chapters 8 & 9 8 & 9 infant nutrition. very specialized nutritional considerations high...
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Very specialized nutritional Very specialized nutritional considerationsconsiderations
High growth rateHigh growth rate Highest requirements for all nutrients Highest requirements for all nutrients Infant has innate ability to self-regulateInfant has innate ability to self-regulate Progression in feeding skills R/T Progression in feeding skills R/T
developmental milestonesdevelopmental milestones Inadequate nutrition may lead to Inadequate nutrition may lead to
consequences that may be lifelongconsequences that may be lifelong
Key TermsKey Terms
Liveborn InfantLiveborn InfantNatality statisticsNatality statisticsInfant mortalityInfant mortality
◦ Death that occurs in first year of lifeDeath that occurs in first year of life
Infant morbidityInfant morbidity◦ Illnesses that occur in first year of lifeIllnesses that occur in first year of life
The Status of Pregnancy The Status of Pregnancy OutcomesOutcomes
Infant mortality:Infant mortality:◦ reflects general health status of a populationreflects general health status of a population
◦ decreases in mortality related to decreases in mortality related to improvements in social circumstances, safe & improvements in social circumstances, safe & nutritious food supply, & infectious disease nutritious food supply, & infectious disease control control
Low Birthweight, Preterm Delivery, & Low Birthweight, Preterm Delivery, & Infant MortalityInfant Mortality
Low birthweight (LBW) or Low birthweight (LBW) or preterm infants at high risk of preterm infants at high risk of dying in 1dying in 1stst year of life year of life
Reducing Infant Mortality & Reducing Infant Mortality & MorbidityMorbidity
Improve birthweight of newbornsImprove birthweight of newborns◦ Desirable birthweight = 3500-4500 g (7 lb. 11oz. to Desirable birthweight = 3500-4500 g (7 lb. 11oz. to
9 lb. 14)9 lb. 14)
Infants born with desirable wt less likely to Infants born with desirable wt less likely to develop:develop:
Heart and Lung diseasesHeart and Lung diseases DiabetesDiabetes HypertensionHypertension
APGAR scoreAPGAR score
Evaluation of of newborn physical statusEvaluation of of newborn physical status Heart rateHeart rate respirationrespiration muscle tonemuscle tone response to stimulationresponse to stimulation skin colorskin color 8-10 best score8-10 best score
Measuring growth for infantsMeasuring growth for infants
Lose weight first few days Lose weight first few days regained by 7-10th dayregained by 7-10th day
Double birth weight Double birth weight 4-6 months4-6 months
Triple @ 1 yearTriple @ 1 year Increase length by 50% @1 Increase length by 50% @1
year – double by 4 yearsyear – double by 4 years
CDC infant growth chartsCDC infant growth charts
Overall patternOverall patternTrendTrend Appendix AAppendix A 0-36 mo, male/female0-36 mo, male/female
• Use months, not yrsUse months, not yrs Variety of chartsVariety of charts
The 50th percentile -median height or The 50th percentile -median height or weight for each age group,weight for each age group, 50% of children will be above & 50% will be 50% of children will be above & 50% will be
belowbelow
change percentiles between 0-18 moschange percentiles between 0-18 mos Then follow channel fairly closelyThen follow channel fairly closely
Nutrient NeedsNutrient Needs KcalsKcals
108 kcals/kg 0-6 months108 kcals/kg 0-6 months 98 kcals/kg 6-12 months98 kcals/kg 6-12 months
ProteinProtein 2.2 g/kg2.2 g/kg 0-6 months0-6 months 1.6 g/kg1.6 g/kg 6-12 months6-12 months
FluidFluid 1.5 mL/kcal NO EXTRA FLUIDS/NEEDS 1.5 mL/kcal NO EXTRA FLUIDS/NEEDS
MET IN BREASTMILK! MET IN BREASTMILK!
Feeding in Early InfancyFeeding in Early Infancy
Breast milk and formulaBreast milk and formula Cow’s milk during infancyCow’s milk during infancy
Breast Milk vs FormulaBreast Milk vs FormulaMACRO-MACRO-NUTRIENTNUTRIENT
Breast MilkBreast Milk Cow’s Milk Cow’s Milk Based Based FormulaFormula
Soy Based Soy Based FormulaFormula
PROPRO 7% of kcals7% of kcals 9-12%9-12% 11-13%11-13%
CHOCHO 38% of 38% of kcalskcals
41-43%41-43% 39-45%39-45%
FATFAT 55% of 55% of kcalskcals
48-50%48-50% 45-49%45-49%
Infant formula/Human milk Infant formula/Human milk substitutessubstitutes
Regulated by FDA – Infant Formula ActRegulated by FDA – Infant Formula Act Nonfat milk with added vegetable fats, V & MNonfat milk with added vegetable fats, V & M Soy based formulasSoy based formulas Specialized formulas(protein hydrolysate); Specialized formulas(protein hydrolysate);
malabsorption, metabolic disordersmalabsorption, metabolic disorders
Powdered formulaPowdered formula Concentrated liquid formulaConcentrated liquid formula Ready-to-use formulaReady-to-use formula
FeedingFeeding
Hold baby– head should be Hold baby– head should be higher than rest of bodyhigher than rest of body
Never prop bottleNever prop bottle Proper mixing, storage, dilutionProper mixing, storage, dilution
Developmental characteristicsDevelopmental characteristics
Sucks well on nippleSucks well on nipple Extrusion reflex causes tongue to protrude Extrusion reflex causes tongue to protrude
when solid food or spoon is put mouthwhen solid food or spoon is put mouth Feeds Q 2-4 hrs during day by 2 mos.Feeds Q 2-4 hrs during day by 2 mos. Finishes each feeding w/n 45 min. by 4 mos.Finishes each feeding w/n 45 min. by 4 mos.
