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Nutri Sci 431 > Exam 3- Infancy > Flashcards

Exam 3- Infancy Flashcards

1
Q

A term infant is __% body fat and a 1 yr old is ___% body fat

A

16, 25

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2
Q

From 1 yr to adulthood the ___ decreases and the ____ increases

A

ECF, ICF

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3
Q

Energy requirements in children determined by

A

Determined by age, size, growth rate and PA

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4
Q

Calorie needs at 3 mo, 2 yr, 8yr, 12yr

A

100, 85, 75, 60 kcal/kg/day (adults are 25)

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5
Q

Optimal Indicator of Nutritional Status:

A

growth

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6
Q

Among growth charts what is a cause of concern?

A

If a child jumps 2 or more lines

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7
Q

Growth charts used for birth to 24 months

A

length, weight, head circumference, weight for length

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8
Q

Growths charts used 2-20 years

A

BMI for age, height, weight

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9
Q

Infancy- key concepts

A
  • most rapid growth
  • Nutritional requirement on the basis of per kg of body weight is highest of all life stages
  • Dramatic development of feeding skills occurs- from reflex sucking at birth to eating at the table by 12 mo
  • weight doubles by 4 mo and triples by 12 mo, length increases by 50% at 12 months and head circum by 40%
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10
Q

Newborn’s GI System: motility

A

Coordinated breathing, sucking & swallowing
GI motility:
- esophagus: lower esophageal sphincter (LES) is weak
- stomach: gastric capacity & emptying: small and fast
- small intestine transit time: longer
- large intestine transit time: shorter
Digestive enzymes
- amount
- activity
Excretion of undigested products

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11
Q

Newborn’s GI System: Digestive enzymes

A

Digestive enzymes
- amount: most are lower disaccharidases and intestinal mucosal peptidases
- activity: trypsin has reduced activity
Excretion of undigested products

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12
Q

Newborn’s Renal Function

A
  • Kidneys immature at birth
  • Need more water to excrete a given amount of “waste”
  • potential renal solute load: comes from protein, Na, Cl, K and P, increase PRSL and increase burden on kidneys *why infants can’t drink cows milk
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13
Q

Psychosocial Development: main point

A

Feeding is the fundamental interaction from which the relationship between parents and infants evolves and the infants psychosocial development proceeds

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14
Q

Temperament

A
  • Inherited pattern of physiologic and behavioral reactions tosituations.
  • Components commonly include activity level, rhythmicity, approach, adaptability, intensity, mood, persistence, distractibility, and threshold
  • classified as “Easy”, “Average”, “Difficult”
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15
Q

Development of feeding skills: 1-3 mo

A

suck and swallow
rooting
tonic neck reflex
head control is poor

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16
Q

Development of feeding skills: 4-6 mo

A

Rooting reflex fades
bite reflex fades
tonic neck reflex fades

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17
Q

Development of feeding skills: 7-9 mo

A

Gag reflex fades
Choking reflex can be inhibited
Develop rotary chewing

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18
Q

Development of feeding skills: 10-12 mo

A

Bites and grasps
Drink from cup
Lick food
Finger feeds with pincer grasp (rather than whole hand)

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19
Q

Key tips to breastfeeding

A

Let baby decide when and how much to eat

Respond to baby’s cues- crying and fussing

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20
Q

DRI – Approach for Infancy

A

Basic approach

  • 2 stages: 0-6 mo and 7-12 mo
  • energy based off total energy expenditure + growth
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21
Q

0-6 mo DRI

A

0-6 mo: all AIs, no EAR/RDA

  • Based on breast milk intake of 780 ml/day
  • AI for all nutrients
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22
Q

0-7 mo DRI

A
  • Based on breast milk intake of 600 ml/day plus solid foods
  • EAR/RDA for protein and iron
  • AI for remaining nutrients
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23
Q

Energy requirement percentages

A 
Growth:
 ~40% at birth,              
~10% at 6 mo                    
 ~3% at 12 mo
BMR:
 ~50% at birth,               
 ~60% at 6 mo            
   ~70% at 12 mo
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24
Q

Growth factor, adds how many calories?

