Nutrition Module 6

  1. the desire of all pregnant moms
    to have a healthy baby
  2. What can help determine the outcome of pregnancy
    • moms health
    • social support mom has
    • environmental factors
    • nutrition
    • medical care
  3. How to ensure healthy pregnancy
    mom should be aware that care should begin prior to conception
  4. Care before conception
    • make sure that mom is taking in adequate vitamin and minerals prior to conception and throughout preg
    • mom should have a healthy body weight
    • mom should control existing health conditions (diabetes, hypertention etc)
    • avoid teratogens (compounds that can cause birth defects)
    • look at special groups (teen moms at high risk and need additional education and support)
  5. Healthcare of mom and newborns
    • one would expect a low mortality rate for both mom and baby.
    • Unfortunately, despite the availability of health care, either through a private company or programs that are available for low income and needy moms, the rate of infant mortality is among the highest in the world
    • teen moms even at more risk bc they are more likely not to seek care during their pregnancy
  6. Normal pregnancy length
    40 weeks, divided into 3 trimesters
  7. First trimester
    • at conception when egg and sperm unite, zygote forms
    • over the next 14 days, cells divide rapidly. this is the Blastogenic stage
    • By day 14 an embryo is formed
    • weeks 2-8 are the embryonic stage
    • embryonic stage is where the organ system develops
  8. Blastogenic stage
    14 days after conception, zygote cells are rapidly dividing
  9. Embryonic stage
    • weeks 2-8 of preg
    • this is where organ system develops
    • week 5: heart begins to beat
    • week 8: the embryo is known as a Fetus

    week 9- birth- different periods of growth occur
  10. Fetal stage
    week 9- end of preg
  11. Why is prenatal care so important
    • look at all of the things that happen just days to weeks after conception- zygote to embryo to fetus 
    • many times, mom does not even know she is pregnant until 2nd month of pregnancy, so need to be prepared nutritionally
  12. Pregnancy Diet
    • "I'm eating for 2" doesn't mean quantity, esp during first part of pregnancy
    • need to eat the quality for 2
  13. Second trimester
    • a developmental period
    • hands, feet, arms and legs develop
    • your baby begins to look like a baby

    mom: breasts enlarge, more fat tissue (to help with breastfeeding) increased blood volume, increased absoroption of vitamins and minerals
  14. Third Trimester
    • a period of growth
    • fetus doubles in length and increases in weight to 7-9lbs at delivery
  15. placenta
    • provides oxygen and nutrients from the mothers blood to the fetus 
    • transfers fetal waste to mom for excretion
    • the amount of nutrients being transported will help determine the weight of the baby and length of gestation
  16. Healthy baby chances
    an infant born after 37 weeks, which is the period of intrauterine growth, and weighs more than 5.5 pounds has a chance at more positive outcomes, less chance of medical issues, and greater quality of life
  17. Low birth weight infants
    infants weighing less than 5.5lbs at birth
  18. Preterm infant
    those born prior to 37 weeks
  19. Small for gestational age
    a baby who is born full term but less than 5.5 pounds
  20. at risk infants
    low birth weight, preterm, and small for gestational age infants are more likely to have increased medical conditions and delayed growth in early months of life
  21. Factors increasing baby health chance
    • an adequate diet
    • education for mom
    • proper prenatal care
  22. Nutrient needs during pregnancy
    • calories
    • adequate weight gain
    • increased protein and carb needs
    • increased vitamin needs
    • increased mineral needs
    • fitness and avoiding teratogens
  23. calorie needs during pregnancy
    • during first trimester, increased calories are required to support growth and development of fetus
    • eating for two: calorie needs don't double, but the need for certain nutrients increase ~50%
    • during second and third trimester, calorie needs increase ~20%
    • make sure youre gaining weight and eating a wide variety
  24. adequate weight gain (nutrient needs during pregnancy)
    • a healthy weight gain of 25-35lbs during pregnancy- good predictor of a healthy preg
    • weight gain should be monitored over course of preg
    • norm: 2-4lbs Tri1 followed by 1lb weekly during the rest of the preg
    • the chance for complications increase when preg mom is overwieght or obese or if baby is larger than normal, so monitor calories
    • weight gain for overweight/obese moms is usually less than 25lbs while a teen or someone underweight may gain more
    • everyone has their own history and needs so consult a doc for diet advice and weight advice
  25. Increased protein and carb needs (nutrient needs during pregnancy)
    • most women eat enough protein
    • preg moms require 25g more than the recommended daily amount, but this is easily met without dietary changes
    • adequate carbs and protein are required to meet energy needs and for growth
    • if inadequate carbs, body will use fat for energy and ketones will be produced
  26. Ketones in pregnancy
    • inhibit brain development of fetus
    • so eat carbs to avoid fat breakdown and protein for muscle maitenance and repair
  27. Vitamin needs (nutrient needs during pregnancy)
    • vitamin needs increase, esp B vitamins
    • b vitamin increased need easily met through a normal diet, EXCEPT folate
    • plan your menu to ensure adequate intake esp of folate
  28. Folate need in pregnancy
    • needed for cell development and DNA synthesis, and RBC development
    • without adequate folate the preg mom may get anemia
    • also inadequate folate prior to conception and early in preg is correlated to higher risk of neural tube defects
    • in some instance, a supplement is needed, but plan meals carefullly. 

