# NTR 315 Exam 2

What physical measurements are taken at each routine doctor's visit to assess growth of an infant?

� length, weight, and head circumference

Describe growth rate / BMR during infancy. By how much does an infant's length and weight
increase during infancy?

� growth triples during the first year of life
� infants weight triples
� length increases by 50%

Based on recommended kilocalories for an infant, what are the approximate daily kilocalories recommended for 4 month old who weighs 10 pounds?

� notes say about 100kcal/kg of body weight.
� So if you weigh 10 lbs, that would be about 4.5 kg so the infant would need about 450 kcal.

An infant's birth weight would be considered healthy between what percentiles on a CDC growth curve?

� I think the 5th and 85th percentile??
� Below the 5th is considered underweight.
� On the powerpoint for this lecture, there's a picture of a bell curve and she highlighted the 5th pe

If an infant's growth declines more than 2 major percentile lines on a CDC growth chart and is plotted near or below the lowest percentile for weight and length, what condition would you suspect?

� failure to thrive
� failure to gain weight as expected, often accompanied by poor height growth.

What DRI standard is used for expressing nutrient recommendations in infants?

� just look at other healthy babies and mothers and compare at what they are eating. it's more of an AI.
� From the book "The 2005 Dietary Guidelines for Americans address the needs of children aged 2 and older�not infants. Recommendations for infants are

What are the recommendations for energy, protein and fat during infancy? How do these recommendations compare to adult recommendations?

� 50% of total kcal should come from fat (infant), 30% of total kcal should come from fat (adult)
� 1.5 g/kg body weight of protein, 0.8-1.0 g/kg for adults
� Infant: about 100 kcal per kg of body weight.

During infancy, what nutrients are needed in significantly higher amounts compared to adults, pound for pound?

� (There are 5 that are obvious) - vitamins A, D, E and C as well as Iodine (these are the 5 obvious ones).
� There are a few others like protein, riboflavin, calcium and zinc (but these aren't so significant).
� magnesium and iron and B6 are the only one

During early infancy, how often does an infant generally want to nurse or bottle feed?

� 3-4 hours (in class I thought she said that it was every 2 hours?) ? looked back on my notes, she said every 2 hrs.

What is the rooting reflex?

� For example, your baby is born with a "rooting" reflex that prompts her to turn her head toward your hand if you stroke her cheek or mouth.
� This helps her find the nipple at feeding time.
� At first she'll root from side to side, turning her head towa

How does breast milk compare to infant formula (cow) in protein carbohydrates and fats? What are the advantages of breast milk compared to formula?

� breast milk is higher in Fat (55%)
� cow milk formula is slightly higher in P (9% ) & CHO (42%)
� soy formula is the highest in P (12%).
� cow & soy doesn't have immunological factors like breast milk

Why is protein added to soy formula?

� because soy proteins are deficient in some amino
acids that babies need.
� Soy proteins aren't readily digest as proteins from breast milk, so they add more protein to the soy formula to increase chances of absorption

13. What type of formula(s) is (are) appropriate for the following conditions? Why?
a. Lactose intolerance
b. Cow's milk allergy
c. Feeding intolerance to protein
d. Prematurity
e. Galactosemia

a. Lactose intolerance - lactose free formula = term infant formula without lactose
b. Cow's milk allergy - Soy formulas
c. Feeding intolerance to protein - Protein hydrolysates or elemental formula (give the hydrolysate first, and give elemental formula

What are the percentages of casein / whey in breast milk versus cow's milk formula?

� human milk = 60:40 whey to casein.
� Cow's milk = 40:60 whey to casein.

At what age is it appropriate to serve cow's milk to infants? Why? (Hint : nutrient differences)

� should wait to feed cow's milk until they are 12 months old.
� Reasons: protein and sodium content are too high? could develop an allergy to milk if they're not ready to digest it yet? very low in iron that is also not very bioavailable (this can cause

The American Academy of Pediatrics recommends that a mother breastfeed her child for how long?

� exclusively for 6 months and to continue for at least 12 months.

What are some hunger cues of young babies?

� hand in mouth, sucking motion, body movements, sounds, cries or fusses.

What is the extrusion reflex?

� The other reflex your baby has is an extrusion reflex.
� This is when they'll push any food placed on their tongue out the front of their mouth.
� This is completely normal, and doesn't mean they don't like their food it just means they're not capable o

At what age should an infant start solid foods? Why?

� Breast milk or formula is the only food
� mayo clinic. However, by ages 4 months to 6 months (that's what the notes say too is 4 to 6 months), most babies are ready to begin eating solid foods as a complement to breastfeeding or form

How do you know if an infant is ready to eat solid foods? - probably with the decreased extrusion reflex?

