Infant & Child Nutrition - Exam 1 Flashcards
What is colostrum? When is it present?
Pre-Milk secretion in breast feeding moms
present for the first 2-3 days after delivery
What is colostrum high in? low in? Has a normal ______ action that makes it an ideal natural starter food
high: protein, vitamin A, immunoglobulin, sodium, chloride content
lower: carbs, potassium and fat content than mature breast milk
laxative
Breast-feeding , according to the WHO and AAP, should be the exclusive form of nutrition for ________. With continued breastfeeding with complementary feeding through ______
approx the first 6 months of life
through at least 1 year of life
What are some barriers that may impede breast feeding?
lack of education about breast feeding
misconception that formula is equivalent
not the social norm/embarrassed about breastfeeding in public
lactation problems
work restrictions
What are some factors that will increase maternal confidence about breast feeding?
Promoting prenatal and postpartum education
Frequent mother-baby contact
Advice about technique
Early follow up after delivery
family support
Babies are born with a _____ reflex. When is the baby usually introduced to the breast?
sucking
within the first hour
What does bringing the baby to the breast within the first hour help with?
Signal uterus to contract and decrease chance of excessive bleeding after delivery
encourage baby to smell the colostrum and want to latch and begin
How long and how often does a baby need to breastfeed?
Breast-fed babies will generally need to feed 8-12 times per day on demand, or every 2-3 hours, with longer intervals (4 hours) at night
How long should the baby stay latched to the breast? What day after delivery does the mother’s milk usually come in?
1st day: 5 minutes per breast
2nd day: 10 min per breast
3rd day and beyond: 10-15 min per breast
Eventually, the infant may only need approx 15 total
milk usually comes in around day 3
What are the growth velocity difference with regards to breast fed and formula fed babies?
breast: first 3 months will be heavier, 6-12 months will be lighter
formula: will gain more weight than breast babies and grow rapidly around 3-4 months
How often will a well nourished infant void? How many stools?
void approx 6-8 times per day
Stooling should occur from 4-6 times per day
What does a healthy infant’s stool look like from birth to a month old?
starts out black and tarry and slowly transitions to a yellowish seedy poop
How much weight should a baby gain a day? If newborn is exclusively breastfeeding and still needs to gain weight, what is the recommendation?
½ oz to 1 oz of weight gain per day
formula or expressed breast milk: 1-2 oz after session of breastfeeding
babies will lose approx _____ in the first week of life. Want them to be back up to their birth weight by _____
8-9 ounces
2 weeks old
What is in breast milk? How many calories in 1 ounce?
low but highly bioavailable protein content, high quantity of essential fatty acids; the presence of long-chain unsaturated fatty acids.
Low sodium and solute load but highly bioavailable concentrations of calcium, iron and zinc. Secretory IgA, bacterial and viral antibodies and nonspecific immune factors
20 calories/ounce
**What does breast milk NOT have? What is the recommendation?
**Does not contain vitamin D
**can supplement with drop at 1 mL (400 IU) qd while breast milk is main source of nutrition
Can be given directly into cheek or taken off Mother’s breast
What are the benefits of breastfeeding for the baby? **What are the 2 highlighted ones?
milder symptoms of diseases when compared to formula fed infants, shortened duration
limited exposure to environmental pathogens
**prevents GI infection
**reduced frequency and duration of respiratory illnesses
protection against H flu and Strep Pneu
decreased rates of OM/UTI
Can protect the premature infant from necrotizing enterocolitis
reduce incidence of food allergies and eczema
can increase visual acuity
What are the maternal benefits of breastfeeding?
enhanced bonding
first hour postpartum increases uterine contractility due to increase in oxytocin which reduced postpartum hemorrhage
helps with postpartum weight loss
reduce stress hormones
some contraceptive effect if used exclusively for 4-6 months
decrease risk of breast, ovarian cancer and T2DM
Why does breastfeeding act as a form of contraception?
Due to suckling reflex, increases prolactin, which in return suppresses GnRH, which does not allow FSH/LH to be released, thereby amenorrhea or anovulatory menses
Does breast size indicate breast feeding success?
