From Fertilized Egg to Newborn
An estimated 50% of pregnancies are unplanned in the United States.2 Therefore, all sexually active women of childbearing age should be aware of their likelihood of becoming pregnant.
The prenatal period (gestation) encompasses the time from conception, the moment a male sperm cell enters a female egg cell, until the birth of a full-term infant, about 38 to 42 weeks later.
During the first 2 weeks after conception, the fertilized egg (ovum) divides repeatedly, forming a mass of cells that enters the woman’s uterus, the female reproductive organ that protects the developing organism.
The mass of cells buries itself into the nutrient-rich lining of the uterus and continues to develop.
For the next 6 weeks, the rapidly dividing mass of cells, called an embryo, increases in size and forms organs. Eight weeks after conception, the developing human being is referred to as a fetus
During the first 2 weeks after conception, the fertilized egg divides repeatedly, forming a mass of cells that eventually enters the uterus and buries itself into the organ’s nutrient-rich lining.
From 14 days through 8 weeks after conception, the rapidly dividing mass of cells is called an embryo. Eight weeks after conception and until its birth, the developing human being is referred to as a fetus.
During the first trimester, the embryo/fetus develops most of its organs, and by the end of this period, the fetus can move.
The first trimester is a critical stage in human development because nutrient deficiencies or excesses and exposure to toxic compounds, such as alcohol, are most likely to have devastating effects on the embryo/fetus. However, many women who are in their first trimester do not realize they are pregnant.
As the second trimester begins, the fetus is still very tiny, about 2½ to 3 inches in length, and weighs only about an ounce. However, the fetus is beginning to look more like a human infant—it has fully formed arms, hands, fingers, legs, feet, and toes.
The fetus’s organs continue to grow and mature in their ability to function. As the fetus moves around, its mother becomes increasingly aware of its presence within her body.
By the beginning of the third trimester, the fetus is approximately 12 inches long and weighs about 1½ to 2 pounds.
During this trimester, the fetus will nearly double in length and multiply its weight by three to four times. Thus, the fetus usually weighs about 6 to 8 pounds and is 19 to 21 inches long by the time it is full-term and ready to be born.
Throughout the prenatal period, the embryo/fetus depends entirely on its mother for survival. During most of the pregnancy, the expectant mother nourishes her embryo/fetus through the placenta, the organ of pregnancy that connects the uterus to the embryo/fetus via the umbilical cord
The role of the placenta is to transfer nutrients and oxygen from the mother’s bloodstream to the embryo/fetus. Additionally, the placenta transfers wastes from the embryo/fetus to the mother’s bloodstream, so her body can eliminate them.
the placenta does not filter many microbes and toxic substances, such as alcohol and nicotine, from the mother’s blood.
agents of infection and harmful chemicals can pass through the placenta, enter the embryo/fetus, and cause disease, birth defects, or embryonic/fetal death.
A fetus generally needs to spend at least 37 weeks developing within the uterus to be physiologically mature enough to survive after birth without the need for special care
A fetus’s weight depends on the supply of nutrients that it receives through the placenta.3 If the placenta fails to grow properly, the developing fetus is likely to be born too soon and be lighter than average at birth.
Birth weight is a major factor that determines whether a baby is healthy and survives his or her first year of life.
Low-birth-weight (LBW) infants generally weigh less than 5½ pounds at birth. In 2009, about 8.2% of infants born in the United States were low birth weight. .5 Additionally, women who smoke during pregnancy are at risk to have LBW babies
Pregnant females who are 45 to 54 years of age or under 15 years of age are more likely to give birth to low-birth-weight infants than women in other age groups
Additionally, women who smoke during pregnancy are at risk to have LBW babies
Low birth weight is often associated with premature or preterm births. In 2009, approximately 12.2% of births in the United States were preterm
that is, they occurred before the 37th week of pregnancy. Preterm birth and LBW are one of the leading causes of death among American infants who are less than 28 days of age
In 2009, about 2% of births were very preterm, that is, the infants were born before 32 weeks of gestation.
Very preterm infants are more likely to have serious health problems or die soon after birth than babies delivered after 32 weeks of pregnancy
A very preterm infant who is born after about 26 weeks of pregnancy may survive if cared for in a hospital nursery for high-risk newborns
However, the tiny infant’s body will not have stores of fat and certain minerals that normally accumulate during the last month of pregnancy. Additionally, very preterm babies are likely to have conditions that complicate their medical care and food intake, such as breathing difficulties and weak sucking and swallowing abilities.
When is a baby called a fetus
until 8 weeks after conception
transfers oxygen and nutrients from the mother’s blood and waste to the mother blood
What is a major factor that determines whether a newborn baby is healthy and survives its first year of life?
low birth weightDuring pregnancy, hormones signal the breasts to increase in size in preparation for lactation.
What is a preterm birth?
birth before 37 week
During pregnancy, a woman’s body undergoes major physiological changes, such as increased blood volume, breast size, and levels of several hormones.
These adaptations enable her body to nourish and maintain the developing embryo/fetus, as well as produce milk for her infant after its birth. However, some of the physical changes cause discomfort for the pregnant woman.
in the first trimester, most women experience physical signs that they are pregnant, such as enlarged breasts and “morning sickness.”
Other common nutrition-related signs as well as complaints of pregnancy include extreme tiredness, swollen feet, constipation, and heartburn. In most cases, such discomforts do not create serious complications and they resolve within a few months.
During pregnancy, hormones signal the breasts to increase in size in preparation for lactation.
The mother’s pituitary gland in the brain produces prolactin, a hormone that stimulates the development of milk-producing tissue in the breasts.
A pregnant woman’s breasts do not form milk, because high levels of progesterone, a hormone that helps maintain pregnancy, inhibit milk production
After birth, the level of progesterone drops rapidly, essentially removing the “brakes” from the breasts’ ability to produce milk.
A common sign of pregnancy is morning sickness, nausea that is sometimes accompanied by vomiting.
The name “morning sickness” is misleading because the queasy feeling can occur at any time of the day. The cause of this unpleasant condition is unclear, but it may be the result of the pregnant woman’s body adapting to higher levels of female hormones
emotional stress and certain foods can contribute to nausea. The condition generally begins early in the first trimester, and most women are no longer affected by the sixteenth week of pregnancy
However, some women experience nausea and vomiting occasionally throughout their pregnancies.
To help control mild morning sickness, pregnant women can avoid odors and foods, such as fried or greasy foods, that trigger nausea. Some women find that eating crackers and drinking some water helps reduce the likelihood of feeling nauseated, especially before they get out of bed in the morning
Furthermore, eating smaller but more frequent meals and nutritious snacks can be helpful.
If the nausea and vomiting contribute to weight loss of more than 2 pounds, the pregnant woman should contact her physician for treatment. Morning sickness that persists beyond the fourth month of pregnancy should also be brought to the attention of a physician.
During pregnancy, excessive vomiting is harmful because it can lead to dehydration and nutritional deficiencies.
Early in pregnancy, the mother’s blood volume expands to approximately 150% of normal. The number of red blood cells, however, increases by only 20 to 30%, and this change occurs more gradually.
pregnant woman develops physiological anemia, a condition characterized by a lower concentration of red blood cells in the bloodstream. This form of anemia is a normal response to pregnancy, rather than the result of inadequate nutrient intake
physiological anemia may be responsible for the extreme tiredness experienced by pregnant women during their first trimester. As their red blood cell numbers increase, expectant mothers report having more energy, especially during the second trimester.
