Chapter 12

1. Chapter 12 Diet during Infancy

2. 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

3. 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)

4. 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

5. Breastfeeding • Infants obtain temporary immunity to many infectious diseases • Have fewer infections • Has benefit of being the following: • Economical • Nutritionally perfect • Sterile • Easily digested (continues)

6. 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)

7. Breastfeeding • Also beneficial to mothers • Less risk of breast cancer and osteoporosis • Indications of adequate nutrition include: • 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

8. Bottle Feeding • Infant should be cuddled and held in semi-upright position • Infant should be burped often • Formulas made from modified cow’s milk to resemble breast milk in nutritional value (continues)

9. 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)

10. 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

11. 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?

12. 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)

13. 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)

14. 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

15. Indications for Readiness for Solid Foods • Disappearance of extrusion reflex • Pushing food out with tongue • 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

16. 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

17. Special Nutritional Needs • Premature infants • Cystic fibrosis • Failure to thrive • Metabolic disorders: • Galactosemia • Phenylketonuria (PKU) • Maple syrup urine disease (MSUD)

18. 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)

19. 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

20. 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)

21. Cystic Fibrosis • Digestive enzymes and fat-soluble vitamin supplementation at meal times • Nighttime tube feedings may be indicated

22. 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)

23. Failure to Thrive • First six months most crucial for brain development

24. 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)

25. 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

26. 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)

27. PKU • Lifelong diet therapy: • Commercial formula Lofenalac • Regular blood tests • Synthetic milk for older children • Avoidance of phenylalanine • Hospitals required to screen newborns before discharge

28. 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)

29. 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

30. 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

31. 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