Podcast
Questions and Answers
What is the main purpose of dietary fat intake in infants?
What is the main purpose of dietary fat intake in infants?
Which statement regarding energy requirements as children age is accurate?
Which statement regarding energy requirements as children age is accurate?
At what age is most brain growth complete for life?
At what age is most brain growth complete for life?
What is indicated as a nutritionally acceptable alternative to breast milk?
What is indicated as a nutritionally acceptable alternative to breast milk?
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Which food or substance is contraindicated during breastfeeding due to its potential effect on neurodevelopment?
Which food or substance is contraindicated during breastfeeding due to its potential effect on neurodevelopment?
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What is the recommended approach for introducing complementary foods to infants?
What is the recommended approach for introducing complementary foods to infants?
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Which condition makes breastfeeding contraindicated, but expressed breast milk is still acceptable?
Which condition makes breastfeeding contraindicated, but expressed breast milk is still acceptable?
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What outcome is associated with inadequate nutrition in children?
What outcome is associated with inadequate nutrition in children?
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What is the primary concern when infant formula is prepared too concentrated?
What is the primary concern when infant formula is prepared too concentrated?
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Which of the following is a micronutrient requirement for all full-term infants consuming less than 32 ounces of formula per day?
Which of the following is a micronutrient requirement for all full-term infants consuming less than 32 ounces of formula per day?
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When is it acceptable for infants older than 6 months to drink water?
When is it acceptable for infants older than 6 months to drink water?
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Which food should be avoided in infants under 12 months due to the risk of botulism?
Which food should be avoided in infants under 12 months due to the risk of botulism?
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What is the recommended approach for introducing allergenic foods to infants?
What is the recommended approach for introducing allergenic foods to infants?
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For infants with severe eczema or an egg allergy, what should be done before introducing peanuts?
For infants with severe eczema or an egg allergy, what should be done before introducing peanuts?
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What can result from diluting infant formula excessively?
What can result from diluting infant formula excessively?
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Which of the following groups should receive a multivitamin with iron daily to prevent anemia?
Which of the following groups should receive a multivitamin with iron daily to prevent anemia?
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At what age do primary teeth typically begin to exfoliate?
At what age do primary teeth typically begin to exfoliate?
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What dental condition is associated with full-thickness demineralization of tooth enamel?
What dental condition is associated with full-thickness demineralization of tooth enamel?
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Which type of teeth primarily grinds food?
Which type of teeth primarily grinds food?
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Which layer of the tooth contains nerves and blood vessels?
Which layer of the tooth contains nerves and blood vessels?
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What is the primary health risk associated with untreated dental cavities in children?
What is the primary health risk associated with untreated dental cavities in children?
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Which set of teeth are considered to erupt after primary teeth?
Which set of teeth are considered to erupt after primary teeth?
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What is the primary benefit of saliva in relation to oral health?
What is the primary benefit of saliva in relation to oral health?
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What milestone signifies that all 20 primary teeth have erupted?
What milestone signifies that all 20 primary teeth have erupted?
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What is a significant dental concern related to prolonged pacifier use beyond 15 months of age?
What is a significant dental concern related to prolonged pacifier use beyond 15 months of age?
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Which of the following is a proper technique when brushing a child's teeth between the ages of 1 to 3 years?
Which of the following is a proper technique when brushing a child's teeth between the ages of 1 to 3 years?
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What is an important factor to consider when assessing fluoride status in drinking water?
What is an important factor to consider when assessing fluoride status in drinking water?
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What ingredient in dental products helps in the remineralization of early carious lesions?
What ingredient in dental products helps in the remineralization of early carious lesions?
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In which situation should a child be referred to a dentist?
In which situation should a child be referred to a dentist?
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What common oral hygiene practice is recommended before the eruption of the first tooth?
What common oral hygiene practice is recommended before the eruption of the first tooth?
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What is a potential consequence of excessive ingested fluoride during childhood?
What is a potential consequence of excessive ingested fluoride during childhood?
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In what situation should hydroxyapatite toothpaste be considered for use?
In what situation should hydroxyapatite toothpaste be considered for use?
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What dietary habit is known to contribute to dental caries in children?
What dietary habit is known to contribute to dental caries in children?
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What is the recommended amount of fluoride toothpaste for children aged 3 years and above?
What is the recommended amount of fluoride toothpaste for children aged 3 years and above?
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Study Notes
Macronutrients and Micronutrients
- Macronutrients are needed in large amounts: fat, carbohydrate, protein, and water.
- Micronutrients are needed in small amounts: vitamins and minerals.
Growth and Nutrition
- Rapid growth occurs in infancy and adolescence.
- By 12 months, body weight triples, length increases 55%, head circumference increases 33%, and brain weight triples.
- Most brain growth is complete by 4 years old.
- Inadequate nutrition leads to inadequate growth.
Energy Requirements
- Daily calorie requirements per unit body weight decrease with age.
