ChaptersChapters

8 & 9 8 & 9

Infant Infant NutritionNutrition

Very specialized nutritional Very specialized nutritional considerationsconsiderations

High growth rateHigh growth rate Highest requirements for all nutrients Highest requirements for all nutrients Infant has innate ability to self-regulateInfant has innate ability to self-regulate Progression in feeding skills R/T Progression in feeding skills R/T

developmental milestonesdevelopmental milestones Inadequate nutrition may lead to Inadequate nutrition may lead to

consequences that may be lifelongconsequences that may be lifelong

Key TermsKey Terms

Liveborn InfantLiveborn InfantNatality statisticsNatality statisticsInfant mortalityInfant mortality

◦ Death that occurs in first year of lifeDeath that occurs in first year of life

Infant morbidityInfant morbidity◦ Illnesses that occur in first year of lifeIllnesses that occur in first year of life

The Status of Pregnancy The Status of Pregnancy OutcomesOutcomes

Infant mortality:Infant mortality:◦ reflects general health status of a populationreflects general health status of a population

◦ decreases in mortality related to decreases in mortality related to improvements in social circumstances, safe & improvements in social circumstances, safe & nutritious food supply, & infectious disease nutritious food supply, & infectious disease control control

Low Birthweight, Preterm Delivery, & Low Birthweight, Preterm Delivery, & Infant MortalityInfant Mortality

Low birthweight (LBW) or Low birthweight (LBW) or preterm infants at high risk of preterm infants at high risk of dying in 1dying in 1stst year of life year of life

Reducing Infant Mortality & Reducing Infant Mortality & MorbidityMorbidity

Improve birthweight of newbornsImprove birthweight of newborns◦ Desirable birthweight = 3500-4500 g (7 lb. 11oz. to Desirable birthweight = 3500-4500 g (7 lb. 11oz. to

9 lb. 14)9 lb. 14)

Infants born with desirable wt less likely to Infants born with desirable wt less likely to develop:develop:

Heart and Lung diseasesHeart and Lung diseases DiabetesDiabetes HypertensionHypertension

APGAR scoreAPGAR score

Evaluation of of newborn physical statusEvaluation of of newborn physical status Heart rateHeart rate respirationrespiration muscle tonemuscle tone response to stimulationresponse to stimulation skin colorskin color 8-10 best score8-10 best score

A-ppearanceA-ppearance P-ulseP-ulse G-rimaceG-rimace A-ctivityA-ctivity R-espirationR-espiration

Measuring growth for infantsMeasuring growth for infants

Lose weight first few days Lose weight first few days regained by 7-10th dayregained by 7-10th day

Double birth weight Double birth weight 4-6 months4-6 months

Triple @ 1 yearTriple @ 1 year Increase length by 50% @1 Increase length by 50% @1

year – double by 4 yearsyear – double by 4 years

CDC infant growth chartsCDC infant growth charts

Overall patternOverall patternTrendTrend Appendix AAppendix A 0-36 mo, male/female0-36 mo, male/female

• Use months, not yrsUse months, not yrs Variety of chartsVariety of charts

The 50th percentile -median height or The 50th percentile -median height or weight for each age group,weight for each age group, 50% of children will be above & 50% will be 50% of children will be above & 50% will be

belowbelow

change percentiles between 0-18 moschange percentiles between 0-18 mos Then follow channel fairly closelyThen follow channel fairly closely

Nutrient NeedsNutrient Needs KcalsKcals

108 kcals/kg 0-6 months108 kcals/kg 0-6 months 98 kcals/kg 6-12 months98 kcals/kg 6-12 months

ProteinProtein 2.2 g/kg2.2 g/kg 0-6 months0-6 months 1.6 g/kg1.6 g/kg 6-12 months6-12 months

FluidFluid 1.5 mL/kcal NO EXTRA FLUIDS/NEEDS 1.5 mL/kcal NO EXTRA FLUIDS/NEEDS

MET IN BREASTMILK! MET IN BREASTMILK!

Feeding in Early InfancyFeeding in Early Infancy

Breast milk and formulaBreast milk and formula Cow’s milk during infancyCow’s milk during infancy

Breast Milk vs FormulaBreast Milk vs FormulaMACRO-MACRO-NUTRIENTNUTRIENT

Breast MilkBreast Milk Cow’s Milk Cow’s Milk Based Based FormulaFormula

Soy Based Soy Based FormulaFormula

PROPRO 7% of kcals7% of kcals 9-12%9-12% 11-13%11-13%

CHOCHO 38% of 38% of kcalskcals

41-43%41-43% 39-45%39-45%

FATFAT 55% of 55% of kcalskcals

48-50%48-50% 45-49%45-49%

Infant formula/Human milk Infant formula/Human milk substitutessubstitutes

Regulated by FDA – Infant Formula ActRegulated by FDA – Infant Formula Act Nonfat milk with added vegetable fats, V & MNonfat milk with added vegetable fats, V & M Soy based formulasSoy based formulas Specialized formulas(protein hydrolysate); Specialized formulas(protein hydrolysate);

malabsorption, metabolic disordersmalabsorption, metabolic disorders

Powdered formulaPowdered formula Concentrated liquid formulaConcentrated liquid formula Ready-to-use formulaReady-to-use formula

FeedingFeeding

Hold baby– head should be Hold baby– head should be higher than rest of bodyhigher than rest of body

Never prop bottleNever prop bottle Proper mixing, storage, dilutionProper mixing, storage, dilution        

Developmental characteristicsDevelopmental characteristics

Sucks well on nippleSucks well on nipple Extrusion reflex causes tongue to protrude Extrusion reflex causes tongue to protrude

when solid food or spoon is put mouthwhen solid food or spoon is put mouth Feeds Q 2-4 hrs during day by 2 mos.Feeds Q 2-4 hrs during day by 2 mos. Finishes each feeding w/n 45 min. by 4 mos.Finishes each feeding w/n 45 min. by 4 mos.

