NHM 201 1st Edition Exam 3 Study Guide Chapter 8 Infant Nutrition Nutrition is an important contributor to the complex development of infants Birthweight and infant mortality Motor and cognitive development Energy and nutrient needs Physical growth assessment Infant feeding skills Physical Assessment APGAR Immediately after birth Size Immediately after birth Periodic intervals as baby grows APGAR Scores APGAR score given immediately after birth at specific timed intervals Appearance skin coloration Pulse heart rate Grimace response reflex response Activity and muscle tone Respirations breathing rate and effort 1952 Dr Virginia Apgar Testing done one minute and five minutes after birth 1 minute how well newborn did in birthing process 5 minute how well newborn adapting to environment Each factor scored 0 2 Totals are scaled 1 10 to give APGAR Birthweight as an Outcome Full term infant 37 42 weeks Typical weight 2500 3800 g 5 5 8 5 lbs Typical length 47 54 cm 18 5 21 5 in 88 of US infants are born full term Assessing Newborn Health Standard Newborn Growth Assessment Appropriate for gestational age AGA Small for gestational age SGA and intrauterine growth retardation IUGR mean newborn was 10th wt age Large for gestational age LGA means newborn was 90th wt age Assessing Newborn Health Infant mortality defined as death that occurs within the first year Major cause is low birthweight 2500 g Other leading causes include Congenital malformations Preterm births SIDS Combating Infant Mortality Factors associated with mortality Social and economic status Access to health care Medical intervention Teenage pregnancy Availability of abortion services Failure to prevent preterm and LBW births Infant Development Newborns Hear and move in response to familiar voice CNS is immature resulting in inconsistent cues for hunger and satiety Strong reflexes especially suckle and root reflexes are protective for newborns Terms Related to Development Reflex automatic response triggered by specific stimulus Rooting reflex infant turns head toward the cheek that is touched Suckle reflex causing tongue to move forward and backward Infant Development Motor development ability to control voluntary muscles Motor development is top down controls head first and lower legs last Muscle development from central to peripheral Influences ability to feed self and the amount of energy expended Major Reflexes in Newborns Gross Motor Skills Critical periods A fixed period of time in which certain behaviors or developments emerge Necessary for sequential behaviors or developments If the critical period is missed there may be difficulty later on Cognitive Development Factors that impact cognition Sensorimotor development Interactions with the environment Adequate energy and protein Stimulation of social and emotional growth Genetics Digestive System Development Fetus swallows amniotic fluid which stimulates intestinal maturation and growth At birth the healthy newborn can digest fats protein and simple sugars Common problems include gastroesophageal reflux GER diarrhea and constipation Factors that impact rate of food passage in colon Osmolarity of foods or liquids Colon bacterial flora Water and fluid balance in the body Parenting New parents must learn Infants cues of hunger and satiety Temperament of infant How to respond to infant cues Energy and Nutrient Needs The recommendations for infants are from the DRI National Academy of Medicine AAP and the Academy of Nutrition and Dietetics Energy needs Protein needs Fats Metabolic rate calories fats and protein how do they all tie together Energy Calories 108 kcal kg day from birth to 6 months range from 80 120 98 kcal kg day from 6 to 12 months Factors that influence calorie needs Weight and growth rate Sleep wake cycle Temperature and climate Physical activity Metabolic response to food Health status recovery from illness Protein Needs 2 2 g kg day from birth to 6 months 1 6 g kg day from 6 to 12 months How much is that Newborn weighing 4 kg 8 8 lbs needs 2 2 x 4 8 8 g protein 6 month old weighing 8 kg 17 6 lbs needs 1 6 x 8 12 8 g protein Protein needs are similar to that of energy but are also influenced by body composition Fat Needs No specific recommended intake level for infants Breastmilk contains about 55 calories from fat Infants need cholesterol for gonad and brain development Breast milk contains short chain and medium chain fatty acids In addition to the long chain Easier to digest and utilize than long chain fatty acids Metabolic Rate Calories Fats and Protein Metabolic rate of infants is highest of any time after birth The higher rate is related to rapid growth and high proportion of muscle Low carbohydrate and or energy intake results in protein catabolism impacting growth Other Nutrients and Nonnutrients Fluoride 0 1 0 5 mg d depending on age too much may cause tooth discoloration Vitamin D 400 IU day Sodium 120 200 mg day Iron 11mg for infants 7 12 months Fiber no recommendations Lead non may be toxic Physical Growth Assessment Newborns grow faster than any other time of life Growth reflects Nutritional adequacy Health status Economic and environmental adequacy There is a wide range of growth normal Calibrated scales and recumbent length measurement board required for accurate measures Measuring Growth Accurately in Infancy Interpretation of Growth Data Measures over time identify change in growth rate and need for intervention Warning signs Lack of weight or length gain Plateau in weight length or head circumference for 1 month Drop in weight without regain in a few weeks Feeding in Early Infancy Breast Milk and Formula Recommend exclusive breast feeding for 1st 6 months continuation to 1 year Initiate breast feeding right after birth Growth rate and health status indicate adequacy of milk volume Standard infant formula provides 20 cal fl oz Preterm formula provides 22 24 cal fl oz Typical Daily Volumes for Young Infants Not Being Breastfed How Infant Formulas Are Modified Compared to Breast Milk Breast Milk 7 of calories from protein 38 calories from carbs 55 calories from fat Cow s Milk Based Formula 9 12 calories from protein 41 43 calories from carbs 48 50 calories from fat Cow s Milk during Infancy Whole reduced fat or skim cow s milk should not be used Iron deficiency anemia linked to early introduction of cow s milk Anemia linked to GI blood loss Low absorption of calcium and phosphorus Displacement of iron rich foods Soy Protein Based Formula