Chapter 6.1_removed.pdf

Chapter 6 – Part I Infancy and Childhood Weight Gain in Infants in the First Five Years of Life major changes in weight that needs to be monitor regularly: affected by nutrition growth rarely seen if don’t eat enough 6 different time points to measure it until 1 year of age (1, 2, 4, 6, 8 and 12 mon...

Chapter 6 – Part I Infancy and Childhood Weight Gain in Infants in the First Five Years of Life major changes in weight that needs to be monitor regularly: affected by nutrition growth rarely seen if don’t eat enough 6 different time points to measure it until 1 year of age (1, 2, 4, 6, 8 and 12 months) 2 times from 1 to 2 once after the age of 2 typically, most infants in first two years of life settle into one of these growth channels —> can predict where the child will end up Trauma can be assessed by looking at these growth channels can be readily caught before it goes too far if more chronic problem: weight and height suffers weight is sensitive parameter bc growing so rapidly —> need appropriate nutrition Eating Developmental Patterns Nursing Period – Breast milk &/or infant formula = complete source of nutrition (4-6 months) Transitional Period – Introduction of semi-solid foods with high milk consumption (6-10 months) Modified Adult Period – Most food = adult-type (> 10 months) Milk Feeding Issues Exclusive breastfeeding: 0 – 6 Months Cow’s milk: not recommended in 1st year Partly skimmed milk: not recommended in 1st 2 years infant needs more energy dense diet and fat in milk to grow increase risk of allergy if solids before 6 months Percentages of Energy Yielding Nutrients in Human Milk and in Infant Formula very high fat content Percentages of Energy Yielding Nutrients in Human Milk and in Recommended Adult Diets Tracking and interpreting growth data Growth Standard Charts—developed by the WHO Derive data from breastfed infants Intended to be used for children ages 2–19 years Provide data points of growth of healthy children in optimal conditions Tracking and interpreting growth data Growth chart interpretation Measurements are plotted on growth charts to help interpret data Measurements fall into percentiles Point plotted on the 95th percentile line on the weight-for-age chart means that 95 of 100 children (95%) of the same age and sex have a lower weight for age Plotted measurements correspond to nutrition indicators Tracking and interpreting growth data 5th and 95th percentiles are the outermost percentile cutoff values indicating abnormal growth Interpreting plots over time can: Create a picture of child’s overall growth status compared with that of other children Provide data on the individual child Tracking and interpreting growth data Tracking and interpreting growth data Growth rates Second year of life: Average weight gain ~ 3 to 5 pounds Average growth ~ 3 to 5 inches per year Children 4 to 5 years old: Average weight gain ~ 4 to 6.5 pounds per year Average growth ~ 3 inches per year BMI used to assess appropriate weight for height after 2 years of age BMI does not differentiate contribution of excess fat mass versus excess lean mass to weight Tracking and interpreting growth data Situations that warrant further investigation and possible interventions: If weight, length, or head circumference measurements do not increase for more than a 1-month period If weight and height do not increase over time If there is a drop in weight that is not regained in a 3- to 4-week period Tracking and interpreting growth data Normal growth indicated by growth points following current percentile line or within one to two percentile line changes Movement crossing two or more percentile lines is potentially a sign of growth disturbance. Warrants further consideration, monitoring, and assessment Monitoring Growth in Early Childhood Beyond growth charts May perform further nutrition assessment as necessary through: Biochemical/laboratory measurements and other anthropometric measurements Nutrition-focused physical examination to assess signs and clinical symptoms of malnutrition Motor and cognitive development Developmental milestones Developing a new skill Knowing general ages when milestones usually occur can help with monitoring infant growth and development over time Delay can be symptom of larger problem Early detection of certain problems helps improve treatment outcomes Motor and cognitive development Usual infant motor development. Motor and cognitive development Infants first gain control of head and neck, then middle, followed by legs. Motor development tends to move from center to peripheral. Energy needs increase with increased movement. Spoon feeding appropriate when baby can sit and has head and neck control Motor and cognitive development Cognitive development progresses rapidly during first 2 years of life Depends on interaction with environment Sensorimotor stage Infants construct ideas as they experience different situations through their senses. Feeding abilities change as infants meet development goals Maximal brain development requires Proper nutrition Social and emotional interactions Infancy and Dietary Intake Infant feeding patterns and hunger cues Feeding patterns based on hunger response Infant stomach very small at time of birth First few days can hold only 5–7 mL By day 3 can hold around 22–27 mL By day 10 can hold 60–81 mL Feeding frequency may decrease as volume increases. Infancy and Dietary Intake The capacity of a baby’s stomach during the first 10 days of life Infant Feeding Skills Development Infants born with innate reflexes and ability to regulate food intake Infant should dictate eating schedule Cluster feeding Occurs when baby shifts from feeding every few hours to every hour, or feeding in spurts Most common during the evening and in young infants Milk Feeding Risks Overdilution or underdilution of formula Sterile water for milk formula Microwaving formula Nursing Bottle Syndrome Inappropriate milk substitutes Inappropriate milk substitutes Plant-based beverages (soy, rice) Low energy