Infancy Ch 8

Question 1

Define: infant mortality

Answer 1

Infant mortality - defined as death that occurs within the first year
-Major cause is low birthweight (< 2500 g)
Other leading causes:
-congenital malformations
-preterm births
-SIDS: Sudden Infant Death Syndrome

Question 2

Define: SGA, AGA, LGA

Answer 2

SGA - small for gestational age: newborn was 90th percen1le of wt/age

Question 3

Define: failure to thrive

Common Nutrition Problem & Concern

Answer 3

FTT

• Inadequate weight or height gain
• Energy deficit is suspected

(may involve social worker)
(when you don’t see adequate medical issues & symptoms)

Question 4

Infant dev: newborn development

Answer 4

Newborns:

• Hear and move in response to familiar voice
• CNS is immature resulting in inconsistent cues for hunger and sa1ety
• Strong reflexes that are protective for newborns

Question 5

what are factors associated w/ infant mortality

Answer 5

Social and economic status
Access to health care
Medical interven1ons
Teenage pregnancy
Availability of abor1on services
Failure to prevent preterm & LBW births

Question 6

Infant reflexes:

Answer 6

Reflex—automatic response triggered by specific stimulus
Rooting reflex—infant turns head toward the cheek that is touched
Suckle—reflex causing tongue to move forward and backward

Question 7

Infant dev: Infant development & feeding skills development progresses?

Answer 7

Digestive System Development:
-During the 3rd trimester: Fetus swallows amniotic fluid
which stimulates intestinal maturation and growth
-At birth: the healthy newborn can digest fats, protein, & simple sugars.
-Common problems include gastroesophageal reflux (GER), diarrhea, and constipation

Question 8

infant dev: factors that impact food

Answer 8

Factors that impact rate of food passage in colon and gastrointestinal discomfort in infants:

• Osmolarity of foods or liquids
• Colon bacterial flora
• Water and fluid balance in the body

Question 9

infant dev: parenting for feeding practices

Answer 9

new parents learn:

• Infant’s cues of hunger and safety
• Temperament of infant
• How to respond to infant cues

Question 10

What are the energy and protein needs for infants according to body weight (birth to 6 months and 6 to 12 months)? What factors are associated with protein and calorie needs?

Answer 10

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

Question 11

Recommendations for infants for food:

Answer 11

The recommenda1ons for infants are from the Dietary Reference Intakes (DRI) - Na1onal Academy of Medicine, American Academy of Pediatrics, and the Academy of Nutri1on and Dietetics

• Energy needs
• Protein needs § Fats

Question 12

Protein needs: What are the protein needs for infants according to body weight (birth to 6 months and 6 to 12 months)?

Protein needs are similar to that of energy but are also influenced by body composition

Answer 12

Protein Needs
2.2 g/kg/day from birth to 6 months
1.6 g/kg/day from 6 to 12 months
===
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

Question 13

Energy needs: What factors are associated with calorie needs?

Answer 13

Factors that influence calorie needs:

• Wt & growth rate
• Sleep/wake cycle
• Temp & climate
• Physical activity
• Metabolic response to food
• Health status/recovery from illness

Question 14

Metabolic Rate, Calories, Fats & Protein: How do you assess growth?

Answer 14

-Metabolic rate of infants is highest of any time after birth
-The higher rate is related to rapid growth and high
proportion of muscle
-Low carbohydrate and/or energy intake results in protein catabolism impacting growth

Question 15

Physical growth assessment: What are the indicators of growth problems?

Answer 15

Newborns grow faster than any other time of life
Growth reflects:
-Nutritional adequacy
-Health status
-Economic & environmental adequacy
-There is a wide range of growth = typical
-Calibrated scales & recumbent length measurement board required for accurate measures

Question 16

Compare growth charts: CDC vs. WHO. How do you use and interpret each growth chart?

Answer 16

WHO ‘TIL 2:
data & pop. is different
CDC bbs born in US

CDC 2000:

1. US selected sites w/ 5k measurements
2. descriptive reference reflecting past: how infants have grown
3. 66% formula fed & 33% BF for 3mos
4. birth - 36 mo (3 yrs)
5. high prevalence

WHO 2011:

1. WW: 6 selected sites w/ 19K measurements
2. Prescriptive optimal standard: how infants should grow
3. All BF @ for 4mo
4. Birth-24 mos
5. Low prevalence

Question 17

CDC recommendations

Answer 17

CDC recommends that health care providers:

• Use the WHO growth charts to monitor growth for infants & children ages 0-2 yrs
• Use the CDC growth charts to monitor growth for children age 2 yrs and older

Question 18

WHO charts (4)

Answer 18

Head circumference
weight-for-length (recombinant)
weight-for-age
length-forage

Question 19

CDC Charts (3)

Answer 19

BMI-for-age
Weight-for-age
length-for-age (stature)

Question 20

Feeding in Early Infancy: What are the recommended feeding practices during early infancy?

