Infant Nutrition

Assessing Newborn Health

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% die Under weight typical of 28 week gestation period 16% die

Infant Mortality
US ranks 27th in the world
Why? Prevalence of preterm births major factor Socioeconomic factors Access to health care How to improve? Prevent premature births. Interventions to save newborns, decrease barriers to health care, decrease teen pregnancies

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

Programs to Decrease Infant Mortality

WIC Bright Futures: comprehensive program with government and professional groups CDC and WIC track growth parameters to monitor changes

Standard Assessment Tests

EPSDT: Early Periodic Screening, Detection, and Treatment Program: part of Medicaid IUGR: Intrauterine Growth Retardation. Below 10%tile weight for gestational age FTT: Failure to Thrive APGAR: A rating score for newborns;

EPSDT
Part of Medicaid and provides routine checkups for low-income families

IUGR
Clinical Examination of the newborn and sometimes the placenta may reveal small for gestational age
Other terms used: intrauterine growth retardation

Failure to Thrive(FTT)
Small for gestational age may set up FTT FTT to thrive is a smaller than usual growth pattern

APGAR
http://kidshealth.org/parent/pregnancy_newborn/pregnanc y/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; Low scores generally reflect later problems

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 the tongue moving forward and backwards to help with feeding

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

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 or occupational therapist/physical assessment to do an assessment

Critical Periods
Development in Pregnancy: Hyperplasia & Hypertrophy There is a time period within certain behaviors are 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

Cognitive Development
Closely tied with Physical Development: Sensorimotor development Speech skills emerge when infant is sensitive to food textures Illustration 8.2

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 as infant gets older Eg. Lipase activity improves with age, so infant is able to tolerate a greater assortment of fats with age.

Physical Growth
Weight for age Length for age Weight for length Head Circumference for age BMI percentile

Nutrition Care Manual

www.nutritioncaremanual.org

Avoiding Measurement Errors

Calibrated equipment Make sure infant is not holding anything that adds weight
Diapers?

Confirm position of infant for length measurements Head Circumference at widest part of the head

Avoiding Errors in Plotting

Calculate ages accurately in months after establishing the date of birth Confirm plotting is done correctly. Mind your ps and qs (is it in kg or pounds?) Confirm that the plots are easy to read

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

Cows Milk
Whole cows milk first introduced at 12 months
Reduced fat cows milk at 2 years Reasons:
Renal solute load Milk protein allergies Potential for Fe deficiency anemia
Low absorption of Fe GI blood loss

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

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 per day 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. Mother encourages upset baby to eat. She must be hungry. What would you suggest?

Questions
What signs is baby Sam giving to show the she needs comforting rather than food? How might Kathy (mom) change her routine to give Sam more attention? At 8 months, is Samantha too young ot overeat out of emotional needs? Should Kathy stop or continue breastfeeding to improve Sams eating?

Samantha Intervention
Intervention:
Baby needs time to become calm. She probably needs the attention of being held and

comforted. 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.

Breast/ Bottle to Cup: Weaning

Breast to cup/Bottle to cup between 12 and 24 months
If breastfed for recommended 12 months, after 6

months, 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

Food and Texture

Weaning: When nutritional value of breast milk is provided by foods. By 6 to 8 months, infants are ready for food with lumps By 8-10 months, infants are ready for soft mashed foods Mature chewing skills dont develop until toddler years

What Infants Eat

4 to 6 months: Foods added to stimulate mouth muscle development; Most nutrition should still come from breast milk or formula
First foods: dry rice cereal that is Fe fortified and hypoallergenic Add one new food at a time. Why? Commercial baby foods are NOT required. Home prepared are fine. Pros and Cons?

Case Study 8.2 Paul and His Baby Food

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 4 to 7 months

Inappropriate Foods
Choking hazards:
Peanuts Popcorn

Whole grapes
Hot dog pieces Hard candy

Supplements for Infants

Flouride: if water supply has less than 0.7 ppm Elemental iron if mother was anemic during pregnancy B12 if mother is vegan Vit D if no sun exposure If breastmilk only nutrition after 4 to 6 months then Poly Vi-Flor (A,D,C and Fl)

Common Nutrition Problems

Failure to Thrive
Organic: caused by a medical diagnosis. A biological cause is present

Non-Organic: without medical diagnosis; Environmental cause is suspected

Mixed: Both may contribute

Failure to Thrive: Nutrition Assessment

Table 8.10, pg 217. Complete assessment should include

Other common problems

Colic Iron-deficiency anemia Constipation and diarrhea Baby bottle caries and ear infections Food allergies and intolerances Lactose intolerance

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

Infants and Vegetarian Diets

Two potential difficulties:
Infants may not be able to consume the quantities required to obtain adequate Calories

and nutrients Alternative vegetarian food products may not be of high nutritional quality or offered in appropriate sizes for infants.

Nutrition Risk Intervention and Risk Reduction

In US all newborns are screened for rare conditions:
PKU

Galactosemia
Hypothyroidism Sickle cell disease As many as 30 more from the same dried blood sample

WIC
Eligible households may receive WIC intervention:
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

Case Study 8.3 Baby Derrick