By the third trimester, however, most pregnant women are easily fatigued again, possibly because carrying a rapidly growing fetus is physically demanding
High levels of certain hormones can cause various tissues to retain fluid during pregnancy.
Although the extra fluid causes some minor swelling (edema), especially in the hands and feet, the condition is normal. In most cases, mild edema does not require treatment such as restricting salt intake or taking diuretics. Edema, however, can be a sign of trouble if hypertension and the appearance of extra protein in the urine accompany the swelling.
During pregnancy, certain hormones produced by the placenta relax muscles of the digestive tract.
As a result, intestinal movements slow down and digested material takes longer to pass through the tract, increasing the likelihood of constipation
AI for fiber and water
To help prevent constipation, pregnant women should consume adequate amounts of fiber and fluids. During pregnancy, the Adequate Intake (AI) for fiber is 28 g/day, and the AI for total water is 3 L/day
Heartburn is another common complaint of pregnant women. As the fetus grows, the uterus pushes upward in the mother’s abdominal cavity and applies pressure on her stomach
When this occurs, stomach acid can enter the esophagus, causing heartburn . To help avoid heartburn, the pregnant woman can consume smaller meals, avoid lying down after eating, eat less fatty foods, and learn to identify and avoid foods that seem to contribute to heartburn. If heartburn continues to be bothersome, the woman should consult her physician and discuss other ways to treat the condition.
women can analyze the nutritional adequacy of their diets and choose to eat foods that correct any marginal or deficient intakes.
Prior to pregnancy, sedentary women can begin an exercise regimen; overweight or obese women can lose some excess weight; and women who smoke can join smoking cessation programs. The time to remedy faulty lifestyle practices and increase chances of having a healthy pregnancy and baby is long before pregnancy occurs.
During pregnancy, the mother-to-be should follow a diet that meets her own nutritional needs as well as those of her developing offspring. Depending on the trimester, an expectant woman’s requirements for energy (calories), protein, and many other nutrients are greater than her needs prior to pregnancy.
Nevertheless, a pregnant woman does not need to double her usual food intake just because she is “eating for two.” Table 13.1 compares Recommended Dietary Allowances (RDA) for energy and selected nutrients that apply to healthy 25-year-old nonpregnant and pregnant women.
In the first trimester, a pregnant woman’s daily energy requirement (Estimated Energy Requirement or EER) is essentially the same as a nonpregnant woman’s, because the embryo/fetus is quite small
he fetus grows rapidly during the second and third trimesters, and the pregnant woman requires more energy and nutrients to support its growth as well as her own body’s needs.
During the second trimester, the expectant mother should consume approximately 340 more kilocalories per day than her prepregnancy EER. Throughout the third trimester, she should add about 450 kcal per day to her prepregnancy EER
If a woman is physically active during her pregnancy, she may need to increase her kilocalorie intake by even more than these levels. Why? As the pregnant woman gains weight, her muscles require more energy to move her body. The average expectant mother, however, reduces her physical activity level during the third trimester, conserving energy.
A pregnant woman’s requirements for folate and iron are 50% higher than those of a nonpregnant woman. It is important for women to enter pregnancy with adequate folate status, because embryos need the vitamin to support rapid cell division.
pregnant women who are folate deficient have high risk of giving birth to infants with neural tube defects, such as spina bifida
To obtain adequate folate, women of childbearing age as well as pregnant women should include
rich food sources of folate in their diets, such as green leafy vegetables, and take a vitamin/mineral supplement that supplies at least 400 mcg of folic acid, a form of folate.
As the pregnant woman’s blood volume expands, her need for iron increases because her body must make more hemoglobin for the extra red blood cells.
he woman’s body transfers iron to the fetus to build its stores of the mineral. If women fail to meet their iron needs during pregnancy, their iron stores can be severely depleted, and they can develop iron deficiency anemia. Pregnant women who are iron deficient have high risk of giving birth prematurely and having low-birth-weight infants
Even when their diets include good sources of iron such as red meats and enriched cereals, pregnant women often need a supplemental source of iron.
most physicians recommend special prenatal multiple vitamin/mineral supplements that contain iron for their pregnant patients.
Rather than view pregnancy as a time to splurge by eating energy-dense empty-calorie foods, the mother-to-be should obtain the extra calories from nutrient-dense foods.
drinking an additional cup of fat-free milk, eating a bowl of an enriched whole-grain cereal, and taking a prenatal supplement each day can supply extra kilocalories as well as protein, fiber, and micronutrients.
Table 13.2 presents a day’s meals and snacks for a sedentary 25-year-old woman who is in her second trimester of pregnancy.
Her prepregnancy EER was 2000 kcal, so her sample menu is based on MyPlate recommendations for 2400 kcal, enough to cover her increased EER during this trimester.
Fish and shellfish (e.g., clams, shrimp, and crabs) are excellent sources of many minerals, omega-3 fatty acids, and high-quality protein. However, most fish and shellfish contain very small amounts of methylmercury, a compound that contains the toxic mineral mercury.
For most healthy adults, ingesting amounts of methylmercury that are generally in fish and shellfish is not thought to be harmful. Certain kinds of fish and shellfish, however, contain higher levels of methylmercury than others. When a pregnant woman eats these foods, the methylmercury in them can eventually reach the developing fetus and damage its nervous system.
According to recommendations issued by the U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA), women who may become pregnant, are pregnant, or are breastfeeding their babies should
Eat up to 12 ounces of various fish and shellfish per week that generally contain small amounts of mercury, such as shrimp, canned light tuna, salmon, pollock, and catfish. (Albacore tuna contains more methylmercury than canned light tuna, but eating up to 6 ounces of albacore tuna per week is allowed.)
Avoid eating types of fish that often contain high amounts of methylmercury, particularly shark, swordfish, king mackerel, and tilefish.
The FDA and the EPA also recommend that caregivers should not feed fish that contain high amounts of methylmercury to young children because their nervous systems are still developing.
The stereotype of a pregnant woman who craves pickles and ice cream is not simply a myth.
Cravings are common during this stage of life. However, ask pregnant women to identify the foods they crave, and you are likely to get a variety of responses. The causes of cravings are unknown, but they may be responses to the hormonal changes associated with pregnancy or to the emotional state of the mother-to-be. In other instances, specific food cravings may simply reflect the pregnant woman’s family traditions. Unless food cravings contribute to excess weight gain, they are generally harmless.
Some women develop pica, the craving of nonfood items such as laundry starch, chalk, cigarette ashes, and soil. Some studies have linked pica with iron and zinc deficiency, but it is not clear if pica is the result or the cause of such deficiencies.
Pregnant women should refrain from practicing pica, especially eating clay or soil. Soil may contain substances that interfere with the absorption of minerals in the intestinal tract. Furthermore, eating soil can be harmful because the dirt may be contaminated with toxic substances, such as lead and pesticides, and pathogenic microbes.
Nearly all pregnant women experience weight gain. In fact, gaining an appropriate amount of weight is crucial during pregnancy. How much weight a woman should gain depends on her prepregnancy weight.
