Infancy Flashcards
Infancy is what age range?
birth - 12 months
Early infancy
0-6 months
Later infancy
6-12 months
Reflex
automatic response triggered by specific stimulus
Rooting reflex
infant turns head toward the cheek that is touched
Suckle
reflex causing tongue to move forward and backward
Five domains of development
motor, sensort, cognitive/mental, language/communication, social/adaptive/emotional
Motor Development
ability to control voluntary muscle movement
Sensory
information from environment
Intrinsic influence
child’s health (nutrition), brain function, temperament
Extrinsic influence
family, environment, cultural
The development of motor control starts with?
head and truck control, then lower legs
Order of motor development
Top down
- controls head first, lower legs last
- central to extremities (shoulders controlled before fingers)
- influences ability to be fed, feed self and the amount of energy expended
Gross motor skills - average age they can control head and core?
6 months
Gross motor skills - average age they can walk?
11 months
Sensorimotor
knowledge of world limited to sensory perception and motor activity
Which sensory organ is an important source of stimulation and pleasure?
mouth
Is a humans gut functional at birth?
yes - can digest fat, protein, simple sugars
At what age does GI tract mature?
~6 months
Changes to the GI as infant ages?
- levels of digestive enzymes expand
- speed of stomach emptying increases
- peristalsis becomes more consistent
Infants inherent preference
sweet taste
What changes are seen at 4-6 weeks?
reflexes fade, infant begins to purposely signal wants/needs
What changes are seen at 4-6 months?
tongue moves side to side, teeth arrive, can swallow pureed foods and hold bottle
What changes are seen at 9-12 months?
self feeding with hands/spoon, munching/biting skills, lumpy and chopped foods, drinking from open cup
Energy needs from birth to 6 months?
108 kcal/kg/day
Energy needs from 6-12 months?
98 kcal/kg/day
Energy needs to babies born prematurely?
120 kcal/kg/day
Factors that influence caloric needs
weight, growth rate, sleep/wake cycle, temperature/climate, metabolic response to food, health status
When do growth spurts occur?
typically 3 weeks and 3 months
Birth to 6 months protein requirements
2.2 g/kg/day
6-12 months protein requirements
1.6 g/kg/day
Premature protein requirements
1.52g/kg adequate if growth/digestion are not affected
3-3.5 g/kg required for preterm or recovery from illness
4 g/kg may be needed for extremely low birth weight (
What can be sued for ‘premies’ or sick infants to provide enough protein?
Hydrolyzed protein or single AA
Fat needs
30g/day for all ages
Do infants need cholesterol?
Yes - for brain development
Birth to 6 months carb requirement
60g/day
6-12 months carb requirement
95g/day
What happens to protein and carb requirement as infant ages?
Carbs increase
Protein decreases
When is metabolic rate the highest in humans?
infancy - rapid growth and high proportion of muscle
Other important nutrients at infancy?
fluoride, vitamin D, iron
Vitamin D requirement
breast fed babies need supp. of 400 IU from birth-1 year
birth to 6 months iron requirement
0.27 mg/day
6-12 months iron requirement
11 mg/day
What types of food are recommend for infants to deliver iron?
iron-fortified cereals and other iron-rich foods starting at 6 months
Hierarchy of milk recommendations
breast milk > cows milk formula > soy based formula
What’s good about specialized formulas?
- higher energy
- hydrolyzed proteins
- lactose replaced with other sugars
- MCT added
- DHA added
- prebiotics
- decreased minerals
- fiber for thickness
If an infant is exclusively breast fed and not exposed to adequate amounts of sunlight, he or she may be deficient in?
Vitamin D
Health Canada infancy recommendations
- support breastfeeding up to 2 years or beyond, as long as mother/child want to continue
- whole, reduced-fat or skim cow’s milk should not be used before 9 months of age
- Complementary feedings starts at 6 months
- gradually increase frequency of complementary feedings
- no honey before 1 year
- gradually increase frequency of complementary feedings
- progress in textures gradually
- allergens
- consider food safety and possible choking hazards
Why should whole, reduced-fat or skim cow’s milk not be used before 9 months of age?
Iron deficiency anemia is linked to early intro of cow’s milk (GI blood loss and displacement of iron rich foods)
Complementary feedings starts at 6 months
start with iron rich food (cereals/meats) then slowly progress (1 new food every 2-3 days) to a variety of food the family eats
- serve food prepared without sugar
gradually increase frequency of complementary feedings
By 12 months, 3 meals and 3 snacks/day
Why no honey before the age of 1?
