Pediatric nutrition

Question 1

Can breast milk cover all needs for infants? If so when?

Answer 1

Yes, breast milk can cover all needs for infants age 0 to 6 months, with the exception of vitamin D.

Question 2

Name some advantages of feeding your infant breast milk.

Answer 2

Breast milk is cheap, hygienic and has the right temperature for the infant.
Breast milk is easily digested and therefor prevents the infant from getting constipated.
Formula fed infants might be harder to introduce to new foods.

Question 3

What effect does garlic in the mother’s diet have on the breastfeeding?

Answer 3

Garlic in the mother’s diet prolongs the meals.

Question 4

How many milliliters of breast milk / baby formula is needed to feed: a) an infant 0-3 months old? b) an infant 4-6 months old?

Answer 4

a) 150 ml/kg body weight per day.

b) 130 ml/kg body weight per day.

Question 5

For how long is breastfeeding recommended?

Answer 5

For the first 12 months (and longer if the mother and baby feel happy with it.)
(For the first 6 months breastfeeding is recommended exclusively. Between the ages of 6 and 12 months breastfeeding is recommended as a supplement to solid foods.)

Question 6

When is it advised to begin introduction to complementary foods in infants? Are the recommendations the same for breastfed and formula fed infants?

Answer 6

No earlier than 4 month (17 weeks).
No later than 6 months (26 weeks).
Yes, the recommendations are the same.

Question 7

From what age is vitamin D supplementation advised in infants?

Answer 7

From week 4 of age (1 month).

Question 8

Why is vitamin D supplementation advised in infants?

Answer 8

Vitamin D supports the absorption of calcium. It is therefore important to dental and skeletal health (preventing osteomalacia).

Question 9

When breastfeeding is not possible, what other nutritional substitution can be used?

Answer 9

Human milk substitute formulas are the only approved nutritional substitution to breast milk.

Question 10

When introducing an infant to solid foods, how should it be done?

Answer 10

Gradually - the infants interest sets the pace.
In small portions - about half a teaspoon.
Soft consistency - could be mixed with a bit of breast milk or formula, increased thickness before introducing lumpy foods.

Question 11

When choosing a porridge for your infant what is important to remember?

Answer 11

Iron enrichment - If used, non-iron enriched porridge should only be used as taste variation. (Fruits rich in vitamin C can be served alongside the porridge to increase the uptake of iron.)
Gradual introduction to gluten - Corn or rise porridge should be used for the first taste portions.
Ready made porridge is advised and preferred.

Question 12

What is the recommended daily iron intake for a baby?

Answer 12

8 mg.

Question 13

Why is there a need to supplement breast milk with other sources of energy after 6 months of breastfeeding?

Answer 13

The energy and nutrient content of the breast milk will gradually decrease.

Question 14

From what age can cow’s milk as a milk drink be introduced to a child’s diet? Why not earlier?

Answer 14

From 1 year of age.

Not earlier because cow’s milk is low in iron and has a higher content of proteins.

Question 15

Name some foods that should not be introduced to the infant’s diet during the first year of life.

Answer 15

Honey.
Cow’s milk (as a milk drink).
Spinach, beet root, leaf celery, nettle and fennel.
Smoked and salted fish and meats. (Can only be given in very small portions.)
Fish liver, Svolvær- and Lofot-pate.
Salt. (The child has a limited ability to excrete salt.)
Products containing artificial sweeteners, such as diet sodas and chewing gum. (Should not be introduced until the age of 3 years.)
Rice milk and rice cookies. (Has a high content of inorganic arsenic and is therefore not suitable for children under the age of 6 years.)

Question 16

Is it recommended that children drink cow’s milk (in Norway)? Why?

Answer 16

Yes, from the age of 1 year it is recommended that children drink three glasses (500-600 ml) of cow’s milk (or other dairy products, e.g. yogurt) daily.
Cow’s milk is recommended because of it’s calcium and protein content.

Question 17

In short, for what purposes is energy used in children?

Answer 17

Maintenance, growth and activity.

Question 18

How many kilocalories (Kcal) are there in a) 1 gram of protein? b) 1 gram of carbohydrates? c) 1 gram of fat?

Answer 18

a) 4 Kcal.
b) 4 Kcal.
c) 9 Kcal.

