Infant Nutrition Flashcards
What is the usual weight and length for full term infants?
weigh 2500-3800 grams (5.5-8.5 lbs)
length 47-54 centimeters (18.5-21.5 inches)
88% of babies in the US are full-term
What issues affect infant mortality rates?
access to healthcare SES of families and women medical interventions teenage pregnancy rates availability of abortion services failure to prevent preterm and low-birth-weight births
What concepts underscore the commitment of resources to infants?
recognizes that birth weight is important for long-term health outcomes and that prevention and treatment for at-risk infants are investments in the future
What are major reflexes found in newborns?
babinski, blink, moro, palmar, rooting, sucking, stepping, withdrawl
What are the role of reflexes in newborns?
To protect them
What direction is muscle development and control in?
top-down and central to peripheral
How does motor development impact an infant’s ability to feed?
ex) able to sit in a high chair, head control, balance
changes amount of calories expended
What is sensorimotor development?
an early learning system in which the infant’s senses and motor skills provide input to the CNS
How long does it take for the infant GI tract to mature?
up to 6 months - considerable variation
How does the digestive system develop?
- third trimester - fetus swallows amniotic fluid - stimulates intestine lining to grow and mature
- at birth - gut is functional, doesn’t have the same level of digestive enzymes or rate of emptying
- through early infancy - improved coordination of peristalsis
What conditions may reflect the immaturity of the gut?
colic, gastroesophageal reflux, unexplained diarrhea, constipation
*don’t interfere with ability to absorb nutrients and usually doesn’t hinder growth
What factors influence the rate of food passage through colon?
osmolarity of food and liquids
colon bacterial flora
water and fluid balance in the body
Where do energy and nutrient recommendations for infants come from?
Dietary Reference Intakes
What are the average caloric needs for infants?
birth-6 months: 108 cal/kg of body weight
6-12 months: 98 cal/kg of body weight
range is quite broad
What factors account for the range of calorie needs?
weight, growth rate, sleep/wake cycle, temperature and climate, physical activity, metabolic response to food, health status and recovery from illness
What are the recommended protein intakes for infants?
birth-6 months: 2.2g/kg of body weight
6-12 months: 1.6g/kg body weight
vary for the same reasons as calories
When might protein intake be inadequate or excessive?
formula made incorrectly, baby cereal added to formula, consume more formula than recommended for age
What are the recommended fat intakes for infants?
no specific recommendations
restriction isn’t recommended - cholesterol is needed for brain development
What complicates fat requirements?
differences in digestion and transport of fats based on fatty acid chain length (long-chain are more difficult to utilize)
What do infants use fats for?
supply energy to liver, brain, muscles (heart)
essential fatty acids are substrates for hormones, steroids, endocrine, and neuroactive compounds in the brain
Why are sufficient amounts of CHO so important?
glucose is the primary body fuel for metabolism
if glucose is inadequate, the body will convert amino acids into glucose for energy
then amino acids aren’t available for growth
What is the DRI for fluoride?
> 6 months: 0.1 mg/day
7-12 months: 0.5 mg/day
breastfed infants may need a supplement
What is the recommendation for Vitamin D?
400 IU daily
supplement of EBF or PBF
What is the recommendation for sodium?
0-5 months: 120 mg
6-12 months: 200 mg
*rec based on breast milk content
*don’t need salt added to foods
What are typical gains in weight during infancy?
0-3 months: 600-900g/month (1.3-2 lbs)
3-6 months: 450-630g/month (1-1.4 lbs)
6-12 months: 300-390g/month (0.7-0.9 lbs)
doubles at 4-5 months, triples at 1 year
What are typical gains in height during infancy?
0-3 months: 30mm (1.2 in)
3-6 months: 20mm (0.8 in)
6-12 months: 14mm (0.6 in)
What are warning signs of growth difficulties?
lack of weight or height gain
plateau in weight, length or head circ. for more than 1 month
drop in wt without regain within a few weeks
Why isn’t cow’s milk recommended during infancy?
linked to iron-deficiency anemia
low iron availability from GI blood loss, low absorption of Ca and P, lack of iron-rich foods in diet
Why isn’t soy-based formula recommended unless indicated by allergy?
different PRO, FAT, CHO components
contain plant-origin hormone like components and dietary fiber that can alter mineral absorption
How are appetite and food intake regulated after the reflexes fade and before speaking is possible?
biological and environmental factors interact
What are developmental signs an infant is ready for spoon feeding?
able to move tongue side to side without moving head
can keep head upright and sit with little support
What are cues from the infant that influence feeding-skill progression?
watching food be opened in anticipation
tight fits or reaching for a spoon - hunger
shows irritation if feed pace is too slow or stops temp.
start to play with food or spoon - full
slow the pace and turning away from food - want to end meal
stop eating or spit out food - had enough to eat
What problems does associating eating with discomfort cause?
