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NU FS 356 > Infant and Toddler Nutrition > Flashcards

Infant and Toddler Nutrition Flashcards

1
Q

ER birth-6 months

A

~100 kcal/kg
* more metabolizable energy goes into growth

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2
Q

ER 7-12 months

A

~80 kcal/kg
* more metabolizable energy goes into activity (start crawling)

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3
Q

What factors vary the ER for infants?

A
  • growth rate
  • sleep/wake cycle, physical activity
  • temperature and climate
  • health status, recovery from illness
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4
Q

What is responsive feeding?

A

learning your baby’s cues for hunger, and for being full, and responding appropriately to those cues

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5
Q

parent and infant roles in responsive feeding in young infants

A

infant led and on cue
* parents choose what milk is offered (breastmilk or formula)
* infants choose where, when and how much

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6
Q

parent and infant roles in responsive feeding in infants 1 year of age

A
  • parents choose what foods offered and where (+breastmilk/formula)
  • infants choose how much
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7
Q

Infant CHO reccomendations

A

most carbohydrates provided as lactate in breast milk or formula
* increase variety and consumption of more complex CHO
* facilitate Ca absorption

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8
Q

Protein reccomendation for infants

A

High growth rate requires higher per kg protein intake than adult but varies similar to energy factors
* AI 0-6 months: 1.5g/kg/d
* RDA 7-12 months: 1.2 g/kg/d
* Premature infants: up to 4 g/kg/d

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9
Q

Fat requirements for infants

A

~ 50% kcal for growth which breastmilk is rich in fats and there are no fat restrictions <2 years of age
* essential fatty acids and cholesterol required
* importance of LCPUFA: accumulate in CNS 3rd trimester to 18 months

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10
Q

Vitamin D reccomendations for infants

A
  • 400IU vitamin D supplement birth to 12 months for full or partial breastfed infants
  • formula fed only is fortified
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11
Q

Iron reccomendations for infants

A
  • have stores for first 6 months
  • first foods at 6 months should be iron-rich
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12
Q

What is the reccomended introduction of solid foods?

A

Recommendation is to introduce foods at 6 months of age in addition to breastfeeding
or infant formula

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13
Q

Why is the timing of transition to solid foods important?

A
  • facilitate developmental skills – “critical periods”
  • ensure nutritional requirements
  • minimize risk of allergies, solute load
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14
Q

Why not introduce solid foods at less than 6 months?

A
  • risk of decreased growth (↓ breastmilk due to ↓ hunger)
  • risk of nutrient deficiencies since breastmilk (and formula) is perfectly adequate for young infants
  • iron deficiency due to reduced absorption when ingested with other foods
  • Associated with increased risk of allergy, obesity and chronic disease
  • motor skills not yet suited to learning to eat solid foods
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15
Q

Who not introduce solid foods later than 6 months?

A
  • risk of developmental feeding problems
  • risk of nutrient deficiency such as iron since stores will start to go down but still required for growth
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16
Q

Breastmilk reccomendations after 6 months with solid foods

A
  • 6-11 months: 80% of energy needs from breastfeedin and decrease down to 50%
  • 12-24 months: ~ one third of energy needs can be from breasfeeding
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17
Q

What are the motor skills that are needed for solid food introduction

A

head control, able to sit up straight, loss of extrusor reflux, tongue movement, grasp objects
* usually not yet developed under 6 months

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18
Q

What should an infants first foods be?

A

Always iron-containing
* single grain iron fortified cereals (usually rice, barley or oatmeal)
* meats and meat alternatives such as beans, legumes, lentils

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19
Q

What is the texture progression of solid foods?

A
  • 6 months: Semi-solids
  • 6-8 months: Soft solids (easy to chew)
  • 9-12 months: Harder textures
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20
Q

examples of semi-solid foods

A

cereal in water, purees, mashed
* essentially runny foods

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21
Q

examples of soft solids

A
  • dissolvable solids (arrowhead biscuits)
  • soft foods cut into pieces, finger foods
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22
Q

examples of harder texture foods

A

9-12 months
* cheerios, crackers

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23
Q

How often should new foods be introduced?

A

One new food every 1-2 days to monitor for allergies and to introduce new foods

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24
Q

What milk should be given to infants 9-12mnths?

A

whole milk - 3.25%

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25
Q

What to look for on nutrition labels of commercially available baby foods

A
  • salt content
  • added sugars
  • hydrogenated fats
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26
Q

What is a serving of baby food for infants?

