Infancy and Weaning

Question 1

Growth patterns in first 2 years of life

Answer 1

Check ups within 1–2 weeks of birth, 1, 2, 4, 6, 9, 12, 18 and 24 months of age, then yearly
- for wt, ht and head circumference

Normal growth patterns follow within 1-2 percentiles

Question 2

Growth charts

Answer 2

Use of percentiles - ex. 95th percentile = 95% of children with weight for age lower
corresponds with nutrition indicators

growth charts used for birth to 36 months and then 2 to 20 years

used to detect changes in growth out of norm - weight is a sensitive barometer
- allows for tracking growth and comparing to other children for context

Question 3

Microcephaly definition and diagnosis

Answer 3

Microcephaly determined from head circumference measurements in first 2 years of life

Head size in < 3rd percentile is considered microcephaly

Due to small brain size - growing brain is stimulus for skull to grow

No catch up growth for head circumference - correcting nutrition later on does not compensate
- Can still benefit from supplementation of milk/formula

Question 4

Nutrition indicators corresponding with growth chart measurements

Answer 4

Length for age → < 2nd percentile → short stature

Weight for length → < 2nd percentile → Low weight for length

Weight for length → > 98th percentile → high weight for length

BMI* for age → <5th or >95th percentile → underweight or obese

Stature for age → < 5th percentile → short stature

*BMI after age 2

Question 5

Average weight gain pattern up to age 5

Answer 5

1st year rapid growth as weight doubles in 4 months, triples in 12 months

2nd year of life:
- average weight gain = 3-5 lbs
- average growth gain = 3-5”

Years 4-5 per year:
- average weight gain = 4-6.5 lbs
- Average growth gain = ~3”

Question 6

Feeding periods

Answer 6

Nursing period: breast milk/infant formula complete source of nutrition months 4-6

Transitional period: intro of semi-solid foods with high milk/formula intake months 6-10
- spoon feeding, self feeding, chewing

Modified adult period: most foods = adult-type months >10

Question 7

When to investigate/intervene related to growth patterns:

Answer 7

No increase in weight, height or head circumference for 1 month

No weight/height increase over time

A drop in weight not regained in 3-4 weeks

Movement crossing 2+ percentiles of growth

Question 8

Sensorimotor development

Answer 8

Sensorimotor stage = child learning about themselves and the environment by constructing ideas as they experience different situations through their senses

maximal development requires proper nutrition + social/emotional interactions
- caregiver’s emotions can affect child’s emotional development

cognitive + nutritionally issues go hand in hand and feed into each other

Question 9

Motor development begins

Answer 9

with head and neck → middle → legs
from center → peripheral

more movement = ↑ energy needs

depends on interaction with environment/stimulation

Question 10

Developmental signs for readiness transition to solid foods

Answer 10

Ages 4-6 months

teeth have developed (mostly) and ability to swallow solid food

Weight doubled

consumes > 32 oz formula and still hungry or consume > 8 oz and still hungry < 4 hours later

Sits with little support and controls head movement/head upright

Moving tongue side to side

Question 11

Timeline of infant feeding skills development:

Answer 11

10 weeks - no extrusion reflex

3-6 months - palmar grasp

4 months - can move head forward and turn away

6-8 months - rotary chewing, critical period that requires stimulus of solid food intro

9 months - holding onto bottle solo

1-3 years - increasing ability to eat with oral and muscular development

Question 12

Dietary recommendations during infancy

Answer 12

Cow’s milk not recommended in first year of life
- Partly skim milk not recommended first 2 years of life
- Cow’s milk is a poor source of Fe

Feeding frequency and duration changes with increasing stomach size
- frequency ↓ with volume ↑
- 1-2 marble = 5-7 mL, day 3 ping pong ball = 22-27, day 10 (chicken egg) = 60-81 mL

avoid milk substitutes such as rice or soy
- low energy density, low vit D, high phosphates, high Mn → toxicity

avoid goat’s milk: folic acid deficient, low B6, B12, high protein (dehydration + renal load)
- low Ca:P ratio → hyperphosphatemic tetany

During weaning maintain 60 mL/kg/day breast milk/formula for protein (2g/kg/day)

Question 13

Dietary concerns during infancy

Answer 13

Feeding patterns depend on hunger cues - can be affected by cognitive delays

Question 14

Fat content in human milk, cow’s milk and adult diet (max recommended)

Answer 14

Infancy is the only time when fat has an RDA - fat required for optimal growth

Human milk: 55% fat, 6% protein

Formula: 49% fat, 9% protein
higher protein → faster growth, ↑ rates of obesity (↑ adiposity)

Adult diet: 30% fat, 12% protein

Question 15

risks of weaning too early

Answer 15

↑ morbidity including diarrhea and allergies

Under-nutrition due to responsive decrease in mother’s milk

↑ risk developing allergies or diabetes - immune response to proteins attacks pancreas
- oral tolerance - immune system can handle proteins

↑ risk of choking

Question 16

risks of weaning too late

Answer 16

growth faltering

↓ immune protection due to under-nutrition

Under-nutrition especially: energy, protein, Fe, Zn, vitamin A and D

Breast milk is a poor source of Fe

Question 17

Guidelines for introducing solid foods

Answer 17

1-2 tablespoons of semi-soft food offered for each meal 1-2x/day

one new food at a time 2-3 days apart → can check for allergies
- if a food is rejected, should try again later

introduce new foods at start of meal

1 Tbsp per year of age

introduce all food groups within a few weeks

Question 18

Introduction of foods timeline

Answer 18

4-6 months of age:
- breastfeeding continues, introduce first foods
- wide variety of flavors - most accepting of new flavors from months 4-7 compared to after 12 months

6-8 months of age:
- milk ↓, Fe fortified foods continues, add meats, beans, eggs, fruits, vegetables (cooked) → everything pureed and strained
- add finger foods for palmar grasp like biscuits

9-12 months of age:
- breast milk as before, add new cereal textures, finely cut table meats, well chopped or mashed and cooked fruit/veg, add table foods
- increase finger foods for pincer grasp
add juice or formula by cup after 1 year of age

Transition is complete when kcal from food = amount provided from bottle/breast milk

Question 19

First foods to introduce

Answer 19

iron-fortified and iron-rich foods → hemoglobin synthesis
- rice cereals + breast milk/formula
meat, poultry, fish
- firm tofu, legumes, eggs

pureed fruits and vegetables
- variety is good - sets precedent for openness to new foods later in life

gradually increase food thickness

nothing that can be a choking hazard: grapes, peanuts, hot dogs

choose whole grains, no added sugar