nutrition for infancy
TRANSCRIPT
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 1/61
U T R IT IO N D U R IN G U T R IT IO N D U R IN G
IN FA N C YN FA N C Y
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 2/61
Nutritional requirements
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 3/61
Energy:Infants need energy for growth, and normal
development.infant’s energy or caloric requirementdepends:
1.body size and composition.
2. metabolic rate.3. physical activity
4. medical conditions.
5.growth rate.Recommended energy intake is:
108 kcal/kg in first 6 months.
95 kcal/kg from 6-12 months.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 4/61
Energy Intake and Growth Rate:
A general indicator of whether aninfant is consuming an adequatenumber of kilocalories per day is
the infant’s growth rate inlength,weight, and headcircumference.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 5/61
Carbohydrates :
Should supply 30-60% of energy intake.
RDA:
0–6 months 60 g/day.
7–12 months 95 g/day.
Sources: The major type of carbohydrate normallyconsumed by young infants is lactose.
Some infants cannot tolerate lactose (dueto lactase enzyme deficiency in the smallintestines) and required a modifiedformula.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 6/61
Older infants derive CHO from
additionalSources: legums ,cereals, fruits,
vegetables.
( avoid some fruit juices for infants< 6months as: apple, pear, prune).
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 7/61
Protein : The current recommendation for the
infant’s protein requirement are:2.2g/kg for first 6 months.1.7 g/kg form 6-12 months.
The infant needs all the eight essential
amino acids plus histidine.Under certain conditions other amino acidsbecome essential:1.infant has phenylketonuria cannotmetabolize phenylalanine to tyrosine sotyrosine become essential.2.premature infants require an externalsource of tyrosine and cystine.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 8/61
The amount of protein in breast
milk& infant formula is adequate forthe first 6 months.
In the next 6 months diet of infant
should be supplemented withadditional source of protein such as:meats, egg yolks, yogurt, legums,cereals.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 9/61
Fat:
During the first 6 months of life, fatshould account for approximately 50% of the infant's total calorie intake.Between months 7-12 this percentage
drops somewhat, but a range of 35-40%is still recommended for fat intake as apercent of total calories.RDA: 30g/dayInfants need essential fatty acids that arerequired for normal brain development,healthy skin and hair, normal eyedevelopment, and resistance to infectionand disease.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 10/61
Breast milk & infant formula provideabout 50% of their calories from lipids.
Breast milk provides approximately5.6 g/liter of linoleic acid.
Infant formulas currently provide 3.3–
8.6 g/liter.older infants derive lipids from diet as:meat, egg yolks, dairy products, oils
added to home prepared foods.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 11/61
Water:
The requirements for water are:
0-6 month 0.7L/day7-12 month 0.8L/day
- Infant is vulnerable to water imbalancedue to immature kidney.
- Water deficit lead to hypernatremicdeyhration and neurologicalconsequences.- Water intoxication result in
hyponatremia ,nausea, vomiting,diarrhea, irritabilty this occur if water isfed as a replacement for milk or if theformula is excessively diluted.- Under normal conditions,infants fed
breast milk or infant formula don’t needadditional water.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 12/61
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 13/61
Minerals
1-calcium:
RDA:
0-6 months:400mg/day.
7-12 months:600mgday.
The recommended intake of calcium is planned tomeet the needs of formula fed infants as they retainless than half of the calcium intake.
Breast fed infants retain two third of their calciumintake.
Sources:
1-adequate amounts of breast milk or infant formula.
2-from complementary foods such as: yogurt,
cheese, fortified grain products, green leafyvegetables.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 14/61
2-Iron:
RDA:
First 6 months:6 mg/day.
7-12 months: 10mg/day.
full-term infants are born with adequate iron stores
that are not depleted until about 4 to 6 months of age.94% of iron in human milk , 10% of iron in cow’s milk,4% of iron in iron fortified formula’s is absorbed.
Sources:
1.Breast milk , infants formula.2.meat, liver; legumes; fortified grain products; anddark green vegetables.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 15/61
3-Zinc:
RDA: 5mg during first year.
The infant is born without zinc body stores thereforebecome rapidly dependant on a dietary source.
Sources:
1-breast milk; infant formula.
2- meat; poultry; liver; egg yolks; cheese; yogurt;legumes; and cereals.
