Transcript Fundamentals of Nutrition - Delmar

Chapter 12
Diet during Infancy
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Objectives
• State effect inadequate nutrition has on infant
• Discuss positive aspects of breastfeeding and
bottle feeding
• Describe when and how foods are introduced
into infant’s diet
• Describe inborn errors of metabolism and their
dietary treatment
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nutritional Requirements of the Infant
• Birth weight doubles by 6 months and triples
within first year
• Requirements:
– Approximately 98 to 108 calories per kilogram of body
weight each day
– 1.5 mL of water per calorie
• Nutritional needs depend on child’s growth rate
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nutritional Requirements of the Infant
• Basis of diet:
– Breast milk or formula
• Vitamin K supplement routinely given at birth
• Vitamin D supplement given in breastfed
infants not exposed to sunlight
• Excess vitamin A or vitamin D can be toxic
• Fluoride may be supplemented as needed
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Breastfeeding
• Infants obtain temporary immunity to many
infectious diseases
– Have fewer infections
• Has benefit of being the following:
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Economical
Nutritionally perfect
Sterile
Easily digested
(continues)
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Breastfeeding
• Promotes oral motor development
• Offer breast every two hours in first few weeks
• Have infant nurse 10 to 15 minutes on each
breast
• Growth spurts occur at approximately 10 days,
two weeks, six weeks, and three months
– Infant may nurse more frequently
(continues)
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Breastfeeding
• Also beneficial to mothers
– Less risk of breast cancer and osteoporosis
• Indications of adequate nutrition include:
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Infant has six or more wet diapers per day
Infant has normal growth
Infant has one to two bowel movements per day
Breast becomes less full during nursing
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Bottle Feeding
• Infant should be cuddled and held in semiupright position
• Infant should be burped often
• Formulas made from modified cow’s milk to
resemble breast milk in nutritional value
(continues)
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Bottle Feeding
• Synthetic formula made from soybeans may be
used for infants who are sensitive or allergic
• Formula must be prepared with correct amount
of water to prevent health complications
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Bottle Feeding
• Cow’s milk can cause gastrointestinal blood
loss in infants
– Avoid use
• Use consistent temperature for formula
• Putting infants to bed with bottle may cause
baby bottle mouth
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Stop and Share
• Share with a partner your own feelings
regarding breastfeeding versus bottle feeding.
– Do you support a woman who decides to breastfeed?
– Do you support a woman who decides to bottle feed?
– Could your beliefs affect the care you give?
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Supplementary Foods
• Wait until 4 to 6 months before introducing
solid foods
– Do so gradually
• Solids should be started with iron-fortified rice
cereal
– Then other infant cereals
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Supplementary Foods
• Follow with cooked and pureed vegetables,
then cooked and pureed fruits, egg yolk, and
finely ground meats
• Between 6 and 12 months, add toast, Zwieback
teething biscuits, and Cheerios
(continues)
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Supplementary Foods
• Never give honey to infant
– Could be contaminated with Clostridium botulinum bacteria
• Can introduce juice when drinking from cup
– Never give from bottle
• Will fill up on juice and not get enough calories from other sources
– Use only 100 percent juice products
– Limit to 4 ounces per day
• Nutrient-dense
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Indications for Readiness for Solid
Foods
• Disappearance of extrusion reflex
– Pushing food out with tongue
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Willingness to participate
Ability to sit up without support
Control of head and neck
Drinking of more than 32 ounces of formula or
nursing eight to 10 times in 24 hours
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Developing Good Eating Habits
• By age 1, most babies can eat foods from all
food groups
• Can use table foods
• Avoid excess sugar and salt
• Avoid foods that can cause choking
• Help children develop active lifestyle and
healthy eating habits
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Special Nutritional Needs
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Premature infants
Cystic fibrosis
Failure to thrive
Metabolic disorders:
– Galactosemia
– Phenylketonuria (PKU)
– Maple syrup urine disease (MSUD)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Premature Infants
• Infant born before 37 weeks of gestation
• Sucking reflex not developed until 34 weeks of
gestation
– Infants born earlier require total parenteral nutrition, tube
feedings, or bolus feedings
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Premature Infants
• Other concerns:
– Low birth weight, underdeveloped lungs, immature
gastrointestinal tract, inadequate bone mineralization, and
lack of fat reserves
• Many special formulas available, but breast
milk best
– Composition perfect even for premature infants
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Cystic Fibrosis
• Inherited disease in which body secretes
abnormally thick mucus
• Decreased production of digestive enzymes
and malabsorption of fat
• Recommendation:
– 35 to 40 percent of diet should be from fat
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Cystic Fibrosis
• Digestive enzymes and fat-soluble vitamin
supplementation at meal times
• Nighttime tube feedings may be indicated
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Failure to Thrive
• Determined by plotting infant’s growth on
standardized charts
• May be caused by watering down formula,
congenital abnormalities, acquired
immunodeficiency syndrome (AIDS), lack of
bonding, child abuse, or neglect
(continues)
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Failure to Thrive
• First six months most crucial for brain
development
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Galactosemia
• Caused by lack of transferase
– Converts galactose to glucose
• Amount of galactose in blood becomes toxic
• Results in diarrhea, vomiting, edema, and
abnormal liver function
• Cataracts may develop
• Galactosuria and mental retardation occur
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Galactosemia
• Diet therapy:
– Exclusion of anything containing milk from any mammal
– Nutritional supplements of calcium, vitamin D, and
riboflavin
• Lifelong elimination or restriction of lactose in
diet may be needed
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
PKU
• Infants lack liver enzyme phenylalanine
hydroxylase
– Necessary for metabolism of amino acid phenylalanine
• Infants normal at birth, but if untreated,
become hyperactive, suffer seizures, and
become mentally retarded between 6 and 18
months
(continues)
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PKU
• Lifelong diet therapy:
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Commercial formula Lofenalac
Regular blood tests
Synthetic milk for older children
Avoidance of phenylalanine
• Hospitals required to screen newborns before
discharge
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MSUD
• Congenital defect resulting in inability to
metabolize three amino acids:
– Leucine, isoleucine, and valine
• Named for odor of client’s urine
• Ketosis occurs with protein ingestion
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
MSUD
• Hypoglycemia, apathy, and convulsions occur
– If not treated promptly, may result in death
• Lifelong diet therapy:
– Extremely restricted amounts of the three amino acids
– Special formula and low-protein diet
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Spotlight on the Life Cycle
• Women, Infants, and Children (WIC)
– Federally funded program that provides monthly food
packages of infant formula or milk, cereal, eggs, cheese,
peanut butter, and juice to new mothers
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Conclusion
• Infants must have adequate diets to avoid
impairment of physical and mental development
• Breastfeeding
– Nature’s way of feeding infant
• Formula feeding also acceptable
• Some infants have special nutritional needs
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.