NO! small breasted women still successfully breastfeed.
may limit the volume of milk that can be stored so may have to feed more frequently
What are the 5 CI for breastfeeding?
mom has TB
HIV/CMV positive
chemotherapy agents
infants with galactosemia
certain medications
What is the recommendation about breastfeeding with active HSV lesion?
women with herpetic breast lesions should not breastfeed from that side and should cover the lesions to prevent infant contact
What is the recommendation for breastfeeding if born to a hepatitis B surface antigen + mother?
should receive immune globulin and vaccine, eliminating concerns of transmission through breastfeeding
What is the breastfeeding recommendation for women who abuse drugs? Alchol?
Women who abuse drugs should not breastfeed until drug free
anything more than 1 glass of wine per day should pump and dump for 24 hours
What is breastfeeding jaundice due to? What is the recommendation to the mother? What should you order?
which is exaggerated physiologic jaundice associated with inadequate intake of breast milk, infrequent stooling, and unsatisfactory weight gain. Technically due to borderline dehydration from low milk volume
increase feedings and can augment with breast pump and increase volume of feeds
Order Total serum/direct Bilirubin
What is the base of infant formulas?
modified whole cow milk
**What is the pt education regarding formulas during the first 4 months of life? How often do you feed the baby with formula?
Must mix with sterile water (can boil tap water, cool it and use it)
Feedings are generally 6-8 times per day or every 3-4 hours, with longer intervals at night
What is in formula? How many calories an ounce?
Fat source-vegetable oil, soy, coconut, corn, oleo, and safflower oils
Carbohydrates-lactose
that is also fortified with multiple vitamins and minerals
20 calories/ounce
What are the different formula options?
milk based: milk protein
soy based: soy protein/ NO LACTOSE
hydrolyzed: predigested protein/NO LACTOSE
When are soy based formula indicated?
galactosemia, milk allergy ( MPA )-(however, 20% are also allergic to soy)—soy is very constipating and not commonly used
When are hydrolyzed formulas indicated?
milk protein allergy, bloody/mucousy stool, colic
_____ is great for supplementation for breastfed babies (digested more like breast milk)
hydrolyzed formula
______ are generally used when baby is still having issues on completely hydrolyzed formula or for severe milk protein allergy
specialty formulas
formula fed babies are at increased risk for ____ later in childhood
obesity
What are some advantages of formula feeding?
Able to cater to specific needs of the child, including iron intake, PKU, Galactosemia, milk protein allergy
No vitamin or mineral supplementation needed (vitamin D)
More comfortable feeding in public
Can measure the volume - helps nervous moms
How will a cow’s milk protein allergy present? What is first step tx? If no improvement, then what? **What is important pt education?
May present with vomiting, esophagitis, colitis with blood/mucus in stool, irritability, slow weight gain, diarrhea, rashes on skin (think GERD s/s)
mom decrease dairy and egg intake
switch to completely hydrolyzed formula
**two week lag, so s/s may persist for 2 weeks before you see an improvement
treatment is the same for a human milk allergy
How long can breast milk last in the fridge? frozen? **What should you NOT due to breastmilk?
fridge for 4 days and frozen for 6 months
CANNOT microwave breast milk (destroys good antibodies) needs to be placed in a bottle warmer instead
**What is the AAP/WHO recommendation with regards to introducing solid foods? When should meat be introduced?
**6 months of age
8 or 9 months
When is a good time developmentally to start introducing food?
Able to hold head up
Can sit unassisted
Showing interests in foods-watch you eat and open when you take a bite
Ability to track spoon and open mouth
Why do you need to wait until 6 months to start introducing solid foods into the diet?
due to the sucking reflex at 6 months it changes so that when a spoon is inserted between the lips, they part, the tongue depresses, and food placed in the mouth is drawn to the back of the pharynx and swallowed
What is the recommendation at which to start introducing complementary foods? When can you start introducing foods that require some chewing?
