Lect 10 - NUTR recommendations for infants

Question 1

Who chooses what, when, where, and how much in young infancy feeding?

Answer 1

Parents: choose what milk is offered
Infants: choose when, where, and how much

Question 2

Who chooses what, when, where, and how much in feeding at 1 year?

Answer 2

Parents choose: when and what food is offered
Infants choose: how much they eat

Question 3

Protein DRIs of premature, 0-6mos, and 7-12mos infants

Answer 3

Premature: 4g/kg/day
0-6 mos AI: 1.5g/kg/day
7-12 mos RDA: 1.2g/kg/day

Question 4

Fat requirements

Answer 4

50% kcal

Question 5

When are LC PUFAs critical?

Answer 5

3rd trimester to 18 mos because it is a critical period of fat accumulation in the CNS

Question 6

What supplement needs to be provided to breastfed infants at birth to 12 mos

Answer 6

Vitamin D: 400IU

Question 7

When should solid foods be introduced?

Answer 7

6 mos in addition to breastfeeding or formula

Question 8

What are risks of introducing solid foods too early (<6 mos)

Answer 8

• Decrease growth
• Nutrient deficiencies (iron is absorbed less when consumed with other foods)
• Also associated with allergy, obesity, and chronic disease risks

Question 9

Risks of introducing solid food too late (>6 mos)

Answer 9

• Developmental feeding problems
• Nutrient deficiencies (fetal hemoglobin recycled and stores start decreasing at around 6 mos, but iron is still required for growth)

Question 10

What foods should be introduced after 6 mos?

Answer 10

• Nutrient, iron dense solid foods
• Breast milk/formula should still be provided (50% of energy)
• Single grain iron fortified cereals, meats and meat alternatives should be the first foods

Question 11

How much energy can be from breastfeeding from 12-24 mos?

Answer 11

1/3 of energy

Question 12

Texture progression at 6, 6-8 mos, 9-12 mos

Answer 12

6 mos: semi-solids
6-8 mos: soft solids
9-12 mos: harder textures

Question 13

How often should new foods be introduced

Answer 13

One per every 1-2 days to test for allergies

Question 14

How to introduce solid foods

Answer 14

• Gradually replace one feeding at a time
• Offer baby a bottle or cup at the feeding that they are usually the least hungry (they may refuse)
• Offer a cup with a meal if they are eating solid food
• Start to replace more feedings
• Start with smooth or pureed or mashed foods and gradually change textures and flavours
• Start with 1-2 TBSP food per day and gradually increase number per day and then amount

Question 15

Feeding goal at 1 year

Answer 15

• Drinking from cup rather than bottle
• Eating same foods as family
• Self-feeding

Question 16

Safety concerns of feeding for infants

Answer 16

• Choking hazards including raisins, popcorn, grapes, peanuts should be introduced late at 4-5 years
• Sit to eat
• No honey <1 year because of botulism risk

Question 17

What age is considered a toddler or preschooler?

Answer 17

Toddler: 1 and 2 year olds
Preschooler: 3 and 4 year olds

Question 18

What is normal growth for toddlers and preschoolers per year?

Answer 18

Toddler: 2.8kg and 12 cm per year
Preschooler: 2kg ad 7 cm per year

Question 19

How is growth monitored and assessed up to 2 years and older than 2 years of age

Answer 19

up to 2: weight for age, length for age, weight for length
2 and up: weight for age, height for age, BMI for age

Question 20

BMI trends

Answer 20

• Correlates with body fat at 2 years of age +
• BMI assessed based on age (same BMI can be different percentile for age)
• Decrease BMI age 2 - 6 years compared to infancy
• Lean mass and height gains > fat mass gains compared to infancy

Question 21

BMI and Weight for Length classifications of WHO chart

Answer 21

• Underweight: <3rd percentile
• Severely underweight: <0.1 percentile
• risk of overweight: >85th percentile
• Overweight: >97th percentile
• Severely obese: >99.9th percentile

