Infancy Ch 8 Flashcards
Define: infant mortality
Infant mortality - defined as death that occurs within the first year
-Major cause is low birthweight (< 2500 g)
Other leading causes:
-congenital malformations
-preterm births
-SIDS: Sudden Infant Death Syndrome
Define: SGA, AGA, LGA
SGA - small for gestational age: newborn was 90th percen1le of wt/age
Define: failure to thrive
Common Nutrition Problem & Concern
FTT
- Inadequate weight or height gain
- Energy deficit is suspected
(may involve social worker)
(when you don’t see adequate medical issues & symptoms)
Infant dev: newborn development
Newborns:
- Hear and move in response to familiar voice
- CNS is immature resulting in inconsistent cues for hunger and sa1ety
- Strong reflexes that are protective for newborns
what are factors associated w/ infant mortality
Social and economic status Access to health care Medical interven1ons Teenage pregnancy Availability of abor1on services Failure to prevent preterm & LBW births
Infant reflexes:
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
Infant dev: Infant development & feeding skills development progresses?
Digestive System Development:
-During the 3rd trimester: Fetus swallows amniotic fluid
which stimulates intestinal maturation and growth
-At birth: the healthy newborn can digest fats, protein, & simple sugars.
-Common problems include gastroesophageal reflux (GER), diarrhea, and constipation
infant dev: factors that impact food
Factors that impact rate of food passage in colon and gastrointestinal discomfort in infants:
- Osmolarity of foods or liquids
- Colon bacterial flora
- Water and fluid balance in the body
infant dev: parenting for feeding practices
new parents learn:
- Infant’s cues of hunger and safety
- Temperament of infant
- How to respond to infant cues
What are the energy and protein needs for infants according to body weight (birth to 6 months and 6 to 12 months)? What factors are associated with protein and calorie needs?
Energy (Calories):
- 108 kcal/kg/day from birth to 6 months (range from 80 to 120)
- 98 kcal/kg/day from 6 to 12 months
Recommendations for infants for food:
The recommenda1ons for infants are from the Dietary Reference Intakes (DRI) - Na1onal Academy of Medicine, American Academy of Pediatrics, and the Academy of Nutri1on and Dietetics
- Energy needs
- Protein needs § Fats
Protein needs: What are the protein needs for infants according to body weight (birth to 6 months and 6 to 12 months)?
Protein needs are similar to that of energy but are also influenced by body composition
Protein Needs
2.2 g/kg/day from birth to 6 months
1.6 g/kg/day from 6 to 12 months
===
Newborn weighing 4 kg (8.8 lbs) needs 2.2 X 4 = 8.8 g
protein
6-month-old weighing 8 kg (17.6 lbs) needs 1.6 X 8 = 12.8 g protein
Energy needs: What factors are associated with calorie needs?
Factors that influence calorie needs:
- Wt & growth rate
- Sleep/wake cycle
- Temp & climate
- Physical activity
- Metabolic response to food
- Health status/recovery from illness
Metabolic Rate, Calories, Fats & Protein: How do you assess growth?
-Metabolic rate of infants is highest of any time after birth
-The higher rate is related to rapid growth and high
proportion of muscle
-Low carbohydrate and/or energy intake results in protein catabolism impacting growth
Physical growth assessment: What are the indicators of growth problems?
Newborns grow faster than any other time of life
Growth reflects:
-Nutritional adequacy
-Health status
-Economic & environmental adequacy
-There is a wide range of growth = typical
-Calibrated scales & recumbent length measurement board required for accurate measures
Compare growth charts: CDC vs. WHO. How do you use and interpret each growth chart?
WHO ‘TIL 2:
data & pop. is different
CDC bbs born in US
CDC 2000:
- US selected sites w/ 5k measurements
- descriptive reference reflecting past: how infants have grown
- 66% formula fed & 33% BF for 3mos
- birth - 36 mo (3 yrs)
- high prevalence
WHO 2011:
- WW: 6 selected sites w/ 19K measurements
- Prescriptive optimal standard: how infants should grow
- All BF @ for 4mo
- Birth-24 mos
- Low prevalence
CDC recommendations
CDC recommends that health care providers:
- Use the WHO growth charts to monitor growth for infants & children ages 0-2 yrs
- Use the CDC growth charts to monitor growth for children age 2 yrs and older
WHO charts (4)
Head circumference
weight-for-length (recombinant)
weight-for-age
length-forage
CDC Charts (3)
BMI-for-age
Weight-for-age
length-for-age (stature)
Feeding in Early Infancy: What are the recommended feeding practices during early infancy?
