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Spring Child > Infant > Flashcards

Infant Flashcards

1
Q

What were the millenium developmental goals?

A

UN Initiative 2000-2015

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2
Q

When do we use WHO vs CDC growth charts?

A

WHO CDC >24 months

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3
Q

Why use the WHO growth charts?

A
  • for
  • Growth of BF infant is standard
  • Better description of physiological growth in infancy
  • Based on high quality study aimed at developing growth charts
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4
Q

What is stunting?

A

Low height for age (2 SD)

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5
Q

When does stunting start?

A

•before birth ( poor maternal nutrition)

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6
Q

Why does stunting occur?

A
  • Before birth: poor maternal nutrition
  • Poor feeding practices
  • Poor food quality
  • Frequent infection (–> slowed growth)
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7
Q

What is wasting?

A

Low Weight for Height

by 2 SD

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8
Q

Definition of underweight

A

Low Weight for Age

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9
Q

Major contributor to under-five deaths?

A

Undernutrition

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10
Q

Interventions to prevent undernutrition?

A

•Breast feeding within one hour of birth•Exclusive breast feeding through 6 mos•Adequate complementary feeding•Micronutrient supplements

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11
Q

Why is breastfeeding recommended?

A

•Bonding•Nutritional value•Availability•Different effects on metabolism•Self regulation•More open to variety of tastes (formula always tastes the same, BM flavor varies w/mom’s diet)

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12
Q

Why is formula used?

A

As a substitute for human milk

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13
Q

How is formula regulated in the U.S.?

A

•Carefully controlled by FDA

  • –Nutrients (sugar, fat and protein)
  • –Safety
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14
Q

Preparations of formula on the market

A

Ready to feedPowderConcentratemake sure you ask how they prepare their formula - ensure doing correctly

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15
Q

Why is iron fortification recommended in formula?

A

•Rationale–Meet hgb needs after maternal stores depleted (RBCs last 120 days - after 4 months needs restoring)–Increase stores prior to whole cow’s milk: Prevent IDA–Improve alertness, ability to interact and learn

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16
Q

Iron absorption from breast milk vs formula?

A

•50% of iron absorbed from breast milk
•12% of iron absorbed from formula

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17
Q

How much iron in iron fortified formulas?

A
  • Iron fortified formulas contain 10-12 mg/l

* Low iron formulas discontinued (were used for fussy babies - no evidence and deprives of needed Fe)

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18
Q

Formula recommendations for non-breast fed term healthy babies?

A

–Start on CM formula at 20cal/oz–Iron-fortified formula–0-12 mos

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19
Q

What is DHA/ARA and why is it being added to formulas?

A

newer ingredients•DHA(Omega-3)/ARA (Arachidonic acid)–Structural fats found in brain and retina–Better cognitive and visual development (until 18 months)–Now all formulas fortified

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20
Q

Why are prebiotics being added to formula?

A

to help develop the immune system

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21
Q

Rationale for avoiding palm oil in formula?

A

Improved calcium absorption w/o palm oil

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22
Q

What are the various types of formula on the market?

A

•Cow’s milk•Soy protein•Partially hydrolyzed•Elemental•Lactose free•AR•DF•Preterm•Specialty•Follow-up

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23
Q

Contents of Cow’s Milk Formulas

A

•Sugar – lactose•Protein– cow’s milk•Minor differences in whey/casein ratios•Non-nursing babies started on CM formula

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24
Q

Brands of Cow’s Milk Formula available? Position of AAP?

A

•Similac, Enfamil, Good Start, store brands•AAP – no statement supporting brand

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25
Q

What is different aboutSimilac Organic formula?

A

•Meets USDA criteria: 95% free–Hormones–Antibiotics–Other chemicals

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26
Q

How is does Similac organic compare to non-organic similac?

A

•Same nutrition as other Similac•DHA, ARA supplements•AAP – no benefit to organic BUT:–Lower exposure to pesticides–Meats not treated with antibiotics

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27
Q

2012 Position of AAP on organic foods?

A

•no benefit to organic BUT:–Lower exposure to pesticides–Meats not treated with antibiotics ( resistance)–No large studies to prove better–Higher costs to families

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28
Q

What age group os Similac Newborn intended for?

