Nutrition Chapter 8 - Infant Nutrition - full-term infants: infants born between 37 and 42 weeks gestation - healthy preterm infants: infants born at 34 weeks or later - preterm infant: infants born before 37 weeks of gestation Assessing Newborn Health Birth Weight as an Outcome - the weight of a newborn is a key measure of health status during pregnancy - average full-term baby weighs between 5.5-8.5lbs and height is 18.5-21.5inches) Infant Mortality - infant mortality: death that occurs within the first year of life - preterm birth is a key risk factor for infant death since it is continuing to increase - 3 leading causes to of infant mortality in 2006 were congenital malformations, complications related to preterm births, and sudden infant death syndrome (SIDS) Combating Infant Mortality -The Early Periodic Screening Detection, and Treatment Program (EPSDT): part of Medicaid and provides routine checkups for low-income families Standard Newborn Growth Assessment - newborn health status is assessed by various indicators of growth and development taken right after birth. Indicators include birth weight, length, and head circumference for gestational age - intrauterine growth retardation (IUGR): fetal under-growth from any cause, resulting in a disproportionality in weight, length, or weight-for-length percentiles for gestational age. Sometimes called intrauterine growth restriction - the designation small for gestational age (SGA); also called small for dates, IUGR, or intrauterine growth restriction - means that newborn s birth weight falls below the 10 th percentile of weight gestational age - infants above the 90 th percentile are considered large for gestational age (LGA) - those in between are appropriate for gestational age (AGA) Infant Development - full-term newborns can hear and move in response to familiar sounds, such as the mother s voice. They demonstrate 4 states of arousal, ranging from sleeping to fully alert, and
responsiveness differs in part on their state of arousal - reflex: an automatic (unlearned) response that is triggered by a specific stimulus - rooting reflex: action that occurs if one cheek is touched, resulting in the infant s head turning toward that cheek and the infant opening his mouth - suckle: a reflexive movement of the tongue moving forward and backward; earliest feeding skill Motor Development - motor development reflects an infant s ability to control voluntary muscle movement - the development of muscle control is top-down, meaning head control is the start and last comes lower legs - muscle development is also from central to peripheral, meaning the infant learns to control the shoulder and arm muscles before the muscles in the hands Critical Periods - concept of critical period is based on a fixed time period during which certain behaviours emerge - a critical period for the development of oral feedings may explain some later feeding problems in infancy Cognitive Development - sensorimotor: an early learning system in which the infant s senses and motor skills provide input to the central nervous system Digestive System of Development - during the 3 rd trimester, the fetus swallows amniotic fluid and this stimulates the lining of the intestine to grow and mature - at birth, the healthy newborn s digestive system is sufficiently mature to digest fats, protein and simple sugars and to absorb fats and amino acids - after birth and through the early infancy period, the coordination of peristalsis within the gastrointestinal tract improves. Maturation of peristalsis and rate of passage are associated with some forms of gastrointestinal discomfort in infants - infants often have conditions that reflect the immaturity of the gut, such as colic, gastroesophageal reflux (GER), unexplained diarrhea, and constipation - gastroesophageal reflux (GER): movement of the stomach contents backwards into the esophagus due to stomach muscle contractions. - other factors influence the rate of food passage through the colon and the gastrointestinal discomfort seen in infants. These include: - osmolarity of foods or liquids (which affects how much water is in the intestine)
- colon bacteria flora - water and fluid balance in the body - osmolarity: measure of the number of particles in a solution, which predicts the tendency of the particles to move from high to low concentration Energy and Nutrient Needs - recommendations of children aged 2 and older. Recommendations for infants are from the DRI intakes, which are based on research over decades on infant growth and health from professional groups such as the National Academy of Medicine, the American Academy of Pediatrics, and the American Dietetic Association Caloric Needs - the average caloric requirements for individual infants is broad, ranging from 80 to 120 calories per kg (2.2lb) body weight. - average caloric need of infants in the first 6 months of life of 108 cal per kg body weight, based on growth in breastfed infants - from 6-12 months of age, average caloric need is 98 cal/kg - factors that account for the range of caloric needs of infants include the following: - weight - growth rate - sleep/wake cycle - temperature and climate - physical activity - metabolic response to food - health status and recovery from illness Protein Needs - recommended protein intake from birth up to 6 months averages 2.2g of protein per kg of body weight, and from 6-12 months the need is for 1.6g of protein per kg - most young infants who breastfeed or consume the recommended amounts of infant formula meet protein needs without added foods - infants may exceed their protein needs based on the DRI when they consume more formula than recommended for age and when protein sources such as baby cereal are added to infant formula Fats - no specific recommended intake levels of fats for infants - breast milk provides 55% of its calories from fat, and this percentage reflects an adequate intake of fat by infants
