Nutrition: Week Four

Chapter Seven: Nutrition Across the Lifespan

Major stages of the lifespan that have specific nutritional needs include pregnancy, infancy, childhood, adolescence, and adulthood and older adulthood.
Nurses must address nutritional needs across the lifespan and have a thorough understanding of how needs change.

Pregnancy & Lactation

Dietary Guidelines

•Achieving an appropriate amount of weight gain during pregnancy prepares a client for the energy demands of labor and lactation, and contributes to the delivery of a newborn of normal birth weight.

•The recommended weight gain during pregnancy depends on their body mass index and weight prior to pregnancy. See figure 7.1 of ATI book.

•Lactating clients require an increase in daily caloric intake. If breastfeeding an additional 330 calories is recommended during the first 6 months, and additional 400 calories per day during second 6 months.

Major & Micronutrient Requirements

Protein should comprise 20% of the daily calorie intake. The DRI for protein during pregnancy is 71 g/day.
Fat should be limited to 30% of total calorie intake.
Carbohydrates should comprise 50% of the daily calorie intake.
Most vitamins and mineral needs are increased during pregnancy and lactation. See table 7.2 for DRIs during nonpregnancy, pregnancy, and lactation.

Additional Dietary Recommendations

Fluid: 2,000 to 3,000 mL fluids from food and drinks. Water, fruit juice, and milk preferred.
Alcohol: Abstain. No safe recommendation during pregnancy.
Caffeine: moderate use (less than 200 mg/day) does not appear harmful but it does cross the placenta and affect movement and heart rate.
Vegetarian diets: well balanced and should include dairy

Additional Dietary Recommendations - continued

Folic acid intake: recommended 600 mg/day during pregnancy. 500 mg/day when lactating. Needed for maternal blood cell production and fetal neurological development.
Iron: DRI increases by 50% during pregnancy. Recommended supplement of 27-30 mg/day.
Nonnutritive sweeteners: occasional use
Fish: advisory for shellfish due to mercury. Fish are good source of omega 3 fatty acids. Limit consumption to 12 oz per week.

Dietary Complications

Nausea and constipation: For nausea eat dry crackers, toast, salty or tart foods. Avoid alcohol, caffeine, fats, and spices. For constipation increase fluid intake to at least 8 cups/day, and increase fiber in diet.
Maternal phenylketonuria (PKU) – maternal genetic disease causing fetal intellectual disability and behavior problems. Start PKU diet 3 months prior to pregnancy. Consume foods low in phenylalanine. Monitor levels through pregnancy.

Infancy

Growth rate more rapid than any other period of the life cycle. 1 inch per month during first 6 months, 0.5 inches per month for months 6-12.
Birth rate should double by 4-6 months and triple by 1 year of age.
Weight gain averages 5-7 oz/week during first 5 to 6 months.
Head circumference increases 1.5 cm per month for first 6 months, 0.5 cm/month for months 6-12. By one year head size should increase 33%.
Breast milk, infant formula is sole source of nutrition for first 6 months.
Semisolid foods should not be introduced before 6 months.
Iron supplementation for breast fed infants after 4 months until solid foods are introduced.
Milk should not be introduced until one year of age.

Breastfeeding

Newborn is offered immediately after birth and frequently thereafter. 8-12 feedings in a 24-hour period.
15 minutes per breast
Frequent feedings (every 2 hours can be indicated). Awaken infant to feed every 3 hours during the day and every 4 hours at night.
Expressed milk can be refrigerated for up to 24 hours, 3 months if frozen.
Thaw in refrigerator. Can be stored for 24 hours after thawing. Do not microwave or heat to defrost. Do not refreeze.
Limit alcohol and caffeine while breastfeeding.

Formula Feeding

If formula-fed, an iron-fortified formula is recommended for the first 12 months or until solid foods are introduced.
Fluoride supplements may be necessary.
Bottles of mixed formula or open cans require refrigeration. Do not use if left at room temp for 2 hours or longer. Do not reuse partially emptied bottles.
Can be fed chilled, warmed, or at room temp.
Infant should not drink more than 32 oz per 24-hour period unless directed by provider.

Introducing Solid Food

If formula-fed, an iron-fortified formula is recommended for the first 12 months or until solid foods are introduced.
Fluoride supplements may be necessary.
Bottles of mixed formula or open cans require refrigeration. Do not use if left at room temp for 2 hours or longer. Do not reuse partially emptied bottles.
Can be fed chilled, warmed, or at room temp.
Infant should not drink more than 32 oz per 24-hour period unless directed by provider.

Nutrition Related Problems

Colic: persistent crying lasting 3 hpurs or longer per day. If breastfeeding, eliminate cruciferous vegetables, cow’s milk, onions, chocolate, and limit caffeine and nicotine. Burp infant in upright position.
Lactose intolerance: soy-based or casein hydrolysate formulas can be prescribed.
Failure to Thrive: inadequate gains in weight and height.
Diarrhea: passage of more than 3 loose, watery stools over a 24-hour period. Overfeeding or infectious causes. Treat with oral rehydration solutions. Not sports drinks. Contact provider if signs of dehydration.
Constipation: inability or difficulty to evacuate the bowels. Not common when breastfeeding. Can be cause by formula.

