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Chapter 8

NUTR 2050 Chapter Notes - Chapter 8: Abdominal Pain, Extracellular Fluid, Macrobiotic Diet


Department
Nutrition
Course Code
NUTR 2050
Professor
Simone Holligan
Chapter
8

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Chapter 8—Infant Nutrition
Introduction:
This chapter is about healthy full-term infants (born between 37-42 weeks). These newborns
are expected to have typical growth and development. The Healthy People 2020 objectives
about infants are concerned with reducing infant mortality, preterm birth rates, incidence of
spina bifida and neural tube defects, fetal alcohol syndrome, and other birth defects.
Assessing Newborn Health
Birth Weight as An Outcome
The weight of a newborn is a key measure of health status during pregnancy. The average
gestation for a full-term infant is 40 weeks, with a range from 37-42 weeks. Full-term infants
usually weigh 2500-3800 grams (5.5 to 8.5 lbs) and are 47-54 cm (18.5-21.5 inches) in length.
Infants with normal birth weights are less likely to require intensive care and are usually healthy
in the long run. Conversely, preterm infants, regardless of birth weight, are those born at 37
weeks or less. Preterm means incomplete development has taken place.
Infant Mortality
The mortality has been decreasing globally. This accounts for death that occurs within the first
year of life. This poor ranking has been linked to the prevalence of low birth weight infants, less
than 2500 grams (5.5lb). The three leading causes of infant mortality in the US in 2009 were
congenital malformations, complications related to preterm births, and sudden infant death
syndrome.
Combating Infant Mortality
This is a multifaceted problem, however affected by: Social and economic status of the families
and women, access to health care, medical interventions, teenage pregnancy rates, availability
of abortion services, and failure to prevent preterm and low-birth-weight births. The following
concepts underscore the commitment of resources for infants:
- Recognition that birth weight is important for long-term health outcomes
- Understanding that prevention and treatment of complications for at-risk infants are
investments for future
Early Periodic Screening, Detection, and Treatment Program (EPSDT) is a major source of
preventive and routine care for infants in low-income families. Immunizations during infancy are
another example of a prevention approach. The Bright Futures program promotes and improves
health, education, and well-being of infants and children.
Standard Newborn Growth Assessment
Indicators include birth weight, length, and head circumference for gestational age. Intrauterine
growth retardation (IUGR) or intrauterine growth restriction—means the newborns birth weight

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falls below the 10th percentile of weight for gestational age. Those in between are appropriate
for gestational age (AGA).
Infant Development
Full-term newborns have a wider range of abilities than previously recognized; they hear and
move in response to familiar sounds, such as the mothers voice. Newborns demonstrate 4
states of arousal, ranging from sleeping to fully alert, and responsiveness differs in part on their
state of arousal. The newborns central nervous system is immature; that is, the neurons in the
brain are less organized compared to those of the older infant. As a result, the newborn gives
inconsistent or subtle cues of hunger and other needs, compared to the cues given later. The
fact that newborns can root (action that occurs if one cheek is touched resulting in the infants
head turning toward that check and the infant opening its mouth), suckle (a reflex of the tongue
moving forward and backward; earliest feeding skill), and coordinate swallowing and breathing
within hours of birth shows that feeding is directed by reflexes and the central nervous system.
Newborn reflexes are protective for them. These reflexes (automatic unlearned response that is
triggered by specific stimulus) fade as they are replaced by purposeful movements during the
first few months of life. Table 8.2 page 229 lists major reflexes in newborns**.
Motor Development
Motor development reflects an infants ability to control voluntary muscle movement. Illustration
p230 illustration 8.1 depicts motor development during first 15 months*. The development of
muscle control is top-down, meaning head control is the start, and the last comes lower legs.
Muscle development is also from central to peripheral meaning the infant learns to control the
shoulder and arm muscles before muscles in the hands. Motor development influences both the
ability of the infant to feed and the amount of energy expended in the activity. Only when an
infant has achieved the motor development of head control and sitting balance and certain
reflexes have disappeared can oral feeding with a spoon be achieved.
Critical Periods
The concept of critical period is based on a fixed time period during which certain behaviours
emerge. A critical period for development of oral feeding may explain some later feeding
problems in infancy. Under such circumstances the critical period for associating mouth
sensations with pleasure and exploration may have been missed.
Cognitive Development
The concept of biological and environmental systems in interacting is seen in illustration 8.2 on
page 231, showing sensorimotor development (early learning system in which the infants
sense and motor skills provide input to the central nervous system). These skills influence
feeding in important ways. For example, the stage during which infants are very sensitive to
food texture is also when the speech skills are emerging. The baby’s interaction with the
environment stimulates its developing brain, which is now seen as structuring the nervous
system in the long term. Cognitive development is also subjected to genetic controls, which turn

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genes on and off in different time frames and at different sites within the body. Specific vitamins
needed at specific frames of development .
Digestive System Development
It takes up to 6 months for the infant gastrointestinal tract to mature, and the time required
varies considerably from one individual to another. During the 3rd 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. The gut is functional at birth. Maturation of
peristalsis and rate of passage are associated with some forms of gastrointestinal discomfort in
infants. Probiotics and prebiotics impact the intestinal bacteria and the development of the
intestinal mucosa as a defense system in infancy. Infants often have conditions that reflect the
immaturity of the gut, such as colic gastroesophagea reflux (GER—movement of the stomach
contents backward into esophagus due to stomach muscle contractions. The condition may
require treatment depending on its duration and degree), unexplained by diarrhea, and
constipation. Such conditions do not interfere with the ability of the intestinal villa to absorb
nutrients, and typically do not hinder growth. Rate of food passage includes factors such as:
- Osmolarity of foods or liquids (which affects how much water is in the intestine)
- Colon bacterial flora
- Water and fluid balance in the body
Parenting
Even though the newborn can breast- or bottle-feed after birth, skills of new parents develop
slowly. Temperature has a biological basis and includes the infant’s style or patterns of
behaviour. Temperament includes the infant’s emotional reactions to new situations, activity
level, and sociability. The fit between the infant’s temperament and that of the parents can
increase or decrease feeding problems.
Energy and Nutrient Needs
Energy and nutrient requirements include:
- Dietary Reference Intakes (DRI) from the academy of medicine
- The American Academy of Pediatrics
- The Academy of Nutrition and Dietetics
- The European Society of Paediatric Gastroenterology, Hematology and Nutrition
Committee on Nutrition
The 2010 Dietary Guidelines for Americans address the need of children aged 2 and older—
not infants
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