Infants & Early Childhood Flashcards
Importance of nutrition in infants
- vital to growth & development
- maintenance of all body function
- fluid balance & electrolyte maintenance
- healing & prevention
Weight doubles by what age?
5 months
Weight triples in what age?
1 year
Length increases ______% by 5 months of age
30%
Length increases ______% by 1 year
50%
The brain is ______% of adult size at birth
25%
The brain reaches ____% of adult size by 1 year
75%
What are the 5 things you look at in nutrition assessment in infants?
- Anthropometry & growth
- Diet history
- Social & environmental considerations
- Physical assessment
- Estimating nutrient needs
Anthropometry of infants
- weight
- length/height
- weight for length (proportion)
- head circumference
How long do you measure head circumference?
First 3 years of life
Weighing an infant
Should be nude or wearing only clean, dry diaper
Measuring length/height in infant
- 2 people often needed to get an accurate measurement
______ can help separate normal growth patterns from abnormal ones
Growth charts
Growth charts
- use WHO & CDC
- information is only as good as the accuracy of measurements, age determination and plotting
What charts are recommended by WHO to use in 0-2 years?
- weight for age
- length for age
- weight for length
- head circumferance
What charts are recommended by CDC in years 2-20 years?
- weight for age
- stature for age
- BMI for age
Infants used to construct WHO charts were…
- breastfed at least 4 months
- introduced to complementary foods between 4-6 months
- continued to be breastfed until 12 months
Charts published by the CDC are based on pooled data from ____ national health and nutrition examination surveys
5
Why use WHO growth charts?
- growth of breastfed infant has been established as norm for growth
- provides better description of physiological growth in infants
- based on high quality study designed explicitly for creating growth charts
Monitoring growth
- use appropriate growth chart
- monitor trends in growth, not value
- normals fall within 5-95%
- evaluate changes in percentiles
BMI > ____ percentile is classified as overweightin children
85th
Diet history of infant
- formula
- foods consumed (as applicable)
- fluids consumed
- frequency of feedings
- vitamin/mineral supplement
- use of nutrition support (tube, parenteral)
- diarrhea or vomiting?
- feeding environment
- allergies
Social and environmental considerations in child nutrition
- family structure
- insurance & financial situation
- culture & religious considerations (diet, fasting, vegan)
Physical assessment in nutrition in children
- evaluation of muscle & subcu fat mass
- appearance of skin, eyes, hair, lips & nails
Evaluation of muscle & subcu fat mass reflects what in children?
Adequacy of protein & calorie provision
Appearance of skin, hair, eyes, lips and nails can reflect what in infant nutrition
Hydration status and nutrient deficiencies
What do you look at in estimating nutrient needs in infants?
- calories
- protein
- fluid
- vitamins/minerals
What are the major determinants of caloric needs in infants?
- BMR
- activity level
- increased needs of growth
- stress (infection, surgery, illness)
- others (thermic effect of food)
What are 2 equations you can use to estimate the energy needs of a child?
DRI (dietary reference intake)
EER (estimated energy requirements)
EER for infants
Kcal/day
(89 x wt -100)
+ 175: 0-3mo
+56: 4-6mo
+22: 7-12mo
+20: 13-35mo
EER 3-18 years
Different charts for boys vs girls
- height in meters
When do you start to look at physical activity values in children?
3-18 years
Sedentary
Typical daily living activities
Low active
30-60 min daily moderate activity
Active
> 60 min daily moderate activity
Very active
> 60 min daily moderate activity + 60 min vigorous activity or 120 min moderate activity
Estimating maintenance fluid needs chart
2-10kg: 100ml/kg
11-20kg: 1000ml + 50ml/kg
> 20kg: 1500ml + 20ml/kg
Feeding options for newborns
Breastfeed
Formula
Breastfeeding guidelines
- minimum of 4 months, preferably 6 months
- continue through at least 1st year of life
What is the best alternative to breast feeding in the first year of life?
Iron fortified formula
T/f whole milk, 1%, 2%, goat’s milk can be used in first 12 months of life
FALSE!
Too much protein
Can irritate GI
Breastfeeding advantages
- immunological benefits
- decreased incidence of (ear infections, UTI, gastroenteritis, respiratory illness, bacteremia)
- convenient & ready to eat
- reduced chance of overfeeding
- eliminates preparation errors
- fosters mother infant bonding
Contraindications to breastfeeding
- galactosemia
- mom invected with HIV
- infectious lesions close to breast (herpes)
- mom on drugs
Galactosemia
Disorder that affects how the body processes galactose
3 forms of infant formula
- ready to feed
- concentration
- powder
Fat amount in formula
50% kcals
Protein amount in formula
8-10% kcals
ratio of hey to casein varies, most 60-40
Carbohydrate amount in formula
40-45% kcals
Caloric density in formula
standard formula: 20 cal/oz
Micronutrients in formula
higher vitamin/mineral content than human milk to cover 97% of population
Soy formula uses
- vegetarians
- lactose deficiency
- galactosemia
- IgE mediated allergy to cow’s milk
Pre-term infant formula
- unique to premies
- predominant whey protein
- cow’s milk based
- higher protein/calcium
- 20-50% MCT
- 20-24 calories/ounce
Protein hydrolysate/elemental formula uses
- infants who cannot digest or are allergic to intact protein
- free amino acids
Uses for elemental formulas
- milk soy protein intolerance (MSPI)
- intractable diarrhea
- biliary atresia
- short gut syndrome
- protein maldigestion/malabsorption
- eosinophilic esophagitis
Similac PM 60/40 lower in:
- calcium
- phosphorus
- potassium
- sodium
Calcilo-XD lower in:
- very low in calcium
- vitamin D free
T/F Solids can be eaten by infants 3 months old
False!
