Infant-Child Nutrition.pdf

7/26/2019 Infant-Child Nutrition.pdf

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INF NT NUTRITION


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INFANCY

refers to a person not more than 12 months of age

healthy full term infant weighs 2.7 to 3.2 kg (6 to 7

lbs) and measure 48-50 cm (19-20 inches) in length. Head circumference averages 35cm (14 inches).

Skin is moist, elastic and not wrinkled.


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DIET:

Breastfeeding

Has physiologic and psychologic value for mother

and infant. Meets nutrient needs of early months

Provides immunity factor and reduces chances forinfection


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DIET:

Bottlefeeding

Formula designed to match nutritional ration of

breastmilk composition, water dilution to reduceprotein and mineral concentration, addedcarbohydrate to increase energy value

May meet needs of working mother

Must be prepared under clean conditions andsterilized to prevent contamination


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If the delivery was uncomplicated and the neonateis alert and healthy, the neonate can be brought to

the mother for feeding immediately.

Successful breastfeeding is enhanced by puttingthe neonate to the breast as soon as possible after

delivery. Spitting mucus after feeding is common (because

gastroesophageal smooth muscle is lax) but shouldsubside within 48 h.


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If spitting mucus or emesis persists past 48 h or ifvomit is bilious, complete evaluation of the upper

GI and respiratory tracts is needed to detectcongenital GI anomalies.


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Nutrition Assessment

To determine an infants nutritional needs anddevelop a nutrition care plan, an accurateassessment of the infants nutritional status must beperformed.

The nutrition assessment provides the nutritionistor health counselor with important feedingpractices and other information pertinent to aninfants health.


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The assessment should include an examination of:

Health and medical information

Information gathered throughchart review, caregiver interview, health care providerreferral form(s), or other sources that may includehistory of chronic or acute illnesses or medicalconditions, birth history, developmental disabilities, aclinical assessment identifying signs of nutritionaldeficiencies, and other pertinent information (e.g.immunization record)


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Dietary intake data:

Feeding history Eating behaviors, feeding techniques,feeding problems, and environment;

Appetite and intake Usual appetite, factors affectingintake such as preferences, allergies, intolerances,chewing/swallowing problems, feeding skills;


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Diet history Breastfed and/or infant formula-fed;frequency and duration of breastfeeding; frequency andamount of infant formula or complementary foods fed;

age at introduction of complementary foods; variety ofcomplementary foods provided; vitamin/mineral orother supplements given; and problems such asvomiting, diarrhea, constipation, or colic;


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Socioeconomic background Primary and othercaregivers, food preparation and storage facilities, useof supplemental feeding and financial assistance

programs, access to health care, and ethnic and/orcultural influences on the diet.


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Anthropometric Data Anthropometricmeasurements, i.e., weight for age, length for age,weight for length, and head circumference for age;

Biochemical Data Data used to diagnose or confirm

nutritional deficiencies or excesses; hemoglobin,hematocrit, or other hematological tests areperformed to screen for iron deficiency anemia.


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Energy Needs

Infants need energy from food for activity,

growth, and normal development. Energy comesfrom foods containing carbohydrate, protein, orfat. The number of kilocalories (often termedcalories) needed per unit of a persons body

weight expresses energy needs.

A kilocalorie is a measure of how much energy afood supplies to the body and is technically

defined as the quantity of heat required to raisethe temperature of 1 kilogram of water 1 degreeCelsius.


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Energy Needs

An infants energy or caloric requirement

depends on many factors, including body sizeand composition, metabolic rate (the energy thebody expends at rest), physical activity, size atbirth, age, sex, genetic factors, energy intake,

medical conditions, ambient temperature, andgrowth rate. Infants are capable of regulatingtheir intake of food to consume the amount ofkilocalories they need.


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Energy Intake and Growth Rate

A general indicator of whether an infant is

consuming an adequate number of kilocaloriesper day is the infants growth rate in length,

weight, and head circumference.

However, physical growth is a complex processthat can be influenced by size and gestational age

at birth, environmental and genetic factors, and

medical conditions, in addition to dietary intake.

