infant nutrition(ch8 brown)
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Infant Nutrition
Assessing NewbornHealth
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Birthweight
40 weeks gestation (37-42 weeks)
Normal: 2500-3800 grams (5.5 to 8.5 lbs.)
47-54 cm (18.5-21.5 inches)
3.9 million births in US/yr; 3.6 were full-term
Birth weight makes a difference: If infant
requires ICU over 2500 grams only 2% dieUnder weight typical of 28 week gestation
period 16% die
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Infant Mortality
US ranks 27th in the world
Why? Prevalence of preterm births major
factorSocioeconomic factors
Access to health care
How to improve? Prevent premature births.
Interventions to save newborns, decreasebarriers to health care, decrease teenpregnancies
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Better Infant Mortality Rates
Japan: 4.4
Singapore: 2-3
Sweden: 4.8
Finland: 4.4
Norway: 5.9 Canada: 6.1
Germany 6.2
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Programs to Decrease Infant
Mortality WIC
Bright Futures: comprehensive program
with government and professional groups
CDC and WIC track growth parameters to
monitor changes
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Standard Assessment Tests
EPSDT: Early Periodic Screening, Detection, andTreatment Program: part of Medicaid
IUGR: Intrauterine Growth Retardation. Below10%tile weight for gestational age
FTT: Failure to Thrive
APGAR: A rating score for newborns;
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EPSDT
Part of Medicaid and provides routine
checkups for low-income families
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IUGR
Clinical Examination of the newborn and
sometimes the placenta may reveal small
for gestational ageOther terms used: intrauterine growth
retardation
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Failure to Thrive(FTT)
Small for gestational age may set up FTT
FTT to thrive is a smaller than usual
growth pattern
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APGAR
http://kidshealth.org/parent/pregnancy_newborn/pregnancy/apgar.html Activity, Pulse, Grimace, Appearance, and Respiration.
Score based on five elements: Color
Heart rate
Respiratory effort
Muscle tone
Reflex irritability
Maximum score of 10 taken at 1 and 5 minutes after birth; Lowscores generally reflect later problems
http://kidshealth.org/parent/pregnancy_newborn/pregnancy/apgar.htmlhttp://kidshealth.org/parent/pregnancy_newborn/pregnancy/apgar.htmlhttp://kidshealth.org/parent/pregnancy_newborn/pregnancy/apgar.htmlhttp://kidshealth.org/parent/pregnancy_newborn/pregnancy/apgar.html -
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Infant Development
Reflex: An automatic, unlearned response
Rooting Reflex: Action that occurs when
one cheek is touched Sucking Reflex: Action in which an infant
will suck on anything
Suckle: A reflexive movement of thetongue moving forward and backwards tohelp with feeding
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Major Reflexes
Table 8.2 page 202
Babinski: Babys toes fan out when sole is
stroked
Blink: Babys eyes close with bright light
Withdrawal: Baby withdraws foot when
pricked
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Motor Development
Illustration 8.1
Standards to consider with development
Not meeting standards requires question:
Why?
Organic Problem or inorganic problem;
Often takes a referal to a social worker oroccupational therapist/physical assessment to
do an assessment
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Critical Periods
Development in Pregnancy: Hyperplasia &
Hypertrophy
There is a time period within certain behaviorsare learned
This enables sequential learning
Problems meeting behaviors may disrupt development
EG: Mouth is a source of pleasure and exploration; infant on
respirator may have this taken away and post respirator may
be a reluctant feeder
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Cognitive Development
Closely tied with Physical Development:
Sensorimotor development
Speech skills emerge when infant is
sensitive to food textures
Illustration 8.2
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Digestion
Gut function develops with time
Maturation of gut isnt complete at birth
Open gut Improvements of peristalsis, production of
digestive enzymes, etc becomes more mature asinfant gets older
Eg. Lipase activity improves with age, so infantis able to tolerate a greater assortment of fats withage.
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Physical Growth
Weight for age
Length for age
Weight for length
Head Circumference for age
BMI percentile
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Nutrition Care Manual
www.nutritioncaremanual.org
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Avoiding Measurement Errors
Calibrated equipment
Make sure infant is not holding anything
that adds weightDiapers?
