Instructor Manual: Marie A. Boyle, Community Nutrition in Action, 8th ed., ISBN 9780357367957; Chapter 11: Mothers and Infants:
Nutrition Assessment, Services, and Programs
Instructor Manual
Marie A. Boyle, Community Nutri琀椀on in Ac琀椀on, 8th ed., ISBN 9780357367957; Chapter 11:
Mothers and Infants: Nutri琀椀on Assessment, Services, and Programs
Table of Contents
Purpose and Perspective of the Chapter.......................................................................................................2
Chapter Objectives......................................................................................................................................2
Chapter Outline...........................................................................................................................................2
Discussion Questions...................................................................................................................................8
Activities and Assignments.......................................................................................................................11
Additional Resources.................................................................................................................................17
Videos....................................................................................................................................................17
Internet Resources................................................................................................................................17
Appendix...................................................................................................................................................18
Generic Rubrics......................................................................................................................................18
Standard Wri琀椀ng Rubric........................................................................................................................18
Standard Discussion Rubric...................................................................................................................19
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 1
website, in whole or in part.
, Instructor Manual: Marie A. Boyle, Community Nutrition in Action, 8th ed., ISBN 9780357367957; Chapter 11: Mothers and Infants:
Nutrition Assessment, Services, and Programs
Purpose and Perspec琀椀ve of the Chapter
The purpose of this chapter is to examine trends in maternal and infant health, factors that support health
in mother and infants, and federal programs to support low-income women and their infants and children.
A case study presents an opportunity for students to plan a breastfeeding promotion program for low-
income women. A Professional Feature presents a plan for planning for the future.
Chapter Objec琀椀ves
The following objectives are addressed in this chapter:
11.1 List the recommendations for maternal weight gain during pregnancy.
11.2 Explain the relationship of maternal weight gain to infant birthweight.
11.3 Identify nutritional factors and lifestyle practices that increase health risk during pregnancy.
11.4 Describe the benefits of breastfeeding.
11.5 Describe the purpose, eligibility requirements, and benefits of the federal nutrition programs
available to assist low-income women and their children.
11.6 Identify the common nutrition-related problems of infancy.
11.7 Describe current recommendations for feeding during infancy.
Chapter Outline
I. Introduction
A. The effects of nutrition extend from one generation to the next, and this is especially evident
during pregnancy.
B. If a mother’s nutrition stores are inadequate early in pregnancy when the placenta is developing,
the fetus will develop poorly. Infants born of malnourished mothers are more likely than healthy
women’s infants to become ill, have birth defects, and have impaired mental or physical
development.
II. Trends in Maternal and Infant Health
A. Introduction
1. The United States spends more money on health care than most other countries, but its infant
mortality rate (IMR) of 5.8 (2017) is considerably higher than that of several other
industrialized countries.
a. Disparities in IMRs persist between ethnic groups and between poor and non-poor
infants.
b. Failure to further improve the IMR in the U.S. has been attributed to the number of
infants born with low birthweights.
c. The leading causes of death among infants are birth defects, preterm delivery and low
birthweight (LBW), sudden infant death syndrome (SIDS), and maternal complications
during pregnancy.
d. Birthweight and length of gestation are the primary indicators of an infant’s future health
status.
2. Several factors, including poverty, poor nutrition, and low level of educational achievement,
must be addressed to reduce the incidence of low-birthweight babies.
3. Although maternal mortality rates have decreased significantly from a high of 83.3 per
100,000 live births in the 1950s to 17.4 in 2018, considerable racial disparities in maternal
mortality exist.
B. National Goals for Maternal and Infant Health: Healthy People 2020
1. Healthy People 2030 takes a broad scope, encompassing maternal and infant health, as well
as child health, birth defects, and developmental disabilities.
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 2
website, in whole or in part.
, Instructor Manual: Marie A. Boyle, Community Nutrition in Action, 8th ed., ISBN 9780357367957; Chapter 11: Mothers and Infants:
Nutrition Assessment, Services, and Programs
2. For the U.S. to achieve further reductions in infant mortality and eliminate racial and ethnic
differences in pregnancy outcomes, health care professionals must focus on changing
behaviors, both protective and risky, that affect pregnancy outcomes as well as advocate for
social and environmental changes to facilitate behavior change.
