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NHD > Infancy & Childhood > Flashcards

Infancy & Childhood Flashcards

1
Q

What is complementary feeding?

A

Complementary feeding:
* Feeding alongside breastfeeding
* Any food or liquid other than breast milk

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2
Q

According to WHO/UNICEF 2003, when should complementary feeding begin?

A

According to WHO/UNICEF 2003, complementary feeding should begin at 6 months.

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3
Q

According to WHO/UNICEF 2003 how long should breastfeeding continue for?

A

According to WHO/UNICEF 2003 breastfeeding should continue alongside complimentary feeding up to 2 years or beyond.

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4
Q

Why do infants need complementary feeding?

A

Infants need complementary feeding to:
* Increase their exposure to different foods> this may affect how they eat later in life
* They may become iron deficient
* Their energy requirements increase

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5
Q

ESPGHAN Committee 2008 Infant Feeding Recommendations

A

ESPGHAN Committee 2008 Infant Feeding Recommendations
* Exclusive breast feeding for ~6months desirable
* Solids shouldn’t be introduced before 17 weeks (4 months and 1 week)
* All infants should start solids by 26 weeks (6 months)
* Recommendations for solid introduction applies to breast and bottle fed babies
* Introduction of potentially allergenic foods such as eggs, fish shouldn’t be delayed even in at risk infants (research doesn’t support it). It might increase risk of allergy.
* 90% of iron requirements should be met by weaning foods
* No cows milk as main drink before 12 months (1 year)
* Early (<4 months) and late (>7months) introduction of gluten should be avoided.
* Gluten should be introduce while infant is still breastfed.

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6
Q

Department of Health (DoH) 2003 Infant Feeding Recommendations

A

Department of Health (DoH) 2003 Infant Feeding Recommendations
* Breastmilk is the best form of nutrition
* Exclusive breastfeeding for first 6 months (24 weeks)
* Breastfeeding (and/or breastmilk subs) should continue >6months alongside complementary feeding.
* There are 3 things that indicate that an infant is ready for complementary feeding.

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7
Q

What are the 3 key competencies that show an infant is ready for complementary feeding according to the DoH?

A

3 key competencies that show ready:
1. Stay in sitting position and hold head steady
2. Can coordinate eyes, hands and mouth so able to look at the food, pick it up, and put it into mouths by themselves
3. Can swallow foods, infants not yet ready will push their food back out with their tongue

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8
Q

SACN 2018 Infant Recommendations

A

SACN 2018 Infant Recommendations
* Delaying weaning to 6 months doesn’t ↑ difficulty in accepting foods
* Earlier weaning ↓ breastfeeding (breastfeeding should be encouraged)
* ↑ times of offering and ↑ variety → ↑ acceptance
* Energy intakes are ↑ even in babies
* All breastfed babies should be taking a Vitamin D supplement
* Only 14% of infants taking a Vit D supplement
* Delayed introduction of peanut and egg past 6 months ↑ risk of allergy
* Infants don’t routinely need iron supplement
* Soy formula only on medical advice for <1 year

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9
Q

Which vitamin supplements do infants need aged 1-5 years?

A

Infants aged 1-5 need vitamin A,C and D supplements.

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10
Q

Which supplement should all breastfed babies be taking?

A

All breastfed babies should be taking a Vitamin D supplement.

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11
Q

_________________________ should be encouraged

A

**Breastfeeding **should be encouraged.

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12
Q

When might infants need an iron supplement?

A

Infants might need an iron supplement if their mother is deficient.

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13
Q

Which nutrient is complementary feeding key for?

A

Complementary feeding is key for iron.

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14
Q

At 6 months, a ________ of food should be introduced quickly.

A

At 6 months, a **variety **of foods should be introduced quickly.

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15
Q

What is early weaning associated with?

A

Early weaning is associated with a reduction in breastfeeding.

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16
Q

When should allergenic foods be introduced?

A

Allergenic foods need to be introduced at 6 months.

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17
Q

How should complementary feeding be introduced?

A

Complementary feeding should be introduced with gradual increased frequency.

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18
Q

What do soy formulas usually have?

A

Soy formulas usually contain a high amount of sucrose.

