Transcript Module_7 - HCC Learning Web

Nutrition During Infancy
and for Lactation
By Jennifer Turley and Joan Thompson
© 2013 Cengage
Introduction
• The physical, cognitive, and social triad
during infancy
– Successful growth and development
• Nutrition needs for the lactating mother
• Nutrition needs during infancy
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Breast Feeding
Formula Feeding
Energy and Nutrient Needs for Baby
Baby’s First Foods
• Infant fitness and lifestyle management
Successful Growth and
Development
• Helplessness to walking in one year.
• Notable developmental changes by
body system.
Organ/Site
Circulatory
System
Damage
Three blood flow changes occur after birth and are mostly
complete within hours after birth and totally complete
within three weeks to several months. Newborns have
more blood cells that are needed due to changes in
respiration, therefore the liver breaks down the RBC’s to
bilirubin which is normally excreted. Excess bilirubin results
in jaundice or yellowish appearance and can cause brain
damage. Treatment involves exposure to UV light which
breaks down bilirubin in the skin.
Digestive System
Endocrine System
Integumentary
System
Muscular System
Nervous System
Reproductive
System
Respiratory System
Skeletal System
Urinary System
Infants can detect the smell of their mother’s milk. Taste is
influenced by the mother’s diet if breast fed. Gastric pH is
alkaline at birth then becomes acidic within 24 hours. Acidity
then decreases for a few months. Some enzymes are equal to
that of an adult (trypsin). Others are only ten to 60% of an adult
(chymotrypsin, lipase, amylase). Intestines are larger than an
adult and may be ‘leaky’.
Hormonal changes occur during adolescence during puberty and
again in the older adult during menopause and andropause.
The sense of touch is fairly developed at birth. The skin is soft
and elastic.
Muscular development is largely controlled by the hormones
governing growth and natural physical activity.
The brain is only 25% developed (continues through childhood)
and nerve fibers are not completely myelinated until age two.
Reproductive capability develops during adolescence and then
ceases in women after menopause.
Respiration initiates at birth. During the final month of pregnancy
the neonate begins breathing like motions although the lungs are
filled with amniotic fluid. The birthing process causes most of the
amniotic fluid to be expelled from the lungs.
Bone matrix is increasing and mineralizing with the nutrition
delivered in breast milk or infant formula.
Is immature until five months. By one month the kidney
nephrons are mature and water balance can be maintained.
Successful Growth and
Development
• Dramatic increase in body weight and
length.
• Successful growth and development are
measurable by CDC and WHO growth
grids.
– There are many types of grids and
differences between CDC and WHO grids
– Baby well check visits at 3, 6, 9, and 12
months
– Tendency to follow a grid pattern
– Deviation indicates a health problem and
failure to thrive (FTT)
Successful Growth and
Development
• Good nutrition supports cognitive
development and is needed for skills
acquisition
• Eating is a time for social maturation
• Sensations develop so that eating is
pleasurable
– Olfaction (smell)
– Gustation (taste)
– Mouth feel
The Lactating Mother
• Lactation is a maternal, mammalian
biological process
• In the 1st trimester, hormonal changes
cause the breasts to enlarge, the
ducts and alveoli multiply rapidly
• Proper nutrition supports milk
production, volume, and quality
• Mature milk from a properly nourished
lactating woman is high in fats,
contains cholesterol, and is adequate
in protein, carbohydrates, vitamins and
minerals.
The Lactating Mother
• Breast milk composition
changes
• 3 stages of lactogenesis
– 1: 12 weeks before delivery
when the breasts
(mammary glands) begin
to secrete colostrum.
Breast size increases
further as the alveoli
become filled with
colostrum.
– 2: after birth, first fluids
contain colostrum, milk
comes in after 2-3 days.
