infancy

Birth to 1 year

infancy age range

37-42 weeks gestation

Full term infants

2500-3800 grams (5.5-8.5 Ibs)

healthy weight for infants

48-50 cm

normal length for infants

35 cm (14 in)

Head circumference

moist, elastic & not wrinkled

skin of infant

Birthweight and the length of gestation

two of the most important predictors of an infant's survival and later health

Critical : first 24 hours

• Begin to breathe

• receive oxygen; remove carbon dioxide

• Assume responsibility for their own circulation, temperature regulation, and metabolic support; own digestion, absorption, assimilation and ecxretion

5 months

Weight is doubled by

tripled

Weight is —— by 1 year

50%

Increase length by —- : 1 year

25 centimeters (10 inches)

Length changes more slowly than weight, increasing about —- from birth

1 year or about 50%

• Length changes more slowly than weight, increasing about 25 centimeters (10 inches) from birth to

growth

reflects differing growth patterns of all internal organs

5-8%

Weight loss due to loss of fluid and some catabolism of tissue——

10th day

Birth weight is regained by the

weight gain

Rapid but decelerating rate

20-25g / day

Ave. Weight gains for 4 months

15g/day

Ave. Weight gains for next 8 mos

4 mos

weigh twice their birth weights

12 mos

weigh 3x what they weighed at birth

Males

increase in weight to twice their birthweights earlier than do females

Smaller newborns

increase in weight to twice their birth sooner than do heavier neonates

50%

Increase length

25-30 cm (10-12 inches)

Ave. Length

"catch-up" or "lag-down"

growth may occur

Total body water (extracellular Water)

decreases throughout infancy approx. 70% at birth to 60% at 1 year of age

lean body mass

matures in body composition

body fat

develops slowly during fetal life; fat 0.5% of body weight at 5* month of fetal growth, 16% at term

2-6 months

• increase in adipose tissue is more than twice as great as the increase in the volume of muscle

females

deposit a greater % of weight as fat than the male

head proportion

decrease as torso & leg proportion increases

¼

At birth, head accounts for approx.
——- of total body weight;

head

is disproportionally large

leg

are bowed and short

1/8

Growth ceased: head accounts for —- of total body length

3/8th

Bet. Birth & adulthood: leg length increases from approx. —- of newborns' length to ½ of adult's total body weight

stomach actions

• At birth ? Much smaller, shaped differently, functionally immature

• First few mos. [3 foods move slowly and are mixed less efficiently in the stomach

200 ml

Stomach capacity: 10-12 ml ? —- ml by one year of age

Gastric pH

• slightly alkaline at birth, but within 24 hours, acid secretion reaches a peak

• Declines to a low level, remaining lower than that of adult for first few mos.

2 ½ - 3 hours

Stomach at birth empties in about—- hours

small, frequent feeds

Newborns require

Emptying rate

depends on the amount & composition of food consumed

Fat

is last nutrient to leave the stomach, contributing to the satiety of the feed

Intestinal actions

• Larger in relation to body size than adult's

• Larger surface area for absorption

enzymatic secretions

provide the capacity for infants to digest & absorb the milk & food consumed

lactase, sucrase , & maltase

enzymes that are well established at birth

pituitary gland

produces only limited vasopressin which inhibits diuresis; by 1 month maintain water balance as efficiently as adult

renal functions

• Functioning but immature kidney

• Limited capacity of renal system further justifies delaying the introduction of solid food

• Limited ability to filter wastes or to excrete sodium

Brain

• Grows faster than any other systems

• Cells rapidly increase in number and size up to one age

25%

BRAIN: of its adult weight at birth

age 12-24 mos

BRAIN: Reaching 75% of its adult size by

20

—-baby teeth to erupt

age 3

teething is complete by

Psychosocial development

• Trust versus distrust

• Identification of infant's cues of hunger & satiation are basic to developing a sense of trust and to learning to regulate appetite

Early infancy hunger behavior

Fusses and cries ; mouths and nipple

Early infancy satiety behaviors

Draws away from nipple; falls asleep

16-24 weeks hunger behavior

Actively approaches breast or bottle; leans forward to spoon

16-24 satiety behavior

Releases nipple & withdraws head; fusses or cries; bites nipple; increases attention to surroundings

28-36 weeks hunger behaviors

Vocalizes eagerness for bottle or food

28-36 weeks satiety behavior

Changes position, shakes head, keep mouth tightly closed; hands become more active

40-52 weeks hunger behavior

Point’s or touches spoon or feeder’s hand

40-52 weeks satiety behavior

behaviors as above, sputters with tongue & lips ; hands bottle or cup feeder

motor development

• control over bodily movements through coordinated activity of the nerves & muscles