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19
Q

Why isn’t soy formula recommended?

A

Soy formula isn’t recommended because:
* It contains phytoestrogens which may mimic oestrogen in the body
* They usually contain high amounts of sucrose

20
Q

What type of feed is preferred to soy?

A

A hydrolysed feed such as pregestimil formula is preferred to soy.

21
Q

What other protein may children allergic to cow’s milk be allergic to?

A

Some children allergic to cow’s milk will also react to soy protein.

22
Q

Which 3 things are NOT signs that an infant should have complementary foods introduced < 6 months according to the BDA (2013/2020)?

A
  • Hand chewing
  • Waking at night
  • Wanting extra feeds
    are NOT signs that an infant needs to be weaned before 6 months (BDA, 2013;2020)
23
Q

What is the optimum weaning (complementary feeding) age?

A

The optimum weaning (complementary feeding) age:
* Should be flexible and in tune with the baby and family
* By 6 months
* Not before or after 6 months
* At ~6 months
* Not before 4 months

24
Q

What is the weaning window?

A

The weaning window is 17-26 weeks.

25
Q

What are 3 signs that a baby is ready for complementary feeding?

A

3 signs that a baby is ready for complementary feeding:
* Infant is beginning to sit unsupported
* Infant takes objects into mouth accurately
* Infant is beginning to chew and bite

26
Q

BDA Infant Feeding Recommendations

A

BDA Infant Feeding Recommendations
* Complementary from 6 months advised but individual development should be considered
* Exclusive breastfeeding from birth is optimal
* Breastfeeding should continue alongside complementary food until age 1
* Diverse and iron containing foods should be introduced when complementary feeding begins
* Infants require repeated exposure to foods
* Delayed introduction of allergenic foods may increase allergy risk.
* Allergenic foods should be introduced one at a time and consumed regularly unless they cause a reaction
* Introduction of allergenic foods may lower allergy risk
* Allergenic foods should be introduced after 4 months
* If a baby reacts to a food, medical advice should be sought and baby should stop having said food.
* Gluten can be introduced from start of complementary feeding
* Breastmilk, water and formula are only drinks that should be offered in infancy
* Fruit juices etc. not recommended under 6 months
* Unmodified cows milk can be introduced as main source after 1st year as it can interfere with iron status
* Plant based milks not adequate for nutrition in 1st year. Not to be given as main source of milk until aged 2
* Preterm infants need special attention from medical professionals
* Preterm infants: complementary feeding according to cues but not before 4 months after expected delivery
* Partial/exclusive breast fed babies need 8.5-10mcg of Vitamin D
* Infant formula babies: don’t need Vitamin D unless having less than 500ml/day
* Foods high in sugar and salt should be avoided. Linked to dental caries, obesity and hypertension.
* Home-prepared foods with no added sugar or salt are recommended.
* Health care professionals should support parents and caregivers with nutrition and acknowledgement of milestones regardless of their choices.

27
Q

Why is 6 months the optimum weaning/complementary feeding age?

A

6 months is the optimum weaning/complementary feeding age because:
* ↑ energy and nutrient needs as infant grows rapidly during most of first year
* ↑ neuromuscular coordination required for bolus formation and swallowing of solid foods which isn’t present < 6 months
* Maturation of infant renal system to handle higher solute load foods
* GI tract has ↑ digestive capacity e.g., secretion of gastric acid and digestive enzymes
* ↑ immuno-capacity
* Not later as ↑ nutritional deficiencies, underdeveloped feeding skills, ↑ allergies, ↑ fussy eaters (ESPGHAN 2008)

28
Q

Why shouldn’t weaning/complementary feeding be started after 6 months?

A

According to ESPGHAN 2008, weaning/complementary feeding shouldn’t be started after 6 months because:
* It can ↑ nutritional deficiencies
* Cause underdeveloped feeding skills,
* ↑ allergies
* ↑ fussy eaters (ESPGHAN 2008)

29
Q

What can affect movement to lumpier foods?

A

Weaning/complementary feeding disruption can affect movement on to lumpier foods.

30
Q

What shouldn’t be introduced before the age of 6 months?