3. Uneven Progress for Maternal and Infant Health
a. Improvement was seen in the small decline in infant mortality rates for Hispanics, whites,
and blacks; a decreased incidence of spina bifida; an increase in breastfeeding by women
in all race and ethnic groups; and a continued decline in cigarette smoking during
pregnancy.
b. No progress or movement in the wrong direction occurred in the areas of maternal death
for African American women, alcohol use in pregnancy, iron deficiency in women aged
12 to 49 years, and low birthweight.
III. Healthy Mothers
A. A number of factors—genetic, environmental, and behavioral—contribute to maternal and infant
health.
B. Maternal Weight Gain. Normal weight gain and adequate nutrition support the health of the
mother and the development of the fetus.
1. A woman who begins pregnancy at a healthful weight should gain between 25 and 35
pounds, with approximately 32 percent of women gaining this recommended amount.
2. Low weight gain in pregnancy is associated with increased risk of delivering a low-
birthweight infant, with pregnant teenagers and African-American women tending to gain
insufficient weight during pregnancy.
3. Excessive weight gain increases the risk of complications during delivery, as well as
postpartum obesity.
4. The suggested rate of weight gain is 2-4 pounds for the first trimester, followed by a steady
gain of about one pound per week thereafter.
C. Adolescent Pregnancy is associated with higher rates of pregnancy-related hypertension, iron-
deficiency anemia, premature birth, stillbirths, low-birthweight infants, and prolonged labor.
1. Mothers under 15 years of age are at particularly high medical and nutritional risk.
2. Adequate nutrition can substantially improve the course and outcome of adolescent
pregnancy.
D. Nutrition Assessment in Pregnancy. Prenatal visits of pregnant women should include
assessment in the following components:
1. Dietary measures including food habits and use of vitamin and mineral supplements.
2. Clinical measures including outcome of previous pregnancies and obstetric history.
3. Anthropometric measures such as weight for height.
4. Laboratory values including screening for anemia, gestational diabetes, and preeclampsia.
IV. Healthy Babies
A. Introduction
1. A baby grows faster during the first year of life than ever again, with their birthweight
doubling during the first 4-6 months and tripling by the end of the first year.
2. Adequate nutrition is critical to support this rapid growth and development.
B. Nutrient Needs and Growth Status in Infancy. Infants need smaller total amounts of the
nutrients than adults do, but based on body weight, infants need over twice as much of many of
the nutrients.
1. Anthropometric Measures in Infancy. Anthropometric measures that are routinely
obtained in the examination of infants include length, weight, and head circumference.
a. Length should be measured in the recumbent position on a measuring board.
b. Head circumference confirms that growth is proceeding normally and can also detect
protein-energy malnutrition.
c. Weight-for-length less than the 5th percentile reflects failure to thrive.
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 3
website, in whole or in part.
, Instructor Manual: Marie A. Boyle, Community Nutrition in Action, 8th ed., ISBN 9780357367957; Chapter 11: Mothers and Infants:
Nutrition Assessment, Services, and Programs
d. Weight-for-length less than the 10th percentile reflects suspect for failure to thrive.
e. Gaining weight more rapidly than indicated on the growth charts may serve as an early
warning sign of overweight.
C. Breastfeeding Recommendations. During the first 2-3 days of lactation, the breasts produce
colostrum that contains antibodies and white cells from the mother’s blood, which favors the
growth of friendly bacteria called Lactobacillus bifidus.
1. Breast milk also contains a powerful antibacterial agent, lactoferrin.
2. Breast milk is tailor made to meet the nutrient needs of the young infant and breastfed
infants usually require no supplements except for vitamin D and fluoride.
3. Breastfeeding rates have increased since 1999 but continue to fall short of Healthy People
2030 objectives regarding duration and exclusivity.
4. Breastfeeding rates continue to be highest among women who are older, well educated,
relatively affluent, and/or living in the western United States.
