Infant Nutrition Flashcards
Maximal GI tract growth and differentiation happens from week _____ and onward of gestation
28
Premature infants (born before ____ weeks gestation) have reduced ___________________
-37
GI function
Premature infants born before ____ weeks gestation have especially reduced GI function
32
What is impacted by premature birth affecting gastrointestinal maturation? (7)
- sucking
- swallowing
- gastric emptying
- intestinal peristalsis
- defecation
- production of saliva
- production of pancreatic and hepatobiliary secretions
Infants born before ____ weeks cannot coordinate sucking/swallowing/breathing and may need tube feeding until these reflexes mature
34
Liquid nutrition is appropriate for all infants until which reflexes/movements mature?
- sucking
- swallowing
- breathing
- complex tongue movements
Maturation of sucking, swallowing, breathing, and complex tongue movements typically occurs at age ______ months (after full gestation)
4-6
When can solid foods be safely added to the diet?
4-6 months
Premature infants may have less _______________ and thus decreased surface area for digestion
small intestine
Adult length of the intestine is reached by age
4
Why can premature and full-term infants digest most carbs?
Production of many intestinal enzymes are sufficiently mature at birth
______________ activity starts later in fetal life and then begins to decline after age of three
lactase
Why don’t more infants have trouble with lactose containing formula?
salivary amylase helps break it down
Role of Lactose
Unabsorbed lactose that enters the colon helps with the growth of helpful bacteria while suppressing the growth of more pathogenic organisms
How does lactose help with the growth of helpful bacteria?
lactose is fermented by bacteria
This creates an acidic environment that favors the growth of lactobacilli
The acidic environment created by lactose promotes __________________ and prevents _______________________
- water absorption
- osmotic diarrhea
Early in life we need frequent feeding every __________ hours
2-3
How small is a newborn’s stomach? (5 lb 8 oz)
Max 20 mL - 90 mL
As infants grow, so does their stomach. By 1 month the stomach can hold
90 mL - 150 mL
Human milk empties the stomach ________ than that of infant formula; thus, human milk fed infants typically eat _______ often than formula fed infants
- faster
- more
Kidney maturation plays an important role in nutrition because it determines the ability of the kidney to ______________________
excrete a solute load
After birth, rate of _________________________ increases until growth stops (around 20 yrs old)
glomerular filtration
Solute load
Mass of solute that enters the body of a certain amount of time
Renal Solute Load
Solutes of endogenous or dietary origin that requires excretion
Water weight loss occurs immediately after birth over a period of __________ and ___________________ of body weight
- 1-2 weeks
- 6%-10%
Energy requirements vary with _______ and _________________________
- age
- clinical condition
Growth that is significantly lower than the norms for gender and age
Failure to Thrive
4 most common associated factors of failure to thrive
- medical
- nutritional
- developmental
- social
We use _______________ for full-term infants to determine if they’re thriving
WHO growth charts
Children recovering from ‘failure to thrive’ will need ______________________ for nutritional failure to thrive
‘catch-up’ calories
Amount of ‘catch-up’ calories depends on
disease/syndromes
Use of the World Health Organization (WHO) growth standards is recommended by
CDC, NIH, AAP
Normal values for __________, ______________________, and _________________________ in infancy and children are usually expressed in terms of ‘percentile-for-age’
- weight
- length/height
- head circumference
Growth charts establish _____________________ as the norm for growth
growth of breastfed infant
Growth charts provide a description of _____________ growth
physiologic
Growth charts use __________________________ to create the charts
high quality study design
Limitations of growth charts
not all children with a given condition may be accurately represented by the data
There are different types of charts for
premature infants and certain pathologic conditions
BMI between _____ and _____ percentile is classified obese
- 85th
- 95th
BMI below ____ percentile is considered underweight
5th
Estimates of energy requirements for children are based on meeting total energy expenditure (energy for digestion, thermoregulation, activity, etc.) PLUS _______________________
promoting growth
Estimated energy requirements of infants is ____________ in relation to body mass than adults or older children
HIGHER
Why are energy requirements for infants so high?
