Nutrition Flashcards
Infant Nutrition
- Breastfeeding and bottle feeding are both acceptable methods
- Breastmilk and formula provide all the infant’s nutritional daily requirements until 4 to 6 months of age
•Cognitive developmental is supported by an adequate diet in infancy
Infants - Solid Food readiness
- Tongue extrusion reflex (necessary for sucking) needs to disappear
- Ability to swallow solid foods
- Sit unsupported in high chair
Introducing Solids to infants
- Rice or oatmeal infant cereal first
- Start with a thinner consistency
- New food every 4 to 7 days (allergies)
- No salt, sugar or seasonings should be added
Solid foods for 6 to 8 months
- Soft table foods can be added
- Cheerios
- Avoid hard food pieces
- Use of a cup
Solid foods do not substitute for breastmilk or formula which should still be their primary source of nutrients until 12 months
Infants – Foods to Avoid
Until 12 months
- Honey
- Peanuts, popcorn, hard foods, grapes and hot dogs
- Strawberries
- Cow’s milk
- Peanut butter
Toddlers food needs
- DONT reduce fat intake of a child less than 2 years of age
- calcium daily (but limit milk intake, too much calcium not enough iron)
- 19 grams of fiber daily
- limit juice - offer water between meals
- 3 meals and 2 snacks daily
Toddlers – Promoting self feeding
Many be hungrier during growth spurt
- Use child size utensils
- Do not force feed or utilize the “clean plate” rule
- Keep toddler in a secure chair at a comfortable height
- Never leave the toddler unattended at meal times
- Promote a family meal time
- Minimize distractions during meals ( avoid just sitting in front of tv)
Constipation can decrease appetite
Preschoolers
- Continue the principles discussed for toddlers
- By age 5, can understand the social context of meal time
- More likely than toddler to try new foods
- Will enjoy helping with food preparation and clean-up
- Promote a family meal time
Obesity – Toddlers and Preschoolers
What causes it and what can be done to prevent?
•More prone to obesity if a parent is obese
- Unlimited 🧃 and 🥛 consumption
- Do use the “Clean your plate” rule
- Offering high sugar “junk food” just so child will eat
- Not starting healthy eating habit from birth (ranch for 🥕 or 🧀 for 🥦 will help them eat healthy)
- Offer new choices multiple times
- Do not use food as a reward or punishment
- Use a structured meal time
School age
Needs vary by size, age, gender and activity level
•Appetite⬆️ but caloric needs⬇️
•Diet choices established earlier will continue
•More influenced by parents, peers and social media
•Offer a high quality PROTEIN with each meal
•Increased CALCIUM needs
•Still benefits from a family meal time
School Age - Obesity is caused by
- Lack of exercise and time outside
- More “screen” time
- Unstructured meal time
- Increased consumption of sugar laden beverages
- Peer influence
Adolescents needs
And what to avoid and encourage
•Higher caloric needs
- May appear to be constantly hungry
•Higher calcium and protein needs
- avoid “specialty” diets
- Habits will continue as adult
- Encourage physical activity daily
- Family meal times are still very important
Adolescents - Obesity
What to encourage to prevent obesity?
•Encourage healthy eating habits - less fast food - fruits and vegetables •Include adolescent in meal planning with family •Exercising with peers and family
- Obesity as an adolescent is a direct link to obesity as an adult
- Influenced by peers
Anemia
- Iron deficiency anemia is the most common cause of anemia in childhood.
- Often occurs when transitioning from formula to whole milk. Infant formulas are iron fortified. When formula is stopped the child is not receiving enough iron from other food sources.
- Cow’s milk actually makes it harder for the body to absorb iron. Toddlers can develop iron deficiency anemia if they drink too much cow’s milk (more than 24 ounces a day) and do not eat enough foods that are rich in iron such as green leafy vegetables and red meat.
Anorexia
causes more complications and adolescent deaths, distorted body image; has social, psychologic, behavioral, cultural and physiologic components
Bulimia
binge eating accompanied by purging, may be cyclic, may not change physical appearance, a psychologic disorder
Bulimics have a much higher recovery rate than anorexic adolescence
Failure to thrive (FTT)
Inadequate growth resulting from an inability to obtain or use calories required for growth.
