Chapter 13: Nutrition for Infants, Children, and Adolescents

is growth in the first year of life more rapid than at any other time in the life cycle

yes

explain the birth rate in terms of infancy (brith to 1 year)

DOUBLES by 4 to 6 months of age

from 6 to 12 months rapid growth continutes but at a slower pace

at year one in terms of average growth

-birth weight triples

-length increases by 50%

do infants require more calories and nutrients than adults.

yes, adequate growth means the infant is consuming adequate nutrition

what percentage of calories is provided from fat in breast milk and infant formulas

40% to 50%

explain infancy and vitamin k

infants are born with low amounts of vitamin K stored in the body and a decreased ability to utilize vitamin K

-thus need a shot of vitamin K at birth

why is breast milk

*specifically designed to support optimal growth and development in the newborn

what is the composition of breast milk made out of

• Easily digestible protein source: whey

• High levels of essential AAs

• High linoleic acid

• Increased rate of iron absorption – 50% vs. 4% in formula

• Antibodies / anti-infectives / GI flora promotion

exclusive breastfeeding is recommended for the first ____ months

for the first SIX months and should continue through the ONE year or longer if desired

added potential health benefits include

• Reduced risk of diarrhea and respiratory tract infection

• Possible protective effect against inflammatory bowel disease, leukemias, and certain types of type 1 diabetes

• Lowered risk of obesity in some populations

• Close mother–infant bonding 

all infants exclusively breastfed/ receiving breast milk and formula need what kind of supplement

a vitamin D supplement of 400 IU/DAY

• Do exclusively breastfed infants need supplements? If so, which one?

Typically, breast milk provides infants with all the essential nutrients they need for the first six months of life. However, pediatricians often recommend vitamin D supplements for exclusively breastfed infants, as breast milk alone may not provide enough of this vitamin.

- development of strong bones

• What are the recommendations for breastfeeding during the first year of life? 

exclusive breastfeeding for 6 months

• Components of human milk and what benefits does it provide? 

-whey for protein

-high levels of amino acids

-high linoleic acids

-antibodies/ anti-infectives / GI flora promotion for immunity

MOST IMPORTANT AVAILIABILTIY OF IRON

explain infant formula

• May be used in place of breastfeeding, as an occasional supplement to breastfeeding, or when exclusively breastfed infants are weaned before 12 months of age

all formula used in the United States is fortified with

IRON

there are different categories of infant milk for full term and preterm infants include

cow’s milk based (695 of the formula used is this type)

soy (few circumstances for choosing soy over cows milk based formulas)

hydrolyzed

what are hydrolyzed formulas

formulas in which macronutrients have been broken down or predigestion

what is the benefit of hydrolyzed formula

They can be beneficial for lots of reasons – allergies with cows and soy proteins are one reason

specialized formulas

• specifically altered to be LACKING or DEFICIENT in one or more nutrients, so they are not suitable for healthy infants. 

specialized formula EXAMPLE

we talked about PKU last week – there is an infant formula make just for PKU – so it does not contain Phenylalaine 

^when the body can not break down protein^

Preterm Formulas

• designed to promote “catch-up growth.” They are HIGHER than routine formulas in calories, protein, and certain minerals

  -NICUs use this formla as their gold standard if EBM is unavailable 

Premature infant discharge formulas

• less calorically dense than preterm formulas but higher in calories than term formulas

  -for babies who have been using specialized formulas but are not ready yet to transfer over to a REGULAR FORMULA

infant feeding

• Requires parents to recognize verbal and nonverbal feeding cues

newborns

rooting / sucking / and hand movement

-SHR

older inFANTS

hand to mouth movements / lip smacking / crying / excited arm and leg movements / opening the mouth / and moving toward a spoon as it comes near

• Depending on the infant’s age, satiety cues include fussiness during feedings

slowing the pace of eating / turning away from the nipple / stopping sucking / spitting out/refusing the nipple / falling asleep / or spitting up milk

frequency of breastfeeding

in the first months of life,

-minimum of 8 to 12 times/ 24 hours

-approximately ever 2 to 3 hours

do feedings become less FREQUENT as the infant grows

YES

Teaching points for breastfeeding: 

• Start with 5” per side, then move towards 15” per breast by the end of the first week of life

• Alternate side started with at each feeding

• Early substitution of formula or introducing solid foods may diminish milk supply

• Pumped milk can be stored in fridge 24 hours or frozen / 3 months if frozen

In the first weeks of life

2 oz.  every 2 to 3 hour

-offer more formula if the infant appears hungry

Beginning at 2 months

6 to 8 feedings/ 24 hours

4-month-old

an average of 31 oz/day (range of 26– 36 oz/day) without complementary foods

A 6-month-old and olde

formula intake is 24 to 32 oz/day in addition to complementary foods. 

as solid food intake increase, what decreases

the volume of formula consumed decreases

NEVER DO WHAT

force feed an infant to take more than they wish to have

-discourage the misconception that “a fat baby a health baby = good parents

how long do feedings take

20 to 30 minutes per fedings

What micronutrient is nearly all infant formula fortified with? 

