Chapter 13: Lifespan Nutrition From Pregnancy to the Toddler Years

Pregnancy Summary

Importance of Healthy Nutrition

• Good nutrition is essential for healthy pregnancy and fetal development.

• Increased nutrient needs are critical; unmet nutritional needs can lead to low birth weight and developmental issues.

The Early Days of Pregnancy

• Pregnancy is measured from the last menstrual period until childbirth (approximately 40 weeks).

• Early nutrition is crucial for cell division, organ development, and reaching pregnancy milestones.

• Both parents should maintain healthy diets to support fertility and overall well-being.

Tools for Change

• Women of childbearing age should intake 400 mcg of folate daily before pregnancy and 600 mcg during.

• Folate is essential for DNA production and preventing neural tube defects (1 in 1000 pregnancies).

• Sources of folate include leafy greens, legumes, liver, and fortified cereals.

Weight Gain during Pregnancy

• Weight gain is a key change; inadequate gain may risk low birth weight and other complications.

• Normal weight gain recommendations:

  • Underweight: 28–40 lbs

  • Normal: 25–35 lbs

  • Overweight: 15–25 lbs

  • Obese: 11–20 lbs

• Initial weight gain is typically 2–5 lbs in the first trimester, then around 1 lb per week.

Weight Loss after Pregnancy

• Post-delivery weight loss occurs initially through childbirth and fluid loss.

• Regular physical activity during pregnancy helps new mothers lose excess weight post-pregnancy.

• Excess weight gain poses risks for future health complications.

Nutritional Requirements

• Increased calorie and nutrient intake is essential, especially in the second and third trimesters.

• Recommended caloric increase:

  • 340 calories/day in the second trimester

  • 450 calories/day in the third trimester

• Daily nutrient recommendations include:

  • Carbohydrates: 175–265 grams

  • Protein: 71 grams

Vitamins and Minerals

• Increased RDA for most vitamins and minerals during pregnancy, e.g., Folate (600 mcg), Iron (27 mg).

• Important micronutrients for fetal development include Vitamin D, Calcium, and Iron.

• Pregnant women should avoid excess intake of certain supplements to prevent toxicity.

Guide to Eating During Pregnancy

• Focus on nutrient-dense foods (fruits, vegetables, whole grains, lean meats).

• Prenatal supplements to ensure adequate iron and folate.

• Follow dietary guidelines to enhance iron absorption and overall health.

Foods to Avoid

• Pregnant women should avoid alcohol completely to prevent fetal alcohol spectrum disorders.

• Limit caffeine intake to about 200 mg/day (approx. one 8-ounce cup of coffee).

• Avoid raw fish and high-mercury fish to mitigate foodborne illnesses.

Foodborne Illness

• Pregnant women are at higher risk for foodborne illnesses (e.g., Listeria).

• Precautions include washing produce and avoiding unpasteurized dairy and undercooked meats.

Physical Activity During Pregnancy

• Regular moderate exercise (30 minutes most days) is beneficial for health and recovery post-pregnancy.

• Avoid high-risk activities that may cause injury or complications.

Food Cravings and Aversions

• Food aversions (common foods include milk and meat) and cravings are generally not harmful unless they severely limit diet.

• Pica (consumption of non-nutritive substances) can occur and may require nutritional intervention.

Complications During Pregnancy

• Common complications include gestational hypertension and diabetes.

• Managing diet and regular check-ups are essential for prevention and early intervention for both conditions.

Infancy Summary

Overview

• Diet and nutrition significantly impact a child's development from infancy to adolescence.

• A healthy diet affects growth, immunity, intellectual capabilities, and emotional well-being.

• Ensuring children receive necessary nutrients is a key parental responsibility.

Breastfeeding Support

• Most mothers consider how to feed their babies early in pregnancy.

• Breastfeeding education should start at the first prenatal appointment.

• Family support is crucial for decision-making and breastfeeding success.

• Approximately 83.2% of babies in the U.S. start breastfeeding; only about 25% are exclusively breastfed by 6 months.

• Healthcare providers can guide mothers in breastfeeding techniques and benefits.

• International Board Certified Lactation Consultants (IBCLCs) provide support.

• Important hospital practices include initiating breastfeeding within an hour of birth and allowing rooming-in.

• Spousal, familial, and employer support greatly influence breastfeeding success.

• Legislation like the Affordable Care Act mandates workplace accommodations for breastfeeding mothers.

• State laws, such as those in Hawai‘i, support breastfeeding rights, including public breastfeeding and workplace accommodations.

Nutritional Needs

• Infants experience major physiological changes requiring adequate nutrition.

• Growth charts track development; rapid growth may indicate malnourishment or failure-to-thrive (FTT).

• Macronutrient needs are higher than any other life stage; breastfeeding fulfills this need.

• After 6 months, complementary foods should be introduced but not before due to allergy risks.

Energy and Macronutrients

• Higher energy needs in infants: 472-645 kcal/day (0-6 months) and 645-844 kcal/day (6-12 months).

• Carbohydrates make up 40-55% of breast milk, followed by protein (5-9%) and fats (30-50%).

