Nutrition in Infancy and Childhood. Growth of infants. Infant Growth

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Daniela Hoover
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Nutrition in Infancy and Childhood Infant Growth Infant Growth and Development To understand the dynamic patterning of infant growth To understand which factors influence growth potential- genetic,

1 Nutrition in Infancy and Childhood Infant Growth Infant Growth and Development To understand the dynamic patterning of infant growth To understand which factors influence growth potential- genetic, environmental, nutritional To describe typical patterns of infant growth To understand basic anthropometric technique for length, weight, and OFC measures To understand the principles underlying the CDC growth charts Growth of infants How is normal growth defined? What is acceptable growth? What is abnormal growth? What affects growth? Nutrient intake, other factors What predictors do we have for infant growth? Can athropometry be used to identify malnutrition? Should ethnic differences in growth play a role in clinical practice? How are growth charts most useful? Infant Growth Changes in Body Conformation Components of growth Typical growth Expected channels changes in growth 1

2 2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning is a trademark used herein under license. BMI in infancy Weight gain in the first five years of life Monitoring Growth and Development The pattern of growth varies with the stages of development. Growth is most rapid during the first year, when an infant doubles in length and weight. Malnutrition is most critical during the most rapid periods of growth: Undernutrition may lead to permanent physical, emotional, behavioral, and cognitive problems. CDC Infant Growth Charts CDC Growth Charts, 2000 Reference Population: Standard Normal Curve 50 th Percentile 5 th 95 th 2

Normal infant growth Measurements between the 25th and 75th %ile Crossing channels is not unusual 10th-25th and 75th-90th%ile measures may or may not be OK depends on pattern of measures, genetic

3 Normal infant growth Measurements between the 25th and 75th %ile Crossing channels is not unusual 10th-25th and 75th-90th%ile measures may or may not be OK depends on pattern of measures, genetic factors, environmental factors <10th and >90th%ile measures should be checked Is this a typical pattern of infant growth? Is this a typical pattern of infant growth? Considerations in Assessment of Growth Ethnicity and Assessment of Growth Ethnicity Infant birth size Parent size Health and wellness 3

4 Birth size and expected growth Can expect to see some changes in growth channel..based on birth size and adjustment to genetic potential large infants lag-down small infants catch-up Changing channels is often typical Appropriate change in growth channels Catch-up growth due to illness Several models have been defined to assess the impact of illness or malnutrition on infant and childhood growth Model defining catch-up growth Appropriate catch-up growth 4

5 Monitoring Infant Growth and Development Rate of growth compare to CDC Growth Charts Support appropriate nourishment meet recommendations for protein, energy, vitamins and minerals Support developmental progress with foods provide textures for experience and nourishment Factors affecting growth Nourishment issues Infants who are growing poorly Infant who are growing too well Family issues Short stature Tall stature Familial short stature Constitutional slow maturation Emotional deprivation Chronic malnutrition Short stature Chronic diseases Intrauterine growth retardation Chromosomal abnormalities Skeletal dysplasia Disorders of hgh secretion & action Reasons for Being <5th%ile Weight short, malnutrition, chronic renal disease,psychosocial deprivation, infectious disease, iron deficiency anemia Length or stature short parents, malnutrition, psychosocial deprivation, delayed maturation, endocrinopathies, chromosomal abnormalities, chronic renal disease Weight-for-length dehydration, recent febrile illness, recent malnutrition, Marfan syndrome OFC microcephaly, craniostenosis, genetic disorders Reasons for Being above the 95th%ile Weight tall, obesity, edema Length or stature tall parents, accelerated maturation, marfan syndrome, pituitary giants Weight-for-length or stature obesity, edema, achrondroplasia Head circumference hydrocephaly Breastfeeding vs.. bottle feeding and growth 5

Poor growth demo by a breastfed infant Weight more affected than length Extended breastfeeding No solids added HBV protein Infant at risk for obesity Intake described in appropriate range for age

6 Poor growth demo by a breastfed infant Weight more affected than length Extended breastfeeding No solids added HBV protein Infant at risk for obesity Intake described in appropriate range for age Formula = 20 kcal/oz Limited and appropriate solids Patterns of growth based on degree and type of insult How would you assess the growth of this infant? Note <length and weight velocity; parent size How would you approach evaluation of the growth of this child? Catch-up growth 6

How would you approach evaluation of the growth of this child? How would you approach evaluation of the growth of this child? How would you approach evaluation of the growth of this child? What would you do?

7 How would you approach evaluation of the growth of this child? How would you approach evaluation of the growth of this child? How would you approach evaluation of the growth of this child? What would you do? 7 month old infant normal development exclusively breast fed feeding q 4 hours weight = length = baby hungry q 2 hours triglycerides = (900) fasting triglycerides= (350) Models for assessing growth of infants 7

8 Calibrating degree of malnutrition Nutritional Influences on Growth Growth & Protein energy ratio Growth & protein quality Growth & fluid requirements Growth & specific nutrient deficiency Protein-Energy Ratio Protein at requirement level + adequate energy = appropriate growth Protein at requirement level + inadequate energy = poor growth Growth and Specific Nutrients Energy Protein Calcium Vitamin D Vitamin B12 Zinc Folate 8

2013 Child Growth. Child growth and growth charts in the early years. Background

2013 Child Growth. Child growth and growth charts in the early years. Background Child growth and growth charts in the early years Background Children s growth is an important marker of their health and development. Poor growth inutero and early childhood is associated with short and