Question 22

Motor skill development progression

Answer 22

Walking: 12mos
Crawling up stairs: 15 mos
Running: 18 mos
Walking up stairs: 24 mos
Pedalling on a tricycle: 36 mos

Question 23

Feeding skills that should be acquired by toddlers/preschoolers

Answer 23

Toddlers: self feeding and using a cup; preference for hand feeding; chewing ability enhanced
Preschoolers: Use of spoon and fork; participation in meal prep

Question 24

Effect of parental control on preschoolers

Answer 24

Too much: lowered self confidence and initiative
Too little: anxiety

Question 25

Cognitive and social development of toddlers and preschoolers

Answer 25

Toddlers: fears can develop, observe and imitate others, learn family customs, expression of wills, newly discovered independence and interaction with others, language skills (10 -100 words from 18-24 mos)
Preschoolers: egocentrism and magical thinking, increasing social interaction and cooperative play, internalization of behaviour limits

Question 26

Food preferences at early childhood

Answer 26

• Preferences for sweet, salty, savoury
• Dislike of salty and bitter
• Fear and dislike of unfamiliar foods (important to expose to many foods early)

Question 27

How does higher intake of ultra-processed foods affect nutrient intake

Answer 27

Higher intake of: carbs, fats, sat fats, added sugar, sodium, some B vitamins
Lower intake of: fibre, proteins, potassium, phosphorus, zinc, magnesium, riboflavin, B6, B12, Vitamins A and C

Question 28

Micronutrients of concern at early childhood

Answer 28

• Iron is the most common nutr deficiency despite only 5% of 1-8 year olds with inadequate intake
• Calcium: 23% of 4-8 year olds has <EAR intake
• Vitamin D: 86% of 1-3 year olds and 93% of 4-8 year olds had intake <EAR (sun and supplements not included)
• Sodium: 77% of 1-3 year olds and 93% of 4-8 year olds had intake above UL
• Potassium: Median intake <AI in 1-8 year olds

Question 29

Stages of iron deficiency

Answer 29

Stage 1: reduction of iron stores
Stage 2: reduced iron transport
Stage 3: iron deficiency anemia

Question 30

Iron deficiency in Canadian children

Answer 30

1-3% of children 3-11 years are iron deficient
25-50% of indigenous urban children
Concerns about cognitive development

Question 31

Vegetarian diet concerns

Answer 31

• Possible to be healthy for children
• difficult to get adequate energy and fat <2 years, but possible
• soy-based follow up formulas and fortified cereals recommended
• Nutrients of concern: protein, B12, omega 3, calcium, iron, zinc Vit D

Question 32

Division of responsibility (Parent and Child) in feeding

Answer 32

Parent: what, where, and when
Child: how much and if they eat

Question 33

How toddlers/preschoolers should be fed (8 Points)

Answer 33

• Role modelling
• foods available and accessible
• role in food prep
• consistent eating schedule with some flexibility
• remove distractions, eat with family when possible
• exposure to variety of foods and texture
• offer new foods with preferred foods
• encourage self feeding to develop motor skills

Question 34

Common feeding concerns

Answer 34

• Lack of interest in foods (slowed growth in early childhood from infancy)
• Neophobia (normal response)
• Unpredictable amounts of food eaten (easily distracted)
• Food jags (when they are interested in a food for a period of time, but then show disinterest; normal)

Question 35

What foods should be offered to toddlers/preschoolers?

Answer 35

• Breast feeding can continue until 2 years of age with Vitamin D supplementation (formula not needed after 12 mos)
• Limit sweetened beverages; only milk should be offered with meals
• 3.25% milk until 2 yrs

Question 35

What foods should be offered to toddlers/preschoolers?

Answer 35

• Breast feeding can continue until 2 years of age with Vitamin D supplementation (formula not needed after 12 mos)
• Limit sweetened beverages; only milk should be offered with meals
• 3.25% milk until 2 yrs

Question 36

How are dental caries formed

Answer 36

Bottle/sippy cup, constant exposure to monosaccharides which are fermented by bacteria to produce acid, eroding enamel