Childhood - Toddlers: 1 to 3 Years Old

NUTRITIONAL GUIDELINES

•Generally grow 2-3 inches in height and gain 5-6 lb/year.
•Limit 100% juice to 4-6 oz/day.
•1- to 2-year-olds require whole cow’s milk.
•Food serving size is 1 tbsp for each year of age.
•Avoid snacks or desserts high in sugar, fat, sodium.
•Avoid foods that are a choking hazard, cut small, bite-sized pieces and supervise.

NUTRITIONAL CONCERN/RISKS

•IRON: most common deficiency in children. Lean red meats provide sources of iron. Consuming Vit C with plant sources of iron (beans, raisins, peanut butter, whole grains) maximizes absorption. Limit milk to 24 oz because it is a poor source of iron.

•Vitamin D: essential for bone development. Recommended 5 mcg/day. Milk and fatty fish are good sources. Sunlight exposure leads to Vit D synthesis.

Childhood - Preschoolers: 3 to 6 Years

NUTRITIONAL GUIDELINES

•Generally grow 2–3 inches in height and gain 5-6 lb/year.

•Need to consume 13 to 19 g/day of complete protein.

•If good nutrition no supplements are needed.

•Patterns and preferences are first learned from the family, peers begin influencing preferences and habits at around 5 years of age.

NUTRITIONAL CONCERN/RISKS

•Concerns include overfeeding, intake of high=calorie, high-fat, high-sodium snacks, soft drinks, and juices, and inadequate intake of fruits and vegetables.

•Iron-deficiency anemia

•Lead poisoning- a risk for children younger than 6 years of age because they frequently place objects in their mouths that can contain lead.

Childhood - School-age: 6 to 12 Years

NUTRITIONAL GUIDELINES

•Generally grow 2–3 inches in height and gain 5-6 lb/year.

•Diet should provide variety, balance, and moderation

•Young athletes need to meet energy, protein, and fluid needs.

•Educate children to make healthy choices.

•Children enjoy learning how to safely make nutritious snacks.

•Children need to learn to eat snacks only when hungry, not when bored or inactive.

NUTRITIONAL CONCERNS/RISKS

•Not eating breakfast- occurs in 10% of children.

•Overweight/obesity- affects 20% of children.

Adolescence

•The rate of growth during adolescence is second only to the rate in infancy. Nutritional needs for energy, protein, calcium, iron, and zinc increases at the onset of puberty and the growth spurt.

•The female adolescent growth spurt usually begins at 10 or 11 years of age, peaks at 12 years, and is completed by 17 years. Female energy requirements are less than that of males, as they experience less growth of muscle and bone tissue and more fat deposition.

•The male adolescent growth spurt begins at 12 or 13 years of age, peaks at 14 years, and is completed by 21 years.

•Eating habits of adolescents are often inadequate in meeting recommended nutritional intake goals.

NUTRITIONAL CONSIDERATIONS

•Energy requirements average 2,000 cal/day for a 12- to 18-year-old female and 2,200 to 2,800 cal/day for a 12- to 18-year-old male.

•The USDA reports that the average U.S. adolescent consumes a diet deficient in folate, vitamins A and E, iron, zinc, magnesium, calcium, and fiber. This trend is more pronounced in females than males.

•Diets of adolescents generally exceed recommendations for total fat, saturated fat, cholesterol, sodium, and sugar.

NUTRITIONAL RISKS

•Increased need for iron. Females 14-18 years of age require 15mg/day of iron to support expansion of blood volume and blood loss during menstruation. Males 14 -18 years of age require 11 mg/day of iron to support expansion of muscle mass and blood volume.

•Inadequate calcium intake can predispose the adolescent to osteoporosis later in life. Adolescents require at least 1,300 mg/day of calcium, which can be achieved by three to four servings from the dairy food group.

•Dieting. The stigma of obesity and social pressure to be thin can lead to unhealthy eating practices and poor body image, especially in females. Males are more susceptible to using supplements and high-protein drinks in order to build muscle mass and improve athletic performance. Some athletes restrict calories to maintain or achieve a lower weight. Eating disorders can follow self-imposed crash diets for weight loss.

•Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder) commonly begin during adolescence.

•Adolescent pregnancy. The physiologic demands of a growing fetus compromise the adolescent’s needs for their own unfinished growth and development.

•Inconsistent eating and poor food choices place the adolescent at risk for anemia, pregnancy-induced hypertension, gestational diabetes, premature labor, miscarriage, and delivery of a newborn of low birth weight.

Adulthood & Older Adulthood

•A balanced diet for all adults consists of 45% to 65% carbohydrates, and 20% to 35% fat (with 10% or less from saturated fats).

•The recommended amount for protein is unchanged in adults and older adults

•Older adults need to reduce caloric intake. This is due to the decrease in metabolic rate that occurs from the decrease in lean body mass that develops with aging.

•Dehydration is the most common fluid and electrolyte imbalance in older adults.