Exam 2 Flashcards
1
Q
infant nutrition needs to support…
A
rapid growth (doubles birth weight by 5 months), increasing levels of activity as infant matures, rapid development (growth and development of all organs, continued brain development for years)
2
Q
human brain development in order
A
sensory pathways, language, higher cognitive function
3
Q
0-6 months of age
A
breast milk or formula
4
Q
6-12 months of age
A
incorporate solid food
5
Q
total caloric intake accounts for
A
health status, growth rate, sleep and wake cycle, and physical activity
6
Q
how many calories should infants consume per day?
A
490-610 (100kcal/kg body weight per day compared to 30 in adults)
7
Q
energy needs: fat
A
fat content increases energy density of diet, percentage decreases from 6 months to a year, AMDR stays higher for infants than adults
8
Q
What fats do infants need?
A
omega 3s and omega 6s because nervous system develops beyond the womb, and because it helps with brain development and cell membrane integrity
9
Q
carbohydrate intake for infants
A
0-6 months: carbs in milk
6-12 months: increase in percent energy of types of carbohydrates (solids, decrease exposure through lactose)
10
Q
lactase
A
enzyme that breaks down lactose to enable absorption (after infancy lactase gene expression decreases, activity peaks post natal period)
11
Q
lactase non-persistence
A
lactose intolerance, inability to absorb lactose due to lack of lactase, bloating, cramping, diarrehea
12
Q
lactase persistence
A
mutation of the lactase gene, allows for adequate lactase production over a lifetime
13
Q
infant protein needs
A
double compared to adults, easily met through breastmilk and formula (formula puts infant at risk for excessive or deficient protein intake)
14
Q
iron infant needs
A
levels are low in breastmilk, if mother is deficient or if breastfed exclusively infant can take 1 mg supplement, iron fortified formula (drops)
15
Q
Vitamin D
A
deficiency is high in breastfed infants, supplementation of 400 IU a day recommended (other risk factors include polluted climate)
16
Q
fluoride
A
adequate levels needed for bone and teeth development, brush around 6 months with pea/bite sized fluoride tooth paste, drink fluorinated water (after 6 months), over exposure may cause spotting, it could interfere with minerals, mutations)
17
Q
Vitamin K
A
plays a role in blood clotting, newborn at risk for hemorrhaging, newborns receive injection (provides enough until gut bacteria can synthesize)
18
Q
introducing solid foods
A
recommended to start after 6 months (neck and teeth), majority of infants start earlier, formula fed starts earlier, helps build tongue and mouth muscles, cereal is good first option for iron, oatmeal preferred (decrease arsenic)
19
Q
introduction order
A
spoon fed, soft finger foods, differing textural finger foods, use of utensils
20
Q
liquids
A
water given when baby is sick or in hot/humid conditions, water throughout day is normal after 6 months, at 1 year transition to whole cow milk
21
Q
nursing bottle syndrome
A
improper bottle use, increased sugar contact time with teeth (from juice in bottle or bottle in bed) juice not recommended until 1 year (watered down)
22
Q
choking hazards
A
nuts, whole grapes, sticky foods, raw fruits and veggies
23
Q
foods to avoid
A
honey (can harbor toxic bacteria that digestive tract cannot yet handle, causing “botulism”), cows milk (infants cannot handle nutrient load and missing key ingredients)
24
Q
growth chart
A
plots patterns of children, adults, and adolescents of the same weight and sex height, weight, and head circumference. slight fluctuations are normal
25
big fluxes on growth chart
indicators of poor growth: increasing weight but not height (overfed), slower growth (disease, abuse, mal-absorption, congenital disease)
26
breastmilk vs. formula
both meet nutrient requirements, choice depends on
27
childhood, preadolescence
childhood: 5-12
preadolescence: 9-11 for girls, 10-12 for boys
psychosocial, cognitive and emotional development is rapid
ecocentric/make believe to concrete and rationality
socialization and independence
home environment play a role in these developmental aspects
28
eating behaviors in childhood and preadolescence
do chores, make meals, involvement in meal preparation influence positive attitudes towards food
29
innate hunger cues
decline starting at about age 9, hunger is now influenced by "external factors"
30
external factors influence innate hunger cues
peer pressure, stress, preferred foods, time of day
31
increased independence influencing eating
own money to buy snacks, choose what they prefer, finish all because it tastes good, boredom
32
childhood and preadolescence growth rate
growth rate declines, but still growing
calories per day depend on size, activity, and age
DRI covers 4-8 and 9-13
33
carbohydrates in childhood and adolescence
focus on fiber and whole grains, correlated fiber intake as adult, associated with health benefits seen in adults
34
protein in childhood and adolescence
lean tissue development
35
micronutrients in childhood and adolescence
iron: important to lean body mass deposition, brain development, RBC
calcium and vitamin D: important for rapid bone mass development, only 15% of preadolescence females are consuming adequate calcium (due to social constructs and influence)
36
fats in childhood and adolescence
essential fatty acids focus
37
what are children and adolescence in the US actually eating?
