Infancy Flashcards

Question

What are the neuromuscular developmental milestones?

Answer 1

* 4-6 months: biting and chewing added to sucking; sits erect * 6-9 months: grasps and finger feeds; sits without support * 9-12 months: tongue lateralization, rotary motion of jaw, finger-thumb motions * >1 year: ‘proficient’ self-feeding

Answer 2

Dietary References Intakes - Adequate Intakes (AI) 0-6 months 7-12 months - RDA proteins, iron, zinc Based on: - Breast milk intake & composition (and after 6 months intake from complementary foods) - Direct data from infants - Extrapolations from adults

Answer 3

A. Basal metabolix rate

Answer 4

Basal metabolic rate: activities of brain, liver, heart and kidneys Cost of tissue accretion: - Higher kcal/day but decreases fast to 3-6 months Physical activity: not accounted for in EER equations EER = total energy expenditiure (basal metabolism) + energy deposition

Answer 5

780 mL x (4.0g/100mL) = 31 g/d

Answer 6

* Up to 55% of energy! * Concentrated energy needed for growth AI for fat * 0-6 months: Based on human milk content * 7-12 months: 30 g/d Based on human milk + complementary foods

Answer 7

* AI for omega-3 and omega-6 * Human milk (and formulas) provide >5% of energy as omega-6 and ~1% omega 3 * Deficiency may develop if <1% of energy is supplied by linoleic acid

Answer 8

0-6 months * AI based on protein and non-protein N content of human milk * AI: 1.5 g/kg/d 7-12 months * EAR established using the **factorial method **based on needs for maintenance and growth * EAR: 1.0 g/kg/d * RDA: 1.2 g/kg/d Factorial method: adding up all losses (urine + feces) + growth Highest needs during 0-6 months compared to adults

Answer 9

C. Young infants should not normally consume water

Answer 10

AI based on calcium intake * 0-6 months: 200 mg (breast milk) * 6-12 months: 260 mg (breast milk plus food) Proportionately more calcium added to bone in first year than at any other time of life Infant absorbs 55–60% of calcium in breastmilk * Calcium content is lower but bioavailability is higher from breast milk than formula

Answer 11

nfants are born with low levels of vitamin K because: - Low transfer in pregnancy - Low amounts in breastmilk - Immature gut microbiome Low vitamin K can lead to **vitamin K deficiency bleeding** - Blood cannot clot - Internal bleeds may not be apparent and can be fatal Recommend routine intramuscular administration of a single dose of vitamin K at 1.0 mg to all newborns

Answer 12

* Limited sun exposure + low amounts in breast milk = potentially low vitamin D in infants * Risk of rickets in breast-fed infants who do not receive supplement Supplemental vitamin D is recommended for breastfed infants

Answer 13

Breast milk contains very little iron, but it is absorbed well Infants have adequate iron for first ~6 months * AI 0–6 months: 0.27 mg Will need additional sources of dietary iron thereafter * RDA 7–12 months: 11 mg Iron deficiency anemia most common at ~9 months of age * May lead to lasting impaired cognitive development

Answer 14

At birth, fetal hemoglobin replaced with adult hemoglobin Recycling of hemoglobin + iron stores + iron in breastmilk provide adequate iron for first 6 months of life No need for iron supplements for breastfeed infant

Answer 15

* Bilirubin = byproduct of hemoglobin breakdown * Immature newborn liver has limited ability to metabolize and excrete bilirubin * Newborn is predisposed to hyperbilirubinemia which causes **neonatal jaundice**

Answer 16

* Build up of bilirubin * Presents as yellow coloring of skin * Elevated bilirubin can cause permanent neurological damage if not resolved Most frequent cause for hospital readmission for newborns during the first 2 weeks of life

Answer 17

Physiological jaundice: Frequent breastfeeding to aid in excretion of bilirubin Pathological jaundice: Phototherapy - lethargy; weight loss >10% body weight

Answer 18

D. Blood type incompatibility

Answer 19

Child * Breast/bottle feeding only * Strong reflexive component * Child is in control of when and how much to eat Caregiver Roles * Cue recognition/responsive, trusting relationship * Physical support/positioning * Supporting milk production (maternal nutrition) or preparation of infant formula

Answer 20

Breastfeeding is the normal and unequalled method of feeding infants. * Recommend exclusive breastfeeding for the first six months. Breastfeeding initiation and duration rates increase with active protection, support, and promotion. Supplemental vitamin D is recommended for breastfed infants. First complementary foods should be iron-rich. Routine growth monitoring is important to assess infant health and nutrition. Feeding changes are unnecessary for most common health conditions in infancy. Breastfeeding is rarely contraindicated. Recommendations on the use of breastmilk substitutes * Individually counsel those families who have made a fully informed choice not to breastfeed on the use of breastmilk substitutes

Answer 21

Human milk provides: * Sufficient energy and nutrients for babies for the first six months of life * Nutrients in the correct quantity and quality to promote absorption * Bioactive factors that offer protection against gastroenteritis, diarrhea, respiratory infection, and allergy in early life

Answer 22

1. Expressed mother’s own milk (MOM) 2. Donor milk - pasteurization destroys potential pathogens but decreases some immune factors and vitamins in milk - healthy and non-smoking mothers 3. Human milk substitutes (infant formula)

Answer 23

Growing demand has led to informal ”milk sharing”, which carries risk of * Infection with hepatitis B and C, HIV... * Transfer of drugs, tobacco or alcohol in milk Unpasteurized milk sharing is not endorsed by the CPS

