Infant and Toddler Nutrition Flashcards
ER birth-6 months
~100 kcal/kg
* more metabolizable energy goes into growth
ER 7-12 months
~80 kcal/kg
* more metabolizable energy goes into activity (start crawling)
What factors vary the ER for infants?
- growth rate
- sleep/wake cycle, physical activity
- temperature and climate
- health status, recovery from illness
What is responsive feeding?
learning your baby’s cues for hunger, and for being full, and responding appropriately to those cues
parent and infant roles in responsive feeding in young infants
infant led and on cue
* parents choose what milk is offered (breastmilk or formula)
* infants choose where, when and how much
parent and infant roles in responsive feeding in infants 1 year of age
- parents choose what foods offered and where (+breastmilk/formula)
- infants choose how much
Infant CHO reccomendations
most carbohydrates provided as lactate in breast milk or formula
* increase variety and consumption of more complex CHO
* facilitate Ca absorption
Protein reccomendation for infants
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
Fat requirements for infants
~ 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
Vitamin D reccomendations for infants
- 400IU vitamin D supplement birth to 12 months for full or partial breastfed infants
- formula fed only is fortified
Iron reccomendations for infants
- have stores for first 6 months
- first foods at 6 months should be iron-rich
What is the reccomended introduction of solid foods?
Recommendation is to introduce foods at 6 months of age in addition to breastfeeding
or infant formula
Why is the timing of transition to solid foods important?
- facilitate developmental skills – “critical periods”
- ensure nutritional requirements
- minimize risk of allergies, solute load
Why not introduce solid foods at less than 6 months?
- 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
Who not introduce solid foods later than 6 months?
- risk of developmental feeding problems
- risk of nutrient deficiency such as iron since stores will start to go down but still required for growth
Breastmilk reccomendations after 6 months with solid foods
- 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
What are the motor skills that are needed for solid food introduction
head control, able to sit up straight, loss of extrusor reflux, tongue movement, grasp objects
* usually not yet developed under 6 months
What should an infants first foods be?
Always iron-containing
* single grain iron fortified cereals (usually rice, barley or oatmeal)
* meats and meat alternatives such as beans, legumes, lentils
What is the texture progression of solid foods?
- 6 months: Semi-solids
- 6-8 months: Soft solids (easy to chew)
- 9-12 months: Harder textures
examples of semi-solid foods
cereal in water, purees, mashed
* essentially runny foods
examples of soft solids
- dissolvable solids (arrowhead biscuits)
- soft foods cut into pieces, finger foods
examples of harder texture foods
9-12 months
* cheerios, crackers
How often should new foods be introduced?
One new food every 1-2 days to monitor for allergies and to introduce new foods
What milk should be given to infants 9-12mnths?
whole milk - 3.25%
What to look for on nutrition labels of commercially available baby foods
- salt content
- added sugars
- hydrogenated fats
What is a serving of baby food for infants?
- 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
How to replace feedings with baby food
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
How to increase feedings of baby food
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
Examples of baby food
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
Goal at 1 year for feeding
- Drinking from a cup rather than a bottle
- Eating same food as family at meals
- Self-feeding
Common choking hazards
raisins, popcorn, peanuts, grapes
How to prevent choking hazards
- delay introduction until 4-5 years
- always sitting to eat
What is the problem with honey?
Botulism risk so no honey <1 year
Age of toddlers and preschoolers
- toddler: 1 and 2 years old
- preschooler: 3 and 4 years old
What is toddler and preschooler age important for?
Important time to establish healthy food preferences and eating habits
toddler growth
gain average 2.8kg and 12cm per year
preschooler growth
gain average 2kg and 7cm per year
how does growth and appetite differ in toddlers compared to infants?
Progressively lower growth rate than in infancy
therefore appetite and interest in food will decrease relative to infancy
* growth occurs in spurts
How does growth spurt occur?
height increase prior to weight increase
Appetite during growth spurts
variability in appetite/energy intake
How is growth monitored and assessed up to 2 years of age?
- weight-for-age and length-for-age
- weight-for-length
How is growth monitored and assessed 2 years of age and older?
- weight-for-age and height-for-age
- body mass index-for-age
weight for age is 10 years and younger only
BMI index for assessment
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
General trends for 2-6
- decrease BMI age 2 to ~6 years compared to infancy
- lean mass and height gains > fat mass gain
What are the classifications of the WHO growth charts?