    all grain products now fortified with folate as a precautionary measure to lower risk of neural tube defects
  29. Increased mineral needs (nutrient needs during pregnancy)
    • need increased minerals, esp iodide, zinc and iron
    • if you eat animal products, iodized salt and fortified breakfast cereals youll meet the iodide and zinc requirements
    • iron needed to make hemagloben
    • women in general have a higher iron need bc of periods, but during pregnancy even more is needed bc increased blood volume and iron also needs to be provided to the fetus
  30. iron deficiency anemia in pregnancy
    • can lead to preterm delivery, low birth weight, increased risk of fetal death
    • animal products and fortified breakfast cereals are good sources
    • combine plant iron sources with vitamin C rich sources to increase iron absorption
  31. Fitness and teratogens (nutrient needs during pregnancy)
    • moderate levels of physical activity are encouraged daily
    • avoid alcohol and other known teratogens
  32. Known Teratogens
    • caffeine
    • drugs (overcounter, prescription and illegal)
    • alcohol
    • tobacco
  33. Tobacco in pregnancy
    increases risk of miscarriage, stillbirth, preterm delivery and low birth weight infants
  34. Alcohol in pregnancy
    linked to fetal alcohol syndrome, which can result in physical abnormalities, mental disabilities and growth retardation
  35. drugs in pregnancy
    increase risk of Low birth weight, preterm delivery, miscarriage, birth defects and infant addiction
  36. Common changes that occur during pregnancy that may affect appetite and intake
    • heartburn
    • morning sickness
    • constipation
  37. heartburn in pregnancy
    • hormones produced by the placenta relax GI tract muscles. which can allow backflow of stomach contents into esophagus, which gives a burning sensation
    • avoid foods that trigger the reflux (spicy, high fat)
    • avoid lying down for 1hour after a meal 
    • eat small frequent meals
  38. Constipation in pregnancy
    • as the fetus grows intestinal muscles relax causing constipation
    • increase fiber in diet
    • increase fluid consumption
    • regular moderate exercise with dr.s approval will help keep the gi tract functioning (its a muscle)
  39. Morning sickness
    • pregnancy related nausea and vomitting
    • may interfere with a woman's intake and can be triggered by the smell of food or hormone changes in pregnancy
    • avoid greasy foods
    • eat smaller meals
    • have good ventilation when cooking
    • avoid large amounts of liquid at one time
    • can occur at any time of day
    • more common during first trimester, symptoms can persist throughout preg
    • while annoying, symptoms can be managed with dietary changes, and present little risk
  40. Special situations during pregnancy that can have more severe health consequences
    • physiological anemia
    • gestational diabetes
    • pregnancy-induced hypertension (aka preeclampsia)
    • pica
  41. Physiological anemia
    • occurs during pregnancy as the blood volume increases and the concentration of RBCs is diluted
    • if iron intake is too low to meet increased needs of preg, anemia develops and can have negative consequences on mother and baby
  42. Gestational diabetes
    • may occur sometime after week 20
    • hormones made by the placenta may interfere with insulin production and blood glucose control
    • as a result, blood glucose levels rise bc insulin levels are not sufficient to transport the glucose from blood into the cells
    • women over 35, family history of diabetes, or overweight before preg are most at risk
    • blood glucose levels often return to normal after delivery, but mom then has increased risk of type II diabetes later in life
    • if not controlled during pregnancy, can lead to a large baby (13-14lbs) requiring a c section and increased risk of trauma at birth
  43. Pregnancy induced hypertension (hypertension is high blood pressure)
    • aka preeclampsia- the early form, where bp just begins to rise
    • or eclampsia in the severe form
    • can be dangerous to both mom and fetus
    • edema of the tissues occurs and increased blood pressure, protein in urine and changes in blood clotting
    • if untreated: kidney failure, convulsions and death may result
    • women under 17 or over 35, family history of pregnancy induced hypertension or overweight/obese most at risk
    • a good dietary intake with additional calcium and limited sodium appears to help prevent this
  44. pica
    • an abnormal craving for both food and nonfood items
    • should be discussed with doctor
    • a nightly craving for ice cream and pickles is harmless, the desire to drink a floor cleaner or eat chalk is not
    • cravings are usually caused by a nutrient deficiency which once corrected eliminates the cravings
  45. Breastfeeding
    • moms who were concerned about their diet during pregnancy and wish to ensure proper nutrition for baby after birth, this can be a great choice
    • American Dietetic Association and American Academy of pediatrics reccommend breastfeeding for first year
  46. Breastfeeding occurance
    although its the preffered nourishment for baby, # of women who breastfeed is lower than recommendation outlined by Healthy People 2020
  47. Factors that can influence a woman's decision to breastfeed vs bottlefeed
    • education concerning breastfeeding
    • social concerns
    • working outside the home
    • physical inability to nurse
  48. Education concerning breastfeeding
    • #1factor
    • misinformation about bfeeding can cause a women to choose formula
    • obstetricians and nurses can help dispel the misinformation and guide the new mom through process
    • short hospital stays after delivery has negative affect on number of women who choose bfeeding
    • new moms need knowledge and support over the first week to ensure feeding is going well
