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Child HealthNursing
Partnering withChildren & Families
Chapter 9Nutrition pp 318-344
Kristine Ruggiero CPNP, MSN, RN
Child Health Nursing: Partnering with Children & FamiliesBy Jane W. Ball and Ruth C. Bindler
Nutritional Needs Infancy Todlerhood Preschool School age Adolescence Nutritional challenges
Nutritional assessment Physical and behavioral measurement
Common nutritional concerns Overweight and obese Collaborative care Dietary deficiencies (iron, ca, vit d, folic acid, protein-energy)
Feeding and eating disorders Pica Ftt
Nutritional concepts
Nutrition: Taking in food and assimilating it metabolically for
use by the body. Macronutrients:
Major building blocks Carbohydrates, proteins and fats
Micronutrients: Substances needed in small quantities for health
body functioning.
Carbohydrates
Energy source: composed of carbon, hydrogen, and oxygen.
Saccharides (sugar molecules) 50% of daily calories Fiber= indigestible carbohydrate
components, ensures healthy movement of fecal matter thru bowel
FIGURE 9–16 While a child’s nutritional status influences health, it is also important to consider conditions that may affect the child’s nutrition and include this knowledge in your assessment.
Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families
Infants need minimum of 120 cal/kg/day to maintain weight and growth
20 cal/oz is the usual calories found in formula
Feedings/day q3-4 hrs= 6-8 feedings/ day
Question…
How much formula would an infant who weighs 4.3 kg need at each feeding if they feed every 4 hours?
Answer…Let’s break it down
1. Infant weight in kg is multiplied by 120 calories/ number of feedings per day Baby weight= 4.3 kg
2. Calories needed/day= 4.3 x 120 Calories needed/day= 516 calories/ day
3. calories needed per feeding= 516/6 Calories needed per feeding= 86
4. ounces per feeding= calories needed per feed/number of calories per ounce of formula 86/20= 4.3 ounces/ feeding
Breast and Formula Feedings Breast milk: advantages include:
Excellent nutrition Promotion of GI function Fostering immune defense lower incidence of OM’s, Type 2 Diabetes, and
obesity Psychological benefits Economic advantage
Breast Feeding
Nursing role: Includes education, and encouragement to foster
breastfeeding Help mothers to have positive experience w/
Breastfeeding Encouragement Lactation consultant/ group support
Contraindications to breastfeeding
Chemotherapy Active untreated maternal TB Maternal HIV/AIDS Maternal primary herpes in the breast Certain medications (chloramphenicol) Use of alcohol and recreational drug abuse
FIGURE 9–4 Breastfeeding offers many physical and emotional benefits for the infant. This new mother is learning to breastfeed her baby. How can nurses encourage mothers to have positive breastfeeding experiences?
Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families
Initial introduction of foods Appropriate first foods: rice cereal
Weaning occurs at 12 months Longer bottle feeding increases
Dental caries Otitis media allergies
General nutrient requirements of an infant
Introduction of whole milk at 1 year, and low-fat milk at 2 years
Fluoride supplements at 6 months if not in water
Iron enriched cereals should be started first New foods added gradually Introduce veggies b/f fruits No honey b/f 1 year…infant botulism
FIGURE 9–6 Early childhood caries. This child has had major tooth decay related to sleeping as an infant and toddler while sucking bottles of juice and milk. Courtesy of Dr. Lezley Mcllveen, Department of Dentistry, Children’s National Medical Center, Washington, DC.
Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families
Food jags (eating only a few foods for a few days of weeks)
Socialization (associative play) Help with food preparations Dental care Meal and snack patterns Nutritional requirements
FIGURE 9–8 Preschoolers learn food habits by eating with others. Engaging them in food preparation enhances knowledge of food and promotes intake at meals.
Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families
FIGURE 9–11 Growth chart with first few entries in same channel and then a change indicated. The growth for the child indicated on this chart remained steady and in the same channel (75th percentile) for some months. Then the weight measurement decreased to another channel. What kind of dietary assessment will you complete with the parents? What could be the possible causes?
Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families
H&H Blood Chemistry Lipid Profile Renal and Liver function tests
Nutrition Assessment
Dietary intake 24 hour food recall 3 day food history Genogram to recognize nutrtional risk (heart
disease and hypertension)
Overweight and Obesity
Public health epidemic in US Increasing incidence Factors influencing obesity include:
Genetics Psychological Environmental (excessive TV, lack of exercise, %
of calories from fat)
Obesity by the numbers
Childhood obesity has reached epidemic levels in developed countries.
Twenty five percent of children in the US are overweight and 11% are obese. About 70% of obese adolescents grow up to become obese adults
US children at risk for being overweight= 25% Overweight + obese children in US= 15% Increase in obesity since 1960= 300%
Overweight and Family History
When a child has one obese parent, chances of the child being overweight are increased by 220%. In families where both parents are overweight, the incidence of obesity in children increases by 320%.
Finally, the child who has obese parents, and is overweight as an adolescent has an 80% risk of being an obese adult
Definitions of Obesity and Overweight
The Center for Disease Control and Prevention defined overweight as at or above the 95th percentile of BMI for age and "at risk for overweight" as between 85th to 95th percentile of BMI for age.
Treatment of obesity
Medical treatment and referrals Nutrition and behavioral counseling Treat family
Focus on family environment Nonjudgmental support
Focus on concern for health, not appearance
Treatment of obesity
Discourage food as a reward Encourage healthy eating patterns
Family meals around table Plan for small changes one at a time Decrease sedentary behavior
Decrease tv time to 2 hrs/day
Specific Dietary Deficiencies
Calcium Iron Vitamin D:
Rickets Folic acid:
Prevention of neural tube defects and cleft defects
PICA
Ingestion of nonfood substances or atypical ingestion of foods
Pregnant women and young children Commonly ingested substances
Lead paint Soil contaminated by lead based gas fumes
Strong association w/ anemia Treatment
What is failure to thrive? Organic vs Non-organic FTT:
Nonorganic, NOFTT; also called psychosocial failure to thrive is defined as decelerated or arrested physical growth
(height and weight measurements fall below the fifth percentile, or a downward change in growth across two major growth percentiles) associated with poor developmental and emotional functioning. Usually occurs in a child younger than 2 y.o w/ no known medical condition
Organic failure to thrive occurs when there is an underlying medical cause.
FIGURE 9–14 Infants with failure to thrive may not look severely malnourished, but they fall well below the expected weight and height norms for their age. This infant, who appears to be about 4 months old, is actually 8 months old. He has been hospitalized for feeding disorder of infancy.
Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families