LIFE CYCLE NUTRITION: INFANCY, CHILDHOOD, AND ADOLESCENCE CH:12

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GOOD NUTRITION

is paramount importance for both infants and children

ERIK ERIKSON

american psychoanalyst who formulated a theory of psychological developmement based on an individuals interactions with other people.

ERIKSON'S THEORY OF PSYCHOSOCIAL DEVELOPMENT

divided life into 8 stages, each of which involves a psychosocial developmental task to be mastered and a opposite negative trait that emerges if the task is not mastered

STAGE OF LIFE: INFANCY

trust v~ distrust

STAGE OF LIFE: TODDLER

autonomy v~ doubt

STAGE OF LIFE: PRESCHOOLER

initiative v~ guilt

STAGE OF LIFE: SCHOOL-AGE CHILD

industry v~inferiority

STAGE OF LIFE: ADOLESCENT

identity v~role confusion

GROWTH

a baby's birth weight should double by age 4-6 months and triple by 1 yr

INFANT GASTROINTESTINAL SYSTEM

for several months an infants salivary and pancreatic amylases are inadequate to easily digest complex carbohydrates, but infants have lingual lipase for the disgestion of fat, an enzyme that adults lack
~the more mature intestine permits absorption of amino acids but not whole proteins

SUCKLING

for the first 3-4 months the infant suckles by using an up and down motion of the tongue. if semisolid food is offered at this time, the natural motion of the tongue tends to spit it out

INFANTS URINARY SYSTEM

the infants kidneys are imature and have limited capacity to filter solutes. not until the end of the 2nd month can the infant's kidneys excrete the waste of semisolid foods.
~by the infants 1st birthday the kidneys have reached full functional capacity

PROTEIN

the protein in breast milk is easy for the infant to digest.
the infants body can absorb it easily and without much processing can use it for building tissue. thus gastric emptying is faster with human milk than with cow milk formula

ENERGY

infants need much higher relative energy intakes than do adults, primarily because the resting metabolic rates of infants and their needs for growth and development are so high.

ENERGY USAGE

because of the large proportion of skin surface to body size, teperature regulation takes significant energy. an activity such as crying may double the infants energy expenditure

CARBOHYDRATE

the carbohydrate in breast milk is easily digested by the infant. breast milk contains amylase that is 40-60 times more active than that of cow's milk.
one source of carbohydrates that infants must not be given is honey

HONEY

none should be given to an infant until after the first birthday because it frequently contains organisms that the infant cannot fight off. bees may contaminate honey with botulism spores acquired from plants or the soil

VITAMINS

infants need all the vitamins that other humans need but in different amounts

VITAMIN K

in adults intestinal bacteria produce vitamin k. until the infants intestines becomes colonzied with E. coli he/she is at risk for bleeding problems

AMERICAN ACADEMY OF PEDIATRICS AND VITAMIN K

recommends that all newborns be given a single intramuscular dose of vitamin k after the first breast-feeding and within 6 hours of birth

MINERALS

infants need the same minerals as other human beings

FLUORIDE

should not be administered to infants until after 6 months of age. even then, supplementation is recommended for all child over 6 months of age only if the water supply contains less than 0.3 ppm of flouoride and for children >3yrs if water supply contains less than 0.6 ppm

BREAST-FED INFANT

breast milk is designed for human infants and is the standard against which subsititute milks are measured

COLOSTRUM

the milk secreted for the first 2 to 4 days after the birth of the baby. it is thin, yellow, cloudy fluid. colostrum is high in proteins such as immunolglobulins, in fat soluable vitamins and in minerals and low in fat

TRANSITIONAL MILK

follows colostrum and continues through the second week after delivery. transitional milk contains lactose, fat, and water-soluble vitamins at the level of mature milk. it is produced in larger quantities than colostrum