A

Birth to 3 months

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29
Q

Benefits of Similac Newborn?

A

–27 oz. provides all Vit D (vs 32 oz)• no need for supplement–Whey-casein (60-40) ratio more similar to BM in first 6 mos

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30
Q

When and why was soy-based formula introduced?

A

•1929- intolerance to CM formula

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31
Q

Brands of soy-based formula?

A

•All brands equivalent–Prosobee–Isomil–Alsoy

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32
Q

Is soy formula iron fortified?

A

yes

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33
Q

Calories /nutrition in soy based formula vs cow’s milk formula?

A

Same caloriesBUT recent studies call into question nutritional adequacy and safety

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34
Q

Composition of soy’based formula?

A

•CHO sources–Sucrose–Corn syrup solids–Maltodextrin•Protein: soy•Fats from vegetable oil•Iron fortified, zinc fortified•Meet vitamin, mineral, -lyte specs

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35
Q

What are phytoestrogens?

A

•Non-steroidal estrogens (isoflavones)found in soy

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36
Q

What are potential negative effects for kids of phytoestrogens?

A

–Sexual development and reproduction–Neurobehavioral development–Immune and thyroid function•No conclusive data re kids or adults

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37
Q

What are potential benefits of phytoestrogens to adults?

A

–Coronary artery disease–Some cancers•No conclusive data re kids or adults

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38
Q

Why was soy based formula previously used in diarrhea?

A

If diarrhea, gp off formula, use a kind of ORS, then titrate up on soy. Theory had washed lactase out of system w/diarrhea and thus not give lactose. Recent info does not hold this up.•Similac Soy Expert Care DF: plays on this belief

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39
Q

Should soy based formula be used for recovery from AGE?

A

•Most infants OK with breast or CM formula during recovery from AGE

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40
Q

Should soy based formula be used in preterm infants?

A

NO.•Serum phosphorous lower•Alkaline phosphatase higher•Degree of osteopenia increased even with Ca and D supplements

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41
Q

Relationship between soy formula and cow’s milk sensitivity

A

•Cross reactivity to soy protein if enterocolitis from CM formulas–Bloody diarrhea•High incidence of sensitivity to CM AND soy–25% –5% 6-12 mos

42
Q

Indications forSoy Formula

A

•Disorders of carbohydrate metabolism–Galactosemia ( newborn screening)–Primary lactase deficiency ( very rare)•Family’s desire to avoid animal products

43
Q

Benefit of soy formula in colic?

A

•10-20% of 0-3month old infants with “colic”•Calming attributed to sucrose and fiber in soy•Controlled studies – no differences in soy or CM

44
Q

What formulas are marketed for colic?

A

•CM protein partially broken down = partially hydrolyzed–Similac Sensitive–Carnation Good Start–Enfamil GentleEase•Reduced lactose•Marketed for fussiness and gas

45
Q

Rule of 3s for colic

A

“3 weeks old, 3 hours a day, 3 months”- normal!Doesn’t mean they need treatment, have gerd, etc

46
Q

What percentage of infants have a CM protein allergy?

A

2-3%

47
Q

Types of CM protein allergy reactions

A

•IgE mediated reactions (antibody-mediated)•Non IgE mediated (cell- mediated)

48
Q

Immediate response (IgE) toCM protein allergy?

A

–Urticaria–Angioedema–Vomiting–Acute flare of eczema–Severe GI symptoms•Bloody mucousy stools

49
Q

Delayed response to CM protein allergy

A

–Irritability–GER–Atopic dermatitis–Enteropathy

50
Q

Diagnosis of CM protein allergy

A

–Positive skin prick–Positive serum specific IgE

51
Q

Prognosis for CM protein allergy

A

•75% outgrow by 3 yrs•90% outgrow by 6 yrs

52
Q

MGMT recommendations for CM protein allergy, BF and non

A

•Anaphylaxis rare•Breast feeding encouraged•Management if symptoms con’t with BF:–Mom to avoid all milk products–Read labels!!–Try for 2-4 weeks

53
Q

When to use elemental formulas?

A

•If–careful nursing–CM or (?) soy formula tried•And–still severe symptoms

54
Q

Brands of elemental formulas?

A

•Alimentum•Nutramigen•Pregestimil–Fat malabsorption and protein allergy

55
Q

When should you see improvement on elemental formulas?

