Infant and Child Nutrition Flashcards
Infants have innate
_____ of their caloric needs
self- regulation
Newborns lose ____% of their birth weight in 1st week (day 3 avg)
7-10
If infants not gaining their weight back, assess
o Feeding
o Urine output
o Stool output
o Signs of any other issues
T/F Preterm infant or malnourished pt needs more calories
T
need 120 kcal/kg/day
Basal expenditures in newborns vs. adults
Adult brain 2% of body
weight- uses 19% of energy
Infant brain- 10% of body
weight, 44% of energy
Gain back to birth weight should happen by week ____
2-3
Weight gain velocity, formula vs. breastfed:
0-3 months: Breastfed > Formula fed
6-12 months: Formula fed > Breastfed
Possible that visual acuity and possibly psychomotor development of formula-fed preterm infants is improved in formulas supplemented with _____
DHA (22:6ω3) and ARA (20:4ω6)
*Recommend to continue prenatal vitamin with DHA
Caloric needs formula ages 1-4
1000 kcal/day + 100 kcal/years old
Fat nutrition
o 9 kcal/g
o 50% of the caloric content in human milk
o Needed for absorption of fat-soluble vitamins and
development of CNS/brain
o Low energy cost to store
Protein nutrition
o 4 kcal/g
o Need protein! Infancy is high growth phase
o Source: food- amino acids
o No major stores
The protein content of human milk
decreases with time:
1.4–1.6 g/100 mL (early lactation)
0.8–1.0 g/100 mL (3–4 months)
0.7–0.8 g/100 mL (6 months)
Carbohydrate nutrition
o 4 kcal/g
o 40% of caloric content in breastmilk- as lactose
A note about lactase deficiency
o Lactase hydrolyzes lactose to glucose and galactose
o Levels highest in infants, decrease with age
Carbohydrate nutrition after age 2:
o 50%–60% of calories from carbs
o Complex carbs
o Limit sugar: <25 g added sugar
Iron supplementation in infants
- Term baby supplies decrease around 4 mos.
- Breastmilk lacks
- Exclusive breastfed babies 4+ mos
- 1 mg/kg per day of oral iron
Vit D supplementation in infants
- Lack of maternal stores, sunscreen
- 400 IU per day
- Exclusively breastfed
Fluoride Supplementation
- Lack of maternal stores, sunscreen
- 400 IU per day
- Exclusively breastfed
Standard American Diet
o Standard American Diet
o Heavy in processed, sugared foods
o Increases insulin resistance
____ of sugar = 1 teaspoon
4 grams
Parents’ feeding jobs:
Choose and prepare the food.
Provide regular meals and snacks.
Make eating times pleasant.
Step-by-step, show children by example how
to behave at family mealtime.
Be considerate of children’s lack of food
experience without catering to likes and dislikes.
Not let children have food or beverages
(except for water) between meal and snack
times.
Let children grow up to get bodies that are
right for them.
Children’s eating jobs:
Children will eat.
They will eat the amount
they need.
They will learn to eat the
food their parents eat.
They will grow predictably.
They will learn to behave
well at mealtime.
Breast milk is generally made up of:
*87% water
*7% lactose
*4% fat
*1% protein
Breastfeeding Recommendations
0-6 months: Exclusive breastfeeding
6+ months: Introduce solids (complementary foods), Continue breastfeeding
12+ months: Continue breastfeeding as long as desired, Expand solid food choices
If a woman is meeting many obstacles and breastfeeding begins to
be a roadblock to mental or physical health:
o Better to have a happy mom and fed baby
o Not all or nothing- something is better than nothing
Breastfeeding basics- Timing
o Goal: Breastfeeding every 2-3 hours on demand, approx. 30-45 min
o Alternate starting breast
o As baby grows and schedule establishes, breastfeed Q 3 hrs
o Best not to watch the clock for how long to feed- watch the baby
and breast emptying
o Pushing away from breast, turning head, breast emptied, unlatches
Sleep, Eat, Awake/Play cycle
o Establishes a predictable schedule of needs and feedings
o Removes some guesswork for mom and baby
o Newborns mostly eat and sleep
o Roughly 3 hour cycles begin after 4-6 weeks (may lengthen as
solid foods start)
o Watch baby for cues! For hunger and sleep
o Don’t nurse to sleep- baby falls asleep, doesn’t get full feed only
a snack, gets hungry to soon (bedtime ok)
Assess the latch:
o Should include more breast tissue of areola, not just the nipple
(not like a binky)
o Should not be painful
o Should see baby’s jaw moving
o Chin should touch breast and they can breathe through the nose
o Should hear sound of swallowing every few sucks
o If latch hurts, try again- break latch by pulling gently on corner of
baby’s mouth
Breastfeeding-Problems
Engorgement
Nipple pain
Plugged Ducts
Mastitis
“Low Supply” “Not enough”
Engorgement
- Physiologic or demand mismatch
- Sxs: Hard, full breast
- Tx: ibuprofen Q 6-8 hrs, warm packs before/cold backs after feeding,
cabbage leaves, express small qty of milk to relieve pain
Nipple pain treatment
- Sxs: Sharp, stabbing, bleeding, scabbing, blisters
- Tx: FIX THE LATCH!