� no extrusion reflex, opens mouth for spoon

What are appropriate/ inappropriate foods and textures for an infant during the first year of development?

� one inappropriate food is cow's milk.
� Any foods that can cause choking
� "Honey, very salt & sweet foods, foods that cause choking, cow's milk, excessive juice." from review

When feeding an infant it is recommended that you introduce new foods one food at a time over a 2 - 4 day period. Why?

� you want to go slowly to check for allergies and intolerances

At what age does an infant generally crawl? At what age does an infant generally walk?

� crawls at 8-10 months.
� Walks at 10-12 months.

Honey should not be fed to infants who are under 12 months of age. Why?

� because the honey contains botulism spores that the baby cannot digest as well as an adult can and it is therefore dangerous to the infant.

What vitamin supplements / fortified foods are recommended for breast fed versus formula fed infants (0-1 year old)?

� vitamin K, vitamin D, fluoride, B12 and iron

The American Academy of Pediatrics recently came out with a new recommendation for iron supplementation in breast fed infants. At what age should iron supplementation begin in these infants?

4 months

Define failure to thrive.

� Defined as 2 occasions where the child is below the 5th percentile.
� DECELERATION OF GROWTH HAS TO CROSS TWO MAJOR PERCENTILE LINES IN A SHORT PERIOD OF TIME - THIS IS A RED FLAG THAT THE CHILD IS NOT ABLE TO MAINTAIN GROWTH

What is colic and how long does it generally last?

� from WebMD "Colic is when a baby, for no apparent reason, is really fussy and cries for hours at a time, often at the same time every day. Colic typically starts when a baby is about three weeks old, and usually ends at about three months, so babies do

Why is infant diarrhea a serious problem that needs immediate attention?

� I think it's because they can get dehydrated very easily but not sure
� diarrhea is caused by an infection or feeding intolerance

Why is vitamin K given as a single dose at birth?

� Babies have very little vitamin K in their bodies at birth.
� Vitamin K does not cross the placenta to the developing baby, and the gut does not have any bacteria to make vitamin K before birth.
� After birth, there is little vitamin K in breast milk an

What foods typically cause choking in infants?

� hotdogs (not until they're 3)
� Hard candy, nuts such as almonds and grapes, cut meats that are coarse
� Hard raw veggies
� Popcorn
� Peanut butter

What are the concerns with feeding large amounts of juice to infants?

� it is very caloric.
� Can contribute to dental caries.
� Can also cause diarrhea and has a lot of sugar alcohols like sorbitol.

If an older infant became iron deficient what are some possible causes? What are the symptoms of iron deficiency?

� From mayo clinic "Infants and children at highest risk of iron deficiency include:
? Babies who are born prematurely � more than three weeks before their due date � or have a low birth weight
? Babies who drink cow's milk before age 1
? Breastfed babies

Healthy birth weight

� infants are usually born 5.5lbs to 8.5 lbs and are in between the 10th and 90th percentile

Low birth weight

� any birth weight under 5.5 lbs (probably 3237 weeks)

Very low birth weight

� less than 3 and 1/3 lbs (probably 28 - 37 weeks)

High birth weight

� review says HBW includes post term and large for gestational age (maybe its greater than 8.5lbs)

Small for gestational age

� less than 10th percentile

Large for gestational age

� infants above the 90th percentile in birth weight

What is the difference between preterm and small for gestational age?

� preterm = 37 weeks and below while small for gestational age = less than 10th percentile for birth weight in a population.

80% of preterm infants are born within the range of _____________week gestation.

32 to 37 weeks

Why has the US seen an increase in preterm births in the past 25 years?

� in 8 births is preterm ( 2nd highest in the world)
� older mothers (getting pregnant later in life)
� infertile couples using fertility drugs end up with multiple fetuses; really hard to sustain a pregnancy with so many babies like octomom
� c sections

What is the average length of gestation for a full-term pregnancy? At how many weeks
gestation is a newborn considered to be preterm? At how many weeks gestation is a newborn considered to be post term?

� 40 weeks is considered full term.
� Below 37 weeks is preterm.
� Over 42 weeks is considered post term.
� Normal is considered 37 to 42 weeks.

What are some of the causes associated with low birth weight?

� being premature, using drugs, and smoking.
� Fertility drugs, multiple pregnancy, caesarean sections, advancing age of first time moms, preeclampsia, eclampsia, HTN, chronic diseases, poor maternal nutrition, substance abuse & tobacco use.

