Lect 10 - NUTR recommendations for infants Flashcards
Who chooses what, when, where, and how much in young infancy feeding?
Parents: choose what milk is offered
Infants: choose when, where, and how much
Who chooses what, when, where, and how much in feeding at 1 year?
Parents choose: when and what food is offered
Infants choose: how much they eat
Protein DRIs of premature, 0-6mos, and 7-12mos infants
Premature: 4g/kg/day
0-6 mos AI: 1.5g/kg/day
7-12 mos RDA: 1.2g/kg/day
Fat requirements
50% kcal
When are LC PUFAs critical?
3rd trimester to 18 mos because it is a critical period of fat accumulation in the CNS
What supplement needs to be provided to breastfed infants at birth to 12 mos
Vitamin D: 400IU
When should solid foods be introduced?
6 mos in addition to breastfeeding or formula
What are risks of introducing solid foods too early (<6 mos)
- Decrease growth
- Nutrient deficiencies (iron is absorbed less when consumed with other foods)
- Also associated with allergy, obesity, and chronic disease risks
Risks of introducing solid food too late (>6 mos)
- Developmental feeding problems
- Nutrient deficiencies (fetal hemoglobin recycled and stores start decreasing at around 6 mos, but iron is still required for growth)
What foods should be introduced after 6 mos?
- 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
How much energy can be from breastfeeding from 12-24 mos?
1/3 of energy
Texture progression at 6, 6-8 mos, 9-12 mos
6 mos: semi-solids
6-8 mos: soft solids
9-12 mos: harder textures
How often should new foods be introduced
One per every 1-2 days to test for allergies
How to introduce solid foods
- 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
Feeding goal at 1 year
- Drinking from cup rather than bottle
- Eating same foods as family
- Self-feeding
Safety concerns of feeding for infants
- 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
What age is considered a toddler or preschooler?
Toddler: 1 and 2 year olds
Preschooler: 3 and 4 year olds
What is normal growth for toddlers and preschoolers per year?
Toddler: 2.8kg and 12 cm per year
Preschooler: 2kg ad 7 cm per year
How is growth monitored and assessed up to 2 years and older than 2 years of age
up to 2: weight for age, length for age, weight for length
2 and up: weight for age, height for age, BMI for age
BMI trends
- 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
BMI and Weight for Length classifications of WHO chart
- Underweight: <3rd percentile
- Severely underweight: <0.1 percentile
- risk of overweight: >85th percentile
- Overweight: >97th percentile
- Severely obese: >99.9th percentile
Motor skill development progression
Walking: 12mos
Crawling up stairs: 15 mos
Running: 18 mos
Walking up stairs: 24 mos
Pedalling on a tricycle: 36 mos
Feeding skills that should be acquired by toddlers/preschoolers
Toddlers: self feeding and using a cup; preference for hand feeding; chewing ability enhanced
Preschoolers: Use of spoon and fork; participation in meal prep
Effect of parental control on preschoolers
Too much: lowered self confidence and initiative
Too little: anxiety
Cognitive and social development of toddlers and preschoolers
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
Food preferences at early childhood
- Preferences for sweet, salty, savoury
- Dislike of salty and bitter
- Fear and dislike of unfamiliar foods (important to expose to many foods early)
How does higher intake of ultra-processed foods affect nutrient intake
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
Micronutrients of concern at early childhood
- 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
Stages of iron deficiency
Stage 1: reduction of iron stores
Stage 2: reduced iron transport
Stage 3: iron deficiency anemia
Iron deficiency in Canadian children
1-3% of children 3-11 years are iron deficient
25-50% of indigenous urban children
Concerns about cognitive development
Vegetarian diet concerns
- 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
Division of responsibility (Parent and Child) in feeding
Parent: what, where, and when
Child: how much and if they eat
How toddlers/preschoolers should be fed (8 Points)
- 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
Common feeding concerns
- 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)
What foods should be offered to toddlers/preschoolers?
- 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
What foods should be offered to toddlers/preschoolers?
- 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
How are dental caries formed
Bottle/sippy cup, constant exposure to monosaccharides which are fermented by bacteria to produce acid, eroding enamel
