Infant Nutrition
NDD 10603INFANT NUTRITIONDR. SHARIFAH WAJIHAH WAFA BTE SST
WAFASchool of Nutrition and DieteticsFaculty of Health
[email protected]
KNOWLEDGE FOR THE BENEFIT OF HUMANITY
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESTOPIC LEARNING OUTCOMESAt the end of this lecture, the
students should be able to:Identify the assessment for infants
physical growth.Discuss the energy and nutrients needs of
infants.Explain the nutrition-related problems that affect the
infants.
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCES
A newborn infant, or neonate, is a child under 28 days of age.
During these first 28 days of life, the child is at highest risk of
dying. It is thus crucial that appropriate feeding and care are
provided during this period, both to improve the childs chances of
survival and to lay the foundations for a healthy life. (WHO
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESCourse OutlineBirthweight and infant mortalityMotor and
cognitive developmentEnergy and nutrient needsPhysical growth
assessmentInfant feeding skillsCommon Nutritional Problems and
Concerns
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESAssessing Newborn HealthBirthweight as an OutcomeFull-term
infant (37 to 42 wks)The average Malaysian newborn weight is around
3.2kgThe average length of full-term babies at birth is 51 cm,
although the normal range is 46 cm to 56 cm.
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESAssessing Newborn HealthInfant mortality - defined as death
that occurs within the first year Major cause is low birthweight
(< 2500 g)Other leading causes include: 1) congenital
malformations2) preterm births 3) SIDS
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESAssessing Newborn HealthCombating Infant MortalityFactors
associated with mortality:Social and economic status Access to
health careMedical interventionsTeenage pregnancyAvailability of
abortion servicesFailure to prevent preterm & LBW births
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCES
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCES
Source: The World Bank DataFigure 1:Mortality rate, infant (per
1,000 live births)
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESAssessing Newborn HealthStandard Newborn Growth
Assessment:Appropriate for gestational age (AGA)Small for
gestational age (SGA) and intrauterine growth retardation (IUGR)
mean newborn was 90th % wt/age
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESInfant DevelopmentNewborns:Hear and move in response to
familiar voiceCNS is immature resulting in inconsistent cues for
hunger and satietyStrong reflexes, especially suckle and root
(reflexes are protective for newborns)
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESInfant DevelopmentTerms Related to Development:
Reflexautomatic response triggered by specific stimulusRooting
reflexinfant turns head toward the cheek that is
touchedSucklereflex causing tongue to move forward and backward
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESMajor Reflexes Found in Newborns
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESNine Reflexes of Baby
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESInfant Development1. Motor development: ability to control
voluntary musclesMotor development is top down controls head first
and lower legs last2. Muscle development from central to
peripheralInfluences ability to feed self & the amount of
energy expended
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESGross Motor Skills
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESInfant DevelopmentCritical periodsA fixed period of time in
which certain behaviors or developments emergeNecessary for
sequential behaviors or developmentsIf the critical period is
missed, there may be difficulty later on
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESInfant Development3. Cognitive DevelopmentFactors that
impact cognitionSensorimotor developmentInteractions with the
environmentAdequate energy and proteinStimulation of social and
emotional growthGenetics
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESSensorimotor Stage of DevelopmentThe sensorimotor stage is
divided into 6 substages:Simple reflexes (Birth - 1 Month Old)
Primary circular reactions (1-4 Months OldSecondary circular
reactions( 4-8 Months Old) Coordination of secondary circular
reactions(8-12 Months Old)Tertiary circular reactions (12-18 Months
Old) Internalization of schemes(18-24 Months Old) A shift to
symbolic thinking
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESSensorimotor Stage of Development1. Reflexes (0-1
month):During this substage, the child understands the environment
purely through inborn reflexes such as sucking and looking.
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESSensorimotor Stage of Development2. Primary Circular
Reactions (1-4 months):This substage involves coordinating
sensation and new schemas. For example, a child may such his or her
thumb by accident and then later intentionally repeat the action.
These actions are repeated because the infant finds them
pleasurable.
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESSensorimotor Stage of Development3. Secondary Circular
Reactions (4-8 months):During this substage, the child becomes more
focused on the world and begins to intentionally repeat an action
in order to trigger a response in the environment. For example, a
child will purposefully pick up a toy in order to put it in his or
her mouth.