A

2-4 weeks

56
Q

How long to use elemental formulas

A

Continue at least until 12 months

57
Q

What is a super hypoallergenic formula?

A

•Neocate /Elecare–100% free amino acids–No intact proteins–Lactose free

58
Q

When to use a super hypoallergenic formula?

A

•Multiple food protein intolerances•Soy and protein hydrolysate not helpful–Previously only available by prescription, now OTC.

59
Q

What is a lactose free formula?

A

•Cow’s milk formula–No lactose – corn syrup solids for CHO–Promoted for “non-specific formula intolerance”– Same calories/oz as standard formulas

60
Q

Why is a lactose free formula questionably necessary?

A

LI is not usually present at birth

61
Q

Why do preterm infants need special formulas?

A

–low body stores of nutrients–deficient bone mineralization–accumulated energy deficit

62
Q

Formulas available for preterm infants?

A

–Enfacare Lipil–Neosure

63
Q

How many calories per ounce in preterm infant formulas?

A

–22 calories/oz

64
Q

How long should preterm infant formulas be used?

A

–Recommended until 9 months, often stopped earlier

65
Q

What spit-up formulas are available and why are they used?

A

•Enfamil A.R. Lipil and Similac Spit Up• - full-term infants who spit up frequently orwho need a thickened formulacan thicken your own formula w/a spoonful of rice cereal

66
Q

How does spit-up formula compare to other formulas?

A

–Nutrients same–Rice starch for thickening–Viscosity 10 X routine formula–Flows through standard nipple–Milk–based fatty acid pattern similar to breast milk–Iron fortified–Easier preparation than adding rice to formula–Contains DHA and ARA

67
Q

What are follow up formulas?

A

•Marketed for 9 months through toddler•Increased iron and calcium–Similac 2–Enfamil Next Step–Carnation Good Start Supreme 2•V/M of 2-3 servings of F/V in sippy cup!!!•NOT needed if good variety of solids

68
Q

Examples of when specialty formulas may be used

A

Inborn errors of metabolism: -PKU -Maple syrup urine disease -Homocystenuria -Methylmalonic acidemia -Organic acid disorders

69
Q

Problems with goat milk formula

A

•Not the best alternative•Low– Vitamin D– Iron– Vitamin B12–Folate•may lead to IDA or megaloblastic anemia

70
Q

Recommendations for patients using goat milk formula

A

–Chose•Pasteurized, supplemented with Vitamin D and Folic Acid–Supplement•additional carbohydrate, such as sugar or corn syrup.–Need vitamin supplements with iron

71
Q

Recommendation forAlmond Milk Formula?

A

Just don’tcan lead to scurvy, FTT, etc

72
Q

Usefulness of differently shaped bottles

A

One option to try for fussy babies - before “flipping formulas”

73
Q

Why is Vit D important to G&D?

A

•Essential for calcium absorption( bones)•Maintains healthy immune system•May help prevent–Autoimmune disease–Some cancers–Type 2 DM

74
Q

Consequences of inadequate Vit D?

A

can lead to rickets and low calcium

75
Q

How much Vit D supplementation is recommended (BF vs FF)

A
  • Supplementation–Breast fed infants: 400 IU•TVS, PVS, D-VS*–Formula fed •
  • *Vitamin D-Only: care with administration- risk of toxicity
76
Q

What are AAP’s 2014 fluoride recommendations?

A

•Toothpaste ––When teeth emerge ( grain of rice am’t)–At three years of age ( pea-sized am’t)•Fluoride varnish–At tooth emergence and every 3-6 mos•Community water fluoridation – YES•Dietary supplements–If drinking water not fluoridated•Fluoride rinse - ≥ 6 yrs old

77
Q

Considerations when introducing eggs, nuts, peanuts, shellfish - when and special considerations?

A

•Previously eggs delayed until 12 months;Nuts, peanuts, shellfish until 2-3 yrs•Now: Solids held until 4-6* mos; above foods can be given unless–Positive family history of food allergy(1 first degree relative-parent or sib), then wait until ~ 2 yrs–Also controversial in literature

78
Q

Percent of 6 mo olds who are obese?

