Infancy and Weaning Flashcards
Growth patterns in first 2 years of life
Check ups within 1–2 weeks of birth, 1, 2, 4, 6, 9, 12, 18 and 24 months of age, then yearly
- for wt, ht and head circumference
Normal growth patterns follow within 1-2 percentiles
Growth charts
Use of percentiles - ex. 95th percentile = 95% of children with weight for age lower
corresponds with nutrition indicators
growth charts used for birth to 36 months and then 2 to 20 years
used to detect changes in growth out of norm - weight is a sensitive barometer
- allows for tracking growth and comparing to other children for context
Microcephaly definition and diagnosis
Microcephaly determined from head circumference measurements in first 2 years of life
Head size in < 3rd percentile is considered microcephaly
Due to small brain size - growing brain is stimulus for skull to grow
No catch up growth for head circumference - correcting nutrition later on does not compensate
- Can still benefit from supplementation of milk/formula
Nutrition indicators corresponding with growth chart measurements
Length for age → < 2nd percentile → short stature
Weight for length → < 2nd percentile → Low weight for length
Weight for length → > 98th percentile → high weight for length
BMI* for age → <5th or >95th percentile → underweight or obese
Stature for age → < 5th percentile → short stature
*BMI after age 2
Average weight gain pattern up to age 5
1st year rapid growth as weight doubles in 4 months, triples in 12 months
2nd year of life:
- average weight gain = 3-5 lbs
- average growth gain = 3-5”
Years 4-5 per year:
- average weight gain = 4-6.5 lbs
- Average growth gain = ~3”
Feeding periods
Nursing period: breast milk/infant formula complete source of nutrition months 4-6
Transitional period: intro of semi-solid foods with high milk/formula intake months 6-10
- spoon feeding, self feeding, chewing
Modified adult period: most foods = adult-type months >10
When to investigate/intervene related to growth patterns:
No increase in weight, height or head circumference for 1 month
No weight/height increase over time
A drop in weight not regained in 3-4 weeks
Movement crossing 2+ percentiles of growth
Sensorimotor development
Sensorimotor stage = child learning about themselves and the environment by constructing ideas as they experience different situations through their senses
maximal development requires proper nutrition + social/emotional interactions
- caregiver’s emotions can affect child’s emotional development
cognitive + nutritionally issues go hand in hand and feed into each other
Motor development begins
with head and neck → middle → legs
from center → peripheral
more movement = ↑ energy needs
depends on interaction with environment/stimulation
Developmental signs for readiness transition to solid foods
Ages 4-6 months
teeth have developed (mostly) and ability to swallow solid food
Weight doubled
consumes > 32 oz formula and still hungry or consume > 8 oz and still hungry < 4 hours later
Sits with little support and controls head movement/head upright
Moving tongue side to side
Timeline of infant feeding skills development:
10 weeks - no extrusion reflex
3-6 months - palmar grasp
4 months - can move head forward and turn away
6-8 months - rotary chewing, critical period that requires stimulus of solid food intro
9 months - holding onto bottle solo
1-3 years - increasing ability to eat with oral and muscular development
Dietary recommendations during infancy
Cow’s milk not recommended in first year of life
- Partly skim milk not recommended first 2 years of life
- Cow’s milk is a poor source of Fe
Feeding frequency and duration changes with increasing stomach size
- frequency ↓ with volume ↑
- 1-2 marble = 5-7 mL, day 3 ping pong ball = 22-27, day 10 (chicken egg) = 60-81 mL
avoid milk substitutes such as rice or soy
- low energy density, low vit D, high phosphates, high Mn → toxicity
avoid goat’s milk: folic acid deficient, low B6, B12, high protein (dehydration + renal load)
- low Ca:P ratio → hyperphosphatemic tetany
During weaning maintain 60 mL/kg/day breast milk/formula for protein (2g/kg/day)
Dietary concerns during infancy
Feeding patterns depend on hunger cues - can be affected by cognitive delays
Fat content in human milk, cow’s milk and adult diet (max recommended)
Infancy is the only time when fat has an RDA - fat required for optimal growth
Human milk: 55% fat, 6% protein
Formula: 49% fat, 9% protein
higher protein → faster growth, ↑ rates of obesity (↑ adiposity)
Adult diet: 30% fat, 12% protein
risks of weaning too early
↑ morbidity including diarrhea and allergies
Under-nutrition due to responsive decrease in mother’s milk
↑ risk developing allergies or diabetes - immune response to proteins attacks pancreas
- oral tolerance - immune system can handle proteins
↑ risk of choking
risks of weaning too late
growth faltering
↓ immune protection due to under-nutrition
Under-nutrition especially: energy, protein, Fe, Zn, vitamin A and D
Breast milk is a poor source of Fe
Guidelines for introducing solid foods
1-2 tablespoons of semi-soft food offered for each meal 1-2x/day
one new food at a time 2-3 days apart → can check for allergies
- if a food is rejected, should try again later
introduce new foods at start of meal
1 Tbsp per year of age
introduce all food groups within a few weeks
Introduction of foods timeline
4-6 months of age:
- breastfeeding continues, introduce first foods
- wide variety of flavors - most accepting of new flavors from months 4-7 compared to after 12 months
6-8 months of age:
- milk ↓, Fe fortified foods continues, add meats, beans, eggs, fruits, vegetables (cooked) → everything pureed and strained
- add finger foods for palmar grasp like biscuits
9-12 months of age:
- breast milk as before, add new cereal textures, finely cut table meats, well chopped or mashed and cooked fruit/veg, add table foods
- increase finger foods for pincer grasp
add juice or formula by cup after 1 year of age
Transition is complete when kcal from food = amount provided from bottle/breast milk
First foods to introduce
iron-fortified and iron-rich foods → hemoglobin synthesis
- rice cereals + breast milk/formula
meat, poultry, fish
- firm tofu, legumes, eggs
pureed fruits and vegetables
- variety is good - sets precedent for openness to new foods later in life
gradually increase food thickness
nothing that can be a choking hazard: grapes, peanuts, hot dogs
choose whole grains, no added sugar