What are the chances of survival for an infant born before 25 weeks compared to an infant born after 27 weeks gestation?

� Survival is dependent on gestational age.
� Infant born at 24 weeks has 40-70% chance to survive and after 27 weeks the infant has a 90% or greater
� class notes: "90% if 27 weeks and 10% survival if 22 weeks or lower

How long does it generally take for a preterm infant born at a VLBW (28 - 37 weeks gestation) to catch up in growth to a full term infant?

Why are fluid needs so high in preterm infants?

� because of insensible water loss which is when they lose water through the skin and the respiratory system (and they have a high resp. rate)

Describe the risks/conditions associated with prematurity (see below):
a. Heart
b. Gastrointestinal
c. Lung
d. Central Nervous System
e. Eyes
i. Poor vision
f. Bones
i. Osteopenia

a. Heart
� Patent Ductus Anteriosis - basically babies have a hole in their heart and if they are born prematurely then that hole may stay open and that condition is called patent ductus anteriosis
b. Gastrointestinal
� Necrotising Enterocolitis - conditi

All preterm infants have Respiratory Distress Syndrome. Why?

� because the lungs are the last organs to develop and if they have left the womb before they are ready then that
would be likely to be something that hasn't fully developed yet

Hyperbilirubinemia results from an immaturity of what organ system? What is a physical sign of hyperbilirubinemia?

� Jaundice is a condition that makes a newborn's skin
and the white part of the eyes look yellow.
� It happens because there is too much bilirubin in the
baby's blood (hyperbilirubinemia).
� Bilirubin is a substance that is made when the body breaks down

Why would a preterm infant younger than 26 weeks be fed a formula that is lactosefree?

� because a baby doesn't develop the lactase enzyme until about 35 weeks
� They have decreased digestive enzymes.
� Sucrose develops at 27 weeks and lactase develops at 35.

At what gestational age does the sucking reflex develop

32-34 weeks gestational age.

Under what conditions would a preterm infant be fed by the following feeding modalities?
a. Parenteral (IV)
b. Enteral (tube feedings)
c. Bottle feeding / breast feeding

a. Parenteral (IV)
i. Peripheral vein short term?
ii. TPN (central line) long
term? goes through the peripheral vein and is routed to the heart? can deliver a lot of nutrients long term? goes to the heart? can also go to the umbilical line. (IV)
b. Entera

What are the benefits of enteral feeding compared to parenteral feeding?

adv. (improve nutrient intake & GIT maturation, reduce jaundice, full volume feedings tolerated earlier)

What are the risks associated with enteral feedings?

disadv. (feeding intolerance, aspiration, & Necrotizing enterocolitis [ NEC]).

Joey is 10 weeks old and was born at 26 weeks gestation. He is 2.4 kg in weight and 46 cm
in length. Using the growth chart below, plot Joey's weight and length for his corrected
gestational age. Is Joey's growth adequate for his corrected gestational age

xxxxxxx

What are the energy /protein recommendations for premature infants (per kilogram (kg) body
weight compared to healthy full term infants?

Needs for preterm and LBW infants
energy
� 120 kcal / kg / day
� (full term is usually about 100)
protein
� 3 to 4 g / kg bw
� (full term is usually about 1.5)
Fats
� 50% of calories generally
� about the same fat levels as full term
Fluid
� increased nee

Joey is 12 � months old and was born at 26 weeks gestation. He is 9 kg in weight and 71 cm in length. Using the growth chart below, plot Joey's weight and length for his corrected age. Is Joey's growth adequate for his corrected age? (Be sure to convert t

xxxx

Risks for nutrient deficiencies are high in preterm infants. Why?

they may not have gotten enough nutrients from the mother since they left the womb early

What are the criteria used to determine if a preterm infant is ready to go home from the hospital?

� regulate body temperature
� breathe independently
� weigh > 1800 grams (4 lbs)
� enteral / oral feedings tolerated
� gaining weight

Describe the growth rate of toddlers and preschoolers as compared to infants.

� Not as rapid? Somebody confirm please (Yes this is true, the highest rate of growth is within the first years, then growth slows down, but is still on rise. just not as much as it would be in infancy)

What physical measurements are taken to measure growth in toddlers up to 2 years of age?

� Recumbent length and weight

What is BMI for age and how is it used?

