infancy/childhood Flashcards
The period of fastest growth is _____. What is the expected weight increase?
first year
double by 4 months, should triple by 1 year
True/False: growth charts are used as a diagnostic tool
False; can only be used with other information to assess general health
___ and ___ are constantly monitored as an indicator of health and nutrition.
weight; height
Are there differences in growth of breast fed vs bottle fed infants?
yes; breast fed tends to be leaner (normal)
Do race and ethnicity play a significant role in infant growth rates?
No; major factor is environment and health
Describe the growth rates from infancy to adolescence:
fastest rate of growth in first year, slows gradually in preschool years, gradual growth until adolescent growth spurt
What type of cows milk should not be given until children are at least 2 years old?
skim or part skim; infants require high fat in diet (low fat milk has less energy, vitamins, EFA)
When can cow’s milk be given to infants?
not in first year (though can introduce small amounts around 1 month)
List in increasing order of fat content: formula, human milk, adult diet
adult diet < formula < human milk
The 3 stages of eating developmental patterns:
nursing period (only milk, 4-6 months) transitional period (some semi-solids, still mostly milk, 6-10 months) modified adult period (mostly food, >10 months)
What are the risks associated with formula feeding? (5)
improper preparation (overdilute/underdilute)
water quality (need sterile water, should boil)
microwave uneven heating
nursing bottle syndrome
inappropriate substitutes (soy, plant milks, goat)
Goat milk is too high in ___, and too low in ____.
protein
folic acid, B12, B6
What is nursing bottle syndrome?
baby given bottle to go to sleep
sugar will cause dental caries
The low ___:___ ratio in goat milk can lead to ____, which is a painful contraction of the muscles.
Ca:P
hyperphosphatemic tetany
Plant milk generally has less: (2)
vitamin D, energy
what compounds in plant milks may make them harmful? (2)
Mn (high amounts, above UL in many brands - neurotoxicity)
Phosphates/phytic acid - affect nutrient absorption
A baby should be fed ___ times a day. What is a good way to judge how much a baby is feeding?
8 or more
number of soiled diapers
What is the risk of overdiluting or underdiluting formula?
overdilute: not enough nutrition
underdilute: too many solutes and protein -> dehydration, metabolic acidosis, hypernatremia (strains kidneys)
What are risks of introducing food too early?
- rejection - EXTRUSION REFLEX
- choking risk
- allergies, possibly diabetes (allergen response)
- morbidity risk
- undernutrition (due to weaning)
What vegetables should be avoided in young infants (<5 months) and why?
What can be done to make them safe?
spinach/turnip/collard greens/carrot/beets
contain natural nitrites -> oxidize Hb -> METHEMOGLOBINEMIA (high levels of MetHb, lower ability to deliver O2 to tissues)
Can boil, throw away water
The introduction of semisolid foods is known as ___, and should happen when?
Beikost
4-6 months
What indicates that a baby is ready to try semisolids? (5)
- can sit up, control head
- weight has doubled
- consumes large amounts of milk but still hungry
- drinks milk but hungry short time later
- tooth development, can swallow
With continued formula feeding past 6 months, the baby will become deficient in: (6)
protein, energy, vit A, vit D, Zn, Fe
What are common allergens, and what should be done as a precaution when introducing new food?
cow milk, egg white, peanuts
give small amount with supervision, wait 3 days
if no family history of allergy, introduce small amount early, can actually reduce allergy development risk
What are the risks of introducing food too late? (4)
- baby no longer receptive to new food
- undernutrition (milk not adequate anymore)
- less growth
- reduced immunity (immune system not developing)
What are the effects of excess sorbitol in diet of the baby (2)?
alcohol derivative of glucose, poorly absorbed -> travel to colon, exert osmotic effect -> diarrhea
carb malabsorption (sorbitol or too much fructose) will cause gas (bacteria produced) -> intestinal pain -> colic
What types of protein foods are not suitable for babies?
deli meats: high salt and nitrates large fish (mercury), smoked fish, raw fish (parasites) soft tofu: high in water, so lower protein/Fe
Infants should have limited consumption of :
harmful fats (shortening, hydrogenated oils)
sugar (all types!)
salt
sugar substitutes
What drink should be limited and why (2)? If given, what type is preferable?
fruit juice; little nutritional value and displace other foods; dental caries
Grape is better (orange may cause allergy, apple or pear have too much sorbitol)
What foods should a baby be started with? Give some examples.
iron rich foods
fortified baby cereal (sugar free, salt free, whole grain) meat/poultry fish tofu legumes eggs
The additional milk consumption during the weaning period will supply adequate ____, but food is needed to supply ____ in the form of ___ and ____.
protein
energy; carbs and fat
When can cows milk and dairy be given to infants, and what are the general guidelines (amount, type, etc)?
9 month +
- give whole pasteurized
- <750mL/day (increase gradually)
- give with IRON-RICH foods (milk low iron)
- mild cheese, kefir, etc
- no skim products until 2yr +
By 2 years of age, what habits should be developed? (2)
- taste, enjoyment, acceptance of VARIETY of foods
- healthy attitude/practices for lifelong healthy eating patterns
How can we promote healthy eating habits in young children?