An infants growth rate can be assessed by

periodically plotting the infants weight, length, and

head circumference for age and weight for length

on growth charts throughout the first year of life.


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CARBOHYDRATES

AI for Infants

06 months - 60 g/day of carbohydrate

712 months - 95 g/day of carbohydrate


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FUNCTIONS

Carbohydrates are necessary in the infants diet becausethey:

Supply food energy for growth, body functions, and

activity; Allow protein in the diet to be used efficiently forbuilding new tissue;

Allow for the normal use of fats in the body; and

Provide the building blocks for some essential body

compounds.


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SOURCES

The major type of carbohydrate normally consumed byyoung infants is lactose, the carbohydrate source inbreast milk and cows milk-based infant formula.

Lactose-free infant formulas, such as soy-based infantformulas, provide carbohydrates in the form of sucrose,corn syrup, or corn syrup solids. These infant formulasare prescribed to infants who cannot metabolize lactose

or galactose, a component of lactose.


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Some specialty infant formulas contain othercarbohydrates in the form of modified corn starch,tapioca dextrin, or tapioca starch. In later infancy,infants derive carbohydrates from additional sourcesincluding cereal and other grain products, fruits, andvegetables.

Infants who consume sufficient breast milk or infant

formula and appropriate complementary foods later ininfancy will meet their dietary needs for carbohydrates.


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Carbohydrates in Fruit Juices

Some fruit juices, such as prune, apple, and pear,contain a significant amount of sorbitol andproportionally more fructose than glucose. Infants canabsorb only a portion of the sorbitol (as little as 10percent) and fructose in these juices.

Unabsorbed carbohydrate is in these juices.

Unabsorbed carbohydrate is fermented in the lowerintestine causing diarrhea, abdominal pain, or bloating.


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Carbohydrates in Fruit Juices

These symptoms are commonly reported in infants andtoddlers who drink excessive amounts of juice.

For this and other reasons, infants up to 6 months of

age should not be offered fruit juice; infants over 6months should be offered no more than 4 to 6 ouncesdaily of pasteurized, 100 percent juice from a cup.


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FIBER

Dietary fiber is found in legumes, wholegrain foods,fruits, and vegetables.

Breast milk contains no dietary fiber, and infants

generally consume no fiber in the first 6 months of life.

As complementary foods are introduced to the diet,fiber intake increases; however, no AI for fiber has beenestablished.


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FIBER

It has been recommended that from 6 to 12 monthswhole-grain cereals, green vegetables, and legumes begradually introduced to provide 5 grams of fiber per dayby 1 year of age.


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PROTEIN

AI for Infants

06 months - 9.1 g/day of protein RDA

for older infants - 712 months 11 g/day of protein


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PROTEIN

All proteins are combinations of about 20 commonamino acids. Some of these amino acids aremanufactured in the body when adequate amounts ofprotein-rich foods are eaten.

Nine amino acids that are not manufactured by thehuman body and must be supplied by the diet are calledessential or indispensable amino acids.


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PROTEIN

These include: histidine, isoleucine, leucine, lysine,methionine, phenylalanine, threonine, tryptophan, andvaline.

Two other amino acids, cystine and tyrosine, areconsidered essential for the preterm and young terminfant because enzyme activities involved in theirsynthesis are immature.


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Functions of PROTEIN

Infants require high quality protein from breast milk,infant formula, and/or complementary foods that:

Build, maintain, and repair new tissues, including

tissues of the skin, eyes, muscles, heart, lungs, brain,and other organs

Manufacture important enzymes, hormones,antibodies, and other components

Perform very specialized functions in regulating bodyprocesses.


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Functions of PROTEIN

Protein also serves as a potential source of energy if thediet does not furnish sufficient kilocalories fromcarbohydrate or fat.

As with energy needs, protein needs for growth per unitof body weight are initially high and then decrease withage as growth rate decreases.


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Sources of PROTEIN

Breast milk and infant formulas provide sufficient protein to meeta young infants needs if consumed in amounts necessary tomeet energy needs.

In later infancy, sources of protein in addition to breast milk andinfant formula include meat, poultry, fish, egg yolks, cheese,yogurt, legumes, and cereals and other grain products.

