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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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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