- Daily protein, carbohydrate, and fat requirements also decrease with age.
- Dietary fat is critical for infant brain development and should not be restricted.
Nutrition Guidelines
- Dietary Guidelines for Americans, 2020-2025 and American Academy of Pediatrics provide guidelines.
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Infants 0-12 months:
- Breast milk is usually best.
- Exclusive breastfeeding is recommended for the first 4-6 months.
- Breast milk with complementary foods is recommended from 4-6 months to 12 months.
- Solid foods and some breast milk are recommended for 12 to 24 months.
- Iron-fortified infant formula is the only acceptable alternative to breast milk.
- Homemade formulas, cow's milk, goat's milk, and plant milks are not nutritionally adequate.
- Complementary foods (infant cereals, commercial and homemade infant foods, table foods) should be introduced around 4-6 months when infants are developmentally ready.
Breast Milk Contraindications
- Mothers with HIV, human T-cell lymphocytic virus types 1 or 2, or untreated brucellosis.
- Infants with certain inborn errors of metabolism, e.g., galactosemia.
- Mothers taking certain medications, e.g., chemotherapeutic agents.
- Breast milk is still recommended if access to clean water and/or infant formula is not reliably available.
Breastfeeding Contraindications (Expressed Breast Milk Is Ok)
- Active HSV lesions on the breast.
- Untreated tuberculosis.
- Varicella.
- H1N1 influenza.
- Breastfeeding and breast milk are not recommended while consuming alcohol or illicit substances.
Indications for Infant Formula
- When mothers choose to provide formula.
- When breast milk and breastfeeding are contraindicated.
- When there is insufficient maternal breast milk supply.
- Use formula for supplementation when breast milk alone doesn't meet growth demands (e.g., prematurity, congenital heart disease).
- Fortify breast milk with formula to increase calories, macronutrients, and micronutrients.
Commercial Infant Formula Formats
- Ready to feed: no need to add water, most expensive.
- Concentrate: mix with equal parts water.
- Powder: mix 1 scoop of powder to 2 ounces of water, least expensive.
Micornutrient Requirements
- Vitamin D3 400 I.U. daily for all full-term infants consuming < 32 ounces of commercial infant formula per day. This helps prevent vitamin D deficiency rickets.
- MVI with iron daily for all preterm infants. This helps prevent iron deficiency anemia and rickets.
- Preterm means born before 37 weeks gestation.
Contraindicated Foods for Infants < 12 Months
- Cow’s milk, goat’s milk, and plant milk (inappropriate nutrient composition).
- Homemade infant formula (inappropriate nutrient composition).
- Fruit juice (dental caries, diarrhea, less nutritious than eating whole fruit).
- Unpasteurized dairy products (food-borne illness).
- Undercooked meat, eggs, seafood (food-borne illness).
- Honey (botulism).
- Foods that are small, round, and hard (choking hazards, e.g., whole grapes).
- Foods high in sodium and added sugars.
- Water: Up to 8 ounces of water per day is safe for infants 6 months and older. Infants under 6 months should not be given water to drink. Their kidneys are not mature enough to process free water. This can lead to hyponatremia.
Allergenic Foods
- Peanuts, tree nuts, sesame seeds, soybeans, cow milk, eggs, fish, shellfish, and wheat.
- Introduce these after 4 months of age to build immune tolerance and reduce risk for food allergies.
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Peanut introduction caveat:
- For infants with severe eczema or egg allergy, check a peanut-specific IgE first.
- If < 0.35 kUA/L, peanut ingestion is safe.
- If ≥ 0.35 kUA/L, hold peanut and refer to a pediatric allergist.
- For infants with mild to moderate eczema, introduce peanut after 6 months old.
- Introduce one new food at a time and monitor for allergic reaction (e.g., vomiting, hives, wheezing).
- Infants with signs of a food allergy should be evaluated by a pediatric allergist.
Tooth Development
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Primary (deciduous) teeth:
- Form in the womb.
- Start erupting between 6-10 months of age.
- All 20 primary teeth erupt by 2-3 years old.
- Exfoliate (fall out) between 6-7 years old.
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Secondary (permanent) teeth:
- Form after birth.
- Start erupting between 6-7 years old.
- All 28-32 permanent erupt by early adulthood.
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Wisdom teeth:
- Third set of molars.
- Were crucial for chewing tough foods for our ancestors.
- Not necessary in modern times due to cooked food and utensils.
- Often require extraction due to jaw size limitations.
Tooth Anatomy
-
Four types of teeth:
- Incisors: Cut food.
- Canines: Tear food.
- Premolars: Grind food.
- Molars: Crush food.
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Dental identification system:
- Letters for primary teeth.
- Numbers for permanent teeth.
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Dental anatomy:
- Enamel: Calcium and phosphorus layer covering the tooth surface.
- Dentin: Bony tissue comprising the bulk of the tooth, containing nerves.
- Pulp: Soft center of the tooth housing nerves, blood vessels, and connective tissue.
