Abbreviations/Definitions

• FTT: Failure to thrive – condition in which a child’s physical growth is decelerated or arrested (height and weight measurements fall below the third or fifth percentile, or a downward change in growth across two major growth percentiles) – associated with abnormal growth and development – caused by inadequate nutrition
• Tetralogy of Fallot (TOF): a rare congenital heart condition caused by a combination of four heart defects present at birth – (1) pulmonary valve stenosis, (2) ventricular septal defect, (3) overriding aorta, and (4) right ventricular hypertrophy – defects cause oxygen-poor blood to flow out of the heart and to the rest of the body – infants and children with this condition usually have blue-tinged skin because their blood doesn’t carry enough oxygen
• PKU: Phenylketonuria– an inherited inability to metabolize phenylalanine that causes brain and nerve damage if untreated
• Prader Willi Syndrome: a genetic condition – in infancy, it is characterized by weak muscle tone, feeding difficulties, poor growth, and delayed development – beginning in childhood, some develop an insatiable appetite, which leads to chronic overeating and obesity, which can lead to the development of Type 2 Diabetes Mellitus
• Cystic Fibrosis: a lifelong hereditary disorder characterized by abnormally thick mucus secretions from the epithelial surfaces of various organ systems, including the respiratory tract, the gastrointestinal tract, the liver, the genitourinary system, and the sweat glands

Anatomy/Physiology

Describe the typical pattern of growth and development of an infant during the first year of life. (Include skills related to feeding/eating.)

0-6 months:

• Infant normally loses 5-10% of their birth weight soon after birth – should start to gain weight and grow quickly around 2 weeks
• Infant’s birth weight should double around 4-6 months
• Normal growth – ½ to 1 inch per month
• Reflexes during the first 6 months
  • Mouthing reflexes – sucking and swallowing reflexes
    • Baby will automatically begin to suck when their mouth or lips are touched
    • Rooting reflex – the baby turns head toward your hand if you touch their cheek – reflex helps them find the nipple for feeding – starts to fade at around 4 months

6-12 months:

• Normal growth – 1 cm per month
• Normal weight gain – 5-7 ounces per week
• Infant’s birth weight should triple by 12 months

Describe the typical pattern of growth and development of toddlers and young school-age children.

Toddlers (1-3 years) develop many new skills including gross motor (walking, running, climbing), fine motor (feeding themselves), sensory (development of the five senses), language (saying single words, then sentences), and social (playing with others, taking turns, doing fantasy play). It is during these years that they begin to have consistent meal times – sitting at the table with the family and feeding themselves. Growth rates vary because not everyone develops at the same rate, so as long as the toddler is developing along their growth curve there is no need to be concerned.

Young school-aged children usually have smooth and strong motor skills; however, this can vary widely. Coordination, endurance, balance, and physical abilities also vary. They are starting to become more social and tend to imitate what they see. Height and weight changes vary and are influenced by genetics, diet, and exercise.

Describe the typical pattern of growth and development during the adolescent period.

During adolescence there is physical and mental growth and development. During this time, children develop the ability to understand abstract concepts, establish and maintain satisfying relationships, and they begin to develop their self-identity. Puberty begins during the adolescent years and brings with it many physical and emotional changes. For girls, breasts develop, body hair begins to grow in new places, and menarche occurs. For boys, their genitals begin to grow, hair begins to grow in new places, and their voices begin to change. Socially, they begin to separate from their parents and spend more time with their friends as they develop their own identity. They begin making their own decisions about how to spend their time and who to spend it with.

Nutritional Management

Compare the composition of breast milk to commercial infant formulas.

Nutrient	Breast Milk	Standard Infant Formulas	Soy-Based Infant Formulas	Protein-Hydrolysate Infant Formulas
Fats	“Milk fat globule” – contains LCTs (DHA/ARA, palmitic acid, bile-salt stimulated lipase), MCTs, phospholipids, and cholesterol	Vegetable oils Can add MCTs instead of vegetable oils	Vegetable oils Can add MCTs instead of vegetable oils	Vegetable oils Can add MCTs instead of vegetable oils
Protein	Intact protein Whey and casein in a 60:40 ratio Non-nutrient protein (growth factors, immune factors)	Intact protein Hydrolyzed cow’s milk protein	Intact protein Soy milk protein	Non-intact protein Peptides (complete amino acid formula)
Carbohydrates	90% is lactose Oligosaccharides (prebiotic)	Lactose	Modified starch, corn syrup solids, maltodextrin, or sucrose	Modified starch, corn syrup solids, maltodextrin, or sucrose
Vitamins and Minerals	Normally contains enough vitamins and minerals independent of the mom’s diet Dependent on mom’s diet – vitamin B12, selenium, and iodine Insufficient ones – vitamin K, vitamin D, iron	Less biologically available so fortified with extra	Less biologically available so fortified with extra	Less biologically available so fortified with extra

What foods are responsible for the majority of food allergies in children under three years of age?

Cow’s milk, eggs, peanuts, soybean, and wheat

How are the nutritional needs of a pre-mature infant different from that of a full-term infant?

Full-term infants need about 100 calories per kilogram per day from either breast-milk or formula. Breast-milk or infant formula alone can usually provide sufficient calories until around 4-6 months. At around 4-6 months, nutrient needs are greater than what they can provide, and the introduction of solids is necessary. Macronutrient distribution during infancy is generally recommended to be 40-50% from fat, 7-11% from protein, and the remaining calories from carbohydrates. Water needs is based on calorie needs and is 1.5 ml per calorie. Pre-mature infants have greater overall nutrient needs than full-term infants. However, nutrition care for pre-mature infants is not homogenous, it depends on a variety of factors including their gestational age, clinical condition, weight, length and head circumference, and ability to tolerate enteral feedings. Additionally, their clinical condition and feeding modality affects their nutritional needs, so determining what to feed, what volume and nutrient density to provide, and how to administer nourishment must be assessed daily. The goal is to provide optimal calories and protein to support intrauterine growth rates, promote the development of a healthy gastrointestinal tract, provide adequate nutrients to support bone mineralize, and individualize nutrient provision to meet specific needs in disease conditions. If the infant is being giving parenteral nutrition, the total calorie needs are ~85-100 calories per kilogram per day (calorie needs are even higher if they are being fed enterally because they do not absorb enough), and 3-4 grams of protein per 100 calories provided.

Describe a recommended strategy for management of pediatric obesity.

A recommended strategy for managing pediatric obesity is intervening in schools to improve children’s nutrition and physical activity habits. This includes, but is not limited to, providing nutrition education, offering healthier food options (more fruits and vegetables, less fried foods and sweets), limiting the availability of foods that contribute to obesity (e.g., removing soft drink vending machines), developing student-run gardens, and having longer gym periods where the students are engaged in fun physical activities that improve their health.

List three strategies for encouraging grade school children to consume more vegetables.

1. Make healthy snacks easily available at home and at school
2. Give them a variety of fruits and vegetables so they don’t get bored, and ask them which ones they like best
3. Set a good example – parents should act as healthy eating role models for their kids