The deceleration of growth for both weight and height.
Diagnosis is based on growth parameters that
1) drop more than 2 percentiles from baseline,
2) are persistently below the third to fifth percentiles.
Gastroesophageal Reflux (GER)
Passage of gastric contents into the esophagus
Most infants outgrow reflux by 12 months; particularly common in preemies
Sphincter is very lose- when burp may throw up a little, don’t shake after eating !
Will eventually tighten, standing and sitting up and more solid foods will help as well
Gastroesophageal Reflux Disease (GERD)
What complications develop
most involve the airway and can be life threatening in infants:
Esophagitis Anemia Recurrent pneumonia Asthma Bradycardia Apnea ALTE
Therapeutic Management of GERD
Depends on severity. No therapy is needed for infant who is thriving and has no respiratory complications.
Keeping head elevated for at least 30 minutes after feedings.
Prone position should NOT be used due to increased risk of sudden infant death syndrome (SIDS)
Small frequent feedings, space between feedings should still be permitted to allow formula in stomach
time to digest.
Burping infant frequently (after every 1 to 2 ounces) during feeding, and after
feeding.
Using pre-thickened formulas such as Enfamil AR
For older children, decrease foods that exacerbate acid reflux (caffeine,
citrus, tomatoes, peppermint, spicy or fried foods)
Cleft Lip (CL) surgery
cheiloplasty: 10 – 12 weeks (approximate)
surgery for the lip can be done early, it needs no extra time for growth
Cleft palate surgery
Repair/palatoplasty: 6 to 12 months (approximate)
has to wait to allow for more growth but needs to be done before it alters speech patterns
Nursing Care Management for a child with a cleft lip, palate or both
Interventions in assisting parents in accepting a birth defect
Use of Haberman nipples for feeding, or a large syringe with soft, red rubber catheter
** More air will be taken in because of the cleft; so the infant will need burping often
The infant with unrepaired cleft palate is at risk for aspiration with oral feeding
Management of care: after cleft lip or palate surgery
Promotion of surgical closure
Prevention of complications
Facilitate normal growth/development
Speech issues are common with Cleft Palate even after initial repair
Postoperative Care for Cheiloplasty
Monitor airway Protect the suture line pain management No suctioning Proper positioning
Postoperative Care for Palatoplasty
Monitor airway
Protect the suture line ATC pain management Soft diet
Complications of Cleft Lip/Palate
Feeding difficulties Altered dentition Delayed or altered speech development Otitis media Excessive air intake – gagging, choking, regurgitation
Promoting Nutrition in infant with cleft lip or palate
Encourage breastfeeding
Burping infant more often during feeding
Monitor for aspiration
Encourage Skin to Skin contact
GERD signs
Vomiting Colic -intense crying or fussiness Wheezing Failure to thrive Ear infections Abnormal posture Pneumonia
After cleft lip or palate repair
Prevent crying
Logan bow
Pain medication
Elbow restraint
NO: Suctioning Pacifier Nipple Hard food or items
Feeding after repair
Haberman Feeders
Breck Feeders
Spoon to lips only
Syringes
Pigeon Feeders
Preschooler nutrition needs
Calcium daily Iron daily fiber daily Fat intake 1000 – 1600 calories per day Limit juice- Encourage water intake
Infant nutrition needs
Breast milk and formulas: 20 cal/oz
Requirements met with multiple feedings
Gain weight at rate of 1 oz per day for 1st 6 months
On Demand
Hunger cues
Bottle feed every 3-4 hours
Breast feed every 2-3 hours, 10-20 min on each breast
Weaning
Individualized decision
Encourage stopping bottle feeding between 12 to 15 months
No spill sippy cups are not recommended for everyday use
Diagnostic Evaluation of GERD
History and physical examination Upper GI series Esophageal pH monitoring Esophagogastroduodenoscopy (EGD) CBC and hemoccult