4-Flouride:RDA:
0–6 months 0.1 mg/day.7–12 months 0.5 mg/day.
The major dietary sources for infants are fluoridatedwater, infant formulas made with fluoridated water.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 16/61
Vitamins
Vitamin A:
RDA:
0–6 months 400 μg/day.
7–12 months 500 μg/day.
Sources:1-Breast milk and infant formula are major food sourcesof vitamin A.
2-for infants consuming complementary foods : liver,
egg yolks, dark green leafy vegetables and fruits.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 17/61
Vitamin D :RDA: 200 IU/day.
Sources:
1-Adequate sunlight exposure.
2- fortified infant formulas.
3-Breast milk contains a small amount of vitaminD(25 IU/L or less)
4- the major dietary sources: Fish, liver, and egg yolk.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 18/61
Vitamin k:
RDA:
0-6 months: 5 μg /day.7-12 months: 10 μg/day.
Adequate intake can be supplied by maturebreast milk but not in the first week so it is
recommended that all infants should be given anintramuscular injection(0.5 mg) of vitamin K atbirth.
Sources:
1-mature breast milk, infant formula.
2-green leafy vegetables, and liver.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 19/61
Vitamin E:
RDA:
0–6 months 4mg/day.
7–12months 5mg/day.
-The requirement of for this vitamin depend on thedegree of saturation of fats in the diet.
Sources:
1-Infants receive vitamin E from breast milk andinfant formula.
2- green leafy vegetables; wheat germ; cereals,butter; liver; and egg yolks.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 20/61
Vitamin C:
RDA:0–6 months 30mg/day.
7–12 months 40 mg/day.
Sources:1-breast milk and infant formulas are majorsources.
2-vegetables and fruits.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 21/61
Vitamin B12:
RDA:
0–6 months 0.4 μg/day.7–12 months 0.5 μg/day.
-An infant’s vitamin B12 stores at birthgenerally supply his or her needs for
approximately 8 months.Sources:
2- Major food sources of vitamin B12 are breastmilk and infant formulas.
3-Complementary foods such as meat, eggyolks, and dairy products provide this vitaminlater in infancy.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 22/61
Folate:
RDA:
0-6 months:25 μg/day.
7-12 months:35 μg/day.
Body stores of folate at birth are small and rapidlydepleted .
Sources:
1-breast milk; infant formula.
2-green leafy vegetables; fruits cereals, andlegumes,egg yolks; and liver.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 23/61
Vitamin B6 (Pyridoxine):
RDA:
0–6 months 0.3 mg/day.
7–12 months 0.6 mg/day.
Sources:
1-breast milk; infant formula.
2-liver; meat, cereals, legumes; and potatoes.Riboflavin:
RDA:
0-6 months:0.4 mg/day.
7-12 momths:0.6 mg/day.
sources: dairy products, lean meats, poultry, fish,grains, broccoli.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 24/61
( ) :h ia m in V ita m in B 1
:D A – . / .0 6 m o n th s 0 2 m g d a y
– . / .7 1 2 m o n th s 0 3 m g d a y
R e q u ire m e n t fo r th ia m in re la te d to e n e rg y in ta ke
(since itsfunctions as vitalcoenzyme factor in
).e n e rg y m e ta b o lism
:ources
- ; .1 b re a st m ilk in fa n t fo rm u la
- - , , ;2 w h ole g ra in brea d s cere als le g u m es a n d
.potatoes
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 25/61
N ia cin ::D A
– / .0 6 m o n th s 2 m g d a y
– / .7 1 2 m o n th s 4 m g d a y
:ources- ; .1 b re a st m ilk in fa n t fo rm u la
- ; ; ; ; ,2 e g g y o lks p o u ltry m e a t fish ce re a ls a n d fo rtifie d
.g ra in p ro d u cts
-3 N ia cin ca n b e fo rm e d in th e b o d y fro m th e
.tryptophan
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 26/61
supplementation
1-A supplement of vit D is recommended for :a- breastfed infants who are not exposed to adequatesunlight .
b-infants who are consuming less than 500 mL per day
of vitamin D-fortified infant formula2-Breast fed and formula fed infants should receiveadditional source of iron at 6 months (iron fortifiedcereals and formula are common sources).
