Page 380 - Encyclopedia of Nursing Research

NuTRITION IN INFANCy AND CHILDHOOD n 347

most prevalent nutritional disorder in child- The American Academy of Pediatrics
hood and adolescence and is linked with (AAP) Committee on Nutrition (2005) rec-
many of these chronic conditions. Nutrition ommends human milk as the ideal source N
has always been a cornerstone of pediatric of nutrition for the first 6 months of life. In
primary health care; however, these collec- situations where breast-feeding is not prac-
tive diet-disease observations, primarily of tical or desired, commercial formulas are
adult populations, have placed increasing recommended as the alternative form of
emphasis on preventive interventions begin- infant nutrition. Recent AAP Committee on
ning early in life. Nutrition (2005) recommendations reaffirm
Infancy is a time of rapid growth and human milk or commercial formula as the
developmental change in all domains includ- primary milk source throughout the first year
ing physical, cognitive, and psychosocial of life and discourage cow’s milk, reduced fat,
processes. energy requirements during this and evaporated milk. In addition, breast-fed
period of the life course exceed others and are infants should receive 400 international units
approximately 90 to 100 kcal/kg body weight/ of vitamin D daily and iron supplementation
day. Recommended (or reference) intakes of at 4 months of age.
most nutrients have now been established and Accumulated data indicate that the age
appear to fulfill the unique nutritional needs of introduction of supplemental foods should
of infants and young children. The Food and not be rigidly specified; however, 6 months
Nutrition Board of the National Academy of age appears to be optimal for the majority
of Sciences has provided estimated average of healthy term infants. AAP (2005) empha-
requirement and adequate intake (AI) refer- sized the introduction of single-ingredient
ence data for infants (birth to 6 months of age foods, started one at a time at weekly inter-
and 7–12 months of age), toddlers (1–3 years vals, to allow for the identification of food
of age), and children of early school age (4–8 intolerance. Progression of feeding practices
years). The currently recommended energy beyond this point may vary as a function of
intakes are based on total energy expendi- individual, family, cultural, and economic
ture measured by the doubly labeled water factors. Achievement of individual growth
technique plus allowance for growth based and developmental milestones, however, is
on changes in body composition. These are universally recommended as a major deter-
about 15% lower than the previous recom- minant of nutrition throughout the first year
mended daily allowance established require- of life (AAP, 2005).
ments. Sufficient fat for essential fatty acid Although significant advances in the
requirements (0.5–1.0 g/kg/day of linoleic art and science of infant nutrition have been
acid plus a smaller amount of alpha-linoleic made in the past two decades, many chal-
acid) and sufficient carbohydrate to prevent lenges remain. A continuing focal point for
hypoglycemia and/or ketosis are required pediatric health care professionals is increas-
(~5.0 g/kg/day). Controversy continues ing the proportion of women who breast-feed
regarding the need for long-chain polyun- in the early postpartum period and through-
saturated fatty acid supplementation (for out the first 6 months of life. Breast-feeding
formula-fed infants). A recent evidence-based has been listed as a continued goal from
report to the Food and Drug Administration Healthy People 2010 to Healthy People 2020.
reaffirmed selected neurodevelopmental ben- The rates appear increased in some segments
efits associated with this supplementation; of the population: the goals are being revised
however, because results were not consistent for Healthy People 2020 to 85% at inception,
across studies, infant formula manufacturers 60% at 3 months of age, and 35% at 6 months
have the option to include long-chain polyun- of age. The prevalence of iron-deficiency
saturated fatty acid. has decreased in the past several decades;