infant nutrition(ch8 brown)

8/4/2019 Infant Nutrition(Ch8 Brown)

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Infant Nutrition

Assessing NewbornHealth


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Birthweight

40 weeks gestation (37-42 weeks)

Normal: 2500-3800 grams (5.5 to 8.5 lbs.)

47-54 cm (18.5-21.5 inches)

3.9 million births in US/yr; 3.6 were full-term

Birth weight makes a difference: If infant

requires ICU over 2500 grams only 2% dieUnder weight typical of 28 week gestation

period 16% die


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Infant Mortality

US ranks 27th in the world

Why? Prevalence of preterm births major

factorSocioeconomic factors

Access to health care

How to improve? Prevent premature births.

Interventions to save newborns, decreasebarriers to health care, decrease teenpregnancies


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Better Infant Mortality Rates

Japan: 4.4

Singapore: 2-3

Sweden: 4.8

Finland: 4.4

Norway: 5.9 Canada: 6.1

Germany 6.2


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Programs to Decrease Infant

Mortality WIC

Bright Futures: comprehensive program

with government and professional groups

CDC and WIC track growth parameters to

monitor changes


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Standard Assessment Tests

EPSDT: Early Periodic Screening, Detection, andTreatment Program: part of Medicaid

IUGR: Intrauterine Growth Retardation. Below10%tile weight for gestational age

FTT: Failure to Thrive

APGAR: A rating score for newborns;


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EPSDT

Part of Medicaid and provides routine

checkups for low-income families


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IUGR

Clinical Examination of the newborn and

sometimes the placenta may reveal small

for gestational ageOther terms used: intrauterine growth

retardation


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Failure to Thrive(FTT)

Small for gestational age may set up FTT

FTT to thrive is a smaller than usual

growth pattern


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APGAR

http://kidshealth.org/parent/pregnancy_newborn/pregnancy/apgar.html Activity, Pulse, Grimace, Appearance, and Respiration.

Score based on five elements: Color

Heart rate

Respiratory effort

Muscle tone

Reflex irritability

Maximum score of 10 taken at 1 and 5 minutes after birth; Lowscores generally reflect later problems
http://kidshealth.org/parent/pregnancy_newborn/pregnancy/apgar.htmlhttp://kidshealth.org/parent/pregnancy_newborn/pregnancy/apgar.htmlhttp://kidshealth.org/parent/pregnancy_newborn/pregnancy/apgar.htmlhttp://kidshealth.org/parent/pregnancy_newborn/pregnancy/apgar.html


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Infant Development

Reflex: An automatic, unlearned response

Rooting Reflex: Action that occurs when

one cheek is touched Sucking Reflex: Action in which an infant

will suck on anything

Suckle: A reflexive movement of thetongue moving forward and backwards tohelp with feeding


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Major Reflexes

Table 8.2 page 202

Babinski: Babys toes fan out when sole is

stroked

Blink: Babys eyes close with bright light

Withdrawal: Baby withdraws foot when

pricked


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Motor Development

Illustration 8.1

Standards to consider with development

Not meeting standards requires question:

Why?

Organic Problem or inorganic problem;

Often takes a referal to a social worker oroccupational therapist/physical assessment to

do an assessment


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Critical Periods

Development in Pregnancy: Hyperplasia &

Hypertrophy

There is a time period within certain behaviorsare learned

This enables sequential learning

Problems meeting behaviors may disrupt development

EG: Mouth is a source of pleasure and exploration; infant on

respirator may have this taken away and post respirator may

be a reluctant feeder


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Cognitive Development

Closely tied with Physical Development:

Sensorimotor development

Speech skills emerge when infant is

sensitive to food textures

Illustration 8.2


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Digestion

Gut function develops with time

Maturation of gut isnt complete at birth

Open gut Improvements of peristalsis, production of

digestive enzymes, etc becomes more mature asinfant gets older

Eg. Lipase activity improves with age, so infantis able to tolerate a greater assortment of fats withage.


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Physical Growth

Weight for age

Length for age

Weight for length

Head Circumference for age

BMI percentile


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Nutrition Care Manual

www.nutritioncaremanual.org


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Avoiding Measurement Errors

Calibrated equipment

Make sure infant is not holding anything

that adds weightDiapers?