they have very rapid growth in infancy
Infant Formula Act of 1980 gave FDA authority to
- revise nutrient levels for infant formulas
- establish quality controls
- require adequate labeling
FDA sets min standards for ____ nutrients and max standards for ___
- 29
- 9
All formulas marketed in US must meet requirements
• Formula manufactured in China ______________ meet FDA standards
do not
Some formulas are exempt to the nutrient rules but they are ______________________________________ and should only be used ___________________________________
- used for unusual medical problems/dietary needs
- under advice and supervision of specialist
Components of a Healthy Diet
Fluid, carbs, proteins & amino acids, fats & essential fatty acids, micronutrients
Macronutrients
carbs/fiber, protein, and fat/cholesterol
Water makes up the________________________ of the infant’s body weight than that of older children or adults
larger proportion
Total body water _______________ as adipose tissue _______________
- decreases
- increases
Human milk and formula provide adequate water intake for term infants in first _______________ of life
6 months
At ________ months food is introduced
6-12
Most infant foods contain _____________ more water than other food
60%-70%
At 6-12 months it is ideal for infant to
still consume human milk or formula
Infant fluid loss due to
- renal excretion
- evaporation from skin, lungs
- elimination via feces
Dehydration and electrolyte imbalances may result from increased water loss due to
- diarrhea
- fever
- unusually rapid breathing
- especially with decreased water intake
________ intake should be balanced with ______ intake to allow for appropriate neurologic development
- Carb
- fat
In general ______________ diet is undesirable
low carb or carb-free
Congenital lactase deficiency, premature infants, and infants recovering from diarrhea or malnutrition may be unable to completely break lactose down due to ______________________________
low lactase activity
Low lactase activity may result in
diarrhea, abdominal pain/distention, bloating, gas, cramping
Infants rarely require supplemental _______ to maintain bowel function
fiber
In adults, high fiber diets have been associated with
prevention of colon cancer and coronary artery disease
Starting at 6-12 months __________________, _________________, ___________________ are introduced
- whole cereals
- green veggies
- legumes
whole cereals, green veggies, and legumes provide a good source of __________ in the infant diet
fiber
Essential amino acids
Human body cannot create them from amino acids or carb precursors
Preterm infants have high __________ requirements that are not completely met with human milk
protein
Preterm infants need __________ for protein
fortification
most calorically dense component of our diet
fat
Infant feeding choices, especially ______ and _________________, are increasingly being linked to obesity and other disease
- fat
- calorie intake
Children younger than __________ should not be placed on fat restricted diets in general
2 yrs
Humans need appropriate ________________ for neurologic development and _____________ for growth
- fat intake
- calories
Diet must contain small amount of the two essential polyunsaturated fatty acids :
DHA & ARA
DHA is in many RX and OTC ______________
Prenatal vitamins
Micronutrients
Vitamins, minerals, trace elements
Exact needs of _______________ hard to determine
micronutrients
Infant formulas are fortified with adequate amounts of ____________________ to meet the needs of term and preterm infants
micronutrients
Human milk needs _______________ to meet preterm infant needs
fortified
The infant mortality rate in the US is higher than other high-income countries
• 1st step: ____________________ during pregnancy and improving women’s health in general
high-quality care
_____________________ factors affect breast feeding
socioeconomic
Which women are less likely to breast feed? (3)
Poor, unmarried, poorly educated
Healthy people 2030 goals (3)
- improve the health and safety of infants
- exclusively breastfed for first 6 months
- AAP supports breastfeeding through first 2 years
Infant Food Sources
• Human Milk
• Cow Milk
-Whole
-Reduced fat
-Evaporated milk
• Goat Milk
• Commercial Infant Formulas
WHO and AAP recommend breastfeeding without supplemental foods or liquids for about the first
6 months
WHO and AAP encourage mothers breastfeed for first year of life or longer if:
desired by mother and child
__________________________ is the only acceptable alternative to human milk per AAP Committee on Nutrition
Iron-fortified infant formula
Human milk should be stored in ___________ containers if possible because non-___________ containers have been associated with destruction of key components
glass
Breastfeeding Benefits: Infants (5)
- nutrition
- mother-child bonding
- decreased incidence of severity of various infections
- decreased rates of SIDs, diabetes, obesity, asthma, eczema, celiac disease
- slightly enhanced performance on IQ test
AAP recommends use human milk for all preterm infants due to many favorable outcomes on
neurodevelopment and feeding tolerance
Breastfeeding Benefits: Mother
• Mother-child bonding
• Decreased postpartum bleeding
• Decreased menstrual blood loss
• Increased spacing between children
• Earlier return to pre-pregnancy weight
• Decreased risk of breast and ovarian cancer
• Decreased risk rheumatoid arthritis
• Decreased rates of hip fracture and osteoporosis in post-menopausal period
Medical Contraindications to Breastfeeding in the United States
• + HIV status of mother
• Can be transmitted through breast milk
• Active tuberculosis without at least two weeks prior treatment
• Infant galactosemia
• Maternal need for medication that is not compatible with breastfeeding
References for breastfeeding
- Briggs’ Drugs in Pregnancy and Lactation
- Hale’s Medications and Mothers Milk
- LactMed
Medications and Breastfeeding
• Overall risk depends on concentration in infant blood and effect of drug on the infant
Feeding _______________ mother’s dose help minimize exposure
immediately before
Concentration in milk is probably lowest at the end of the dosing interval but exception to this is
fat soluble drugs
Options for medications and breastfeeding
• Alternating breast and bottle feeding
• ‘Pump and dump’
Primary nutrient source for most commercially based infant formula
Cow milk
Whole cow milk is not suitable for providing nutrition to infants younger than
1 year
When whole cow milk is fed with solid-food, infants receive unnecessarily high intake of ____________ and ________________
- protein
- electrolytes
With whole cow milk, low concentration and poor bioavailability of ________ is associated with _________________________
- iron
- iron deficiency anemia
Iron deficient (even mild) impairs __________________________ and _______________________
- psychomotor development
- cognitive function
With whole cow milk, sensitivity to the proteins may lead to _________________ and further risk of anemia
GI bleeding
All versions of reduced-fat cow milk have been shown to prevent ___________ and _________________ in adults
- obesity
- atherosclerosis
When kids under 2 years old are given reduced-fat cow milk, it puts them at risk for _____________________________ and _________________________________________________
- failure to thrive
- impaired neuro development
With reduced-fat cow milk, kids under 2 years old get too much ______________ and inadequate ____________
- protein
- fat
Reduced-fat cow milk may possibly be used if the child is between 1 and 2 yrs and the family has a history of __________
CVD
Reduced-fat cow milk is not recommended for kids over 2 yrs during diarrhea due to
exacerbation of dehydration
Sterile, convenient source of cow milk
Evaporated Milk
Evaporated Milk has standardized concentrations of
protein, fat, carbs
Is Evaporated Milk recommended for infant feeding?
