What are the factors associated with mortality? (4)
social and economic status
access to health care
teenage pregnancy
failture to prevent preterm and LBW births
provides healthier care for children in PA that don't qualify for medicaid
Child health initiatives program (CHIP)
education for healthcare workers to provide proper care for infants
bright futures
Indicators of newborn health status (3)
birthweight
length
head circumference (indicates brain growth)
Appropriate for gestational age for weight...what percentile?
10th-90th
small for gestational age or intrauterine growth retardation for weight...what percentile?
less than the 10th percentile
Large for gestational age for weight...what percentile?
>90th percentile
True/False: Newborn's CNS is immature and so they with have inconsistent cues for hunger
True
infant turns head toward the cheek that is touched and open mouth
rooting reflex
reflex causing tongue to move forward and backward
suckle
infants ability to control voluntary muscle movement
motor development
True/False: motor development is bottom up--starts with the legs and then head
FALSE
top down--head first then lower legs last
True/False: muscle development is from central to peripheral
true
shoulders before hands
a fixed period of time in which certain behaviors or developments emerge
critical periods
True/False: certain skills must be developed during critical periods in order for subsequent learning to occur
true
True/False: if the critical period is missed, there may be a difficulty later on
true
factors (4) that impact cognition
sensorimotor development
adequate energy and protein intake
positive social and emotional interactions
genetics
What does the fetus swallow that stimulates the intestinal lining to grow and mature?
amniotic fluid
how long does it take for the GI tract to mature
6 months
can occur due to immaturity if the gut (3)
GERD, diarrhea, constipation
factors that impact the rate of food passage through the colon (3)
osmolarity of foods or liquids
colon bacterial flora
water and fluid balance in the body
Cals needed from birth to 6 months (DRI)
108 kcal/kg/day
Cals needed from 6 moths to 12 months (DRI)
98 kcal/kg/day
Protein needed from birth to 6 months
1.52 g/kg/day (more specific)
9.1 g/day (general)
Protein needed from 7 months to 12 months
1.2 g/kg/day (specific)
11 g/day (general)
True/False: protein needs are influence more directly by body composition than every needs are
true
What is the recommendation for fat for infants
no specific recommended intake
Where do infants get their fat?
breast milk
True/False: Breast milk contains SCFA and MCFA (in addition to LCFA)
true
True/False: LCFA are easier to utilize and digest than MCFA and SCFA
FALSE
True/False: metabolic rate of infants is the lowest of any time after birth
FALSE
highest! and is related to rapid growth and so they need more calories
Why is it important for growing children to get CHO?
when CHO intake is limited, amino acids will be converted to glucose for energy and will be less available for growth
Flouride requirements for infants 0-6 months and 6-12 months
0-6: 0.1 mg/day
6-12: 0.5 mg/day
Vitamin D requirement for infants
400 IU/day
Sodium requirements for infants
120-200 mg/day
True/False: if your child doesn't follow the normal growth pattern they are not normal
False: there is a wide range of growth patterns considered normal
Newborns ____ their birthweight by 4-6 months and ___ by a year
double
triple
Typical weight gain for birth to age 6 months
~30 g/day
1.5-2.5 cm/month
Typical weight gain for 6 months to 12 months
~85-140 g/day
1 cm/month
when do practitioners stop measuring head circumference?
~ 2 years old
Types of WHO growth charts (4)
weight for age
weight for length
length for age
head circumference
True/False: since you measure growth rate over time if you find one off measurement that means ur child has a problem
false
look at trends not individual measurements
Warning signs for growth problems (3)
lack of weight or length gain
plateau in weight, length, or HC for >1 month
drop in weight without regain in a few weeks
AAP and AND recommend ____ ___ for the 1st ___ of life and continuation to ___
exclusive breastfeeing
6 months
1 year
kcals in standard formula
20 kcals/oz
kcals in preterm formula
22-24 kcal/oz
kcals in breastmilk
~20-22 kcal/oz
What is breastmilk higher in when compared to formula?
fat!
55% from BM vs 48-50% in F
What is breastmilk lower in when compared to formula?
protein but it is adequate
What type of milk should NOT be used during infancy (1st year of life)
whole, reduce-fat or skim cow's milk (doesn't include cow's milk based formula)
what is linked to the early introduction of cow's milk?
iron-deficiency anemia
linked to:
decreased iron abs due to competition with calcium and phosphorus
displacement of iron-rich foods
GI blood loss
Why is the high protein in cow's milk a problem?
too much and too harsh on the GI tract and the kidneys
True/False: there should be limited use of soy protein-based formula during infancy due to the little evidence for benefit of increase soy over milk-based
true
Why should one use a hydrolyzed formula for milk protein allergy as opposed to soy protein formula?
one can become allergic to soy
What to use for lactose-intolerant babies
reduced lactose cow's milk based formula
when do reflexes fade and infants begin to purposely signal wants and needs?