A

7%

79
Q

Overweight 5yo are __x more likey to be obese w/in 9 years

A

4**obesity at 5y is a strong indicator for obesity as an adult

80
Q

Infant interventions to prevent obesity

A

•Recognize hunger and satiety cues•Engage infant in other ways than feeding•No need to “finish the feeding”•Variety of foods after (4) 6 months•May need to introduce new foods (5-10x)•Avoid “kid foods” with ↑fat/calories

81
Q

Duration of infant feeding patterns

A

Last longer than previously thought!Early taste preferences for F/V, sugary bevs last

82
Q

According to 2014 pediatrics study, when is the best time to set infant feeding patterns?

A

10-12 months - start earlyAgain, patterns last

83
Q

What is WIC?

A

Women, Infants, Children•1970’s - nutrition program for low-income pregnant, breast feeding and non-breast feeding moms, infants and children

84
Q

Obesity and WIC

A

More obesity

85
Q

Where is WIC available?

A

•50 state health departments•34 Indian Tribal Organizations•DC•5 territories–Puerto Rico–Guam–America Samoa–Northern Mariana–Virgin Islands

86
Q

WIC eligibility

A

•Nutritional risk–Medical ( LBW, anemia)–Diet•Inappropriate feeding habits•Does not meet current guidelines for AmericansIncome–185% of federal poverty guidelines•Family size and income ( family of 4; 44,123)–Medicaid and/or SNAP

87
Q

WIC services

A

•Nutrition risk assessment•Nutrition education•Breast feeding education•Health, social and welfare referrals

88
Q

Outcomes associated with WIC services

A

Success:•Lower Medicaid costs for mom and baby•Longer gestations•Higher birth weights•Lower infant mortality

89
Q

How does WIC support breastfeeding?

A

•Incentives–If fully breast feeding mom•More foods•More fruits and vegetables–If fully breast fed baby•More fruits and vegetable•More baby meats•Less formula

90
Q

Recent revisions to WIC for infants (2009)

A

–No cereal until 5 months–Decrease in amount of formula > 6 months–Baby foods added–No juice

91
Q

Recent revisions to WIC for children (2009)

A

–Juice limited–Voucher for fruits/vegs @ FM–Less milk and more calcium substitutions but not yogurt or rice milk in CT–Whole wheat/grain bread–Fewer eggs

92
Q

WIC Foods: Federal vs State decisions

A

•Feds determine nutritional values•States determine specific foods–Some allow organic milk, eggs, cheese–All allow organic fruits and vegetables–Food packages adapted to needs of family•Allergy, intolerance, medical conditions

93
Q

APRN role in r/t WIC

A

•Collaborate/communicate with WIC colleagues•Make both roles more effective in helping children to be healthy weight•Complete forms with essential information

94
Q

Immediate risks to obesity

A

•Shame•Low self esteem•Negative body image•Depression•Lack of friends•Inability to play•Behavior problems•Poor academics

95
Q

Long term risks to obesity

A

•Hypertension•dyslipidemia•Diabetes•Respiratory•Orthopedic•Hepatic

96
Q

Obstacles to healthy nutrition

A

•Lack of knowledge/information from PCPs•Heavily marketed toddler foods•Resources•Parenting styles:–Authoritarian: Rigid, controlling–>decreased intake of healthy–Avoidance of conflict–>poor eating habits–Flexible yet firm–>healthy eating habits

97
Q

High risk populations for obesity

A

•Low SES•Southern region of US•African-American•Hispanic•American Indian•Difficult to separate SES and racial/cultural factors

98
Q

Challenge of feeding with Toddlers?

A

Developmentally: exploring, saying noErickson’s stages: independence. –> picky eatingTricky to give healthy food!

99
Q

Approaches with Toddlers/Preschoolers

A

•Self feed•Healthy choices and reasonable quantities–Colorful, fun•Limit milk ( 20-24 oz/day)–WCM 12-24 months; Low fat or skim >24 months–If significant family history – low fat milk @ 12 mos•Do not force to eat if not hungry or food averse•Avoid juices, sweetened drinks, cereals, candy, fast food

100
Q

Nutrition resources

A

•CDC.gov•who.int/en•myplate.gov•AAP.org•nhlbi.nih.gov/health/public/heart/obesity/wecan•healthykids.org•nationaldairycouncil.org

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