Infant Motor Development & Nutrition

Motor Skill Development (Bayley Scales)

• Table 4.4 outlines motor skill development milestones according to the Bayley Scales of Infant Development.
• Holds head erect and steady when held upright:
  • Average age achieved: 7 weeks.
  • Age range: 3 weeks to 4 months.
• When prone, elevates self by arms:
  • Average age achieved: 2 months.
  • Age range: 3 weeks to 5 months.
• Rolls from side to back:
  • Average age achieved: 2 months.
  • Age range: 3 weeks to 5 months.
• Rolls from back to side:
  • Average age achieved: 4 1/2 months.
  • Age range: 2 to 7 months.
• Grasps cube:
  • Average age achieved: 3 months 3 weeks.
  • Age range: 2 to 7 months.
• Sits alone, good coordination:
  • Average age achieved: 7 months.
  • Age range: 5 to 9 months.
• Pulls to stand:
  • Average age achieved: 8 months.
  • Age range: 5 to 12 months.
• Uses neat pincer grasp:
  • Average age achieved: 9 months.
  • Age range: 7 to 10 months.
• Plays pat-a-cake:
  • Average age achieved: 9 months 3 weeks.
  • Age range: 7 to 15 months.
• Stands alone:
  • Average age achieved: 11 months.
  • Age range: 9 to 16 months.
• Walks alone:
  • Average age achieved: 11 months 3 weeks.
  • Age range: 9 to 17 months.

Nutrition During the First Two Years

• Nutritional Needs: Physical development in infancy depends on good nutrition, including appropriate amounts of protein, calories, vitamins, and minerals.
• Challenges to Meeting Nutritional Needs:
  • Poverty: Parents may be unable to afford nutritious foods.
  • Conventional eating practices: Fast food consumption may lead to unbalanced diets.
• Infant vs. Older Children Nutritional Needs:
  • Infants eat less in absolute amounts but require more nutrients in proportion to their body weight.
  • Example: A 3-month-old needs more than 56.8ml of liquid per 450 grams of body weight, while an 18-year-old needs about one-third of this amount.
  • If adolescents consumed liquids in the same proportion, they would need 6.6 liters (25 cups) per day.

Infant Feeding Recommendations

• Breastfeeding: Health experts recommend human milk as the sole source of nutrition for the first six months and as a major source for at least the next six months.
• The World Health Organization (WHO) recommends exclusive breastfeeding for six months and continued breastfeeding for two or more years with complementary foods.
• Benefits of Breastfeeding:
  1. Protection from diseases.
  2. Closer match to nutritional needs (more iron).
  3. Better development of jaw and mouth muscles due to stronger sucking motions.
  4. Encourages a healthy emotional relationship through close physical contact.
• Alternatives to Breastfeeding:
  • Partial or complete bottle-feeding is an option when breastfeeding is impractical (e.g., medication use, job situations).
  • Legislation in Australia prohibits discrimination against breastfeeding women, and many workplaces provide suitable areas for breastfeeding.

Introduction of Solid Foods

• Timing: Solid foods (strained cereals, fruits) can be introduced around six months.
• Progression: Introduce other foods requiring a more mature digestive system (strained meats, cooked eggs) gradually.
• Monitoring: Babies need close monitoring as nutritional needs change because solid foods may lack the nutrients found in breast milk or formula.
• Table 4.5 outlines a healthy infant diet, including when to introduce different foods:
  • Birth–6 months: Breast milk or baby formula.
  • 6 months: Pureed single-grain cereal (iron-fortified).
  • 6 months: Water, diluted fruit juices ($\frac{1}{2}$ cup per day).
  • 6–8 months: Pureed vegetables or fruit, finger foods (e.g., chopped banana).
  • 10–12 months: Pureed meats or poultry, soft chopped foods (e.g., lumpy potatoes).
  • 24 months: Low-fat milk.
• Indigenous Child Health Program: The "Keeping kids healthy makes a better world" program in remote Northern Territory communities in Australia develops culturally appropriate nutrition programs for children aged 0-5 years, decreasing anemia rates.

