 2010 compared with 1 in 4 mothers in 2005
• Initial breastfeeding rate increased from 76% in 2005 to 81% in 2010

Question 11

Infant formula

Answer 11

• Most infants have formula at some point
• Must comply with detailed UK regulations
• Compositions vary little between brands
• Manufactures may add non-nutritient factors e.g. Long-chain polyunsaturated fatty acids, nucleotides and probiotics
• Preparing formula
  
  • All formula- 1 level sccop add 30 ml of boild and cooled water

Question 12

Standard infant formula

Answer 12

Question 13

Alternative formula

Answer 13

Question 14

Specialist formula

Answer 14

• Preterm formula should usually be stopped at 6 months corrected age
• The growth of an infant on a high energy formula should be monitored by a health care professional and stopped when appropriate growth achieved

Question 15

Complementary feeding

Answer 15

• Breastfeeding is the best form of nutrition for infants. Exclusive breastfeeding is recommended for the 6 months of an infant life
• The introduction of solid food should commence no later than 6 months of age but not before four months

Question 16

Inappropriate complementary feeding

Early

Answer 16

• Immature gut
• Poor head control/immature swallow
• Increased food allergies in atopic families
• Increased renal solute load
• Increased risk of infections
• Potential for faltering growth

Question 17

Inappropriate complementary feeding

Answer 17

• Difficulty starting after 9 months
• Food refusal and feeding difficulties
• Nutritional deficiencies e.g. Fe, Vit D and faltering growth
• Difficulties associated with progressing from puree to lumps

Question 18

Complementary feeding

Answer 18

• Exclusive breastfeeding until solid foods are introduced is optimal
• Infants develop at different rate so should be managed individually
• Parental feeding decisions need to be supported
• Children up to 5 yrs should be given a vit A,C and D supplement

Question 19

Complementary feeding

Signs an infant may be ready

Answer 19

• They can sit up and hold their head steady
• Chewing fists
• Showing interest in others eating
• Hungry between mild feeds
• Stopped sleeping through the night

Question 20

Foods and drinks to be avoided

Answer 20

• Sugar
• Salt
• Honey
• Cows milk
• Eggs
• Nuts
• Gluten
• Adult drinks

Question 21

Formula and milkInf that are not recommended

Answer 21

• Infants formula
  
  • Soya formula before 6 months
  • The only non-cows milk b ased formula approved in Nannycare
• As a main drink
  
  • Any milk except formula
  • Oat milk in 3yr old
  • Rice milk 5 yr old

Question 22

Pre school nutrition 1-4 yr

Answer 22

• Over 1 yr should be eating family foods
• High energy requirements but small stomach
• High fibre, low fat ‘ healthy eating is inappropriate
• Often regular meals and snacks
• Toddlers eat to appetite- develop understanding of feeling hunger and satisfaction
• Don’t encourage to finish plate

Question 23

Healthy start

Answer 23

• Vouchers- to help buy some basic foods
  
  • Cows milk, plain fresh or frozen fruit and veg
  • Infant formula (not follow-on formula)
• Healthy start vitamins
  
  • Coupons to swap for free healthy start vitamins
  • Pregnant / breastfeeding
  • Children up to 5

Question 24

Vitamin supplementation

Answer 24

• All children up to age 5 should have a vitamin supplement of A&D
  
  • E.g. healthy start vitamins, Abidec drops
• Breastfed babies should start at 1 month
• Formula fed babies should start at 6 months

Question 25

School age children 5-11

Answer 25

* Parents have control over food choices * Appropriate to introduce lower fat, higher fibre diet * Preference for sweet, salty and energy-dense foods * Need to motivate to try new foods * Increasing obesity rates due to ease of energy dense food and sedentary lifestyle

Question 26

Adolescence 12+

Answer 26

* Low fat, high fibre diet recommended * They take control over food choices * Peer pressure can influence food choice * Higher protein and calorie requirements due to growth * High calcium and iron requirements- would recommend increase dietary intake not a vitamin/minearal supplement * Sedentary lifestyle and easy access to food increasing obesity rates * More focus on body image

Question 27

Fe deficiency anaemia

Answer 27

* Common in early childhood * **Consequences**: frequent infections, poor weight gain, developmental delay and behaviour disorders * **Caused by:** early introduction cows milk (As main drink), over dependence on milk (replaces Fe rich food), Focus on sweet not savoury weaning foods, fussy eating * **Prevention:** Encourage Fe rich foods, reduced dependence on milk, can use toddler formula * **Treatment:** Often prescribed Fe supplementation

Question 28

Vit D deficiency

Answer 28

* Vit D deficiency is an increasing issue in all age ranges * Vit D controls the absorption of calcium * Deficiency: \<25nmol/L of 25-hydroxyvitD * Deficiency can cause: rickets, hypocalcemia * Main source: sunlight * Food: oily fish, fortified foods e.g. margarine, infant formula, some cereals and yoghurts

Question 29

Obesity

Answer 29

* In 2012/12: 33% of 10-11 yr olds and 22% of 4-5 yr olds were overweight or obese * Excessive weight gain is due to imbalance of energy in v energy out * **Consequences** * Increased severity of asthmaRespiratory conditions * Social discrimination can lead to * Low self-esteem\< lower quality of life and lower academic acheivement * Increased risk of type II diabetes- atherosclerossi& CVD

Question 30

Obesity

Answer 30

* No easy solution, need family centred approach * Encourage physical activity * Limit sedentary behaviour * Encourage family wide healthy eating and activity