density; < 80% of energy density of infant formula Imbalanced nutrient profile - ↓ vitamin D, xs phosphate compounds Failure to thrive xs Mn intake - risk of neurotoxicity Goat’s milk Deficient in folic acid, vitamin B6 and B12 Higher in protein - risk of dehydration and higher renal solute load Low Ca:P - risk of hyperphosphatemic tetany Doré, Nicole; Le Hénaff, Danielle. From Tiny Tot to Toddler: A practical guide for parents from pregnancy to age two. Québec, Institut national de santé publique du Québec, 2017.776 pages. Doré, Nicole; Le Hénaff, Danielle. From Tiny Tot to Toddler: A practical guide for parents from pregnancy to age two. Québec, Institut national de santé publique du Québec, 2017.776 pages. Infant Feeding Issues 4-6 months of age: developmentally ready for new foods (Beikost) Teeth have developed Ability to swallow solid foods Indications of readiness Weight has doubled Consumes > 32 oz formula and still hungry Consumes 8 oz and still hungry < 4 h later Sits with support, controls head movement Introduction of Food When initiated too early, weaning ↑risk of: ↑ Morbidity (diarrhea & food allergies) Under-nutrition (Normal ↓in maternal milk production) May ↑ risk for allergies and maybe diabetes ↑ Risk of choking Introduction of Food Introduction of solid foods initiated too late  Growth faltering ↓ Immune protection Under-nutrition - exclusive breastfeeding or formula feeding becomes inadequate Inadequate energy and protein intake and deficiencies of Fe, Zn, vitamin A & vitamin D Infant Feeding Skills Development Infant feeding position Improper positioning associated with discomfort, possible choking, and ear infections Infant should be in semi-upright position when offered bottle Spoon feeding most successful when infant is capable of controlling their head and mouth Infant Feeding Skills Development Introducing solid foods Typically appropriate around 6 months Signs of readiness: Moving tongue from side to side Keeping the head upright Sitting with little support Recognizing cues helps progress feedings Solids offered via spoon Total of 1–2 tablespoons of semisoft foods for each meal, one to two times a day Babies sensitive to new tastes and smells Use recommended techniques to help infant’s first experience with solid foods. Infant Feeding Skills Development First foods Iron-fortified infant rice cereal thinned with breastmilk or formula Pureed fruits and vegetables Offer one new food at a time Space out to determine whether food allergies present Thicker foods added gradually Portion sizes determined by infant Avoid inappropriate foods that present choking risk Start with Iron Rich Foods Infant’s first foods should be rich in iron and given twice a day (6 mo -1 year) Iron-enriched baby cereal Meat and poultry Fish Tofu Legumes Eggs Introduction of Food Weaning period = progressive transfer from breast milk/formula to usual diet Introduction of weaning foods: in addition to breast milk or formula Milk: 60 ml/kg/d  supply required amount of protein (2 g/kg/d), but not energy Additional energy (CHO or fat) One new food at a time; wait 2-3 days before adding new food - All food groups within a few weeks - Choose sugar-free cereals - Whole grain (fiber) Introducing New Foods Introduce new foods at beginning of meal Crunchy foods better liked than overcooked foods Portion sizes: 1 Tbsp/year of age Do not force new foods on a child Do not force child to clean plate Introduction of Food need to know for exam the general: different type of foods from 4-6 months to 6-8 months (strained, mashed, etc.) to 9-12 months Food Milk feeds 4 – 6 Months Breast feeding can continue 6 – 8 Months Milk feeds decreases from 150 mL/kg to 600 – 800 mL per day 9 – 12 Months 600 – 800 mL per day Iron-fortified cereals for infants, cooked strained porridge Add Add Add different textures – infant cereals with fruit pieces, cereal bits Introduction of Food Food Meats, beans, egg Fruits 4 – 6 Months 6 – 8 Months 9 – 12 Months Add strained Gradually eliminate strained meats and introduce table meats Add strained Gradually eliminate strained & introduce chopped & wellcooked Introduction of Food Food Vegetables Juice or formula by cup 4 – 6 Months 6 – 8 Months Add strained; prepare hygienically and with no added sugar salt, fat and oil 9 – 12 Months Gradually eliminate strained foods and introduce table foods Add after 1 year of age juice can be filling: don’t give too much bc might not be hungry to eat more nutrient dense foods Introduction of Food Food 4 – 6 Months Finger foods, such as biscuits or toast Well-cooked mashed or chopped table foods 6 – 8 Months Add those foods that can be secured with a palmar grasp 9 – 12 Months Increase the use of small finger foods as the pincer grasp develops Add Infant Feeding Skills Development Drinking from a cup Introduce cup around 6 months of age By 10–12 months, infants can typically control cup and movement of tongue Continue bottle- or breastfeeding while introducing new foods Transition to solid foods complete when food and liquids the infant takes in daily are equal in calories to amount provided by bottle feeds or breastmilk Infant Feeding Skills Development Food preferences Breastfed infants exposed to wider variety of tastes Infants are more accepting of new foods between 4–7 months versus when introduced after 12 months. Preferences are largely learned. Should be sensitive to infant’s needs Refusal to eat may be need for attention or complaint against discomfort last slide for exam Infant Feeding Skills Development - Exposure to new textures & flavors  oral maturation - 10 weeks: no extrusion reflex - 3-6 months: palmar grasp - 4 months: can move head forward and turn away - 6-8 months - Rotary chewing – pairs of opposing teeth - Critical period of development in relation to eating - Requires specific stimulus of introduction of solid food - 9 months: holds onto bottle by him/herelf - 1-3 years: child still developing orally and muscularly  increases ability to eat Krause’s Food and the Nutrition Care Process, 13th Ed.