• Nutritional requirements include:

  • Carbohydrates: 60g (0-6 months), 95g (7-12 months)

  • Protein: 9.1g (0-6 months), 11g (7-12 months)

  • Total fat: 30g (0-6 months), 31g (7-12 months)

Micronutrients

• Breast milk provides essential vitamins and minerals; supplements may be needed for Vitamin D and K.

• Infants may require additional iron beginning at 6 months.

Hydration

• Fluid needs are 1.5 mL/kcal; met through breast milk or formula.

Benefits and Components of Breastfeeding

• Breastfeeding improves immune function and reduces illness risk.

• Types of breast milk:

  • Colostrum: High in antibodies, provides initial nutrition.

  • Transitional Milk: Creamy, richer in nutrients following colostrum.

  • Mature Milk: Varies in composition based on feeding time and maternal diet.

• Breastfeeding fosters a bond and has emotional and health benefits, including reducing risks of certain cancers for mothers.

Baby-Friendly Hospital Initiative (BFHI)

• Launched to create supportive breastfeeding environments in maternity facilities.

• Over 15,000 hospitals worldwide designated as 'baby-friendly'.

Barriers to Breastfeeding

• Challenges include painful engorgement, latching issues, public discomfort, and workplace accommodation.

• Education and support can help address these issues.

Contraindications to Breastfeeding

• HIV-positive mothers and those on certain medications should not breastfeed.

• Infants with galactosemia cannot process breast milk effectively.

Bottle-Feeding

• Suitable alternative when breastfeeding isn't possible; various formulas available.

• Standard, soy, and preterm formulas cater to different needs.

• Proper preparation and sanitation are crucial for formula safety.

Introducing Solid Foods

• WHO recommends exclusive breastfeeding for the first 6 months; solids should be nutrient-dense.

• Introduce foods after 6 months, avoiding allergens initially, and monitor for reactions.

• Cultural practices can influence infant feeding; for example, poi is nutritious and often used in traditional Hawaiian diets.

Foods to Avoid

• Honey and cow's milk should not be given before 12 months.

• Certain vegetables and foods pose choking hazards.

Toddler Years

Major Physiological Changes

• Limbs grow faster than the trunk, resulting in a more proportionate appearance.

• By age three, toddlers are taller, slender, and have increased bone density as cartilage is replaced by bone (ossification).

Developmental Milestones

• Key milestones include running, drawing, toilet training, and self-feeding.

• Dramatic intellectual, emotional, and social changes occur.

• Transition from breastfeeding/bottle-feeding to solid foods; higher fluid requirements due to increased risk of dehydration.

Nutritional Requirements

• Use MyPlate for dietary guidance; serving size is about one-quarter of an adult's.

• Example Meal Portion:

  • 1 ounce of meat or chicken or 2-3 tablespoons of beans

  • 1/4 slice of whole-grain bread

  • 1-2 tablespoons of vegetables and fruit.

Energy Needs

• Daily caloric intake: 1,000 to 1,400 calories (40 calories per inch of height).

• Importance of small, frequent, nutritious meals and snacks.

Serving Sizes for Toddlers

• Grains: 3-5 ounces, ideally whole grains.

• Proteins: 2-4 ounces of diverse sources.

• Fruits: 1-1.5 cups of fresh or 100% juice.

• Vegetables: 1-1.5 cups raw/cooked.

• Dairy: 2-2.5 cups per day.

Macronutrients

• Carbohydrates: 45-65% of daily calories (113-163 grams for 1,000 calories).

• Protein: 5-20% of daily calories (13-50 grams for 1,000 calories).

• Fat: 30-40% of daily calories; encourage healthy oils and limit unhealthy fats.

Micronutrients

• Increased demands for vitamins/minerals; essential for development.

• Recommended 600 IU of Vitamin D daily; consider supplements if necessary.

• Iron deficiency is common; toddlers should consume 7 to 10 mg of iron daily.

Learning to Handle Food

• Encourage self-feeding with easy-to-handle foods to avoid choking hazards.

• Parents should provide:

  • Small utensils and cups

  • Plates with edges

  • Appropriate table settings for height.

Feeding Problems

• Common challenges include picky eating and overcoming food aversions.

• Satter's approach: parents control what, when, and where children eat; children decide how much to eat.

• Continuous exposure to disliked foods may encourage acceptance over time.

Picky Eaters

• Appetite may decrease due to slower growth.

• Involve children in meal preparation to encourage eating behavior.

Toddler Obesity

• Obesity rates have increased in young children; some minority groups show higher prevalence.

• Contributing factors: busy lifestyles leading to fast food reliance, lack of access to healthy food, physical inactivity.

• Preventive measures include regular family meals, appropriate portions, and promoting active play.

Early Childhood Caries

• Risk increases with higher sugar consumption; educate on healthy eating habits.

• Discourage high-sugar processed foods and ensure good dental hygiene.

Iron-Deficiency Anemia

• Can occur as toddlers transition from iron-rich foods.

• Parents should include iron-rich foods like lean meats and legumes, and monitor iron intake.

• Treatment may include iron supplements and enhancing absorption with Vitamin C.