Pediatric Nutrition Flashcards
*When can kids have solids?
Starting around 6 months if there are no developmental delays…start slow
Infant digestive process (first 6 months)
- system very immature
- poorly coordinated swallowing until 3-4 months
- no saliva until 3M
- at risk of developing food allergies if solids introduced too early
Infants nutritional requirements—first 6 months
- 110-120 k/cal/kg/day
- 140 cc/kg/day of fluids
- no solids until 4-6M
Infants growth—first 6 months
If growing well, their healthy is pretty good—about an ounce/day; lose 10% births eight in first 10-14 days but back to birth weight at 2 weeks age
Feeding
- breast milk/formula—20oz at 1M
- breast milk/formula—30oz by 6M
- water not needed even when hot bc dilution is easy to do—give milk if thirsty
- don’t give cow’s milk, honey or corn syrup for first year
- can start an iron fortified cereal (first solid food) with water or milk at 6 months
- Easy to overfeed bc tiny stomach
Formula prep
- 1 scoop to 2 oz of water = 20 cal/ounce of most formula
- to warm bottle place in warm or hot water NOT microwave
- throw formula/BM away after 4h of being warmed
Know baby is ready for solids at 6 months when…
- Can sit with little support and have good head control
- drink 30-32 oz of formula/day and want more
- drink 8 oz of formula and is hungry in <4 hours
- doubled birth weight
Infants digestive process (second 6 months)
- amylase to digest complex carbs
- dispose available for fat absorption
- tongue thrust gone
- tooth eruption begins
Infant nutrition—second 6 months
- 105 k/cal per kg/day
- limit formula to 24-30 oz/day when added to foods
- iron, fluoride add at 4-6M when supplementing
- need adequate source of vit 6 after 4-6M (in fruit—baby food, or fruit juice but can lead to excess sugar—needs to be watered down)
Infant growth—second 6 months
- Weight gain of 3-5 oz/weekly
- 1/2 inch monthly
Second 6 months feeding
- introduce solids
- offer juice from a cup, mix with juice from cereal to improve absorption of iron
- start with strained foods and introduce one food at a time, try for 3-5 days before adding something else
- meat is last
- start with finger foods around 6-7M—very soluble
- chopped foods by 9-12M—they can start chewing now
Foods to avoid in first year of life
Nuts, strawberries, wheat, shellfish, egg whites, citrus
Choking hazard foods and foods to avoid
Grapes, hard candy, popcorn, hotdogs, raw mini carrots, smooth/hard foods, fried food, high concentrated sugary food and drink
Toddler digestive process
Inc in gastric activity, digestive process more mature and complex, physiologic anorexia—not very hungry
Toddlers nutritional requirements
- off bottle by 1 year
- vitamin and mineral needs increase
Toddlers feeding
- wean from bottle
- 2-3 cups of milk/day
- after 2Y of age can get skim milk or low-fat
- frequent nutritious snacks
- grazing ok
- breast milk is ok but not too nutritious at this point
- one T of solid food per Y of age
- eating habits established during toddler years are critical to establish eating patterns
- consistency and rituals are important
Preschooler digestive process
Mature
Preschool feeding
- may be picky eaters
- table manners can be taught around age 4-5
- may have food jags—only want to eat one food, food fad
- five a day fruit and veg encouraged
School age nutritional requirements
- need more protein
- girls over 10 need 2200 cal, boys 2500
- need independence in meals
- formation of habits that influence the future
- choose health over junk food
School age feeding concerns
- junk food popular
- school food programs
- threat of childhood obesity
- influence by media, family, school food programs, outside food influences
Adolescent nutrition requirements
- Females—more iron and calcium
- Growth spurt—iron, calcium, zinc
- Varied based on puberty
- inc risk of poor nutrition, obesity from sedentary, eating disorders, cholesterol
Subjective data for nutritional assessments
Talk to child alone—nutritional status during pregnancy, infant feeding, 24 hour recall, 3 day food diary is better, supplements—iron, fluoride, feeding patterns of child and family, feeding capabilities of child, activity pattern/play, wound healing
Objective data for nutritional assessment
Fontanelles, muscle tone, bowels, mucous membranes, knock-knee past 2-7, bowlegged past toddler, hair, skin folds, albumin, nitrogen balance, mineral, HIB, Hct, iron/ferritin levels, cholesterol
Criteria for referral for nutritional assessment
- markedly over or under weight
- feeding skills below developmental level
- unusual food habits
- inadequate dietary intake
- nutritional tx central to medical management
- physical signs of nutritional deficiency
- emotional disturbances associated with habits
- high risk for compromised nutrition