A

0-3: 175
4-6: 56
7-12: 22

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25
Q

2ndary indicator of getting enough energy

A

Diapers- 3-4 stools per day, 5-6 wet diapers per day. Yellow, seedy, semisolid stool

26
Q

Infants require a larger percentage of their calories to come from ___, ____ and ___

A

Protein, linolenic acid (precursor of DHA), linoleic acid

27
Q

Macronutrient Contents in Human Milk - Carbohydrates

A

Types: lactose and oligosaccharides
Lactose:
- de novo synthesis in the mammary gland from galactose & glucose by enzymes that require a-lactalbumin as co-factor
- stimulates gut microorganisms
- enhances Ca and other mineral absorption
Oligosaccharides:
- function as resistance factors

28
Q

Macronutrient Contents in Human Milk - Protein

A

-Colostrum contains higher protein than mature human milk
-Major proteins in human milk: casein and whey
Casein: 20-30% in colostrum, ~45% in mature human milk - form hard curds in the stomach (lowPH)
Whey: 70-80% in colostrum, ~55% in mature human milk - proteins that remain soluble after casein precipitates
- form softer curds in the stomach, easier to digest
- major whey protein: lactalbumin, synthesized de novo - other whey proteins: immunoglobulins, lactoferrin & other resistance factors
Non-protein nitrogen: urea & nucleotides
- account for 1/4 of total nitrogen in human milk

29
Q

Macronutrient Contents in Human Milk - Fat

A
  • Colostrum contains less fat than mature human milk
  • Within each feeding, fat content is lower in foremilk than hindmilk
  • > 90% fat in human milk is triglycerides (TG)
  • unique TG structure: palmitate (16:0) in sn-2 position, easier to absorb than stereate (18:0)
30
Q

Macronutrient Contents in Human Milk - Fat - FA profile

A

FA profile
- rich in PUFA; more EFA [linoleic (C18:2, n-6) and linolenic (C18:3, n-3)] than cow’s milk
- also contains EPA (C20:5, n-3) and DHA (C22:6, n-3) (cow’s milk does not contain DHA)
DHA: essential for brain and retina development

31
Q

Macronutrient Contents in Human Milk - Fat - Cholesterol

A
  • present in human milk but not in cow’s milk

- stimulate enzymes for cholesterol degradation

32
Q

DHA in Infancy

A

-DHA accumulates in brain and retina during 0-2 yr
-DHA synthesis from linolenic acid is limited, dietary supply is needed
-Human milk contains DHA, cow’s milk does not
DHA supplementation in maternal diet during breastfeeding
- increased maternal blood DHA, breast milk DHA and infant’s blood DHA
- neural function and visual acuity did not differ
DHA supplementation in infant formula
- increased infant’s blood DHA
- neural function/visual acuity are better at age 1 y but not 3 y

33
Q

Micronutrient Requirement in Infants: Iron

A

Fe metabolism in infants

  • very high Hgb level at birth, decline to adult level by 6 mo
  • Birth to 6 mo: req met by Fe store and recycled Fe from hemoglobin
  • after 6 mo: Fe store depleted; rely on dietary intake

Iron DRI, 0-6 mo
- AI = 0.27 mg/d, based on breast milk content
Iron DRI, 7-12 mo
EAR = (basal loss + Fe deposition)/10% absorption
= (0.26 mg + 0.43 mg)/10% = 6.9 mg/d
RDA = 11 mg/d
AAP recommendations on iron supplementation
- BF infants: begin at age 4-6 months
- FF infants: not needed bc Fe-fortified formula