– 3: mature milk supply
occurs, supply and demand
Lactation and Nutrition Needs
• Calories: EER + 330 Calories in 1st 6 months of
breastfeeding, + 400 2nd 6 months
• Carbohydrate: 210 gm/day minimum DRI, 4565% of Calories ≤25% of Calories from sugars, 1.4
grams per 100 Calories fiber DRI
• Protein: 1.1 gm/kg to support milk production
• Fat: Increased EFA DRIs, 20-35% of Calories,
omega-3’s support the central nervous system
• Vitamins, Minerals and Water: Many nutrients
needed in higher amounts, 3.8 liters of water per
day is the DRI
Nutrition Needs during Infancy
Benefits
Tips for Success
Infant
benefits
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Mother
benefits
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Other
benefits
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Highly bioavailable and balanced nutrient
source
Hormonal support for psychological
development
Cognitive development
Strengthened immunity; possible protection
against hypertension, type 1 diabetes, and
allergies later in life
Uterus contraction
Conserves iron by preventing menses (not a
reliable method of contraception)
Possible breast and ovarian cancer protection
Cost savings from improved health and no
formula purchasing
Environmentally responsible choice of non
manufactured, processed, packaged, and
shipped food source
Breast milk of formula to age 1
Breast Feeding
• Gold standard
• Bonding process
• Controlled by oxytocin
• On demand feeding
• Requires proper technique
• If baby is growing and
developing as expected,
then baby is getting enough
breast milk
Formula
• Nutritionally balanced off of
breast milk
• Often cow’s milk or soy
based
• Many contain DHA
• Some contain taurine
• Specialized formula’s made
with hydrolyzed proteins to
improve tolerance
• Reconstitute per
instructions
Energy and Nutrient Needs
for Baby
• Calories: EER, high Calorie need, 2-4
times more per Kg than adults
• Carbohydrate: 60 gm/day (0-6 mo &
high lactose); 95 gm/day (7-12 mo); no
DRI for fiber
• Protein: 1.52 gm/Kg (0-6 mo); 1.5
gm/Kg (7-12 mo); 10 EAA,
underdeveloped kidney’s
• Fat: High intake and a DRI; 31 gm/day
(0-6 mo); 30 gm/day (7-12 mo); DRIs for
the EFAs, long chain omega-3 FA are
health promoting
Energy and Nutrient
Needs for Baby
• Vitamins: focus on
vitamin K, D, B12
• Minerals: focus on
iron, iodine and
fluoride
Vitamins & Minerals
• Vitamin K: injection given at birth for blood
clotting, sterile gut so no bacterial synthesis
• Vitamin D: If breast fed provide liquid supplement
400 IU/day
• Vitamin B12: A concern for breast fed infants with
strict vegan mothers
• Iron : reserves up to age 6 mo, formula is typically
fortified, introduce iron fortified cereals and other
iron rich sources in time, prevent milk-anemia
• Iodine: critical for proper growth and development,
deficiency of iodine causes irreversible brain and
central nervous system damage
• Fluoride: for tooth formation, amount
supplemented depends on water fluoridation and
filtration
Water
• Need positive water balance for nutrient
and waste transport, body temperature
regulation, and as the medium for
metabolism
• 75% body composition is water, by age 1
60%. 15% daily turnover from urine, feces,
skin, and breath.
• Breast milk or infant formula replaces
fluids. No need for extra water under
normal circumstances.
• DRI: 0.7 L/day (0-6 mo); 0.8 L/day (7-12
mo)
Baby’s First Foods
• Division of Responsibility
– Parent or Caregiver and Infant
– Caregiver feeds infant on demand and
provides scheduled healthy and
appropriate foods
– Baby decides how much to eat and pace
• Sequence of Introducing Foods
– Age of first foods
– Skills based progression
Age
0-1 Month
2-4 Months
4-6 Months
Growth & Development
Feeding Skill
Large head with soft spot on top; Rooting reflex;
May hiccup, spit up, startle easily, Sucking reflex; initially
sneeze, and tremble at the jaw;
swallows liquids using back
Sleeps most the time
of tongue
Lifts head briefly when lying on
Gradually begins to use
stomach; Smiles, coos, and
front of tongue along with
gurgles; Whole body moves when back of tongue; Strong
lifted or touched; Deliberate
extrusion reflex
communication and movement
(tongue-thrust) to push
begins; Sleeps most the time
food out
Weight nearly doubled and
Extrusion reflex diminishes,
growth increased three to four
ability to swallow non
inches since birth; Follows objects liquid foods develops;
with eyes and reaches for objects Indicates desire for food
with both hands; Grasps objects
by opening mouth and
with palm of hand; Puts fingers
leaning forward; Opens
and objects in mouth; Turns over, mouth for spoon and
vocalizes, sits erect with support; closes lips over spoon;
Sleeps six to seven hours at night Swallows semi-solid food;