NO
___________________ is the primary milk source for more than 50% of the world’s population
Goat milk
Is goat milk used in the US for infants with milk intolerance?
rarely used in US even for infants with milk intolerance
Unfortified goat milk not rec. by AAP because it is deficient in ____________ and low in ________ and __________________
- folate
- iron
- Vitamin D
In what form is goat milk commercially available for infants?
powdered & evaporated and supplemented with Vitamin D and folic acid
__________________________ would be required with use because goat milk is not a complete formula
Vitamin supplementation
• Voluntary, non-profit trade association
• Composed of Abbott Nutrition, Mead-Johnson, Nestle, Perrigo, and Pfizer
International Formula Council established that liquid formulations must be free of
all viable pathogens and other organisms that may degrade the product
Formula must meet certain concentrations to be accordance with FDA Infant Formula Act of 1980. This was established to ensure
safety and efficacy
Manufacturers sterilize liquid formulations using _________
heat
_______________ formulas are not required or guaranteed to be sterile
powdered
(formula generalities) In emulsion of oils in aqueous solutions _________________________ rarely occurs
fat separation
______________________ and __________________________ are calculated specifically for the formulation
- Caloric density
- osmolality/osmolarity
Ready to Use products cannot be further __________________ or ________________________
- diluted
- concentrated
_________________ formulas must be reconstituted by following the directions exactly
Powdered
Milk-Based formulas are made of _____________________ fortified with _____________________________ (to add the fat back in) and _______________________
- Non-fat cow milk
- vegetable oils
- carbohydrates
Therapeutic formula is only to be used under
close medical supervision
Therapeutic formula must be recommended by
the HCP caring for the infant
_________________________ formula is considered a therapeutic formula, however, there are few true indications for it
Soy Protein-Based
What does data show about soy protein-based formulas?
based on sales, parents are choosing this vs provider recommendation
Soy Protein-Based formulas are a safe and nutritionally sound alternative for infants not fed human milk for MOST children such as (3 instances)
- cannot tolerate cow milk
- infant galactosemia
- parent choice due to vegetarian diet
Soy Protein-Based formulas may not provide adequate nutrition for certain children with _________________________
increased needs
Soy Protein-Based formulas are not recommended for infants with __________________ because ______________________________
- cystic fibrosis
- they do not utilize the soy protein adequately
__________ is a ________ formula that contains no carbs and is marketed as the only formula to be used for the ketogenic diet
- RCF
- soy
What food can diarrhea happen with?
any food type
Acute diarrhea may lead
What condition cannot tolerate cow milk?
Infant galactosemia
Why might parents choose soy protein-based formulas?
Due to a vegetarian diet
What may soy protein-based formulas not provide for certain children?
Adequate nutrition for children with increased needs
Why are soy protein-based formulas not recommended for infants with cystic fibrosis?
They do not utilize the soy protein adequately
What is RCF?
A soy formula that contains no carbs and is marketed for the ketogenic diet
What food can cause diarrhea?
Any food type
What can acute diarrhea lead to?
Dehydration
What can chronic diarrhea lead to?
Failure to thrive
What is a potentially formula-related cause of diarrhea?
Improper dilution of concentrated liquid or powdered formula
Why are infants very susceptible to dehydration?
Higher metabolic rate and higher ratio of surface area to weight and height
How quickly can fluid depletion by vomiting and diarrhea cause dehydration?
Within 24 hours
What imbalances can severe dehydration due to diarrhea cause?