5. Breastfeeding Promotion
a. Increasing a woman’s knowledge about the benefits of breastfeeding is not enough to
improve breastfeeding rates.
b. Breastfeeding support after birth in the hospital and in the workplace, as well as positive
social norms in families and communities, are important factors impacting breastfeeding
rates.
c. The U.S. Preventive Services Task Force recommends multifaceted breastfeeding
interventions for increasing breastfeeding initiation, duration, and exclusivity.
d. One successful approach to increasing breastfeeding rates in low-income urban
populations is the peer counselor method.
D. Other Recommendations on Feeding Infants
1. Whole cow’s milk is not recommended during the first year of life, but iron-fortified
formulas can be used to support normal development in the baby’s first months of life.
E. Primary Nutrition-Related Problems of Infancy. Two of the primary nutrition-related
problems of infancy include:
1. Iron Deficiency. To prevent iron deficiency, the AAP recommends exclusive breastfeeding
for six months, followed by continued breastfeeding as complementary foods, including
iron-fortified cereals, are introduced through the first year of life. Infants who are given
formula should receive iron-fortified formula.
2. Food Allergies.
a. Genetics is probably the most significant factor affecting an infant’s susceptibility to food
allergies.
b. New foods should be introduced singly to facilitate prompt detection of allergies.
c. There is no evidence that delaying the introduction of allergenic foods beyond six months
prevents atopic disease, including peanuts, eggs, and fish.
V. Programs in Action: Using Peer Counselors to Change Culturally Based Behaviors
A. The use of peer counselors to help women successfully breast feed by Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC) clinics and organizations such as the
La Leche League is described.
VI. Domestic Maternal and Infant Nutrition Programs
A. The WIC Program. The Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC) provides supplemental foods to infants, children up to age five, and pregnant,
breastfeeding, and non-breastfeeding postpartum women.
1. The WIC program is based on two assumptions:
a. Inadequate nutritional intakes and health behaviors of low-income women, infants, and
children make them vulnerable to adverse health outcomes.
b. Nutrition intervention at critical periods of growth and development will prevent health
problems and improve the health status of participants.
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 4
website, in whole or in part.
Nutrition Assessment, Services, and Programs
Instructor Manual
Marie A. Boyle, Community Nutri琀椀on in Ac琀椀on, 8th ed., ISBN 9780357367957; Chapter 11:
Mothers and Infants: Nutri琀椀on Assessment, Services, and Programs
Table of Contents
Purpose and Perspective of the Chapter.......................................................................................................2
Chapter Objectives......................................................................................................................................2
Chapter Outline...........................................................................................................................................2
Discussion Questions...................................................................................................................................8
Activities and Assignments.......................................................................................................................11
Additional Resources.................................................................................................................................17
Videos....................................................................................................................................................17
Internet Resources................................................................................................................................17
Appendix...................................................................................................................................................18
Generic Rubrics......................................................................................................................................18
Standard Wri琀椀ng Rubric........................................................................................................................18
Standard Discussion Rubric...................................................................................................................19
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 1
website, in whole or in part.
, Instructor Manual: Marie A. Boyle, Community Nutrition in Action, 8th ed., ISBN 9780357367957; Chapter 11: Mothers and Infants:
Nutrition Assessment, Services, and Programs
Purpose and Perspec琀椀ve of the Chapter
The purpose of this chapter is to examine trends in maternal and infant health, factors that support health
in mother and infants, and federal programs to support low-income women and their infants and children.
A case study presents an opportunity for students to plan a breastfeeding promotion program for low-
income women. A Professional Feature presents a plan for planning for the future.
Chapter Objec琀椀ves
The following objectives are addressed in this chapter:
11.1 List the recommendations for maternal weight gain during pregnancy.
11.2 Explain the relationship of maternal weight gain to infant birthweight.
11.3 Identify nutritional factors and lifestyle practices that increase health risk during pregnancy.
11.4 Describe the benefits of breastfeeding.
11.5 Describe the purpose, eligibility requirements, and benefits of the federal nutrition programs
available to assist low-income women and their children.
