Lesson 5 Chapters 8

1
Lesson 5 Chapters 8 9

• Infant Nutrition
• A babe is fed with milk and praise. Charles
  Lamb, The First Tooth

2
Key Nutrition Concepts

• The dynamic growth experienced in infancy is the
  most rapid of any age.
• Inadequate nutrition in infancy, however, leads
  to consequences that may be lifelong, harming
  both future growth and development.

3
Key Terms

• Full-Term Infantborn between 37 and 42 weeks
  gestation
• Preterm Infantborn at or before 37 weeks
  gestation

4
Assessing Newborn Health

• Birthweight as an Outcome
• Full-term infant (37 to 42 wks)
• Typical weight 2500-3800 g (5.5 to 8.5 lbs)
• Typical length 47-54 cm (18.5 to 21.5 in)
• 88 of U.S. infants are born full-term

5
Infant Mortality

• Infant mortality defined as death that occurs
  within the first year
• Major cause is low birthweight (lt 2500 g)
• Other leading causes inlcude
• 1) congenital malformations,
• 2) preterm births, and
• 3) SIDS

6
Assessing Newborn Health

• Standard Newborn Growth Assessment
• Small for gestational age (SGA) and
  intrauterine growth retardation (IUGR) mean
  newborn was lt10th wt/age
• Large for gestational age (LGA) means newborn
  was gt90th wt/age

7
Infant Development

• Newborns
• Hear and move in response to familiar voice
• CNS is immature resulting in inconsistent cues
  for hunger and satiety
• Strong reflexes, especially suckle and root

8
Infant Development

• Terms Related to Development
• Reflexautomatic response triggered by specific
  stimulus
• Rooting reflexinfant turns head toward the cheek
  that is touched
• Sucklereflex causing tongue to move forward and
  backward

9
Major Reflexes Found in Newborns
10
Critical Periodsof Infant Development

• A fixed period of time in which certain behaviors
  or developments emerge
• Necessary for sequential behaviors or developments

11
Digestive System Development of Infants

• Factors that impact rate of food passage in GI
• Osmolarity of foods or liquids
• Colon bacterial flora
• Water and fluid balance

12
Energy Needs

• Energy (Calories)
• 108 kcal/kg/day from birth to 6 months (range
  from 80 to 120)
• 98 kcal/kg/day from 6 to 12 months
• Factors that influence calorie needs
• Weight
• Growth rate
• Sleep/wake cycle
• Temperature and climate
• Physical activity
• Metabolic response to food
• Health status

13
Protein Needs

• Protein Needs
• 2.2 g/kg/day from birth to 6 months
• 1.6 g/kg/day from 6 to 12 months
• How much is that?
• Newborn weighing 4 kg (8.8 lbs) needs 2.2 X 4
  8.8 g protein
• 6-month-old weighing 8 kg (17.6 lbs) needs 1.6 X
  8 12.8 g protein

14
Fat Needs

• Breastmilk contains about 55 calories from fat
• Infants need cholesterol for gonad and brain
  development
• Breast milk contains short-chain and medium-chain
  fatty acids (in addition to the long-chain)
• easier to digest and utilize than long-chain
  fatty acids

15
Metabolic Rate, Calories, Fats and ProteinHow Do
They All Tie Together?

• Metabolic rate of infants is highest of any time
  after birth
• Low carbohydrate and/or energy intake results in
  protein catabolism impacting growth

16
Physical Growth Assessment

• Newborns double birthweight by 4-6 mos and triple
  it by 1 yr
• Growth reflects
• nutritional adequacy
• health status
• economic environmental adequacy
• Calibrated scales recumbent length measurement
  board required for accurate measures

17
Physical Growth Assessment
18
Interpretation of Growth Data

• Measures over time identify change in growth rate
  and need for intervention
• Warning signs
• Lack of Wt or Lt gain
• Plateau in Wt, Lt or HC for gt 1 month
• Drop in Wt without regain in a few weeks

19
Feeding in Early InfancyBreast Milk and Formula

• AAP ADA recommend exclusive breast feeding for
  1st 6 months continuation to 1 yr
• Initiate breast feeding right after birth
• Growth rate and health status indicate adequacy
  of milk volume
• Standard infant formula provides 20 cal/oz
• Preterm formula provides 22-24 cal/oz

20
Typical Daily Volumes for Young Infants Not Being
Breastfed
21
How Infant Formulas Are Modified Compared to
Breast Milk
22
Cows Milk during Infancy