When an infant starts receiving a substantial portion of energyfrom foods other than breast milk or infant formula, these

complementary foods need to provide adequate protein.


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Sources of PROTEIN

Proteins in animal foods contain sufficient amounts of all theessential amino acids needed to meet protein requirements.In comparison, plant foods contain low levels of one or moreof the essential amino acids.

However, when plant foods low in one essential amino acidare eaten on the same day with an animal food or otherplant foods that are high in that amino acid grain productssuch as mashed rice [high in methionine, low in lysine]),sufficient amounts of all the essential amino acids are madeavailable to the body.

The protein eaten from the two foods would be equivalentto the high-quality protein found in animal products.


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Protein Deficiency

In developing countries, infants who are deprived ofadequate types and amounts of food for long periods oftime may develop kwashiorkor, resulting principallyfrom a protein deficiency; marasmus, resulting from adeficiency of kilocalories; or marasmus-kwashiorkor,resulting from a deficiency of kilocalories and protein.


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LIPIDS

AI for Infants

06 months - 31 g/day of fat

712 months - 30 g/day of fat


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LIPIDS

Lipids are a group of substances including fats, oils, andfat-like substances, such as cholesterol.

Fatty acids are the major constituent of many lipids.

Fatty acids that must be provided in the diet to maintainhealth are called essential fatty acids.

Linoleic acid and -linolenic acid are both essential fatty

acids. Small amounts of linoleic and -linolenic acidmust be provided in the diet.


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LIPIDS

AI for n-6 Polyunsaturated Fatty Acids (Linoleic acid[LA], Arachidonic acid [ARA])

06 months

- 4.4 g/day of n-6 polyunsaturated fatty acids

712 months



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LIPIDS

AI for n-3 Polyunsaturated Fatty Acids (-Linolenicacid [ALA], Docosahexaenoic acid [DHA])

012 months



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FUNCTIONS OF LIPIDS

Infants require lipids in their diets because they:

Supply a major source of energy fat suppliesapproximately 50 percent of the energy consumed in

breast milk and infant formula;

Promote the accumulation of stored fat in the bodywhich serves as insulation to reduce body heat loss, andas padding to protect body organs;

Allow for the absorption of the fat-soluble vitaminsA, D, E, and K;


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FUNCTIONS OF LIPIDS

Infants require lipids in their diets because they:

Provide essential fatty acids that are required fornormal brain development, healthy skin and hair,

normal eye development, and resistance to infectionand disease.


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SOURCES OF LIPIDS

Breast milk and infant formula are important sources oflipids, including essential fatty acids, during infancy.

The lipid content of breast milk varies, but after about

the first 2 weeks postpartum, breast milk providesapproximately 50 percent of its calories from lipids.


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SOURCES OF LIPIDS

Breast milk and infant formula are important Infantformulas also provide approximately 50 percent of theircalories as fat. Breast milk provides approximately 5.6g/liter of linoleic acid, while infant formulas currentlyprovide 3.38.6 g/liter.

Breast milk provides approximately 0.63 g/liter of n-3polyunsaturated fatty acids (including -linolenic acid

and docosahexaenoic acid) while infant formulasprovide 0 to 0.67 g/liter.


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SOURCES OF LIPIDS

Manufacturers of infant formulas add blends ofvegetable oils, which are high in linoleic acid, to improveessential fatty acid content.

Food sources of lipids in the older infants diet, otherthan breast milk and infant formula, include meats,cheese and other dairy products, egg yolks, and any fatsor oils added to home-prepared foods.


