FEEDING & NUTRITIONIN YOUNG CHILDREN

(0-5 Yrs)

Dr Somendra ShuklaMBBS, DNB (Pediatrics), MNAMS, MRCPCH (UK),

Fellow Neonatology

Sr. Consultant Pediatrics & Neonatology

Objectives

• To recognize the changing nutritional needs of developing children, from infancy to 5 yrs of age.

• To understand that nutritional recommendations for children vary by age, & stage of development.

• To recognize that nutritional and dietary behaviors learned in children can have a significant impact on adult health concerns such as obesity, cardiovascular disease, and osteoporosis.

Why is Nutrition Important?

• Energy of daily living - Carbohydrate• Maintenance of all body functions- Minerals & vitamins• Vital to growth and development- Protein & fats• Therapeutic benefits

Healing - Protein

Prevention

Growth in Infants

Rapid body growth and brain development during the first year:

• Weight increases 200%• Body length increases 55%• Head circumference increases 40%• Brain weight doubles

Nutrition for Infants < 6 months

Breast Milk vs. FormulaConvenience vs. health

Nutrition for Infants < 6 months

(Better Nutrition, 2000)

•Premature infants

•Long-chain polyunsaturated fatty acids

•Faster brainstem maturation

Nutrition in young children < 6 months

(Core, 2003)

Poor nutrition = hampered mental development• Information processing• Language• Below average for age

Feeding the Newborn

What are the options?

Breast feedingThe Indian & American

Academy of Pediatrics recommends exclusive breast feeding for 6 months.

Formula feeding

Breast Feeding Questions

• Why should I breast feed my baby? I thought formula was the identical alternative.

• How often and for how long will my baby nurse?• How do I know if the baby is getting enough? • How many months can I breast feed the baby ?

Breast Feeding : Advantages to Infants

• Immunologic benefits (>100 components)• Decreased incidence of ear infections, UTI, gastroenteritis,

respiratory illnesses, and bacteremia.• Convenient and ready to eat.• Reduced chance of overfeeding?• Fosters mother-infant bonding.

Breast Feeding :Advantages to Mothers

• May delay return of ovulation.• Loss of pregnancy-associated adipose

tissue and weight gain.• Suppresses post-partum bleeding.• Decreased breast cancer rate.

Assessment of Breast Feeding

• Weight pattern - consistent weight gain.• Voiding - # wet diapers/day, soaked?• Stooling - generally more stools than formula.• Feed-on-demand ~ every 2-3 hours.• Duration of feedings - generally 10-20 min/side.• Need for high fat hind milk.• Activity and vigor of infant.

Assessing Readiness to Feed

• At what age it is best to introduce solid foods?

• How do I know if he is ready to eat?• What food should I give the baby first?

Feeding Skills Development

5-6 mos - experience new tastes.

6-7 mos - sits with minimal support.

8-9 mos - improved pincer grasp.

10-12 mos - pulls to stand, reaches for food.

12-18 mos - increased independence.

18 mos -2 yrs - growth slows, less interest in eating.

2-3 yrs - intake varies, exerts control.

NUTRITION 7 MONTHS ONWARDS

6-7 mos - experience new tastes.

Give rice cereal .7-8 mos - sits with minimal support.

Add fruits and vegetables.8-9 mos - improved pincer grasp.

Add protein foods and finger foods.10-12 mos - pulls to stand, reaches for food.

Add soft table food, allow to self-feed.

12-18 mos - increased independence.

Stop bottle, practice eating from a spoon.18 mos -2 yrs - growth slows, less interest in eating.

Encourage self-feeding with utensils.2-3 yrs - intake varies, exerts control.

Pre-school (1 to 6 Years)

1-2 years: on average, grows 12 cm, gains 3.5 kg.

Rate of growth slows by 4 years.

6-8 cm/year

2-4 kg/yearBrain growth triples by 6 years.

Common Complaints

UNCOMMON COMPLAINT WHICH IS MORE COMMON

Whats eating your child

HOW TO DIAGNOSE OBESITY

BODY MASS INDEX (BMI)

Meal Components

Milk (fluid)Fruits & vegetablesBreads & grains

RiceBread

Meats & meat alternates

Meat (e.g., chicken, turkey, fish)EggsCheeseBeansYogurtNuts and nut butters

Meal Component Requirements for Children

Breakfast One serving each: • fluid milk • 100% juice, fruit, or vegetable • bread or cereal

Lunch or Supper One serving each: • fluid milk • meat or acceptable meat alternate • bread or acceptable bread alternate Plus: • two servings of fruit and/or vegetables

Snacks Total of two servings: • fluid milk • meat or acceptable meat alternate • bread or acceptable bread alternate • 100% juice, fruit, or vegetable

Serving Sizes

Start with the recommended serving for age and food group

If children are still hungry, allow them more food

Encourage them to check in with their tummy (cues)Encourage fruits and vegetables first

Serving sizes are a min, not a max!

