Nutrition in infants Flashcards
Why do babies need formula and not milk:>
- Babies under 12 months of age should not have:
- Normal cow’s milk as a main drink; proteins, electrolytes not in right amount.
- Skim, evaporated, powdered, or sweetened condensed milk.
- Dairy alternatives like soy, rice, almond, or coconut milk.
Stage 1 and Stage 2 formulas:
- 6 mo dif to >6 mo; may/not be advantageous
Which baby formula is best?
- Soy-based baby formula.
- Hydrolysed baby formula.
- Prethickened formula and thickening agents.
No real difference
Feeding issues more linked to mother-child bond.
Toddler formulas
- better off on cow’s milk by 12 mo–>weaning not just off breastmilk but to other foods
Discuss the transition from breastfeeding to feeding
- Breastfeed for at least 6 mos, to 12 mo is fantastic, then transition to complementary feeding and family foods
- socialising and eating key not just for feeding and social development
Discuss differential organ growth
- head max velocity at birth, brain plateaus at 2
- height fast in relation to organ systems
- if out of sync– affects overall development
- optimise brain growth, social development
Discuss growth and activity
First year - Walking
Running - By the age of 5 years
Adiposity rebound - Puberty
- ** Triggers for fat and lean mass change**
Describe enegy expendtiure
- most BMR, physical activity, thermogenesis, and growth
- what falls off first in malnutrition is growth
Discuss common feeding issues
- Gastro-oesophageal reflux ^[every child refluxes. When is intervention necessary? weight loss associated with vomiting] (what are you giving? how much? how frequent?–especially with bottle feeding as breastfeeding is self-regulated)
- note not rigid, some reach developmental milestones earlier/later
- Introducing solids
- Excessive milk or juice intake (milk and o/weight; juice needs extra water if bottlefed)
- Food inhalation typically with excessive eating, or cerebral palsy
- Low-fat diets
- Vegetarian diets
- Diets for ADHD (?colourings, refined sugar)
- Teenagers – advertising, peer group, skipping meals, fads, effects on calcium accretion
Discuss managing toddler diets
- Family style (3 meals, social meals).
- Food fights.
- Break from bribes and kids’ manipulation.
- Try, try again; introducing.
- Variety: the spice.
- Make food fun.
- Involve kids in meal planning.
- Tiny chefs.
- Crossing bridges.
- A fine pair.
Discuss puberty and growth
- growth velocity declines over early years, then spurts during adolexcence
Describe epigenomics and growth
Intrauterine growth restriction (IUGR) is associated with an increased propensity to develop adult-onset disease and is described by the developmental origins of adult disease hypothesis.
Sequelae of foetal growth restriction include metabolic disease as well as nonmetabolic disorders.
Although it has become clear that the morbidities associated with IUGR are complex and result from disruptions to multiple pathways and multiple organs, the mechanisms driving the long-term effects are only just beginning to be understood.
IUGR affects most organ systems by either interrupting developmental processes such as apoptosis or producing lasting changes to levels of key regulatory factors.**
Both of these are associated with an often persistent change in gene expression. Epigenetic modulation of transcription is a mechanism that is at least partially responsible for this.**
IUGR is accompanied by changes in the quantity and activity of enzymes responsible for making modifications to chromatin as well as global and gene-specific modifications of chromatin.**
Gene expression and epigenetic modulation in later life:
- What factors might significantly change disease patterns through childhood and into adult life?
- What are we doing to our diets that might have longer terms consequences? i.e. additives
Discuss role of the microbiome
- food consumption in early life
- pathogen protection
- immune system development
- vitamin synthesis
- promotion of fat storage
among many others
Discuss igE mediated, immediate onset reactions
Gastrointestinal
Cutaneous
Respiratory
Generalised
- Gastrointestinal anaphylaxis: Symptoms include vomiting, pain, and/or diarrhoea.
- Urticaria, angioedema, pruritus, morbilliform rashes, and flushing.
- Acute rhinoconjunctivitis, wheezing, coughing, and stridor.
- Anaphylaxis
Increasing incidence
Discuss mixed IgE and cell mediated immediate to delayed onset reactions
Gastrointestinal (GI)
Cutaneous
Cell-mediated
Gastrointestinal
Respiratory
- Eosinophilic oesophagitis
- Atopic eczema
- Food protein-induced enterocolitis, food protein-induced proctocolitis, and food protein-induced enteropathy syndrome—which may present with a clinical picture of “sepsis.”
- Food-induced pulmonary haemosiderosis (Heiner syndrome) (rare)—pulmonary haemosiderosis or bleeding in the lower respiratory tract.
Increasing incidence
Discuss energy cost of growth
2 components:
- Energy used to synthesize new tissue (energy requirement and BMR, heat, growth, activity).
- Energy deposited within newly acquired tissue (energy stored).
-
Difficult to measure.
- In malnutrition: 4-6 kcal/g deposited.
-
Can measure by calculation type of tissue acquired and assumption of energy content of fat and FFM. - changes in different phases of development
- Infant in first year, 20 cm/year: 215 kJ per day (50 Kcal): 9% average requirement.
- Boy at peak adolescence, 10 cm/year: 139 kJ per day (32 Kcal): 1%.
REE
- Body size.
-
Body composition.
- Determined by FFM. (free fat mass)
-
Organs and skeletal muscle.
- In children, organs metabolically active.
- Higher REE in boys. resting energy expenditure (REE)
- Some ethnic differences.
- Decreases with age.
Discuss age group based nutritional principles
Children <3 yrs
- Should include three main meals and two smaller meals.
- Diets should be energy-dense and varied to provide micronutrients: good sources of iron and vitamin C with each meal to encourage micronutrient absorption.
- Whole milk rather than skimmed or semi-skimmed at least until 2 years.
- High fibre diets should be avoided but fibre in diets gradually increased.
Preschoolers <5 yrs
Three meals, two snacks, but other food in between meals discouraged:
- Increasing foods with fibre content.
- Perhaps some semi-skimmed milk if children taking an otherwise balanced diet.
- Careful modification of diet if child getting progressively fatter rather than slimming down from ‘puppy’ fat.
- Encourage active lifestyle and discourage periods of inactivity in front of television.
- Discourage eating between meals and outside recognized snack periods.
- Fresh fruit as snacks. Water as beverage. Low energy fruit squash rather than carbonated drinks.
- Vegetarian diets need careful attention for energy adequacy and micronutrient bioavailability.
School children 5-10 years
- Control of high energy snack foods.
- Maintain active lifestyle both at home and in school:
- Encourage walking to school etc., or at least using bus rather than car.
- Encourage hobbies, interests, and activities other than television watching and computer games.
- Restrict television viewing.
- Create nutritionally adequate and healthy school meals which are palatable and acceptable.
- Watch for obesity and develop lifestyle management to cope with this.
- Guard for dieting obsessions which might suggest early anorexia nervosa/bulimia.
- Educate to understand advertising pressures in food and nutrition.
