CASE STUDY – PREGNANCY AND THE WIC PROGRAM



Case Study #2: Infancy

100 points

Spring 2017

Due: March 1 by 11:59 pm in Canvas.

Purpose: The purpose of this case study is to evaluate the growth pattern of an infant, identify any nutrition-related concerns for growth and development, and develop a feeding plan that presents the infant with optimal nutrition while meeting the mother’s needs.

Instructions:

• Complete case study individually and submit your assignment to Canvas. This will include:

o Typed answers to the essay questions and tables

o Completed WHO growth charts

• Do not put your name on this document. Grading will be done anonymously and linked from your submission in Canvas.

• Use these resources to assist you with this case study:

o Textbook and class notes

o WHO growth charts

o Airplane Choo Choo: A Guide to Feeding your Baby for the First Two Years

o

o Use of Soy Protein-Based Formulas in Infant Feeding (AAP article)

Background Information (Assessment data):

Andy is a 7-month-old infant boy. His mother exclusively breastfed him until two weeks ago, at which time she began using an infant formula and introduced baby food bananas and peaches. Today, during Andy’s routine, well-child pediatrician visit, his mother, Janet, informs the pediatrician that she stopped breastfeeding and introduced formula and infant foods. Janet indicates that she “no longer has a milk supply” (has stopped lactating), but is now worried that she should not have stopped breastfeeding, because Andy does not seem to be as hungry or growing as fast as he did two to four weeks ago. When she was breastfeeding, Janet nursed Andy six times each day (once every four hours), for about 30 minutes during each breastfeeding session. Janet discloses that she stopped lactating, because she has a one-week vacation planned with her husband later in the month to celebrate their 5th anniversary; she wanted to wean her son off the breast before the trip.

The pediatrician evaluated Andy and he tested negative for food allergies. Andy did well at breastfeeding and did not exhibit any problems digesting the breast milk. When asked why she chose Similac® Soy Isomil® Infant Formula with Iron, Janet replied the internet source she found said soy was better for the baby than casein based formula. Janet obtained her information from a blog called “Mother Earth News” that is hosted by individuals who follow vegan lifestyles and only eat organic foods. Even though Janet consumes small amounts of meat and dairy, she thought giving Andy soy would be best.

Janet feeds Andy 8 ounces of Similac® Soy Isomil® Infant Formula with Iron 4 times per day (~947 mL total). She uses the powder formula. She prepares the formula according to the package directions. The information on “Mother Earth News” also recommended that when feeding with formula, babies should be kept on a very regular schedule and that complementary foods should be given separately from formula to help with digestion.

Janet tries to maintain a schedule where she provides formula at 7 am, 1 pm, 7 pm, and 1 am. At mid-morning (10 am), mid-afternoon (4 pm), and in the evening (around 8 pm), Janet feeds Andy 1 Tbsp of Gerber® bananas or 1 Tbsp of Gerber® peaches for a total of 3 Tbsp of baby food fruit each day. She has found lately that Andy is very hungry in the morning and eats very well. In the afternoon, he is quite fussy and she cannot figure out what is the matter.

Andy’s growth information is below:

|Age (month) |Weight (pounds) |Length (inches) |Head circumference (inches) |

|Birth |7 lbs, 2 oz |19.1” |14.2” |

|1 month |10 lbs, 0 oz |21.0” |15.0” |

|2 months |11 lbs, 9 oz |22.5” |15.8” |

|3 months |13 lbs, 6 oz |24.1” |16.3” |

|4 months |14 lbs, 14 oz |25.1” |16.6” |

|5 months |15 lbs, 5 oz. |26.0” |17.2” |

|6 months |(missing) |(missing) |(missing) |

|7 months |16 lbs, 3 oz. |27.8” |17.6” |

Use the background information to answer the questions below. Type your answers.

Assess the GROWTH PATTERN

1. Select the appropriate WHO charts and accurately plot Andy’s growth trajectory (pattern) for weight-for-age; length-for-age; weight-for-length, and head circumference-for-age. Submit the growth charts with your case study (either as part of this document or a separate document). (12 points)

The graphs are attached to the bottom of this document.

2. Evaluate Andy’s growth pattern for his: weight; length; and head circumference to determine whether Andy is growing appropriately. In your evaluation, discuss the rate of growth, the pattern of growth, and the meaning of the growth patterns in relation to overall growth and development. (8 points)

It is important to watch the growth of children to ensure they are growing properly. Their growth can be evaluated through 4 different growth charts. First, the Weight-for-age is within the average range of development. This measurement is important to indicate underweight, under-nourishment, or overweight. In the Length-for-age chart, Andy is in the correct range of development. Length is an important measurement to ensure they are growing properly. Some children may exhibit slow growth in length if they are undernourished. Weight is also used an indicator of nutritional status. Next, the Weight-for-length chart is also within the correct range for development. This measurement is the key indicator of determining wasting in children and helps determine a child’s nutritional status. Wasting is a major cause of mortality in children under 5 so it is important to track to avoid this. These measurements also can tell parents about the child’s risk factor of child obesity. Lastly, Andy’s Head circumference-for-age is within the correct range for development. During the early years of a child’s life, head circumference is used as a valuable measurement because it indirectly reflects brain size and growth. Since almost all brain growth happens by age two these measurement help tracks a child’s brain health.

DIET AND NUTRITION Assessment and Diagnosis

Evaluate the two Infant Formulas

3. Compare Similac® Soy Isomil® ()

to Enfamil® Infant formula () by filling in the blanks in the following table. (12 points)

|Per 100 Calories |Similac® Soy Isomil® |Enfamil® Infant |

|prepared | | |

|Energy (kcals) |100 kcals |100 kcals |

|Carbohydrate (g) |10.4 g |11.3 g |

|List carbohydrate sources |Corn syrup solid (39%), soy protein isolate|Nonfat Milk, Lactose, polydextrose, |

|(Read the ingredient list) |(14%), sugar (10%) |galactoligosaccharides |

|Protein (g) |2.45 g |2 g |

|Fat (g) |5.46 g |5.3 g |

|List fat sources |High Oleic Safflower Oil (11%), coconut oil|Vegetable oil, palm Olein, coconut oil, soy |

|(Read the ingredient list) |(8%), soy oil (8%), C. cohnii oil |oil, high oleic sunflower oils, C cohnii oil |

|Iron (mg) |1.9 mg |1.8 mg |

|Source of long chain omega-3 fatty acids (DHA) |C. Cohnii oil |Crypthedocinum cohnii oil |

Estimate Andy’s energy and nutrient needs and compare them to his current intake

4. Fill out the chart below with the following. Show your calculations below the chart. (8 points):

a. Andy’s estimated energy and nutrient needs based on the appropriate DRIs.

b. Calculate Andy’s daily intake of energy and nutrients from his formula and from his baby food.

| |Andy’s Estimated Needs |Andy’s Current Intake |Andy’s Current Intake from |

|Per day | |from formula |complementary foods |

|Energy (kcals) |743 kcal/day |607 kcal/day |37.5 kcals |

|Protein (g) |11 g/day |14.87 kcal/day |Not a significant source ( ................
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