• Whole, reduced-fat or skim cows milk should not
  be used in infancy
• Iron-deficiency anemia linked to early
  introduction of cows milk
• Anemia linked to
• GI blood loss
• Calcium phosphorus
• Displacement of iron-rich foods

23
Development of Infant Feeding Skills

• Infants born with reflexes food intake
  regulatory mechanism
• Inherent preference for sweet taste
• At 4-6 wks, reflexes fade infant begins to
  purposely signal wants needs
• At 4-6 months, infants move tongue from side to
  side indicating readiness for solid foods

24
Development of Infant Feeding Skills
25
Introduction of Solid Foods

• Food offered from spoon stimulates muscle
  development
• At 4-6 months, offer small portions of semisoft
  food on a spoon once or twice each day

26
Recommendations for Introduction of Solid Foods

• Infant should not be overly tired or hungry
• Use small spoon with shallow bowl
• Allow infant to open mouth extend tongue
• Place spoon on front of tongue with gentle
  pressure
• Avoid scraping spoon on infants gums
• Pace feeding to allow infant to swallow
• First meals may be 5-6 spoons over 10 minutes

27
The Importance of Infant Feeding Position

• Improper positioning may cause choking,
  discomfort, and ear infections
• Position young bottle-fed infants in a
  semi-upright
• Spoon-feeding should be with infant seated with
  back and feet supported
• Adults feeding infants should be directly in
  front of infant making eye contact

28
Preparing for Drinking from a Cup

• Offer water or juice from cup after 6 months
• Wean to a cup at 12 to 24 months
• First portion from cup is 1-2 oz
• Early weaning may result in plateau in weight
  (due to reduced calories) and/or constipation
  (from low fluid intake)

29
First Foods

• 4-6 monthsiron-fortified baby cereal
• Rice cereal is hypoallergenic
• 6 monthspureed fruits and vegetables
• Only one new food over 2-3 days
• Commercial baby foods are sanitary and convenient
• 9-12 months soft table foods

30
Inappropriate and Unsafe Food Choices

• Foods that choke infants
• Popcorn
• Peanuts
• Raisins, whole grapes
• Stringy meats
• Hard candy or jelly beans
• Hot dogs
• Hard fruits or vegetables

31
Water

• All forms of fluids contribute to water intake
• Additional plain water needed in hot, humid
  climates
• Dehydration is common in infants
• Pedialyte or sports drinks provide electrolytes
  but lower in calories than formula or breast milk
• Limit juice
• (Avoid colas and tea)

32
How Much Food is Enough for Infants?

• Infants vary in temperament
• Crying or fussiness may be interpreted as hunger
  resulting in overfeeding
• First foods may appear to be rejected due to
  immature tongue movement

33
How Infants Learn Food Preferences

• Infants learn food preferences
• Flavor of breast milk influenced by mothers diet
• Genetic predisposition to sweet taste
• Food preference from infancy sets stage for
  lifelong food habits

34
Nutrition Guidance

• Infants and exercise
• Supplements for infants
• Fluoridefor breastfed infants
• Ironif mother was anemic
• Vitamin B12for vegans
• Vitamin Dneeded if low sun exposure

35
Infant Feeding Recommendations
36
Common Nutritional Problems and Concerns

• Failure to thrive (FTT)
• Inadequate wt or lt gain
• Organicdiagnosed medical illness
• Nonorganicnot based on medical diagnosis
• Intervention for FTT
• May be complex and involve a team approach
  including the registered dietitian

37
Complete Nutritional Assessmentsto Rule Out
Failure to Thrive
38
Colic

• The sudden onset of irritability, fussiness or
  crying
• Episodes may appear at the same time each day
• Disappear at 3rd or 4th month
• Cause unknown but associated with GI upset,
  infant feeding practices

39
Iron-deficiency Anemia

• Uncommon in infants because of prenatal irons
  stores of the mother
• More common in low-income families
• Breastfed infants may be given iron supplements
  and iron-fortified cereals at 4-6 months
• Iron-fortified versus Low-iron formula

40
Diarrhea and Constipation

• Infants typically have 2-6 stools/d
• Causes of diarrhea constipation
• Breastmilk
• Iron-fortified formula
• Soy formula
• Bacteria or virus