4-6 weeks
Hunger cues of infants (5)
sucking on fists
reaching for spoon
watching the food being opened in anticipation of eating
pointing at food
irritation if feeding pace is too slow
Satiety cues (6)
seals lips together
turns head away
playing with food or spoon
eating rate slow down
pushed food away
spits out food
at what age do you start introducing pureed foods on a spoon? how much?
at 6 months offer 1-2 TBSP for 1-2 meals per day
*bulk of nutrition is breast milk or formula
What must happen before the introduction of pureed food?
must be able to sit up and keep head up in high chair
Recommendations for introduction of solid foods (7)
shouldn't be overly tired or hungry
use small spoon with shallow bowl
allow infant to open mouth and extend tongue
place spoon on front of tongue with gentle pressure
avoid scraping spoon on gums
pace feeding to allow infant to swallow
first meals may be small= 5-6 spoons over 10 mins
position for young bottle fed infants
position in semi-upright position
position for spoon feeding
infant seated with back and feet supported
adults feeding infants should be:
in front of infant and making eye contact
offer water (1-2 oz) from a cup at what age?
6 months
wean infant from bottle drinking at what age?
12-18 months
true/false: changing from bottle to covered "sippy" cup with a small spout is the same as weaning to an opening cup
FALSE not the same
When to introduce soft, lumpy foods
6-8 months
when can infants chew and swallow soft mashed foods?
8-10 months
can't require much chewing (use like a mashed banana) because they aren't developed yet
Examples of first foods at 6 months (2)
iron-fortified baby cereal mixed with breast milk or water
pureed fruits and vegetables
why is rice cereal normally used for infants?
easily digest and hypoallergenic
Example of first foods at 9-12 months
soft table foods such as mashed potatoes, hot cereal, banana
add only ___ new food at a time and offer over a ____ day period
one
3-5
Foods to AVOID (8)
popcorn
peanuts and nuts
rasins, whole grapes
stringy meats
marshmallows, gum and gummy candy
hard candy and jelly beans
hot dog pieces
hard raw fruits or vegetables
True/False: Honey should not be fed to infants less than 1 year old
true!!!
honey is potential source of clostridium botulism and infants have immature gut so they can't pass the spore successfully
-spores produce a toxin which causes muscle weakness and can lead to paralysis and respiratory failure
True/False: breast milk or formula prodvide adequate water for health infants up to 6 months
True
* additional water needed in hot, humid climates after 6 months
true/false: dehydration due to illness is not common in infants
false it is common bc of diarrhea
use pedialyte
true/false: juices are not recommended before one year of age
true
due to hyperosmolality and dental carries
**avoid colas, clear/colored sodas and tea
Crying or fussiness may be interpreted as ____ resulting in overfeeding
hunger
Are babies most likely to be overfed with bottle or breast feeding?
Bottle
With breastfeeding baby stops on their own and only a specific amount of milk is produced
babies have an inherent predisposition to what taste?
sweet
____ infants may be exposed to a wider variety of flavors than ____ infants
breast fed
formula fed
Recommend a Fluride supplement at 6 months if
the family lives in an area where there is not Fl in the water
may be prescribed if the mother (who is breast feeding) is the a vegan
Vitamin B12
Is breast milk is the only form of nutrition, supplementation 400 IU per day recommended (especially if mom is not in a sunny are). Don't need for formula fed infants
Vitamin D
if exclusively breastfed it is recommended to have ____ of supplemental ___ starting at 4 months until begins on iron-fortified baby cereal
1 mg/kg/d
iron
if exclusively breastfed preterm infant, ____ is recommended starting at age 1 month until 12 months to prevent deficiency
2 mg/kg/d iron supplement
why are preterm infants iron deficient?
don't have time to build up stores
condition of irritability and excessive, inconsolable in a healthy, well-fed infant
can occur from early infancy up to 4 or 5 months and episodes may appear at the same time each day
colic
Cause of colic
unknown but may be due associated with GI upset and may be related to mother's diet when breastfeeding (cow's milk, onions)
Recommendations to relieve colic (3)
rocking and swaddling to calm infant
proper positioning during feeding
burping the infant more frequently
True/False: iron stores in the infant reflect the iron stores of the mother
True
Long term severe iron deficiency anemia may result in
long-term learning delays
Why is constipation common in infants?
the peristalsis in the GI tract isn't that great yet
Why are high fiber foods generally not recommended for constipation?
mant sources are a choking hazard
stick with baby food of fruits and vegetables
Why can diarrhea be a serious problem?
at a risk for dehydration
Why are infants at a high risk for dehydration with diarrhea? (3)
higher metabolic rate
smaller fluid reserves
dependence on other to provide fluids
What is a common cause of diarrhea for older infants
excessive fruit just intake
What causes allergic reactions?
absorption of intact proteins
What should you use if an infant is allergic to cow's milk protein (based formulas)?
hydrolyzed protein formulas
True/False: GI infections can cause a temporary lactose intolerances that resolves
True
**lactose intolerance in infancy tends to be overestimated
Nutrients of concern with vegetarian and vegan diets (6)
DHA
vitamin D
vitamin B
calcium
iron
zinc
A federally funded community based program that provides child development and family support services to low-income families with children from birth to age 3 and includes nutrition education services and helping with alcohol and drug abuse, and helping family sign up for WIC, SNAP, medicaid