11.6 Identify the common nutrition-related problems of infancy.
11.7 Describe current recommendations for feeding during infancy.
Chapter Outline
I. Introduction
A. The effects of nutrition extend from one generation to the next, and this is especially evident
during pregnancy.
B. If a mother’s nutrition stores are inadequate early in pregnancy when the placenta is developing,
the fetus will develop poorly. Infants born of malnourished mothers are more likely than healthy
women’s infants to become ill, have birth defects, and have impaired mental or physical
development.
II. Trends in Maternal and Infant Health
A. Introduction
1. The United States spends more money on health care than most other countries, but its infant
mortality rate (IMR) of 5.8 (2017) is considerably higher than that of several other
industrialized countries.
a. Disparities in IMRs persist between ethnic groups and between poor and non-poor
infants.
b. Failure to further improve the IMR in the U.S. has been attributed to the number of
infants born with low birthweights.
c. The leading causes of death among infants are birth defects, preterm delivery and low
birthweight (LBW), sudden infant death syndrome (SIDS), and maternal complications
during pregnancy.
d. Birthweight and length of gestation are the primary indicators of an infant’s future health
status.
2. Several factors, including poverty, poor nutrition, and low level of educational achievement,
must be addressed to reduce the incidence of low-birthweight babies.
3. Although maternal mortality rates have decreased significantly from a high of 83.3 per
100,000 live births in the 1950s to 17.4 in 2018, considerable racial disparities in maternal
mortality exist.
B. National Goals for Maternal and Infant Health: Healthy People 2020
1. Healthy People 2030 takes a broad scope, encompassing maternal and infant health, as well
as child health, birth defects, and developmental disabilities.
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 2
website, in whole or in part.
, Instructor Manual: Marie A. Boyle, Community Nutrition in Action, 8th ed., ISBN 9780357367957; Chapter 11: Mothers and Infants:
Nutrition Assessment, Services, and Programs
2. For the U.S. to achieve further reductions in infant mortality and eliminate racial and ethnic
differences in pregnancy outcomes, health care professionals must focus on changing
behaviors, both protective and risky, that affect pregnancy outcomes as well as advocate for
social and environmental changes to facilitate behavior change.
3. Uneven Progress for Maternal and Infant Health
a. Improvement was seen in the small decline in infant mortality rates for Hispanics, whites,
and blacks; a decreased incidence of spina bifida; an increase in breastfeeding by women
in all race and ethnic groups; and a continued decline in cigarette smoking during
pregnancy.
b. No progress or movement in the wrong direction occurred in the areas of maternal death
for African American women, alcohol use in pregnancy, iron deficiency in women aged
12 to 49 years, and low birthweight.
III. Healthy Mothers
A. A number of factors—genetic, environmental, and behavioral—contribute to maternal and infant
health.
B. Maternal Weight Gain. Normal weight gain and adequate nutrition support the health of the
mother and the development of the fetus.
1. A woman who begins pregnancy at a healthful weight should gain between 25 and 35
pounds, with approximately 32 percent of women gaining this recommended amount.
2. Low weight gain in pregnancy is associated with increased risk of delivering a low-
birthweight infant, with pregnant teenagers and African-American women tending to gain
insufficient weight during pregnancy.
3. Excessive weight gain increases the risk of complications during delivery, as well as
postpartum obesity.
4. The suggested rate of weight gain is 2-4 pounds for the first trimester, followed by a steady
gain of about one pound per week thereafter.
C. Adolescent Pregnancy is associated with higher rates of pregnancy-related hypertension, iron-
deficiency anemia, premature birth, stillbirths, low-birthweight infants, and prolonged labor.
1. Mothers under 15 years of age are at particularly high medical and nutritional risk.
2. Adequate nutrition can substantially improve the course and outcome of adolescent
pregnancy.
D. Nutrition Assessment in Pregnancy. Prenatal visits of pregnant women should include
assessment in the following components:
1. Dietary measures including food habits and use of vitamin and mineral supplements.
2. Clinical measures including outcome of previous pregnancies and obstetric history.
3. Anthropometric measures such as weight for height.
4. Laboratory values including screening for anemia, gestational diabetes, and preeclampsia.
IV. Healthy Babies
A. Introduction
1. A baby grows faster during the first year of life than ever again, with their birthweight
doubling during the first 4-6 months and tripling by the end of the first year.