    • lactation consultants are a valuable resource for info and provide help and support as questions or concerns arise
  49. La Leche League
    • offers classes in breastfeeding and provides support for bfeeding moms
    • most communities have a local chapter
  50. Social concerns related to breastfeed
    • social concerns about feeding in public places
    • second major factor
    • women should be assured that breastfeeding can be done modestly and successfully almost anywhere
    • often times people dont even know breastfeeding is occuring
  51. Working outside the home in relation to breastfeeding
    • in many families, mom has to work
    • can make breastfeeding difficult
    • 3rd biggest issue
    • breast pumps can be used to collect milk that can then be stored in the fridge and freezer
    • this milk can be used during th day and the baby can nurse in the evening
    • if this becomes to difficult, you can do a combination of formula and breastfeeding
  52. Physical inability to nurse
    • for some women its impossible to nurse due to breast or nipple structure
    • for others, the demand of the baby might be larger than the amount of milk they can make
    • working with consultants and getting support/advise from other moms can help
    • in other cases, formula may be the best option for baby and mom
  53. breastfeeding in the developing world
    • in underdeveloped countries, breastfeeding is almost always the healthiest choice and the most important
    • lack of sanitary water and limited education about formula prep could cause illness if the infant is formula fed
    • mom may also try to stretch out the formula as long as possible and dilute it to save money
    • many times, mom will start breastfeeding, and if she becomes pregnant again afterward, and must wean the infant off too early which can lead to malnutrition and death
  54. Production of breast milk
    • in preg, the body readies the breast by increasing the amount of fat in the breast tissue and maturation of the structure
    • hormones stimulate these changes and produce lobules
  55. lobules
    • sac like strucutres in the breast for milk
    • formed by hormones during pregnancy
  56. Prolactin
    after birth, this hormone is secreted by the pituitary gland to produce milk
  57. Letdown reflex
    as the infant nurses, this reflex causes the release of milk from the milk ducts in the breasts
  58. Oxytocin
    • a hormone important for breastfeeding success
    • stimulates the lobules in the breast which in turn stimulates the letdown reflex
  59. How long does it take to make a breastfeeding routine
    2-3 weeks for a feeding routine to be established and for milk supply to meet demand
  60. What does the breastmilk look like
    • the first few days after delivery: a think yellowish substance called colostrum
    • several days following delivery: the milk composition changes and has a thin watery bluish appearance (but still very high in nutritional quality)
  61. colustrum
    • thick yellow substance released from the breast in the first few days
    • rich in protein and immune factors that protect the intestinal health of the newborn
    • so important, even if you can just get a mom to breastfeed for a few days to give this to baby
  62. What is one of the biggest differences between breastfeeding and formula feeding
    • a mother's breastmilk adapts to her infants individual requirements
    • ie: the amount of fatty acids produced. we need fatty acids for the synthesis of brain tissue and CNS development. Moms milk for preterm infant had more fatty acids than moms milk for a full term infant
  63. Cows milk for an infant
    • formula is fine, but cows milk should NEVER be given to an infant under a year
    • cows milk is too high in protein and minerals for the baby's GI tract
    • they cant digest the protein
    • if they do eat it before a year it can cause digestive disabilities and food allergies
  64. Formula milk
    • made to meet infant needs
    • a variety of types are available to meet different needs
    • still an accptable way to feed
  65. How to ensure adequate milk production
    • bfeeding mom needs to get plenty of rest
    • find a relaxed atmosphere to nurse in
    • eating eathy
    • hydration- 13 cups fluid per day
  66. Nutrient needs during lactation
    • similar to what a woman needs during 2nd and 3rd trimesters of preg
    • increased need for vitamins A, E, C, and riboflavin 
    • increased need for many minerals
    • calorie needs are higher in lactation than during pregnancy
    • hydration very important- drink 13 cups fluid per day for adequate milk production
    • a diet that provides the proper amount of calories (ask dr how much), moderate fat and a variety of fruits, veggies, whole grains and dairy will meet bfeeders needs
  67. Other benefits of breastfeeding
    • helps mom recovery from the pregnancy faster and return to her pre-preg weight 
    • convenient and economical
    • while it provides advantages over bottle feeding with formula, formula meets an infants needs and promotes adequate growth
    • a mother should be supported whether she chooses bmilk or formula
  68. calorie and nutrient requirements in the first year
    During the first year of life, an infant requires more nutrients and calories per pound of body weight than in any other time of life
  69. Infant weight changes
    • rapid growth occurs
    • infant will double their weight during the first 4 to 6 months of life
    • weight will triple in the first year
    • after the first year, growth slows but adequate nutrients and calories are necessary to support brain and physical growth
  70. Undernutrition in children
    • Children who do not receive adequate nutrients are at risk 
    • causes kids to be short and underweight for their age
    • more prevalent in developing countries where bfeeding ceases and the child relies on rice as their main staple in diet with minimal protein
  71. Best way to track child growth
    • use a growth chart
