Midterm 2 Flashcards
typical weight of full term infant
2500-3800 g
5.5-8.5 lb
typical height of full term infant
47-54 cm
18.5 to 21.5 in
full term infant born…
37-42 weeks
___% are born full-term
88%
infant mortality
death that occurs in first year
major causes of infant mortality
low birth weight (<25000g)
congenital malformations
SIDS
newborns have ___ reflexes
strong
motor development is top down
controls head first, lower legs last
muscle development from ___ to ___
central to peripheral
factors that impact cognition
sensorimotor development interactions with environment adequate energy and protein stimulation of social and emotional growth genetics
critical periods
fixed periods of time which certain behaviors or developments emerge, necessary for sequential behaviors or developments
newborns ___ birth weight by ___ months and ___ by 1 year
double by 4-6 months
triple by 1 year
___and ___ are important components of health assessment of infants
weight and length (recumbent length measurement boards)
CDC 2000 infant growth charts show
weight for age
length for age
weight for length
head circumference for age
____ kcal/kg/day from birth to 6 months
108 (range from 80 to 120)
newborn 4 kg (8.8lb) = 432kcal/day
____ kcal/kg/day from 7-12 months
98
7 month old 8kg (17.6 lb) = 784 kcal/day
___ g/kg/day of protein from birth to 6 moths
2.2 g
newborn 4 kg (8.8 lb) = 8.8 g
____ g/kg/day of protein from 6-12 months
1.6 g
6 month 8 kg (17.6 lb) = 12.8 g
____ g/day of fat from birth to 6 months
31 g
____ g/day of fat from 7- 12 months
30 g
breast milk contains about ____% calories from fat
55%
breast milk contains short-chain and medium-chain fatty acids (easier to digest)
infants need cholesterol for ___
gonadal and brain development
AAP and Academy of Nutrition and Dietetics recommend exclusive breast feeding for ___
1st 6 months and continuation to 1 year
standard formula provides ___ cal/fl oz
20
formula intake for birth to 1 month
16-20 fl oz / day
8-12 feedings/day
1-2.5 fl oz per feeding
formula intake for 1-2 months
18-26 fl oz/day
8-10 feedings/day
2-4 fl oz / feeding
formula intake for 2-3 months
22-30 fl oz /day
6-8 feedings /day
3-5 fl oz / feeding
formula intake for 3-4 months
24-32 fl oz /day
4-6 feeding / day
4-8 fl oz / feeding
cow’s milk during infancy
should not be used
linked to iron deficiency anemia (low iron availability in cows milk, high calcium and casein inhibit absorption of iron)
breast milk calories from protein, carbs, and fat
7% from protein
38% from carbs
55% from fat
cow milk calories from protein, carbs, and fat
9-12% from protein
41-43% from carbs
48-50% from fat
soybean - based formula
use should be limited
has compounds with estrogen properties
11-13% from protein
formula intake for birth to 1 month
16-20 fl oz / day
8-12 feedings/day
1-2.5 fl oz per feeding
formula intake for 1-2 months
18-26 fl oz/day
8-10 feedings/day
2-4 fl oz / feeding
formula intake for 2-3 months
22-30 fl oz /day
6-8 feedings /day
3-5 fl oz / feeding
formula intake for 3-4 months
24-32 fl oz /day
4-6 feeding / day
4-8 fl oz / feeding
cow’s milk during infancy
should not be used
linked to iron deficiency anemia (low iron availability in cows milk, high calcium and casein inhibit absorption of iron)
breast milk calories from protein, carbs, and fat
7% from protein
38% from carbs
55% from fat
cow milk calories from protein, carbs, and fat
9-12% from protein
41-43% from carbs
48-50% from fat
soybean - based formula
use should be limited
has compounds with estrogen properties
11-13% from protein
at 4-6 weeks reflexes for food intake regulation….