- Nipple cream- lanolin
- Newman’s Ointment (All Purpose Nipple Ointment)
- Contains an antifungal, steroid, mupirocin
- Apply small amt after breastfeeding until pain/cracks heal, up to 10 days
Plugged Ducts
- Statis of milk + inflammation
- Poor drainage, compression, narrowing of ducts
- Sxs: Breast pain, wedge section of hard tissue
- Tx: Optimize latch, start on affected breast, warm packs before/cold packs after
feeding, Ibuprofen, Lecithin 1200 mg 3-4x/day; - Therapeutic ultrasound!
Mastitis
- Stasis of milk + infection
- Sxs: Fever, flu-like, chills, fatigue, breast pain, wedge of redness
- Tx: Ibuprofen @ 6-8 hrs; if sxs are mild (redness), supportive care for 24 hours; if
progress (fever)- antibiotics - Therapeutic ultrasound!
- Dicloxacillin 500 mg Q 6 hrs x 10 days
- Cephalexin/Clindamycin in PCN allergy
Low supply breastfeeding issue
- Indicators of “low supply”=insufficient weight gain or diaper output
- Insecurity because can’t count ounces from a breast
- Increased breastfeeding increases supply
- Tx: Check growth, reassure, educate
- Feed on demand
- Reducing breastfeeding and supplementing will decrease supply
Complementary foods @ 6 mos.
o No specific order- focus on first foods that
are higher in iron and zinc such as puréed
meats and rice cereal.
o Baby cereals, fruits, veggies
o Introduce allergenic foods (peanuts, eggs fish
etc) at 6 months same as other foods
o Advance from thin to thick puree, to finger
food (8-10 mo) to self-feeding
o Avoid choking hazard foods
Congenital lactase deficiency-
rare autosomal recessive disorder
o Mainly occurs in Finland and Western Russia
o Persistent watery diarrhea from birth
o Require a change to a lactose-free formula
Developmental lactase deficiency-
temporary lactase deficiency
in premature infants
o Gut bacteria can usually adapt, manage sxs
Colic is defined as:
crying ≥3 hours per day
≥3 days per week
<3 months of age.
for no apparent reason, otherwise healthy infant
Colic episodes consistent findings:
Episodes with start and stop, inconsolable
* “screaming,” “piercing,” “distressing,” or “irritating“
* facial flushing, clenched fists, difficulty consoling
* Late afternoon/early evening
Usually starts between age 2-6 weeks
* May peak ~6 weeks old
Gradually resolves by 3-4 mos.
Colic- Management
- Caregiver support and education
- Soothing techniques- so many to try
- Change feeding technique
- Time-limited trial of mom’s diet- no milk or a hypoallergenic (eg, no milk, eggs,
nuts, wheat), or for formula fed babies- extensive hydrolysate infant formula - Give permission to put baby down in crib and walk away to calm down
- Support system
Clinical Features of iron deficiency
- Microcytic, hypochromic anemia
- Lethargy
- Pallor
- Irritability
- Cardiomegaly
- Poor feeding
- Tachypnea
Clinical Features of zinc deficiency
- Mild: impaired growth, poor appetite, impaired immunity.
- Moderate to severe: mood changes,
irritability, lethargy, impaired immune
function, increased susceptibility to
infection; acroorificial skin rash, diarrhea,
alopecia.
Clinical Features of copper Deficiency
- Osteoporosis
- Enlargement of costochondral cartilages,
- Cupping & flaring of long bone metaphyses
- Spontaneous rib fractures
- Neutropenia & hypochromic anemia
resistant to iron therapy - Defect of copper metabolism (Menkes kinky
hair syndrome) results in severe CNS disease.