According to experts with the American College of Obstetricians and Gynecologists (ACOG), women who were underweight prior to pregnancy should gain 28 to 40 pounds; women whose prepregnancy weights were within the healthy range can expect to gain 25 to 35 pounds.13 Women who were overweight before they became pregnant should gain 15 to 25 pounds, and obese women should gain at least 15 pounds during pregnancy. The recommendations are higher for women who are pregnant with more than one fetus. For example, a healthy woman who is carrying twins may gain as much as 45 pounds during pregnancy.14 In 2009, experts with the Institute of Medicine (IOM) issued new weight gain guidelines for obese pregnant women. According to the experts, the obese women should limit their weight gain to 11 to 20 pounds
In 2006, 21% of women in the United States gained more than 40 pounds during pregnancy.4 Women who gain excess weight during pregnancy are likely to retain the extra pounds long after their babies are born
expectant mothers who gain excessive amounts of weight are more likely to give birth to high-birth-weight (HBW) babies.15 HBW newborns generally weigh more than 8.8 pounds. When compared to newborns with healthy weights, HBW infants have higher risk of being injured during the birth process and of having birth defects. Furthermore, HBW infants are more likely to develop obesity, diabetes, and hypertension at some point in their lives.16 In 2006, about 8% of babies born in the United States were HBW
Underweight women who do not gain enough weight during pregnancy are at risk of having preterm or low-birth-weight (LBW) infants. Underweight pregnant women should try to reach healthy weights by the end of the first trimester and then meet the recommended weight-gain goals. Obese women have a greater risk of developing hypertension as well as type 2 diabetes during pregnancy.
Obese pregnant women are also at risk of giving birth to HBW babies.15 However, women should not try to lose weight while they are pregnant because calorie restriction may harm the fetus.
It is important to understand that much of the weight a woman gains during a healthy pregnancy is not body fat.
By the end of a full-term pregnancy, the average fetus weighs about 7½ pounds, and the placenta and amniotic fluid that surrounds the fetus account for about 3½ pounds. The remaining weight is comprised of tissues and fluids the mother’s body gains during pregnancy (maternal weight gain).
For an expectant mother, the rate of the weight gain is important, as well as the amount of weight gained. Most pregnant women add up to 4 pounds of weight during the first trimester.
Throughout the rest of their pregnancies, women typically gain at a faster rate, 3 to 4 pounds each month. Figure 13.4 charts the course of weight gain in a healthy pregnancy. Note how the rate reaches a steady pace of about 1 pound/week during the second and third trimesters.
women of childbearing age should plan for pregnancy and receive dietary advice before becoming pregnant. If this is not possible, prenatal care should begin early in pregnancy, because many medical problems that may occur during this life stage can be diagnosed and treated before the health of the mother or her fetus are threatened.
Prenatal care is specialized to meet the health care needs of pregnant women. Routine prenatal health care includes measuring and monitoring the pregnant woman’s weight, blood pressure, blood glucose level, and uterine growth. The prenatal health care provider may also discuss various concerns with the expectant mother, such as morning sickness, safe types of physical activity, what to expect during the birth process, and basic infant care skills. Additionally, the health care provider can advise the pregnant woman to make appropriate lifestyle choices, such as avoiding the use of tobacco, alcohol, and illegal substances. Women who receive adequate prenatal care are more likely to have good pregnancy outcomes, including babies who have healthy birth weights, than women who do not receive such car
During pregnancy, it is important for a woman to decide whether she will breastfeed her baby.
Pregnant women who decide to breastfeed their babies should inform their physicians and learn as much as they can about breastfeeding early in their pregnancy.
According to estimates, 3 to 8% of pregnant women in the United States develop type 2 diabetes during pregnancy (gestational diabetes). When a woman has gestational diabetes, her fetus receives too much glucose and converts the excess into fat.
Thus, women with this form of diabetes often give birth to high-birth-weight babies. After birth, these infants often have difficulty controlling their own blood glucose levels and are at risk of becoming overweight as children.
Gestational diabetes can be detected during routine prenatal care. Diet and exercise are usually necessary to treat the condition, but in some cases, insulin injections are required.
After giving birth, the women who developed diabetes during pregnancy generally experience a decline in their blood glucose levels to normal values. However, women who have experienced gestational diabetes have higher risk of developing type 2 diabetes later in life.
Rapid weight gain, especially after the fifth month of pregnancy, could be a sign of a serious type of hypertension called pregnancy-induced hypertension (PIH). PIH is commonly referred to as preeclampsia (pre-e-klamp’-see-a).
Preeclampsia is characterized by sudden, dramatic increase in weight that is due to edema, particularly of the hands, calves, and face; hypertension; and protein in urine.18 If a woman suffering from preeclampsia develops convulsions, her condition is called eclampsia (e-klamp’-see-a). In the United States, eclampsia is the second leading cause of death among pregnant women
Hypertension is a common complication of pregnancy. In the United States,
6 to 8% of pregnant women develop high blood pressure.19 Pregnant women who have high risk of PIH are those who are under 20 or over 40 years of age, are overweight or obese, have a history of diabetes or hypertension, and are carrying more than one fetus. Major signs of preeclampsia include sudden weight gain, elevated blood pressure, edema, and protein in urine.
Most American women have normal pregnancies and deliver healthy infants, but some women experience serious health problems such as PIH. At present, the only effective treatment for PIH is delivering the fetus, but infants born before the 24th week of pregnancy are unlikely to survive. If the fetus is older than 24 weeks, its mother may be hospitalized for treatment.
This practice helps physicians monitor the mother’s condition and enables the fetus to mature until it has a better chance of surviving after a premature birth.
Exposure to alcohol and tobacco is harmful to the embryo/fetus. Women who drink alcohol during pregnancy are at risk of having a child with a fetal alcohol spectrum disorder such as FAS (see Fig. 6.30). Scientists do not know if there is a “safe” amount of alcohol that pregnant women can consume; therefore, women of childbearing age who are sexually active or pregnant should avoid alcoholic beverages. The Chapter 6 “Highlight” provides more information about fetal alcohol spectrum disorder.
ompared to pregnant women who do not smoke cigarettes, expectant mothers who smoke have higher risk of giving birth too early and having LBW babies. Furthermore, expectant mothers who smoke cigarettes may increase the risk of having babies with birth defects or that die of sudden infant death syndrome (SIDS). SIDS is the sudden, unexplained death of an infant younger than 1 year of age and the leading cause of death for babies between 1 month and 1 year of age.20
The use of illegal drugs, herbal supplements, and medications during pregnancy can also harm the embryo/fetus. Ideally, the time to quit abusing illegal drugs is before pregnancy. Pregnant women should consult their physicians before using herbal supplements or taking any drugs, even over-the-counter medications.
Women can derive many benefits from being physically active during pregnancy, including enhanced muscle tone and strength, reduced edema, and improved mood and sleep. Most pregnant women can continue their prepregnancy exercise regimens, especially those that included low- or moderate-intensity activities. However, the exercise routine should not result in weight loss. Recommended activities generally include walking, cycling, swimming, or light aerobics.
Pregnancy is not the time to begin an intense fitness regimen or perform high-risk physical activities. Activities that are risky and should be avoided include downhill skiing; contact sports such as judo, soccer, and basketball; and scuba diving.21 Pregnant women should discuss their physical activity practices and needs with their physicians. Some expectant women, such as those experiencing PIH or premature labor contractions, may need to restrict their physical activity.
Identify at least three different nutrition-related signs of pregnancy.
enlarged breasts, morning sickness, swollen feet, constipation and heartburn
According to recommendations of the American College of Obstetricians and Gynecologists, how much weight should a woman at a healthy weight gain during pregnancy; how much weight should she gain if she was underweight before becoming pregnant? How much weight should she gain if she was overweight or obese before pregnancy?