Infant formulas are typically fortified with iron

Describe what hunger cues an infant may give when it’s time to eat

*must find difference if for newborn (SRH) or infant

-examples include

Describe what a hydrolyzed formula is

A hydrolyzed formula is basically a baby formula where the proteins are broken down into smaller pieces. This makes it easier for babies to digest, especially for those who might have trouble with regular formulas. It's like pre-digesting the proteins to make it gentler on little tummies!

n what instance would you use soy based formula? 

Soy-based formula is often used when babies are ALLERGIC to or CAN’T TOLERATE COW’S MILK. It's a dairy-free alternative for little ones who need it!

what is complementary food and when can they be introduced

SOLIDS become a necessary source of nutrients around 6 months of age

-most infants exhibit readiness to spoon feed at around 4 to 6 months of age

first solid foods introduced should be ____ rich foods like

• First solids offered should be IRON-RICH FOODS; continue through 11 months to maintain adequate stores

  like MEATS

at what age do infants need supplemental fluoride

at 6 months of age

complementary foods =

introducing soldis

-around 6 months of age

-foods that provide iron should be added first, such as iron fortified infants cereals or pureed meats

how are new foods suppose to be introduced

about 3 days at a time so that nay allergic reaction can be identifited

what will help prevent overweight and obesity

establishing regular meal-times and snack times instead of continuous grazing

• By 12 months of age, infants should be eating a variety of table foods and various textures.

1. FLUIDS

2. FOOD

   -three to five solid feedings/day are appropriate

should fat intake be restricted

NO AND NEVER; choose healthier fats

why should plain cow milk be avoided until 12 months of age

because it LACKS IRON and has excessive amount of sodium, potassium, and protein compared to formula or breast milk

Foods and beverages that should not be given are those 

• that are high in sodium

• have added sugars

• contain low- and no-calorie sweeteners

• contain HONEY in any form, including cooked or pasteurized

• that are unpasteurized

• that may cause choking

make a list of food items that may cause choking

round slices of hot dogs and sausages

hard candy

cough drops

peanuts and other whole nuts

whole grapes and cherries

raw carrot sticks

whole cherry or grape tomatoes

• When are solids typically introduced and what is a good “first food”? 

at age six months and good first food should be IRON RICH (like purred meats)

• Describe foods that should be avoided due to choking hazards

large pieces of raw vegetables or fruit

olives with pits

tough meat

celery

popcorn

dried fruit

marshmallows

potato and corn chips and similar snack foods

What foods should be avoided in babies? (think about healthy options vs. not so healthy options)

• that are high in sodium

• have added sugars

• contain low- and no-calorie sweeteners

• contain honey in any form, including cooked or pasteurized

• that are unpasteurized

• that may cause choking

why should not infants honey

botulism

• When do we recommend introducing cow’s milk? 

Cow's milk is typically introduced around the age of 1

• Do we restrict fat intake in infants? 

NO, just limit to healthy fats

in terms of food allergy

• There is no evidence that delaying the introduction of allergenic foods beyond 4 to 6 months of age prevents atopic disease

  -instead we should be gradually introducing infants to food that produce the most allergies

TRUE OR FALSE

-new foods are added to the child’s diet one at a time so that any allergic reaction can be identified

True

Rationale: New foods are added one at a time for about 3 days so that any allergic reaction can be identified.

what does adequate nutrition during early childhood focus on

• promoting normal growth through the appropriate amount and types of foods within an environment that allows the child to self-regulate

what are growth charts, when do they begin, and what do they monitor

*beginning at age 2 year & monitor

1.size and growth patterns

2.weight status outside the definition of normal or healthy

3.deviations in a child’s percentile channel warrant further attention

in terms of “weight status based on BMI”

underweight = <5th percentile

obese = >95th percentile

• When should infants at high risk of peanut allergy be introduced to peanuts? 

high risk: introduce at 4 to 6 months

mild to moderate risk: introduce at 6 moths

low risk: when age appropriate

• When do we start using growth charts based on BMI? 

at 2 years old

• How do we currently define an overweight child using the growth chart? 

if the child is within the >85th to 94th percentile

• How do we define an underweight child using the growth chart?

if an child is within the <5 percentile

nutrition during early childhood (1 to 5 year): physical activity

physical activity is interwined with nutrition in promoting growth and development and overall health

• Key physical activity guidelines for preschool-aged children state that

children ages 3 through 5 should be physically active throughout the day

adult caregivers should encourage active play that includes a variety of activity types 

• Parental Influences on Eating Habits

Early parental influence is associated with the development of a child’s relationship with food later in life.