toon many calories, too many foods in fats and added sugar (SOFAS), too many refined grains, from 4-8 and 9-13, males and females consume the most added sugars
38
economic, racial, and ethnic disparities
low-income children exposed to more nutrient poor foods, culturally irrelevant or experience food insecurity
39
how are children getting their calories?
eating away from home, snacking, beverages
40
smart snacks standards
federal requirement for schools to have healthy options available (vending machines and snack stores): low in sodium, have a fruit or vegetable available, having whole grains
41
rationale for smart snacks standards
remember: about 27% of calories come from snacks, healthier eating leads to better academics, most children buy food at school, if avaliable
42
continued work needed for smart snacks standards
good start, need to be more in line with dietary guidelines, snacks still contain: synthetic food dyes (ADHD), non-nutritive sweeteners, too many added sugars
43
exclusive breastfeeding
no other food, not even water
44
partial breastfeeding
providing the infant of a mix of breastmilk and formula
45
complementary foods
solid foods provided to the infant in addition to breastmilk
46
expression of milk
removal of breastmilk by hand, manual or electric breast pump
47
childhood and preadolescence: physical activity guidelines
1. 60 or more minutes per day
2. variety of intensities
3. reduce time sitting
physical activity will: prevent chronic disease, develop of muscle, bone, and joint, shape cardiovascular health
48
current breastfeeding recommendations
exclusive breastfeeding for about the first six months of a baby's life (WHO), continue breastfeeding for as long as mutually desired by the parent and baby up to 2 years of space (AAP), with appropriate complementary foods until 2 years of age and beyond
49
breastmilk composition
meet nutrient needs of infant plus bioactive factors, nutrient and bioactive contents vary daily: changes with breast feeding parents diet, effected by environment, freeze and thaw
50
breast milk production and release
amount produced varies with infant demand
51
infant suckling produces hormones
prolactin stimulates milk production, oxytocin stimulates contraction and release of milk
52
first stage of breastfeeding
colostrum: first fluid produced following birth, "immature birth," yellowish fluid (liquid gold),
higher levels of immune factors (lactoferrin, white blood cells, IgA), lower in fat and carbs, higher in protein and micronutrients, higher water provides laxative effects and keeps baby hydrated
low volume- only about 1.5 fluid ounces per day
produced for about 2-4 days following birth
53
what could influence the activity level of a child?