- respect: allow for food preference, allow for caution towards new food
- no coercion, eat until satisfied
- small portions (less intimidating)
- relaxed and casual
- offer balanced variety
- avoid distraction
- serve HEALTHY dessert only when everyone is finished
How should new foods be introduced to children (5), to avoid what potential issues? (2)
avoid rejection/allergies:
introduce @ beginning of meal (hungry) small portion (tbsp per year age) do not force to try or finish! 1 new thing at a time, no mixing consider texture (crunchy is more acceptable)
How do feeding patterns change as the child grows?
younger: smaller, more frequent feedings
older: larger portions, 3 meals + snacks
What foods should be limited/avoided in young children? (3)
choking hazards: round, gummy, smooth, sticky foods
(should cut, debone, etc; supervise!)
honey: botulinum spores; may germinate in stomach (low pH) -> botulism
Caffeine, sweets, salt
What could result from feeding an infant/young child honey?
botulinum toxin poisoning
SIDS, resp distress, decreased feeding, constipation, weakness
___ deficiency is the most preventable nutrition deficiency in kids, and the greatest risk is in ______. It is associated with: (2)
iron
children <5yr
high cow milk intake (low iron), lead exposure
How is cow milk associated with iron deficiency in children? (2)
displaces iron rich foods if more than 2-3 cups per day
if given too early -> microscopic GI bleeding -> further iron losses
How can the absorption of iron be improved?
Increased intake of vit C (leafy greens, fruits) -> take with iron source
how is lead and iron absorption related?
use the same absorption receptor (DMT1)
will compete competitively!
-> more lead -> less iron absorbed
or: very little iron -> more susceptible to lead
lead exposure can come from: _____
What are the negative health effects?
food, air, pipes, cans, dust, paint, pollution, etc
- lower iron absorption
interferes with iron-dependent processes (less heme synthesis)
Iron deficiency can lead to ______. What are the effects of this condition?
hypochromic microcytic anemia (small pale cells)
lack of energy, slow wt gain, poor cognitive performance, impair psychomotor performance, impair renal tubule function
What are the differences in dietary fat recommendations as children age?
preschool/childhood: do NOT limit fat; focus on NUTRITIOUS food choices
early adolescence: energy intake adequate to SUSTAIN GROWTH, gradually lower fat intake
no more linear growth: <35% of diet should be fat (adult AMDR)
Why is a low fat diet NOT recommended for children?
- does not improve serum cholesterol long-term
- micronutrient deficiencies (Ca, Zn, VitA, B2)
- growth stunting (low protein, Ca, Zn)
- predisposition to eating disorders
How does a low fat diet contribute to micronutrient deficiencies?
tends to be low in animal products
-> more complex carbs -> more fibre -> binds to minerals
-> less Ca intake, vit A, vit B2, poorer absorption of fat soluble vitamins
In quebec, the nutrient most frequently deficient in children is:
Ca
The most common complaint by parents of young kids is ______. This could be due to issues with the infant: _______ or issues with the parent: ________.
feeding problems
infant: colic, diarrhea, constipated, refusal to eat
parent: anxiety, ill mother, breast-feeding issues
Refusal to eat in children is associated with: (4)
failure to thrive
behaviour problems
impaired growth
recurrent infections
Can the effects of feeding issues as a young child be reversed?
4yrs +: catch up growth is possible; but feeding difficulties can persists, may be hyperactive
The diagnostic criteria for feeding disorder:
no underlying mental or medical issue
no wt gain/loss for >1month
no lack of available food
< 6 yrs age
Define “failure to thrive:”
not disease or disorder: SIGN OF UNDERNOURISHMENT
downward deviation from normal growth curve for age/gender
(significant percentile drop, or in very low percentile: 3-5%)
What is the usual cause of failure to thrive, and what are the effects?
refusal to eat (mostly nonorganic cause)
(but can have organic or nonorganic causes)
effects: delayed social/motor/language skills
may need hospitalization
The organic vs nonorganic causes of failure to thrive:
organic (from child itself): cong. heart defect, malabsorption, infection, anemia, heart/renal/endocrine problem, intellectual delay, parasites, etc
nonorganic (external): not enough food ($, neglect, distorted health belief), eating too little (premature, dev delay, autistic, behaviour problems, bad relationship w/ caregiver)
*no underlying disease: 80% of cases!
Compare stunting vs wasting:
stunting: low HEIGHT: severe prolonged malnutrition
wasting: low WEIGHT: acute malnutrition (most sensitive indicator; first to drop)
* both falling together is primary disorder of growth
the 3 patterns of failure to thrive:
- small head circumference; wt/ht <5th percentile
(intellectually handicapped; difficult to feed) - normal HC, normal ht, LOW WT
(malabsorption, chronic disease, allergies) - normal HC, LOW WT, VERY LOW HT
(malnutrition from poverty, behaviour problems; deficient in essential nutrients/calories)
How might organic and nonorganic causes of failure to thrive be connected?
usually both involved;
organic cause -> baby less willing to eat -> struggle with caregiver to feed -> poor relationship (inorganic)
The ___ the child, the greater the risk related to failure to thrive
What are the risks associated with nonorganic FTT?
younger
< 1 yr -> risk of cognitive delay
< 6 month -> (max period of brain dev) -> max risk of problems
The prognosis of nonorganic FTT:
with treatment, can stabilize wt > 3rd percentile
may still have problems with behaviour associated with eating
extreme FTT treatment may require:
doctor, social worker, dietician, occ. therapist, psychologist, speech therapist, specialists, etc
may need hospitalization, tube feeding (1.5x cal per day), medical/psych/social support