A
  • 1 serving is the size of about an ice cube from 6-12 months
  • 1 serving at 1 year is about 2 ice cube sizes
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27
Q

How to replace feedings with baby food

A

Do so gradually by replacing one feeding at a time.
* If baby has been exclusively breastfed, offer your baby a bottle or cup at the feeding when he is usually the least hungry. He may refuse it at first. This is normal. Offer it again each day.
* start to replace other feedings when baby is taking the cup or bottle well at 1 feeding.
* offer a cup with a meal if he is eating solid food

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28
Q

How to increase feedings of baby food

A

Start with 1-2 tbsp of one food once per day then increase number per day, then amount and graduate to self feeding as appropriate
* Start with smooth or mashed food and change the textures and flavours as baby grows and develops better eating skills

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29
Q

Examples of baby food

A

Feed them what yo are eating!
* Apple sauce -> grated apple -> smalle pieces of apple (softened dipped in yogurt)
* Pureed broccoli —> sampled cooked pieces of broccoli —> broccoli and potato cassserole with cheese
* Puréed chicken —> chunks of cooked chicken —> chicken chunks with pasta pieces in tomato sauce

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30
Q

Goal at 1 year for feeding

A
  • Drinking from a cup rather than a bottle
  • Eating same food as family at meals
  • Self-feeding
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31
Q

Common choking hazards

A

raisins, popcorn, peanuts, grapes

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32
Q

How to prevent choking hazards

A
  • delay introduction until 4-5 years
  • always sitting to eat
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33
Q

What is the problem with honey?

A

Botulism risk so no honey <1 year

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34
Q

Age of toddlers and preschoolers

A
  • toddler: 1 and 2 years old
  • preschooler: 3 and 4 years old
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35
Q

What is toddler and preschooler age important for?

A

Important time to establish healthy food preferences and eating habits

36
Q

toddler growth

A

gain average 2.8kg and 12cm per year

37
Q

preschooler growth

A

gain average 2kg and 7cm per year

38
Q

how does growth and appetite differ in toddlers compared to infants?

A

Progressively lower growth rate than in infancy
therefore appetite and interest in food will decrease relative to infancy
* growth occurs in spurts

39
Q

How does growth spurt occur?

A

height increase prior to weight increase

40
Q

Appetite during growth spurts

A

variability in appetite/energy intake

41
Q

How is growth monitored and assessed up to 2 years of age?

A
  • weight-for-age and length-for-age
  • weight-for-length
42
Q

How is growth monitored and assessed 2 years of age and older?

A
  • weight-for-age and height-for-age
  • body mass index-for-age

weight for age is 10 years and younger only

43
Q

BMI index for assessment

A

BMI correlates with body fat 2 years of age - 18 years and older but must be assessed based on age due to body fat changes during growth
* changes in BMI during development reflects increases in both body fat and lean body mass

44
Q

General trends for 2-6

A
  • decrease BMI age 2 to ~6 years compared to infancy
  • lean mass and height gains > fat mass gain
45
Q

What are the classifications of the WHO growth charts?

A
  • underweight and severely underweight
  • risk of overweight and overweight
  • obese and severely obese
46
Q

Progression of ability to move

A
  • Walking at ~ 12 months
  • Crawling up stairs at ~ 15 months
  • Running at ~ 18 months
  • Walking up stairs at ~ 24 months
  • Pedaling on a tricycle ~ 36 months
  • Expanded ability for physical activity by 5 years of age (ie throwing and kicking a ball)
47
Q

motor development for feeding skills of toddler

A
  • self-feeding and using a cup
  • preference for hand feeding, use of spoon and form developing
  • chewing ability enhanced (rotary jaw movement enhanced and move tongue side to side)
48
Q

motor development for feeding skills of preschoolers

A
  • use of spoon and fork (knife spreading developing)
  • Able to participate in meal prep
49
Q

Cognitive and social development of toddlers

A
  • newly discovered independence and more interactive with broadening social interactions
  • observe and imitate others
  • learn family customs
  • fears can develop
  • expression of wills: negativism, temper tantrums
50
Q

development of toddler language skills

A

from 10 words at 18 months to over 100 at 24 months

51
Q

Cognitive and Social Development of Preschoolers

A
  • egocentrism and magical thinking
  • increasing social interaction and cooperative play (~2.5 years)
  • external behavior limits → internal limits
  • testing of limits (control)
52
Q

problem with too much or too little parental control

A
  • too much parental control: lowered self-confidence and initiative and less likely to take risks
  • too little parental control: anxiety
53
Q

What are the innate taste preferences?

A
  • desire for sweet, salty and savoury (umami)
  • dislike of sour and bitter
54
Q

Food preferences of early childhood

A

Prefer familiar flavours and texture
* neophobia: fear or dislike of the unfamiliar
* exposure to variety of flavours and texture during early feeding important; breastfeeding exposure to flavours of mother’s diet to help develop preferences

55
Q

How does the family influence food preferences?

A

observational learning is significant
* learn family customs related to acceptable foods
* learn family eating patterns, manners, how to as for foods

56
Q

What is a traditional early feeding practice?

A

Parental concern for childs undernutrition therefore encouragement to eat which interferes with responsive eating

57
Q

Current food environment?

A

The current obesogenic environment has increased availability of inexpensive, ultra-processed foods high fat, energy, sugar and salt

58
Q

Where does energy intake mostly come from for 2 years and older?

A

Majority ultra processed foods

59
Q

What is there a higher intake of with ultra processed foods?

