Infant & Child Nutrition - Exam 1

Question 1

What is colostrum? When is it present?

Answer 1

Pre-Milk secretion in breast feeding moms

present for the first 2-3 days after delivery

Question 2

What is colostrum high in? low in? Has a normal ______ action that makes it an ideal natural starter food

Answer 2

high: protein, vitamin A, immunoglobulin, sodium, chloride content

lower: carbs, potassium and fat content than mature breast milk

laxative

Question 3

Breast-feeding , according to the WHO and AAP, should be the exclusive form of nutrition for ________. With continued breastfeeding with complementary feeding through ______

Answer 3

approx the first 6 months of life

through at least 1 year of life

Question 4

What are some barriers that may impede breast feeding?

Answer 4

lack of education about breast feeding

misconception that formula is equivalent

not the social norm/embarrassed about breastfeeding in public

lactation problems

work restrictions

Question 5

What are some factors that will increase maternal confidence about breast feeding?

Answer 5

Promoting prenatal and postpartum education

Frequent mother-baby contact

Advice about technique

Early follow up after delivery

family support

Question 6

Babies are born with a _____ reflex. When is the baby usually introduced to the breast?

Answer 6

sucking

within the first hour

Question 7

What does bringing the baby to the breast within the first hour help with?

Answer 7

Signal uterus to contract and decrease chance of excessive bleeding after delivery

encourage baby to smell the colostrum and want to latch and begin

Question 8

How long and how often does a baby need to breastfeed?

Answer 8

Breast-fed babies will generally need to feed 8-12 times per day on demand, or every 2-3 hours, with longer intervals (4 hours) at night

Question 9

How long should the baby stay latched to the breast? What day after delivery does the mother’s milk usually come in?

Answer 9

1st day: 5 minutes per breast

2nd day: 10 min per breast

3rd day and beyond: 10-15 min per breast

Eventually, the infant may only need approx 15 total

milk usually comes in around day 3

Question 10

What are the growth velocity difference with regards to breast fed and formula fed babies?

Answer 10

breast: first 3 months will be heavier, 6-12 months will be lighter

formula: will gain more weight than breast babies and grow rapidly around 3-4 months

Question 11

How often will a well nourished infant void? How many stools?

Answer 11

void approx 6-8 times per day

Stooling should occur from 4-6 times per day

Question 12

What does a healthy infant’s stool look like from birth to a month old?

Answer 12

starts out black and tarry and slowly transitions to a yellowish seedy poop

Question 13

How much weight should a baby gain a day? If newborn is exclusively breastfeeding and still needs to gain weight, what is the recommendation?

Answer 13

½ oz to 1 oz of weight gain per day

formula or expressed breast milk: 1-2 oz after session of breastfeeding

Question 14

babies will lose approx _____ in the first week of life. Want them to be back up to their birth weight by _____

Answer 14

8-9 ounces

2 weeks old

Question 15

What is in breast milk? How many calories in 1 ounce?

Answer 15

low but highly bioavailable protein content, high quantity of essential fatty acids; the presence of long-chain unsaturated fatty acids.
Low sodium and solute load but highly bioavailable concentrations of calcium, iron and zinc. Secretory IgA, bacterial and viral antibodies and nonspecific immune factors

20 calories/ounce

Question 16

**What does breast milk NOT have? What is the recommendation?

Answer 16

**Does not contain vitamin D

**can supplement with drop at 1 mL (400 IU) qd while breast milk is main source of nutrition
Can be given directly into cheek or taken off Mother’s breast

Question 17

What are the benefits of breastfeeding for the baby? **What are the 2 highlighted ones?

Answer 17

milder symptoms of diseases when compared to formula fed infants, shortened duration

limited exposure to environmental pathogens

**prevents GI infection

**reduced frequency and duration of respiratory illnesses

protection against H flu and Strep Pneu

decreased rates of OM/UTI

Can protect the premature infant from necrotizing enterocolitis

reduce incidence of food allergies and eczema

can increase visual acuity

Question 18

What are the maternal benefits of breastfeeding?

Answer 18

enhanced bonding

first hour postpartum increases uterine contractility due to increase in oxytocin which reduced postpartum hemorrhage

helps with postpartum weight loss

reduce stress hormones

some contraceptive effect if used exclusively for 4-6 months

decrease risk of breast, ovarian cancer and T2DM

Question 19

Why does breastfeeding act as a form of contraception?

Answer 19

Due to suckling reflex, increases prolactin, which in return suppresses GnRH, which does not allow FSH/LH to be released, thereby amenorrhea or anovulatory menses

Question 20

Does breast size indicate breast feeding success?