start to fade
infant begins to purposely signal wants and needs
at 4-6 months…
infants move tongue from side to side indicating readiness for solid foods
at ___ months offer small portions of semisoft foods ___ each day
~6 months, twice a day
can swallow pureed soupy food at ___ months
4-6 months
iron-fortified baby cereal mixed with breast milk
pureed fruits and vegetables at 6 months
can swallow very soft, lumps food at __ months
6-8 months
can eat soft mashed foods
8-10 months
soft table foods 9-12 months
Ellyn Satter’s Division of Responsibility in Feeding
parents/caretakers provide structure, support, and opportunities (what)
children choose how much and whether to eat from what the parents provide (how much)
fluoride supplements for infants
for breastfed infants after 6 months or if in any area with no fluoridated water
iron supplements for infants
after 4-6 months if breastfed
vitamin B12 supplement for infants
for vegans
Vitamin D supplements for infants
needed if exclusively breastfed
FTT
failure to thrive
inadequate length or weight gain (suspected calorie deficit)
reason social service agencies become involved with families
organic FTT
diagnosed medical illness in infant
gastroesophageal reflux (GER) or infection
nonorganic FTT
not based on medical diagnosis
maternal depression, inappropriate infant care, over dilution of formula, etc
colic
sudden onset of irritability and crying for extended periods with no reason
appears during first 2 weeks - 3rd or 4th month
associated with GI upset, GER, feeding, etc.
no accepted medical treatment
Iron deficiency anemia in infants
uncommon because prenatal iron stores of mother
more common in low income
supplements and iron fortified cereal at 4-6 months
iron DRI for infants
.27 mg/day up to 6 months
11 mg/day 7-12 months
infants usually have ___ stools/day
2-6
most states screen for….
3-6 different conditions that may cause disability or death
ex: phenylketonuria (PKU), galactosemia
Children with special health care needs
Federal category of services for infants, children or adolescents with, or at risk for, a physical or developmental disability, or with a chronic medical condition caused by or associated with genetic/metabolic disorders, birth defects, prematurity, trauma, infection, or perinatal exposure to drugs
family can benefit from nutritional and medical interventions without specific diagnosis
developmental delay
conditions represented by at least 25% delay by standard evaluation methods
may be replaced with more specific type of medical diagnosis when child is older
LBW (low birth weight)
<5 lb 8 oz
8% of live births in US ?
very low birth weight (VLBW)
<1500 g (3 lb 5 oz)
extremely low birth weight (ELBW)
<1000 g (2lb 3 oz)
neonatal death
from birth to 28 days after birth
perinatal death
after 20 weeks gestation to 28 days after birth
infant morality
within first year of life
advances in health care have reduced infant mortality by ___% between ____
45% between 1980 and 2008
infants weighing 500-600 g (~23 wks gestation) have ____ chance of survival
~30% chance
infants weighing 900 - 1000 g (~29 wks gestation) have ___% chance of survival
~88% chance
result or reduced infant mortality…
more infants with specialized nutritional needs
NICHD’s “neonatal research network” tracks infants…
with BW between 501 and 1501 g
infant health and development growth charts
for VLBW (<1500g) premature has head circumference, weight, and length adjusted for gestational age
increased calories required for premature infants
120 kcal/kg/day
may be higher with illness
decreased calories recommended for…
spina bifida or down syndrome
protein for infants at risk
1.5 g/kg if growth and digestion no affected
3-3.5 g/kg for premature or recovery from illness
4 g/kg for ELBW
hydrolyzed protein
provide up to ___% calories from fat (for infants at risk?)
55%
about ____ VLBW born in US each year
60,000
survival rate of VLBW
90%
parenteral feeding
nutrients directly to blood stream
enteral feeding
directly to GI tract
oral-gastric
mouth to stomach
transpyloric
nose/mouth to small intestine
gastrostomy
surgical opening to stomach
jejunostomy
surgical opening into small intestine
congenital anomaly
condition diagnosed at or near birth usually as a genetic and chronic condition
examples of congenital disorders
diaphragmatic hernia (1 in 4,000)
tracheoesophageal atresia/disconnection (1 in 4500)
cleft lip and palate
genetic disorders (maple syrup urine disease)
maple syrup urine disease
1 in 180,000
deficiency of metabolic enzyme, leading to buildup of branch chain aa’s (leucine, isoleucine, and valine) in blood and urine