2. Adequate nutrition is critical to support this rapid growth and development.
B. Nutrient Needs and Growth Status in Infancy. Infants need smaller total amounts of the
nutrients than adults do, but based on body weight, infants need over twice as much of many of
the nutrients.
1. Anthropometric Measures in Infancy. Anthropometric measures that are routinely
obtained in the examination of infants include length, weight, and head circumference.
a. Length should be measured in the recumbent position on a measuring board.
b. Head circumference confirms that growth is proceeding normally and can also detect
protein-energy malnutrition.
c. Weight-for-length less than the 5th percentile reflects failure to thrive.
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 3
website, in whole or in part.
, Instructor Manual: Marie A. Boyle, Community Nutrition in Action, 8th ed., ISBN 9780357367957; Chapter 11: Mothers and Infants:
Nutrition Assessment, Services, and Programs
d. Weight-for-length less than the 10th percentile reflects suspect for failure to thrive.
e. Gaining weight more rapidly than indicated on the growth charts may serve as an early
warning sign of overweight.
C. Breastfeeding Recommendations. During the first 2-3 days of lactation, the breasts produce
colostrum that contains antibodies and white cells from the mother’s blood, which favors the
growth of friendly bacteria called Lactobacillus bifidus.
1. Breast milk also contains a powerful antibacterial agent, lactoferrin.
2. Breast milk is tailor made to meet the nutrient needs of the young infant and breastfed
infants usually require no supplements except for vitamin D and fluoride.
3. Breastfeeding rates have increased since 1999 but continue to fall short of Healthy People
2030 objectives regarding duration and exclusivity.
4. Breastfeeding rates continue to be highest among women who are older, well educated,
relatively affluent, and/or living in the western United States.
5. Breastfeeding Promotion
a. Increasing a woman’s knowledge about the benefits of breastfeeding is not enough to
improve breastfeeding rates.
b. Breastfeeding support after birth in the hospital and in the workplace, as well as positive
social norms in families and communities, are important factors impacting breastfeeding
rates.
c. The U.S. Preventive Services Task Force recommends multifaceted breastfeeding
interventions for increasing breastfeeding initiation, duration, and exclusivity.
d. One successful approach to increasing breastfeeding rates in low-income urban
populations is the peer counselor method.
D. Other Recommendations on Feeding Infants
1. Whole cow’s milk is not recommended during the first year of life, but iron-fortified
formulas can be used to support normal development in the baby’s first months of life.
E. Primary Nutrition-Related Problems of Infancy. Two of the primary nutrition-related
problems of infancy include:
1. Iron Deficiency. To prevent iron deficiency, the AAP recommends exclusive breastfeeding
for six months, followed by continued breastfeeding as complementary foods, including
iron-fortified cereals, are introduced through the first year of life. Infants who are given
formula should receive iron-fortified formula.
2. Food Allergies.
a. Genetics is probably the most significant factor affecting an infant’s susceptibility to food
allergies.
b. New foods should be introduced singly to facilitate prompt detection of allergies.
c. There is no evidence that delaying the introduction of allergenic foods beyond six months
prevents atopic disease, including peanuts, eggs, and fish.
V. Programs in Action: Using Peer Counselors to Change Culturally Based Behaviors
A. The use of peer counselors to help women successfully breast feed by Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC) clinics and organizations such as the
La Leche League is described.
VI. Domestic Maternal and Infant Nutrition Programs
A. The WIC Program. The Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC) provides supplemental foods to infants, children up to age five, and pregnant,
breastfeeding, and non-breastfeeding postpartum women.
1. The WIC program is based on two assumptions:
a. Inadequate nutritional intakes and health behaviors of low-income women, infants, and
children make them vulnerable to adverse health outcomes.
b. Nutrition intervention at critical periods of growth and development will prevent health
problems and improve the health status of participants.
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 4
website, in whole or in part.