Risk of infant botulism
progress in textures gradually
pureed –> lumpy –> mashed –> diced
- lumpy foods offered no later than 9 months
Allergens
after 6 months, no evidence that introducing any allergen (peanut, soy, egg) has an increased risk of developing allergy
- offer no more than 1 potential allergen at a time and wait at least 2 days before introducing another
- watch for reactions during multiple offerings (not the first one!)
Consider food safety and possible choking hazards
avoid hard, small, round, smooth and sticky foods
Foods that might choke infants?
popcorn, peanuts, raisins, whole grapes, stringy meats, gummy/hard candy, jelly beans, hot dogs, hard fruits/veggies
Texture recommended at 6-9 months
pureed –> lumpy –> mashed
What should a infant’s diet look like by the end of 9 months?
3 meals with breast fed formula
Texture recommended for 9-12 months
diced soft foods
- foods need to increase in texture to encourage chewing (motor development)
- encourage self feeding and eating ‘family foods’
- 3-4 milk feedings/day
Diet expectations for 12 months
- general pattern = 3 meals/3 snacks
- 2 milk feedings/day
- texture = solids increase in amount progressing towards table foods with some modifications
Which of the following might NOT be a cue that an infant is not hungry?
spitting out food on the floor
Feeding cues - hungry
- watches food being prepared
- reaches for food/spoon
- tightens fists
- irritation if pace is too slow or stops
Feeding cues - full
- plays with food/utensils
- slows pace of eating
- turns away from food
- tries to get out of high chair
- stops eating
- spits out food
Parent is responsible for?
milk, solid food
Infant is responsible for?
whether/if and how much/how fast
Feeding techniques:
- sit in front to feed, make eye contact
- hold spoon about a foot away, wait for baby to open mouth
- new food - put on lip, if familiar - put in mouth
- pace and amount depends on child
- talk together
- stop when signals finished
- provide several opportunities/tastes
Growth reflects?
nutritional adequacy, health status, economic and environmental adequacy
How can growth be assessed?
weight, height/length, head circumference
What does it mean if infant is in the 95th percentile for their age/weight
child weighs the same or more than 95% of the reference population or child weighs less than 5% of the reference population
Warning signs for poor growth (up/down)
- loss of weight or length gain
- plateau in weight or length for >1 month
- drop in weight without regain in a few weeks
- fast gain in weight
? is an unsafe food to give to a one year old infant?
Gummy bears
Alternative for very low birth weight and low birth weight
Fenton chart and infant health and development program charts
What is the gestational adjusted age for a 9 month old infant born at 32 weeks of age?
7 months
How to correct for gestational age?
- subtract gestational age at birth from 40 weeks
- divide by 4 to get months
- subtract that amount from current age
Ex. infant born at 30 weeks; assessing growth at 3 months
- 40-30 = 10 weeks
- 10/4 = 2.5 months
Current age = 3 months so, 3-2.5 = 0.5 months or 2 weeks old
True or false - low birth weight infants are at a greater risk of dying during the first year of life and developing chronic health problems?
True
Failure to thrive (FTT)
when the infant is growing more slowly than other infants of his/her own age
FTT - organic
diagnosed condition (e.g. chronic ear infections)
FTT - inorganic
not based on medical diagnosis (e.g. maternal mental health)
Hypothesis of allergy cause
absorption of intact proteins causes allergic reactions
common allergic reaction symptoms
respiratory/skin rashes
allergy treatment
baby formula with hydrolyzed proteins
Oral tolerance induction
- idea of slow sensitization especially milk, soy, egg, wheat
- overcome risk of allergy by consuming tiny but increasing portions of the food
- train immature immune system
Lactose intolerance
inability to digest the disaccharide lactose
- characterized by cramps, nausea and pain and alternating diarrhea/constipation
- many infants outgrow
Colic
sudden onset of irritability, fussiness or crying (>3 hours/day)
- typically disappears by 3rd or 4th month
- swaddling, rocking, white noise
How is mild-moderate dehydration from acute gastroenteritis managed?
continued breast feeding and oral rehydration therapy
What is one of the signs associated with inadequate growth in infants?
weight remaining the same over 3 months