25-35 lbs for women in the healthy range
28-40 lbs for underweight women
15 for obese
more for multiple births
Why is having adequate folate and iron status important for pregnant women?
neural tube defects – spina bifeta
iron deficiency anemia – premature births and low birth weight
Discuss the harmful effects that a pregnant woman’s alcohol consumption and cigarette smoking can have on her embryo/fetus.
fetal alcohol spectrum disorder – alcohol
smoking – low birth rate, sudden death syndrome, birth defects
Rapid physical growth characterizes infancy, the life stage that extends from birth to about 2 years of age.
During the first 4 to 6 months of life, a healthy baby doubles its birth weight, and by 1 year of age, an infant’s birth weight has tripled. Additionally, an infant’s length increases by 50% during its first year of life. Thus, if a baby girl weighs 7 pounds and is 20 inches long at birth, you would expect her to weigh 21 pounds and be 30 inches long by her first birthday
Growth rates during infancy.
A healthy newborn baby (a) grows rapidly during its first year. During the first 4 to 6 months of life, a baby doubles its birth weight, and by 1 year of age, an infant’s birth weight has tripled (b). Additionally, an infant’s length increases by 50% during its first year of life.
Compared to older children, an infant needs more energy and nutrient(Some women report that colostrum leaked from their breasts late in the pregnancy.)22 By the end of the first week of lactation, colostrum has undergone a transition to mature milk.
If you compare the appearance of mature human milk to cow’s milk, you will notice that breast milk is more watery than cow’s milk and may have a slightly bluish color.s per pound of body weight to support its rapid growth.
Two hundred years ago, if a new mother was unable to breastfeed her baby, the child faced certain death—unless a woman who was producing breast milk could be located to suckle (nurse) the infant.
Today, a new mother can choose to nurse her baby or feed the child an infant formula, a synthetic food that simulates human milk. Although both foods provide adequate nutrition for young babies, breastfeeding provides benefits beyond nutrition for the new mother as well as her infant.
Human milk is uniquely formulated to meet the nutrient needs of a newborn baby. During the first couple of days after giving birth, the new mother’s breasts produce colostrum (co-loss’-trum), a yellowish fluid that does not look like milk.
(Some women report that colostrum leaked from their breasts late in the pregnancy.)22 By the end of the first week of lactation, colostrum has undergone a transition to mature milk. If you compare the appearance of mature human milk to cow’s milk, you will notice that breast milk is more watery than cow’s milk and may have a slightly bluish color.
If they are unaware that colostrum is secreted by breasts soon after birth, women may think something is wrong with their ability to produce milk. However, colostrum is a very important first food for babies, because the fluid contains antibodies and immune system cells that can be absorbed by the infant’s immature digestive tract.
Colostrum also contains a substance that encourages the growth of a type of bacteria, Lactobacillus bifidus (L. bifidus), in the infant’s GI tract. Such biologically active substances help an infant’s body fight infections and hasten the maturation of the baby’s immune system. Thus, breastfed infants, especially those who are exclusively breastfed, have lower risks of allergies and gastrointestinal, respiratory, and ear infections than formula-fed infants.23 Furthermore, breastfed babies are less likely to develop childhood asthma, leukemia, obesity, sudden infant death syndrome (SIDS), and type 1 diabetes than infants who are not breastfed
Human milk is a rich source of lipids, including cholesterol, and fatty acids such as linoleic acid, arachidonic acid (AA), and docosahexaenoic acid (DHA). An infant’s nervous system, especially the brain and eyes, depends on AA and DHA for proper development. Furthermore, the fat in breast milk helps supply the energy needed to maintain the infant’s overall growth.
The practice of breastfeeding also provides some important advantages for parents, particularly the new mother. Breastfeeding is more convenient and economical than using infant formula. Human milk is readily available; there is no need to purchase cans of infant formula and have them on hand. As milk leaves the breast, it is always fresh, free of bacteria, and ready-to-feed without mixing, bottling, or warming. Because human milk production requires a considerable amount of energy, lactating women can lose the extra body fat gained during pregnancy faster than mothers who use infant formula. Additionally, women who breastfeed their babies have lower risks of breast cancer (before menopause) and ovarian cancer than women who do not breastfeed. Some of these benefits depend on whether a woman breastfeeds exclusively, that is, provides no other foods, and the number of months the mother nurses her infant. American infants who are breastfed have a lower infant mortality rate than American babies who are not.
Let down – When an infant suckles, nerves in the mother’s nipple signal her brain to release prolactin and oxytocin (ox-e-tose’-in) into her bloodstream. Prolactin stimulates specialized cells in breasts to form milk.
These cells carry out the lactation process by synthesizing some nutrients and removing others from the mother’s bloodstream and adding them to her milk.
Oxytocin plays a different role in establishing successful lactation. This hormone signals breast tissue to “let down” milk. The let-down reflex enables milk to travel in several tubes (ducts) to the nipple area.
A reflex is a physical response that is automatic and not under conscious control. When let-down occurs, the infant removes the milk by continued sucking (Fig. 13.6). Shortly before the flow of milk begins, the lactating woman often feels a tingling sensation in her nipples, a signal that let-down is occurring.
Embarrassment, emotional stress and tension, pain, and fatigue can easily block the let-down reflex. For example, if a lactating mother is tense or upset, let-down does not occur, and her infant will not be able to obtain milk when it suckles. When this happens, the hungry infant becomes frustrated and angry, and the mother may respond by becoming even more tense and upset, setting up a vicious cycle. At this point, new mothers often give up breastfeeding, reporting that they tried to suckle their babies but were unable to “produce” milk.
Lactating women need to be aware of the connection between their emotional state and failure to let down. To smooth the path to successful lactation, it helps if new mothers are in a comfortable, relaxed environment when they breastfeed their babies. When lactation and breastfeeding are well established, the let-down response often occurs without the need for suckling. For example, the mother’s let-down reflex may be triggered just by thinking about nursing her infant or hearing it cry.When a new mother breastfeeds her newborn immediately after delivery, oxytocin signals her uterus to contract, reducing the risk of excessive uterine bleeding.
Breastfeeding is a skill, and like other skills, it takes some practice to fully master. Thus, it may take a few weeks for the new mother to feel comfortable with the process. By persevering, she and her baby are likely to become a successful breastfeeding team.
Typically, a lactating woman produces over 3 cups of milk per day.9 It is important to recognize that milk production relies on “supply and demand.” The more the infant suckles (demand), the more milk its mother’s breasts produce (supply). However, if milk is not fully removed from the breasts, milk production soon ceases. This is likely to occur when infants are not hungry because they have been given baby food and formula to supplement breast milk feedings.
The size of a woman’s breasts does not influence her ability to breastfeed her infant. However, certain surgical procedures used to enlarge or decrease breast size can disrupt the nerves and milk-producing tissue in the breasts.
Women who had surgery to alter their breasts may be able to produce milk after giving birth, but their infants’ growth rates should be monitored to make sure the babies are obtaining enough milk.
Milk production requires approximately 800 kcal every day. However, the lactating woman’s daily energy needs can be met by adding only about 300 to 400 kcal to her prepregnancy EER.
The difference between the energy needed for milk production and the recommended energy intake can enable the new mother to lose the extra body fat she accumulated during pregnancy. This loss is more likely to occur if she continues breastfeeding her baby for 6 months or more and increases her physical activity level. A woman, for example, who needed 2000 kcal before becoming pregnant would require about 2400 to 2600 kcal daily during lactation.
No special foods are necessary to sustain milk production. However, a lactating woman should drink fluids every time her infant suckles to help her maintain adequate milk volume and keep her body properly hydrated. For as long as she breastfeeds her baby, the lactating mother should limit her intake of alcohol- and caffeine-containing beverages because her body secretes these drugs into her milk.
