What happens to an infants size in the 1st 4 months?
doubles
What happens to an infants size in the first year of life?
it triples
In the first year of life regular monitoring of ht and wt should occur. What are these indicators of?
health
nutrition
What happens to a child's growth in preschool and early school?
gradual growth until adolescent growth spurt
When shout length and wt measurements be taken?
w/in 1-2 weeks of birth
1 month
2 month
4 months
6 months
9 months
12 months
18 months
24 months
then yearly
What are growth chats used for?
assessment of individual normal growth patterns
not diagnostic used with other information to assess general health
Growth chart
Ht/length and wt follow a _____________.
Growth follows on or near the same ________.
1st couple of years infants shift their ________. majority reside near the ______________.
growth channel
same centile
percentiles
50th percentile
Breast fed infants at 3-4 months tend to _______ than bottle fed infants
leaner
this is a natural difference no clinical intervention necessary
What are the eating developmental patterns?
nursing period
transitional period
modified adult period
What is the nursing period?
breast milk and/ or infant formula = complete source of nutrition (4-6 months)
What is the transitional period?
Introduction of semisolid foods with high milk consumption (6-10 months)
semi solid food with a spoon promote normal feeding development
What is the modified adult period?
most food comes from adult-type foods (>10 months)
What are some cows milk feeding issues?
exclusive breastfeeding should be encourages for 1st 6 months
cow's milk is not recommended in the 1st year
partly skimmed milk (1% and 2%) not recommended in the 1st 2 years of life
low fat milk= reduced energy, vitamin and EFA content
Compare the protein content in human milk an infant formula.
human milk 6%
infant formula 9%
Compare the fat content in human milk an infant formula.
human milk 55%
infant formula 49%
Compare the CHO content in human milk an infant formula.
human milk 39%
infant formula 42%
Compare the protein content in human milk an recommended adult diet.
HM= 6%
RAD= 12%
Compare the fat content in human milk an recommended adult diet.
HM 55%
RAD 30%
Compare the CHO content in human milk an recommended adult diet.
increased risk of dehydration, metabolic acidosis, and hypernatremia (high Na and solute load)
How long must water be boiled to be pathogen free?
2 minutes
What are the risks associated with microwaving formula?
possible hot spots that can cause severe burns to infants
What should be done to prevent nursing bottle syndrome?
avoid nocturnal and long term used of bottles containing fluids other than water
do not dip pacifiers or nipples in sugar or honey --> leads to severe dental carries
Why is goats milk an inappropriate milk substitute?
deficient folic acid, vit B6 and B12
higher in protein (3.6g/100mL) vs human milk (1g/100mL) and formula (1.4 g/100 mL) --> risk of dehydration and higher renal solute load
low Ca:P -> risk of hyperphosphatemic tendency (painful and prolonged contraction) in small immature infants
Why are plant based beverages (soy milk, rice based beverages) inappropriate milk substitutes?
low energy density <80% energy density of infant formulas - malnutrition if SB/RB are sole source of nutrition
failure to thrive
insufficient vit D -> rickets, hypocalcemia
several (but nol all) products bear label statements that the product is not a substitute for infant formula
Mn content of these products -> risk of neurotoxicity (infants uniquely sensitive); Mn exposure associated with long term effects on learning ability until after 1 year of age
phosphate compounds, particularly phytic acid (phytate, hexaphosphoinositol) -> decrease the bioavailability of some nutrients
At what age are infants developmentally ready for new foods? What has developed?
4-6 months
teeth have developed
ability to swallow solid foods
What are indications of infant readiness for new foods?
the infants weight has doubled
consumes >32 Fl. oz daily of formula and is still hungry
consumes 8 Fl. oz and is still hungry <4 hours later
sits with support, controls head movments
What does Beikost mean?
introduction of solid foods in addition to breast milk and infant formula
What are the risks of introducing weaning too early?
increased morbidity due to diarrhea and food allergies
under-nutriton due to the normal decrease in maternal milk production as the infant is withdrawn from the breast
may increase the risk for allergies and maybe diabetes
increased risk of choking
rejection of food leading to adverse relationship b/w child and caregiver
What are the risks of introducing solid food too late?
growth faltering
decreased immune protection
under nutrition when exclusive breast feeding or formula feeding becomes inadequate
inadequate energy and protein intake and deficiencies of Fe, Zn, vit A and vit D
feed adversion
oral maturation develops upon _____________
exposures to new textures and flavors
3- 12 months is an important developmental period where the infant learns to do what actions?
learns to chew
transfer food to the back of mouth and swallow
What development occurs at 10 weeks?
tongue ceases to come forward
extrusion reflex
What development occurs at 3-6 months?
palmar grasp
At ___ months infant can move head forward and turn head away if full or disinterested
4
At what ages does a greater need for additional protein and Fe coincide with more mature chewing patterns?