Infant-controlled Feeding:Infant-controlled Feeding:
Attentive to infant behavior – allows quantity to Attentive to infant behavior – allows quantity to varyvary
Holds bottle still at an appropriate angleHolds bottle still at an appropriate angle Poises nipple over lips and allows baby to open upPoises nipple over lips and allows baby to open up
Infant-controlled Feeding:Infant-controlled Feeding:
Allows pauses – gives time to finish feedingAllows pauses – gives time to finish feeding Soothes fussiness – finds reasons for Soothes fussiness – finds reasons for
discomfortdiscomfort
Infant-controlled Feeding:Infant-controlled Feeding:
Ellyn Satter:Ellyn Satter: Parent-whatParent-what Child-when, if, how muchChild-when, if, how much
Parent- controlled FeedingParent- controlled Feeding
Ignores infant behavior – enforces externally Ignores infant behavior – enforces externally determined quantitydetermined quantity
Rotates, tilts, jiggles bottlesRotates, tilts, jiggles bottles Imposes feeding routine-SCHEDULEImposes feeding routine-SCHEDULE
Parent- controlled FeedingParent- controlled Feeding
Terminates feeding abruptly at pausesTerminates feeding abruptly at pauses Interprets infant fussiness as a sign of satietyInterprets infant fussiness as a sign of satiety
Development of Infant Feeding SkillsDevelopment of Infant Feeding Skills
Developmental milestones & readiness for Developmental milestones & readiness for feeding skillsfeeding skills
Introduction of solid foodsIntroduction of solid foods Preparing for drinking from a cupPreparing for drinking from a cup Food texture & developmentFood texture & development First food: baby rice cerealFirst food: baby rice cereal
WaterWater How much food is enough for infants?How much food is enough for infants? How infants learn food preferencesHow infants learn food preferences Inappropriate and unsafe food choicesInappropriate and unsafe food choices
ChokablesChokables
Whole grapesWhole grapes Peanut butterPeanut butter NutsNuts PopcornPopcorn HotdogsHotdogs Coin-sizedCoin-sized Stringy or tough Stringy or tough
meatmeat
GumGum RaisinsRaisins CandyCandy Sticky foods like Sticky foods like
granolagranola Teething biscuitsTeething biscuits French friesFrench fries
Nutrition GuidanceNutrition Guidance
Supplements for infants ?Supplements for infants ? fluoridefluoride ironiron vitamin Bvitamin B1212 vitamin Dvitamin D
Common Nutritional Problems Common Nutritional Problems and Concernsand Concerns
Failure to thrive (FTT)Failure to thrive (FTT) organicorganic nonorganicnonorganic
Nutrition intervention for FTTNutrition intervention for FTT ColicColic Iron-deficiency anemiaIron-deficiency anemia Constipation and diarrheaConstipation and diarrhea
Additional Infant Feeding ConcernsAdditional Infant Feeding Concerns Prevention of baby bottle caries & ear infectionsPrevention of baby bottle caries & ear infections
Food allergies & intolerancesFood allergies & intolerances WheatWheat EggsEggs SoySoy NutsNuts Cow’s MilkCow’s Milk
Lactose intoleranceLactose intolerance Food Safety!Food Safety!
Infants at High RiskInfants at High Risk
LBWLBW born before 34 weeks of gestationborn before 34 weeks of gestation born with consequences of abnormal born with consequences of abnormal
developmentdevelopment chronic health problemschronic health problems special health care needsspecial health care needs
Growth of Pre-Term InfantsGrowth of Pre-Term Infants
Growth in preterm infantsGrowth in preterm infants correction for gestational agecorrection for gestational age
Does intrauterine growth predict outside Does intrauterine growth predict outside growth?growth?
Interpretation of growthInterpretation of growth
Severe Preterm Birth & NutritionSevere Preterm Birth & Nutrition
How sick babies are fedHow sick babies are fed What to feed preterm infantsWhat to feed preterm infants Preterm infants and feedingPreterm infants and feeding
fatiguefatigue low tolerance of volumelow tolerance of volume Defensive to feedingDefensive to feeding Unpleasant=feedingUnpleasant=feeding
Congenital Abnormalities and Congenital Abnormalities and Chronic IllnessChronic Illness
GI tract disordersGI tract disorders diaphragmatic herniadiaphragmatic hernia tracheoesophageal atresiatracheoesophageal atresia
Congenital Abnormalities and Congenital Abnormalities and Chronic IllnessChronic Illness
Cleft lip and palateCleft lip and palate