    • from birth to 36months you can look at length for age and weight for age and measure head circumference to make sure kid is growing the way they should
    • the growth pattern can be tracked and compared to other infants of the same age based on percentiles
    • these percentiles represent the rank of the infant among 100 peers of the same age and gender
    • the pediatrician will weigh and measure length and circumference of infant and use growth charts
    • an infant at the 60% percentile for weight would have 40% peers weighing more and 59% who weigh less
    • there are additional growth charts for people age 2-20 based on gender, weight and height for age
    • BMI can also be used to assess growth
  72. Failure to thrive
    • when poor growth occurs in children younger than 2
    • can be caused by inadequate intake related to disease (constant diarrhea, intestinal problem or some other physical or health problem)
    • usually occurs due to inadequate feeding practices
    • parents may lack information on feeding, be inexperienced and need education to care for the kid, or have lack of resources for food procurement

    • dr will be alerted to the delayed growth by tracking growth pattern and can intervene
    • if not addressed, failure to thrive can lead to poor growth, impaired mental development, and behavioral issues
  73. BMI in children
    • can indicate a risk for overweight and obesity in children and adults
    • in children a BMI of 85 percentile or higher can indicate risk for obesity
  74. How long should the diet be milk
    • human milk or infant formula should make up the total diet for the first 4-6 months
    • parents should follow what the dr. says
    • even after solid food is introduced, human milk or formula should be given for the first year
  75. Infant calorie requirements
    • infants require 2-4 times more calories per kg of body weight than what an adult requires
    • both breast milk and infant formulas are rich in fat to provide a concentrated source of calories as well as the fat needed for brain and nervous system development
  76. Brain and eye development
    • requires the fatty acids arachidonic acid (AA) and docosahexaenoic acid (DHA) 
    • they are long chain fatty acids
    • human milk provides both of these, esp if mom eats fish
    • recently, infant formula has been supplemented with them as well
  77. Carb and protein needs of the infant
    can be met with a varied diet with typical intake of human milk/formula and solid foods
  78. too much protein in infant
    • excess protein should be aboided to prevent putting stress on infants kidneys as they try to clear the waste products from protein metabolisms
    • excess consumption or early introduction of proteins can lead to food allergy as the infants immune system reacts to the protein
  79. 3 nutrients that may need to be supplemented in infants
    • vitamin K
    • iron
    • fluoride

    vitamin D in breastfed
  80. Vitamin requirements of the infant
    • formulas provide all vitamins needed except vitamin K
    • breastfed kids need a vitamin D supplement
    • if the nursing mom is vegan, the infant will need b-12 supplementation
    • all infants given a vitamin K shot at birth to hel with clotting
  81. Infant mineral needs
    • iron is crucial for mental development. lack of it leads to anemia
    • most infant formulas are iron fortified
    • breast fed infans should have adequate amounts provided in the milk until ~6months when solids are introduced
    • if mom was iron deficient in preg, or while nursing, infant may require a liquid iron supplement
  82. Anemia in infants
    if untreated, the infant may experience long term effects of impaired mental development, motor development and behavioral issues later in life
  83. Fluoride supplements
    recommended in infants over 5 months who are nursing and those on formula prepared with non-fluoridated water
  84. Water needs of infant
    In most cases both human milk and formulas provide enough water to meet the needs
  85. Dehydration in infants
    • could occur due to diarrhea, vomiting, fever, or excess sun exposure
    • supplemental water should be given if this occurs
    • extreme dehydration requires medical attention to prevent loss of kidney function
  86. Signs of infant dehydration
    • dark yellow or strong smelling urine
    • lack of wet diapers
    • dry mouth and lips
    • lethargy 
    • absence of tears when crying
  87. Cues that infant is ready for solid food
    • parents for watch for them around 6months
    • between 4-6 months infant will gain head and neck control and be able to sit up with support- they can almost sit up on their own
    • the extrusion reflex will dissappear
    • child can digest protein and starch
  88. Extrusion reflex
    • thrusting of the tongue that pushes food out of the month
    • occurs in infants not ready for solid food
  89. Digestion in infants ready to start solid foods
    • digestive tract and kidneys have matured and kid can digest starch and excrete waste products from the protein
    • whole proteins better absorbed and risk for developing allergies is decreased (even though at this point, chances of allergies start to decrease)
  90. What should you give an infant ready for solids?
    • rice cereal- its less likely to cause allergies
    • begin with a teaspoon of cereal and gradually increase the amount over the next seven days
    • after a week the next food can be introduced
  91. Introducing new foods
    • introduce new foods one at a time 1 week apart, and monitor for allergies
    • order to introduce: cereals, vegetables, fruits, meats, and egg yolks gradually
    • By 1 year your baby should be eating a variety of foods
    • you can do commercial baby foods or make your own by pureeing or grinding food at home with very little seasoning or spice
    • parents should stay calm and expect new foods to not be recieved well. may need to introduce several times
