Nutrition in infancy and childhood Philadelphia University

							Nutrition in Infancy and Childhood
By the end of this lecture, students will be able
     to understand:
•    The importance of nutrition in the first year
     of life
•    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
     intake
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                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
    year.
•   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.



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4
• 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
  both.
• 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
  slide.
• 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
  formula.
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• 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
  milk protein.
• 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
  overfeeding.

                                                         6
    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.



                                                        7
Weaning
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
  smaller amounts.
• Around the age of 15 months, food jags may
  develop reflecting autonomy and
  independence.
• 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



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         Children 4 to 6 years old

• Children can have their independent eating
  styles.
• They understand the time frame of meals
  and can save their appetite for meals.
• Snacks form an integral part of the child’s
  nutrient intake
• 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/
  day                                                10
                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



                                                               11
 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
  neuromuscular problems.
• 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
  indicated.


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• 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.




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• 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




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• 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
  status.
• 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.


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• Fat malabsorption is the greatest
  nutritional problem. Patients should
  receive pancreatic enzyme
  supplements with all meals and
  snacks to enhance fat digestion and
  absorption.
• Infants are, particularly, susceptible to
  protein deficiency and malnutrition
  because of their high protein
  requirements.




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