1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 12 Diet during Infancy

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Objectives State effect inadequate nutrition has on infant Discuss positive aspects of breastfeeding and bottle feeding Describe when and how foods are introduced into infant’s diet Describe inborn errors of metabolism and their dietary treatment

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Nutritional Requirements of the Infant Birth weight doubles by 6 months and triples within first year Requirements: –Approximately 98 to 108 calories per kilogram of body weight each day –1.5 mL of water per calorie Nutritional needs depend on child’s growth rate (continues)

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Nutritional Requirements of the Infant Basis of diet: –Breast milk or formula Vitamin K supplement routinely given at birth Vitamin D supplement given in breastfed infants not exposed to sunlight Excess vitamin A or vitamin D can be toxic Fluoride may be supplemented as needed

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Breastfeeding Infants obtain temporary immunity to many infectious diseases –Have fewer infections Has benefit of being the following: –Economical –Nutritionally perfect –Sterile –Easily digested (continues)

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Breastfeeding Promotes oral motor development Offer breast every two hours in first few weeks Have infant nurse 10 to 15 minutes on each breast Growth spurts occur at approximately 10 days, two weeks, six weeks, and three months –Infant may nurse more frequently (continues)

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Breastfeeding Also beneficial to mothers –Less risk of breast cancer and osteoporosis Indications of adequate nutrition include: –Infant has six or more wet diapers per day –Infant has normal growth –Infant has one to two bowel movements per day –Breast becomes less full during nursing

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Bottle Feeding Infant should be cuddled and held in semi- upright position Infant should be burped often Formulas made from modified cow’s milk to resemble breast milk in nutritional value (continues)

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Bottle Feeding Synthetic formula made from soybeans may be used for infants who are sensitive or allergic Formula must be prepared with correct amount of water to prevent health complications (continues)

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Bottle Feeding Cow’s milk can cause gastrointestinal blood loss in infants –Avoid use Use consistent temperature for formula Putting infants to bed with bottle may cause baby bottle mouth

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stop and Share Share with a partner your own feelings regarding breastfeeding versus bottle feeding. –Do you support a woman who decides to breastfeed? –Do you support a woman who decides to bottle feed? –Could your beliefs affect the care you give?

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Supplementary Foods Wait until 4 to 6 months before introducing solid foods –Do so gradually Solids should be started with iron-fortified rice cereal –Then other infant cereals (continues)

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Supplementary Foods Follow with cooked and pureed vegetables, then cooked and pureed fruits, egg yolk, and finely ground meats Between 6 and 12 months, add toast, Zwieback teething biscuits, and Cheerios (continues)

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Supplementary Foods Never give honey to infant –Could be contaminated with Clostridium botulinum bacteria Can introduce juice when drinking from cup –Never give from bottle Will fill up on juice and not get enough calories from other sources –Use only 100 percent juice products –Limit to 4 ounces per day Nutrient-dense

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Indications for Readiness for Solid Foods Disappearance of extrusion reflex –Pushing food out with tongue Willingness to participate Ability to sit up without support Control of head and neck Drinking of more than 32 ounces of formula or nursing eight to 10 times in 24 hours

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Developing Good Eating Habits By age 1, most babies can eat foods from all food groups Can use table foods Avoid excess sugar and salt Avoid foods that can cause choking Help children develop active lifestyle and healthy eating habits

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Special Nutritional Needs Premature infants Cystic fibrosis Failure to thrive Metabolic disorders: –Galactosemia –Phenylketonuria (PKU) –Maple syrup urine disease (MSUD)

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Premature Infants Infant born before 37 weeks of gestation Sucking reflex not developed until 34 weeks of gestation –Infants born earlier require total parenteral nutrition, tube feedings, or bolus feedings (continues)

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Premature Infants Other concerns: –Low birth weight, underdeveloped lungs, immature gastrointestinal tract, inadequate bone mineralization, and lack of fat reserves Many special formulas available, but breast milk best –Composition perfect even for premature infants

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cystic Fibrosis Inherited disease in which body secretes abnormally thick mucus Decreased production of digestive enzymes and malabsorption of fat Recommendation: –35 to 40 percent of diet should be from fat (continues)

21. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cystic Fibrosis Digestive enzymes and fat-soluble vitamin supplementation at meal times Nighttime tube feedings may be indicated

22. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Failure to Thrive Determined by plotting infant’s growth on standardized charts May be caused by watering down formula, congenital abnormalities, acquired immunodeficiency syndrome (AIDS), lack of bonding, child abuse, or neglect (continues)

23. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Failure to Thrive First six months most crucial for brain development

24. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Galactosemia Caused by lack of transferase –Converts galactose to glucose Amount of galactose in blood becomes toxic Results in diarrhea, vomiting, edema, and abnormal liver function Cataracts may develop Galactosuria and mental retardation occur (continues)

25. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Galactosemia Diet therapy: –Exclusion of anything containing milk from any mammal –Nutritional supplements of calcium, vitamin D, and riboflavin Lifelong elimination or restriction of lactose in diet may be needed

26. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. PKU Infants lack liver enzyme phenylalanine hydroxylase –Necessary for metabolism of amino acid phenylalanine Infants normal at birth, but if untreated, become hyperactive, suffer seizures, and become mentally retarded between 6 and 18 months (continues)

27. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. PKU Lifelong diet therapy: –Commercial formula Lofenalac –Regular blood tests –Synthetic milk for older children –Avoidance of phenylalanine Hospitals required to screen newborns before discharge

28. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. MSUD Congenital defect resulting in inability to metabolize three amino acids: –Leucine, isoleucine, and valine Named for odor of client’s urine Ketosis occurs with protein ingestion (continues)

29. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. MSUD Hypoglycemia, apathy, and convulsions occur –If not treated promptly, may result in death Lifelong diet therapy: –Extremely restricted amounts of the three amino acids –Special formula and low-protein diet

30. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Spotlight on the Life Cycle Women, Infants, and Children (WIC) –Federally funded program that provides monthly food packages of infant formula or milk, cereal, eggs, cheese, peanut butter, and juice to new mothers

31. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Conclusion Infants must have adequate diets to avoid impairment of physical and mental development Breastfeeding –Nature’s way of feeding infant Formula feeding also acceptable Some infants have special nutritional needs