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Chapter 8

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NUTR 2050
Jess Haines

Nutrition Chapter 8 - Infant Nutrition - full-term infants: infants born between 37 and 42 weeks gestation - healthy preterm infants: infants born at 34 weeks or later - preterm infant: infants born before 37 weeks of gestation Assessing Newborn Health Birth Weight as an Outcome - the weight of a newborn is a key measure of health status during pregnancy - average full-term baby weighs between 5.5-8.5lbs and height is 18.5-21.5inches) Infant Mortality - infant mortality: death that occurs within the first year of life - preterm birth is a key risk factor for infant death since it is continuing to increase - 3 leading causes to of infant mortality in 2006 were congenital malformations, complications related to preterm births, and sudden infant death syndrome (SIDS) Combating Infant Mortality -The Early Periodic Screening Detection, and Treatment Program (EPSDT): part of Medicaid and provides routine checkups for low-income families Standard Newborn Growth Assessment - newborn health status is assessed by various indicators of growth and development taken right after birth. Indicators include birth weight, length, and head circumference for gestational age - intrauterine growth retardation (IUGR): fetal under-growth from any cause, resulting in a disproportionality in weight, length, or weight-for-length percentiles for gestational age. Sometimes called intrauterine growth restriction - the designation “small for gestational age” (SGA); also called “small for dates”, “IUGR”, or th intrauterine growth restriction” - means that newborn’s birth weight falls below the 10 percentile of weight gestational age - infants above the 90 percentile are considered large for gestational age (LGA) - those in between are appropriate for gestational age (AGA) Infant Development - full-term newborns can hear and move in response to familiar sounds, such as the mother’s voice. They demonstrate 4 states of arousal, ranging from sleeping to fully alert, and responsiveness differs in part on their state of arousal - reflex: an automatic (unlearned) response that is triggered by a specific stimulus - rooting reflex: action that occurs if one cheek is touched, resulting in the infant’s head turning toward that cheek and the infant opening his mouth - suckle: a reflexive movement of the tongue moving forward and backward; earliest feeding skill Motor Development - motor development reflects an infant’s ability to control voluntary muscle movement - the development of muscle control is top-down, meaning head control is the start and last comes lower legs - muscle development is also from central to peripheral, meaning the infant learns to control the shoulder and arm muscles before the muscles in the hands Critical Periods - concept of critical period is based on a fixed time period during which certain behaviours emerge - a critical period for the development of oral feedings may explain some later feeding problems in infancy Cognitive Development - sensorimotor: an early learning system in which the infant’s senses and motor skills provide input to the central nervous system Digestive System of Development - during the 3 trimester, the fetus swallows amniotic fluid and this stimulates the lining of the intestine to grow and mature - at birth, the healthy newborn’s digestive system is sufficiently mature to digest fats, protein and simple sugars and to absorb fats and amino acids - after birth and through the early infancy period, the coordination of peristalsis within the gastrointestinal tract improves. Maturation of peristalsis and rate of passage are associated with some forms of gastrointestinal discomfort in infants - infants often have conditions that reflect the immaturity of the gut, such as colic, gastroesophageal reflux (GER), unexplained diarrhea, and constipation - gastroesophageal reflux (GER): movement of the stomach contents backwards into the esophagus due to stomach muscle contractions. - other factors influence the rate of food passage through the colon and the gastrointestinal discomfort seen in infants. These include: - osmolarity of foods or liquids (which affects how much water is in the intestine) - colon bacteria flora - water and fluid balance in the body - osmolarity: measure of the number of particles in a solution, which predicts the tendency of the particles to move from high to low concentration Energy and Nutrient Needs - recommendations of children aged 2 and older. Recommendations for infants are from the DRI intakes, which are based on research over decades on infant growth and health from professional groups such as the National Academy of Medicine, the American Academy of Pediatrics, and the American Dietetic Association Caloric Needs - the average caloric requirements for individual infants is broad, ranging from 80 to 120 calories per kg (2.2lb) body weight. - average caloric need of infants in the first 6 months of life of 108 cal per kg body weight, based on growth in breastfed infants - from 6-12 months of age, average caloric need is 98 cal/kg - factors that account for the range of caloric needs of infants include the following: - weight - growth rate - sleep/wake cycle - temperature and climate - physical activity - metabolic response to food - health status and recovery from illness Protein Needs - recommended protein intake from birth up to 6 months averages 2.2g of protein per kg of body weight, and from 6-12 months the need is for 1.6g of protein per kg - most young infants who breastfeed or consume the recommended amounts of infant formula meet protein needs without added foods - infants may exceed their protein needs based on the DRI when they consume more formula than recommended for age and when protein sources such as baby cereal are added to infant formula Fats - no specific recommended intake levels of fats for infants - breast milk provides 55% of its calories from fat, and this percentage reflects an adequate intake of fat by infants - percentage of fat in the diet drops after the infant accepts baby foods, since most baby foods are low in fat - short- and medium-chain fats such as those in breast milk are more readily utilized than long- chain fats, such as in some infant formulas - infants use fats to supply energy to the liver, brain, and muscles, including the heart Metabolic Rate, Calories, Fats, and Protein - How Do They All Tie Together? - the high metabolic rate is primarily related to infants’ rapid growth and the high proportion of infant weigh that is made up of muscle - the usual body fuel for metabolism is glucose Other Nutrients and Non-nutrients Fluoride: - DRI for fluoride is 0.1 mg daily for infants less than 6 months of age - DRI for fluoride is 0.5 mg daily for 7-12 month-olds - fluoride is incorporated into the enamel of forming teeth, including those not yet erupted Vitamin D: - vitamin D
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