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The distribution of calories:Protein : 15%Lipid : 35%

Carbohydrate : 50%


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THE NUTRIENFOR INFANT AND CHILDREN

- NOT EXCESSIVE / LESS

- EASY TO ACCEPT,DIGESTED & ABSORBED

- CLEAN

- FREE FROM BACTERIA /HYGIENIS

- BALANS MENU


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Five keys to safer food

1. Keep clean,

2. Separate raw and cooked,

3. Cook thoroughly,

4. Keep food at safe temperatures,

5. Use safe water and raw materials

WHO 2009


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Breast Milk

The best food for infant

Reflex to control lactation::

Production Reflex

Infant sucking H. prolactin (H.A.) alveoliASI

Let Down Reflex

Infant sucking H. Oxytocin (H.P.) alveoli secretion contraction

Push ASI


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Breast milk variation

Colostrum Transition Mature

Time : 0

4 daysProtein : 4.1

Carbo : 3.5

Lipid : 2.9Volume : +

(ml/day) 40100

4

10 days1.6

6.4

3.5++

100500

after 10 days1.2 g/100 ml

7 g/ 100 ml

3.7 g/ 100 ml+++

700800


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Colostrum

First days production, 58 kal/100 ml BD : 1.040 1.060 (ASI Mature : 1.030)

Much more protein

Much more : Immunoglobulin A, Lactoferin,

Lecocyte Much more mineral : Na, K, Cl dan Zn

Much more Vit. A

Less : Lipid, Lactose

Faster meconeal excretion


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Breast milk vs Cows milk

Lipid :

BM = CM 3.7 g/ 100 ml

BM easy to digest and absorb

Calories source

Mineral :

BM : CM = 1 : 4

BM easy Fe absorb

Renal load


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INFANT FORMULA


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Specialized formula:

Premature baby formula: a) human milk fortifier (HMF), b)premature formula (for premature baby), c) premature-afterdischarge formula (for premature baby after discharge)

Cows Milk Protein Allergy formula: a) extensive-hydrolyzedformula, b) protein-based formula (ie. Soy protein-based formula)

Congenital Metabolic Disease formula: a) free phenilalanin formula

(for phenylketeonuria (PKU) b) free branch of amino acid formula(for MSUD, MMA) c) ketogenic formula

Gastrointestinal Disease formula: a) thickening formula forregurgitation, b) free lactose formula for lactose intolerance


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PKU FORMULA
http://images.google.co.id/imgres?imgurl=http://www.comidamed.de/meta/PKU_A_f.png&imgrefurl=http://www.comidamed.de/metabolics_e.htm&usg=___jLPUPLk-xRtYgU0jXXop8pxd0Q=&h=237&w=150&sz=55&hl=id&start=2&tbnid=64lgM76EwTT1CM:&tbnh=109&tbnw=69&prev=/images?q=formula+PKU&gbv=2&hl=id&sa=Ghttp://images.google.co.id/imgres?imgurl=http://www.comidamed.de/meta/PKU_A_f.png&imgrefurl=http://www.comidamed.de/metabolics_e.htm&usg=___jLPUPLk-xRtYgU0jXXop8pxd0Q=&h=237&w=150&sz=55&hl=id&start=2&tbnid=64lgM76EwTT1CM:&tbnh=109&tbnw=69&prev=/images?q=formula+PKU&gbv=2&hl=id&sa=Ghttp://www.myspecialdiet.com/Files/Prods/Images/Periflex%20Infant%20Photo.JPGhttp://www.myspecialdiet.com/Files/Prods/Images/Periflex%20Infant%20Photo.JPG


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Complementary Food


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Age

(Months)

Food variation

ASI Porridge Soft food Family

food

0 6

6 8

8 12

13 24

> 25

Feeding pattern for children


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Feeding problems during second 6 months of life (6months to 1 years of life),

underfeeding or overfeeding,

regurgitation and vomiting,

loose or diarrheal stools,

constipation,

infantile colic.


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NUTRITION DURING

CHILDHOOD


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1 3th years group

Fast growth

Sensitive to malnutrition

Cant eat solid food

Milk still important

Begin study to eatToilet training


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4 6th years group

The growth more slowly

Active consumer

Must know about good nutrientTogether with family


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7 12th years group

Much more nutrient need

A lot of activity

Baby teeth change for permanent teethNot care about feeding

Not clean snacks, fast food sick

Feeding time with family


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13 18th years group

Fast growth increase nutrient need

Sexual growth and development

Focus : calory, protein, mineral : yodium,Fe, and vitamin

Boys: eat more

Girls: diet


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Documents

Infant-Child Nutrition.pdf