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESSensorimotor Stage of Development4. Coordination of
Reactions (8-12 months):During this substage, the child starts to
show clearly intentional actions.Children begin exploring the
environment around them and will often imitate the observed
behavior of others. The understanding of objects also begins during
this time and children begin to recognize certain objects as having
specific qualities. For example, a child might realize that a
rattle will make a sound when shaken.
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESSensorimotor Stage of Development5. Tertiary Circular
Reactions (12-18 months):Children begin a period of trial-and-error
experimentation during the fifth substage. For example, a child may
try out different sounds or actions as a way of getting attention
from a caregiver.
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESSensorimotor Stage of Development6. Early Representational
Thought (18-24 months):Children begin to develop symbols to
represent events or objects in the world in the final sensorimotor
substage. During this time, children begin to move towards
understanding the world through mental operations rather than
purely through actions.
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESInfant Development4. Digestive System DevelopmentFetus
swallows amniotic fluid which stimulates intestinal maturation and
growthAt birth the healthy newborn can digest fats, protein and
simple sugars.Common problems include gastroesophageal reflux
(GER), diarrhea, and constipation
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESInfant DevelopmentFactors that impact rate of food passage
in colonOsmolarity of foods or liquidsColon bacterial floraWater
and fluid balance in the body
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESInfant DevelopmentParentingNew parents must learn:Infants
cues of hunger and satietyTemperament of infant How to respond to
infant cues
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESBabys Language
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESWhy is Nutrition Important?Energy of daily
livingMaintenance of all body functionsVital to growth and
developmentTherapeutic benefitsHealingPrevention
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESEnergy and Nutrient NeedsThe recommendations for infants
are from the Dietary Reference Intakes (DRI), National Academy of
Medicine, AAP and the Academy of Nutrition and DieteticsEnergy
needsProtein needsFatsMetabolic rate, calories, fats and proteinhow
do they all tie together?
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESEnergy and Nutrient NeedsEnergy (Calories): 108 kcal/kg/day
from birth to 6 months (range from 80 to 120)98 kcal/kg/day from 6
to 12 monthsFactors that influence calorie needsWeight and growth
rateSleep/wake cycleTemperature and climatePhysical
activityMetabolic response to foodHealth status/recovery from
illness
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESEnergy and Nutrient NeedsProtein Needs2.2 g/kg/day from
birth to 6 months1.6 g/kg/day from 6 to 12 monthsHow much is
that?Newborn weighing 4 kg needs 2.2 X 4 = 8.8 g protein6-month-old
weighing 8 kg needs 1.6 X 8 = 12.8 g protein Protein needs are
similar to that of energy but are also influenced by body
composition
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESEnergy and Nutrient NeedsFat NeedsNo specific recommended
intake level for infantsBreastmilk contains about 55% calories from
fatInfants need cholesterol for gonad and brain developmentBreast
milk contains short-chain and medium-chain fatty acids (in addition
to the long-chain)Easier to digest and utilize than long-chain
fatty acids
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESEnergy and Nutrient NeedsMetabolic Rate, Calories, Fats and
ProteinMetabolic rate of infants is highest of any time after
birthThe higher rate is related to rapid growth and high proportion
of muscleLow carbohydrate and/or energy intake results in protein
catabolism impacting growth
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESEnergy and Nutrient NeedsOther Nutrients and
NonnutrientsFluoride0.1 - 0.5 mg/d depending on age (too much may
cause tooth discoloration)Vitamin D400 IU/daySodium120-200
mg/dayIron 11 mg for infants 7-12 monthsFiberno
recommendationsLeadNonemay be toxic
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESEnergy and Nutrient NeedsOther Nutrients and
NonnutrientsFluoride0.1 - 0.5 mg/d depending on age (too much may
cause tooth discoloration)Vitamin D400 IU/daySodium120-200
mg/dayIron 11 mg for infants 7-12 monthsFiberno
recommendationsLeadNonemay be toxic
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESPhysical Growth AssessmentNewborns grow faster than any
other time of lifeGrowth reflects: Nutritional adequacyHealth
status Economic & environmental adequacyThere is a wide range
of growth =normalCalibrated scales & recumbent length
measurement board required for accurate measures
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESPhysical Growth AssessmentHealthy newborns double their
birth weight by age 46 months and triple it by 1 year.