coma and death
diet restricted of branch chain aa
toddlers
1-3
rapid increase in gross and fine motor skills
preschool age
3-5
11.8 million in US
increased autonomy, broader social circumstances, increasing language skills, expanding self control
toddlers gain ___ per year
2.7 kg (6.1 lb) and 12 cm (4.7 in) per year
preschoolers gain ___ per year
4.4 lb and 2.8 inches
weigh and measure toddlers under age 2…
without clothes or diaper
recumbent length
(over 2 with light clothes and stand with no shoes)
2000 CDC growth charts
gender specific age specific (birth to 36months and 2-20 years) weight for age length for age head circumference per age BMI for age
WHO growth charts
birth to 5 years
international growth standards regardless of ethnicity or socioeconomic status
toddler progress by month
15- crawl up stairs 18- run stiffly 24 - walk up stairs on foot at time 30 - alternate feet going up stairs 36- ride tricycle
leading cause of death in toddlers
unintentional injury
no sense of danger
cognitive development of toddlers
orbit around parents
10-15 works at 18 months, 100 at 2 years
3 word sentences by 3 years
completely weaned at…
12 to 14 months
gross and fine motor development
12 months refined pincer
18-24 months - able to use tongue to clean lips and have developed rotary chewing
feeding behaviors in toddlers
hallmark is rituals in feeding
food jags common (strong preferences and dislikes)
imitate parents and siblings
include child in meal prep
toddler sized portions
1 tablespoon per year of age (give less and ask for more)
central issue of preschool age
control
separate from parents vs. limits
vocab expands to___ during preschool age
> 2000 words (complete sentences)
temperament
behavioral style of a child
3 main temperaments
40% easy - adapts to regular schedules and accepts new foods
10% difficult - slow to adapt, negative to new foods
15% slow to warm up - negative to new but can learn
intermediate low and intermediate high
estimated energy requirement for 1-3 year olds
89 x weight(kg) -100+20
RDA protein 1-3
1.1 g/kg/day or 13 g/day
RDA protein 4-8
.95 g/kg/day or 19 g/day
RDA iron, zinc, calcium 1-3
iron: 7 mg/d
zinc: 3 mg/d
calcium: 700 mg/d
RDA iron, zinc, calcium 4-8
iron: 10 mg/d
zinc: 5 mg/d
calcium: 1000 mg/d
___ three year olds are given vit and mineral supplements
1 in 2
___% of children (4-8) consume fast food
25%
___ mins of physical activity each day
60 (for preschool? )
percentages of children with disabilities
5%-31% of children
90% of children wit disabilities have a nutritional problem
FTT may result from…
digestive problems asthma/breathing problems neurological conditions pediatric AIDS abuse/medical neglect
recovery from FTT…
catch up growth
cystic fibrosis
hereditary disorder affecting cells that produce mucus, sweat, saliva, and digestive enzymes think and sticky mucus plug up ducts (in pancreas) 1 in 1500-2000 mutation in CFTR on chromosome 7
CFTR
regulates normal movement of sodium and chloride in and out of cells
1500 mutations identified
symptoms of cystic fibrosis
vary depending on severity wheezing, coughing respiratory infections bulky/greasy stools blockage of bowels cirrhosis of liver delayed growth
cystic fibrosis nutrition
high calorie, enteric-coated oral pancreatic enzymes
bronchopulmonary dysplasia
damage of underdeveloped lungs
asthma
lungs unable to exchange air due to lack of expansion of air sacs
5.8% of children <5 yo
may be result of food allergy
___% of ELBW infants develop chronic lung problems
~80%
breathing problems increase nutrient needs due to…
extra energy expended in breathing and lower interest in eating
autism spectrum disorders
brain development disorder impaired social skills restricted and repetitive behavior onset < 3 yo ~1/166
pathophysiology of autism
excess of neurons
disturbed neuronal migration
unbalanced excitatory-inhibitory networks
abnormal formation of synapses
autism diet
no scientifically proven diet for prevention of treatment
gluten free and casein free have been recommended via groups
Rett Syndrome
sporadic mutation in MECP gene on X chromosome(transcriptional-creating equivalent RNA copy from DNA - repressor)
development normal until 12 -18 months
1 in 10,000
loss of hand use, growth retardation, gait difficulties, seizures, loss of speech, feeding problems
cerebral palsy
group of disorders, impaired muscle activity and coordination present at birth or early childhood
2-2.5/1000 (40-50% of LBW-ELBW)
Prader-Willi syndrome
