Nutrition in Infancy and Childhood
By the end of this lecture, students will be able
• The importance of nutrition in the first year
• How calorie intake in infants is different
from that of an adult
• The gradual transition in diet intake in the
first year of life, and the differences
between breast and bottle feeding
• The concepts related to the assessment of
nutritional intake in infancy
• The transition between infancy and
childhood and how that affects nutritional
Infancy (Birth to 1 year)
• This is a critical period because the rate of
growth and development is more rapid than at
any time in the life cycle
• Birth weight doubles by the age of 4 to 6
months and triples toward the end of the first
• High growth rate necessitates supporting the
infant’s high need for nutrients and calories
• Although the total amount of calorie and
nutrients needed by an infant is much less than
that needed by an adult, the amount per kg of
body weight for calories and most nutrients is
higher at birth than at any other time.
• Milk is the sole source of nutrition up until 4 to 6
months of age. Milk could be in the form of
breast milk, infant formula, or a combination of
• Breast feeding is superior to formula feeding
because it offers unique nutritional and non-
nutritional advantages to both infant and mother.
Advantages of breast milk are presented on next
• Iron-fortified infant milk is an appropriate
substitute or supplement to breast feeding. The
level of many nutrients are higher in formula than
breast milk. Calcium (260 mg/L in breast milk as
opposed to 470 mg/L in formula) is one example.
This higher level is based on the rationale that
some nutrients are less well absorbed from
• Solid foods (such as cereals, pureed fruits and
vegetables) can be introduced when the infant is
developmentally and physiologically ready by the
age of 4 to 6 months.
• Developmental readiness is evident when an
infant can lift the head, sit with support, and turn
the head to indicate that he had enough to eat.
• Physiologic readiness occurs when an infant
begin to produce enzymes capable of digesting
complex carbohydrates and proteins other than
• Some parents, based on unsupported belief,
begin providing solid foods for their infants
before 4 months of age. A major objection to this
behavior is that it may interfere with establishing
sound eating habits and may contribute to
Assessing the Adequacy of Intake in Infancy
• The best indicator for receiving sufficient
nutrition is the adequacy of growth.
• Breast-fed infants usually have a slower
growth rate than bottle-fed infants.
• Infants with impaired growth related to
undernutrition or illness experience “catch-up”
growth, which usually is completed by 2 years
of age. Undernutrition may or may not
permanently affect growth based on its timing,
severity, nature and duration.
• To assess growth percentile for age, height and
weight measurements are plotted on the
appropriate grids of growth chart such as that of
Stuart. A deviation of more than 2 percentile
channels warrants a more in-depth assessment
of growth and nutritional status.
The term weaning means gradually introducing semisolid and
solid foods to the infant until s(h)e is accustomed to the
regular family diet. Breast feeding should not stop. The foods
should be rich in iron and vitamin D. Prolonged breast feeding
without supplements will lead to poor growth rate, wasting and
iron deficiency anemia.
How to introduce weaning food
Start by a small amount of 1-2 teaspoonful once daily
then increase gradually.
The food should be smooth in texture
Do not give two new foods together
Do not offer new food if the baby is unwell
Some infants refuse or spit out the food at the start.
Don’t worry, try again and again
Gradually increase the frequency of meals
Teach the mother about proper hygiene
Between Infancy and Childhood
• The period between age 1 and 2 is a transition
between infancy and childhood. There is
dramatic decrease in growth rate reflected in
disinterest in food.
• By the end of the first year, the child should be
drinking from a cup and eating many of the
same foods as the rest of the family although in
• Around the age of 15 months, food jags may
develop reflecting autonomy and
• At 2 years of age, children can completely self-
feed and can seek food independently.
• Growth, BMR, and endless activity require an
energy supply of 1300 kcal/day for ages 1 to 3.
• Hunger, rather than adult meal schedules,
guide the child’s perception of time to eat
Children 4 to 6 years old
• Children can have their independent eating
• They understand the time frame of meals
and can save their appetite for meals.
• Snacks form an integral part of the child’s
• Children can develop a sense of
responsibility for healthy food selection. They
can understand that although all foods are
fine, some (like fruits, vegetables, and low fat
foods) can be eaten more often than others.
Food jags may continue for a while.
• Parents should educate children that each
food contains a different assortment تشكيلةof
nutrients and offer substitute choices that the
child can finally select from
• Energy requirements increase to 1800 kcal/
Children 7 to 12 years old
• Actual growth may slow down at this stage
• The body is preparing for the puberty growth spurt
• Puberty for girls may begin from around age 9 and on and,
for boys, puberty maybe reached in early teen years
• This prepuberty time maybe reflected by weight buildup; an
increase in chubbiness امتالء الجسمis not alarming if moderate
eating and physical exercises are maintained
• Parents should not overreact to the child’s overeating;
otherwise they may plant the seeds of eating disorders
• To rule out overeating, children can be asked if they are truly
hungry for food or are they just tired or thirsty
• Energy requirements increase to 2000 to 2200 kcal/day
Disorders Unique to or Beginning in Infancy and
childhood and Nursing Interventions
• Failure to thrive: It is inadequate gain in weight
and/ or height in comparison with growth and
development standards. This condition can be
caused by disorders of the CNS, endocrine
system, congenital defects, or intestinal
obstruction, or it can occur due to inability to
suck, chew, or swallow related to
• Nursing interventions and considerations for a
child with failure to thrive shall take into account
that the cause or causes of this condition must
first be identified. Nutrition therapy depends on
the infant’s age and stage of development.
Usually a high-calorie, high-protein diet is
• Colic: This symptom is characterized by
intermittent profuse crying lasting three hours or
longer per day. It most often affects the newborn
and is more common in bottle-fed infants that
those who are breast-fed. Colic usually resolves
itself at 3 months of age. Its exact cause is
unknown but it maybe associated with
overfeeding, feeding too quickly, swallowed air,
or maternal or infant anxiety.
• Nursing intervention should include assessment
of feeding practices: frequency of burping; type
of feeding used; volume, concentration, and
frequency of feeding; and size of nipple (for
bottle-fed infants). Also assessment of mother
diet is indicated to find out whether she takes
cruciferous vegetables, cow’s milk, onion, and
chocolate so that these can be eliminated.
• Cleft Palate: Numerous combinations of
developmental defects involving the lip and
palate can occur and result in an opening in the
roof of the mouth or incompletely formed lips.
• The cause may be hereditary or unknown.
• Caregivers should be advised to feed the infant
slowly in an upright position with the head and
chest tilted slightly backward to facilitate
swallowing without aspiration.
• Surgery could be performed within the first 3
months of life for cleft lip and between 6 and 24
months for cleft palate
• Pyloric Stenosis: This disorder is
characterised by an obstructive
narrowing of the pyloric opening
resulting in projectile vomiting within
30 minutes of feeding, weight loss,
dehydration, and poor nutritional
• The major goal of nutritional therapy is
to achieve fluid and electrolyte
balance as pre-requisite to surgery.
Post-operatively, the infant is given
glucose water then advanced to full-
strength formula as tolerated, after
which she can be breast-fed if desired.
• Fat malabsorption is the greatest
nutritional problem. Patients should
receive pancreatic enzyme
supplements with all meals and
snacks to enhance fat digestion and
• Infants are, particularly, susceptible to
protein deficiency and malnutrition
because of their high protein