Infant-controlled Feeding:Infant-controlled Feeding:

Attentive to infant behavior – allows quantity to Attentive to infant behavior – allows quantity to varyvary

Holds bottle still at an appropriate angleHolds bottle still at an appropriate angle Poises nipple over lips and allows baby to open upPoises nipple over lips and allows baby to open up

Infant-controlled Feeding:Infant-controlled Feeding:

Allows pauses – gives time to finish feedingAllows pauses – gives time to finish feeding Soothes fussiness – finds reasons for Soothes fussiness – finds reasons for

discomfortdiscomfort

Infant-controlled Feeding:Infant-controlled Feeding:

Ellyn Satter:Ellyn Satter: Parent-whatParent-what Child-when, if, how muchChild-when, if, how much

Parent- controlled FeedingParent- controlled Feeding

Ignores infant behavior – enforces externally Ignores infant behavior – enforces externally determined quantitydetermined quantity

Rotates, tilts, jiggles bottlesRotates, tilts, jiggles bottles Imposes feeding routine-SCHEDULEImposes feeding routine-SCHEDULE

Parent- controlled FeedingParent- controlled Feeding

Terminates feeding abruptly at pausesTerminates feeding abruptly at pauses Interprets infant fussiness as a sign of satietyInterprets infant fussiness as a sign of satiety

Development of Infant Feeding SkillsDevelopment of Infant Feeding Skills

Developmental milestones & readiness for Developmental milestones & readiness for feeding skillsfeeding skills

Introduction of solid foodsIntroduction of solid foods Preparing for drinking from a cupPreparing for drinking from a cup Food texture & developmentFood texture & development First food: baby rice cerealFirst food: baby rice cereal

WaterWater How much food is enough for infants?How much food is enough for infants? How infants learn food preferencesHow infants learn food preferences Inappropriate and unsafe food choicesInappropriate and unsafe food choices

ChokablesChokables

Whole grapesWhole grapes Peanut butterPeanut butter NutsNuts PopcornPopcorn HotdogsHotdogs Coin-sizedCoin-sized Stringy or tough Stringy or tough

meatmeat

GumGum RaisinsRaisins CandyCandy Sticky foods like Sticky foods like

granolagranola Teething biscuitsTeething biscuits French friesFrench fries

Nutrition GuidanceNutrition Guidance

Supplements for infants ?Supplements for infants ? fluoridefluoride ironiron vitamin Bvitamin B1212 vitamin Dvitamin D

Common Nutritional Problems Common Nutritional Problems and Concernsand Concerns

Failure to thrive (FTT)Failure to thrive (FTT) organicorganic nonorganicnonorganic

Nutrition intervention for FTTNutrition intervention for FTT ColicColic Iron-deficiency anemiaIron-deficiency anemia Constipation and diarrheaConstipation and diarrhea

Additional Infant Feeding ConcernsAdditional Infant Feeding Concerns Prevention of baby bottle caries & ear infectionsPrevention of baby bottle caries & ear infections

Food allergies & intolerancesFood allergies & intolerances WheatWheat EggsEggs SoySoy NutsNuts Cow’s MilkCow’s Milk

Lactose intoleranceLactose intolerance Food Safety!Food Safety!

Infants at High RiskInfants at High Risk

LBWLBW born before 34 weeks of gestationborn before 34 weeks of gestation born with consequences of abnormal born with consequences of abnormal

developmentdevelopment chronic health problemschronic health problems special health care needsspecial health care needs

Growth of Pre-Term InfantsGrowth of Pre-Term Infants

Growth in preterm infantsGrowth in preterm infants correction for gestational agecorrection for gestational age

Does intrauterine growth predict outside Does intrauterine growth predict outside growth?growth?

Interpretation of growthInterpretation of growth

Severe Preterm Birth & NutritionSevere Preterm Birth & Nutrition

How sick babies are fedHow sick babies are fed What to feed preterm infantsWhat to feed preterm infants Preterm infants and feedingPreterm infants and feeding

fatiguefatigue low tolerance of volumelow tolerance of volume Defensive to feedingDefensive to feeding Unpleasant=feedingUnpleasant=feeding

Table 9-3, p.232

Congenital Abnormalities and Congenital Abnormalities and Chronic IllnessChronic Illness

GI tract disordersGI tract disorders diaphragmatic herniadiaphragmatic hernia tracheoesophageal atresiatracheoesophageal atresia

Congenital Abnormalities and Congenital Abnormalities and Chronic IllnessChronic Illness

Cleft lip and palateCleft lip and palate

Feeding Problems in InfantsFeeding Problems in Infants