41
Prevention of Baby Bottle Caries and Ear
Infections

• Both linked to feeding practices
• Feeding techniques to reduce caries and ear
  infections
• Limit use of bedtime bottle
• Offer juice in cup
• Only give water bottles at bedtime
• Examine and clean emerging teeth

42
Food Allergies and Intolerances

• About 6-8 of children lt 4 yrs have allergies
• Absorption of intact proteins causes allergic
  reactions
• Common symptoms are wheezing or skin rashes
• Treatment may consist of formula with hydrolyzed
  proteins

43
Lactose Intolerance

• Inability to digest the disaccharide lactose
• Characterized by cramps, nausea and pain and
  alternating diarrhea and constipation
• Treated with soybean-based or lactose-free cows
  milk formulas
• Many infants outgrow lactose intolerance

44
Vegetarian Diets

• Infants receiving well-planned vegetarian diets
  grow normally
• Breastfed vegan infants need supplements
• vitamin D
• vitamin B12
• iron
• possibly iron and zinc

45
Nutrition Intervention for Risk Reduction

• Early Head Start Program
• Works with families at risk such as drug abuse,
  infants with disabilities, or teenage mothers
• Model program newborn screening and expanded
  newborn
• Phenylketonuria, galactosemia, hypothyroidism, or
  sickle-cell anemia

46
Key Nutrition Concepts

• Infants who are born preterm or who are sick
  early in life often require nutritional
  assessment and interventions that ensure they are
  meeting their nutritional needs for growth and
  development.

47
Key Terms

• Children with Special Health Care Needs
  Infants, children or adolescents with, or at risk
  for, a physical or developmental disability, or
  with a chronic medical condition
• Low-Birthweight (LBW) Weighing lt2500 g
• Very Low Birthweight (VLBW) lt1500 g
• Extremely Low Birthweight (ELBW) lt1000 g

48
Growth

• Tracking growth reflects nutritional status for
  most infants
• Additional methods to use if underlining
  conditions exist include
• Growth charts for specific conditions
• Biochemical indicators
• Body composition
• Head circumference
• Medications that impact growth

49
Growth

• Growth in Preterm Infants
• Neonatal Research Network Growth Observational
  Study Research Network tracks infant BW between
  501 and 1501 g
• Infant Health and Development Growth Charts
• For LBW Premature
• For VLBW Premature

50
Growth Chart plotting

• Correction for Gestational Age
• Chronological age - of weeks premature
• Catch up Growth in Failure to Thrive
• IBW for ht. x kcal/kg for ht
• Actual body weight

51
Growth

• Does Intrauterine Growth Predict Outside Growth?
• Depends on
• Intrauterine environment
• Fetal origins theory
• Other factors like air pollution
• Interpretation of growth

52
Growth

• Interpretation of Growth
• Rate of growth frequently used to measure
  improvement in preterm or sick infants
• Microcephaly or macrocephaly may affect body
  composition and growth
• Great variability in growth of infants

53
Common Nutritional Problems
54
Common Nutritional Problems

• Down syndrome
• Incidence is 9 per 10,000 live births
• Developmental delays seen in infancy
• Nutrition concerns include
• Weak facial muscles cause feeding difficulty
• Overweight commonclose monitoring of growth
• Low amount of movement resulting in reduced
  caloric needs

55
Severe Preterm Birth and Nutrition

• Incidence and prognosis
• About 60,000 VLBW born in U.S. each year
• Survival rate 90
• Nutrition support generally required
• High metabolic rates
• Preterm infants fed by nutrition support
• Parenteralnutrients delivered directly to the
  bloodstream
• Enteralnutrients delivered directly to GI tract

56
Severe Preterm Birth and Nutrition

• Conditions that require parenteral feeding
• Gastrointestinal problems may interfere with oral
  feeding
• Damage or inflammation to GI tract from
  necrotizing enterocolitis (NEC)

57
Severe Preterm Birth and Nutrition

• Conditions that require enteral feeding
• Gastrointestinal reflux, constipation, spitting
  up, vomiting, etc.
• Types of enteral tube feeding
• Oral-gastric (OG)
• Gastrostomy
• Jejunostomy

58
Preterm and Term Infant Feeding Differences
59
Nutrition Interventions

• Frequent growth assessment
• Monitor intake
• Adjust feeding frequency/volume
• Nutrient density to facilitate eating
• Parent education
• Observe parent-infant interactions
• Consider developmental abilities

60
Infant Formulas for Special Needs
61
Signs of Feeding Problems in Infants
62
Infant Case Study