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Define: infant mortality

Infant mortality - defined as death that occurs within the first year
-Major cause is low birthweight (< 2500 g)
Other leading causes:
-congenital malformations
-preterm births
-SIDS: Sudden Infant Death Syndrome


Define: SGA, AGA, LGA

SGA - small for gestational age: newborn was 90th percen1le of wt/age


Define: failure to thrive
Common Nutrition Problem & Concern

-Inadequate weight or height gain
-Energy deficit is suspected

(may involve social worker)
(when you don't see adequate medical issues & symptoms)


Infant dev: newborn development

-Hear and move in response to familiar voice
-CNS is immature resulting in inconsistent cues for hunger and sa1ety
-Strong reflexes that are protective for newborns


what are factors associated w/ infant mortality

Social and economic status
Access to health care
Medical interven1ons
Teenage pregnancy
Availability of abor1on services
Failure to prevent preterm & LBW births


Infant reflexes:

Reflex—automatic response triggered by specific stimulus
Rooting reflex—infant turns head toward the cheek that is touched
Suckle—reflex causing tongue to move forward and backward


Infant dev: Infant development & feeding skills development progresses?

Digestive System Development:
-During the 3rd trimester: Fetus swallows amniotic fluid
which stimulates intestinal maturation and growth
-At birth: the healthy newborn can digest fats, protein, & simple sugars.
-Common problems include gastroesophageal reflux (GER), diarrhea, and constipation


infant dev: factors that impact food

Factors that impact rate of food passage in colon and gastrointestinal discomfort in infants:
-Osmolarity of foods or liquids
-Colon bacterial flora
-Water and fluid balance in the body


infant dev: parenting for feeding practices

new parents learn:
-Infant’s cues of hunger and safety
-Temperament of infant
-How to respond to infant cues


What are the energy and protein needs for infants according to body weight (birth to 6 months and 6 to 12 months)? What factors are associated with protein and calorie needs?

Energy (Calories):
-108 kcal/kg/day from birth to 6 months (range from 80 to 120)
-98 kcal/kg/day from 6 to 12 months


Recommendations for infants for food:

The recommenda1ons for infants are from the Dietary Reference Intakes (DRI) - Na1onal Academy of Medicine, American Academy of Pediatrics, and the Academy of Nutri1on and Dietetics
-Energy needs
-Protein needs § Fats


Protein needs: What are the protein needs for infants according to body weight (birth to 6 months and 6 to 12 months)?

Protein needs are similar to that of energy but are also influenced by body composition

Protein Needs
2.2 g/kg/day from birth to 6 months
1.6 g/kg/day from 6 to 12 months
Newborn weighing 4 kg (8.8 lbs) needs 2.2 X 4 = 8.8 g
6-month-old weighing 8 kg (17.6 lbs) needs 1.6 X 8 = 12.8 g protein


Energy needs: What factors are associated with calorie needs?

Factors that influence calorie needs:
-Wt & growth rate
-Sleep/wake cycle
-Temp & climate
-Physical activity
-Metabolic response to food
-Health status/recovery from illness


Metabolic Rate, Calories, Fats & Protein: How do you assess growth?

-Metabolic rate of infants is highest of any time after birth
-The higher rate is related to rapid growth and high
proportion of muscle
-Low carbohydrate and/or energy intake results in protein catabolism impacting growth


Physical growth assessment: What are the indicators of growth problems?

Newborns grow faster than any other time of life
Growth reflects:
-Nutritional adequacy
-Health status
-Economic & environmental adequacy
-There is a wide range of growth = typical
-Calibrated scales & recumbent length measurement board required for accurate measures


Compare growth charts: CDC vs. WHO. How do you use and interpret each growth chart?

data & pop. is different
CDC bbs born in US

CDC 2000:
1. US selected sites w/ 5k measurements
2. descriptive reference reflecting past: how infants have grown
3. 66% formula fed & 33% BF for 3mos
4. birth - 36 mo (3 yrs)
5. high prevalence

WHO 2011:
1. WW: 6 selected sites w/ 19K measurements
2. Prescriptive optimal standard: how infants should grow
3. All BF @ for 4mo
4. Birth-24 mos
5. Low prevalence


CDC recommendations

CDC recommends that health care providers:
-Use the WHO growth charts to monitor growth for infants & children ages 0-2 yrs
-Use the CDC growth charts to monitor growth for children age 2 yrs and older


WHO charts (4)

Head circumference
weight-for-length (recombinant)


CDC Charts (3)

length-for-age (stature)


Feeding in Early Infancy: What are the recommended feeding practices during early infancy?

