Chronological or Postnatal age
Age of infant calculated in days/weeks or months from the date of birth
Gestational age
Estimated time since conception
Corrected age
Age adjusted for prematurity
Postmenstrual age
Is the gestational age plus the chronological age and is reported in weeks
Full term infant
37-42 weeks of gestation
Preterm infant
<37 weeks of gestation
Post term infant
>42 weeks of gestation
Low birth weight
2.5 kg
Very low birth weight
1.5 kg
Extremally low birth weight
1 kg
Small for gestational age
Weight <10th percentile
Appropriate for gestational age
Weight between 10th and 90th percentiles
Large for gestational age
Weight >90th percentile
Growth charts for children with special health care
- Premature infant
- cerebral palsy
- Down syndrome
50th means
Avarage
<3rd & >97th
Nutritional risk
-1< z score <0
normal
-2< z score<-1
mild malnutrition
-3< z score <-2
moderate malnutrition
-3 > z score
sever malnutrition
- Birth weight should be regained by
- Weight typically doubles by
- and triples by
- the second week of life
- 5 to 6 months of age
- 12 months old
Term infants weight changes
May lose 7% to 10% of birth weight
Preterm infant weight changes
May lose ≤15%of birth weight
Extremely low birth infants weight changes
May lose<20% of birth weight
Significant weight loss is considered in the following situation
- >2% in 1 week
- >5% in one month
- >7.5% in 3 months
- >10% in 6 months
Waterlow criteria is used for
distinguishing malnutrition as acute (wasting) versus chronic (stunting) in children 1 to 3 years old.
Failure to thrive has been defined as
- Weight that is less than the third percentile on a standard growth chart.
- Weight <80% of predicted weight for-age.
- Decline in growth velocity.
Causes of failure to thrive
Organic • Presence of an underlying medical cause.
Inorganic • Nutritional, Psychological, social, or economic cause.
Goals of medical nutrition therapy for failure to thrive
- Increasing weight
- Correcting nutritional deficiencies
- Correcting any underlying causes
Total energy needs for catch-up growth
When do we use catch up growth?
- may be as high as 150% of expected needs
- Weight is below the 5th% tile
- If the weight drops down more than two major percentile lines
- WT/HT is less than the 5th%tile
Estimating energy needs for children with developmental disabilities
- spina bifidia
- cerebral palsy
- Down syndrome
- Prader-Willi Syndrome
Estimating energy needs for premature infants
- Energy: 125-130 kcal/kg/day
- Protein: 3.5-4 g/kg/day
Some important areas to focus on in the dietary assessment include:
- Maternal, prenatal, and postnatal history
- Birth weight and weight history
- Feeding history
- Chewing and swallowing function
- Past or present gastrointestinal problems
- Typical eating habits, food preferences, amounts
how much does human milk contains of calories approximately ?
20 kcal/30 ml
Recommended feeding schedule
- At least 8-12 feedings/24 hr
- Typically every 1/- 3hr during first few weeks of life
- Feed 10-20 minutes per breast during each feeding
Contraindications to breastfeeding
- galactosemia
- inborn errors of metabolism
- Mothers infected with HIV
- Mothers with herpetic lesion of the breast or other abscesses
- Mothers receiving chemotherapy
- Mothers with substance abuse
- Mothers with untreated syphilis
Assessment of the adequacy of feeding
- infant's growth
- weight losses and gains
- 6 wet diapers/day
- 3 stools/day. 4
- Stool consistency