A woman who breastfeeds her baby should also check with her physician before using any medications, even over-the-counter and herbal products, because such substances may also end up in her breast milk.
Dietitians and pediatricians generally recommend that new mothers breastfeed their infants exclusively during their babies’ first 6 months of life.23, 25 It is not necessary to supplement young infants’ diets with other fluids, such as water, infant formula, and juices, or with solid foods, such as baby food
After an infant reaches 6 months of age, breastfeeding should continue, but the infant can also be offered some appropriate solid foods. Breastfeeding may be combined with infant foods until the child’s first birthday. However, there is no reason why children cannot be breastfed for longer periods. Throughout the world, many mothers continue to nurse their babies well past the babies’ first birthdays, but in the United States, this practice is uncommon.
Although breast milk is highly nutritious, it is not a complete food for all infants. Human milk may contain inadequate amounts of vitamins D and B-12, and the minerals iron and fluoride. The American Academy of Pediatrics (AAP) recommends all breastfed infants be given a supplement that supplies 400 IU of vitamin D per day until they are consuming that amount of the vitamin from food or infant formula.
Exposing the infant to some sun can also help meet part of the child’s vitamin D needs (Fig. 13.7). If a lactating woman is a total vegetarian and she does not consume a source of vitamin B-12, she should consult her physician concerning the need for vitamin B-12 supplementation. When breastfed infants are about 6 months old, they should also be consuming some iron-containing solid foods, because the amount of iron in their mother’s milk may no longer meet their needs. Furthermore, a fluoride supplement may be necessary for breastfed babies. Before giving any dietary supplements to their baby, parents or caregivers should discuss their infant’s nutritional needs with the child’s physician. in the United States, newborns are given an injection of vitamin K to protect them against excessive bleeding.
A question commonly asked is whether the breastfed infant needs additional water, especially in hot weather. Human milk provides adequate water intake for healthy infants who are exclusively breastfed
However, it is important to obtain prompt professional medical care to prevent a baby from becoming dehydrated, particularly if the infant is suffering from diarrhea, vomiting, or fever.
Nearly all healthy women are physically capable of breastfeeding their infants. In 2008, about 75% of American women started breastfeeding their babies soon after birth.26 Within 2 days of birth, almost 25% of the breastfed babies were also consuming formula. By the time the infants were 6 months old, 43% continued to be breastfed. By their first birthday, only about 24% of the babies were still being nourished with their mother’s milk.
Women who breastfeed their newborns often stop the practice within 6 months. There are many reasons why women discontinue nursing their infants too soon. New mothers often quit because they lack information about and support for breastfeeding their babies. Some women discontinue breastfeeding because of uncertainty over how much milk their babies are consuming. Baby bottles are marked to indicate ounces, so a mother who bottle-feeds her infant can easily measure the amount of formula consumed. A lactating mother, however, has to observe her baby for cues indicating the child is full. When a breastfeeding baby is no longer interested in nursing and stops, its mother has to assume the infant is satisfied with the feeding. A well-nourished breastfed infant will gain weight normally and generally have six or more wet diapers as well as one or two soft bowel movements per day. Parents or caregivers who are concerned about their infants’ food intake or nutritional status should consult their physician immediately.
Many new mothers discontinue breastfeeding before their babies are 6 months old because they need to return to work and have caregivers feed their babies.
Although lactating women can learn to express milk from their breasts and preserve it for later feedings, many workplaces do not have comfortable, private facilities for women to express milk and then store it safely.
To enhance the likelihood that a nursing mother continues to breastfeed, it is helpful to enlist the support of a female relative or friend who has successfully breastfed her children. Furthermore, the woman’s partner needs to understand and appreciate the function of the human breast as a source of nearly perfect nourishment for infants.
New mothers are unlikely to begin and continue nursing their babies without their partners’ support. La Leche League is an international organization dedicated to providing education and support for breastfeeding women (1-877-4-LALECHE or www.llli.org). Also, hospitals may employ lactation consultants or specialists. Lactation consultants are often nurses who are trained to provide information and advice about breastfeeding. For more information about breastfeeding, visit www.llli.org.
Not every woman wants or is able to breastfeed her baby. Infant formulas are a safe and nutritionally adequate source of nutrients for babies who are not breastfed
to produce artificial milk for babies, infant formula manufacturers alter cow’s milk to improve its digestibility and nutrient content. Infant formulas generally contain heat-treated proteins from cow’s milk, lactose and/or sucrose, and vegetable oil. Infant formulas generally lack cholesterol, but some of these products have the fatty acids DHA and AA added to them. Vitamins and minerals are added to the product, and in some instances, infant formula contains higher levels of micronutrients than human milk. Although infant formulas mimic the water, macronutrient, and micronutrient content of human milk, their compositions are not identical to human milk. Formula manufacturers have been unable to duplicate human antibodies and other unique immune system factors that are in breast milk.
An interesting feature of human milk is that its fat content changes during each feeding, which usually lasts about 20 minutes. In the beginning of the session, the mother’s milk is low in fat, but as her infant continues to suckle, the fat content of her milk gradually increases
The higher fat content of the “hind milk” may make the baby feel satisfied and, as a result, discontinue feeding. Infant formulas, however, have uniform composition; that is, they do not change their fat content during a feeding session. Thus, the mother or infant caregiver is more likely to control the amount of formula the baby consumes, possibly leading to overfeeding. Nevertheless, the overall energy content of human milk is about the same as that of infant formulas (about 20 kcal per ounce).
Experts with the AAP recommend that caregivers provide an iron-fortified infant formula for babies who are not breastfed. Not all infant formulas contain iron, so it is important to read the product’s label before purchasing it.
Formula-fed babies may also need a source of fluoride, but caregivers should check with their infants’ physicians before providing a supplement containing the mineral. For babies who are allergic to infant formulas made from cow’s milk proteins, similar products made with soy or other proteins are available.
Why not feed fresh fluid cow’s milk to an infant? Cow’s milk is too high in minerals and protein and does not contain enough carbohydrate to meet an infant’s nutrient needs
In addition, infants have more difficulty digesting casein (kay’-seen), the major protein in cow’s milk, than the major proteins in human milk. Cow’s milk can also contribute to intestinal bleeding and iron deficiency.28 Thus, whole cow’s milk should not be fed to infants until they are 1 year of age.25 Furthermore, fat-reduced and fat-free cow’s milk are too low in energy to be given to most children until they are 2 years of age.
Do not heat infant formula or human milk in a microwave oven. The heat can destroy immune factors in human milk and create hot spots that can scald an infant’s tongue.
Allergies are immune system responses to the presence of foreign proteins in the body. Allergies to proteins in foods, especially cow’s milk proteins, often begin in infancy and may persist through childhood. Signs and symptoms of food allergies typically include the following:
Vomiting, diarrhea, intestinal gas and pain, bloating, or constipation
Itchy, swollen, or reddened skin
Runny nose and breathing difficulties, such as asthma
Compared to breastfed infants, formula-fed babies have a greater risk of food allergies.
When a woman has a personal or family history of food allergies, she may be able to prevent her children from developing such allergies if she breastfeeds her babies exclusively for 6 months. Infants rarely develop allergic reactions to food proteins that enter breast milk from the mother’s bloodstream.
Concentrated or ready-to-use infant formulas are highly perishable. Once a container of liquid infant formula has been opened, the product can remain in the refrigerator for only 1 day.