Milk – Infants

Infants under 12 months should receive only breast milk or iron-fortified formula – no cow’s milk.

Whole cow’s milk does not provide enough Vitamin E, iron, and essential fatty acids for infants.

Whole cow's milk protein and fat are more difficult for an infant to digest and absorb.

Milk served to children 12-23 months should be whole.

Milk served to children 2 years and older should be fat-free (skim) or 1% (low-fat).

Flavored milk should not be served

Milk – Children

Rationale – Milk

Children 12 through 23 months need the fat in whole milk for healthy weight gain, growth and development.

Children 2 years and older do not need the extra fat and calories in whole milk.

Juice – Infants

Infants should not be served juice.

Juice – Children

Limit 100% juice to 1 serving per day in a size appropriate to age (4-6 oz.), or don’t serve at all.

All juice served should be 100% fruit or vegetable.

Non-100% juice (e.g., juice “cocktail” or juice “drink”) is a sugary beverage and should not be served at all.

Sugary Beverages

Sugary drinks should never be offeredJuices that are not 100% juice

Fruit drinks (cocktails/-ades)

Sports drinks

Sweet tea

Soda

Energy drinks

Coffee drinks

Rationale: Juice & Sugary Beverages

They are high in sugar and calories which can cause…

overweight/obesity

tooth decay

diarrhea

May displace healthier beverages (like milk)

Whole fruits and vegetables provide more nutrients and fiber than even 100% juice

Fruits & Vegetables

Avoid Fried or pre-fried fruits or vegetables

French fries, tater tots, hash browns, potato chips; fried apples or okra

Serve a fruit (not juice) and/or a vegetable at every meal and snack

French fries, tator tots, and hash browns don’t count as vegetables!

Rationale – Fruits & Vegetables

Fried or pre-fried fruits/vegetables should be avoided because…

They are high in calories and fat. Example:

VS.

57 calories, 0.06 grams fat 180 calories, 5.35 grams fat

Fruits & Vegetables

Are rarely or never prepared with added:Meat fat

Butter

Margarine

Sugar

Breads & Grains

Cereals should contain no more than 6 grams of sugar per serving.

At least half of grains served should be whole grains.

Serve whole grains whenever possible.

Grains high in fat or sugar should be served rarely or never.

Donuts, Danishes, cupcakes, toaster pastries, granola bars, etc.

Ingredients:WHOLE WHEAT FLOUR, WATER, SUGAR, WHEAT GLUTEN, CANE REFINERY SYRUP, YEAST, CONTAINS 2% OR LESS OF EACH OF THE FOLLOWING…

Rationale – Breads & Grains

Whole grains are good sources of dietary fiber, several B vitamins and minerals.

Added sugars supply calories but few or no nutrients.

Fried baked goods are high in calories and fat and low in nutrients.

Example:

Meats & Meat Alternates

Fried/pre-fried and processed meats

E.g., chicken nuggets/tenders, fish sticks, hot dogs, bologna, sausage, salami, spam

Limit to 1x per fortnight or less

Choose a variety of beans and lean meats (whitemeat/ boiled) each week

Cheese & Other Dairy Products

Serve only real cheese – no cheese food or cheese product.(e.g., Velveeta®, Cheez Whiz®)

Serve low-fat or fat-free dairymilk, cheese, yogurt, cream

cheese, etc.

Rationale: Meats & Cheese

Processed and fried meats and fish are typically high in total and saturated fat and sodium.

In general, cheese products contain more sodium and fewer nutrients than real cheese.

Water

Drinking water is visible, available to children

inside and outside, available for self serve.

Developing Healthy Habits

Offer a variety of healthy foods and snacks.Encourage fruit and vegetable intake.No junk food snacking.Limit intake of juices ( 4 oz per day).Increase intake of water (no soda).Encourage low fat dairy products (3-4 servings/ day).Make fun physical activity a habit.Limit TV to no more than 1 to 2 hours per day.Track growth and development carefully.Be a good role model.

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