INFANT NUTRITION

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Infant Nutrition

NDD 10603INFANT NUTRITIONDR. SHARIFAH WAJIHAH WAFA BTE SST WAFASchool of Nutrition and DieteticsFaculty of Health Sciencessharifahwajihah@unisza.edu.my

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 NeedsMetaboli