Any formula that remains in the bottle after a feeding should be discarded, because it will be contaminated by enzymes in the infant’s saliva and bacteria.
Before 6 months of age, babies’ nutritional needs can generally be met with human milk and/or infant formula. According to AAP experts, solid foods should not be introduced to infants until they are about 6 months of age.
At this age, many infants need the additional calories supplied by solid foods. Breastfed babies may also need a dietary source of iron, because their stores of the mineral are usually exhausted about 6 months after birth. Nevertheless, caregivers should continue to provide human milk or iron-fortified infant formula as the foundation of the baby’s diet for the first year.
Many new parents are anxious to start feeding their young infants solid food. However, babies are not physically mature enough to consume solids before they are 4 to 6 months of age. For example, a baby’s kidney functions are quite limited until the child is about 4 to 6 weeks of age. Additionally, an infant’s digestive tract cannot readily digest starch before the child is about 3 months old.
Infants are born with the extrusion reflex, an involuntary response that occurs when a solid or semisolid object is placed in an infant’s mouth. As a result of this reflex, a young baby thrusts its tongue forward, pushing the object out of its mouth. Thus, trying to feed the infant solid foods is a messy, frustrating process, as the child automatically pushes the food out of its mouth. Liquid foods, such as breast milk or infant formula, do not elicit the extrusion reflex, so the baby swallows fluids.
As the infant reaches 4 to 6 months of age, the extrusion reflex disappears, and the child has developed the physiological abilities to digest, metabolize, and excrete a wider range of foods.
Moreover, a 6-month-old infant can usually sit up with back support and coordinate muscular control over his or her mouth and neck movements. These signs indicate the baby is ready physically to eat solid foods, is less likely to choke on such foods, and can turn his or her head away from food when full.
Weaning is the gradual process of shifting an infant from breastfeeding or bottle-feeding to drinking from a cup and eating solid foods. Pediatricians often recommend introducing an iron-fortified infant cereal made from rice as the first solid food. After feeding the infant cereal for the first time, caregivers should offer the food to the baby for at least 4 days and observe the infant for signs and symptoms of food allergy.
If the infant appears to tolerate rice cereal, caregivers can add a new food to the baby’s diet, such as another type of baby cereal or a cooked, strained vegetable. As each new food is introduced, caregivers should wait 2 to 4 days before adding a different food to the child’s diet.29 If the infant develops diarrhea, vomiting, or a rash during this period, he or she may be allergic to the new food.
Is is a good idea to avoid giving mixed foods such as casseroles or commercially prepared baby food “dinners” to infants. If the baby has an allergic response after eating a food mixture, it will be difficult to determine which ingredient was responsible. Serving mixed foods is acceptable when the child has eaten each ingredient individually without having an allergic response.
Many parents think adding solid foods to infants’ diets helps babies sleep through the night. Actually, this developmental milestone generally occurs around 3 to 4 months of age, regardless of what infants are eating.
Infants who have a high risk of food allergy have a parent or sibling who has a history of allergies, including food allergy. Foods that are associated with allergic responses in infants include egg whites, chocolate, nuts, and cow’s milk.
Therefore, caregivers should not offer these foods to high-risk babies under 6 months of age. Many babies outgrow food allergies during childhood, but some children remain allergic to the foods through adulthood.
Many varieties of strained baby food are available at the supermarket. Single-food items, such as carrots or peas, are more nutrient-dense choices for feeding infants than mixed dinners and desserts. Most brands have no added salt, but some fruit desserts contain a lot of added sugar. As an alternative, caregivers can prepare their own baby food by taking plain, unseasoned cooked foods and pureeing them in a blender.
If a large amount of the item is blended, the pureed food can be poured into an ice cube tray, covered with a plastic bag, and frozen. When it is feeding time, an ice cube portion of the baby food can be popped out of the tray and warmed. The Chapter 13 “Recipes for Healthy Living” feature includes an applesauce recipe that both children and adults will enjoy.
At about 6 to 8 months of age, the baby’s first set of teeth, the “primary teeth,” begin to appear. These teeth are important for proper nutrition because they help the child bite and chew food. By 8 to 12 months of age, most infants can use their fingers to pick up and chew “finger foods” such as crackers, toast, and cooked string beans. Babies can also hold a bottle and practice drinking from a special cup (“sippy cup”) that has a lid with a spout
Babies need to practice self-feeding skills, even if it means playing with food and creating messes. By about 10 months of age, many infants are mastering self-feeding and making the transition from baby foods to menu items the rest of the family enjoys.
Learning to drink from a cup.After a baby learns to hold a bottle, the child can practice holding a “sippy cup” and learn how to drink from it.
When feeding solid foods to an infant:
Use a baby-sized spoon—a small spoon with a broad handle.
Hold the infant comfortably on your lap, as for breastfeeding or bottle-feeding, but in a more upright position to ease swallowing.
Add some breast milk or infant formula to the cereal, and place a small dab of the semisolid food on the spoon’s tip. Gently place the spoon on the infant’s tongue and tilt it so the food slides onto the tongue. If the infant spits it out, do not continue with the feeding.
Expect the infant to take only two or three bites during these early feeding sessions.
By the end of the first year, an infant should be consuming many different foods—grain products, meats, fruits, and vegetables—along with breast milk or infant formula. Introducing a baby to various foods helps the child learn about different tastes, odors, and textures. However, certain foods and beverages are not appropriate for infants. Avoid feeding an infant these things:
Excessive infant formula or human milk. Depending on their age, most infants need less than 30 ounces of human milk or infant formula daily. A child who drinks too much milk may not eat enough solid foods that contain nutrients lacking in milk.
Semisolid baby cereal in a baby bottle that has the nipple opening enlarged. This practice contributes to overfeeding and does not help the child learn self-feeding skills.
Candy, flavored gelatin water, or soft drinks. These items provide few micronutrients.
Small pieces of hard or coarse foods. Foods such as hot dogs (unless finely cut into sticks, not coin shapes), whole nuts, grapes, chunks of cooked meat, raw carrots, popcorn, and peanut butter can cause choking. Caregivers should supervise meals to keep young children from stuffing too much food in their mouths.
Excessive amounts of apple or pear juice. The fructose and sorbitol, a sugar alcohol, contained in these juices can lead to diarrhea. Also, if the infant drinks fruit juice or fruit drinks rather than breast milk or infant formula, the child may not be receiving adequate amounts of calcium and other essential minerals.
Unpasteurized (raw) milk. Raw milk may be contaminated with bacteria or viruses.
Goat’s milk. Goat’s milk is low in iron, folate, and vitamins C and D
At bedtime, many caregivers place infants in their cribs with a baby bottle containing formula, juice, or a sugar-sweetened drink. This practice is not recommended, because the sleepy infant sucks slowly, allowing the carbohydrate-containing fluid to bathe the child’s teeth and provide a source of nutrients for bacteria that stick to teeth.
These bacteria produce acids that dissolve tooth enamel, causing cavities to form in the teeth (dental caries). Dentists often refer to this condition as “baby bottle caries” (Fig. 13.10). To reduce the risk of baby bottle caries, infants should be given only water in their bedtime bottles. Baby bottle caries.This infant has baby bottle caries. To reduce the risk of baby bottle caries, infants should be given only water in a baby bottle at bedtime.