caretaker as a model, peer influences, community/school offerings, weather, climate, built environment (parks, walking, biking, affordable indoor facilities)
54
public health impacts of a "healthy" built environment
address chronic disease, promote safety, promote local economic growth, promote health equity, promote clean environment
55
BMI in children
weight status is determined by BMI percentile, put into different weight categories
56
second stage of breast feeding
transitional milk- higher in fat and sugar, still contains bioactive factors
increasing in quantity: 10-28 fl oz. per day
produced during 5-14 days post natally
57
third stage of breastfeeding
mature milk- produced about 2 weeks post-birth
high in energy (fat and carbs), lower protein
65-75 kcal per 3.25 oz
eat about 25-30 oz/day
infant will eat every 2-4 hours
58
stages of breastfeeding in order
colostrum, transitional, mature milk
59
mature milk carbohydrates
free glucose - important energy source
lactose is most abundant carbohydrate (energy source, small amounts travel to baby's large intestine to stimulate microbiome growth (helps to fight foreign microorganisms)
60
lactase
stimulates lactose breakdown to glucose and galactose
61
mature milk carbohydrates
oligosaccharides: medium chained carbohydrates, ability to bind pathogens
62
mature milk fats
fats in milk reflected by female's diet, content level increases as the feeding time increases (fore milk, watery meets thirst needs)
contains digestive lipases to help digest fat
63
mature milk protein
whey (immunoglobulin A- protection against viral and bacterial infections and lactoferrin- bound to iron: helps increase absorption, inhibits growth of iron dependent microorganisms), casein (binds calcium to increase absorption), mucin (binds to pathogens)
64
group one micronutrients
amount in breastmilk reflective of parent intake (vitamins B1, B2, B6, B12, choline, Vitamin A, selenium, iodine, retinol, Vitamin C)
65
group two micronutrients
amount in breast milk depletes maternal stores, parent diet/supplements benefits parent not breast milk (folate, calcium, iron, copper, zinc) if deficient maternal levels become depleted
66
vitamin D breast milk
low concentrations in breast milk no matter parent status/diet, supplementation recommended for infant
67
vitamin K in breastmilk
low concentrations, highly recommended to get vitamin K injection at birth
68
why breastfeeding?
protects babies from common infectious diseases, boosts children's immune systems, providing the key nutrients children need to grow and develop to their full potential. babies who are not breastfed are 14 times more likely to die before they reach their first birthday than babies or are exclusively breastfed.
69
babies who are breastfed for longer periods have
lower infectious morbidity and mortality, especially in digestive and respiratory tracts (dental health, higher intelligence, prevention of obesity, reduced risk of infections and diarrhea)
70
sleep and breastmilk
levels. of hormones differ in milk produced in the morning vs. night (cortisol- alertness, melatonin- sleepiness)
71
suckling benefits
speech development, formation of teeth, airway development (prevention of sudden infant death syndrome or SIDS)
72
short term outcomes of breastfeeding for parents
oxytocin release (helps contract uterus back to normal size), helps lose pregnancy weight (burn energy making milk), prevent type 2 diabetes, delays time to menstruation (increases iron stores and reduces time to need contraception, healthy for spacing of pregnancies)
73
long term outcomes of breastfeeding for parent
protection against breast cancer (5-10 years after pregnancy, most effective before age 30, more months BF = more protection, protection against hormone receptor) more breast cancer in developed countries
74
breastfeeding parent diet during lactation
energy expended: mobilizing nutrient stores and producing milk
energy requirement: + 200-500 kcal/day, +25g protein + 80 g of carbs, increased essential fatty acid intake (same as pregnancy), additional fluids, avoid caffeine and alcohol, continue taking prenatal vitamin, increase micronutrients
75
formula nutrient composition
goal is to match human breastmilk to ensure disease prevention and brain development, more are cow-milk based, alternatives available
76
differences in composition between formula and breastmilk
adequate vitamin D and iron in formula, but formula lacks bioactive components such as immune factors and lipases (cannot be added or survive shelf-life of formula)
77
lead sources
paint, water, soil, products, industry
78
composition of human breastmilk
water, proteins, carbohydrates, vitamins and minerals, fats, probiotics
79
enters milk through diet
vitamin A, B, and C, choline, selenium, iodine
80
enters milk through the bones
folate, calcium, iron, copper, zinc
81
bone absorption increases through...
HPG axis, mammary gland action
82
how does lead affect milk production?