� BMI for age of the child is used to compare to the average BMI for that child's age based on the other kids in the US.
� BMI for age is used to figure out if the child is
overweight or obese or of normal weight.
� Not used in adults because they have st

Describe the dip in BMI for age growth curve from ages 2 4. What does this dip indicate? (Remember that BMI is an index of weight to height)

� It represents growth of height, from 24 you grow a lot, and weight doesn't necessarily grow accordingly to height so that causes a dip. ?Agree

At ages 4 - 6 the BMI growth curve for age gradually rises from its low point. What is this rise called and why does it happen? (Remember that BMI is an index of weight to height)

� adiposity rebound normally happens in age 57
so its not that ??? I think it is adiposity rebound

What are the BMI for age categories for underweight, healthy weight, overweight and obese?

� a child who is in anywhere in the
� below the 5th percentile = underweight
� 5th to 85th percentile = ideal or normal BMI
� 85th to 95th percentile = overweight
� anything over 95th percentile = obese

Be able to calculate BMI and plot BMI for age (weight, height will be given to you).

BMI = kg/m^2
lbs/in2 * 703
or kg/m^2

What foods should be avoided to prevent choking for toddlers up to 3 years of age?

� hotdogs (not until they're 3)
� Hard candy, nuts such as almonds and grapes, cut meats that are coarse
� Hard raw veggies
� Popcorn
� Peanut butter

Toddlers have strong food preferences by age 2 to 2.5 and may not try new foods. Some toddlers are considered picky eaters. Are these children picky because they are difficult to
manage or are they picky because of their taste genetics?

� they could have different genetics that make some foods taste terrible to the child.
� The taste receptors on your taste buds are actually proteins which are made by our genes.
� In a study some people hated the taste of the compound PTC while others co

What is a food jag?

� food jags are when a child will only eat one a couple things for an extended period of time - give them what they want, don't force them but definitely introduce new
foods to them.
� Happens at 2 to 4 years of age.
� If you keep exposing the child to th

Describe a healthy eating environment for a toddler and preschooler. (foods and feeding behavior and surroundings, social / emotional)

Healthy Feeding Relationship
� Recognized developmental abilities
� Encourages self feeding
� Offer a variety of foods and textures
� Allow self regulation of food intake
� Respond to hunger and satiety cues
� Be a good role model

What are some good food sources for protein, fats, fiber, calcium, iron, zinc, vitamin A, vitamin C, vitamin E, and vitamin D?

� protein = dairy, meats and beans, eggs, fish, grains.
� Fiber = legumes, whole grains, veggies and fruits.
� Calcium = dairy, fortified foods and juices, greens, sardines. Iron = meat and beans, fortified / whole grains, legumes, eggs, greens.
� Zinc =

What foods provide docosahexanoic acid (DHA). Why is this lipid important in growth of toddlers?

� it is important in for healthy neurological growth and is an omega 3 fatty acid that is commonly found in things like fatty fish, flaxseed and some fortified foods
(like some eggs and is also in some Horizon Organic milk products)

What are the appropriate portion sizes for grains, fruits, and vegetables in toddlers?

� MYPlate - age 2
� Grains - 3 oz
� veggies 1 cup
� fruits - 1 cup
� 1 tbsp per year of age

At what age is it appropriate to serve low fat
or fat free cow's milk? Why?

� 2
� they need all that extra fat for brain development from 0-2 years old after that i think you can serve lower % fat milk. but you can't serve them any milk until they are 1. (other than milk from the teat and stuff).
� they can have whole milk from 1

Many toddlers and preschoolers do not meet recommendations for iron, vitamin D and calcium. Describe diseases / symptoms associated with these nutrient deficiencies.

� Iron deficiency
� 4% of toddlers deficient
� Low income families/ highest in Hispanics with 17%
� Causes: infants who have too much milk
� Signs/symptoms: growth deficiency/low attention span/behavior problems
-

In what ethnic populations do we see vitamin D deficiency in young children?

blacks

A child can meet his/her vitamin D needs by means other than foods or supplements. How?

the sun

Compare the protein recommendations of infant, toddlers and preschoolers.

� 3-4 g/kg for preterm infants, 1.5 g/kg for infants, 1.1 g/kg for toddlers, .95 g/kg for preschoolers.

What variables are used to calculate the energy needs (Estimated Energy Requirement DRI) for preschool children?

height, weight, age, gender, activity level

According to the American Academy of Pediatrics, what is the recommended fiber intake for a toddler who is 30 pounds and 2 years old?

� (2.2 pounds = 1 kilogram) - Age + 5 g = # of g / day
� isin't this 19 grams?> she said that was too high and to do the 5 + age
� So is it 7 grams/day ? yes

What are the risk factors for lead poisoning? What are some sources of lead in the environment and how is lead poisoning prevented?