Poor Nutrition and Deficiencies

• Common Deficiencies: Western diets often lack vitamin A, vitamin C, and iron.
• Vitamin A and C deficiencies can create deficits in motor ability.
• Iron deficiency can lead to deficits in cognitive performance.
• Severity: Nutritional deficiencies are serious for 4-5% of infants, requiring immediate remedy; another group of similar size faces less severe but still concerning deficiencies.
• Long-Term Risks: Even seemingly healthy undernourished infants may face later developmental problems due to associated deprivations (poor sanitation, inadequate healthcare, lack of education).

Malnutrition

• Global Prevalence: Widespread in war-torn areas and developing countries.
• In 2016, over two-thirds of wasted children (too thin for their height) under five lived in Asia, and over one-quarter lived in Africa.
• Over half of stunted children (too short for their age) live in Asia, and over one-third live in Africa.
• Global prevalence of stunting decreased from 32.7% in 2000 to 22.9% in 2016.
• Impact: Undernutrition contributes to nearly half of all deaths in children under 5 (3 million young lives a year).
• It increases the risk and severity of infections and delays recovery.
• Long-Term Effects: Poor nutrition in the first 1000 days can lead to irreversible stunted growth and impaired cognitive ability.
• Diseases Resulting from Malnutrition:
  • Kwashiorkor: Occurs when infants are weaned onto low-protein diets, leading the body to break down its own protein. Characterized by an enlarged belly, swelling feet, rash, and hair loss.
  • Marasmus: Results from a severe calorie deficit, leading to a wasted condition of the body due to a diet low in essential nutrients. Often appears in the first 12 months and can lead to chronic diarrhea and death.
• Ongoing Issues: Moderate to severe undernutrition results in stunted growth, cognitive and behavioral function impairment (poorer academic achievement, impaired motor skills, ADHD), and physiological effects (increased fat accumulation, insulin resistance, high blood pressure).
• These effects can be passed on through epigenetics, impacting socioeconomic status due to reduced education and employment capacity.

Overnutrition

• Problem: Occurs in affluent Western societies due to excessive consumption of calorie-rich, nutrient-poor foods.
• Food manufacturers prioritize high fat, sugar, and salt content over nutritional guidelines.
• Short-Term Result: Too many calories and wrong nutrients, not enough of other nutrients.
• Long-Term Result: Establishes food preferences that create health risks in childhood and adulthood (heart problems, type 2 diabetes, cancer).
• Trends: The rate of overweight children under five in Oceania nearly doubled between 2000 and 2016.
• US dietary surveys showed infants and toddlers exceeding energy requirements by 20-30%, often eating inappropriate high-energy, low-nutrient foods.
• Parental Influence: Overfeeding due to misinterpreting discomfort as hunger, or overcontrolling food intake due to weight gain fears.
• Using food as reinforcement can lead infants to attach special value to treats.
• Weight Concerns: While weight itself is not a medical concern in infancy if moderately above/below average, excess weight gain in early infancy is linked to obesity later in life.
• Associated with other health problems like diabetes and cardiovascular disease.
• Nutritional Imprinting: High caloric intake and rapid weight gain in early infancy adversely affects metabolism and promotes lifelong accelerated growth.
• Breastfeeding: Thought to offer protection against obesity by promoting better appetite self-regulation.

Impairments in Growth

• Variations: Healthy infants grow at various rates and sizes, which is generally normal.
• Concerns: A small percentage of infants do not grow as large as they should, leading to concerns and potential infant mortality.
• Low-Birth-Weight Infants: Newborns weighing less than 2500 grams (2.5 kilograms) are considered low birth weight.
• In 2013, Australia's rate of low-birth-weight babies was around 6.5% of total births (on par with the EU average).
• South Asia had the highest incidence of low birth weight from 2009 to 2013 (28%).
• Accurate estimates are challenging in developing countries due to almost half of infants not being weighed at birth.
• Causes of Low Birth Weight:
  • Malnourishment of the mother during pregnancy.
  • Harmful practices like smoking, alcohol, or drug use.
  • Teenage mothers or those from low socioeconomic backgrounds.
  • Multiple births (twins, triplets).
  • Illnesses or mishaps (traffic accidents causing damage to the placenta).