Answer 20

NO! small breasted women still successfully breastfeed.

may limit the volume of milk that can be stored so may have to feed more frequently

Question 21

What are the 5 CI for breastfeeding?

Answer 21

mom has TB

HIV/CMV positive

chemotherapy agents

infants with galactosemia

certain medications

Question 22

What is the recommendation about breastfeeding with active HSV lesion?

Answer 22

women with herpetic breast lesions should not breastfeed from that side and should cover the lesions to prevent infant contact

Question 23

What is the recommendation for breastfeeding if born to a hepatitis B surface antigen + mother?

Answer 23

should receive immune globulin and vaccine, eliminating concerns of transmission through breastfeeding

Question 24

What is the breastfeeding recommendation for women who abuse drugs? Alchol?

Answer 24

Women who abuse drugs should not breastfeed until drug free

anything more than 1 glass of wine per day should pump and dump for 24 hours

Question 25

What is breastfeeding jaundice due to? What is the recommendation to the mother? What should you order?

Answer 25

which is exaggerated physiologic jaundice associated with inadequate intake of breast milk, infrequent stooling, and unsatisfactory weight gain. Technically due to borderline dehydration from low milk volume increase feedings and can augment with breast pump and increase volume of feeds Order Total serum/direct Bilirubin

Question 26

What is the base of infant formulas?

Answer 26

modified whole cow milk

Question 27

**What is the pt education regarding formulas during the first 4 months of life? How often do you feed the baby with formula?

Answer 27

Must mix with sterile water (can boil tap water, cool it and use it) Feedings are generally 6-8 times per day or every 3-4 hours, with longer intervals at night

Question 28

What is in formula? How many calories an ounce?

Answer 28

Fat source-vegetable oil, soy, coconut, corn, oleo, and safflower oils Carbohydrates-lactose that is also fortified with multiple vitamins and minerals 20 calories/ounce

Question 29

What are the different formula options?

Answer 29

milk based: milk protein soy based: soy protein/ NO LACTOSE hydrolyzed: predigested protein/NO LACTOSE

Question 30

When are soy based formula indicated?

Answer 30

galactosemia, milk allergy ( MPA )-(however, 20% are also allergic to soy)---soy is very constipating and not commonly used

Question 31

When are hydrolyzed formulas indicated?

Answer 31

milk protein allergy, bloody/mucousy stool, colic

Question 32

_____ is great for supplementation for breastfed babies (digested more like breast milk)

Answer 32

hydrolyzed formula

Question 33

______ are generally used when baby is still having issues on completely hydrolyzed formula or for severe milk protein allergy

Answer 33

specialty formulas

Question 34

formula fed babies are at increased risk for ____ later in childhood

Answer 34

obesity

Question 35

What are some advantages of formula feeding?

Answer 35

Able to cater to specific needs of the child, including iron intake, PKU, Galactosemia, milk protein allergy No vitamin or mineral supplementation needed (vitamin D) More comfortable feeding in public Can measure the volume - helps nervous moms

Question 36

How will a cow's milk protein allergy present? What is first step tx? If no improvement, then what? **What is important pt education?

Answer 36

May present with vomiting, esophagitis, colitis with blood/mucus in stool, irritability, slow weight gain, diarrhea, rashes on skin (think GERD s/s) mom decrease dairy and egg intake switch to completely hydrolyzed formula **two week lag, so s/s may persist for 2 weeks before you see an improvement treatment is the same for a human milk allergy

Question 37

How long can breast milk last in the fridge? frozen? **What should you NOT due to breastmilk?

Answer 37

fridge for 4 days and frozen for 6 months CANNOT microwave breast milk (destroys good antibodies) needs to be placed in a bottle warmer instead

Question 38

**What is the AAP/WHO recommendation with regards to introducing solid foods? When should meat be introduced?

Answer 38

**6 months of age 8 or 9 months

Question 39

When is a good time developmentally to start introducing food?

Answer 39

Able to hold head up Can sit unassisted Showing interests in foods-watch you eat and open when you take a bite Ability to track spoon and open mouth

Question 40

Why do you need to wait until 6 months to start introducing solid foods into the diet?

Answer 40

due to the sucking reflex at 6 months it changes so that when a spoon is inserted between the lips, they part, the tongue depresses, and food placed in the mouth is drawn to the back of the pharynx and swallowed

Question 41

What is the recommendation at which to start introducing complementary foods? When can you start introducing foods that require some chewing?

Answer 41

Single ingredient complementary foods are introduced one at a time at a 3-4 day interval chewing: 7-9 months

Question 42

at _______ okay to start adding in some soft table food

Answer 42

9-12 months but need to be caution about choking hazards

Question 43

what items should be avoided in infants due to choking hazard?

