NUTR2003 Lecture Notes - Lecture 7: Dental Caries, Fluid Balance, Length Measurement
NUTR2003 LECTURE SEVEN
• 1st year life: rapid growth and development (rapid weight gain)
• Breast milk or iron-fortified formula is the primary food for the first year with gradual introduction
of solids at around 6 months age
• Preterm infants different nutrient needs
• Growth directly reflects nutrient intake
Key concepts:
• Dynamic growth experiences most rapid of any age
• Inadequate nutrition in infancy leads to consequences that may be lifelong, harming both future
growth and development
• Progression in feeding skills expresses important developmental steps in infancy that signal growth
and development
• Changing feeding practices, such as the care of infants outside the home and early food
introduction, markedly affects nutritional status of infants
Full-term infant: born between 37 and 42 weeks gestation
Preterm infant: born at or before 37 weeks gestation
Birth-weight as an outcome:
Full term:
2500-3800 grams (5.5 to 8.5 lbs)
47-54 cm length
88% US infants born full-term
Infant Mortality: death occurs within the 1st year
Major cause = low birth weight (<2500g)
2. Congenital malformations
3. Preterm births
4. SIDS
Infant mortality rates have decreased over time
Factors association with mortality:
• SES
• Access to health care
• Medical interventions
• Teenage pregnancy
• Availability of abortion services
• Failure to prevent preterm and LBW births
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Standard Newborn Growth Assessment
SGA - “all for gestatioal age
IUGR - itrauterie groth retardatio mean newborn was <10th percentile wt./age
LGA - Large for gestatioal age means newborn was >90th percentile wt./age
Feeding in Early Infancy Breast Milk and Formula
• WHO & NHMRC recommend exclusive breast feeding for 1st 6 months & continuation to 1 year
• Initiate breast feeding right after birth: Colostrum
• Growth rate and health status indicate adequacy of milk volume
BREAST MILK:
IMMUNOLOGICAL PROTECTION
• Colostrum, the first secretions from the breast, provides antibodies and WBCs
• Bifidus factors allow for the growth of normal flora
• Lactoferrin is a protein that binds iron so that bacteria cannot grow
• Lactadherin is a protein that fights viruses that cause diarrhoea
RECOMMENDED: First few weeks: eight to 12 feedings per day on demand, every two to three hours
NUTRIENTS
• Lactose, the form of carbohydrate in breast milk
• Alpha-lactalbumin, the form of protein in milk, is easily digested and absorbed
• Fat is generous in essential fatty acids
• Vitamin D content is low
• Calcium is well absorbed
• High bioavailability of iron and zinc, low in sodium and fluoride
Infant Formula
• Manufacturers aim to mimic breast milk
• Infants can be weaned to formula and/or other appropriate foods when breastfeeding is ended
• Cows milk appropriate after first year
Risks of formula feeding
• Contains no antibodies
• Requires proper food-handling techniques and access to clean water
Inappropriate choices
• Soy beverages are nutritionally incomplete and inappropriate
• Goat's milk is deficient in folate
Caution against nursing bottle tooth decay:
• Can be caused by formula, milk or juice
• Prolonged exposure to formula when sleeping
• Upper and lower teeth may be affected by decay
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ENERGY AND NUTRIENT NEEDS
Estimation based on:
• intakes of infants growing normally
• nutrient content of human milk
Australia guidelies: speify AIs ased o aerage reast ilk oetratios
Recommendations set for two periods:
0-6 months
7-12 months
Vitamins and minerals
• More than double the needs of an adult in proportion to weight
• Vitamin A, vitamin C, vitamin D and iodine especially high
• Water (higher percentage compared to adults)
Energy (Calories):
• 108 kcal/kg/day from birth to 6 months (range from 80 to 120)
• 98 kcal/kg/day from 6 to 12 months
Factors that influence calorie needs:
• Weight
• Growth rate
• Sleep/wake cycle
• Temperature and climate
• Physical activity
• Metabolic response to food
• Health status
• Childs eight doules the first fie oths, triples y year
• High basal metabolic rate
Energy requirements:
• 420–450 kJ/kg body weight
• Carbohydrates: at 60 per cent of energy intake, needed for brain
• Fat provides most of the energy
• Protein especially important for growth and development; excess can cause kidney damage.
Special Needs of Preterm Infants
• A premature birth deprives the infant of the nutritional support of the placenta during a time of
maximal growth
• Limited nutrient stores
• High risk for nutritional imbalances
• Physical and metabolic immaturity
• Preterm breast milk higher in protein in a smaller volume to support growth
• Preterm breast milk fortified with preterm formula or supplements
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Document Summary
Key concepts: dynamic growth experiences most rapid of any age. Full-term infant: born between 37 and 42 weeks gestation. Preterm infant: born at or before 37 weeks gestation. Infant mortality: death occurs within the 1st year. Major cause = low birth weight (<2500g: congenital malformations, preterm births, sids. Factors association with mortality: access to health care, medical interventions, teenage pregnancy, availability of abortion services. Lactose, the form of carbohydrate in breast milk. Lactoferrin is a protein that binds iron so that bacteria cannot grow. Lactadherin is a protein that fights viruses that cause diarrhoea. Iugr - (cid:862)i(cid:374)trauteri(cid:374)e gro(cid:449)th retardatio(cid:374)(cid:863) mean newborn was <10th percentile wt. /age. Lga - (cid:862)large for gestatio(cid:374)al age(cid:863) means newborn was >90th percentile wt. /age. Feeding in early infancy breast milk and formula: who & nhmrc recommend exclusive breast feeding for 1st 6 months & continuation to 1 year, growth rate and health status indicate adequacy of milk volume.