MATURE MILK

as breast-feeding becomes extablished, the mother produces mature milk which varies in composition
contains less fat at the beginning of a feeding (fore-milk) and more fat at the end (hind-milk) fat provides sattiety or feeling of fullness/satisfaction

UNIQUE ADVANTAGES OF BREAST-FEEDING

protection against disease that mothers milk provides
lowered risk of allergies
a negative association with obesity and enhancement of cognition

INFECTION FIGHTING AGENTS IN BREAST-MILK

leukocytes or wbc's the highest concentration of wbc's in human milk occurs in the first few days of lactation 1-3 million/mL

PREVENTION OF ALLERGIES IN BREAST MILK

the young infants gastrointestinal tract can permit the passage of whole proteins into the bloodstream. these proteins can stimulate an allergic response in susceptible infants

FORMULA FED INFANT

formula is the only food that is regulated by its own law, the Infant Formula Act of 1980 which sets minimum levels of 29 nutrients and maximal levels of 9 nutrients
formula contains more protein tha breast milk

FORMULA PREPARATION

commercial formulas come in 3 forms: powder (mix with water), liquid concentrate, and ready-to-feed
opened cans of liquid formula may be stored covered in the fridge but must be used within 48 hrs.

POTABLE WATER

american academy of pediatrics recommends boilig potable water for 1 min and cooling it before mixing with infant formula preparation

BOTTLE STERILIZATION

they should be washed thoroughly in hot soapy water, rinsed well, covered with water in a pot and boiled for 5 minutes. separate utensils should be kept for formula preparation

FEEDING TECHNIQUES

ongoing observation of the infant's urinary output is used to confirm the adequacy of intake. the infant's urine should be light yellow and voided several times per day. major changes in output merit medical attention

PREMATURE INFANTS

may need to have their diets supplemented with the minerals calcium phosphorus and sodium. rickets of prematurity can occur in the 2nd postnatal month due not to the lack of vitamin D but to the lack of calcium and phosphorus

HAZARDS OF FORMULA FEEDING

most common one that can be monitored is preparation
(1)the wrong dilution
(2) prepared with contaminated water, equipment, or hands
(3) kept at feeding temperature too long (body temp is just right for bacteria)

BREAST V~ BOTTLE

in US infants can be well nourished whether breast or bottle-fed. to raise a child successfully takes more than simply supplying the correct ratio of nutrients. the mothers informed decision should be supported and appropriate teaching provided

SEMISOLID FOODS

if solids are introduced too early the infant may develop allergies because the permeability of the intestine. solid foods especially high-protein items add to the renal solute load

AMERICAN ACADEMY OF PEDIATRICS AND SEMISOLID FOODS

supports exclusive breast-feeding (nothing but breast-milk and vitamins, minerals and medication) for 6 mo while recognizing that infants are often developmentally ready for complementary foods between 4-6 months

SEMISOLIDS AND INFANT DEVELOPMENT

infant should achieve voluntary control of swallowing at about 3-4 months. before being offered solid foods the infant should be able to control his or her head and trunk. with this ability the baby can trun away when satisfied

DELAY IN INTRODUCING SOLIDS

waiting to long may delay the infants acquiring the skill to manipulate the to gue appropriately

HOW TO FEED

new foods should be introduced 1 at a time and a week apart so that if a problem develops, it can be readily identified. a food should be tried for 3-5 days before the infant is permitted to reject it. food atha has been heated and not consumed should be discareded because of possible contamination w/ salivary enzymes and bacteria

WEANING THE INFANT

if mother decides to wean the chid from breast or bottle before its 1st birthday the replacement should be infant formula not unmodified cow's milk. the bottle-fed infant may not be ready to give up the bottle until 12-14 mo

IRON DEFICIENCY ANEMIA (INFANT)

the lack of adequate iron stores in the body to meet physiological needs for growth, affects 9% of children under 2 yrs