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESPhysical Growth Assessment
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESPhysical Growth Assessment
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESInterpretation of Growth DataMeasures over time identify
change in growth rate and need for interventionWarning signs:Lack
of Weight or Length gainPlateau in Weight, Length or head
circumference for > 1 monthDrop in Weight without regain in a
few weeks
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESFeeding in Early InfancyBreast Milk and Formularecommend
exclusive breast feeding for 1st 6 months & continuation to 1
yr Initiate breast feeding right after birth Growth rate and health
status indicate adequacy of milk volumeStandard infant formula
provides 20 cal/fl ozPreterm formula provides 22-24 cal/fl oz
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESHow Infant Formulas Are Modified Compared to Breast
MilkBreast Milk7% of calories from Protein38% calories from
carbs55% calories from fat
Cows Milk-Based Formula9-12% calories from Protein41-43%
calories from carbs48-50% calories from fat
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESCows Milk during InfancyWhole, reduced-fat or skim cows
milk should not be used in infancyIron-deficiency anemia linked to
early introduction of cows milk Anemia linked to: GI blood loss Low
absorption of calcium & phosphorus Displacement of iron-rich
foods
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESSoy Protein-Based Formula During InfancySoy protein in
place of milk protein should be limited in its useThe use of soy
formula is not recommendedFor managing infantile colicLactose free
and hydrolyzed formulas are better for infants unable to breastfeed
or be fed cows milk formulas
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESDevelopment of Infant Feeding SkillsInfants born with
reflexes & food intake regulatory mechanism Inherent preference
for sweet tasteAt 4-6 wks, reflexes fade; infant begins to
purposely signal wants & needs
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESDevelopment of Infant Feeding SkillsCues infants may give
for feeding readiness include:Watching the food being opened in
anticipation of eatingTight fists or reaching for spoonIrritation
if feeding too slow or stops temporarilyPlaying with food or
spoonSlowing intake or turning away when fullStop eating or spit
out food when full
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESIntroduction of Solid FoodsFood offered from spoon
stimulates mouth muscle development
At 6 months, offer small portions of semisoft food on a spoon
once or twice each day
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESRecommendations for Introduction of Solid FoodsInfant
should not be overly tired or hungryUse small spoon with shallow
bowlAllow infant to open mouth & extend tonguePlace spoon on
front of tongue with gentle pressureAvoid scraping spoon on infants
gumsPace feeding to allow infant to swallowFirst meals may be 5-6
spoons over 10 minutes
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESThe Importance of InfantFeeding PositionImproper
positioning may cause choking, discomfort, and ear
infectionsPosition young bottle-fed infants in a semi-upright
positionSpoon-feeding should be with infant seated with back and
feet supportedAdults feeding infants should be directly in front of
infant making eye contact
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESPreparing for Drinking from a CupOffer water or juice from
cup after 6 monthsWean to a cup at 12 to 24 monthsFirst portion
from cup is 1-2 ozEarly weaning may result in plateau in weight
(due to reduced calories) and/or constipation (from low fluid
intake)
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESPreparing for Drinking from a CupChanging from a bottle to
a covered sippy cup with a small spout is not the same
developmental step as weaning to an open cup
Open cup drinking skills also encourage speech development
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESThey say fingers were made before forks and hands before
knives.