  92. Why should you introduce vegetables before fruit?
    • fruits are sweeter in taste than veggies
    • if you start with fruits you may have a hart time getting them to eat veggies
  93. Foods that should never be given to an infant under 1year
    • these foods can cause allergies or be choking hazards
    • Honey: contains spores of botulinum which could lead to botulism. spores are harmless to older children and adults but can be fatal for those under a year. its a neurotoxin serotype A (botox)
    • Egg whites, chocolate and nuts: commonly cause allergic reactions (nuts are choking hazard too)
    • choking hazards: small round foods like grapes or hotdogs, sticky foods (peanut butter), hard foods like candy and popcorn. These extend through age 5
    • Excess apple or pear juice: excess juice may replaceing human milk or formula and infant may not be getting enough calcium for bone development. can also lead to failure to thrive if consumed instead of solids. linked to poor oral health and obesity. contain fructose and sorbitol which can cause diarrhea
    • cow, goat and unpasteurized milk: due to inability to digest the proteins in this milk before 1year
  94. When can self feeding begin
    • 6-7 months
    • this is when coordination develops and the infant is eager to explore and experiment with food
  95. appetite in preschool
    • between ages 2-5 toddler growth slows and appetite declines
    • trying to meet nutrient needs can be more difficult but can be accomplished with some careful meal planning and adding snacks
  96. How to feed preschoolers
    • offer nutrient dense foods with limited sugar, fat and sodium to help establish ahealthy eating pattern that can be followed for the rest of the kids life
    • your job as a parent is to be a good role model- offer the food and provide positive role modeling by eating behaviors and eating a variety of foods
    • offer foods in a variety of ways- steamed veggies with cheese sauce, cooked veggies or raw veggies with dip to help improve acceptance
    • allow them to help with the meal, let them choose fruits/veggies at the store or letting them mix the salad making mealtime pleasant
  97. One bite rule
    • encourages the child to try one bite of food
    • can be helpful in trying a variety of foods
  98. Preschool children food preferences
    • over time they develop their own preferences
    • these kids develop food jags
  99. Food jag
    • the desire to eat the same food or only a certain color food at every meal
    • if caregivers continue to offer a variety of foods for meal and snacks the child will begin to try them and the jag will dissappear
  100. Preschool taste buds
    • they have more taste buds than adults
    • more sensitive to taste
    • crisp textures, colorful food, milk flavors and finger foods are well accepted
  101. Common feeding difficulties with preschoolers
    • my child is a picky eater
    • my child always wants a snack
    • my child wont eat vegetables
  102. My child is a picky eater
    • preschoolers have small stomachs and adults often overestimate how much they need to eat
    • a good measuring tool- 1 tbsp or each food item per year of life- if you have roast beef, potatoes, peaches and they are 3 they should eat 3 tbsp roast beef, 3 tbsp of pots and 3 tbsp of peaches. may not look like a lot but its enough
    • children should be allowed to pick the amount of grains and milk to eat based on their appetite
    • if excess milk consumed, parents may need to limit intake to allow them to have room for other food groups
    • within reason, children should be allowed to express their independence and food prefereence
    • kids preference may be based on temp, taste, appearance and texture- parents can encourage this by offering a variety of healthy foods
    • eating habits over the course of a week are more important than choices at one meal
  103. My child always wants a snack
    • bc kids have small stomachs, snacks are important
    • offering 6 small meals a day, focusing on nutrient dense choices will enable your child to meet their nutrient needs
    • however- avoid juice, diet soda or even milk in large quantities as this will decrease the amount of solid foods eaten
    • whole fruits and veggies are a better choice than juice and water with some of these snacks can be beneficial
    • if juice offered give no more than 4-6 oz per day for kids 1-6
    • for 7-18year olds no more juice than 8-12 oz/day
  104. My child wont eat vegetables
    • fruits are often better accepted than veggies bc the natural sugar makes the sweet
    • encourage your child to eat the rainbow
    • look through magazines together or examine the different fruits and veggies at the grocery store and their many colors
    • the more color on the plate, regardless of whether its a fruit or veggie= more nutrients
    • have the child help prepare the vegetable and offer it in many ways to improve acceptance
  105. do preschoolers need a multivitamin
    • a toddler or preschooler who eats a variety of foods from many food groups is likely meeting their nutrient needs
    • in most cases a multivitamin not reccommended for children
    • exceptions: child who is ill and unable to eat a healthy diet or a child with very erratic eating habits
    • in the exceptions case, the american academy of pediatrics says a child may benefit from a children's multivitamin that does not exceed 100% of the daily value
    • still, focus should be on healthy food rather than supplement
  106. Nutrition concerns that affect preschoolers
    • iron deficiency anemia
    • constipation
    • dental caries
  107. Iron defeciency anemia in preschoolers
    • usually manifests between 6 and 24 months
    • oxygen supply to cells declines and can lead to decreased energy an dlearning ability as well as decreased immunity and increased risk of disease
    • iron fortified breakfast cereal and a small amount of meat will provide enough iron to meet a child's needs
  108. Constipation in preschoolers
    • may be related to a medical condition
    • usually though its caused by other factors
    • increase fiber through fresh fruits and veggies, whole grains, cereals and bean to help
    • consume 4-5 cups fluid a day with the additional fiber
    • encourage the child go to the bathroom when they feel the urge
  109. Dental caries in preschoolers
    • occur when sugar from food and drink is allowed to ie on the teeth or gums for a period of time
    • to prevent them from developing never put a baby to bed with a bottle of milk, formula or juice
    • wipe your infants gum and teeth after drinking and eating
    • for toddlers and preschoolers avoid sticky high sugar snacks and encourage brushing with a small amount of fluoridated toothpaste
  110. Subgroups of preschoolers who require specific diet plans
    • children who follow total vegetarian diets: emphasis should be placed on adequate intake of plant sources of protein, vitamin D, vitamin B12, calcium, iron and zinc (all of these are abundant in animal products, but require careful meal planning for vegetarians)
    • autistic children: nutritional intervention for these is in early research stages. gluten free, casein free diets and supplements of vitamin B6, magnesium, probiotics and essential fatty acids can be beneficial
  111. Feeding school aged children
    • these years bring additional loss of control from parents and increased pressure from peers, the media and the childs own exertion of their independence when making food choices.