EARLY DIAGNOSIS OF IRON DEFICIENCY ANEMIA (INFANT)

to be sure that iron deficiency anemia is diagnosed promptly in infnats and toddlers, monitoring of the hemoglobin level is recommended throught the infants 2nd birthday

PREVENTION AND TREATMENT OF IRON DEFICIENCY ANEMIA (INFANT)

exclusive breast-feeding for 4-6 months, without supplementary liquid, formula or food is a method of primary prevention

ALLERGIES

special caution is needed for infants with a family history of allergies. if a parent or sibling has allergies the infants risk of developing allergies doubles
both exposure to allergens and a genetic predisposition probably involving multiple genes seem to interact to produce an allergy

COMMON FOOD ALLERGENS IN INFANCY

allergies develop for the most part when a person is exposed to an allergen, is usually a protein which sensitizes the individual to that item, causing the immune system to produce IgE antibodies. the most common allergetnic foods are milk eggs peanuts and wheat

SIGNS AND SYMPTOMS

food allergies may produce signs and symptoms in the gastrointestinal tract and other systems. they can cause skin and respiratory problems as well. an infant may have hives, eczema, or other rashes; asthma, bronchitis, wheezing or runny nose, called allergic rhinitis. chronic reoccuring atopic eczema is the main sign of atopic disease in the first years of life

TREATMENT OF ALLERGIES

soy formula has been used to treat children allergic to cow's milk protein, but soy also can cause allergies. other special for,ulas contain hydrolyzed protein or amino acids in an atempt to break up the protein into small acids in an attempt to break up the protein into small pieces so that the body does not recognize the antigen

COLIC

cause is unknown the condition is name for the presumed manifestation, spasms of the muscles of the colon. abdomen is tense and the infant draws its legs up to its belly. may cry for hours starting late afternoon just when caregivers are tired and cranky

RULE OF 3'S

classic definition of colic
crying for more than 3 hours a day
more than 3 days a week
for more than 3 wks

POSSIBLE CAUSE OF COLIC

suggested causative factors fall into 2 major groups:gastrointestinal and non gastrointestinal

TREATMENT OF COLIC

holding baby upright, burping, or giving it some warm water sometimes helps. diluting the formula or offering cold formula has been successful with some babies. other interventions reported to soothe colicky infants are swaddling carrying the infant, rocking and soft repetitive sounds

DIARRHEA

passage of more than 3 loose , watery stools a day distinguishes acute diarrhea
75% of an infants body weight is water, 54% of it extracellular for this reason an infant is at high risk of rapid dehydration

CAUSES OF DIARRHEA

infants are subject to osmotic diarrhea. overfeeding and food intolerances are common causes of diarrhea. apple juice may produce diarrhea in infants because of carbohydrate malabsorption
the most co,mon cause of infectious enteritis in human infants is rotavirus

TREATMENT OF DIARRHEA

usual protocol is:
oral rehydration solutions
for breast fed infants, nursing should be continued
for formula fed infants diluted formula is not recommended and special formula usually is not necessary

WHEN TO CALL A PHYSICIAN

call primary health care provider for diarrhea under the following conditions:
-young or small infant
-fever > 38C (100.4F)
-visible blood in stool
-persistant vomiting
-signs of dehydration
-changes of mental status
-suboptimal response to oral rehydration

NUTRITION IN CHILDHOOD

the growth periods of the toddler the preschool child and the school age child

PSYCHOSOCIAL DEVELOPMENT

according to Erikson the psychosocial developmental task of the toddler is to buid autonomy or independence. every 2 yr old knows the word "NO"

1YR OLD'S INTAKE

a 1yr old's stomach holds 1 cup

NEW FOODS

all new foods that were not recommended until after the 1st birthday can now be gradually introduced if family history of allergies is not a concern. these include unmodified cow's milk, egg whites, wheat, citrus fruits, seafood, chocolate and nut butters

SERVING SIZE

a serving size is 1/4 -1/5 the size of an adult serving. a god rule of thub is to serve 1 Tablespoon for each year of age

IRON DEFICIENCY ANEMIA (CHILDREN)

CDC recommends that milk intake be limited to 24 oz per day for children aged 1-5yrs to maintain the appetite for iron enriched cereals , meats, and iron-rich fruits and vegetables.