- percentage of fat in the diet drops after the infant accepts baby foods, since most baby foods are low in fat - short- and medium-chain fats such as those in breast milk are more readily utilized than longchain fats, such as in some infant formulas - infants use fats to supply energy to the liver, brain, and muscles, including the heart Metabolic Rate, Calories, Fats, and Protein - How Do They All Tie Together? - the high metabolic rate is primarily related to infants rapid growth and the high proportion of infant weigh that is made up of muscle - the usual body fuel for metabolism is glucose Other Nutrients and Non-nutrients Fluoride: - DRI for fluoride is 0.1 mg daily for infants less than 6 months of age - DRI for fluoride is 0.5 mg daily for 7-12 month-olds - fluoride is incorporated into the enamel of forming teeth, including those not yet erupted Vitamin D: - vitamin D is recommended for all infants starting shortly after birth at the level of 400 IU/day Sodium: - is a major component of extracellular fluid and an important regulator of fluid balance - estimated minimum requirements for sodium are 120mg for 0-5 months and 200mg for 6-12 month olds Fiber: - there are no dietary recommendations for infants - commercial and homemade baby foods are generally not significant sources of dietary fiber because preparation methods reduce dietary fiber Development of Infant Feeding Skills - several models help assess readiness for a breastfed infant to begin eating from a spoon at around 6 months - developmental model is based on looking for signs of readiness, such as being able to move the tongue from side to side without moving the head - they must be able to keep their head upright and sit with little support - the parents ability to read the infant s cues of hunger, satiation, tiredness, and discomfort influence feeding-skill progression. - cues infants give may include:
- watching the food being opened in anticipation of eating - tight fists or reaching for the spoon as a sign of hunger - showing irritation if the feeding pace is too slow or if the feeder temporarily stops - starting to play with the food or spoon as the infant begins to get full - slowing the pace of eating, or turning away from food when they want to end the meal - stopping eating or spitting out food when they have had enough to eat Introduction of Solid Foods - infants begin with food offered on a spoon in a small portion of 1-2 tablespoons for a meal, with one or 2 meals per day - babies respond strongly to new tastes or smells, regardless of the first food. - Introducing a baby to food on a spoon include these recommendations: - time the first spoon-feeding experiences for when the baby is not overly tired or hungry, but active and playful - offer a small spoon with a shallow bowl. The temperature of the spoon may have to be considered if it can conduct hot or cold readily - give the baby time to open his or her mouth to extend the tongue toward the food. If the baby cannot extend the tongue farther out than the lower lip, the baby is not ready for spoon feeding - place the bowl of the spoon on the tongue with slight downward pressure toward the front of the mouth. Touching the back of the tongue may elicit a gag response - the spoon should be almost level. It is not a good practice to scrape the food off the spoon with the baby s gums by tilting the spoon handle up too high. The baby s chin should be slightly down to protect the airway - the pace of eating should be based on watching for the baby to swallow. Rushing will increase the risk of choking and of the infant having an unpleasant experience - first meals may be small in volume - only 5 or 6 baby spoons - and last about 10 minutes Preparing for Drinking from a Cup - weaning: discontinuation of breastfeeding or bottle-feeding and substitution of food for breast milk or infant formula - recommended age for weaning the infant from the breast or from a bottle to drinking from a cup is from 12-24 months - developmental readiness for a cup begins at 6-8 months. Inappropriate and Unsafe Food Choices - examples of unsafe foods for infants: - popcorn, - peanuts
- raisins, whole grapes - uncut stringy meats - gum and gummy-textured candies - hard candy, jelly beans - hot dog pieces - hard raw fruits or vegetables such as apples, green beans - some foods present a choking risk for infants because of their lower chewing skills. Underchewed pieces of food can obstruct the infant s airway because voluntary coughing and clearing the throat are skills not yet learned Common Nutritional Problems and Concerns - common nutritional problems during infancy are failure to thrive, colic, iron-deficiency, anemia, constipation, dental caries, and food allergies Failure to Thrive - failure to thrive (FTT): condition of inadequate weight or height gain thought to result from a caloric deficit, whether or not the cause can be identified as a health problem - organic failure to thrive: inadequate weight or height gain resulting from a health problem, such as iron-deficiency anemia or a cardiac or genetic disease - nonorganic failure to thrive: inadequate weight or height gain without an identifiable biological cause, so that an environmental cause is suspected - developmental disabilities: general term used to group specific diagnoses together that limit daily living and functioning and occur before age 21 Nutrition Intervention for Failure to Thrive - correction of FTT usually is not as simple as just feeding the baby, but increasing caloric and protein intake is the first step - the dietician s role is to assess the growth and nutritional adequacy, establish a care plan, and provide follow-up as part of a team approach - other interventions include: - gaining agreement from the caregivers about how and when intake and weigh monitoring will be done - enrolling the infant in an early intervention program in the local area Colic - colic: a condition marked by a sudden onset of irritability, fussiness, or crying in a young infant between 2 weeks and 3 months of age who is otherwise growing and healthy - recommendations to relieve colic may include rocking, swaddling, bathing, or other ways of
calming the infant, positioning the baby well for eating, or burping to relieve gas or change baby formulas if the infant is not breastfeeding Prevention of Baby-Bottle Caries and Ear Infections - found in children older than 1 year - the use of a bottle containing formula, juice, or other high-carb foods to calm a baby enough to sleep may set her up for dental caries - during sleep, the infant swallows less, allowing the contents of the bottle to pool in the mouth - ear infections are also correlated with excessive use of a baby bottle as a bedtime practice, as a result of the feeding position - the shorter and more vertical tubes in the ears of infants are under different pressure during the process of sucking from a bottle. If the infant is feeding by lying down, the liquid does not fully drain from the ear tubes - good feeding practices to limit baby-bottle caries and ear infections related to baby bottles: - limit the use of a bottle as part of a bedtime ritual - offer juices in a cup, not a bottle - put only water in a bottle if offered for sleep - examine and clean emerging baby teeth to prevent caries from developing Lactose Intolerance - is a food intolerance in infancy characterized by cramps, nausea, and pain, and by alternating diarrhea and constipation - lactose: a form of sugar or carbohydrate composed of galactose and glucose - lactose intolerance is less common during infancy than at older ages in groups that are susceptible to it