Single ingredient complementary foods are introduced one at a time at a 3-4 day interval
chewing: 7-9 months
at _______ okay to start adding in some soft table food
9-12 months
but need to be caution about choking hazards
what items should be avoided in infants due to choking hazard?
grapes, hot dogs, peanuts, boned chicken, hard candy, pieces of meat, fish with bones, sunflower seeds, apples, popcorn
How old do you need to be before it is okay to have honey? Why?
honey: at least 1 year old
risk of botulism
What are some common foods that can trigger an allergic reaction?
milk
eggs
gluten
nuts/peanuts
seeds
soy
shellfish
fish
When can common allergy food be introduced into the diet? Do kids tend to outgrow food allergies?
6 months like any other food
some kids outgrow milk/eggs allergy but peanut allergies is generally lifelong
breast milk has little _____ so babies need to get it from food. How much is in breastmilk? formula?
iron: need to consume it from red meats and green veggies but due to choking risk not advised at a young age
Breast milk has 1 gram/ L of iron
formula 10-12 grams/ L
_____ is the general age that weaning occurs. How should you start?
1 year old
Begin with substituting one breast-feeding with a bottle or cup feeding, usually the midday meal and replace gradually over a period of 1-4 weeks
What happens to a mother’s milk supply during weaning?
Due to the stimulus of regular emptying of the breast is removed
If demand is low, supply shrinks
When should you introduce whole cow’s milk into a kid’s diet? Why? How long should they remain on whole milk?
Introduced at 1 year of age, when weaning off formula/breast milk
avoiding iron deficiency anemia
AAP recommends a child stay on whole milk until 2 years of age
Why is whole milk important for the growth and development for a kid? How long should they stay on it?
Whole milk until two for baby’s growth and development
During this time, baby’s brain and nervous system make amazing gains in size and complexity
Because brain and nervous tissue are composed mostly of fat, it is reasonable to think whole milk greatly contributes to this
Once the kid turns 2, what is the milk recommendation?
At age 2, a transition to 2%, 1%, or skim milk should be undertaken
Should kid have 2%, 1%, or skim milk before 2 years old?
NO! Due to the fact that at a time when milk serves as a major source of food, skim milk provides too few calories, excessive protein, and inadequate amount of essential fatty acids
_____ drops sharply after the kid first birthday
appetite and growth slows so not as much food is required
What is the nutrition recommendation for a 1 year old?
they will eat when hungry, no need to force it!
Offer a larger selection of nutritious items, and let them decide/choose
What is the nutrition recommendation for toddlers 2 years and older?
Consumption of three regular meals per day, and one or two healthful snacks according to appetite, activity and growth needs
high fiber
limit soft drinks, sweetened beverages, processed foods
What is the juice limitation for a toddler? young child? 7-18 years old?
Limit juice to 4-6oz per day for toddlers and young children
7-18 yrs of age, limit 8-12oz
or NONE AT ALL
______ is one (and really the only benefit) of juice in a kid’s diet
constipation relief
How many calories/day should infants have? Closer to 1 year old? 1 year old and up?
120kcal/kg/days as an infant and down to 90kcal/kg/day by 1 year
1 year old and up: add 100kcal/y to the base of 1000 calories a day
What is colic? What is the crying component?
unexplained paroxysms of irritability, fussing, or crying which may develop into agonized screaming. The infant may draw up his/her knees against his/her tense abdomen as if there were abdominal pain.” in an otherwise healthy infant
cry for >3hrs a day, for >3days a week, for >3 weeks
When does the crying associated with colic mostly occur? What age does it peak?
mainly late afternoon-evening
Peaks at 2-3 months, generally ending around 4m
very common
What are some potential causes of colic? What does it lead to in the parent?
food allergies, GERD, temperament, parental stress
Can lead to feelings of inadequacy and anxiety
______ is the most important diagnostic tool for colic. What lab tests should you order?
complete history
lab testing is seldom indicated
What is the tx for colic? When should the s/s resolve? What should you NOT do?
parent reassurance that their baby is healthy!!
enlist the help of family members!! parents need a break
consider switch to hydrolyzed formula
consider GERD tx
likely get better by the 3rd or 4th month
DO NOT SHAKE THE BABY!!