Breast Milk and Formula
-Recommend exclusive breast feeding for 1st 6 months &
continuation to 1 yr
-Initiate breast feeding right amer birth
-Growth rate and health status indicate if milk volume intake is adequate
-Standard infant formula provides 20 cal/fl oz
-Preterm formula provides 22-24 cal/fl oz
Compare breast milk and formula (cow’s and soy based)
COW: Whole, reduced-fat or skim cow’s milk should not be used in infancy
-Iron-deficiency anemia linked to early introduc1on of
cow’s milk
Anemia linked to:
-GI blood loss
-Low absorp1on of calcium & phosphorus
-Displacement of iron-rich foods
SOY Protein-Based Formula During Infancy:
- Soy protein in place of milk protein should be limited in its use
- The use of soy formula is not recommended for managing infan1le colic
- Lactose free and hydrolyzed formulas are beker for infants unable to breasoeed or be fed cow’s milk formulas
What are the consequences of using cow’s milk in infancy?
- lots of energy
- not enough iron*
Intro to solid foods: What are the recommendations for solid foods introduction?
- At 6 months, offer small portions of semisom food on a spoon once or twice each day
- Food offered from spoon s1mulates mouth muscle development
- –
- Infant should not be overly tired or hungry
- Use small spoon with shallow bowl
- Allow infant to open mouth & extend tongue
- Place spoon on front of tongue with gentle pressure
- Avoid scraping spoon on infant’s gums
- Pace feeding to allow infant to swallow
- First meals may be 5-6 spoons over 10 minutes
Which foods should be first offered?
1st foods:
-iron-rich foods
6 months—iron-fortified baby cereal
-Rice cereal is hypoallergenic
-6 months—fruits and vegetables
-Only one new food over 2-3 days
-Commercial baby foods are not necessary but do provide sanitary and convenient choices
-9-12 months som table foodsWhich foods are considered unsafe?
Foods that choke infants
- Hot dogs
- Popcorn, potato chips
- Peanuts, chunks of peanut butter
- Raisins, whole grapes
- Stringy meats
- Gum & gummy-textured candy, hard candy or jelly beans
- Hard fruits or vegetables
Discuss difficulties related to the weaning process
Offer water or juice from cup amer 6 months
- Wean to a cup at 12 to 24 months
- First portion from cup is 1-2 oz
- Early weaning may result in plateau in weight (due to reduced calories) and/or cons1pa1on (from low fluid intake)
- Changing from a bokle to a covered “sippy” cup with a small spout is not the same developmental step as weaning to an open cup
- Open cup drinking skills also encourage speech development
What are the recommendations regarding water, juice and supplements during infancy
-Breast milk or formula provide adequate water for healthy infants up to 6 months
-Dehydration is common response to illness in infants (vomit and diarrhea)
-Pedialyte or sports drinks provide electrolytes but lower in calories than formula or breast milk
-Limit juice
-AAP recommends juice is not needed to meet the fluid
needs before the age of 6 months
Avoid colas and tea
Supplements for infants
- Fluoride—for breasoed infants amer 6 months or if in any area with no fluoridated water
- Vitamin B12—for vegans
- Vitamin D—needed if exclusively BF
Discuss common nutritional problems and management strategies in infancy: colic
Colic - the sudden onset of irritability, fussiness or crying
- Episodes may appear at the same 1me each day
- Disappear at 3rd or 4th month
- Cause unknown but associated with GI upset, infant feeding practices
Discuss common nutritional problems and management strategies in infancy: iron deficiency
- Less common in infants than in toddlers
- Iron stores in the infant reflect the iron stores of the mother
- More common in low-income families
- BF infants may be given iron supplements and iron- for1fied cereals at 4-6 months
Discuss common nutritional problems and management strategies in infancy: diarrhea/constipation
Diarrhea and Cons1pa1on -Infants typically have 2-6 stools per day Causes of diarrhea & cons1pa1on: -Viral and bacterial infections -Food intolerance -Changes in fluid intake
To avoid cons1pa1on assure adequate fluids
Con1nue to feed the usual diet during diarrhea
Discuss common nutritional problems and management strategies in infancy: cavities & ear infections
Prevention of Baby Bottle Cavities and Ear Infections
- Are linked to feeding practices
- Feeding techniques to reduce cavities and ear infections -Limit use of bed1me bottle
- Offer juice in cup
- Only give water bottles at bed1me
- Examine and clean emerging teeth
Discuss common nutritional problems and management strategies in infancy: food allergies
Food Allergies and Intolerances
- About 6-8% of children < 4 yrs have allergies
- Absorption of intact proteins causes allergic reactions
- Common symptoms are wheezing or skin rashes
- Treatment may consist of formula with hydrolyzed proteins
Discuss common nutritional problems and management strategies in infancy: food intolerances
Lactose Intolerance
- Inability to digest the disaccharide lactose
- Characterized by cramps, nausea and pain and alterna1ng diarrhea and cons1pa1on
- Lactose intolerance in uncommon and tends to be overestimated