6-8 months
What is rotary chewing and when does it develop?
lateral jaw movements
usually at 8 months when infant develops pairs of opposing teeth
6-8 months is a critical period of development in relation to eating. What does it require?
requires more specific stimulus of introduction of solid food
otherwise it is more difficult accepting foods later, increased risk of nutrient deficiencies (Fe)
child increasingly reluctant to try new tastes; manipulative behavior
1-3 years the child is still developing __________________________ increasing its ability to eat
orally and muscularly
at what age can the infant hold the bottle by itself
8 months
what foods should be added to the diet of a 4-6 month old child
iron fortified rice cereal, followed by other single-grain cereals, mixed with breast milk, formula, or water
perhaps vegetables before fruits so the baby will learn to like their less sweet flavors
what foods should be added to the diet of a 6-8 month old child
infant breads and crackers
mashed vegetables and fruits, and their juices
if energy and protein requirements are met then _____________________________ deficiencies are unlikely.
vitamin, mineral and trace element
What actions during feeding are developmentally important for infants?
playing with food (splash, crumble, drop, etc.)
learns about height and distances
What action supports self feeding skills?
the ability of the infant to transfer objects from hand to mouth such as breads, biscuts and crackers (6-8 months)
What foods should be avoided before 4-5 months? Why?
spinach, collards, carrots, beets, and turnips
nitrates causes methemoglobinemia
What is methemoglobinemia?
impairs oxygen binding
How do you test for allergies?
What allergies account for 75% of all allergies?
wait 3 days after the introduction of new foods to check for allergic symptoms
cow's milk, egg whites, peanuts
What reduces the risk of allergies?
exclusive breast feeding in the first 6 months
why should the use of fruit juices be limited?
excessive intake of sorbitol is harmful to infants
dont feed before 6 months
grape juice is preferable as orange can cause allergies and apple and pear have too much sorbitol
juice given in a bottle can lead to dental carries
What is sorbitol? and why is it harmful to babies?
sorbitol is a reduced alcohol derivative of glucose (in fruit juices eg apple, peach, pear,and plum)
sorbitol proceeds unchanged to the colon-> osmotic effect -> fluid enters the colon -> diarrhea
What is infant colic associated with?
associated with CHO malabsorption from fruit juices containing sorbitol and a high fructose:glucose ratio
malabsorbed CHO produces excess hydrogen gas
increase in breath hydrogen gas excretion levels
Describe the amount of breast milk given to 4-6 month olds, 6-8 month olds, and 9-12 month old.
4-6: breast feeding can continue
6-8: decreased from 150 mg/kg to 600-800mL/day
9-12: 600-800 mL/day
Describe the type of Fe fortified cereals for infants, cooked strained porridge given to 4-6 month olds, 6-8 month olds, and 9-12 month old.
4-6: add
6-8: add
9-12: add different textures- infant cereals with fruit pieces, cereal bits
Describe the type of meats, beans, egg yolk given to 4-6 month olds, 6-8 month olds, and 9-12 month old.
4-6: none
6-8: add strained
9-12: gradually eliminate strained meats and introduce table meats.
Describe the type of fruits given to 4-6 month olds, 6-8 month olds, and 9-12 month old.
4-6: none
6-8: add strained
9-12: gradually eliminate strained and introduce chopped and well cooked
Describe the type of vegetables given to 4-6 month olds, 6-8 month olds, and 9-12 month old.
4-6: none
6-8: add strained; prepare hygienically and with no added sugar, salt, fat, and oil
9-12: gradually eliminate strained foods and introduce table foods
Describe the type of juice or formula by cup given to 4-6 month olds, 6-8 month olds, and 9-12 month old.
9-12: add
Describe the type of finger foods such as biscuits or toast given to 4-6 month olds, 6-8 month olds, and 9-12 month old.
6-8: add those that can be secured with a palmar grasp
9-12: increase the use of small finger foods as the pincer grasp develops
Describe the type of well cooked mashed or chopped table food given to 4-6 month olds, 6-8 month olds, and 9-12 month old.