During routine “well baby” checkups, a health professional usually measures the infant’s length, weight, and head circumference (Fig. 13.11). Head circumference measurements assess brain growth, which occurs at a rapid rate during the first 18 months of life. The three values are then compared to those indicating typical growth patterns displayed on growth charts available at the Centers for Disease Control and Prevention website
The charts display percentile divisions; a percentile ranks the child’s size among other children who are the same age and gender. If an infant boy’s length, for example, is at the 90th percentile according to the length-for-age chart, he is the same length as or taller than 90% of the other boys his age. Furthermore, this child is the same length as or shorter than 10% of boys his age. If the infant’s rate of growth slows down too much or is higher than normal, the child’s physician should investigate whether a medical or nutritional problem is responsible for the unusual measurements.
What is the “let-down reflex”?
brain releases oxytocin
hormone signals breast to let down milk
milk travels through tubes to the nipple
How does lactation affect a new mother’s energy needs?
300 – 400 kcals more than pregnancy needs
What is colostrum, and why is it a valuable first food for breastfed babies
colostrum is a very important first food for babies, because the fluid contains antibodies and immune system cells that can be absorbed by the infant’s immature digestive tract. reduces infectin
Dietitians and other health experts recommend that infants be breastfed exclusively during their first months of life.
identify at least three benefits that women derive from breastfeeding their babies.
free of bacteria
antibodies and immune cells
reduce risk of allergies
reduces uterine bleeding
decreases risk of breast and ovarian cancer before menapause
Compare the energy, macronutrient, and calcium contents of an ounce of human milk with those of an ounce of cow’s milk.
more carbs and fat
Identify at least three physiological indications that an infant is ready to eat solid foods.
loss of extrusion reflex
coordinate head and mouth muscles
digest, metabolize, excrete wider range
Describe three ways that a qualified health care practitioner can monitor an infant’s growth.
monitor height, weight, head circumference
Childhood can be divided into the preschool period (2 to 5 years of age) and the school-age period (6 to 11 years of age).
The rapid growth rate that characterizes the first 12 months of life tapers off quickly during the preschool years and proceeds at a slow but steady rate until the end of childhood. If an average infant’s growth rate did not slow down, he or she might weigh about 190 pounds and be about 5′7″ tall by 3 years of age! However, the average 3-year-old weighs about 32 pounds and is about 3 feet in height.
The preferred growth standard for children who are 2 to 20 years of age is the body mass index (BMI)-for-age.
The BMI-for-age is a number calculated from the child’s height and weight. BMI charts for children are both sex- and age-specific. An overweight child has a BMI-for-age that is at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex.30 An obese child has a BMI-for-age that is at or above the 95th percentile for children of the same age and sex.
Eight weeks after conception, the developing human being is referred to as a fetus.
The role of the placenta is to transfer nutrients and oxygen from the mother’s bloodstream to the embryo/fetus. Additionally, the placenta transfers wastes from the embryo/fetus to the mother’s bloodstream, so her body can eliminate them.
Birth weight is a major factor that determines whether a baby is healthy and survives his or her first year of life.
A preterm birth is defined as one that occurs before 37 weeks of pregnancy.
Women whose prepregnancy weights were within the healthy range can expect to gain 25 to 35 pounds. Underweight women should gain 28 to 40 pounds; overweight women should gain 15 to 25 pounds during pregnancy. Obese women should gain at least 15 pounds during pregnancy. The recommendations are higher for women who are pregnant with more than one fetus.
Pregnant women who are folate deficient have a high risk of giving birth to infants with neural tube defects, such as spina bifida. Pregnant women who are iron deficient can develop iron deficiency anemia, a condition that increases the risk of giving birth prematurely and having low-birth-weight (LBW) infants.
Women who drink alcohol during pregnancy are at risk of having a child with a fetal alcohol spectrum disorder. Compared to pregnant women who do not smoke cigarettes, expectant mothers who smoke have higher risk of giving birth too early and having LBW babies. Furthermore, expectant mothers who smoke cigarettes may increase the risk of having babies with birth defects or that die of sudden infant death syndrome.
In response to an infant sucking on its mother’s nipple, the brain releases oxytocin, a hormone that signals breast tissue to “let down” milk. The let-down reflex enables milk to travel in several tubes to the nipple area. When let-down occurs, the infant removes the milk by continued sucking.
Lactation increases a new mother’s energy needs by about 300 to 400 kcal more than her prepregnancy energy needs.
Colostrum is the first secretion of the breasts that occurs after delivery. Colostrum is a very important first food for babies, because the fluid contains antibodies and immune system cells that can be absorbed by the infant’s immature digestive tract. Colostrum also contains a substance that encourages the growth of a type of bacteria in the baby’s intestinal tract that reduces the risk of infection.
A food jag is a period in which the child refuses to eat a food that was liked in the past or in which the child wants to eat only a particular food.
In children, iron deficiency can lead to decreased physical stamina, learning ability, and resistance to infection.
Answers will vary but should include brushing teeth with a pea-sized amount of fluoride-containing toothpaste twice daily; providing routine pediatric dental care; offering fluoridated drinking water; not eating sticky, sugary snacks, especially between meals; and offering sugarless chewing gum.
Foods that commonly trigger allergic responses in children are peanuts, tree nuts, fish, shellfish, milk, eggs, soybeans, and wheat.
Factors that contribute to obesity among children include spending too much time on sedentary activities; consuming too many energy-dense empty-calorie foods and beverages; and having a family history of obesity, high birth weight, and obese family members.
Compared to preschoolers, older children often skip breakfast, and they typically consume more foods away from home, larger portions of food, and more fried foods and sweetened beverages.
School-age children also tend to consume less milk and fewer fruits and vegetables, except fried potatoes.
higher-than-normal blood pressure, cholesterol, and glucose levels. Obese children are also more likely to have low self-esteem, sleep apnea, musculoskeltal problems, and heartburn than children who have healthy body weights. Obese children are at risk of hypertension, heart disease, obesity, and type 2 diabetes later in life.
Children need at least
60 minutes of moderate-intensity physical activity, most days of the week.
tips to get kids to eat
encouraging children to eat breakfast and other tips from the “Food & Nutrition Tips” feature in the “School-Age Children” section
Boys usually begin their growth spurt when they are between 12 and 15 years of age.
Most girls begin their growth spurt between 10 and 13 years of age.
Obese teenagers are at risk of developing
type 2 diabetes, elevated blood cholesterol, and hypertension.
Iron deficiency leads to increased fatigue and decreased ability to concentrate and learn.
Inadequate calcium intake during adolescence is associated with decreased bone mass and increased likelihood of bone fractures later in life.
Life expectancy is the length of time a person born in a specific year, such as 1900, can expect to live.
Life span refers to the maximum number of years a human can live.
Compared to younger persons, older adults have greater risk of nutritional deficiencies because of physiological changes associated with the normal aging process.
Other factors that can influence an older person’s nutritional status include illnesses, medications, low income, and lack of social support.
Diets of older adults, particularly older women, often provide inadequate amounts of
vitamins D, A, C, and B-12 and minerals such as calcium, iron, and zinc.
Caregivers can improve nutrient intakes of older persons by adding more spices to foods, making mealtimes social events, and serving energy-dense snacks between meals, such as cheese, milkshakes, nuts, or oatmeal cookies.
If the elderly person has difficulty chewing, serving soft items such as ground meats, cooked vegetables, pureed fruits, and puddings can increase food intake.