34
Q

Micronutrient Requirement in Infants: Vitamin D

A
  • breast milk contains little vitamin D
  • vitamin D AI established based on maintaining adequate serum 25(OH)D
    -AI = 400 IU for both 0-6 and 7-12 mo
    AAP recommendations:
    -BF infants: supplement at birth
    -FF infants: no supplement needed, fortified
35
Q

Micronutrient Requirement in Infants: Fluoride

A
  • 0-6 mo: AI = 0.01 mg/d, based on breast milk content (no correlation between Fl intake at this age & dental carries)
  • 6-12 mo: AI = 0.5 mg/d, based on protection for dental caries
  • AAP recommendations:
    BF infants: supplement beginning at 6 mo
    FF infants: supplement beginning at 1 mo if water used to prepare formula is not fluoridated
36
Q

Micronutrients in Human Milk: Vitamins

A
  • concentrations vary depending on maternal nutritional status and vitamin contents in maternal diets
  • vitamin D in human milk insufficient to meet infant requirement, supplementation (400 IU/day) should be given shortly after birth
37
Q

Micronutrients in Human Milk: Minerals

A
  • concentrations lower than cow’s milk but high bioavailability- advantage to newborn’s immature renal system
    e. g., Zn: 10% bioavailable in cow’s milk; 49% bioavailable in breast milk
  • Fe in human milk insufficient to meet infant requirement, supplementation needed beginning at 4 months of age
38
Q

Non-nutritional Beneficial Compounds in Human Milk

A

Resistance (anti-infective) factors:- Immunoglobulins: 90% are secretory IgA (sIgA); colostrum contains the highest content of IgA
- Bifidus factor
- Binding proteins: lactoferrin (binds iron) & B12-binding protein
Enzymes
- Digestive enzymes:, e.g., lipases, amylase
- Lysozymes
Cellular components
- Macrophages, T- and B-lymphocytes, neutrophils
Hormones and growth factors

39
Q

Effect of Maternal Nutritional Status on Human Milk Production and Composition

A
  • Moderate calorie deficit, e.g., caloric intake at 80% of requirement does not reduce vol of breast milk production or nutrient content
  • More severe protein-energy malnutrition, e.g., caloric intake <60% of requirement decreased the vol of milk produced but does not decrease caloric density or nutrient content
  • Variation in maternal diet does not influence breast milk concentrations of protein, CHO, total fat and most minerals
  • Variation in maternal diet does influence breast milk concentrations of: FA profile and vitamins (esp water soluble)
40
Q

Alternative to Breast Milk – Infant Formula

A

Cow’s milk NOT appropriate

  • too much pro, Na, Cl, k and P
  • low EFA, no DHA, vit A, D, E and iron
  • GI blood loss found in infants fed cow’s milk
41
Q

Infant formula kinds

A
  • cow’s milk based
  • soy-based
  • special formulas (for infants with special health care needs)
42
Q

Cow’s Milk Based Infant Formula

A

decreasing protein amount & modifying type of protein - decrease casein, increase whey; casein/whey ratio vary among brands
-adding carbohydrate
- to compensate for reduced protein
-changing fat composition
- remove milk fat (decrease SFA), add vegetable oil (increase UFA)
-add EFA and DHA
-decrease Ca, P, Na, Cl, K; increase vitamin A, C, D, E, iron
Two subtypes of cow’s milk based formula on the market
-low-iron or high-iron (iron-fortified)
(1-1.5 mg/L) (10-12 mg/L)
AAP recommends iron fortified cows milk formula

43
Q

Soy Based Infant Formula

A
  • For infants with galactosemia, congenital lactose deficiency and cows milk protein allergy
  • Made with soy protein isolate + corn syrup + veg oil
  • major CHO in corn syrup is glucose polymers
  • supplemented with methionine (limiting AA in soy)
  • higher protein and mineral content than cow’s milk formula b/c lower protein quality & mineral bioavailability - all soy formula are high-iron (iron-fortified); no low-iron soy formula
  • higher PRSL than cow’s milk formula
  • Not recommended by AAP for healthy term infants
44
Q

Introduction to Solid Foods: When?