not wanting to eat, being irritable and hard to calm
later pickiness, food refusals and difficult meal time behavior
What is the purpose of offering food on a spoon around 6 months?
stimulate mouth muscle development
less about nutritional needs
What are some recommendations for introducing foods on a spoon?
start when they aren’t overly tired or hungry
small spoon with shallow bowl
give the baby time to extend the tongue out of the mouth
place the pressure on the front of the mouth
keep the spoon almost level, don’t scrape food off
don’t rush
first meals will be small
What problems can improper feeding position cause?
choking, discomfort while eating, ear infections
What position should be used for feeding for the first few months?
semi-upright
What is the recommended position for spoon-feeding?
upright seated position, support for back and feet
don’t require the baby to turn its head
hips and legs at 90 degrees
What is the recommended age for weaning from the breast or bottle to a cup?
12-24 months
usually consume less calories from a cup due to less efficient mouth skills so you don’t want to wean too soon
When is developmental readiness for drinking from a cup?
begins at 6-8 months, closer by 10-12 months
EBF for 12 months - should offer water or juice from a cup around 6 months
When is weaning complete?
when the caloric intake is fully provided from foods and liquids
Which food textures are appropriate at different stages of development?
first only thin fluids, advance to soupy purees at 6 months
6-8 months: foods w/lumpy, but soft textures
8-12 months: soft mashed foods
mature chewing skills don’t develop until toddlerhood
What are the recommendations for frequency of introducing new foods?
offer them one at a time and offer it over 2 to 3 days
helps id negative reactions
What foods are inappropriate or unsafe for infants?
popcorn, peanuts, raisins, whole grapes, uncut stringy meats, gum, gummy-textured candies, hard candy, jelly beans, hot dog pieces, hard raw F&V
How long does breast milk or formula provide adequate water?
6 months in healthy infants
Which supplements are recommended for breastfed infants?
fluoride if water isn’t fluoridated or breastmilk is only form of nutrition after 6 months
iron if mother was anemic during pregnancy
B12 if mother is vegan
Vitamin D if EBF or PBF
What supplements do infants born early at low birth weight possibly need regardless of breastfeeding status?
A, E, iron
What are common nutritional problems during infancy?
colic, failure to thrive, iron-deficiency anemia, constipation, food allergies, dental caries
What is FTT?
failure to thrive
inadequate weight and height gain thought to result from a caloric deficit not from a health problem
What are the types of FTT?
organic - diagnosed medical illness as basis
nonorganic - not based on medical diagnosis
mixed type
What are some nonorganic or environmental factors of FTT?
maternal depression, mental illness, alcohol or drug abus in the home, feeding by siblings or others untrained to respond to infant cues, over dilution of formula
What are some organic reasons of FTT?
untreated GER, chronic illness (ear or respiratory infections), developmental disabilities
What is included in nutrition intervention for FTT?
- increase caloric and protein intake
- set up agreement for intake and weight monitoring
- enroll in early intervention program
- arrange for transport or solve other barriers to follow-up care
- assess social supports to assure constant supply of food and formula
- assist in healthcare advocacy for the infant
What is colic?
the sudden onset of irritability, fussiness, or crying in a young infant
no definitive cause
usually clears by 3 or 4 months
What are risks that infant with iron deficiency may also be exposed to?
low birth weight, elevated lead levels, generalized undernutrition
What is the effect of long-term and severe iron deficiency in infants?
long-term learning delays due to role in CNS development
What does growth reflect (proxy measure)?
environment, SES, nutritional adequacy, health status
Where should an infant fall on the growth curve at subsequent check-ups?
You want to see them staying in the same percentile and following along their curve on the growth chart. Don’t want to see them falling into lower percentiles.
What ages do the CDC growth charts follow?
0-24 months
3 month intervals
What are the leading causes of infant mortality?
low birthweight - major cause
congenital malformations, preterm birth, SIDS
What does IUGR stand for?
inter-uterine growth retardation
less than 10th percentile weight/age
What are major developmental milestones to be ready to eat?
rooting and sucking reflex extrusion reflex - pushing food out with tongue when back of the tongue is stimulated (develops around 4 months) muscle control head control - able to turn away sitting up reaching out to grab something shows interest
What are the five s-es?
swaddling, shushing, soothing, sucking, side-lying, swinging
reminds baby of being in the womb - activates their calming reflex
What is the energy source for full-term infants?
mix of CHO and FAT
How does digestion and absorption develop?
full-term infant
fat digestion not fully developed
lingual lipase hydrolyzes fatty acids in the stomach
human milk contains lipoprotein lipase and bile salt-stimulated lipase
proteolytic activity in stomach is limited, but is mature in intestines (breaking down proteins)
What is the American Academy of Pediatrics recommendation for infant feeding?
EBF until 6 months, continue BF until 1 year
introduce complementary foods at 6 months
no other milks until 1 year
How does cow’s milk based formula differ from human milk?
larger % of calories come from protein
lower % of fat comes from fat
