Infancy (0-12 Months) Flashcards
1
Q
Infancy
A
- 0-12 months
- Highest nutrient requirement per kg
- Direct relation between growth and nutritional status so careful assessment is required
- Stage specific assessment tools
- Growth charts
- Length, weight and head circumferences
- Up toage 3
- Data recorded as percentiles
2
Q
Infancy Stage Changes
A
- Dramatic changes occur
- Babies have no head control → standing and walking
- Period of most rapid growth
- Changes in food and feeding abilities
- Reflexive sucking → feeding themselves
3
Q
Growth and Maturation
A
- Nutrition influences physical and psychosocial growth and development
- Under and over nutrition detrimental
- First 6 months critical for brain growth
- Stage of maturation determines types of food
-
Substantial requirement of energy for growth from 0-4 months
- Growth rate slows from 4-12 months
- Caloric reqs/kg decrease
- Nutritional status determined by anthropometrics
- Bond between infant and parents, siblings, etc. is established in this stage
4
Q
Birth Weight
A
- Determined by:
- Mother’s medical history
- Nutritional status before and after preg
- Events during preg
- Fetal characteristics
- Pre-preg weight
- Weight gain during preg
5
Q
Weight Changes during Infancy
A
- Immediately after birth → 6-10% weight loss → regained by 10-14th day
- Weight gain proceeds at a rapid, but decelerating, rate
- By 4-6 months, birth weight usually doubles
- By 1 year, BW triples
- Rate of growth slows substantially in 2nd half of infancy
6
Q
Length
A
- Increases by 50% in first year of life
- Average length gain is 10-12 inches
- Some infants shift percentiles up or down on growth grids
- Race may influence growth rate
- AA smaller than white at birth, but they grow more rapidly during first 2 years
7
Q
Growth Assessment
A
- Growth grids used to plot weight, length and head circumference
- Physical growth is an indicator of health and nutritional status
- Accurate measuring and recording is critical
- Periods of growth acceleration and growth deceleration should be monitored carefully
- Growth Charts, 2000
- Originally based on white, mostly bottle-fed infants
- Revised based on a more representative sample
- Birth - 36 months
- Wt, L, HC (for age) and wt for length
- Wt-ht percentile rank infant in relation to 100 others of same length
8
Q
Body Composition Changes
A
- Percent water decreases in first year
- Intracellular water increases
- Extracellular water decreases
- Increase in LBM and fat mass
- Gender related differences appear
- Females deposit a greater percentage of weight as fat than do males
9
Q
Body Proportions
A
- Head proportion decreases with age
- Torso and leg proportion increase with age
10
Q
Psychosocial Development
A
- Key part of overall infant development
- Feeding is the fundamental interaction from which parent-infant relationship evolves
- Healthy development facilitated by:
- Parents’s response to hunger should be immediate in newborn to assure baby their needs will be met
- Close physical contact during feeding is beneficial
- Development of trust is critical
- Propping bottle is not safe and hinders development in first few months of life
- Babies generally don’t feed well when they are distressed
- Temperment of infant needs tobe considered
- Quiet, wakeful state
- Parent/caregiver must be cued into infants signs of hunger and satiation
- Infant’s cues rapidly change with development
11
Q
Development of GI tract
A
- Development influenced by
- exposure of fetal GI to growth factors, hormones, enzymes and immunoglobulins
- Factors in human milk, such as growth factors, hormones and enzymes
-
Digestion requires:
- Coordinated sucking and swallowing function
- Gastric Emptying
- Intestinal motility
-
Absorption Requires:
- Savliary, gastric, pancreatic and hepatobiliary secretions
- Intestinal cell function
- Expulsion of undigested waste products
12
Q
GI Function in Newborns
A
- Frequent “spitting up” is normal
- Esophageal motility decreased
- Lower esophageal sphincter pressure is less
- Gastric emptying delayed
- Intestinal motility not organized
- Stomach capacity 10-12cc increases → 200cc
- Spitting up
- Small amounts of milk and food
- Not cause for alarm if infant is growing well
- Furter evaluation warranted if:
- Growth is inadequate
- Pain is associated
- Feeding aversions present
- Small intestinal transit time slower to aid in adequate digestion and absorption of nutrients
- Colonic transit time quicker, which may increase risk of dehydration and electrolyte disturbances if diarrhea develops
13
Q
Colic
A
- Severe abdominal pain