Confirm position of infant for length
measurements Head Circumference at widest part of the
head
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Avoiding Errors in Plotting
Calculate ages accurately in months after
establishing the date of birth
Confirm plotting is done correctly. Mindyour ps and qs (is it in kg or pounds?)
Confirm that the plots are easy to read
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Feeding in Early Infancy
Breast Milk vs Formula
Before 4 to 6 months, this is all that is
recommended
How Breast milk differs from formula
Table 8.6 pg 209
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Developmental Feeding
Concerns Table 8.7 page 210; Infant Feeding Milestones
Developmental Milestones and Feeding Skills
Example: 7 to 9 months old Hand use emerges with pincer grasp and ability to
release; Stable independent sitting, crawling
Self-feeding with hands; munching and biting
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Case Study 8.1: Baby Samantha
Sam is healthy 8 mo old girl lives with parents
who work full-time and 3 yo sister. Both children
attend day care full-time. Sam nurses twice perday now and gets breast milk offered in bottles
at the day care. When she gets picked up after
work, she wants to be held and not eat her dinner.
3 yo sis wants to eat right away. Motherencourages upset baby to eat. She must be
hungry. What would you suggest?
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Questions
What signs is baby Sam giving to show theshe needs comforting rather than food?
How might Kathy (mom) change herroutine to give Sam more attention?
At 8 months, is Samantha too young otovereat out of emotional needs?
Should Kathy stop or continuebreastfeeding to improve Sams eating?
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Samantha Intervention
Intervention:
Baby needs time to become calm. She
probably needs the attention of being held andcomforted. So some time should be built in.
Maybe this means to give sis a snack while
this happens and dinner be put off for a while.
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Breast/ Bottle to Cup: Weaning
Breast to cup/Bottle to cup between 12 and 24
months
If breastfed for recommended 12 months, after 6months, introducing water and juice by cup is
recommended.
Formula fed can have water and juices by bottle and
then by cup after 6 months as well
Open cup vs sippy cup: different tongue skills
developed: open cup helps develop speech skills
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Food and Texture
Weaning: When nutritional value of breastmilk is provided by foods.
By 6 to 8 months, infants are ready forfood with lumps
By 8-10 months, infants are ready for softmashed foods
Mature chewing skills dont develop untiltoddler years
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Case Study 8.2 Paul and His
Baby Food
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Infants and Food Preferences
Many factors including:
Babys state of rest
Foods offered
Breast feeding vs formula feeding
More tastes in breast feeding
Babies may be more responsive to new foods in 4to 7 months
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Inappropriate Foods
Choking hazards:
Peanuts
Popcorn
Whole grapes
Hot dog pieces
Hard candy
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Common Nutrition Problems
Failure to Thrive
Organic: caused by a medical diagnosis. A
biological cause is presentNon-Organic: without medical diagnosis;
Environmental cause is suspected
Mixed: Both may contribute
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Failure to Thrive: Nutrition
Assessment Table 8.10, pg 217. Complete assessment
should include
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Cross Cultural Considerations
Commercial baby foods do not reflect
diversity: eg, no collards or Mexican
beans. Cultural considerations may play a role in
a familys willingness to participate in
assistance programs such as WIC
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Infants and Vegetarian Diets
Two potential difficulties:
Infants may not be able to consume the
quantities required to obtain adequate Caloriesand nutrients
Alternative vegetarian food products may not
be of high nutritional quality or offered in
appropriate sizes for infants.
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Nutrition Risk Intervention and
Risk Reduction In US all newborns are screened for rare
conditions:
PKU
Galactosemia
Hypothyroidism
Sickle cell diseaseAs many as 30 more from the same dried
blood sample
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WIC
Eligible households may receive WICintervention:
Two criteria: Household income less than 185% of poverty
Presence of nutritional or health risk
These may include:
Nutrition risk during pregnancy
Growth shows underweight
Iron status low(Hct or Hb)
Diet risks: inadequate intake
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Case Study 8.3 Baby Derrick