PUBHLTH 310 Exam 2

Define infancy

period of continued growth and development

what happens during infancy growth

baby doubles in size by 5 months of age

energy needed for infants (calorie, fat, protein)

100 kcal/kg needed per day versus 30 kcal/kg in adults

Higher fat intake (vs carbohydrate intake) due to high Caloric content in fat

Require double amount of protein per kg of body weight per day vs an adult

where are the main sources of nutrition during first 6 months of life

breast milk or formula

lactase persistence

* mutation of lactase gene
* -allows for adequate production of lactase over time to convert lactose into glucose
* continuation of lactase production beyond early childhood that allows a person to digest milk and dairy products

lactase non-persistence (lactose intolerance)

* inability to digest lactose beyond early childhood
* lactase gene expression is reduced after infancy making it difficult to digest milk
* malabsorption of lactose

micronutrient needs for infants

iron, vitamin d, vitamin k, flouride

what micronutrients are common deficiencies in infants (2)

vitamin d and iron

flouride for infants

good for oral health but too much can be an issue

vitamin k for infants

* helps with blood clotting
* infants receive an injection when they're born

water in infants

can take up space in stomach for first 6 months of life

when should solid food be introduced to infants

6 months

are solid foods usually introduced before 6 months of age? (yes or no)

yes

(better sleep, doctor told them to, cues from infant)

the introduction of solid foods helps to develop what?

an infants first muscle movements

what does a growth chart measure

measure's baby's growth: height, weight, and head circumference

abnormal growth trajectories can be a sign of what?

stunted growth and development

changing activity levels during infancy

holding chin up to standing to walking

energy expended during infancy

- growth, sleep, physical activity, health status

fat intake in infancy

* higher than carbohydrate intake because of higher calories
* essential fatty acids (omega 3 and 6)

carbohydrate intake in infancy

- high exposure to lactose in milk from (0-6 months)

proteins intake infants

* doubled compared to adults
* requirements met through breastmilk and formula

iron for infants

* low in breast milk
* iron fortified formula

vitamin d in infants

deficiency is high in breast fed infants

liquids for infants

* before 6 months of age, water is an empty filler (breastmilk should be prioritized)
* after 6 months, water throughout the day is ok
* 12 months old transition to cows milk
* juice not recommended until 1 year old

indicators of poor growth from a growth chart

* rapid increases in weight and not height
* slow growth/rapid decrease in weight
* lack of growth in head circumference

Recommendations for breastfeeding by WHO and AAP

* 6 months of exclusively breastfeeding
* complimentary breast feed until 2 years

exclusive breastfeeding

no other foods or drink besides breast milk

partial breastfeeding

mix of breastmilk and formula

complementary foods

solid foods provided to infant in addition to breast milk

breast milk composition

* meets nutritional needs of infants plus bioactive factors (immune factors, growth factors, digestive enzymes)
* changes based on breastfeeding parent's diet
* effected by environmental exposures

production of breastmilk

varies based on infant demand because infant suckling produces hormones

hormones produced from breastmilk

prolactin- stimulates milk production

oxytocin- stimulates contraction and release of milk

3 stages of breast milk

colostrum, transitional milk, mature milk

colostrum

* first fluid produced following birth (2-4 days following birth)
* immature milk
* yellow gold
* high levels of immune factors (IgA, lactoferrin, white blood cells)
* lower in fat and carbs, high in protein
* high in water (provides laxatives and keeps baby hydrated)

transitional milk

* higher fat and sugar
* still contains bioactive factors
* increasing in quantity
* produced during 5-14 days postnatally

mature milk

* produced 2 weeks post-birth
* high in fat!!
* high in energy (carbs and **fats**) and lower in protein
* fats in milk reflected by female’s diet
* content level increases as time increases
* lots of lactose (stimulates growth of microbiome)