Fluid and electrolyte imbalances, shock, and death
What type of diarrhea typically resolves on its own?
Mild diarrhea
What should be observed with mild diarrhea?
Signs of dehydration
What may be used for mild diarrhea?
Oral rehydration formulated specifically for infants
What are the recommendations for using oral rehydration for mild diarrhea?
Only use short term (4-6 hr rehydration period) and should not replace formula/milk intake
When is medical attention needed for diarrhea?
Diarrhea PLUS severe diarrhea (high frequency), continues for 72+ hours, or if infant has fever, lethargy, anorexia, irritability, dry mucous membranes, or decreased urine output
What are signs and symptoms of infant/child dehydration?
Dry tongue and dry lips, no tears when crying, fewer than six wet diapers per day (for infants), sunken soft spot on infant’s head, sunken eyes, dry and wrinkled skin, deep rapid breathing, cool and blotchy hands and feet
What is a sign of dehydration related to the tongue and lips?
Dry tongue and dry lips
What is a sign of dehydration related to tears?
No tears when crying
What is the minimum number of wet diapers per day for infants?
Fewer than six wet diapers per day
What is the maximum number of hours without urination for toddlers?
No wet diapers or urination for eight hours
What are signs of dehydration related to the soft spot and eyes?
Sunken soft spot on infant’s head and sunken eyes
What are signs of dehydration related to skin?
Dry and wrinkled skin
What are signs of dehydration related to breathing?
Deep and rapid breathing
What are signs of dehydration related to hands and feet?
Cool and blotchy hands and feet
What is ‘Baby Bottle’ tooth decay associated with?
Children who are bottle-fed beyond the typical 1 year and who go to sleep with the bottle
What can also cause ‘Baby Bottle’ tooth decay?
If children are allowed to sip on bottle/training cup frequently
How can ‘Baby Bottle’ tooth decay be prevented?
Substituting plain water for carb-containing formula or other drinks until the infant is weaned from the bottle
What is another way to prevent ‘Baby Bottle’ tooth decay?
Use a cup for high-sugar drinks such as juice
Why are infant juices better for preventing ‘Baby Bottle’ tooth decay?
They contain more water than standard juices
What can be done as an alternative to infant juice?
Water down standard juices
How often should you clean baby’s mouth to prevent ‘Baby Bottle’ tooth decay?
At least once daily
What kinds of water are used for infant formula preparation?
Distilled or other types of purified water
What does WHO/AAP say about boiling water?
All water should be boiled due to reports of municipal tap water contamination in some areas
Have any studies shown that it’s safe to not boil water?
Yes, several have
When must tap water be boiled?
If using well or pond water or are in areas prone to flooding
What solution can be a result of not properly diluted formula?
Hypertonic solution
What extreme cases can overly concentrated formulas lead to?
Metabolic acidosis and renal failure
What can over dilution lead to?
Water intoxication
What can water intoxication lead to?
Irritability, hyponatremia, coma, brain damage, or death
What can cause over dilution of formula?
If a person wants formula to last longer or dilutes ready-to-use formula
What are the three rules for how an infant should be fed?
On demand, not forced to take more than desired, if finished bottle but still seems hungry, offer more
What can grazing be a sign of in breastfeeding infants?
Inadequate intake
What are signs and symptoms associated with overfeeding?
Regurgitation, reflux, vomiting, loose stools, constipation, colic
What is regurgitation?
Stomach contents flow back into esophagus and reach the mouth
What is reflux?
Stomach contents flow back into esophagus but don’t reach the mouth
What does green tinted vomit indicate?
Immediate referral for evaluation
What are colic signs?
Prolonged intense crying/fussiness for no apparent reason
What is WIC?
A federal grant program but funds are allocated by the state
What does WIC require for certain services and products?
Prescription and prior authorization
Who is WIC for?
Pregnant, postpartum, and breastfeeding women, children up to age 5 years, and infants
Is routine supplementation of vitamins and minerals generally needed?
No, but some infants at risk may require supplementation
What common vitamin/mineral supplementation is included?
Vitamin D, iron, multivitamin/mineral
What form can iron supplementation take?
Fortified formula or infant cereal instead of supplement
When is fluoride recommended for children?
When drinking water is inadequately fluorinated and not getting it from other sources
What is too much fluoride called?
Fluorosis
What dental changes can fluorosis cause?
White lines running across teeth; chalky appearance to teeth
What is necessary in preterm infant formula for adequate bone mineralization?
Calcium, phosphorus, Vitamin D
What additional Vitamin D is often needed for preterm infants?
For those receiving steroids for bronchopulmonary dysplasia, furosemide for congestive heart failure or BPD, or antiepileptics for seizure disorders
How long should ‘ready to use’ formulas be used once opened?
Within 48 hours and refrigerate
Why should you not heat formula in the microwave?
Due to hot spots