partial deletion of chromosome 15 1 in 25,000 poor muscle tone and motor skills short stature hypogonadism learning disabilities behavioral problems characteristic facial features FTT in 1st year overweight **low energy needs
celiac disease
sensitivity to gluten in wheat, rye, barley
results in diarrhea
toddler diarrhea typically caused by…
excess sucrose from fruit juices
limit to 4-6 fl oz per day for 1-6 yo
food allergies seen in _____% of children
2-8%
milk, eggs, wheat, peanuts, walnuts, soy, fish
middle childhood
5 to 10 years
school age
preadolescence
9 to 11 for girls
10 to 12 for boys
(school aged)
2000 CDC growth charts based on data from…
National Health and Examination Survey
national health and nutritional examination surveys I, II, and III
(III data for children >6 not included bc overweight)
body fat minimum
in early childhood
16% in females
13% in males
cognitive development of middle childhood
self-efficacy (know what to do and do it) focus on several aspects cause and effect sense of self independence peer relationships
EER school age males
4-8 yo; 1742 kcal/d
9-13 yo; 2279 kcal/d
EER school age females
4-8 yo; 1642 kcal/d
9-13 yo; 2071 kcal/d
protein DRI for 4-13 yo boys and girls
.95 g/kg body wt
acceptable range of fat for 4-18
25% to 35% of energy
linoleic fatty acids
omega 6 seeds, nuts, whole grain cereals precursor for arachidonic acid - cell membrane in CNS 4-8 = 10 g boys 9-13 = 12 g girls 9-13 = 10 g
alpha-linoleic fatty acids
omega 3 fish, flaxseed, soy oil, canola oil precursor for EPA and DA (heart beat, blood pressure) 4-8 = .9 g boys 9-13= 1.2 g girls 9-13 = 1 g
fiber
prevention of chronic disease fruits, vegetables, whole grains 4-8 = 25g boys 9-13 = 31 g girls 9-13 = 26 g
RDA iron, zinc, calcium 9-13
iron: 8mg/d
zinc: 8 mg/d
calcium: 1300 mg/d
soft drinks add ___ kcal/d and ____ mg caffeine to 6-11 yos’ diets
229 kcal/day
35-50 mg caffeine
___% consume up to 8.9 ounces of soft drink/day
32%
___% consume >= 9 ounces of soft drink/day
32%
___% are non-consumers of soft drinks
36%
only ___% of middle and junior high schools require daily physical activity
8%
only ___% of 5-15 yo children walk to school and ___2% ride their bike to school
35%
2%
iron deficiency
less common in children than toddlers
4% in 6-11
5% in 3-5
7% in 1-2 (toddles)
adiposity rebound
7 y = late
for each additional hour to tv, prevalence of obesity increased by ___%
2%
children age ____ have highest rates of daily tv time
11-13
4 stage approach to treatment of overweight/obesity
prevention plus
structured weight management (SWM)
comprehensive multidisciplinary intervention (CMI)
tertiary care intervention (severely obese adolescents)
treatment for BMI 85th-94th %
weight maintenance or slowing of rate of weight gain while gaining height until <85th % achieved
treatment for BMI >95th - 98th %
weight maintenance/slowing rate of grain or gradual weight loss of <85th%
treatment for BMI >99th%
weight loss of <85th
Individuals with Disabilities Education Act (IDEA)
federal legislation that require the last restrictive environment resulting in inclusive setting for children ex: children in wheelchairs or with Down Syndrome spend time in regular classroom
increased calories for
autism, ADHA (low impulse control, and short attention span)
high protein needs for
cystic fibrosis
increases to 150% DRI
supplement for cystic fibrosis
fat- soluble vitamin supplements due to poor intestinal absorption
galactosemia supplement
calcium due to restricted dairy intake
type 1 vs type 2 diabetes
1: autoimmune disease
2: insulin resistance, obesity, varies with ethnicity
consequences: organ damage, premature death
seizures/epilepsy
uncontrolled electrical disturbance in brain
3.5/1000
postictal state
time after seizure of altered consciousness
treatment for seizures
medication - may impact growth/appetite
ketogenic diets: very low CHO diet (ketones instead of glucose are main fuel sources)
cerebral palsy in childhood/pre adolescence
1.4-2.4/1000
resulting from brain damage…
spastic quadriplegia
mots severe form of cerebral palsy
other brain damage with cerebral palsy…
39-44% have mental retardation
26-36% have seizures
14-18% have visual impairment
athetosis
uncontrolled movement with increases energy expenditure (need higher calories)
phenylketonuria (PKU)
inborn error of metabolism
1/12,000 births
body lacks enzyme to metabolize phenylalanine
completely avoid meat, eggs, dairy, nuts, soy
ADHD
most common neurobehavioral problem
5-8% of school age children
Ritalin or Adderal
___ people living with HIV
34 million
___ acquired HIV in 2011
2.5 million
___ people with HIV in USA
682,668
___ people living with AIDS in USA
490,696
