NHM 201 1st EditionExam # 3 Study GuideChapter 8: Infant NutritionNutrition is an important contributor to the complex development of infantsBirthweight and infant mortalityMotor and cognitive developmentEnergy and nutrient needsPhysical growth assessmentInfant feeding skillsPhysical AssessmentAPGARImmediately after birthSizeImmediately after birthPeriodic intervals as baby growsAPGAR ScoresAPGAR score given immediately after birth at specific timed intervalsAppearance: skin colorationPulse: heart rateGrimace response: reflex responseActivity and muscle toneRespirations: breathing rate and effort1952 Dr. Virginia ApgarTesting done one minute and five minutes after birth1 minute: how well newborn did in birthing process5 minute: how well newborn adapting to environmentEach factor scored 0-2Totals are scaled 1-10 to give APGARBirthweight as an OutcomeFull-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 termAssessing Newborn HealthStandard Newborn Growth AssessmentAppropriate for gestational age (AGA)Small for gestational age (SGA) and intrauterine growth retardation (IUGR) mean newborn was <10th % wt/ageLarge for gestational age (LGA) means newborn was >90th % wt/ageAssessing Newborn HealthInfant mortality defined as death that occurs within the first yearMajor cause is low birthweight (<2500 g)Other leading causes include:Congenital malformationsPreterm birthsSIDSCombating Infant MortalityFactors associated with mortalitySocial and economic statusAccess to health careMedical interventionTeenage pregnancyAvailability of abortion servicesFailure to prevent preterm and LBW birthsInfant DevelopmentNewborns:Hear and move in response to familiar voiceCNS is immature resulting in inconsistent cues for hunger and satietyStrong reflexes, especially suckle and root (reflexes are protective for newborns)Terms Related to Development:Reflex: automatic response triggered by specific stimulusRooting reflex: infant turns head toward the cheek that is touchedSuckle: reflex causing tongue to move forward and backwardInfant DevelopmentMotor development: ability to control voluntary musclesMotor development is top down: controls head first and lower legs lastMuscle development from central to peripheralInfluences ability to feed self and the amount of energy expended**Major Reflexes in Newborns** Gross Motor SkillsCritical periodsA fixed period of time in which certain behaviors or developments emergeNecessary for sequential behaviors or developmentsIf the critical period is missed, there may be difficulty later onCognitive DevelopmentFactors that impact cognitionSensorimotor developmentInteractions with the environmentAdequate energy and proteinStimulation of social and emotional growthGeneticsDigestive System DevelopmentFetus swallows amniotic fluid, which stimulates intestinal maturation and growthAt birth, the healthy newborn can digest fats, protein, and simple sugarsCommon problems include gastroesophageal reflux (GER), diarrhea and constipationFactors that impact rate of food passage in colonOsmolarity of foods or liquidsColon bacterial floraWater and fluid balance in the bodyParentingNew parents must learn:Infants’ cues of hunger and satietyTemperament of infantHow to respond to infant cuesEnergy and Nutrient NeedsThe recommendations for infants are from the DRI, National Academy of Medicine, AAP, and the Academy of Nutrition and DieteticsEnergy needsProtein needsFatsMetabolic 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 monthsFactors that influence calorie needsWeight and growth rateSleep/wake cycleTemperature and climatePhysical activityMetabolic response to foodHealth status/recovery from illnessProtein Needs2.2 g/kg/day from birth to 6 months1.6 g/kg/day from 6 to 12 monthsHow much is that?Newborn weighing 4 kg (8.8 lbs) needs 2.2 x 4= 8.8 g protein6-month old weighing 8 kg (17.6 lbs) needs 1.6 x 8= 12.8 g proteinProtein needs are similar to that of energy but are also influenced by body compositionFat NeedsNo specific recommended intake level for infantsBreastmilk contains about 55% calories from fatInfants need cholesterol for gonad and brain developmentBreast milk contains short-chain and medium chain fatty acidsIn addition to the long chainEasier to digest and utilize than long-chain fatty acidsMetabolic Rate, Calories, Fats, and ProteinMetabolic rate of infants is highest of any time after birthThe higher rate is related to rapid growth and high proportion of muscleLow carbohydrate and/or energy intake results in protein catabolism impacting growthOther Nutrients and NonnutrientsFluoride- 0.1-0.5 mg/d depending on age (too much may cause tooth discoloration)Vitamin D-400 IU/daySodium- 120-200 mg/dayIron- 11mg for infants 7-12 monthsFiber-no recommendationsLead-non-may be toxicPhysical Growth AssessmentNewborns grow faster than any other time of lifeGrowth reflectsNutritional adequacyHealth statusEconomic and environmental adequacyThere is a wide range of growth=normalCalibrated scales and recumbent length measurement board required for accurate measures**Measuring Growth Accurately in InfancyInterpretation of Growth DataMeasures over time identify change in growth rate and need for interventionWarning signs:Lack of weight or length gainPlateau in weight, length or head circumference for > 1 monthDrop in weight without regain in a few weeksFeeding in Early InfancyBreast Milk and FormulaRecommend exclusive breast feeding for 1st 6 months & continuation to 1 yearInitiate breast feeding right after birthGrowth rate and health status indicate adequacy of milk volumeStandard infant formula provides 20 cal/fl ozPreterm formula provides 22-24 cal/fl oz**Typical Daily Volumes for Young Infants Not Being BreastfedHow Infant Formulas Are Modified Compared to Breast MilkBreast Milk7% of calories from protein38% calories from carbs55% calories from fatCow’s Milk-Based Formula9-12% calories from protein41-43% calories from carbs48-50% calories from fatCow’s Milk during InfancyWhole, reduced-fat or skim cow’s milk should not be usedIron-deficiency anemia linked to early introduction of cow’s milkAnemia linked to:GI blood lossLow absorption of calcium and phosphorusDisplacement of iron-rich foodsSoy Protein-Based Formula During InfancySoy protein in place of milk protein should be