3-At 6 months both breast fed and formula fed infantswho receive water low in flouride (< 0.3 ppm) needssupplements.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 27/61
Composition of breast milk
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 28/61
Fats:•
• The nutritional composition of breast milkbegins with fat. If you take all the waterout of breast milk, half of what's leftbehind is fat. And, there's lots of cholesterol too.
•
infants, and young children need fats forthe development of the nervous system.• In breast milk, there is an enzyme called
lipase. Lipase breaks down fat so thatthe fat is in small globules. This allowsfor better digestion and absorption inBaby’s stomach.
• In contrast, the fat globules in baby-formula are large because they are from
cow’s milk.•
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 29/61
Carbohydrates:• The next big component of breast milk is
carbohydrates (37%).• most of the carbohydrates are in the form
of lactose.
•
Lactose provides Baby with energy.• Lactose is converted to lactic acid by
the Lactobacillus. The lactic acid makesBaby’s stomach acidic. This in turn
prevents the growth of harmful bacteria.• Cow’s milk has less than 10% lactose.
Formulas manufacturers try to matchthe nutritional composition of breast
milk by adding more lactose
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 30/61
Proteins :
• There are high levels of protein in
colostrum and these levels decrease asbaby grows older and older.
• At 6 months of age baby should receivean external source of protein.
• Whey and casein are the two main types:• Whey is smooth , liquidy and easily
digested.it represent about 60-80%of proteins in breast milk.
• Casein is coarse and not easily digested,present in formula so delay hungrysensation.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 31/61
Other important proteins:
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 32/61
Vitamins, Minerals
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 33/61
-
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 34/61
Benefits for Infants :1. Protects Against Infection
a. Diarrhea
Children less than 12 months of age had a lowerincidence of acute diarrheal disease.
b. Haemophilus Influenzabreastfeeding was protective of infants less than 6
months of age.. c. Enhances Vaccine Response The antibody levels of immunized infants weresignificantly higher in the breastfed than theformula-fed group.
d. NECrare in those whose diet included breast milk; itwas 20 times more common in those fed formulaonly..
e. Otitis Mediaf. Her es Sim lex
2 Protects Against Illnesses :
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 35/61
2. Protects Against Illnesses :a. Immunologic Developmentby the presence of IgA in breast milk.
b. Wheezingc.SIDS.
d. General Morbidity
e.AIDS
the current WHO recommendation thatbreastfeeding should continue to be promoted in alldeveloping countries, including those with high HIV-1prevalence rates in women of child bearing age.
F. Infant Survival There is an association between breastfeeding up to6 months of age and survival of infants throughoutthe first year of life.G. Gastroesophageal Reflex
Breastfed neonates demonstrate gastroesophageal
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 36/61
3. Enhances Development andIntelligence
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 37/61
. :P ro te ctio n Fro m A lle rg ie s
. A lle rg ic Fa m ilie s
, ,B re a stfe e d in g e v e n fo r sh o rt p e rio d s w a s
cle a rly a sso cia te d w ith lo w e r in cid e n ce o f, , ,w h e e zin g p ro lo n g e d cold s d ia rrh e a a n d
.v o m itin g
. E cze m a
E cze m a w as le ss co m m o n a n d m ild e r in( %).b a b ie s w h o w e re b re a stfe d 2 2 In in fa n ts
,fe d ca se in h yd ro ly sate soy m ilk o r co w s
, %, %, % ,m ilk 2 1 6 3 a n d 7 0 re sp e ctiv ely
.d e ve lo p e d a to p ic e cze m a
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 38/61
Types of Formulas:Standard infant formulas:
Cow milk based formulas:AAP recommends iron fortified for all infants.
Low iron formula is nutritionally deficient formula.
Soy based formulas:
It has no proven value in prevention of colic soshould not used as routine formula.
Step 2 formula:
Cow or soy based provide nutients for babies 6months and older.
Contain higher levels of calcium.
Toddler formulas:
For toddlers between 1and3 years
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 39/61
Special infant formulas:
Allergy:Extensively hydrolysedformulas(predigested):
Protein in these broken down.
In more extreme cases completely predigested
formula (aa based)is required.Acid reflux:Thickened formulas:
Thicken by itself once it reaches stomachso,minimize possibility of regurgitation.
Acute diarrhea:Lactose free formulas.Premature babies:premature discharge formulas
Result in greater height and weight gain.
