Infant

Question 1

Standard Newborn Growth Assessment

Answer 1

Appropriate for gestational age (AGA)
- typically 10-90% on growth charts

Small for gestational age (SGA)
- born <10th% for gestational age

Large for gestational age (LGA)
- newborn was >90th % for gestational age

Question 2

Extrusion reflex

Answer 2

when something goes into infants mouth push out with tongue
indication that baby is not ready for solids
diminish around 4 months

Question 3

Motor development in infants

Answer 3

ability to control voluntary muscles
Top down development
Central to peripheral
Influences ability to feed self and the amount of energy expenditure

Question 4

Critical periods in infant development

Answer 4

Definition: a fixed period of time in which certain behaviours or developments emerge
Necessary for sequential behaviours or developments
If missed, may be difficulty later on

Oral feeding: if disrupted, may have difficulty and be reluctant feeder

Question 5

Factors that impact cognition development

Answer 5

Sensorimotor development
interactions with the environment
adequate energy and protein and vitamins
stimulation of social and emotional growth
genetics

Question 6

Development in the digestive system for infants

Answer 6

Fetus swallows amniotic fluid which stimulate intestinal maturation and growth
At birth, the healthy newborn can digest fats, protein and simple sugars
Don’t have many digestive enzymes
Rate of stomach emptying is slower during infancy
Takes 6 months for infant gastrointestinal tract to mature
Stomach shaped differently
Lower concentration of HCl and pepsin
Coordination of peristalsis improves
Renal system is immature

Question 7

Interpretation for WHO growth charts (Birth to 24 months)

Answer 7

Head circumference for age:
- < 3rd percentile or >97th percentile => potential nutrition or developmental problems

Weight-for-length
- <3rd percentile => can indicate child is underweight due to recent malnutrition, dehydration or genetic disorder
- >97th percentile => may indicate the child is obese

Question 8

Describe the stages of malnutrition

Answer 8

Acute: decrease in weight
Chronic: height will be decreased
Chronic and more severe: head circumference will be decreasing below percentiles

Question 9

Factors that influence calories needs

Answer 9

Weight and growth rate
- Birth weight doubles by 5-6 months
- Birth weight triples by 1 year
- Length increases by ~50% by 1 year
- Growth of internal organs

Sleep/wake cycle
Temperature and climate
Physical activity
Metabolic response to food
health status/recovery from illness

Question 10

Protein needs during infancy

Answer 10

1.52 g/kg/day from birth to 6 months
1.20 g/kg/day from 6 to 12 months

Question 11

CHO needs during infancy

Answer 11

0-6 months: 60 g/day
6-12 months: 95 g/day

Question 12

Fat needs during infancy

Answer 12

0-6 months: 31 g/day
6-12 months: 30 g/day

Infants need cholesterol for hormone and brain development
Supply energy to liver, brain, muscles and heart
Essential fatty acids

Low carbohydrate and or energy intake results in protein catabolism impacting growth

Question 13

Why is breast milk food for babies in regards to fats?

Answer 13

Contains 55% calories from fat
contains more short chain and medium chain fatty acids which is easier to digest and utilize

Question 14

Nutrient needs for Vitamin D, iron and calcium

Answer 14

Vit d: 400 IU/day - supplementation required for all breastfed infants

Iron:
0-6 mos: 0.27 mg/day
7-12 mos: 11 mg/day
Significant increased risk of deficiency 6+ mos of age

Calcium:
0-6 mos: 200 mg/day
6-12 mos: 260 mg/day

Question 15

Cues infants may give for feeding readiness

Answer 15

Sits upright in a high chair
Able to hold head up
Watching the food being opened in anticipation of eating
Tight fists or reaching for spoon
Playing with food or spoon
Keeps food in mouth and swallows it, doesn’t push it out
Turns head away if he/she doesn’t want the food item

Question 16

Infant nutrition: 0-4 months

Answer 16

Poor muscle control to swallow solids
poor capacity to digest, metabolize and excrete solid foods

Question 17

Infant nutrition: 4-6 months

Answer 17

decrease in extrusion reflex
start to indicate interest and desire for food
sit with support and control head
still not ready for solids

Question 18

Infant nutrition: 6+ months

Answer 18

First meals are to stimulate mouth muscle development and less for nutritional needs
will try to suck food like it’s a liquid

Question 19

Traditional feeding vs. baby led

Answer 19

Traditional feeding: start with pureed foods and gradually increase towards more solid textures

Baby-led: baby eats same foods as the rest of the family (with some modifications)

Question 20

What solid foods should be introduced first?

Answer 20

Iron rich foods
Offer 2-4 tbsp at each meal, but not uncommon to eat lots at one meal and very little at the next

Question 21

What foods to introduce after iron-rich foods

Answer 21

No set order
Offer foods higher in fat such as avocado, nut butters in foods like oatmeal
Can start to open up ~6 months of age for water, baby don’t have much control until 12+ months

Question 22

When can we introduce cow’s milk

Answer 22

9-12 months (best to wait until 12)
Only pasteurized
No 2%, 1%, or skim milk until 2nd year of life
has low iron content with poor absorption
Slowly work up to 500mL/day as breast bilk is decreased

Question 23

What could happen if cow’s milk introduced too early?

Answer 23

GI blood loss
Low absorption of calcium and phosphorus
Displacement of iron-rich foods
Puts more strain on the kidneys

Question 24

To prevent choking do not offer:

Answer 24

peanut butter or other nut butters spread thickly or served on a spoon.
sticky foods (ex marshmallows or gum)
hard raw fruits or vegetables unless cut into small pieces or grated
stringy our rounded meats (ex sausage, hot dogs)
Popcorn, nuts, seeds
Gummy or hard candy
Fish with bones
Ice cubes

Question 25

Diarrhea and constipation in infants

Answer 25

Infants typically have 2-6 stools per day
As an infant gets older often 1-2/d
Some breastfed infants may not have a stool for up to one week, this is very normal

Causes of diarrhea & constipation:
- Viral and bacterial infections
- Food intolerance
- Changes in fluid intake
- Infant formula made incorrectly

To avoid constipation insure adequate fluids
Continue to feed the usual diet during diarrhea

Question 26

Dental caries and ear infections in infants

Answer 26

Prevention of Baby Bottle Caries and Ear Infections
Are linked to feeding practices
Infant should see a dentist 6 months after first tooth erupts or at 1 year of age
Feeding techniques to reduce caries and ear infections
- Limit use of bedtime bottle
- Limit/avoid juice. Water down with water if consumed.
- Examine and clean emerging teeth

Question 27

Recommendations from birth to 6 months

Answer 27

Exclusive Breastfeeding until 6 mos of age
Supplemental Vit D of 400 IU for breastfed infants
First complementary foods should be iron-rich
Routine growth monitoring