majority of lead is stored in bones, when calcium is released, so is lead! (most lead in colostrum milk)
83
CDC lead recommendations
encourages those with lead levels greater than 40 ug/dL to pump and discard milk until levels drop below 40
84
lead impact on fetus
lead is stored in brain, bones, and kidney of fetus, affecting mitochondria of brain and nerve cells, impairing bone development, and damaging the developing kidney
85
public health approach to prevention of lead
secondary: diet mitigation, increasing calcium and omega 3s can decrease lead effects
86
lead main takeaways
no level of lead is safe, lead is found in human milk, current research on exposures to lead through human milk is inadequate, calcium does not provide the same protection through lactation as it does for pregnancy, omega 3s may be the next public health solution to lead exposure
87
arsenic sources
drinking water, atmosphere
88
arsenic guidelines
dose for inorganic arsenic is 0.0003 mg/kg/day, limit arsenic drinking water to 10 ug/L
89
arsenic health consequences
cancer, immune effects, respiratory disease, cardiovascular diseases, adverse pregnancy outcomes
90
arsenic levels in milk takeaways
decreases as time progresses (most in stage 1), formula may have more arsenic, no guidelines for lactating individuals, limited research
91
prevalence of breastfeeding
globally, most mothers begin breastfeeding, but rates of exclusive breastfeeding across the globe are unsatisfactory
92
seriousness of breastfeeding
breastfeeding has measurable benefits for baby, mother, and the economy; benefitting population health and reducing morbidities and mortality
93
who is breastfeeding?
people receiving support in various ways: workplace, partners/family (more likely to breastfeed if mother did), culture, older women, higher income, non-hispanic asians
93
prevention of breastfeeding
with proper education and support, mothers and their communities of friends, family and healthcare providers can improve breastfeeding rates and duration
93
environmental cost of not breastfeeding
energy for manufacture, materials, transport and distribution, water, and cleaning, water to mix with powder, metal and paper used to package
93
breastfeeding rates
percent of infants breastfed through 6 months: 55.8%
percent of infants exclusively breastfed through 6 months: 24.9%
percent of infants receiving formula at 2 days old: 19.2%
94
costs of breastfeeding vs. formula
formula: $1,200-$2,900 for six months
$500 for breastfeeding (accessories, nutrition, supply)
95
work and breastfeeding
breastfeeding parents who return to work are less likely to continue BF, parents unable to express breastmilk at work may have increase infections and other illnesses (forced to wean their babies)
low BF rates impose an estimated $1.3 billion burden for non-medical costs + ear infections and gastrointestinal infections + 10% increase in healthcare costs
96
barriers to breastfeeding at socioecological model
individual: knowledge, confidence, self-efficacy
interpersonal: support
community: social norms, support
organizational: workplace policy, support
public policy: public protection, workplace policy
97
policies that "support " breastfeeding
50 states protect right to BF in public, break time for mothers through US fair labor Standards Act (space and time to pump), parental leave includes: PTO under family medical leave act
98
global baby friendly hospital initiative
encourages broad scale implementation of 10 steps of successful breastfeeding, providing parents with information, confidence, and skills to initiate and continue to breastfeed their babies, provides health providers means to support lactation
99
some of the 10 steps for baby friendly hospitals
comply fully with international code, have written infant feeding policy that is communicated to staff and parents, establish ongoing monitoring and data-management systems, ensure staff have sufficient knowledge, competence and skills to support BF
100
health care provider perspective on BF
lack of confidence in skills due to poor training, lack of a focus in school/training, lack of culturally relevant or diverse breast models
101
BFHI designation prevalences
almost all countries have implemented, but only 10% of births worldwide occurred in baby friendly facility (when it was implemented more women continued to BF)
102
prematurity
born <37 weeks
common issues: immature organs, feeding ability compromised, inadequate nutrient stores, increased nutrient needs (calories per body weight increases), lung development compromised (lack of alveoli and smaller passage ways, lack of surfactant which allows for lung expansion)- synthetic surfactant research being done
103
prematurity health concerns
respiratory distress syndrome- lack of sufficient surfactant to support lungs
jaundice- yellowed skin or eye (build up of bilirubin, treated by phototherapy)
nutrient challenges- feeding ability compromised, underdeveloped digestive tract, additional nutrients needed to support infections, surgery recovery, body temp regulation, proper growth and organ development