MILK ANEMIA

refers to iro deficiency anemia caused by overconsumption of milk and undersonsumption of iron rich foods

INADEQUATE FAT INTAKE

1-2 yr old children should drink whole milk to provide adequate fat for the still growing brain. cases of swashiorkor and rickets have been reported in toddlers given a rice beverage and a soy beverage not formulated for children in place of milk

DEVELOPING GOOD HABITS

a good supply of wholesome sancks will werve the conscientious parent well. such items as cottage cheese, low fat yogurt fresh fruit, raw vegetables, milk fuit juices, graham crackers or fig bars all are nutrients dense and low in fat.

DENTAL HEALTH

children younger than 6 yrs are likely to swallow rather than to expectorate toothpaste. a pea size portion of toothpast is sufficient. regular dental checkups should be a part of the preschool childs routine

CHILD CARE PROGRAMS NUTRITION

the program should offer food at least every 3 hours but not force it on the child or withhold it when the child fails to consume other food

NUTRITION OF THE SCHOOL AGED CHILD

a balanced diet suitable for healthy adults emphasizing intake of protein vitamins and minerals will als be good for a school age child.
severly curbing intake of meat and milk maynresult in undersupplying energy, iron, zinc, and calcium.

NUTRITION FUNDAMENTALS

vegetables are the least liked of the fod groups. breakfast is very important the child needs energy and other nutrients to last until lunch. breakfast can imporve cognitive fumction although not universally found and is most evident in young and nutritionally vulnerable children. breakfast should contain 1/4 to 1/3 of the days nutrients

PROBLEM AREAS

some children are bothered by caffeine. 8oz of hot chocolate or 12 oz of cola contains 50mg of caffeine. 2 such beverages in 60 pound child are the equivelent of 8 cups of coffe in a 175 pound man. if the chld has difficulty sleeping or has irregular pulse, the first factor to investigate is caffeine

NUTRIENT NEEDS IN ADOLESCENCE

because of their growing and developing bodies, adolescents need more energy, vitamins minerals and protein

PROBLEM AREAS (ADOLESCENCE)

2 common nutritional problems of teenagers is enthusiastic weight control and poor choices of foods

POOR FOOD CHOICES

some fast food restaurant chains offer salad, light salad dressings and reduced fat milks. there are soe healthy choices possible. however the old standbys on the fast food menus are generally higher in kilocalories, fat sugar and sodium than are similar items prepared at home

QUALITY OF ADOLESCENT DIETS

iron deficiency sufficent to cause anemia has a an estimated prevalence of 2% in 12-19 yr old females

OVERWEIGHT CHILDREN AND ADOLESCENCE

because of the increased occurence of overweight and obesity in children, pediatricians are seeing more hypertension dyslipidemia and non-insulin dependent diabetes mellitus in obese children. diabetes complications (heart disease, stroke, gangrene, blindness, and kidney failure) in ever younger clients do not bode well for health of the world

FACTORS AFFECTING OBESITY

sedentary lifestyle cannot be overstated

FOOD ITEM SELECTIONS IMPACT

those eating fast food had higher intakes of energy, fat, saturated fat sodium, and carbonated soft drinks and lower intakes of vitamin A & C, milk, fruits, and vegetables than those not eating fast food on those days

PREVENTION OF OVERWEIGHT AND OBESITY

calculate and plot BMI's yearly on all children and adolescents
encourage healthy eating
routinely promote physical activity
limit tv time to 2 hours/day
healp parents teachers coaches and other to discuss health habits
advocate for socail marketing to promote healthful food choices

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