Chapters 8 & 9 8 & 9 Infant Nutrition

Very specialized nutritional considerations  High growth rate  Highest requirements for all nutrients  Infant has innate ability to self-regulate  Progression in feeding skills R/T developmental milestones  Inadequate nutrition may lead to consequences that may be lifelong

Key Terms Liveborn Infant Liveborn Infant Natality statistics Natality statistics Infant mortality Infant mortality ◦ Death that occurs in first year of life Infant morbidity Infant morbidity ◦ Illnesses that occur in first year of life

The Status of Pregnancy Outcomes Infant mortality: Infant mortality: ◦ reflects general health status of a population ◦ decreases in mortality related to improvements in social circumstances, safe & nutritious food supply, & infectious disease control

Low Birthweight, Preterm Delivery, & Infant Mortality Low birthweight (LBW) or preterm infants at high risk of dying in 1 st year of life Low birthweight (LBW) or preterm infants at high risk of dying in 1 st year of life 

Reducing Infant Mortality & Morbidity Improve birthweight of newborns Improve birthweight of newborns ◦ Desirable birthweight = g (7 lb. 11oz. to 9 lb. 14) Infants born with desirable wt less likely to develop: Infants born with desirable wt less likely to develop:  Heart and Lung diseases  Diabetes  Hypertension

APGAR score  Evaluation of of newborn physical status  Heart rate  respiration  muscle tone  response to stimulation  skin color  8-10 best score

 A-ppearance  P-ulse  G-rimace  A-ctivity  R-espiration

Measuring growth for infants  Lose weight first few days regained by 7-10th day regained by 7-10th day  Double birth weight 4-6 months 4-6 months  1 year  Increase length by year – double by 4 years

CDC infant growth charts  Overall pattern  Trend Appendix A Appendix A 0-36 mo, male/female 0-36 mo, male/female Use months, not yrsUse months, not yrs Variety of charts Variety of charts

 The 50th percentile -median height or weight for each age group, 50% of children will be above & 50% will be below 50% of children will be above & 50% will be below  change percentiles between 0-18 mos Then follow channel fairly closely Then follow channel fairly closely

Nutrient Needs  Kcals 108 kcals/kg 0-6 months 108 kcals/kg 0-6 months 98 kcals/kg 6-12 months 98 kcals/kg 6-12 months  Protein 2.2 g/kg0-6 months 2.2 g/kg0-6 months 1.6 g/kg6-12 months 1.6 g/kg6-12 months  Fluid 1.5 mL/kcal NO EXTRA FLUIDS/NEEDS MET IN BREASTMILK! 1.5 mL/kcal NO EXTRA FLUIDS/NEEDS MET IN BREASTMILK!

Feeding in Early Infancy  Breast milk and formula  Cow’s milk during infancy

Breast Milk vs Formula MACRO- NUTRIENT Breast Milk Cow’s Milk Based Formula Soy Based Formula PRO 7% of kcals 9-12%11-13% CHO 38% of kcals 41-43%39-45% FAT 55% of kcals 48-50%45-49%

Infant formula/Human milk substitutes  Regulated by FDA – Infant Formula Act  Nonfat milk with added vegetable fats, V & M  Soy based formulas  Specialized formulas(protein hydrolysate); malabsorption, metabolic disorders

 Powdered formula  Concentrated liquid formula  Ready-to-use formula

Feeding  Hold baby– head should be higher than rest of body  Never prop bottle  Proper mixing, storage, dilution

Developmental characteristics  Sucks well on nipple  Extrusion reflex causes tongue to protrude when solid food or spoon is put mouth  Feeds Q 2-4 hrs during day by 2 mos.  Finishes each feeding w/n 45 min. by 4 mos.

Infant-controlled Feeding:  Attentive to infant behavior – allows quantity to vary  Holds bottle still at an appropriate angle  Poises nipple over lips and allows baby to open up

Infant-controlled Feeding:  Allows pauses – gives time to finish feeding  Soothes fussiness – finds reasons for discomfort

Infant-controlled Feeding:  Ellyn Satter:  Parent-what  Child-when, if, how much

Parent- controlled Feeding  Ignores infant behavior – enforces externally determined quantity  Rotates, tilts, jiggles bottles  Imposes feeding routine-SCHEDULE

Parent- controlled Feeding  Terminates feeding abruptly at pauses  Interprets infant fussiness as a sign of satiety

Development of Infant Feeding Skills  Developmental milestones & readiness for feeding skills  Introduction of solid foods  Preparing for drinking from a cup  Food texture & development  First food: baby rice cereal

 Water  How much food is enough for infants?  How infants learn food preferences  Inappropriate and unsafe food choices

Chokables  Whole grapes  Peanut butter  Nuts  Popcorn  Hotdogs  Coin-sized  Stringy or tough meat  Gum  Raisins  Candy  Sticky foods like granola  Teething biscuits  French fries

Nutrition Guidance  Supplements for infants ? fluoride fluoride iron iron vitamin B 12 vitamin B 12 vitamin D vitamin D

Common Nutritional Problems and Concerns  Failure to thrive (FTT) organic organic nonorganic nonorganic  Nutrition intervention for FTT  Colic  Iron-deficiency anemia  Constipation and diarrhea

Additional Infant Feeding Concerns  Prevention of baby bottle caries & ear infections  Food allergies & intolerances Wheat Wheat Eggs Eggs Soy Soy Nuts Nuts Cow’s Milk Cow’s Milk  Lactose intolerance  Food Safety!

Infants at High Risk  LBW  born before 34 weeks of gestation  born with consequences of abnormal development  chronic health problems  special health care needs

Growth of Pre-Term Infants  Growth in preterm infants correction for gestational age correction for gestational age  Does intrauterine growth predict outside growth?  Interpretation of growth

Severe Preterm Birth & Nutrition  How sick babies are fed  What to feed preterm infants  Preterm infants and feeding fatigue fatigue low tolerance of volume low tolerance of volume Defensive to feeding Defensive to feeding Unpleasant=feeding Unpleasant=feeding

Table 9-3, p.232

Congenital Abnormalities and Chronic Illness  GI tract disorders diaphragmatic hernia diaphragmatic hernia tracheoesophageal atresia tracheoesophageal atresia

Congenital Abnormalities and Chronic Illness  Cleft lip and palate

Feeding Problems in Infants