A

Foods/drinks that shouldn’t be introduced before 6 months:
* Cow’s milk as main drink
* Foods containing gluten (e.g. bread, pasta, chapatis)
* Nuts and seeds
* Eggs
* Fish, raw or cooked shellfish
* Liver, pate
* Soft and unpasteurised cheeses

31
Q

Why shouldn’t cows milk be the main drink before 12 months?

A

Cows milk shouldn’t be the main drink before 12 months because it can affect iron intake.

32
Q

Why shouldn’t liver and pate be introduced before the age of 6 months?

A

Liver and pate shouldn’t be introduced before the age of 6 months because liver contains high amounts of vitamin A and pate may contain listeria,

33
Q

Why shouldn’t soft and unpasteurised cheeses be introduced before the age of 6 months?

A

Soft and unpasteurised cheeses shouldn’t be introduced before the age of 6 months because they may contain listeria

34
Q

What did WHO 2006 systematic review find about exclusively breastfeeding?

A

WHO 2006 systematic review found that exclusive breastfeeding was associated with:
* Delayed resumption of the menstrual cycle
* Increased postpartum weight loss
* Improved iron status as menstrual cycle was delayed

35
Q

Which types of countries might benefit from longer breastfeeding?

A

Developing countries might benefit from breastfeeding for longer due to the risk of contamination, lack of income.

36
Q

What did WHO 2006 systematic review find about complementary feeding aged 4-6months ?

A

WHO 2006 systematic review found that there was no benefit in introducing complementary feeding before 6 months, aged 4-6months

37
Q

What did WHO 2006 systematic review find about infants exclusively breastfed for 6 months?

A

WHO 2006 systematic review found that infants exclusively breastfed for 6 months:
* Had lower rates of gastrointestinal and respiratory infection
* No deficits in growth

38
Q

Which risks are associated with earlier weaning?

A

Risks associated with earlier weaning:
* Food pathogen exposure resulting in infection (gut isn’t fully mature)
* Gut is functionally immature
* Gut function immaturies might pre dipose infant to age-related GI disease in first 6 months of life

Conclusion: infants should be exclusively breast fed for up to 6 months (Naylor and Morrow 2001)

39
Q

What type of tastes do infants prefer?

A

Infants prefer sweet or salty tastes to bitter or sour.

40
Q

What did Lowden 2018 find about infants and food exposure?

A

Lowden 2018: infants may have to have a food 6-15 times before they like it.

41
Q

Critically discuss current recommended weaning practices

A
  • ESPGHAN 2018
  • Age of weaning
  • Food types
  • Process
  • DoH 2003
  • SACN 2011
  • WHO 2023
42
Q

Appraise nutritional issues during infancy and early childhood

A

Appraise nutritional issues during infancy and early childhood
* Fussy eating: associated with high free sugar intake in adolescence with low protein, fibre and micronutrients
* Food neophobia: repeated exposure to combat. Parents as role models.
* Preference for sweet tastes
* Advertising: promotion of unhealthy foods> increases brand awareness, makes food seem positive. Children more vunerable to effects.
* Study showed that 6-13 years shown food advertisements twice with cartoons had high fat and high sugar consumption.
* Restrictive diets: Veggie, vegan, overly “healthy diets”.
* Veggie: growth maintained by iron deficiency anaemia is common.
* Vegan: usually low energy density. Must include protein sources, tofu or meat substitutes. Must include healthy energy dense foods.
* Overly “healthy” diets: usually high in fibre/low in fat not suitable for kids, can lead to failure to thrive.
* Parental diagnosis of intolerance or food allergy: medical advice must be sought. If a particular food must be removed from the diet, alternatives must be sought to ensure nutritional needs are being met.
* Iron deficiency: iron requirements increase from 7-12 months. Can affect school progress
* Dental caries
* Energy needs increase to support growth, organ formation, immune function and thermoregulation
* Calcium intakes in 1.5- 10 year olds are above recommendations could affect iron absorption
* Vitamins A and C
6 months – 5 years: supplement as precautionary measure (often combined with vit D)
*