Provide more calories,proteins,vitamins andminerals.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 40/61
Complementary feeding
&weaning
l f di
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 41/61
Complementary feeding&weaning
Weaning is the process of separation fromthe breast or bottle feeding
Aim of weaning and complementaryfeeding:
1-the child cannot tolerate more than oneliter of fluid /day so with his increasing needsfor energy more solid foods should be added.
2-growing baby requires more minerals and
vitamins which cannot be all supplied by milkalone.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 42/61
3-to train the child on spoon feeding, chewing, andswallowing of solides.
4-to train GIT to digest starch and other solid foods.
5-to educate the child independence by using spoon
and cup of feed himself .
r nc p es o wean ng an
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 43/61
r nc p es o wean ng ancomplementry foods:
1-weaning should be gradual to prevent GIT
disturbances.2-sudden weaning may predispose theyoung infant to psychological trauma.
Technique:
1- encourage exclusive breast feeding forthe first 6 months
2-start by replacing one milk feed by any
oter foreing food.3-gradually replace milk by foreing fooduntil all milk feeds are replaced at age of 2years
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 44/61
4- the new food is given gradually and in smallamounts at first (1-2 spoon) if accepted by the
baby the amount can be increased5-amout determined by baby’s appetite.6-never force the baby to take anew food.7- the presentation of food is important so
better use colorful attractive spoons andplates to stimulate baby’s interest andappetite.8- new food items should be introduced one
at atime.9- vegetables &non sweetened foods maybe introduced before sweetened foods toreduce te tendency to develop desire forsweets.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 45/61
Introduction of the different newfood items:
At 6 months:- sieved or pureed vegetables given by
spoon
-Strained or pureed fruits (apple, banana,
orange, pear)-Iron fortified cereals
-Unsweetened tomato or orange juice bycup
-Soft cheese
At 7-8 months:
-soft cooked vegetables in strips or slices
-Minced chicken ,chicken liver,fish,rabbit.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 46/61
At 9-11 months :-crusted cheese ,beans ,peas ,bread,
-Sliced fruits (pear, apple, peach)
At 1 year of age:
-whole egg ,whole milk, red meat, cubed cheeseyogurt
-Cooked rice , noodles
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 47/61
Foods to avoid in infancy:
1- food that cause cocking e.g nuts.2-common allergy producing foods especially inpotentially atopic children .
3-food additives.
4-salted foods.
5-junk foods.
6-foods hard to digest.
7- honey.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 48/61
Feeding problems during
infancy
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 49/61
1.Spitting up
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 50/61
Spitting up can be managed with the followingfeeding practice modifications:-
-feed smaller amounts more times per day
-burp the infant every 4_5 minutes during feeding
-switch to hypoallergenic formula, as reflux can bethe result of an allergy to soy or cow’s milk
-position the infant upright during and afterfeeding.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 51/61
2.Vomiting
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 52/61
3.Overfeeding
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 53/61
4.Underfeeding
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 54/61
5.Dehydration
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 55/61
6.Constipation
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 56/61
The following measures are recommended toimprove bowel movement:-
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 57/61
7-Colic:Paroxysm of irritability or crying lasting more than3 hours/day
Colic starts at two weeks of age and last till 3month.
Incidence: 20 % to 30 %.
contributing factors :1-immature digestive system
2-Certain foods eaten by lactating motherscontain volatile chemicals and allergens that in a
small percentage of infants result in colicdiscomfort and digestive upset.
3-Infants often swallow air while feeding or duringstrenuous crying, which increases gas and
bloating, further adding to their discomfort
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 58/61
Treatment:
1-Do not overfeed.
2-Breastfeeding mothers should avoid caffeine,onions, cabbage, beans, broccoli and other gas-producing, irritating foods.
3-In the formula-fed baby, try a completely low-
allergy formula4-Homeopathic remedies : Homeopathy is safe andcompletely allergen-free and side-effect-free.
5- Colic Calm Gripe Water.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 59/61
8.Milk allergy
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 60/61
- Onset of milk allergy usually occurs in the first
4 months of infancy-Most children grow out of it by the age of 2 years.
-Treatment is done by elimination of milk proteinsfrom the diet by switching to a soy or
hypoallergenic formula.
8/9/2019 Nutrition for Infancy
http://slidepdf.com/reader/full/nutrition-for-infancy 61/61
H A N K Y O UH A N K Y O U