Answer 43

grapes, hot dogs, peanuts, boned chicken, hard candy, pieces of meat, fish with bones, sunflower seeds, apples, popcorn

Question 44

How old do you need to be before it is okay to have honey? Why?

Answer 44

honey: at least 1 year old risk of botulism

Question 45

What are some common foods that can trigger an allergic reaction?

Answer 45

milk eggs gluten nuts/peanuts seeds soy shellfish fish

Question 46

When can common allergy food be introduced into the diet? Do kids tend to outgrow food allergies?

Answer 46

6 months like any other food some kids outgrow milk/eggs allergy but peanut allergies is generally lifelong

Question 47

breast milk has little _____ so babies need to get it from food. How much is in breastmilk? formula?

Answer 47

iron: need to consume it from red meats and green veggies but due to choking risk not advised at a young age Breast milk has 1 gram/ L of iron formula 10-12 grams/ L

Question 48

_____ is the general age that weaning occurs. How should you start?

Answer 48

1 year old Begin with substituting one breast-feeding with a bottle or cup feeding, usually the midday meal and replace gradually over a period of 1-4 weeks

Question 49

What happens to a mother's milk supply during weaning?

Answer 49

Due to the stimulus of regular emptying of the breast is removed If demand is low, supply shrinks

Question 50

When should you introduce whole cow's milk into a kid's diet? Why? How long should they remain on whole milk?

Answer 50

Introduced at 1 year of age, when weaning off formula/breast milk avoiding iron deficiency anemia AAP recommends a child stay on whole milk until 2 years of age

Question 51

Why is whole milk important for the growth and development for a kid? How long should they stay on it?

Answer 51

Whole milk until two for baby’s growth and development During this time, baby’s brain and nervous system make amazing gains in size and complexity Because brain and nervous tissue are composed mostly of fat, it is reasonable to think whole milk greatly contributes to this

Question 52

Once the kid turns 2, what is the milk recommendation?

Answer 52

At age 2, a transition to 2%, 1%, or skim milk should be undertaken

Question 53

Should kid have 2%, 1%, or skim milk before 2 years old?

Answer 53

NO! Due to the fact that at a time when milk serves as a major source of food, skim milk provides too few calories, excessive protein, and inadequate amount of essential fatty acids

Question 54

_____ drops sharply after the kid first birthday

Answer 54

appetite and growth slows so not as much food is required

Question 55

What is the nutrition recommendation for a 1 year old?

Answer 55

they will eat when hungry, no need to force it! Offer a larger selection of nutritious items, and let them decide/choose

Question 56

What is the nutrition recommendation for toddlers 2 years and older?

Answer 56

Consumption of three regular meals per day, and one or two healthful snacks according to appetite, activity and growth needs high fiber limit soft drinks, sweetened beverages, processed foods

Question 57

What is the juice limitation for a toddler? young child? 7-18 years old?

Answer 57

Limit juice to 4-6oz per day for toddlers and young children 7-18 yrs of age, limit 8-12oz or NONE AT ALL

Question 58

______ is one (and really the only benefit) of juice in a kid's diet

Answer 58

constipation relief

Question 59

How many calories/day should infants have? Closer to 1 year old? 1 year old and up?

Answer 59

120kcal/kg/days as an infant and down to 90kcal/kg/day by 1 year 1 year old and up: add 100kcal/y to the base of 1000 calories a day

Question 60

What is colic? What is the crying component?

Answer 60

unexplained paroxysms of irritability, fussing, or crying which may develop into agonized screaming. The infant may draw up his/her knees against his/her tense abdomen as if there were abdominal pain.” in an otherwise healthy infant cry for >3hrs a day, for >3days a week, for >3 weeks

Question 61

When does the crying associated with colic mostly occur? What age does it peak?

Answer 61

mainly late afternoon-evening Peaks at 2-3 months, generally ending around 4m very common

Question 62

What are some potential causes of colic? What does it lead to in the parent?

Answer 62

food allergies, GERD, temperament, parental stress Can lead to feelings of inadequacy and anxiety

Question 63

______ is the most important diagnostic tool for colic. What lab tests should you order?

Answer 63

complete history lab testing is seldom indicated

Question 64

What is the tx for colic? When should the s/s resolve? What should you NOT do?

Answer 64

parent reassurance that their baby is healthy!! enlist the help of family members!! parents need a break consider switch to hydrolyzed formula consider GERD tx likely get better by the 3rd or 4th month DO NOT SHAKE THE BABY!!