A

No earlier than 4-6 months, why?

  • Nutritionally not necessary until then
  • developmentally not ready (need to lose tongue reflex)
  • Earlier intro. increases probability of developing allergies and eczema
  • earlier intro doesn’t help baby sleep through the night
45
Q

Major purpose of solid foods

A
  • to develop feeding skills
  • NOT to provide major source of nutrition; breast milk/formula remains the primary source of nutrition up to age 12 mo
46
Q

Feeding Skills & Solid Food Introduction: 6 mo

A

6 mo- intro to solid foods

  • rooting and extrusion reflexes fades
  • open mouth for foods
  • able to sit up with support
47
Q

Feeding Skills & Solid Food Introduction: 7-9 mo

A

Finger foods, self feeding

  • rotary chewing begins; munching more efficient
  • pincer grasp develops; holds bottle & sippy cup
  • able to sit without support
48
Q

Feeding Skills & Solid Food Introduction: 9-12 mo

A

Table Foods and self spoon feeding

  • develops interest to self-feed with spoon/fork (grasp bottle and utensils)
  • begins to drink from an open cup, although not mastered until toddler ages
49
Q

When to wean breast milk/formula

A

At 12 mo, switch to whole milk (not fat free)

50
Q

Guidelines for Introducing Solid Foods: frequency

A

introduce one, single-ingredient food at a time, wait 3-7 days before introducing another one

51
Q

Guidelines for Introducing Solid Foods: order

A
  • First: Fe-rich food (meat) and Fe-fortified food (infant cereal)
  • Second: vegetables and fruits (provide new flavors micronutrients)
52
Q

Guidelines for Introducing Solid Foods: Form and texture for spoon feeding

A

thick liquid to mashed/ground to chopped

53
Q

Guidelines for Introducing Solid Foods:

A

If a food is rejected at the first time, offer it again
-may take 10-12 attempts
Introduce as many varieties as possible between 6-12 mo
Let the baby decide when and how much to eat
- infants have innate ability to regulate energy balance
- Goal is to gradually increase solids and decrease formula/breast milk(general guideline: aim at less thab 32 oz at 6 mo, less than 24 oz by 12 mo)

54
Q

Baby Led Weaning

A

Baby feeds themselves all foods from the beginning of complimentary feeding
-skip purees and spoon feeding, stick shaped pieces
-Parent decides “what;” baby decides if they will eat, “how much,” and “how quickly”
-Encourages responsive feeding practices
Potential pros: may lead to improved eating patterns, healthier weight, greater food acceptance
Potential cons: risk of choking, inadequate iron intake, inadequate energy intake

55
Q

5 important points for safety:

A 
◦Make sure the baby is sitting upright
◦Limit distractions
◦Baby is ready to start eating
◦Don’t put food in baby’s mouth
◦Offer appropriate foods
56
Q

Nutritional Assessment for Infants

A

growth is the most important indicator of nutritional status in infants (and children)

57
Q

Growth

A
  • increase in body mass in set patterns
  • growth rate: differs by stage of childhood
  • measures of growth: weight, weight for length, length, head circumference, BMI
58
Q

Tools to assess growth:

A

growth charts

  • Sources of data for growth charts
  • Age 0-2 years: WHO (breastfed infant based)
  • Age 2-20 years: CDC (US data)
  • Specific for gender and age
59
Q

Length, weight & head circumference-for-age percentiles

A
  • indicate how the baby’s length, weight and head circumference compared to other infants of same age
60
Q

Weight-for-length percentile

A
  • indicate how the baby’s weight compared to other infants that are as tall as the baby (age of the baby is ignored)
  • weight-for-length percentile indicates whether the weight at that particular length is appropriate
61
Q

How do growth percentiles change when malnutrition occurs?

A

Weight drops first, then length and then head circumference

Nutri Sci 431 (8 decks)

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