Nutrition of infants Flashcards
Nutritional assessment - general
The general assessment of nutritional status begins by obtaining,
plotting, and
interpreting weight,
length, and
head circumference data on sex- and age-specific growth curves.
WHO and CDC charts
Nutritional assessment - premature
For premature infants, evaluation of the degree of prematurity is critical and often leads to a decision to initiate tube feedings until oral feeds are possible.
Enteral and/or parenteral nutrition usually is required until a premature infant reaches approximately 34 weeks gestational age.
Determination of malnutrition
deficits in weight for age are classified as “underweight,”
deficits in length for age are classified as “stunting,” and
deficits of weight for length are classified as “wasting”
When the child is critical ill measurements
Anthropometric measures of the arm, These include measures of triceps and/or biceps skinfold thickness (TSF and BSF, respectively) and mid-upper arm circumference (MUAC).
Screening tools
The Subjective Global Nutrition Assessment
The STRONGkids tool
Nutrition Risk Score
The aim of all of these screening tools is to identify children at risk of malnutrition on hospital admission and determine the need for nutritional intervention during hospitalization. However, there are differences in the use of these tools.
INDICATIONS FOR ENTERAL NUTRITION
Any child who is unable to meet nutritional requirements by mouth is a candidate for enteral nutrition. Preexisting undernutrition (as defined by low birth weight, underweight, or wasting) is an indication to begin enteral nutrition sooner than among well-nourished subjects.
- Impaired swallowing or oral motor development, or oral aversion
- Excessive metabolic demands (Infants with sepsis, congenital heart disease, or bronchopulmonary dysplasia)
- Impaired absorption or digestion (short bowel syndrome, cystic fibrosis, Crohn disease)
Types of formulas or feeds
- Cow’s milk protein formulas - generally for all
- Soy protein-based formulas (vegan, galactosemia)
- “Blenderized” feedings - table-food products that are liquified in a food blender to allow administration through an enteral tube: - Use of blenderized formulas require larger bore (16 to 18 Fr) gastrostomy tubes to prevent clogging, and they are not recommended for infusion via jejunostomy tubes
- Amino acid-based formulas: indicated for patients with severe cow’s milk protein allergy or multiple food allergies including some cases of eosinophilic esophagitis
- Elemental formula: Severe protein allergy
Nutritional requirements Preterm infants
120 kcal/kg per day, which is equivalent to 150 to 160 mL/kg per day of preterm formula
Target growth rates are approximately 15 to 18 g/kg per day until 8 weeks post-term
Nutritional requirements Term infants
110 kcal/kg/day at 1 month of age,
95 kcal/kg/day at 3 months of age,
80 kcal/kg/day between 6 and 12 months of age
Target growth rates for healthy infants are approximately 30 g/day until 3 months of age,
20 g/day from 3 to 6 months of age,
11 to 15 g/day from 6 to 12 months
Children 12 to 24 months
Between 12 and 24 months, energy requirements are 80 to 84 kcal/kg/day
Children > 3 years
100 kcal/kg/day in three-year-old children to 40 to 50 kcal/kg/day in adolescents
Children needing catch-up growth
●Energy needs (kcal/kg/day) = EER for age (kcal/kg/day) × ideal weight for height (kg)/actual weight (kg)
Protein needs (g/kg/day) = RDA for protein for age (g/kg/day) × ideal weight for height (kg)/actual weight (kg
Where EER = estimated energy requirement; RDA = recommended dietary allowance.
Normal weight and height 2 yrs
12 kg and 85 cm
Normal weight and height 3 yrs
14 kg and 95 cm
Normal weight and height 4 yrs
15.5 kg and 100 cm