    • studies show that few school aged children meet their daily requirements from all 5 food groups and their diets lack esp in calcium, iron and zinc and are high in sugar and fat
  112. Concerns that occur during the school age years that may impact a child's nutritional status
    • lack of regular meal times
    • excess consumption of saturated fat
    • increasing incidence of overweight and obesity
    • early onset of cardiovascular disease and diabetes
  113. Lack of regular meal times in school age children
    • particularly breakfast
    • consumption of reg meals is important but breakfast often sacrificed so the child can sleep 10 extra minutes
    • in other cases, kids dont like breakfast foods or arent hungry in the morning
  114. Why is breakfast important
    • you are breaking the fast
    • your body requires fuel for physical activity and to fuel your brain
    • kids need to eat breakfast to meet their vitamin and mineral daily requirements
  115. Ready to eat breakfast cereal
    • a good source of iron, vitamin A and folic acid
    • but no limits on what to eat for breakfast- leftovers from dinner, yogurt with granola, pizza, cheese sticks, dried fruit, a sandwich. you just want to combine a good source of protein with a carb to jump start your day and provide energy to get you to lunchtime
  116. Excess consumption of saturated fat
    • All foods can be eaten in moderation and that includes an occasional treat that is high in fat or sugar
    • but many kids eating excess fat in daily diet
    • small changes can make a big deal- switch to lower fat milk, and part skim cheese, sub lean ground turkey for ground beef, take skin off chiken, baking and broiling instead of frying. these significantly decrease fat in food
    • dont overrestrict fat- often results in the good food bad food attitude and is linked to eating disorders later on
  117. Increasing incidence of overweight and obesity
    • Childhood obesity is a serious health risk because approximately 40% of obese children become obese adults
    • it is tough to be an overweight child- health risks and social ridicule and embarassment and isolation at school
  118. Factors contributing to growing childhood obesity
    • super-sized portions
    • fast food
    • convenience foods
    • increased soft drink consumption
    • easy access to sugar laden snack foods
    • lack of physical activity- due to decreased gym time at school, lack of safe play areas and increased TV time
  119. Resolving increasing obesity in kids
    • most adults do a diet- this is not the best approach with kids
    • first step: addressing the problem and look at how much physical activity the child gets in a day
    • getting kids interested in physical activity for fun and enjoyment can help them reach a healthy weight and will set up exercise patterns for the rest of their life
    • appropriate calorie intake is important- limit high calorie foods and focus on nutrient dense choices to help a child grow into their weight
    • understand portion sizes and make small changes in food prep to allow the kid to continue to enjoy the foods they like in moderation and not feel deprived
  120. Exercise recommendation for children and teens
    health professionals reommend 60min of moderate phys. act. per day
  121. Ways to encourage physical activity in children
    • Families can play together by taking a walk, riding bikes, or trying a new sport such as rollerblading
    • Enrolling kids in community leagues or classes that focus on fun rather than competition can provide them with a variety of activities from which they have the opportunity to discover what they enjoy
  122. Early onset of cardiovascular disease and Type 2 Diabetes
    • Not many years ago heart disease and Type 2 Diabetes were usually found in overweight middle age individuals
    • today a high number of children have high cholesterol and type II dabetes
    • early screening advised
    • treatment- a balanced diet and physical activity to help the child achieve a healthy weight
    • Once a healthy weight is achieved, the symptoms of diabetes and high blood pressure generally resolve.