104
premature infants feeding complications
lack of muscle coordination, increased vomiting, constipation, reflux
IV feeding needed to allow time for immunity to develop in digestive tract
milk or formula slowly introduced via bottle, to prevent NEC- inflammation of small intestine leading to holes in the wall (costly, breastmilk can prevent death)
105
premature babies receiving breastmilk
needed to be pumped, iron supplements, vitamin and mineral fortifiers, medium chained triglyceride (MCT) oils also added to breast milk (additional energy density, absorbed easier than other fatty acids)
106
specialized formulas for premature babies
higher caloric value, higher micronutrient status, increase or decrease feeding by monitoring infant (digestive tract tolerance)
107
premature infant growth assessment
charts adjusted to fit their prematurity, head circumference an important indicator of development, progress assessed in feeding skills
108
long term health risks of prematurity
60% develop or born with disability, hearing or vision impairments, neural impairments (behavioral, coordination, learning)
109
PKU
inability to metabolize amino acid phenylalanine to another AA tyrosine due to deficiency in phenylalanine hydroxylase (enzyme), causes phenylalanine build up in brain, may cause seizures, hyperactivity, intellectual disability, death, treated with low phenylalanine diet (formula, vegetables, fruits, beans, special grains)
110
toddler (1-3) developmental milestones
gross and fine motor skills (jumping, walking on stairs, using silverware, drinking from a cup, drawing), language development into phrases/sentences, preferences arise
111
development: toddlers and food
chewing accommodates for different types of food (muscle development and coordination, teeth)
12-18 months: finger foods to utensils, soft texture and small pieces
18-36 months: increasing tolerance to textures and temperatures (meat, raw veggies/fruit, biting off pieces, cold/hot
112
introducing foods for toddlers
8-12 times before trying something new, provide well-known food along new food (spagetti and meatballs), encouragement and praise and imitation, toddler responds to self-hunger cues
113
preschooler (3-5) developmental milestones
increased autonomy, learning to control behavior
114
preschoolers and food
fully capable of utensil and cup use, copying peers and family, still responding to hunger foods (force feeding causes over or under eating), prefers sweet, salty, and fatty foods (stimulates sensations in brain related to satisfaction and happiness), healthy food choices learned by parents, media, activities, and caretakers
115
preschooler "3 levels of temperament" regarding food
easy- adaptable
slow to warn up- needs repeated exposure to new situations
difficult- irregular behaviors and adaptation
116
toddler and preschooler growth rate
periodically, physical cues (outward tummy), varies on a daily/weekly/monthly basis (slower compared to infant years due to decrease in appetite) still high priority
biggest challenge: appropriate balance of nutrients to meet high demands (preferences and snacks)
117
preschool and toddler energy needs
less energy from fats and more from carbs, calories determined for individuals based on sex, height, weight, and age (after 3 physical activity is considered)
118
toddler and preschool proteins
needed for growth and tissue repair, focus on variety of AA
119
toddler and preschool fats
focus on omega 3 and 6 for neural and visual development, whole milk for ages 1-2, 2+ years = fat-free or 1% milk
120
toddler and preschool carbohydrates
45%-65% calories from carbs, emphasis on grains and fiber, naturally increase vitamin and mineral intake, healthy digestive tract (start matching adult intake)
121
toddler and preschool micronutrients
tend to meet or exceed recommendations except for vitamin D, E and potassium, sodium excesses
must monitor bone-related nutrients (calcium, vitamin D, phosphorus, magnesium) and iron for immunity, learning ability, intellectual performance, stamina, mood (supplement only suggested if anemic)
122
vitamin/mineral supplementation suggested for
erratic eating behaviors, lower socioeconomic families, mal-absorption problems, vegetarian or vegan households (concerned about vitamin B12 and D)
supplementation rates are highest for children who do not need them
123
toddler and preschool growth charts
weight, head circumference, height, BMI (recorded as percentiles)
85th-95th percentile is overweight, over that is obese
124
obesity in 2-5 year olds
public health issue
prevention: develop eating behaviors, monitor adiposity rebound (normal surge occurs around 4-7 years old, early may cause obesity, education is powerful in prevention), promote healthy behaviors, family meals (also associated with academic success, decrease depression and eating disorders, positive family dynamics)
best family meal outcomes: both parents present, 3-7 meals a week, decreased technology distractions
125
what conditions could affect a child's nutrient status?