43
Q

Describe the patterns of growth and changes in body composition

A

Describe the patterns of growth and changes in body composition

  • Rapid growth in first year
  • First year: Fat deposition increases from 14% to 25%
  • First year: brain size doubles
  • Body water redistributed from extracellular to intracellular
  • Weight triples
  • % body fat ↑ rapidly from birth peaking at 6-12months
  • Infancy is then followed by a relative “slimming” phase up until 5 years of age
  • 2nd phase of rapid fat deposition until:
    growth stops in girls
    rapid lean mass deposition at puberty in boys
  • 75% height increase
  • First 5 years similar in girls and boys
  • First 5 years: truncal and limb growth
  • Organ maturation: lung alveoli: until 7 to 8 years old
44
Q

Identify factors that affect bone growth

A

Identify factors that affect bone growth
* Vitamin D deficiency> can lead to ricketts (soft, malleable bones> deformed weight borne bones)> reduced linear growth
* Mother’s Vitamin D status could affect
* Fat restriction
* Poverty: associated with stunting and wasting (less of a problem in developed countries but found in developing and developed countries)
* Insufficient protein leads to reduced insulin like growth factor-1 which is a key hormone for bone growth
* Insufficient calcium
* Diseases: cystic fibrosis, coeliac disease, IBDs.

45
Q

What should be the main drinks until 1 year?

A

Should be:
Breast milk or infant formula…
Encourage drinking from a cup from 6 months

Shouldn’t be:
Cows milk: too much protein and sodium
iron too low and poorly absorbed and displaces food
Goats: low in iron, Vit A and D, folic acid
Sheeps: low in iron, vit D and folate, high in vit A
Juices: if must, well diluted with meals from a cup
Soft drinks: not recommended-sugar and sugar free-just as acidic and detrimental to teeth
Tea: not recommended-tannin may impair iron absorption, coffee or cola-caffiene
Follow on formula: higher in protein and iron (but not energy)

46
Q

Explain why children need a nutrient-dense diet, and how it can be achieved

A

Explain why children need a nutrient-dense diet, and how it can be achieved
Energy
* ↑ energy and nutrient needs as infant grows rapidly during most of first year
* An infant requires nearly 3 x >energy per kg/body weight than an adult
* Energy needs increase with age (and growth)
* Greater surface area to volume ratio than adults so children need more energy to maintain normal body temperature

**Lipids **
* Energy provision, organ maturation and immune function
* 30-35% of energy for 2-3 year olds; 25-35% for 4-18 year olds
* Fat restriction can impact growth rate: low-fat dairy < 5 years – skimmed/semi-skimmed
* Favour unsaturated fats from fish, nuts and vegetable oil

  • First foods - at ~6 months of age:
    Soft cooked vegetables/fruit puree
    Baby rice mixed with breast milk or formula
  • 6-9 months
    Can introduce gluten, well cooked egg, fish, lumps, finger foods
    Breast fed or 500-600ml/d formula milk, introduce cup
47
Q

```

~~~

Discuss importance of and strategies to establish lifelong positive food preferences and habits

A

Discuss importance of and strategies to establish lifelong positive food preferences and habits
* Nutrition in childhood could affect nutritional status in adulthood
* Nutrition can influence materialization of disease
* Early life nutrition from first 1000 days can have a lasting impact on tissue and organ development.
* Linked to chronic illness in adulthood
* Nutrition in childhood could affect attained height
* Childhood obesity could continue into adulthood
* Nutrition in childhood may affect taste preference/choices later in life
* 2 YOs that liked sugar liked sugar in adolescence
* Study suggested dietary habits in childhood> adolescence> adulthood

STRATEGIES:
* Don’t force kids to finish plate/punish for not eating all of their food. Linked to adult obesity
* Parents act as a role model: influence intake, appetite regulation, food choice and activity level.
* Parents to use encouragement: linked to influencing food choice
* Japanese study: breakfast skipping in children associated with parents eating behaviour
* Breastfeeding mothers should consume a balanced, diverse, healthy diet. Studies suggest this can influence taste acquisition
* Baby led weaning: increases self regulation and decreases risk of obesity
* Introduce diverse healthy foods when complementary feeding begins
* Expose kids to foods multiple times. Food frequency linked to greater impact on preferences than preferences
* Involve children in cooking
* Educate parents, schools, caregivers on balanced diet, portion sizes etc
*

NHD (15 decks)

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