Breast Milk and Formula
-Recommend exclusive breast feeding for 1st 6 months &
continuation to 1 yr
-Initiate breast feeding right amer birth
-Growth rate and health status indicate if milk volume intake is adequate
-Standard infant formula provides 20 cal/fl oz
-Preterm formula provides 22-24 cal/fl oz


Compare breast milk and formula (cow’s and soy based)

COW: Whole, reduced-fat or skim cow’s milk should not be used in infancy
-Iron-deficiency anemia linked to early introduc1on of
cow’s milk
Anemia linked to:
-GI blood loss
-Low absorp1on of calcium & phosphorus
-Displacement of iron-rich foods

SOY Protein-Based Formula During Infancy:
-Soy protein in place of milk protein should be limited in its use
-The use of soy formula is not recommended for managing infan1le colic
-Lactose free and hydrolyzed formulas are beker for infants unable to breasoeed or be fed cow’s milk formulas


What are the consequences of using cow’s milk in infancy?

-lots of energy
-not enough iron*


Intro to solid foods: What are the recommendations for solid foods introduction?

-At 6 months, offer small portions of semisom food on a spoon once or twice each day
-Food offered from spoon s1mulates mouth muscle development
-Infant should not be overly tired or hungry
-Use small spoon with shallow bowl
-Allow infant to open mouth & extend tongue
-Place spoon on front of tongue with gentle pressure
-Avoid scraping spoon on infant’s gums
-Pace feeding to allow infant to swallow
-First meals may be 5-6 spoons over 10 minutes


Which foods should be first offered?

1st foods:
-iron-rich foods
6 months—iron-fortified baby cereal
-Rice cereal is hypoallergenic
-6 months—fruits and vegetables
-Only one new food over 2-3 days
-Commercial baby foods are not necessary but do provide sanitary and convenient choices
-9-12 months som table foods


Which foods are considered unsafe?

Foods that choke infants
-Hot dogs
-Popcorn, potato chips
-Peanuts, chunks of peanut butter
-Raisins, whole grapes
-Stringy meats
-Gum & gummy-textured candy, hard candy or jelly beans
-Hard fruits or vegetables


Discuss difficulties related to the weaning process

Offer water or juice from cup amer 6 months
-Wean to a cup at 12 to 24 months
-First portion from cup is 1-2 oz
-Early weaning may result in plateau in weight (due to reduced calories) and/or cons1pa1on (from low fluid intake)
-Changing from a bokle to a covered “sippy” cup with a small spout is not the same developmental step as weaning to an open cup
-Open cup drinking skills also encourage speech development


What are the recommendations regarding water, juice and supplements during infancy

-Breast milk or formula provide adequate water for healthy infants up to 6 months
-Dehydration is common response to illness in infants (vomit and diarrhea)
-Pedialyte or sports drinks provide electrolytes but lower in calories than formula or breast milk
-Limit juice
-AAP recommends juice is not needed to meet the fluid
needs before the age of 6 months
Avoid colas and tea

Supplements for infants
-Fluoride—for breasoed infants amer 6 months or if in any area with no fluoridated water
-Vitamin B12—for vegans
-Vitamin D—needed if exclusively BF


Discuss common nutritional problems and management strategies in infancy: colic

Colic - the sudden onset of irritability, fussiness or crying
-Episodes may appear at the same 1me each day
-Disappear at 3rd or 4th month
-Cause unknown but associated with GI upset, infant feeding practices


Discuss common nutritional problems and management strategies in infancy: iron deficiency

-Less common in infants than in toddlers
-Iron stores in the infant reflect the iron stores of the mother
-More common in low-income families
-BF infants may be given iron supplements and iron- for1fied cereals at 4-6 months


Discuss common nutritional problems and management strategies in infancy: diarrhea/constipation

Diarrhea and Cons1pa1on
-Infants typically have 2-6 stools per day
Causes of diarrhea & cons1pa1on:
-Viral and bacterial infections
-Food intolerance
-Changes in fluid intake

To avoid cons1pa1on assure adequate fluids
Con1nue to feed the usual diet during diarrhea