  123. Rapid growth and development in teenager
    • female: ages 10-13
    • ---> grow in height and begin to accumulate both lean and fat tissue
    • --->sexual development and menstration begin
    • male:12-15
    • --->much of the body weight is from lean tissue and males experience a growth in height of ~a food

    • appetites increase substantially
    • thoughts of eating healthy are not formonest in teens minds, satisfying hunger is
    • temptation everywhere
  124. food choices as teens
    • satisfying hunger
    • temptation everywhere
    • ads for snacks and drinks aimed at teens
    • soft drink machines at school
    • increased intake of fast food, sugary beverages, sugar laden snaks replece nutrient dense food choices
  125. what affects teen food choice
    • peer pressure, concern over appearance, and exertion of their independence all affect food choice
    • the result- most teen diets are low in calcium, iron, zinc, fat soluble vitamins and folate
  126. What can parents do to help the teen to be properly nourished
    • they have lost a lot of control- peers decide
    • gently guide teens toward healthier choices by modeling good food habits at home
    • discussing the role that nutrition plays in their development both now and in the future
    • tell them health risks from poor dietary habits that occur later in life
    • encouraging wise food choices when eating at restaurants.
  127. What can healthy eating in adulthood prevent
    • diseases that commonly manifest themselves in middle age
    • hypertension
    • diabetes
    • cardiovascular disease
    • osteoporosis
    • obesity

    can be controlled or prevented
  128. What is the fastest growing pop in the USA
    • those 85 years and up
    • aging is inevitable, not a disease
    • however, a decline in health is not a given with increasing age
    • advances in health care, food safety, and sanitation have allowed many to add years to their life
  129. Adulthood stages
    • each stage has their own unique needs
    • 19-30: Young adulthood. Transition stage where adults are exploring their independence. They are establishing a career, and beginning a family
    • 31-70: Middle adulthood. Individuals are adjusting. Maybe they have empty nest syndrome, juggling a home and kid's schedules and/or dealing with elderly parents
    • 71+: Older adulthood. This is the period of downsizing, retirement, loss of a spouse and dealing with ones own mortality
  130. Growth in adulthood
    • unlike other stages of lifecycle (except preg) there is no growth occuring
    • adulthood is a period of body function maitenance until age 30
    • after 30 we experience physical and physiological changes
  131. Aging
    • physical and physiological changes in body structure in function that occur after 30
    • normal changes
    • although aging occurs throughout adulthood, until we reach 30, the rates of cell synthesis and breakdown are in balance
    • but after 30, breakdown occurs faster than synthesis which can cause a decline in body function
    • aging is inevitable
  132. Normal Aging signs
    • graying hair
    • reduction in cell numbers
    • reduced lung capacity
  133. Is disease part of aging
    • No! 
    • Degenerative or chronic diseases dont have to be accepted as part of it
    • a healthy lifestyle with nutritious diet, exercise, adequate sleep and avoiding poor chioces (smoking and alcohol) can prevent or reverse age related changes
  134. Your choices on how to age
    usual aging or successful aging
  135. Usual aging
    • the expected progression of cell death with age and the physical changes that occur related to unhealthy lifestyle choices
    • ie: loss of bone mass, weight gain, high blood pressure and decreased lean body mass
  136. Successful aging
    • physical and physiological changes taht occur related to growing older but not related to poor lifestyle choices
    • these ppl age at a slower rate and experience age related diseases later than usual agers
    • delay of disabilities
  137. Compression of morbidity
    • delay of disabilities caused by age related disease
    • common in successful agers
  138. Factors that directly affect an individuals aging process
    • heredity
    • lifestyle
    • environment
  139. Heredity in aging
    • our genes play a role in how long we will live
    • a family history of longevity can provide the potential for a long life
    • females live longer than males
    • metabolism can impact lifepsan- thrifty metabolism= more fat storage, once beneficial, but now detrimental as we have low activity and plenty of food
    • your genes can impact your longevity but nurture plays a role too
  140. Lifestyle in aging
    • includes eating and exercise habits, and lifestyle choices such as tobacco or alcohol use
    • Nations that follow the mediterranean diet- a diet high in seasonally fresh, locally grown foods, fish, limited red meat and dairy and focuses on olive oil as a main fait are also known to have longer lives with the least incidence of disease
    • For those of legal age, moderate wine consumption with meals also has heart health benefits
  141. Where is the highest life expectancy
    • Okinawa
    • a typical diet here is plant based with rice and fish as staples
  142. Environment in aging
    • environment is our ability to make decisions
    • many of our decisions are based on the environment and current circumstances
    • education and available resources are important in decisions we make related to meal choices and health care
    • adequate shelter provides safe living conditions and protects us from the elements of physical danger
    • sufficient income is necessary for purchasing food and shelter
    • if any of these are missing or inadequate there can be negative health impacted and faster aging
  143. Benefits of consuming nutrient dense foods in aging
    • delays the onset of some diseases
    • increases physical, mental and social well-being
    • improves immune system
    • aids in recovery from illness
  144. How to increase food quality and decrease quantity consumed
    • diet low in saturated and trans fat, cholesterol, simple sugars and sodium
    • diet focused on plant based foods with minimal processing, fish, whole grains, lowfat dairy and small amounts of meat
  145. Dietary guidelines and choose myplate recomendations
    • healthy diet as previously described
    • maitenance of healthy weight through daily exercise and safe food handling practices to avoid food bourne illness
