Postnatal Nutrition

Question 1

Nutrition after pregnancy

Answer 1

important to help mother recover and to provide enough nutrients and energy for breastfeeding -> healthy diet is recommended and foods that provide enough protein, iron and calcium -> increase of 300-400 calories/day, drink plenty of water, avoid excess caffeine/alcohol and nicotine (can pass through breast milk) -> iron supplements may be needed to prevent iron deficiency anemia if serum ferritin is <= 70 micrograms/L

Question 2

Failure to thrive

Answer 2

slow weight gain -> downward crossing of two or more major percentile lines using the standard growth charts -> management may require a coordinated multidisciplinary approach

Question 3

Failure to grow

Answer 3

may be due to malnutrition, infections, digestive problems, hormonal problems, chronic heart, kidney or lung diseases

Question 4

Malnutrition

Answer 4

11-12 million children die each year before the age of 5, this is a contributory factor in 60% -> even milder forms have effects on cognitive function -> 183 million weigh less than they should for age

Question 5

Nutritional vulnerability in infancy

Answer 5

caused by rapid rate of growth, small body stores, functional immaturity impedes adaptation to both over and undernutrition

Question 6

Kwashiorkor

Answer 6

edema in face, hands and feet, poor wound healing (insect bites) -> initially grows well and develops many diseases due to low immune system

Question 7

Starchy diets

Answer 7

needs to significantly increase the energy intake to satisfy the child’s energy needs -> infections also have a huge effect

Question 8

infant can only take a relatively small amount of fluid so it must contain the maximal amount of nutrients per milliliter -> this nutrient is very important -> the content of this in milk is affected by diet

Answer 8

Fats

Question 9

important factor in ensuring proper growth and development of the infant -> the content of this in milk is not affected by diet -> casein (indigestible), alpha-lactalbumin (highly digestible -> half of enzyme that makes lactose) and gamma globulins

Answer 9

Protein

Question 10

40% of intake in the form of lactose

Answer 10

Carbohydrates

Question 11

fat soluble in milk not affected by diet of the mother, water soluble is affected by the diet

Answer 11

Vitamins

Question 12

provides the baby with all that it needs for the first 6 months of life -> preferred nutrition for this period

Answer 12

Breast feeding

Question 13

similar across all cultures -> on average it is 750g -> this suggests that it is not significantly affected by diet

Answer 13

Breast milk production

Question 14

infant formula has high protein nitrogen, no non-protein nitrogen sources, lower carbohydrates (lactose), slightly lower fat content, same calories as other options of infant feeding

Answer 14

Infant formula

Question 15

has high non-protein nitrogen sources (25% of nitrogen -> urea, free AA and small peptides), high carbohydrates (lactose) and fats (fatty acid types depends on mother’s diet), contains trophic factors (increases cell replication for normal gut function)

Answer 15

Breast milk

Question 16

reduced vulnerability to gastro-intestinal and respiratory infections, less likelihood that the baby suffers constipation, diarrhea and wind, suppression of ovulation in mother, better cognitive development due to higher omega 3 FA, decreased mother’s risk of early breast CA

Answer 16

Advantages of breast feeding

Question 17

introduction of solid foods into infants diet becomes increasingly important at this age (growth curve will begin to taper down in breast feeding alone)

Answer 17

6 months of age

Question 18

timing of introduction should reflect the pace of development, usually no need to introduce early ( it should be a gradual process (allow gut growth and secretions to develop)

Answer 18

Complementary feeding

Question 19

6x the risk of dying from diarrhea at 0-5 months, 2x from pneumonia at 0-5 months, 2x from both diarrhea and pneumonia at 6-11 months

Answer 19

Bottle fed

Question 20

potential downside of breastfeeding in areas of the world where these infections are common -> can be transmitted transplacentally and through breast milk

Answer 20

HIV infection

Question 21

increase chance of infection with HIV than if never breast fed or exclusively breast fed (protective effects in breast milk)

Answer 21

Mixed feeding (loses advantage of protective effects of breast milk)

Question 22

varies to meet demands of infant -> first diluted satisfies thirst and then the milk becomes more rich

Answer 22

Composition of breast milk

Question 23

10% of breast milk protein which is not absorbed (keeps on the surface to repel bacteria)

Answer 23

IgA

Question 24

iron binding protein that has a direct antibiotic effect on bacteria

Answer 24

Lactoferrin

Question 25

has strong influence on the type of bacteria that inhabit the intestinal tract

Answer 25

Lysozyme

Question 26

encourages the growth of lactobacilli which are helpful bacterial that can inhibit many of the disease causing gram negative bacteria and parasites

Answer 26

Growth factors

Question 27

based on modified cow's milk or soya protein -> enriched with vitamins and minerals -> can provide nutritional requirements for up to 6 months

Answer 27

Infant formula

Question 28

used to prevent hemorrhagic disease of the newborn -> may cause major internal bleeding

Answer 28

Vitamin K

Question 29

should be started at 6 months for breastfed infants and 1 year for babies fed on infant formula

Answer 29

Vitamin drops (A, C and D)

Question 30

should receive multivitamins and iron earlier

Answer 30

Preterm and low birth weight infants

Question 31

a child will be on 3 meals, snacks and breast feeds by the end of the first year -> chronic nutritional deficiency leads to failure to thrive -> causes of nutritional deficiency in industrialized countries -> refusal of solids/high intake of liquids, intake of low-density foods (healthy diet), behavioral eating problems, physical illness -> high mortality rates in this age group (nutritional demands are highest in this age group)

Answer 31

Preschool children (1-5 years)

Question 32

effects of eating habits (low intake of micronutrients due to eating habits: fast food, less fruits and vegetables) -> overweight and obesity -> eating disorders (anorexia nervosa, bulimia)

Answer 32

School children and adolescents