Growth and Nutrition
Tara Conway Copper
Carrie Nalisnick
NORMAL GROWTH
Typical Growth Patterns
Pediatricians monitor weight, height, and head circumference over time. Deviation from norms can identify children with nutritional deficiencies, endocrinopathies, and other underlying conditions. (See Appendix C for CDC growth charts.)
Weight
It is normal for a newborn’s weight to decrease up to 10% below birth weight in the first week of life due to limited intake and excretion of extravascular fluid. By 2 weeks of age, the weight is typically regained and may exceed birth weight.
Term infants should grow by 30 g/day in the first 1-3 months of life, 20 g/day during 3-6 months of age, and 10 g/day between 6 and 12 months of age. Typically birth weight doubles by 4 months and triples by 1 year.
Children gain ˜2 kg/year between ages 2 and the onset of puberty. Children who gain <1 kg/year should be monitored closely for nutritional deficiencies.
Height
Term infants should grow 25 cm in the 1st year, 10 cm during the 2nd year, and 7.5 cm during both their 3rd and 4th years. Height should increase by 50% in the 1st year and double by 4 years.
Children grow ˜5 cm/year between age 4 and the onset of puberty.
Prepubertal growth is nonlinear, occurring in spurts and times of slower growth.
Head Circumference
Term infants’ head circumference should increase 2 cm/month in the first 3 months, then 1 cm/month between 3 and 6 months, and then 0.5 cm/month between 6 and 12 months. It typically increases by 2 cm from 1 to 2 years, and head growth is mostly complete by 4 years of age.
Preterm Infants and other Variants from typical Growth Patterns
Preterm infant growth goals differ from term infants, and while further study is needed to understand the nutritional needs of preterm infants, the following growth goals can be used as a guide: weight should increase by 15 g/kg/day, length by 1 cm/week, and head circumference by 0.7 cm/week.
Please see Chapter 18, Endorcrinology, for detailed information on causes of short stature and deviations from typical growth patterns.
NORMAL DIET
Infants
Breastfeeding
The American Academy of Pediatrics (AAP) recommends breastfeeding for the first 12 months of life (exclusively for the first 6 months).
The AAP recommends that breastfeeding infants receive 400 IU of supplemental vitamin D per day.
Formula Feeding
Although breast milk should be the first choice for infant nourishment, there are many infant formulas that provide adequate nutrition (Table 2-1).
While it is common practice to switch formulas in infants with difficulty gaining weight, frequent physiologic reflux, or other feeding difficulties, there are limited data for this practice.
Iron-fortified infant formula is the recommended substitute for infants who are not breastfed. The recommended intake amount is 100 kcal/kg/day. In newborns, this is 2-3 oz every 3-4 hours, and it increases to 4 oz every 3-4 hours at 1 month of age.
If powdered formula is used, ensure that family members are following the instructions for mixing it accurately.
Complementary Foods
Complementary foods (any foods and beverages other than human milk or formula) can be introduced starting between 4 and 6 months of age, when the infant is developmentally ready.
There is no specific recommended sequence for introducing foods, as long as essential nutrients that complement breast milk or formula are provided.
In general, parents should start with single-ingredient foods and introduce them one at a time at 2- to 7-day intervals.
Parents can gradually introduce other pureed foods, soft fruits and vegetables, and soft table foods 2-3 times per day.
Before 12 months of age, cow’s milk, honey, and hard, round foods that are a choking hazard should be avoided.
Toddlers, Children, and Adolescents
At 12 months of age, children can be transitioned from breast milk or formula to whole milk containing calcium and vitamin D. Earlier transitioning to whole milk is associated with the development of iron deficiency anemia.
Children should eat a diet of fruits, vegetables, whole grains, and lean meat.
The United States Department of Agriculture (USDA) created a food guidance system based on the 2010 Dietary Guidelines for Americans called MyPlate to replace the food guide pyramid. Key messages include portion control, making half of your plate fruits and vegetables, making half of your grains whole grains, switching to fat-free or 1% milk, choosing foods with lower sodium, and drinking water instead of sugary beverages.
Feeding schedules include three meals plus 2-3 snacks per day. The amount of intake increases as a child’s weight and energy needs increase. Children are able to selfregulate their energy intake by feeding themselves.
Nutrient needs should be met primarily by consuming a variety of healthful foods, but in some cases, dietary supplements may be necessary to ensure adequate intake of one or more nutrients.
Females of childbearing age should take 400 µg of folate per day from fortified foods, a supplement, or both in addition to a varied diet.
Recommendations for iron intake include:
Children ages 9-13 years: 8 mg/day
Females 14-18 years old: 15 mg/day
Males 14-18 years old: 11 mg/day
Recommendations for calcium intake include:
Children 4-8 years old: 800 mg/day
Children and adolescents 9-18 years old: 1,300 mg/day
Adolescents and adults 19 years and above: 1,000 mg/day
Limit carbonated soda and fruit drinks. Allow no more than 4-6 oz of 100% fruit juice daily due to its high calorie and sugar content.
Dietary excess of fat, cholesterol, sodium, and sugar is common in adolescents. Evaluating the dietary intake of an adolescent is a fundamental component of health supervision.
TABLE 2-1 Common Infant Enteral Nutrition | ||||||||||||||||||||||||||||||||||||
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