Nutrition during Infancy

1. Nutrition during Infancy • Stages of infancy • Physiological changes • Charting growth • Feeding infants: • Formulas: types, concerns • Feeding schedules • Introduction of solid food • Division of Feeding Responsibility • Feeding concerns • Eating Pattern Messages

2. Glossary • Lactase = digestive enzyme that breaks lactose into glucose and galactose • ADH = antidiuretic hormone (vasopressin), produced by pituitary gland • Renal solute load = amount of nitrogen, sodium, potassium, phosphorus, chloride kidneys must filter • Bioavailability = amount of a dietary nutrient that is actually digested/absorbed

3. Stages of Infancy • Prenatal • Perinatal • Neonatal • Postneonatal one year Conception Birth Infancy Prenatal Neo-natal Perinatal

4. Physiological Changes during Infancy

5. Anthropometrics • Weight • immediate loss of 6-10% body weight not uncommon • ______ birth weight by _____ • ______ birth weight by _____ • gain is rapid but • Length • increases ____ by ______ • can “catch-up” or “lag-down” • Body __________ • Body __________!

6. GI tract • Immature; Stomach is small • ______ capacity • empties in _____ hours • so • Nutrient digestion/ absorption • 100% ready for _____ • least ready for ______ • ____depends on

7. Kidneys: Immature • unable to • renal solute load determined by ________ _____________________ concentrations • risk of __________ • by ______: able to regulate ____________ via ADH • by __________: renal tubules mature

8. CDC Growth Charts • Developed by National Center for Health Statistics, 1977 • Based on _______ data • Two sets:

9. CDC Growth Charts: Revised 2000 • based on _______________ infants • racially and ethnically diverse • new ________ charts (for use over age 2) • exclude_______ infants and __________ data for children >6

10. What does a growth chart chart? • Infants, birth to 36 months • Weight-for-age • Length-for-age • Weight-for-length • Head circumference-for-age • Children and adolescents, 2 to 20 years • Weight-for-age • Stature-for-age • BMI-for-age • Preschoolers, 2 to 5 years Weight-for-stature

11. Assessment standards • ____________ percentile • stunting • underweight • overweight • ____________ percentile • risk of overweight (BMI-for-age)

12. Feeding Infants

13. Formulas for Infant Feeding • Formulas are quite similar because • Forms: • ___ regulates composition

14. Formulas for Infant Feeding • __________-based • skim milk, casein proteins • skim milk, whey proteins • _____-based • Casein-________ • + corn oil (Nutramigen) • + medium-chain TGs (Progestimil) • ___________ (Alimentum)

15. Formulas: Concerns • Too diluted • _______________ • water __________ • hyponatremia • irritability • coma, death • Too concentrated • __________ • hypernatremia: • _________ (cellular) • tetany • metabolic acidosis

16. Neonate 2 weeks to 1 month ~ 2 months ~ 6 months On demand: 8-12 times/day every 2-4 hrs for 20 minutes per feeding ~ 6-8 times/day ~ 5 times/day; can sleep through the night 3 meals + 4 milk feedings Feeding Schedule

17. Introduction of Solid Foods • Nutritional need • Physiological capability • Physical ability • loss of ____________ • head and neck control • ability to _______ • Not too early / not too late!

18. Introduction of Solid Foods • Add foods _____________ • Suggested order: • __-fortified _______ • strained _________ • strained _________ • ________ foods • ________ foods • _____ by cup (don’t displace milk and other foods) • Don’t add __________; why bother with _________? • Purchase or prepare at home

19. What Not to Feed Infants < 1 Year Old • Regular _________ • risk of ______ • risk of ____________ due to high renal solute load • risk of ________ • low in _________________ • ________________ • risk of ________ spores producing toxin in body nerve paralysis • Raw carrots

20. What Not to Feed Infants < 1 Year Old • ____________ foods • _____________ foods • small grains, grapes, hot dog bits, hard candy, nuts, popcorn • __________ • Foods of low nutrient density

21. Division of Feeding Responsibility Infancy • Parent is responsible for: • Infant is responsible for:

22. Division of Feeding Responsibility—Early Spoon Feeding • pick out • hold infant on lap • keep infant company, but • wait for infant to • let infant touch and explore food • feed at infant’s speed • allow __________ when interested • stop when

23. Feeding Concerns • Colic • Spitting • “Nursing bottle syndrome” • Allergies • Infant obesity • Constipation

24. Failure-to-thrive • check • check _________ symptoms: • poor _____ • _______ during feeding • reflux • delay of … • nutrient deficiency? • deficiency of _____________ with parents? • infants need

25. “Sudden Infant Death Syndrome” • low maternal age • multiparity • maternal smoking • male infants • soft mattresses • loose blankets • sleeping on stomach

26. Guidance for Infants • Build to a variety of foods • Listen to your baby’s appetite to avoid over-feeding or under-feeding • Don’t restrict fat and cholesterol • Don’t overdo high-fiber foods • Sugar is needed in moderation • Sodium is needed in moderation • Choose foods containing iron, zinc, and calcium

27. Eating Pattern Messages • Breastfeed your baby for as long as possible • If you bottle feed, hold your baby during feeding • If you bottle feed, use formula until the age of one • Offer solid foods only after your baby is 4-6 months old • Introduce foods one at a time