Infant Nutrition

Question 1

Assessing newborn health

Answer 1

Full term infant (37-42 weeks)
Typically 2500g- 3800g and 47-54cm
91% Aus babies born full term
Small for gestation age and intrauterine growth restriction means newborn <10% wt/age
Large for gestational age means newborn was >90th percentile wt/age

Question 2

Infant mortality

Answer 2

Death that occurs within the first year
Major cause <2500g
Other leading causes: congenital malformations, preterm births, SIDS
Increased rate in abo and Torres straight (3-4x)
Factors associated:
SES
Access to healthcare
Medical interventions
Teenage pregnancy
Availability of abortion services
Failure to prevent preterm and LBW births

Question 3

Infant development

Answer 3

Heat and move in response to familiar voice
CNS is immature resulting in inconsistent cues for hunger and satiety
Strong reflexes, especially suckle and root
Major reflexes include:
Babinski: a baby’s toes fan out when some of foot is stroked
Blink- response to bright light or loud noise to protect eyes
Moro- baby through arms out and inward as if embracing. May help baby cling to mother in response to loud noise or when head falls
Palmar- baby grasps an object placed in the palm of its hand
Rooting- when baby’s cheek is stroked it turns its head toward the cheek that was stroked and opens its mouth- helps baby find nipple
Stepping- baby steps if held upright
Sucking- baby sucks when object placed in mouth, permits feeding
Withdrawal- baby withdraws foot when dole is pricked with a pin- protects baby from unpleasant stimulation

Question 4

Motor development

Answer 4

Ability to control voluntary muscles
Top down- controls head first and lower legs last
Muscle development from central to peripheral
Influences ability to feed self and the amount of energy expended
Windows of achievement:
- walking alone: 8-18months
- standing alone: 7-17 months
- walking with assistance: 6-14months
- hands and knees crawling: 5-13 months
- standing with assistance: 5-12 months
- sitting without support: 4-9 months

Question 5

Critical periods of infant development

Answer 5

Fixed period of time in which certain behaviours or developments emerge
Necessary for sequential behaviour or developments
If the critical period is missed, may be difficult to achieve later on

Question 6

Cognitive development of infants

Answer 6

Factors impacting cognition: 
Sensorimotor development 
Adequate nutrient intake
Positive, social and emotional interactions
Genetics

Question 7

Digestive system development of infants

Answer 7

Foetus swallows amniotic fluid which stimulates intestinal maturation and growth in third trimester
At birth the healthy newborn can digest fats, protein and simple sugars
Common problems include gastro oesophageal reflux, diarrhoea, and constipation
Can take up to 6 months for GIT to mature

Question 8

Development of infant feeding skills

Answer 8

Cues for hunger and satiety:
Watching food being opened in anticipation of eating
Tight fists or reaching for spoon
Playing with food or spoon
Slowing intake or turning away when full
Stop eating or spit out food when full
New parents must learn these cues and the temperament of infant

Question 9

Introduction of solid foods

Answer 9

Food offered from spoon stimulates muscle development
At 6 months offer small portions of semisoft food on a spoon once or twice a day- does not meet nutrition so still need breast milk. Simply textural/ taste intro
Recommendations:
Infant should not be overly tired or hungry
Use small spoons with shallow bowl
Allow infant to open mouth and extend tongue
Place spoon on front of tongue with gentle pressure
Pace feeding allow infant to swallow
First meals may be 5-6 spoons over 10 mins

Question 10

Infant feeding position

Answer 10

Improper positioning may cause choking, discomfort and ear infections
Position young, bottle fed infants in a semi upright pos
Spoon feeding should be with infant seated with back and feet supported
Adults feeding infants should be directly in front of infant making eye contact

Offer water or juice from a cup after 6 months
Wean to a cup at 12-24 months
First portion from cup is 30-60ml
Early weaning may result in plateau in weight (due to reduced energy) and or constipation (low fluid intake)
Do not change to covered sippy cup
Open cup drinking skills also encourage speech development

Question 11

Food texture and development

Answer 11

Infants can swallow puréed foods at approx 6 months
Early introduction of lumpy foods may cause choking
Can swallow very soft, lumpy foods at 6-8 months
By 8-10 months can eat soft mashed foods

Question 12

Energy and nutrient needs

Answer 12

0-6months: approx 770ml and wt 7kg
7-12 months: 609 ml and complimentary foods
Factors impacting energy intake:
Weight and growth,
Sleep wake cycle, temperature and climate, physical activity, metabolic responses to food, health status

Question 13

Protein needs

Answer 13

AI 1.43g/kg/d from birth to 6 months (total approx 10g/d)
AI 1.6g/kg/d from 7-12
Months (total approx 14g/d)
Protein needs similar to energy but also influenced by body composition