Question 19

Name some sources of a) karbohydrates, b) proteins, c) fats.

Answer 19

a) Whole grain bread, cereals, legumes, vegetables, and fruits.
b) Fish, meats, poultry, egg, milk, and legumes (soy beans).
c) Fatty fish, oils, soft margarine, nuts, avocado, and olives.

Question 20

What does it mean that infants and toddler are able to self regulate their eating?

Answer 20

When the parents decide what to offer the child, it is capable of deciding how much to eat itself.

Question 21

Which is the better indicator of adequate food intake: The child’s portion size or the child’s growth and development?

Answer 21

The child’s growth and development is the better indicator.

Question 22

What should parents do if they notice there are day-to-day variations in their infant’s/toddler’s food intake?

Answer 22

Nothing. Day-to-day variations in food intake is normal and should be accepted.

Question 23

What should be included when taking a nutritional history?

Answer 23

Meal routines: What is offered at what time? Are the meals regular? Is the child hungry when offered food? Is the food energy/nutrient dense? Is it a balanced diet?

Question 24

What should a diet registry include?

Answer 24

A diet registry should be reflective of what the infant/toddler has eaten during a period of time (at least 3-7 subsequent days). Specific amounts and brands of the foods eaten are essential.

Question 25

What can be done if the child experiences poor growth due to low energy intake?

Answer 25

Vegetable oils or margarine can be added to enriched porridge/formula/dinner. (One teaspoon per 100 grams of food is usually enough.)
Switching to a stronger and more calorie dense formula (on prescription) can be considered.

Question 26

What is neophobia?

Answer 26

The fear of anything new. In the context of children the term i usually used to indicate a tendency to reject unknown or novel foods.

Question 27

When does neophobia / “picky eating” peak in children?

Answer 27

Around 1,5 years of age.

Question 28

What are the national guidelines for healthy eating?

Answer 28

Whole grain bread.
Whole grain pasta / rice and potatoes.
Lean and fatty fish.
Lean meat - less red meats.
Fat reduced dairy products.
Vegetable oils and soft margarine.
Vegetables, fruits and berries.
Reduced sugar intake.
Reduced salt intake.

Question 29

How much of the daily caloric intake should added sugar make up (in children and adults)?

Answer 29

Maximum 10 % E.

Question 30

How is body mass index (BMI) calculated?

Answer 30

BMI = body weight in kg / (body heigh in metres)^2.

Question 31

What are three important things to consider when dealing with overweight in children?

Answer 31

Don’t be afraid to talk about the problem. Create awareness.
Growth will help. Let natural growth help to “catch up” with current excess weight.
Meal routines. Regularity, definition of “snack meals” and reduce intake of extra energy (“empty calories”).
Portion sizes. Should a six year old eat as much as their parents?

Question 32

Explain “the plate model” / “the hand model”.

Answer 32

The “plate/hand model” is meant as guidance in creating healthy, balanced meals.
One meal should ideally contain:
A portion protein (fish, meat, lentils, egg) the size of your fist. (One quarter of the plate.)
A portion carbohydrates (bread, rice, pasta, potato) the size of your fist. (One quarter of the plate.)
A portion of vegetables and/or fruits and berrier the size of your open fist. (Half of the plate.)

Question 33

Should a toddler drink full fat milk?

Answer 33

No, the recommendations say lean milk with a maximum 0,7 % of fat.

Question 34

How much milk products will a toddler need to get enough calcium from their diet?

Answer 34

500-600 ml (or three glasses) per day (including other dairy products such as yogurt).

Question 35

How can we get a 1,5 year old to like vegetables?

Answer 35

Awareness of the neophobic phase. Fear of/unwillingness to try novel foods are a normal part of development in children.
The solution is to keep on trying without pressure.

Question 36

Should we act or await when seeing abnormal weight gain in a three year old child?

Answer 36

It is recommended to act early. The intervention should although be “invisible” in front of the child.

Question 37

Which supplement are used when giving vitamin D to infants/toddlers?

Answer 37

Cod liver oil or vitamin D drops.

Question 38

At what age can cow’s milk be introduced to an infants diet?

Answer 38

At 10 months of age, but not until 12 months of age as a milk drink.