* IgA in mature milk

* anti-microbial factor
* protection against viral and bacterial infections

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lactoferrin protein in mature milk

anti-microbial factor

protein bound to iron to increase absorption

inhibits growth of iron dependent microorganisms

lactose

most abundant carbohydrate

stimulates growth of microbiome

oligosaccrides

* anti-microbial factor
* medium chained carbohydrate
* ability to bind to pathogens

digestive enzymes

contained in human milk

ex: lipase

casein

binds calcium to increase absorption

mucin

binds to pathogens and excretes them in feces

colostrum plays a bigger role in immunity rather than nutrition

true

group 1 micronutrients

amount in breast milk reflective of maternal intake

ex: vitamin B, A, C, choline

group 2 micronutrients

amount in breast milk depletes maternal stores, maternal diet/supplements benefit mother not breast milk (aka breast milk will have same levels of these no matter what and maternal stores will be depleted if not taken in enough through diet)

ex: folate, calcium, zinc

what are two micronutrients that have low concentration in breast milk no matter what?

vitamin D and K

supplement recommended for infant themselves

health advantages of breastfeeding for the child

* decreased risk of infections
* better circadian rhythm (different hormones released in morning versus night)
* suckling helps with speech development, formation of teeth, airway development (prevention of SIDS)

health advantages of breastfeeding for mother

* oxytocin release (contracting uterus back to normal size)
* energy used to make milk helps with weight loss (reduces risk of T2D)
* delays time to menstruation
* pregnancy spacing
* increases iron stores

differences in formula composition include

vitamin K, D, iron levels, bioactive components, enzymes

U.S. rates of breastfeeding vs. other countries

70% global exclusive breastfeeding vs 40% U.S.

who is more likely to breastfeed?

females that are older (30 years and up), higher SES, receiving support, and are white

is breastfeeding less harmful to the environment than formula feeding?

yes! both have an environmental impact though

cost of breastfeeding for 6 months

$500 (infant formula is $1200-$1500)

formula feeding is more costly than breastfeeding in regard to equipment, work loss, and healthcare costs. provide some examples on how?

* breastfeeding women are paid less, discrimination
* low breastfeeding rates impose $1.3 billion burden on non-medical costs

barriers to breastfeeding using socio-ecological model (individual, interpersonal, community, organizational, policy)

individual- knowledge, self-confidence

interpersonal- support

community- changing cultural norms

organizational- workplace support

policy- maternal leave, places to lactate, anti-discrimination laws

policies that exist to protect female’s right to breastfeed in public or at work

break time for nursing mothers, paid time off (12 weeks for U.S.), right to breastfeed in public

what makes a hospital baby friendly?

* provide mothers with information, confidence, and skills to initiate and continue to breastfeed their babies
* recognition to hospitals that implement 10 steps

healthcare workers are ill prepare to address clinical lactation. what populations are especially vulnerable to this?

LGBTQ+ (need extra support), specifically transgender persons

* chest feeding and gender dysphoria

poor breastfeeding training for clinical providers includes:

* lack of confidence in breastfeeding skills, limited time to learn about issues surrounding breastfeeding

when does preterm birth occur?

under 37 weeks gestation

respiratory distress symptoms

lack os sufficient surfactant to support lungs because baby is born premature

* artificial surfactant can be used for treatment

jaundice

yellowed skin or eyes due to build up of bilirubin

* if bilirubin crosses blood brain barrier, damage could be irreversible

necrotizing enterocolitis (NEC)

inflammation of the small intestine leading to holes in the wall due to immature birth

* breast milk prevents death

why are feeding abilities compromised in infants?

lack of muscle coordination and undeveloped digestive tract

how do pre-term babies meet nutritional demands

fortifiers, mct, and special formulas

life-long health outcomes associated with pre-term birth

born with disability (hearing or vision impairment), neural impairments (behavioral, coordination, learning), cerebral palsy

failure to thrive (ftt)