Parents decide what food is offered, but children decide how much to eat (Ellyn Satter dietitian) 

In other words: parents decide what, when, and where of feeding and let your child determine how much and whether to eat of what you provide

• Developmental Milestones Related to Eating

1. at the age one children should be drinking from a CUP

2. by the age of two, the toddler should eat most of the same food as the rest of the family

3. by 24 months (two years) the toodlers should be able to use utensils and spill little of their food

what is the typical pattern for early childhood eating

3 meals and 2 to 3 snacks

when are children more at risk of choking

around age of 4 years

when do children develop food jags and what are they

food jags: strong preferences for certain foods and reject others

-at 15 months

• When can children be expected to eat what their parents are eating? 

by the age of 2

• Describe the Ellyn Satter division of responsibility

Parents decide what and when to serve, and kids decide how much and whether to eat. It's a balanced approach promoting healthy eating habits and autonomy for children

• How long are children at risk for choking? 

At risk of choking until around the age of 4 years. 

• When would you expect a child to learn to drink from a cup? 

at the age of one

• Describe a healthy daily eating pattern for a child (# of meals / snacks)

3 meals and 2 snacks

• Calories and Nutrient Needs: Girls & Boys (Ages 12 to 23 months)

800 to 1000 for both girls and boys 

• Calories and Nutrient Needs: Girls & Boys (Ages 2 to 5 years)

1000 to 1600 cal/day depending on activity 

• Fluid from 12 to 23 Months

Whole milk becomes a major source of nutrients, including fat but should not exceed 2 to 3 cups daily.

-1 to 4 cups of water/ day including being offered when child is thirst

-AVODI sugar sweetened beverages as well as caffeinated beverages

• Fluid from Years 2 to 5

2 to 2½ cups/day of low fat or nonfat milk and 1 to 5 cups of water daily. 

100% fruit juice should be offered only when whole fruit is not available and limited daily to 4 oz for children aged 2 to 3 and 4 to 6 oz for 4 to 5-year-olds.

• Food from Years 2 to 5

A variety of nutrient-dense foods from all food groups should be offered. 

A regular schedule of 3 meals and 2 to 3 nutrient-dense snacks should be established. 

• Age-appropriate serving sizes:

1 tbsp of food per year of age until 4

-Sure, it's like a rule of thumb for serving sizes. For each year of age until four, you give about one tablespoon of food

By age 4 to 6, serving size may

be close to adult size

• Should not be allowed to eat or drink from a cup

while lying down, playing, or strapped in a car seat

• What is the serving size for a child 1- up to 4 years of age? 

one tablespoon of food per year of age.

-So, a 1-year-old might get around one tablespoon per serving, and a 4-year-old might get around four tablespoons per serving

• Describe tips for a parent that has a 2-year-old

Supervise them eating, avoid choking hazards, they can drink from a cup and use utensils, dice their food up in small bite-size pieces, offer a wide variety, they can drink cows milk, etc. 

• Should toddlers be provided juice? 

only when whole fruits are not avaliable and only if it is 100% juice with no added sugar

• What age do we recommend switching from whole milk to lowfat milk? 

The American Academy of Pediatrics recommends switching from whole milk to low-fat milk at the age of 2

Promoting Healthy Eating

• Children should not be pressured or cajoled into eating more.

• Avoid empty-calorie foods and beverages.

• Portions offered should be small:

  • Allow the child to ask for more

• Give children the opportunity to improve self-feeding skills, even though it may be messy.

Behaviors in young children that may indicate nutrition risk include 

• poor appetite 

• inadequate intake from any food group 

• frequent intake of fast food 

• consumption of sugar-sweetened or artificially sweetened beverages

• persistent bottle feeding

• child does not eat with the family

• growth or weight concerns 

• How would you handle a child who isn’t in the “clean plate club”? 

Never force a child to clean their plate – they decide how much if anything they will eat

• What are foods you would tell a parent to avoid feeding their child? 

Avoid choking hazards, empty calories, added sugars and saturated fats, don’t get upset if meal times are messy – this is how they learn

• What behaviors put a child at risk for nutritional concerns? 

Malnutrition, no family meal times, prlonged bottle use, soda, high sugar foods frequently, fast food meals regularly 

annually how much does a child grow

2.5 inches in height and gains about 7 pounds

-the slow growth abruptly and dramatically increases with pubescence. 

when does the growth spurt and puberty begin

GIRLS: ages 9 to 11

BOYS: 10 to 12

what things does physical activity improve

• bone health, weight status, cardiorespiratory and muscular fitness, cardiometabolic health, and cognition, as well as lower risk of depression.