Jonathan Swift
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESFood Texture and DevelopmentCan swallow pureed foods at 6
monthsEarly introduction of lumpy foods may cause chokingCan
swallow very soft, lumpy foods at 6-8 monthsBy 8-10 months, can eat
soft mashed foods
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESFirst Foods6 monthsiron-fortified baby cerealRice cereal is
hypoallergenic6 monthsfruits and vegetablesOnly one new food over
2-3 daysCommercial baby foods are not necessary but do provide
sanitary and convenient choices9-12 months soft table foods
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESWaterBreast milk or formula provide adequate water for
healthy infants up to 6 monthsAll forms of fluids contribute to
water intakeAdditional plain water needed in hot, humid
climatesDehydration is common in infants
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESWaterPedialyte or sports drinks provide electrolytes but
lower in calories than formula or breast milkLimit juice AAP
recommends juice is not needed to meet the fluid needs before the
age of 6 monthsAvoid colas and tea
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESHow Much Food is Enough for Infants?Infants vary in
temperament
Crying or fussiness may be interpreted as hunger resulting in
overfeeding
First foods may appear to be rejected due to immature tongue
movement
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESHow Much Food is Enough for Infants?Infants learn food
preferences based on experiences with foodsFlavor of breast milk
influenced by mothers dietGenetic predisposition to sweet tasteFood
preference from infancy sets stage for lifelong food habits
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESCommon Nutritional Problems and ConcernsFailure to thrive,
Colic, Iron-deficiency anemia, Constipation, Dental caries, and
Food allergies
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESCommon Nutritional Problems and ConcernsFailure to thrive
(FTT) Inadequate weight or height gainEnergy deficit is
suspectedOrganic FTT: Inadequate weight or height gain resulting
from a health problem, such as iron-deficiency anemia or a cardiac
or genetic disease.Nonorganic FTT: Inadequate weight or height gain
without an identifiable biological cause, so that an environmental
cause is suspected (maternal depression, mental illness, alcohol or
drug abuse in the home, feeding delegated to siblings or others
unable to respond to the infant, and overdilution of formula)
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESCommon Nutritional Problems and ConcernsColic - the sudden
onset of irritability, fussiness or cryingEpisodes may appear at
the same time each dayDisappear at 3rd or 4th monthCause unknown
but associated with GI upset, infant feeding practices
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESCommon Nutritional Problems and ConcernsIron-deficiency
Anemia Less common in infants than in toddlersIron stores in the
infant reflect the iron stores of the motherMore common in
low-income familiesBreastfed infants may be given iron supplements
and iron-fortified cereals at 6 monthsIron-fortified versus
Low-iron formula
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESCommon Nutritional Problems and ConcernsDiarrhea and
ConstipationInfants typically have 2-6 stools per dayCauses of
diarrhea & constipation:Viral and bacterial infectionsFood
intoleranceChanges in fluid intakeTo avoid constipation assure
adequate fluidsContinue to feed the usual diet during diarrhea
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESCommon Nutritional Problems and ConcernsPrevention of Baby
Bottle Caries and Ear InfectionsAre linked to feeding practicesRisk
for ear infections is also correlated with excessive use of a baby
bottle as a bedtime practice, as a result of the feeding
position.Feeding techniques to reduce caries and ear
infectionsLimit use of bedtime bottleOffer juice in cupOnly give
water bottles at bedtimeExamine and clean emerging teeth
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESCommon Nutritional Problems and ConcernsFood Allergies and
IntolerancesAbout 6-8% of children < 4 yrs have
allergiesAbsorption of intact proteins causes allergic
reactionsCommon symptoms are wheezing or skin rashesTreatment may
consist of formula with hydrolyzed proteins
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESCommon Nutritional Problems and ConcernsLactose Intolerance
Inability to digest the disaccharide lactoseCharacterized by
cramps, nausea and pain and alternating diarrhea and
constipationLactose intolerance in uncommon and tends to be
overestimated
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESKey PointsInfants born full-term and preterm infants born
between 34 weeks and 38 weeks of gestation are the same in their
milestones of growth, development, and feeding in the first year of
life.The ability of infants to feed and eat is based on
developmental skills that show readiness for the next step; parents
learn to read the signals of readiness from their infants over
time.Energy and nutrient needs of infants are modulated by
individual differences in sleep/wake cycle, exposure to
temperatures, and state of health, among other factors
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESKey PointsThe priority is energy needs first; protein and
carbohydrates will be converted to meet energy needs if sufficient
calories are not consumed, slowing growth over time.Growth as
weight, length, and head circumference accretion is monitored and
interpreted over the first year.Introduction of solid foods is also
a developmental stage for parents in learning to read signs of
hunger, fullness, and food preferences in their infants and to know
safe food choices.
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESKey PointsCommon nutrition problems in the first year such
as failure to thrive, colic, iron deficiency anemia, and baby
bottle caries are usually solved by combining parent educational,
nutritional, and medical approaches.
SCHOOL OF NUTRITION AND DIETETICS . FACULTY OF HEALTH
SCIENCESTHANK YOU