* inadequate growth (height or weight)
* determined through growth charts
* causes: inadequate energy intake, malabsorption problems, developmental disability (autism, down syndrome)
* autism (rhythmic eating patterns, meal time behavior)
* down syndrome (weak face muscles)

vitamin d deficiency causes:

* decreased calcium and phosphorus absorption
* soft, elongated bones

rickets is increasing in prevalence in the U.S.. Why?

attributable to vitamin d deficiency

* causes: less time outside, deficient in diet (through breastfeeding since that is increasing), people with more melanin

who makes up the most cases of rickets?

those breastfeeding and with more melanated skin and who have decreased sun exposure

Phenylketonuria (PKU)

* inability to metabolize amino acid phenylalanine to another amino acid tyrosine
* caused by deficiency in phenylalanine hydroxylase enzyme

how can PKU be regulated

treated by diet changes (low phenylalanine diet and adequate tyrosine diet) (ex: vegetables, fruits, certain beans)

* excess phenylalanine can lead to accumulation in brain and death

toddler and preschool life-stage is the stage of:

psychosocial development (can influence food choice)

ways to develop good eating habits

family meals, shopping for food, being a part of food preparation process

is growth rate slower or faster during toddler years?

slower (time of steady growth and development)

where do most calories come from during toddler/preschool years?

carbohydrates

toddler developmental milestones

gross and fine motor skills, language development, preferences, responding to self-hunger cues

what micronutrients are most monitored in terms of future osteoporosis risk and deficiency?

bone nutrients and iron

growth spurts during toddler

occur periodically

storing energy for growth that is about to happen

growth rate during toddler

slower than in previous years but still more of a priority compared to other life stages

challenge- meeting balance of nutrients

are bone related nutrients (vitamin D, magnesium, phosphorus) monitored more frequently during toddler?

yes

vitamin and mineral supplementation is suggested for which toddlers:

* erratic eating behaviors
* mal-absorption problems
* lower SES families
* vegetarian or vegan houses

describe childhood obesity as a public health problem

lower SES, less physical activity

physiological factors, what family typically eats

interventions for childhood obesity

family meals, monitor adiposity rebound, promote healthy behaviors

cannot be about weight loss!!

adiposity rebound

normal surge in BMI occurring between 4-7 years old

rebound starts as the lowest BMI value starts to increase

early adiposity rebound

before 4-5 years old

positive associate with rate of body fat gain in childhood and positive association with obesity

starting to increase more and more

autism spectrum disorder

group of disorders involving communication, social interaction, and behavior

develops between ages of 2-4

autism signs

infancy: lack of eye contact, language delay, lack of communication

beyond infancy: failure of peer interaction, interact with toys atypically, feeding difficulty

why is nutrient intake difficult for children with autism

behavioral and sensory issues

autism nutrition

* picky about foods
* need foods at certain time
* bad with texture
* trouble swallowing
* need to intervene to prevent malnutrition

why is there an increase in diagnoses over the years?

better diagnosing techniques, older parents, increased public awareness

celiac disease etiology

autoimmune reaction to gluten protein

signs of damage can start as early as infancy

heritable disease

age of onset varies

celiac disease result

causes inflammation of intestinal wall

chronic inflammation destroys villi of small intestine which reduces surface area and makes it harder to absorb nutrients

there’s also a lack of digestive enzymes

how can celiac disease be controlled?

changes in diet

when are signs of attention deficit hyperactivity disorder (ADHD) observed?

in daycare or preschool settings

are people genetically predisposed to ADHD?

yes; environmental triggers like synthetic additives trigger histamine release and people with ADHD are sensitive to this (resulting in more enhanced symptoms)

what is ADHD intervention

behavioral therapy (first option)

parents and child learn management techniques

recommend for toddler and preschool ages

at what age do kids start to recognize brands associated with foods?

age 2

children’s food and beverage advertising initiative (CFBAI)

produces core principles to companies who want to minimize nutrient-poor food to children

* companies pledged to advertise only “healthy for you” foods
* follows dietary guidelines for americans