Clinical Features of selenium Deficiency
- Skeletal muscle pain & tenderness,
macrocytosis, loss of hair pigment. - Keshan disease, often fatal cardiomyopathy in infants & children
Clinical Features of fluoride Deficiency
- Low intake increases incidence of dental
caries
Clinical Features of Iodine Deficiency
- Neurologic endemic cretinism (severe mental retardation, deaf mutism, spastic diplegia, & strabismus) occurs with severe
deficiency. - Myxedematous endemic cretinism
occurs in some central African countries where signs of congenital hypothyroidism are present.
Clinical Features of phosphorus Deficiency
- Muscle weakness
- Bone pain
- Rhabdomyolysis
- Osteomalacia
- Respiratory
insufficiency
Clinical Features of magnesium Deficiency
- Neuromuscular
excitability - Muscle fasciculation
- Neurologic
abnormalities - ECG changes (prolonged QTc,
atrial/ventricular ectopy, atrial tachyarrhythmias & torsades de pointes)
Clinical Features of calcium Deficiency
- Osteopenia or osteoporosis
- Tetany
Clinical Features of sodium Deficiency
- Anorexia
- Vomiting
- Hypotension
- Mental apathy
- Severe malnutrition
- Hypermetabolism may
lead to excess
intracellular sodium,
affecting cellular
metabolism.
Clinical Features of chloride Deficiency
- Associated with failure to thrive & especially poor head growth
- Anorexia
- Lethargy
- Muscle weakness
- Vomiting
- Dehydration, hypovolemia.
Clinical Features of potassium Deficiency
- Muscle weakness
- Mental confusion
- Arrhythmias
Clinical Features of thiamine (B1) Deficiency
Beriberi
* Cardiac syndrome with
cardiomegaly,
tachycardia, a loud
piercing cry, cyanosis,
dyspnea, & vomiting
Clinical Features of riboflavin Deficiency
- Sore throat
- Cheilosis
- Angular stomatitis
- Glossitis
- Dermatitis of nasolabial
fold & genitals - Photophobia
- Indistinct vision
Clinical Features of Niacin Deficiency
- Pellagra (raw skin)
- Photosensitive
pigmented dermatitis - Diarrhea
Clinical Features of Patothenic acid (B5) deficiency
- “Burning feet
syndrome”
(paresthesias &
dysesthesias)
Clinical Features of pyroxidine (B6) Deficiency
- Stomatitis
- Glossitis
- Cheilosis
- Irritability
- Confusion
- Depression
- Peripheral neuropathy
- Microcytic anemia
- Seizures
Clinical Features of biotin Deficiency
- Dermatitis around the eyes,
nose & mouth - Conjunctivitis
- Alopecia
- Altered mental status
- Lethargy
- Hallucinations
- Parathesias
- Myalgia
- Anorexia
- Nausea
Clinical Features of folic acid Deficiency
- Vague symptoms (fatigue,
irritability, cognitive
changes) - Growth retardation
- Delayed CNS development
- Diarrhea
- Neural tube defects
- Macrocytic anemia
Clinical Features of Cobalamin (B12) Deficiency
- Megaloblastic anemia
- Hypersegmented
neutrophils - Neurologic degeneration
- Paresthesias
- Gait problems
- Depression
Clinical Features of carnitine Deficiency
- Newborns & infants tend to
present with more severe
multisystemic disease
triggered by infection or
fasting, often with acute
encephalopathy, liver
failure, & cardiac
involvement, while older
children & adults tend to
present with exercise-
induced myalgias,
weakness, & fatigue.
Clinical Features of Vitamin A Deficiency
- Pathological dryness of the
conjunctiva & cornea - Poor bone growth
- Hyperkeratosis
- Impaired humoral and cell
mediated immune function
Clinical Features of Vitamin D Deficiency
- Rickets ( failure of
mineralization of
growing bone and
cartilage) - Osteomalacia
(impaired bone
mineralization →
bone pain)
Clinical Features of Vitamin E Deficiency
- Ataxia
- Hyporeflexia
- Loss of proprioceptive
& vibratory sensation
Clinical Features of Vitamin K Deficiency
- Bleeding diathesis.
- Bleeding may be seen
in the skin, the
gastrointestinal tract,
genitourinary tract,
gingiva, lungs, joints,
or the central nervous
system - Hemorrhagic disease
of newborn (all
newborns get Vit K
shot)