Question 14

Fat needs

Answer 14

Breast mills contains about 55% kn from fat 
Infants need cholesterol for gonad and brain development 
Breast milk contains short chain and medium chain fatty acids in addition to long chain 
Fat restriction not recommended 
Recommendations:
- 0-6 months: 
AI total fat: 31g/d
N-6 polyun: 4.4g/d 
N- 3 polyun: 0.5g/d 
- 7-12 months:
AI total: 30g/ d
N-6 polyun: 4.6g/d 
N-3 polyun: 0.5g/d

Question 15

Metabolic rate of infants

Answer 15

Highest after birth than any other time
Higher rate related to rapid growth and high proportion of muscle
Low carbohydrate and if energy intake results in protein catabolism impacting growth
CHO needs:
- 0-6 months AI 60g/ day
- 7-12 months AI 95g/ day

Question 16

Other nutrients and non nutrients

Answer 16

Vit D- AI 5microg/d (UL 25/d)

Vit A retinol equivalents- AI 0-6 months: 250micro/d, 7-12 months: 430micro/d (UL 600)

Iron- 0-6 months: AI 0.2mg/d (UL 20mg/d),
7-12 months; EAR 7mg/d RDI 11mg/d (UL 20mg/d)

Question 17

Physical growth assessment

Answer 17

Infant gains 150-200g/ week and then doubles birthweight by 6 months
Growth reflect: nutritional adequacy, health status, economic and environmental adequacy

Wide range of growth is normal.
Calibrated scales, recumbent length measurement board and measuring tape required for accurate measures

Monitored by growth charts to assess nutritional status

Question 18

Interpretation of growth data

Answer 18

Measure over time identify growth rate and need for intervention
Based on a trend not a single point
Look at how infant tracks along a percentile line
Warning signs- lack of weight or Lt gain, plateau in wt, lt or hc for >1 month, drop in wt without regain in a few weeks

Additional methods used if underlying conditions exists- specific charts for conditions, biochemical indicators, body composition, head circumference

Question 19

Feeding in early infancy and breast milk formulas

Answer 19

Exclusive breastfeeding for 6 months and continuation for 12-24
Initiate breast feeding right after birth
Growth rate and health status indicate adequacy of milk volume
Standard infant formula provides 295kj/100g
Preterm formula provides 370-499kj/100g
Infant formula is only recommended alternative to breast milk

Question 20

Cows milk during infancy

Answer 20

Whole, reduced fat, or skim cows milk should not be used in infancy as main drink
Iron deficiency anaemia linked to early introduction of cows milk
Cows milk linked to GI blood loss, lower calcium and phosphorous absorption and displacement of iron rich foods
But cows milk based formula should be used up to 12 months as opposed to soy or alternatives
Soy not an appropriate substitute and little evidence of its benefits for non allergenic people

Question 21

First foods

Answer 21

Complementary feeding- intro of soft and semi solid foods to complement breastfeeding
Include foods from core food group
No particular order in which food should be introduced
Important that 1st foods are high in Fe- iron and fortified cereals, meats and fruit and veg
Texture- smooth, soft lumps, mashed, chopped, finger size
Repeated exposure will overcome neophobia (rejection to foods)
Energy: additional 840kj at 6-8 months and 1250kj at 9-11 months

Question 22

Suitable complementary foods

Answer 22

6months: puréed or well mashed fruits, veg, iron fortified cereal, puréed meat, poultry, fish, puréed tofu, legumes 2-3tbsp twice a day

7-10 months: soft cooked mashed foods, start to introduce some lumps, introduce finger foods, soft cooked meat, poultry, fish, tofu, legumes, cooked veg mashed or cut into pieces , well cooked rice, pasta, toast, crackers, yoghurt, cheese, custards, mashed soft ripe fruit, pieces of peeled fruit. Grade up to 3 meals a day of approx 1/2 cup plus 1 or 2 snacks

9-12 months: finger foods, soft cooked family foods. Breakfast cereal with milk, finely cut up or flaked meat, poultry or fish. Tofu, legumes, eggs, soft cooked veg, yoghurt, cheese, custards, pasta, rice, other grains, toast, crackers, bread, raw soft fruits, stewed fruits. Three meals a day 1/4 cup; plus 1 or 2 snack depending on appetite

Question 23

Recommended servings for infant 7-12 months

Answer 23

Veg and legumes/beans: 1 heaped tbsp (1.5-2)
Fruit: 1 heaped tbsp (1/2)
Grain foods: 1.5 slice of bread or equivalent (2 heaped tbsp)
Lean meats: poultry, fish, eggs, tofu, 30g once a day
Breast milk formula 600ml
yoghurt, cheese or alternative 1tbsp yoghurt or 10 g cheese (1/2 serving)

Question 24

Foods to avoid/ inappropriate

Answer 24

High risk of choking 
Popcorn 
Whole nuts and seeds
Raisins, whole grapes and cherry tomatoes 
Stringy meats 
Hard fruit or veg 
Honey (clostridium) 
Juice/ sweetened Bev