Answer 20

Breast Milk and Formula
-Recommend exclusive breast feeding for 1st 6 months &
continuation to 1 yr
-Initiate breast feeding right amer birth
-Growth rate and health status indicate if milk volume intake is adequate
-Standard infant formula provides 20 cal/fl oz
-Preterm formula provides 22-24 cal/fl oz

Question 21

Compare breast milk and formula (cow’s and soy based)

Answer 21

COW: Whole, reduced-fat or skim cow’s milk should not be used in infancy
-Iron-deficiency anemia linked to early introduc1on of
cow’s milk
Anemia linked to:
-GI blood loss
-Low absorp1on of calcium & phosphorus
-Displacement of iron-rich foods

SOY Protein-Based Formula During Infancy:

• Soy protein in place of milk protein should be limited in its use
• The use of soy formula is not recommended for managing infan1le colic
• Lactose free and hydrolyzed formulas are beker for infants unable to breasoeed or be fed cow’s milk formulas

Question 22

What are the consequences of using cow’s milk in infancy?

Answer 22

• lots of energy

- not enough iron*

Question 23

Intro to solid foods: What are the recommendations for solid foods introduction?

Answer 23

• At 6 months, offer small portions of semisom food on a spoon once or twice each day
• Food offered from spoon s1mulates mouth muscle development
• –
• 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 infant’s gums
• Pace feeding to allow infant to swallow
• First meals may be 5-6 spoons over 10 minutes

Question 24

Which foods should be first offered?

Answer 24

1st foods: 
-iron-rich foods
6 months—iron-fortified baby cereal 
     -Rice cereal is hypoallergenic
-6 months—fruits and vegetables
-Only one new food over 2-3 days
-Commercial baby foods are not necessary but do provide sanitary and convenient choices
-9-12 months som table foods

Question 25

Which foods are considered unsafe?

Answer 25

Foods that choke infants - Hot dogs - Popcorn, potato chips - Peanuts, chunks of peanut butter - Raisins, whole grapes - Stringy meats - Gum & gummy-textured candy, hard candy or jelly beans - Hard fruits or vegetables

Question 26

Discuss difficulties related to the weaning process

Answer 26

Offer water or juice from cup amer 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 cons1pa1on (from low fluid intake) - Changing from a bokle to a covered “sippy” cup with a small spout is not the same developmental step as weaning to an open cup - Open cup drinking skills also encourage speech development

Question 27

What are the recommendations regarding water, juice and supplements during infancy

Answer 27

-Breast milk or formula provide adequate water for healthy infants up to 6 months -Dehydration is common response to illness in infants (vomit and diarrhea) -Pedialyte or sports drinks provide electrolytes but lower in calories than formula or breast milk -Limit juice -AAP recommends juice is not needed to meet the fluid needs before the age of 6 months Avoid colas and tea Supplements for infants - Fluoride—for breasoed infants amer 6 months or if in any area with no fluoridated water - Vitamin B12—for vegans - Vitamin D—needed if exclusively BF

Question 28

Discuss common nutritional problems and management strategies in infancy: colic

Answer 28

Colic - the sudden onset of irritability, fussiness or crying - Episodes may appear at the same 1me each day - Disappear at 3rd or 4th month - Cause unknown but associated with GI upset, infant feeding practices

Question 29

Discuss common nutritional problems and management strategies in infancy: iron deficiency

Answer 29

- Less common in infants than in toddlers - Iron stores in the infant reflect the iron stores of the mother - More common in low-income families - BF infants may be given iron supplements and iron- for1fied cereals at 4-6 months

Question 30

Discuss common nutritional problems and management strategies in infancy: diarrhea/constipation

Answer 30

``` Diarrhea and Cons1pa1on -Infants typically have 2-6 stools per day Causes of diarrhea & cons1pa1on: -Viral and bacterial infections -Food intolerance -Changes in fluid intake ``` To avoid cons1pa1on assure adequate fluids Con1nue to feed the usual diet during diarrhea

Question 31

Discuss common nutritional problems and management strategies in infancy: cavities & ear infections

Answer 31

Prevention of Baby Bottle Cavities and Ear Infections - Are linked to feeding practices - Feeding techniques to reduce cavities and ear infections -Limit use of bed1me bottle - Offer juice in cup - Only give water bottles at bed1me - Examine and clean emerging teeth

Question 32

Discuss common nutritional problems and management strategies in infancy: food allergies

Answer 32

Food Allergies and Intolerances - About 6-8% of children < 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

Question 33

Discuss common nutritional problems and management strategies in infancy: food intolerances

Answer 33

Lactose Intolerance - Inability to digest the disaccharide lactose - Characterized by cramps, nausea and pain and alterna1ng diarrhea and cons1pa1on - Lactose intolerance in uncommon and tends to be overestimated