10 mos

Suckles & smiles at zero to

2-3 mos

Vocalizes & controls head at age

4-5 mos

Control hand & rolls over at

6-7 mos

Sits briefly & crawls at age

8-9 mos

Grasps & pulls up at

10-11 mos

• Walk with support & stands alone at age

one year at age

Starts to walk alone at

premature infant

• Fewer than 270 days of gestation, or

• Weigh less than 2500 g (5.5
  Ib)

• Caused by low birth weight > multiple births or when mothers gain too little or too much weight, smoke/alcohol drinking

• Chances of defects increase

2500 g

premature infant Weigh less than

micro-preemies

• Less than 26 weeks gestation

• Weigh <3 Ibs

• Some eat only
  1 oz a day!

• Spend a few weeks to a few months in the
  NICU

Preemies

• 26-37 weeks gestation

• Weigh 3-5 Ibs

• Prone to upset

indigestion

• Some ready to go home in 1-2 weeks

Full term

• 39+ weeks gestation

• Weigh 5.5-9 Ibs

• Eat 8-12 times per day

• Ready to go home in 1-2 days!

Low-birthweight (LBW) infants

• weigh less than 2500 grams;

Very low-birthweight (VLBW)

infants weigh less than 1500 grams

Extremely low-birthweight

(ELBW) infants weigh less than
1000 grams.

infection, immature kidneys

LBW babies are Susceptibility to

hospitalized

Twice the risk of being —- for first year of life

30

times possibility of dying in neonatal period (first 28 days)

*intrauterine growth failure, LBW, general growth retardation

They have much more water and less protein and minerals per kilogram of body weight

There is little subcutaneous fat

Bones are poorly calcified

The neuromuscular system in incompletely developed, making normal sucking reflexes weak

Digestive-absorptive ability and renal function are limited

Immature liver lacks developed enzymes systems or adequate irons stores

Small for gestational age (SGA)

• Most likely to occur in offspring of malnourished women

• With hypertension, viral infections, other diseases, those who use drugs extensively

• Inadequate intake/poor utilization

• Maternal malnutrition

• Reduced blood volume

• Decreased blood supply to fetus

• Reduced placental size

• Reduced nutrient transfer

• Fetal growth retardation

Relationship between maternal and fetal malnutrition

Nutritional requirements in Infancy

1. The estimation of nutrients requirements for infants are based on intakes of healthy infants with satisfactory growth

2. Refers to the Philippine RENI for the recommended amounts of nutrients during infancy

3. Rationale for the nutritional requirements in infancy

Breastfeeding

b) Artificial feeding or formula or bottle feeding c)

Mixed feeding

1) Supplemental feeding

2) Complemental feeding

1. Breastfeeding

2. Artificial feeding or formula or bottle feeding c)
   Mixed feeding

1. Supplemental feeding

2. Complemental feeding

1. Simple dilution with water or cereal water

2. Boiling or any process to produce smaller curds

3. Addition with weak acid ( lactic acid, acetic acid, citric acid, etc.) to produce smaller curds and speeds up protein digestion

How milk from other species can be modified simulate human milk

Types of milk used for feeding infants

1. Unmoditied cow's milk

2. Modified cow's milk formulas

1. Whole cow's milk

2. Nonfat or dried skim milk

3. Whole cow's milk formulas

Cow's milk is regular unmodified cow's milk

1. not suitable for infants during the early months; may cause GIT bleeding and its solute load is too heavy for infant's renal system to handle

Powdered whole cow's milk formula

whole milk dried under controlled conditions

Full cream evaporated milk

whole milk from which about 50-60% of its water content has been removed; seldom available.

Recombined milk , Reconstituted milk

full cream evaporated milk two good substitutes are

Evaporated filled milk

which is cow's milk from which butterfat has been removed and replace with vegetable oil, 94% coconut oil, and 6% corn oil

Sweetened condense milk

which may be fully cream or filled but high in sugar content resulting in very diluted milk formula

Completely modified milk formula

1. Protein and mineral content are adjusted to resemble that of human milk, with the replacement of butterfat with corn oil and using lactose as sole source of CHO

Casein hydrosylate formulas

infant formula with base of hydrolyzed casein, major milk protein, produced by partially breaking down the casein into smaller peptide fragments, making a product that is more easily digested

Substitute and imitation milks

defined as nutritionally equivalent to whole or nonfat milk based on their content of only 14 to 15 nutrients; does not include all nutrients recommended as components of infants formulas