Chapter 15 Chapter 15 Current Status of Child Current Status of Child Health Health More children are More children are receiving receiving vaccinations vaccinations Fewer teenage Fewer teenage pregnancies pregnancies Lower poverty rate Lower poverty rate More cases of More cases of obesity obesity More cases of type More cases of type 2 diabetes 2 diabetes Less physical Less physical activity activity Increased Increased consumption of consumption of soft drinks soft drinks Infant Growth and Infant Growth and Development Development Rapid growth rate Rapid growth rate Weight Weight Doubles by 4 6 months Doubles by 4 6 months Triples by 1 year Triples by 1 year Length Length Increases 50 by end of 1 Nutrients needed to support proper growth Nutrients needed to support proper growth Inadequate nutrition including fat can Inadequate nutrition including fat can inhibit growth inhibit growth year Increases 50 by end of 1stst year Effects of Undernutrition Effects of Undernutrition Smaller in size height and weight Smaller in size height and weight Growth is an indicator of Growth is an indicator of nutritional health nutritional health Adequate diet later won t Adequate diet later won t compensate for lost growth compensate for lost growth Assessment of Growth Assessment of Growth Growth charts Growth charts Height and weight correspond to a percentile Height and weight correspond to a percentile 5050thth percentile is considered average percentile is considered average Brain growth fastest in infancy Brain growth fastest in infancy Over and underfeeding Over and underfeeding Overfeeding increases number of adipose Overfeeding increases number of adipose cells cells Underfeeding may affect organ development Underfeeding may affect organ development Unwise to restrict diet Unwise to restrict diet Fat intake higher for 3 years Fat intake higher for 3 years Growth Charts Growth Charts Failure to Thrive Failure to Thrive Poor parent infant interactions Poor parent infant interactions Inexperienced parents Inexperienced parents Infants need Infants need Physical contact and eye contact Physical contact and eye contact Proper nutrition Proper nutrition Diet restriction not recommended Diet restriction not recommended Milk Formula Composition Milk Formula Composition Calorie Needs Calorie Needs EER Estimated Energy Requirement EER Estimated Energy Requirement 89 kcal x kg 75 0 3 months old 89 kcal x kg 75 0 3 months old 89 kcal x kg 44 4 6 months 89 kcal x kg 44 4 6 months 89 kcal x kg 78 7 12 months 89 kcal x kg 78 7 12 months 700 kcal day for a 6 month old child 700 kcal day for a 6 month old child Breast milk formula provide sufficient Breast milk formula provide sufficient kcals kcals High energy needs High energy needs Rapid growth and metabolism rate Rapid growth and metabolism rate Higher body surface area loss of heat Higher body surface area loss of heat Carbohydrate Needs Carbohydrate Needs Age 0 6 months Age 0 6 months 60 grams day 35 kcal from CHO 60 grams day 35 kcal from CHO Age 7 12 months Age 7 12 months 95 grams day 50 kcal from CHO 95 grams day 50 kcal from CHO Protein Needs Protein Needs 9 14 grams day based on age 9 14 grams day based on age Half should be from essential amino Half should be from essential amino acids acids Breast milk formula provide Breast milk formula provide sufficient protein sufficient protein High protein diet High protein diet Stress on kidneys Stress on kidneys Excess nitrogen and minerals exceed Excess nitrogen and minerals exceed infant s immature kidney abilities infant s immature kidney abilities Fat Needs Fat Needs 30 grams day 40 kcal as fat 30 grams day 40 kcal as fat 15 5g of total fat should be essential 15 5g of total fat should be essential fatty acids also consider DHA fatty acids also consider DHA arachidonic acid ARA arachidonic acid ARA Excess fat intake may lead to poor fat Excess fat intake may lead to poor fat digestion digestion Vital to nervous system development Vital to nervous system development Half of the energy supplied by breast Half of the energy supplied by breast milk and formula comes from fat milk and formula comes from fat Vitamin K Vitamin K Routinely given as injection at Routinely given as injection at birthbirth Intestinal bacteria then begin to Intestinal bacteria then begin to synthesize vitamin K synthesize vitamin K Other Vitamin Needs Other Vitamin Needs Breast fed infants Breast fed infants Vitamin D supplementation Vitamin D supplementation Vitamin B 12 for infants of vegan Vitamin B 12 for infants of vegan momsmoms Mineral Needs Mineral Needs IronIron stores depleted by 4 6 month of age stores depleted by 4 6 month of age Iron fortified formula for bottle fed infants Iron fortified formula for bottle fed infants Iron supplementation for breast fed infants Iron supplementation for breast fed infants Introduction of iron fortified solid foods Introduction of iron fortified solid foods 4 6 months old 4 6 months old Zinc and iodide Zinc and iodide Supplied by breast milk or formula Supplied by breast milk or formula Fluoride supplement Fluoride supplement 6 months of age 6 months of age Tooth development Tooth development Tap water for formula fed Tap water for formula fed WaterWater Fluid Needs Fluid Needs 3 cups per day 3 cups per day Via breast milk or formula Via breast milk or formula Supplemental water Supplemental water MayMay be necessary in hot climate be necessary in hot climate Diarrhea vomiting also require Diarrhea vomiting also require additional fluids pedialyte additional fluids pedialyte Babies are dehydrated easily dehydrated Babies are easily Can damage kidneys Can damage kidneys Under normal conditions additional Under normal conditions additional not necessary water is not necessary water is Formula Feeding Formula Feeding Cow s milk NOT tolerated by infants Cow s milk NOT tolerated by infants 12 months 12 months Formulas Formulas Must follow strict quality control Must follow strict quality control guidelines guidelines Fortified with vitamins and minerals Fortified with vitamins and minerals except fluoride except fluoride Cow s milk base formula Cow s milk base formula Contains lactose sucrose casein whey Contains lactose sucrose casein whey and vegetable oils and vegetable oils Soy base formula contains soy protein Soy base formula contains soy protein Pre digested formula Pre digested formula Formula Preparation Formula Preparation Monitor safety and cleanliness Monitor safety
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