Confirm position of infant for length

measurements Head Circumference at widest part of the

head


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Avoiding Errors in Plotting

Calculate ages accurately in months after

establishing the date of birth

Confirm plotting is done correctly. Mindyour ps and qs (is it in kg or pounds?)

Confirm that the plots are easy to read


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Feeding in Early Infancy

Breast Milk vs Formula

Before 4 to 6 months, this is all that is

recommended

How Breast milk differs from formula

Table 8.6 pg 209


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Developmental Feeding

Concerns Table 8.7 page 210; Infant Feeding Milestones

Developmental Milestones and Feeding Skills

Example: 7 to 9 months old Hand use emerges with pincer grasp and ability to

release; Stable independent sitting, crawling

Self-feeding with hands; munching and biting


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Case Study 8.1: Baby Samantha

Sam is healthy 8 mo old girl lives with parents

who work full-time and 3 yo sister. Both children

attend day care full-time. Sam nurses twice perday now and gets breast milk offered in bottles

at the day care. When she gets picked up after

work, she wants to be held and not eat her dinner.

3 yo sis wants to eat right away. Motherencourages upset baby to eat. She must be

hungry. What would you suggest?


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Questions

What signs is baby Sam giving to show theshe needs comforting rather than food?

How might Kathy (mom) change herroutine to give Sam more attention?

At 8 months, is Samantha too young otovereat out of emotional needs?

Should Kathy stop or continuebreastfeeding to improve Sams eating?


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Samantha Intervention

Intervention:

Baby needs time to become calm. She

probably needs the attention of being held andcomforted. So some time should be built in.

Maybe this means to give sis a snack while

this happens and dinner be put off for a while.


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Breast/ Bottle to Cup: Weaning

Breast to cup/Bottle to cup between 12 and 24

months

If breastfed for recommended 12 months, after 6months, introducing water and juice by cup is

recommended.

Formula fed can have water and juices by bottle and

then by cup after 6 months as well

Open cup vs sippy cup: different tongue skills

developed: open cup helps develop speech skills


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Food and Texture

Weaning: When nutritional value of breastmilk is provided by foods.

By 6 to 8 months, infants are ready forfood with lumps

By 8-10 months, infants are ready for softmashed foods

Mature chewing skills dont develop untiltoddler years


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Case Study 8.2 Paul and His

Baby Food


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Infants and Food Preferences

Many factors including:

Babys state of rest

Foods offered

Breast feeding vs formula feeding

More tastes in breast feeding

Babies may be more responsive to new foods in 4to 7 months


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Inappropriate Foods

Choking hazards:

Peanuts

Popcorn

Whole grapes

Hot dog pieces

Hard candy


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Common Nutrition Problems

Failure to Thrive

Organic: caused by a medical diagnosis. A

biological cause is presentNon-Organic: without medical diagnosis;

Environmental cause is suspected

Mixed: Both may contribute


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Failure to Thrive: Nutrition

Assessment Table 8.10, pg 217. Complete assessment

should include


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Cross Cultural Considerations

Commercial baby foods do not reflect

diversity: eg, no collards or Mexican

beans. Cultural considerations may play a role in

a familys willingness to participate in

assistance programs such as WIC


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Infants and Vegetarian Diets

Two potential difficulties:

Infants may not be able to consume the

quantities required to obtain adequate Caloriesand nutrients

Alternative vegetarian food products may not

be of high nutritional quality or offered in

appropriate sizes for infants.


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Nutrition Risk Intervention and

Risk Reduction In US all newborns are screened for rare

conditions:

PKU

Galactosemia

Hypothyroidism

Sickle cell diseaseAs many as 30 more from the same dried

blood sample


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WIC

Eligible households may receive WICintervention:

Two criteria: Household income less than 185% of poverty

Presence of nutritional or health risk

These may include:

Nutrition risk during pregnancy

Growth shows underweight

Iron status low(Hct or Hb)

Diet risks: inadequate intake


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Case Study 8.3 Baby Derrick

infant nutrition(ch8 brown)

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