  146. Do adults follow the dietary guideline recommendations?
    • no
    • many adults continue to consume excess calories, fats, sodium and alcohol
  147. Carb changes and benefits
    exchanging complex carbs for simple ones can lower the risk of colon cancer and heart disease, prevent constipation and lower blood cholesterol levels
  148. Water intake as an adult
    • adequate water needed as we age
    • many adults confuse thirst with hunber which results in a mild stage of dehydration
    • as we age we lose our thirst sensation and by the time we realize we are thirsty were dehydrated
    • if inadequate fluids overtime dehydration symptoms will occur- disorientation, mental confusion, constipation, bowl impaction, death
  149. P
  150. Issues related to aging affected food choices
    • physical disabilities: may limit our ability to cook or shop for food
    • dental issues: ie lack of teeth or ill fitting dentures can negatively affect intake of meats
    • taste: declines and our desire to eat may decrease
    • social isolation: may limit food choices or number of meals
    • lack of income: may limit our food choices or number of meals also
  151. Adults and vitamins
    because of issues related to aging can negatively affect food choices, a multivitamin and mineral supplementation being added to their intake is beneficial for many older adults
  152. Vitamins and minerals inadequate in many adults
    • calcium
    • vitamin d
    • iron
    • zinc
    • magnesium
    • b vitamins
    • carotenoids
  153. Main factors that are related to nutrient needs of adults and nutrition concerns that occur with aging
    • physiological factors
    • psychosocial factors

    each of these have multiple components that can impact our nutrition status and affect how we age
  154. Physiological factors that impact adult nutrient needs
    • Body composition changes
    • Skeletal system changes
    • Digestive system changes
    • Chronic Disease
    • Medications
  155. Body composition changes as a physiological component that affects adult nutrient needs
    • sarcopenia: a loss of lean muscle, which leads to a decreased BMR. With this change there is an increase in fat stores and we are not burning calories efficiently
    • increase of fat stores is sarcopenic obesity
    • Aging typically leads to a more sedentary lifestyle that can cause decreased mobility, joint issues related to increased weight and decreased physical activity as well as decresed flexibility
  156. Skeletal system changes as a physiological component that affects adult nutrient needs
    • skeletal changes occur as bone loss related to osteoporosis and decreased bone progresses in both males and females
    • adequate vitamin D and calcium as well as a review of medications should be addressed to maintain bone mass
  157. Digestive system changes as a physiological component that affects adult nutrient needs
    • common in older adults related to lactose malabsorption and decreased stomach acid
    • constipation is a common complaint among the elderly due to lack of fluids, fiber and exercise as well as decreased GI motility
    • gallbladder, liver and pancreas functions also decline with age
  158. Chronic disease as a physiological component that affects adult nutrient needs
    • related to malnutrition, altered nutrient utilization and altered nutrient needs
    • affect many elderly
    • those 65+ who are in an institutional setting are at extra risk
  159. Medications as a physiological component that affects adult nutrient needs
    • can negatively impact nutritional status
    • medications can lead to loss of taste or smell, induce anorexia or interact and inhibit the absorption of nutrients
    • antibiotics can disrupt natural GI flora and delpete vitaminK
    • diuretics can lead to loss of potassium and a
  160. Psychosocial factors affecting adult nutrient needs
    • Social isolation: related to a lack of support from family and friends can lead to poor intake (they dont wanna cook for themselves they dont go out anymore)
    • Depression: can lead to social withdrawal, poor appetite, weight loss and malnutrition
    • Alzheimers Or Dementia: causes loss of memory, confusion and decreased social contact
    • Economic factors: can lead to inability to purchase food or nutrient dense food choices affecting both the quality and quantity of diet
    • a nutrition screening initiative tool that can be used to evaluate an elderly persons risk for malnutrition related to both physiological and psychosocial factors
    • a nutrient checklist that can be performed by medical personnel, family, and the oder person themselves to evaluate individual needs
  162. What does DETERMINE Stand for
    • D: Disease- Alzheimers, cancer, heart disease, etc
    • E: Eating poorly
    • T: Tooth loss
    • E: Economic Hardship
    • R: Reduced social contact
    • M: Medications
    • I: Involuntary weight loss
    • N: Needs assistance
    • E: Elderly- over 80years
  163. What if an older adult is at risk of malnutrition
    • the medical community can provide education and resources to the family to help the person obtain the help they need
    • Nutrition programs for individuals over 60: congregate meal programs, meals on wheels, SNAP, food coops, and religious and social organizations
    • The US Federal govt. subsidizes meals for seniros served in a community setting through the congregate meal programs
    • home health care and adult daycares are other options to help meet the needs of older pop
  164. Meals on wheels
    • a govt subsidized program 
    • a home delivery program
    • one or two meals can be delivered 5 days per week
  165. USDA recommendations for a specific intake of the food groups to meet the unique nutrient needs of the older populations
    • 1. Increased nutrient density
    • 2. Adequate fluid and fiber intake
    • 3. Lean meats to provide iron, zinc, vitamin B6 and B12 which are frequently inadequate
    • 4. Use of multivitamin and mineral supplement
    • 5. Modified physical activity to maintain lean body tissue and prevent unwanted weight gain from fatty tissue
Card Set
Nutrition Module 6
Module 6 exam