Post on 26-Jun-2020
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Nutrition in Infancy and ChildhoodInfant Growth
Infant Growth and DevelopmentTo understand the dynamic patterning of infant growth
To understand which factors influence growth potential- genetic, environmental, nutritional
To describe typical patterns of infant growth
To understand basic anthropometric technique for length, weight,and OFC measures
To understand the principles underlying the CDC growth charts
Growth of infants
• How is normal growth defined?• What is acceptable growth?• What is abnormal growth?• What affects growth?
– Nutrient intake, other factors• What predictors do we have for infant growth?• Can athropometry be used to identify malnutrition?• Should ethnic differences in growth play a role in
clinical practice?• How are growth charts most useful?
Infant Growth
• Components of growth• Typical growth• Expected channels changes in growth
Changes in Body Conformation
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©2001 Brooks/Cole, a division of Thomson Learning, Inc. Thomson Learning™ is a trademark used herein under license.
Weight gain in the first five years of life
BMI in infancy
Monitoring Growth and Development
• The pattern of growth varies with the stages of development.– Growth is most rapid during the first year,
when an infant doubles in length and weight.
– Malnutrition is most critical during the most rapid periods of growth:
• Undernutrition may lead to permanent physical, emotional, behavioral, and cognitive problems.
CDC Infant Growth Charts
CDC Growth Charts, 2000Reference Population: Standard Normal
Curve
95th5th
50th Percentile
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Normal infant growth
• Measurements between the 25th and 75th %ile
• Crossing channels is not unusual• 10th-25th and 75th-90th%ile measures
may or may not be OK– depends on pattern of measures, genetic
factors, environmental factors• <10th and >90th%ile measures should
be checked
Is this a typicalpattern of infantgrowth?
Is this a typicalpattern of infantgrowth?
Considerations in Assessment of Growth
• Ethnicity• Infant birth size• Parent size• Health and wellness
Ethnicity and Assessment of Growth
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Birth size and expected growth
• Can expect to see some changes in growth channel..based on birth size and adjustment to genetic potential– large infants lag-down– small infants catch-up
Changing channels is often typical
Appropriate change in growth channels Catch-up growth due to illness
• Several models have been defined to assess the impact of illness or malnutrition on infant and childhood growth
Model definingcatch-up growth
Appropriate catch-up growth
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Monitoring Infant Growth and Development
• Rate of growth– compare to CDC Growth Charts
• Support appropriate nourishment– meet recommendations for protein, energy,
vitamins and minerals• Support developmental progress with
foods– provide textures for ‘experience’ and
nourishment
Factors affecting growth
• Nourishment issues– Infants who are growing poorly– Infant who are growing too well
• Family issues– Short stature– Tall stature
Short stature
• Familial short stature
• Constitutional slow maturation
• Emotional deprivation
• Chronic malnutrition
• Chronic diseases• Intrauterine growth
retardation• Chromosomal
abnormalities• Skeletal dysplasia• Disorders of hGH
secretion & action
Reasons for Being <5th%ile• Weight
– short, malnutrition, chronic renal disease,psychosocial deprivation, infectious disease, iron deficiency anemia
• Length or stature– short parents, malnutrition,
psychosocial deprivation, delayed maturation, endocrinopathies, chromosomal abnormalities, chronic renal disease
• Weight-for-length– dehydration,
recent febrile illness, recent malnutrition, Marfan syndrome
• OFC– microcephaly,
craniostenosis, genetic disorders
Reasons for Being above the 95th%ile
• Weight– tall, obesity, edema
• Length or stature– tall parents, accelerated maturation, marfan
syndrome, pituitary giants• Weight-for-length or stature
– obesity, edema, achrondroplasia• Head circumference
– hydrocephaly
Breastfeeding vs.. bottle feeding and growth
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Poor growth demo by a breastfed infant
• Weight more affected than length
• Extended breastfeeding
• No solids added• HBV protein
Infant at risk for obesity
Intake described in appropriate range for age
Formula = 20 kcal/oz
Limited and appropriate solids
How would you assessthe growth of this infant?
Note <length and weight velocity; parent size
Patterns of growth based on degree and type of insult
How would you approach evaluation of the growth of this child? Catch-up growth
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How would you approach evaluation of the growth of this child?
How would you approach evaluation of the growth of this child?
How would you approach evaluation of the growth of this child? What would you do?
• 7 month old infant• normal development• exclusively breast
fed• feeding q 4 hours• weight =⇓⇓• length =⇓
• baby hungry q 2 hours
• triglycerides =⇑(900)
• fasting triglycerides= ⇑ (350)
Models for assessing growth of infants
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Calibrating degree of malnutrition Nutritional Influences on Growth
• Growth & Protein energy ratio• Growth & protein quality• Growth & fluid requirements• Growth & specific nutrient deficiency
Protein-Energy Ratio
• Protein at requirement level + adequate energy = appropriate growth
• Protein at requirement level + inadequate energy = poor growth
Growth and Specific Nutrients
• Energy• Protein• Calcium• Vitamin D• Vitamin B12• Zinc• Folate