- underweight and severely underweight
- risk of overweight and overweight
- obese and severely obese
Progression of ability to move
- 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)
motor development for feeding skills of toddler
- 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)
motor development for feeding skills of preschoolers
- use of spoon and fork (knife spreading developing)
- Able to participate in meal prep
Cognitive and social development of toddlers
- 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
development of toddler language skills
from 10 words at 18 months to over 100 at 24 months
Cognitive and Social Development of Preschoolers
- egocentrism and magical thinking
- increasing social interaction and cooperative play (~2.5 years)
- external behavior limits → internal limits
- testing of limits (control)
problem with too much or too little parental control
- too much parental control: lowered self-confidence and initiative and less likely to take risks
- too little parental control: anxiety
What are the innate taste preferences?
- desire for sweet, salty and savoury (umami)
- dislike of sour and bitter
Food preferences of early childhood
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
How does the family influence food preferences?
observational learning is significant
* learn family customs related to acceptable foods
* learn family eating patterns, manners, how to as for foods
What is a traditional early feeding practice?
Parental concern for childs undernutrition therefore encouragement to eat which interferes with responsive eating
Current food environment?
The current obesogenic environment has increased availability of inexpensive, ultra-processed foods high fat, energy, sugar and salt
Where does energy intake mostly come from for 2 years and older?
Majority ultra processed foods
What is there a higher intake of with ultra processed foods?
energy, carbohydrates, sugar, total fat, saturated fat, sodium, some B vitamins
What is there a lower intake of with ultra processed foods?
protein, fibre, potassium, phosphorus, zinc, magnesium, vitamin A, riboflavin, B6, B12, C
Estimated energy expenditure for toddler
EER = (89 x weight kg -100) + 20
Estimated energy expenditure for 3-8 year old
separate formula boys and girls that depeneds on weight, height, age, and physical activity level
prevalance of obesity <18 years
2-17 years - 30% overweight or obese
What are the 3 core principles for 24-hr movement guidelines 0-4?
- move
- sleep
- sit
move reccomendations
- infant (<1 year) - interactive play several times a day
- toddler - 180 min variety of activity
- preschooler - 180 min, 60 min being energetic play
sleep reccomendations
- infant (0-3 months): 14-17 hours total
- infant (4-11 months): 12-16 hours total
- toddlers: 11-14 hours
- preschoolers: 10-13 hours
sit reccomendations
- infant: not restrained for more than an hour
- toddler: no screen time
- preschooler: <1 hour screen time
Early childhood macronutrient reccomendations for:
* CHO
* fibre
* LA
* ALA
* PRO
* water
Current fibre intake for early childhood
- 1-2 years: ~9.9g
- 4-8 years: ~13.4g
AMDRs for early childhood
Current intake of fat in early childhood
- 1-3: 47% fat intake below; <3% above
- 4-8 years: 5.5% fat intake below; 6-8% above
What are the micronutrients of concern?
- iron: intake below EAR
- Calcium: intake below EAR
- Vitamin D: intake below EAR
- Sodium: intake above UL
- potassium: intake below AI
What are the stages of iron deficiency?
- Depletion of stores (stage I)
- Reduced transport of iron (stage II)
- Iron deficiency anemia (stage III)
Who is at risk of iron deficiency in early childhood?
- infants not provided iron-fortified foods at 6 months of age
- young children with high cow’s milk consumption due to interference of Ca+
Prevalence of iron deficiency in Canadian children
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
Is a vegetarian diet okay for early childhood?
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
What are the goals for toddler and preschool feeding?
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
What is the strongest influence on toddler and preschool feeding?
patterns and behaviours of family
What is the division of responsiblity with feeding for toddlers and preschoolers?
- parents decide: what foods are offered; when and where to eat
- children decide: whether or not they eat; how much they eat
Tips for feeding a toddler and preschooler
- 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
What are some common feeding concerns?
- lack of interest in foods
- unpredictable amounts eaten
- neophobia
- picky eating and food ‘jags’
breastfeeding/ formula reccomendations after 12 months
After 12 months, no longer need formula but breastfeeding can continue
* with vitamin D supplement to 2 years
What are some healthy foods to offer toddler/ preschooler?
- variety (all four food groups, different foods within groups)
- unprocessed or minimally processed emphasized
- processed in moderation; ultra-processed not needed
Beverages offered to toddlers/ preschoolers
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
What are dental caries?
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