- Persistent, unexplained crying “Rule of Threes”
- 10-30% infants affected
- Affects both breast and formula fed infants
- Most cases are outgrown
- Most do not respond to nutritional therapies
- Some recent evidence associating foods with symptoms: cow’s milk, egg,s peanuts, tree nuts, wheat, soy and fish
14
Q
Special Health Needs
A
- Poor suck may indicate abnormal muscle tone or cerebral palsy
- Stiffening and arching during feeding may be due to spasticity
- Poor growth may indicate physical or neurological difficulties
- Intervention and assessment by an interdisciplinary team is recommended if any of these signs exist
15
Q
Enzymes
A
- Allow digestion and absorption of nutrients in milk
- Infants have lower levels compared to adults
- Infant GI tract is able to compensate for lower enzyme levels/immature pancreas
- Salivary and gastric lipase
- Amylase and lipase in breast milk
16
Q
Caloric Requirements
A
- 0-6 months → 108 kcal/kg/day (range 80-120)
- 6-12 months → 98 kcal/kg/day
- Based on
- body size
- physical growth
- Rates of growth
- May be overestimated
- Breast fed infants have lower requirements than bottle fed because of more efficient absorption
- Total daily energy requirements increase
- kcal/kg decreases because energy/unit body size decreases
- requirements for growth decrease
- Requirements for activity increase as infant becomes more mobile
17
Q
Protein Requirements
A
- Body protein content increases in first year
- Requirements:
- 1st period → 2.2 g/kg/day
- 2nd period → 1.6 g/kg/day
- Minimum standards for formula → 1.8 g/100 kcal formula (per AAP)
- 9 essential AA plus cysteine and tyrosine
18
Q
Fat Requirements
A
- Supplies 40-50% energy for newborn so protein can be used for tissue synthesis
- Energy from fat drops when carb-rich weaning foods introduced
- do not introduce solids too early
- energy from fat increases when table food introduced
- Inadequate fat intake → growth failure
- Fat and cholesterol intake during infancy → long term effects on lipid metabolism
-
EFA’s necessary
- prevent EFAD
- promote growth and neurological development
- EFA’s serve as precursors for LCFA’s
- AAP and FDA recommend **2.7% linoleic acid **
- Breast milk = 3-7%
19
Q
Docosahexanoic Acid (DHA)
A
- Very important for brain and CNS
- Breast milk is a good source
- Only if the mom has been consuming sufficient DHA
- DHA may
- explain reported higher IQ
- Explain reported improved visual function
- Reduce growth rates
- Ratio of omega-3 to omega-6 FA may be a key factor in growth rate
- DHA and ARA recently added to most formulas
20
Q
Water Requirements
A
- Higher water / kg than adults
- Requirements determined by:
- water losses
- evaporation from skin
- water lost in breath
- elimination in urine and feces
- water required for growth
- solutes derived from diet
- water losses
-
1.5 cc/kcal energy expenditure
- 1st period → 165 cc/kg
- 2nd period → 147 cc/kg
- Excessive → water intoxication
21
Q
Renal Function
A
- Newborns have “stupid kidneys”
- Small range for maintaining water and electrolyte balance
- Infants susceptible to dehydration
- Limited amount of antidiuretic hormone produced by pituitary
- Limited capacity to concentrate urine
22
Q
Vitamins and Minerals
A
- Requirements influenced by:
- GR
- Mineralization of bone
- Increase in bone length
- Increase in blood vol
- Macro intake
23
Q
Ca and Phosporous
A
- Breast milk content is reference point
- Ca absorption varies considerably with source
- Breast milk → 60%
- Formula → 38%
- Formula has more Ca to compensate for lower absorption rate
24
Q
Iron
A
- Iron deficiency in US declined because
- Increased breast feeding
- Use of iron fortified formula
- Iron deficiency → developmental problems
- Iron needs supplied by:
- Prenatal reserves
- Food sources
- Infants at risk for deficiency:
- Premature infants
- Rapidly growing infants
- Absorption is highly variable
- **Exclusively breastfed infants require additional Fe after 6 months **
25
Q
Fluoride
A
- Essential in preventative dental care
- Excess intakes → fluorosis
- Breast milk is low in fluoride and may require infant supplement - debated
- < 6 months → 0.1 mg/day
- > 6 months → 0.5 mg/day
- Formulas mixed with water reflect fluoride in water supply
- Maternal fluoride intake does not affect breast milk
26
Q
Vitamin A
A
- Excess worse than deficiency
- Milk is good source
- Generally no supplementation
- Supplementation recommended for:
- Infants/toddlers with complications of measles
- Older infants with deficiency symptoms
- Immunodeficiency
- Malabsorption
- Malnutrition