and takes three to four naps per
Begins chewing action and
day
brings hand to mouth;
Indicates satiety by turning
away and leaning back
Foods to Introduce
Breast milk or ironfortified infant formula
every few hours on
demand with cuddling
Breast milk or ironfortified infant formula
every three to four hours
or on demand with
cuddling while alert and
calm
Continue cuddling nipple
feeding from breast or
bottle; Begin ironfortified rice cereal
mixed with breast or
infant formula and
pureed vegetables and
fruits according to
baby’s skills using baby
spoon and offering small
bites; Eats six to seven
times per day
6-8 Months
8-10 Months
10-12
Months
Gains in weight and
height are less rapid,
appetite decreases;
Teething occurs; Sits
alone; Stands up with
help; Takes three naps
per day
Sits unsupported and
crawls; Explores
objects with hands,
eyes, and mouth;
Takes two naps per
day
Able to feed self with
fingers; Bites off food;
Chews with rotary motion;
Develops pincher (finger to
thumb) grasp; Begins to
drink from cup; Joins family
meals
Begins to hold own bottle;
Curves lips around cup;
Reaches for and grasps food
and spoon; Chewing
improves
Continue cuddling nipple feeding from
breast or bottle; Begin wheat-free dry
cereal, mashed vegetables, fruits, plain
baby food meats, unsweetened 100%
fruit juices from cup; Spoon feed
thick/lumpy foods; Introduce sippy cup
By twelve months has
tripled birth weight,
increased length by
50%, and begins to
walk unassisted;
Grasps and releases
objects with fingers;
Takes one to two naps
per day
Chewing and cup drinking
improves. Finger feeds and
masters spoon but still spills
some food; By 12 months
engages in family time
eating with self-feeding; Is
offered scheduled meals and
snacks
Continue cuddling nipple feeding from
breast or bottle but at snack time only;
Add variety and increase portion sizes;
At 12 months offer all soft non-choking
risk foods at the family table; May
switch from breast milk or formula to
whole pasteurized milk; Full transition
from bottle to sippy cup with weaning
Continue cuddling nipple feeding from
breast or bottle but at snack time only
beginning around nine months; Begin
breads, cereals, crackers, yogurt, soft
chopped cooked vegetables and fruits,
finely cut meats and fish, casseroles,
cheese, eggs, and mashed cooked
legumes from the table with hands,
fingers, and/or spoon
Inappropriate Foods, Beverages,
and Feeding Methods
• Feed based on the baby’s skills
• Baby’s bottle: avoid microwaving and BPA
plastic bottles
• Formula preparation: watering down formula
can cause FTT and hyponatremia.
• Other: Don’t mix with cereal and put in a bottle,
Don’t jiggle the nipple to speed up the feeding,
don’t put baby to bed alone with a bottle to
self-feed, Do hold baby while feeding
• Avoid choking risk foods: popcorn, peanuts,
hotdogs, hard candy, and whole grapes
• Limit fruit juice once OK to feed
Inappropriate Foods, Beverages,
and Feeding Methods
• Pay attention to allergy signs and
symptoms, don’t introduce foods too early
• No honey or corn syrup, clostridium
botulinum risk
• Don’t force child to clean plate, avoid
putting too much food on child plate, don’t
allow grazing, don’t let child get too hungry
• Model appropriate eating patterns and
manners.
• Offer nutritious foods to support baby’s
nutritional needs best
Food Assistance Programs
• Women, Infants, Children (WIC)
– Supplemental foods, health care referrals, and
nutrition education
– Pregnant, breastfeeding, and non-breastfeeding
postpartum women, and infants and children up
to age five
• The Supplemental Nutrition Assistance
Program (SNAP)
– Modern day food stamp program
Infant Fitness and Lifestyle
Management
• An active baby is a healthy and happy
baby.
• During awake times and as
developmental skills progress, infants do
enjoy physical activity
• Caregiver activities and stimulation at
first, then infant can engage in activities
based on skills
• Provide safe age-appropriate fitness
opportunities on a regular daily schedule
Summary
• Successful growth and development requires adequate
nutrition and cognitive and social stimulation.
• Expected infant growth is monitored using a variety of
anthropometric growth grids.
• Feeding the infant through the first year of life includes
providing breast milk or formula.
• Solid foods may be introduced sometime between four
and six months; one food at a time and the least allergy
risk foods introduced first.
• When feeding, the principles incorporated in the division
of responsibility should be adopted and appropriate
feeding and fitness practices should be established.
References for this presentation are the same as those for this topic found in module 7 of the textbook