Answer 24

Substitute for human milk in those that: – Should not receive human milk or – For whom human milk is not available Based on animal milks (e.g. cow’s) or plant sources (e.g. soy) and designed to mimic human milk as best as possible Regulated by Health Canada 3 Kinds of Formula: Powder, Ready to feed, Liquid concentrate

Answer 25

Cow’s milk based - Recommended for most formula-fed infants Soy milk based * Lactose free & vegan - Recommended for babies who can't have animal products + those who can't have lactose - Not recommended for allergies Therapeutic formulas: – Hydrolyzed or semi-elemental - Proteins broken down – Elemental (amino-acid) – Preterm : Higher calories, protein

Answer 26

Dec. carbs - adding lactose or corn-syrup (glucose) Dec. Pro - Inc Whey/Casein ratio Additon Iron Chane fats composition - Inc. PUFA, DHA Dec. Solutes load (electrolytes)

Answer 27

Feeding should be on demand Following baby cues > precise amounts In general, ~150 mL/kg for first three months

Answer 28

A. It doesn’t provide adequate micronutrients for infant growth and development B. The concentration of protein and some minerals is much higher than human milk D. The fatty acid composition of human milk differs from cow’s milk

Answer 29

**Physical:** * 4-6 months: biting added to sucking, better head and neck control. * 6-9 months: better dexterity, sits without support; seal lips around eating utensils and cups. * 9-12 months: tongue lateralization, rotary motion of jaw, finger-thumb motions * Maturing GI and kidney functions to support solid eating. * >1 year: ‘proficient’ self-feeding **Autonomy:** Improving communication, control **Exploration:** new tastes, textures

Answer 30

Complementary foods provide additional energy and nutrients needed for the growing infant Transition from "feeding" to independent eating Allowing infant to explore new textures and flavors

Answer 31

Spearation/individualization phase - Provide appropriate foods for childs developmental age - Provide boundaries bt setting meal structure - Allow for safe exploration - Balance autonomy/dependency Feeding is at its best when using a competence-based approach and not a deficit-based approach

Answer 32

Developmental Readiness for Solids * Sits by self with good head control * Can track spoon/food and open mouth * Can close lips over a spoon * Can indicate they don’t want something, i.e. turning head away * Interested in food, i.e. leaning forward when food is offered

Answer 33

A. Iron-fortified baby cereal

Answer 34

Age 6-8 months: 2-3 meals and 1-2 snacks each day Age 9-11 months: 3 meals and 1-2 snacks Age 12 months and beyond: 3 meals and 2-3 snacks * When baby starts to show signs of disinterest or tired, it is time to finish the meal regardless how much food baby has eaten. * Offer solid meals when baby is somewhat hungry, but not too hungry.

Answer 35

Offer a variety of textures and finger foods following infant’s readiness: *Prioritize iron-rich food, *Progress and advance beyond pureed and minced textures to lumpy, soft- cooked textures no later than 9-12 months Pureed, lumpy, mashed, ground, soft-cooked, minced

Answer 36

Infant should be in control: must be allowed to eat when they are hungry and stop when they are full Food should be offered in a pleasant environment with positive adult attention; dont' over stimulate or using tactics like coercion or persuasion - Food should not be used as a reward, punishment, or pacificer

Answer 37

Responsive feeding is based on this theoretrical framework - Healthy term infants possess the ability and capacity to **FOOD REGULATE** defined as knowing how much to eat to manage hunger and satiety, and to **FOOD ACCEPT** defined as with enough exposures (up to 20 times, to "come around", and accept new food on their owing timing Based on a **competence stance**, recommend to follow the **trust model** in feeding

Answer 38

Parent's Reponsibility - What is offered - Breastmilk/substitutes - Providing positive and supportive environment Infant's Responsibility - When to eat - How much

Answer 39

Parent's Responsibility - What is offered - When - Where Infant's Responsibility - What is eaten of the foods provided (or if food is eaten) - How much

Answer 40

baby-led weaning believes babies would nautrally learn how to eat at their own pace - not minced or pureed, but simply softly cooked and cut-up to size, food from family foods - without the use of utensils Better health with least amount of interference from parents or caregivers

Answer 41

Prevention of choking hazards needs to continue until baby turns 4 years of age Should not be served to infants and young childern: - Nuts, poocorn, small candies - raw fruite or veges cooked unless very soft - hot dogs or ther foods cut in 'rounds' - whole grapes (suggest cut in half or quarters) - thick peanut butter (suggest spread it thinly on cracker or toast)

Answer 42

9-12 months Guideline: * When a toddler is eating a variety of iron-rich foods, advise that pasteurized whole (3.25% M.F.) cow milk can be introduced in an open cup. Pasteurized, full-fat goat milk, with added folic acid and vitamin D, may be given as an alternative to cow milk. The following may indicate baby is at increased risk: * Consumes skim, 1% or 2% cow milk or goat milk as main milk source. * Consumes plant-based milk alternatives (e.g. soy, rice, almond beverage), goat milk not fortified with vitamin D or homemade infant formula as a milk source. 12-24 months Guideline: * If not breastfed, advise to offer 500 mL (2 cups) pasteurized whole (3.25% M.F.) cow milk (vitamin D fortified goat milk) each day. The following may indicate baby is at increased risk: * Consumes skim, 1% or 2% cow milk or goat milk as main milk source. * Consumes plant-based milk alternatives (e.g. soy, rice, almond beverage), goat milk not fortified with vitamin D or homemade formula as milk source. Until baby is consistently having 2 servings of dairy products and eating a wide variety of vitamin D rich foods, continue with vitamin D drop

Infancy Flashcards

(69 cards)