Oral Homeostasis
- Remineralization: Saliva buffers lactic acid, rinses it away, and supplies calcium and phosphorus to repair damaged tooth enamel.
- Demineralization: Strep mutans (plaque) ferments sucrose into lactic acid, which leaches calcium and phosphorus from tooth enamel.
- Dental caries (tooth decay/cavity): Develop when the balance shifts in favor of demineralization.
Dental Cavity Formation
- 1. White spot: Surface demineralization of tooth enamel, treated topically.
- 2. Brown spot: Full-thickness demineralization of enamel, treated with a filling.
- 3. Dentin decay: Mild toothache, treated with a filling.
- 4. Pulp infection: Severe toothache, treated with a root canal.
- 5. Abscess: Involves gum tissue, treated with antibiotics and possible extraction.
Dental Caries Risks
-
Child health risks associated with dental caries:
- Failure to thrive.
- Exposure to general anesthesia.
- Meningitis.
- Endocarditis
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Systemic health risks associated with dental caries:
- Cellulitis of the cheek.
- Osteomyelitis of the jaw.
- Hematogenous spread.
- Endocarditis.
- Sepsis.
- Death.
Prevention and Early Intervention
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Risk assessment questions before tooth eruption:
- Family history of dental problems.
- Parent's dental health history.
- Fluoride status of home drinking water.
- Regular brushing and flossing by parents.
- Wiping infant's tongue and gums after feeding.
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Risk assessment questions after tooth eruption:
- Fluoride status of drinking water in all settings.
- Sugar-sweetened beverage consumption.
- Snacking habits.
- Bedtime bottle or sippy cup use.
- Brushing twice daily with fluoride toothpaste and flossing once daily.
- Regular dental checkups every 6 months.
- Pacifier or thumb-sucking habits.
Home Brushing Tips
- Before first tooth eruption: Wipe gums and tongue after feeding.
- First tooth to 3 years: Brush twice daily using a rice grain-sized amount of fluoride toothpaste. Do not rinse the toothpaste. Floss between touching tooth surfaces.
- 3 years to 8-10 years: Brush twice daily using a pea-sized amount of fluoride toothpaste. Spit out the toothpaste. Floss at least once daily.
Additional Home Brushing Tips
- Use a soft-bristled toothbrush.
- Replace the toothbrush every 3 months.
- Use an up-and-down motion to gently clean the gum line.
- Brush for 2 minutes.
- Consider different positions for brushing, such as:
- Sitting in a parent's lap facing a mirror.
- Parent sitting facing the child.
- Child laying down.
- Parents sitting knee-to-knee with the child.
Examining a Child's Teeth
- Lift the lips to examine teeth for:
- Plaque.
- White spots.
- Dark spots.
- Enamel pits.
- Caries.
- Inspect the gingiva for inflammation and bleeding.
- Inspect the gums for a dental abscess.
- Assess tooth alignment for malocclusion.
- Assess eruption and exfoliation.
- Assess for tooth injury.
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Refer to a dentist for:
- Caries.
- Abscess.
- Trauma.
- Lack of a dental home.
Fluoride
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Benefits:
- Helps prevent dental decay and cavities.
- Fortifies tooth enamel against demineralization.
- Enhances remineralization of early carious lesions.
- Reduces the cariogenic activity of plaque.
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Ingested fluoride:
- Prenatal vitamins.
- Oral fluoride supplements.
- Fluoridated drinking water.
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Topical fluoride:
- Most important defense.
- Fluoridated drinking water.
- Fluoride toothpaste.
- Topical fluoride applications.
Fluoride Harm (Fluorosis)
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Caused by:
- Excess ingested fluoride.
- Not caused by topical fluoride.
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Signs:
- Hypomineralized enamel.
- White striations and pits.
- Increased susceptibility to wear and breakage.
Avoiding Fluorosis
- Use a combination of tap water (with fluoride) and bottled water (fluoride-free) for infant formula.
- Follow fluoride toothpaste recommendations for infants and children:
- Rice grain-sized amount for first tooth to 3 years old.
- Pea-sized amount for 3 years and up.
- Use systemic fluoride with caution.
Dental Sealants
- Plastic coating bonded to the chewing surfaces of teeth.
- Barrier to colonization by cariogenic bacteria.
- Applied once first permanent molars erupt.
- Prevents cavities on chewing surfaces, while fluoride prevents caries on smooth surfaces.
Hydroxyapatite Toothpaste
- Studies demonstrate equal effectiveness with fluoride toothpaste in preventing dental caries.
- Bond strength with tooth enamel is physiologic (natural), while fluoride bond is supraphysiologic (above natural levels).
- Not currently approved by the American Dental Association due to being fluoride-free.
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Description
This quiz explores the essential macronutrients and micronutrients required for growth and development, particularly in infants and adolescents. It also covers energy requirements and current dietary guidelines critical for ensuring adequate nutrition at different life stages.