- no nutritional need for solids before 6 months
- some infants may be developmentally ready between 4-6 months
- early introduction of solids can have negative effect
Signs of developmental readiness for starting solid food
- can sit up in high chair with minimal support
- can hold/support their own head
- loss of tongue thrust reflex
- baby should be able to lean forward with open mouth to express hunger and lean back with closed mouth to express satiety
T/F solids can be fed in infant feeder or bottle
False!
- should be fed with spoon
Feeding skills by 4-6 months
experience new tastes
give rice cereal with iron
Feeding skills by 6-7 months
sits with minimal support
add fruits/veggies
Feeding skills by 8-9 months
improved pincer grasp
add protein foods/finger foods
Feeding skills by 10-12 months
pulls to stand and reaches for food
add soft table food
allow to self feed
Feeding skills by 12-18 months
increased independence
stop bottle
practice eating from a spoon
Feeding skills by 18months - 2 years
growth slows
less interest in eating
encourage self feeding with utensils
Feeding skills by 2-3 years old
intake varies
exerts control
The brain triples in size by what age?
6
Psychological and social changes in toddlers
- need to develop independence
- limits must be set
- control issues
- ned to feel successful
Rule of thumb for toddler food
serve about 1/4 - 1/3 of an adult portion OR 1 tbsp of food/year of age
T/F when in doubt give less food and let child ask for more in toddlers
true
What vitamins should be required for children under 6 months who receive iron fortified infant formula?
only vitamin D
When should fluoride be supplemented in infants?
fluoride in areas where content of local water supply less than 0.3ppm
Over 6 months
When should you start iron supplement in infant?
- start by 4-6 months preferably with complimentary foods
- esp those who breastfeed (low in iron)
- premature babies (fewer iron stores)
When should you screen for iron deficiency and iron deficiency anemia in infants?
12 months
Vitamin B12 in infants
breastfed infant or vegetarian mother
How much vitamin D should infants have?
ALL infants 4000 IU/day from beginning of birth to childhood
Who is vitamin supplementation recommended for in infants?
- malabsorption & liver disease
- children from deprived families or abuse
- poor appetite and eating habits, fad diets
- chronic disease
- in dietary program for obesity
- pregnant teens
Nutritional concerns in children and adolescents
- malnutrition and pregnancy
- overweight & obese
- hyperlipidemia & heart disease
- bone mineralization & osteoporosis
- food fads
- overuse of vitamins
- eating disorders
Malnutrition in infants leads to…
- Weight loss (acute <3 months)
- Diminished height velocity (chronic >3 months)
- Head circumference (Chronic >3 months)
- delayed wound healing
- loss of lean body mass
- infections
- immune dysfunction
ASPEN defines malnutrition in infants as imbalance between nutrient requirement and intake resulting in deficits of what?
- energy
- protein
- micronutrients
Based on etiology, malnutrition in childhood is either:
- illness related (>1 diseases/injuries directly result in nutrient imbalance
- Environmental/behavioral
or both
When dose atherosclerotic process begin?
in childhood
T/F childhood cholesterol levels associated with degree of early atherosclerotic changes
true
Treatment of cardiovascular disease in childhood
- healthy lifestyle (diet/exercise)
- achieve and maintain healthy body weight (monitor trends in weight)
When does bone mineralization peak?
teenage and young adult years
Strategies to maximize bone mineralization
Diet: calcium, vit D, Na, P
Weight bearing exercise
T/F maximization of peak bone mineralization may decrease the risk of adult osteoporosis
true
T/F 1/2 of children/adolescents are overweight/obese
False
1/3
T/F prevalence has more than quadrupled in children and doubled in adolescents in the past 30 years
False
Doubled children
Quadrupled adolescents
Etiology of pediatric obesity
- genetic (80% if both parents obese)
- environment
- dietary intake
- physical intake/sedentary activity
Treatment of pediatric obesity
- multidisciplinary and comprehensive
- formal behavior modification
- family based
- establish healthy habits
WIC
supplemental nutrition program for women, infants and children
Healthy habits in pediatrics
- offer variety of healthy foods and snacks
- avoid short order cooking
- encourage fruit and veggie intake
- no junk food snacking, avoid grazing, limit fast food
- encourage reading food labels
- limit intake juice (4oz/day)
- increase water
- encourage low fat dairy products
- make fun physical activity a habit
- limit TV to no more than 1-2 hours/day
- track growth and development carefully
- be good role model