A

energy, carbohydrates, sugar, total fat, saturated fat, sodium, some B vitamins

60
Q

What is there a lower intake of with ultra processed foods?

A

protein, fibre, potassium, phosphorus, zinc, magnesium, vitamin A, riboflavin, B6, B12, C

61
Q

Estimated energy expenditure for toddler

A

EER = (89 x weight kg -100) + 20

62
Q

Estimated energy expenditure for 3-8 year old

A

separate formula boys and girls that depeneds on weight, height, age, and physical activity level

63
Q

prevalance of obesity <18 years

A

2-17 years - 30% overweight or obese

64
Q

What are the 3 core principles for 24-hr movement guidelines 0-4?

A
  • move
  • sleep
  • sit
65
Q

move reccomendations

A
  • infant (<1 year) - interactive play several times a day
  • toddler - 180 min variety of activity
  • preschooler - 180 min, 60 min being energetic play
66
Q

sleep reccomendations

A
  • infant (0-3 months): 14-17 hours total
  • infant (4-11 months): 12-16 hours total
  • toddlers: 11-14 hours
  • preschoolers: 10-13 hours
67
Q

sit reccomendations

A
  • infant: not restrained for more than an hour
  • toddler: no screen time
  • preschooler: <1 hour screen time
68
Q

Early childhood macronutrient reccomendations for:
* CHO
* fibre
* LA
* ALA
* PRO
* water

A
69
Q

Current fibre intake for early childhood

A
  • 1-2 years: ~9.9g
  • 4-8 years: ~13.4g
70
Q

AMDRs for early childhood

A
71
Q

Current intake of fat in early childhood

A
  • 1-3: 47% fat intake below; <3% above
  • 4-8 years: 5.5% fat intake below; 6-8% above
72
Q

What are the micronutrients of concern?

A
  • iron: intake below EAR
  • Calcium: intake below EAR
  • Vitamin D: intake below EAR
  • Sodium: intake above UL
  • potassium: intake below AI
73
Q

What are the stages of iron deficiency?

A
  • Depletion of stores (stage I)
  • Reduced transport of iron (stage II)
  • Iron deficiency anemia (stage III)
74
Q

Who is at risk of iron deficiency in early childhood?

A
  • infants not provided iron-fortified foods at 6 months of age
  • young children with high cow’s milk consumption due to interference of Ca+
75
Q

Prevalence of iron deficiency in Canadian children

A

Not totally clear but large population studies have shown 1-3% of children 3-11 years iron deficient and higher in other populations
* First Nations and Inuit communities; disadvantaged urban: 25-50% childrenn have iron deficient anemia
* concern about impact of deficiency on cognitive development and learning

76
Q

Is a vegetarian diet okay for early childhood?

A

Can be a healthy option but difficult to get adequate energy and fat <2 years without animal product therefore need to be cognizent of potential micronutrients that might lack
* soy-based follow-up formulas for toddlers and fortified cereals recommended

77
Q

What are the goals for toddler and preschool feeding?

A

Toddlers are very good at regulating intake and know precisely what they need, very good at listening to cues so do not need to force feed them.
* adequate, but not excessive, energy and nutrient intake
* support normal development (growth, motor, cognitive and social)
* establish healthy eating patterns and behaviors
* patterns and behaviors of family strongest influence
* support self-regulation of energy intake

78
Q

What is the strongest influence on toddler and preschool feeding?

A

patterns and behaviours of family

79
Q

What is the division of responsiblity with feeding for toddlers and preschoolers?

A
  • parents decide: what foods are offered; when and where to eat
  • children decide: whether or not they eat; how much they eat
80
Q

Tips for feeding a toddler and preschooler

A
  • role modeling
  • foods available and accessible
  • food preparation
  • consistent eating schedule
  • remove distractions when eating
  • exposure to variety of foods and textures
  • new foods offered with preferred foods
  • encourage self-feeding
81
Q

What are some common feeding concerns?

A
  • lack of interest in foods
  • unpredictable amounts eaten
  • neophobia
  • picky eating and food ‘jags’
82
Q

breastfeeding/ formula reccomendations after 12 months

A

After 12 months, no longer need formula but breastfeeding can continue
* with vitamin D supplement to 2 years

83
Q

What are some healthy foods to offer toddler/ preschooler?

A
  • variety (all four food groups, different foods within groups)
  • unprocessed or minimally processed emphasized
  • processed in moderation; ultra-processed not needed
84
Q

Beverages offered to toddlers/ preschoolers

A

Beverages other than water should be limited
* adequate milk but not excessive; 3.25% until 2 years
* soy/plant based milk not reccomended for toddlers but soy formula until 2 if no breast or other animal milk
* no sweetened beverages

85
Q

What are dental caries?

A

tooth decay: simple CHO used by bacteria in mouth → bacteria produce acid → erodes enamel
* common cause in young children: use of bottle or sippy cup when sleeping or through-out day

NU FS 356 (21 decks)

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