disability, behavioral disability, chronic conditions
126
Autism spectrum disorder
group of disorders involving communication, social interaction and behavior
diagnosed between 2-4 years of age, signs start occurring in infancy (lack of eye contact or turning head due to noise, language delay, lack of communication)
signs beyond infancy: failure of peer interaction, interact with toys atypically, feeding difficulty
risk factors: genetic, sibling has ASD, more males, maternal environment exposure, older parents
127
autism spectrum disorder diagnosis
complex, determined by pregnancy health history, sensory tests, developmental milestone history, educational determination by teacher and specialized educator
128
ASD feeding difficulties
behavioral-related: refuse foods, particular food presentations and mealtime routines, use of specific utensils
muscle related: specific textures and types of foods (ex: limit to 5 foods or less, no crunchy foods), trouble chewing or swallowing
may cause rickets, osteoporosis, iron deficiency, weight issues, eating disorder, inadequate growth
129
feeding behaviors ASD treatment PLAN
working with family, occupational or physical therapists, positive reinforcement/reward, over-exposure to foods they are sensitive to
130
ASD (increasing prevalence) consequences
$: medical costs, special education, caretaker may work less
health: anxiety, attention deficients, depression, epilepsy, GI problems, obesity, sensory-processing difficulties, sleep problems, stigma
131
ASD prevention and treatment
EARLY intervention
brain development- early therapy for coping mechanisms
decrease healthcare costs, less need for special needs/education as they age
best nutritional outcomes support growth and development
132
celiac disease
autoimmune reaction to gluten, heritable (HLA2 gene), chronic inflammation destroys villi of small intestine, unable to absorb (prolonged damage may lead to weight loss, anemia, osteoporosis)
signs develop by 2 years of age: diarrhea for toddlers and preschoolers, infancy may consist of spitting up, vomiting, running diaper, abdominal pain, fatigue, behavioral related
133
celiac diagnosis
growth charts, elimination diets, blood test (antibody or genetic testing), intestinal biopsy
treatment: eliminate foods with even traces of gluten or cross contamination (allowed: rice, soy, potato, corn flours, oats
134
vitamin D deficiency
Vitamin D activates mineral transporters, increasing dietary calcium and phosphorus absorption, activating transport of calcium and phosphorus across bones
deficient: bone will grow in length but no addition of minerals (rickets: elongated yet soft bones)
effects: skeletal deformities, pain, weakness
risk factors: deficient in diet (breastfed infants), darker skin, liver or kidney problems
Rickets long term consequences: curved spine, bowed legs, thickened wrist, knee, elbow, ankles, breastbone projection
on the rise due to technology, less time outside, breastmilk, veg. households
treatment: calcium and vitamin D supplementation, bracing off affected bone area
135
food advertising
of hours of TV watched associated with overweight (lack of physical activity, increase in advertising)
2-6 years old can recognize food brands and have beliefs attached to them (less than 5 years do not differentiate between programs and commercials) 96% of ads for low nutrient foods
136
children's food and beverage advertising initiative
devote 100% of child directed ads for healthy foods (special criteria)
optional pledge to have zero ads directed towards children younger than 6
this helps (nickelodeon), but limited because young kids watch older shows and "poor" food ads still exist
137
food insecurity
household is uncertain of having or unable to acquire. enough food to meet the needs of all
their members because they had
insufficient money or other
resources for food
138
community food insecurity
A condition in which all community
residents obtain a safe, culturally
acceptable, nutritionally adequate
diet through a sustainable food
system that maximizes community
self-reliance and social justice.
139
what are some reasons that food insecurity varies by geographic region
politics (minimum wage, available support programs), healthy food availability (smaller stores do not have the ability to serve produce)
140
at risk for food insecurity
single houses, those with middle aged children, people of color
141
food insecurity trends
households with children have more food insecurity, decrease in 2020 due to programming and resources and benefits
142
health risk of food insecurity
STRESS of food insecurity can head to hormonal changes, insulin resistance, depression, and behavior changes
143
hunger effects on children
affect ability to concentrate, learn, and perform well in school, behavioral and emotional problems, may cause a lifetime of disordered eating
144
relevant federal agencies
department of health and human services, department of agriculture
15+ federally funded programs, most successful include SNAP, WIC, NSLP, SBP
145
national school lunch program
everyone gets lunches for free, demand of food decreases, price of food decreases (economic ripple effect)
146