9-12: add
What skills do infants require for eating by 2nd year of life?
to develop a sense of taste and acceptance and enjoyment of different foods
attitudes and practices which from basis for lifelong health promoting eating patterns
How should food be served?
in a casual, relaxed manner
balanced food choices should be offered but child should be allowed to have food preferences (choices normally change as the child ages)
children that are pushed to eat new foods are less likely to try than if left by themselves
What is a goal of early feeding?
establish eating in moderation
let infant stop when he or she is full
encourage eating in quite voice
respect infants caution regarding eating
What can forcing a child to eat result in?
frustration of care giver
making child resentful
power struggle
what controls how much a child chooses to eat?
the appetite center of the brain
How should new foods be introduced to childen?
introduce new foods at the beginning of the meal
crunchy foods better liked than overcooked foods
portion sizes: 1tbs/year of age
do not force new foods on a child
do not force a child to clean plate
introduce foods one at a time no mixed dishes
see if allergy develops
What foods should be avoiding in children under 3 due to their choking risk?
whole nuts
popcorn
grapes
large berries
peanut butter
marshmellows
ice cubes
hot dogs in chunks
in general hard, small, round smooth and sticky solid foods
no running or playing while eating
Why should honey be avoided?
botulinum spores present in honey or corn syrup
spores resistant to pasteurization, can germinante in GI tract -> toxin
SIDS
decreased feeding, weakness, respiratory distress, and constipation
why should caffeine consumption be avoided?
hyperactive behavior
one 12-oz cola= 50 mg caffeine =>equivalent on a body weight basis of consuming 8 cups of coffee for the (175 lbs.) adult
sleepllessness, restlessness, irregular heartbeats, and decreased attention span
Describe Iron Deficiency Anemia in children.
most preventable nutritional deficiency in children in North America
greatest risk is in children <5 years
rapid growth in the 1st 1-2 years leads to an increased risk
difficulty chewing meats
associated with excessive cows milk intake (milk babies)
associated with excessive exposure to lead
Why should cow's milk be limited to 2-3 cup/day in children?
it displaces Fe rich foods
microscopic GI bleeding caused by excessive unheated milk intake
What are sources of lead for children?
factory pollution
power plant emissions
lead in water
lead in air
lead in pipes
lead in oil paint
lead dust on pets
lead in food
lead in soil
lead dust on toys
lead in food cants
lead in old or imported pottery
waste incinerator fallout
T or F
nutritious food choices should be eliminated or restricted b/c of fat content
F
For early adolescence emphasize energy intake ____________________________
adequate to sustain growth with a gradual lowering of fat
When are fat intakes currently recommended appropriate?
when linear growth has stopped
What are the health risks of low fat diets in children?
controversial effect on long-term modifications on serum CH
increased risk of micronutrient deficiencies (Ca, Zn, Vit A, Riboflavin)
risk of growth stunting with excessively low fat diets
EFA deficiencies
higher intake of candy and sugar and lower intake of milk products leading to lower intake of protein, Ca, riboflavin, vit A
predisposed to increased risk of ED implied message that all fats are bad
What is an effect of decreasing meat intake in children?
more fiber from complex CHO
increased fiber intake + Lower animal protein ---> decreased essential mineral bioavailability (phytates and oxalates)
linear growth affected by Zn deficiencies cause by higher intake of plant foods
What are feeding problems associated with?
diarrhea
constipation
colic
refusal to eat
some related to feeding difficulties induced by parents: high anxiety, ill health of mother, breast feeding problems
refusal to eat is usually associate with:
behavioral problems
failure to thrive
impaired growth
recurrent infections at 2 years of age
at 4 years of age may experience catch up of growth but may still have feeding difficulties and hyperactivity
What are some consequences of lack of breakfast?
associated with poor attention span
decreased problem solving abilities
my indicate poor nutritional intake in general
What is failure to thrive?
a downward growth deviation from the age and gender norms
responsible for 1-5% of pediatric hospitalizations
more common in children <1 year old
stunted= impaired height gain
wasted= weight loss of decreased rate of weight gain
organic and non-organic causes; many cases are a mix of the 2
causes: medical, psychological, nutritional, and developmental
associated with delayed motor skills, language acquisition, social skills
associated with refusal to eat
What are organic causes of failure to thrive?
congenital heart defect
malabsorption syndromes
infections
anemia
heart and renal problems
endocrine problems
intellectual developmental delay
organic = disease
What are non-organic causes of failure to thrive?
abnormal development and behavior of child
distorted relationship b/w care giver and child
maybe associated with deprived background or high income parents with distorted health beliefs
nonorganic= causes external to infant= majority of FTT cases
What are the 3 general patterns of FTT?
decreased head circumference, weight and height <5th percentile
-normally intellectually handicapped
- could be inpart due to mechanical feeding difficulties such aas extrusion response
normal head circumference; weight is impaired but height is normal
-constitutionally short stature, chronic disease such as malabsorption, endocrine disorders (cystic fibrosis)
-these disorders associated with poor utilization of calories and nutrients (CF, milk intolerance allergy, parasites) or food not well retained
normal head circumference, lower weight and greatly lowered height
-normally malnutrition related including poverty or infant behavioral problems
-also macrobiotics (insufficient vit D [higher incidence of rickets], calories, protein, Fe, and riboflavin intake)