Meals on Wheels and the congregate food program is a program that
offers home-delivered meals for older adults who are homebound. Low income, illness, lack of social support, inadequate grain, milk, vegetable, fruit, and overfat, loss of muscle mass and strength, physical inactivity, increase type 2 diabetes, hypertension, CVD, osteoarthritis. After 70 loss of taste, loss of teeth, trouble swallowing, increase seasoning, socialize meals, energy dense snacks (cheese, milkshakes, nuts, oatmeal cookies)
The leading causes of death for Americans are chronic diseases—heart disease, cancer, and stroke.
Lifestyles, especially dietary practices and physical activity patterns, contribute to the development of these chronic conditions. Other factors that influence a person’s overall health include heredity, relationships, environment, income, education level, and access to health care.
Embryonic/fetal life is characterized by rapid rates of cell division, resulting in a dramatic increase in cell numbers. The first trimester of pregnancy is a critical stage in human development because inadequate or excessive nutrient intakes as well as exposure to toxic compounds can have devastating effects on the embryo/fetus during this period.
The placenta is the organ of pregnancy that transfers nutrients and oxygen from the mother’s bloodstream to her embryo/fetus. The placenta also transfers wastes from the embryo/fetus to the mother’s bloodstream so her body can eliminate them. Infectious agents and harmful chemicals can pass through the placenta, enter the embryo/fetus, and cause disease, birth defects, or embryonic/fetal death.
Women of childbearing age should take steps to ensure they are in good health prior to becoming pregnant. During pregnancy, the woman’s body undergoes various physiological changes.
These changes enable her body to nourish and maintain the developing fetus, as well as to produce milk for her infant after its birth. A pregnant woman should follow a diet that meets her own nutritional needs as well as those of her developing offspring. During the second and third trimester, the pregnant woman’s energy needs increase beyond her prepregnancy energy requirement. Additionally, needs for certain vitamins and minerals increase during pregnancy. The mother-to-be can use MyPlate to develop nutritionally adequate daily menus, but she may also need to take a prenatal vitamin/mineral supplement.
Women whose prepregnancy weights were within the healthy range can expect to gain 25 to 35 pounds during pregnancy. Women who gain excess weight during pregnancy may retain the extra weight long after delivery. Most women gain up to 4 pounds during the first trimester; they gain 3 to 4 pounds each month during the second and third trimesters.
Monitoring weight gain is an important aspect of prenatal care. Rapid weight gain, especially after the fifth month of pregnancy, could be a sign of pregnancy-induced hypertension (PIH). Underweight women who do not gain enough weight during pregnancy are at risk of having preterm or low-birth-weight infants. Obese women have greater risk of developing hypertension and type 2 diabetes during pregnancy. However, women should not try to lose weight while they are pregnant
School-age children often skip breakfast, and they tend to consume more foods away from home, larger portions of food, and more fried foods and sweetened beverages. Children who eat breakfast are more likely to have better diets and healthier body weights than children who skip this meal. Diets of many school-age children fail to supply recommended amounts of calcium and potassium while providing too much sodium.
ublic health experts are very concerned about the increasing prevalence of obesity among children in the United States. Overfat children have higher risks of elevated blood pressure, cholesterol, and glucose levels than children whose weights are within the healthy range. Overfat children may also have higher risk of hypertension, heart disease, and type 2 diabetes later in life. Such children are also more likely to have low self-esteem and become obese as adults.
According to biogerontologists, longevity results from the body’s ability to prevent and repair the damage done by a lifetime of exposure to the environment and the effects of everyday “wear and tear.”
Little credible scientific evidence exists to support the use of antiaging therapies that include taking hormones or megadoses of vitamins and antioxidants. At this point, there is no way to prevent aging from following its natural course in humans. Nevertheless, researchers are conducting experiments to better understand the process of aging and the keys to longevity.
During pregnancy, a mother-to-be should double her food intake because she’s “eating for two.
he natural size of a woman’s breasts is not a factor in determining her ability to breastfeed her baby
Experts with the American Academy of Pediatrics recommend adding solid foods to the infant’s diet within the first month after a baby is born.
Over the past 35 years, the prevalence of obesity has increased among American school-age children.
Compared to younger persons, older adults have lower risks of nutritional deficiencies.
Many parents think adding solid foods to infants’ diets helps babies sleep through the night.
Actually, this developmental milestone generally occurs around 3 to 4 months of age, regardless of what infants are eating.
Infants who have a high risk of food allergy have a parent or sibling who has a history of allergies, including food allergy.
Foods that are associated with allergic responses in infants include egg whites, chocolate, nuts, and cow’s milk. Therefore, caregivers should not offer these foods to high-risk babies under 6 months of age. Many babies outgrow food allergies during childhood, but some children remain allergic to the foods through adulthood.
Many teenagers are plagued by acne—pimples, blackheads, and reddening of the skin—that often occurs on the face, upper back, and chest. Many people think acne is caused by eating certain foods, especially greasy foods and chocolate.
However, no scientific evidence links specific foods with acne. According to physicians who treat skin disorders (dermatologists), hormonal changes normally associated with puberty cause acne.
The embryo/fetus develops most of its organs during the
The placenta cannot
transfer nutrients from the mother’s bloodstream to the embryo/ fetus.
eliminate waste products from the embryo/fetus.
prevent all toxic substances from reaching the embryo/fetus.
transfer oxygen from the mother’s bloodstream to the embryo/ fetus.
prevent all toxic substances from reaching the embryo/fetus.
During the first trimester, a pregnant woman’s daily energy requirement is ______ her daily energy needs before she became pregnant.
300 kcal lower than
about the same as
300 kcal higher than
500 kcal higher than
about the same
Women with prepregnancy weights within the healthy range should gain ______ during pregnancy.
Preeclampsia is a form of ______ that can develop during pregnancy.
Which of the following statements is true?
A woman’s energy needs are higher during the first trimester than at any other time in pregnancy.
Using infant formula to bottle-feed a baby is more convenient and less expensive than breastfeeding a baby.
Oxytocin is necessary for the “let-down” reflex to occur.
The American Pediatric Association recommends feeding fresh whole milk to infants when they are 6 months of age.
Oxytocin is necessary for the “let-down” reflex to occur.
healthy infant who weighs 6.5 pounds at birth can be expected to weigh ______ pounds by her first birthday.
Breastfed infants are ______ than babies who are fed infant formula.
more likely to have diarrhea
less likely to have cystic fibrosis
more likely to have respiratory infections
less likely to have ear infections
less likely to have ear infections
Infants are physically ready to start eating solid foods when they are ______ of age.
4 to 6 weeks
4 to 6 months
6 to 12 months
12 to 14 months
4 to 6 months
Pediatricians often recommend ______ as the first solid food offered to an infant.
iron-fortified infant rice cereal.
mixed baby food dinners.
cooked egg whites
iron-fortified infant rice cereal.
Which of the following foods is not a common source of food allergens?
Which of the following factors is associated with increased risk of obesity during childhood?
having a family history of obesity
eating 3 to 5 servings of fresh fruit daily
being a low-birth-weight infant
All of the choices are correct.
having a family history of obesity
Which of the following factors can influence an older person’s nutritional status?
All of the choices are correct
Which of the following practices has been scientifically shown to extend the human life span?
taking antioxidant supplements
eating a high-protein diet
performing vigorous physical exercise
None of the choices are correct.
a baby born before 37th week is
declining organ function after physical maturity
gradual physical decline that is related to aging and during which the body becomes less strong and efficient.
trend in food intake from infancy to childhood
food intake decreases from infancy to childhood
milk let down
high birth weight
for infants if mother is vegetarian
doubles in length
increase 3 to 4 times in weight
poor absorption of b12