NUTRITION DURING INFANCY
[Link]
Nutrition
during Infancy
INFANC
Y
INFANCY
• INFANCY: The first year of life!
• Extends from birth to age 12 months;
• Neonatal specifically refers to the
first 28 days of life.
• A healthy full term has moist skin,
elastic and not wrinkled
Normal newborn appearance
1. Acrocyanosis – body pink, extremities blue
2. Pallor – white discoloration of the skin
3. Harlequin sign – immaturity of circulation
[side of the body lying down will appear pink]
4. Mongolian spot – slate gray patches at the
buttocks
5. Lanugo – fine downy hair that covers the
shoulders.
ACROCYANOSIS PALLOR
Grepmed
Harlequin sign
Mongolian spots
AmeriCorpshealth
NORMAL NEWBORN APPEARANCE
1. Desquamation – drying of the newborns skin
2. Petechiae on face and neck – due to
intravascular pressure during delivery
3. Milia – unopened sebaceous gland found in the
nose chin and cheeks; disappears in 2-4 weeks.
4. Vernix caseosa
PRIMITIVE REFLEXES
First observable reflex. Essential to NB survival. Not
learned; involuntary and necessary for survival.
LOCOMOTOR REFELEXES
Present at birth or shortly thereafter. Relates to body
movement or locomotion
blinking Flashes of light or puff or Close both eyes
air
Babinski Sole of foot stoked Fans out toes, twist foot
Grasping Palmar Attempt to grasp finger
Plantar
Moro [startle] Loud noise Flings out arms
Rooting Cheek stroke Turns head & opens mouth
Stepping Infant held Moves feet as if to walk
Sucking Object touching mouth Sucks automatically
Reflexes
Reflexes
ENERGY [Calories]
Caloric requirements: caloric intakes of 110 to 150
kcal/kg/day PROTEIN
Protein requirements are highest during the first 6
months of life. Requirements are adjusted to
infant’s size and growth.
NUTRITIONAL LIPIDS
Fats should comprise 30% - 50% of an infant’s total daily
REQUIREMENTS caloric intake. It is a form of Linoleic acid
Human milk and cow’s milk provide 48%-54% calories
while commercial infant formulas 36%-38%
WATER INTAKE
Infants have greater need than adults; obtains it from
breast milk and commercial infant formula.
Newborns tend to eat 2 to 3 ounces of breast milk or
formula at a time every two to three hours a day
• 1-month-olds may be eating -3 to 4 ounces every two to
four hours a day.
• 2-month-olds may consume 4 to 5 ounces of breast milk or
formula every three to four hours a day.
• 3-month-olds may consume about 4 to 5 ounces of breast
milk or formula every three to four hours.
BREAST FEEDING
•
Most Most preferred form of nutrition in full term infants.
•
Three types of breast milk
•
Colostrum first milk with high level immunoglobulin
•
Transitional milk replaces colostrums contain high level
of fat, lactose, water-soluble vitamins and calories.
•
Mature milk the final milk produced contains high
percentage of water and provides 20kcal per oz.
BREAST FEEDING
•
Most preferred form of Most preferred form of nutrition in full term
infants.
•
Contains mostly saturated fatty acids, differing amounts of amino Contains
mostly saturated fatty acids, differing amounts of amino acids and higher
protein, calcium, sodium and chloride levels than breast milk.
•
acids and higher protein, calcium, sodium and chloride levels than BREAST MILK.
•
Formula designed to match the ratio of breast milk composition
•
May meet the needs of working mother
•
Must be prepared under clean conditions and sterilized to prevent contamination
ADVANTAGES
•
Provides a suitable alternative to breast feeding
•
Less restrictive to the woman than BF
•
Allows more accurate assessment of infants intake
•
May be indicated for infant with congenital anomaly
•
Necessary if infants require a special formula
• DISADVANTAGES OF BOTTLE FEEDING
•
More difficult for infant to digest than Breast milk.
•
More expensive and more time consuming to prepare
• Mixed feeding is a combination of breast and bottle
• feeding.
Two methods of formula preparation:
1. Aseptic method
• sterilized separately for at least 25 min.
• 2. Terminal method
• formulas are poured into clean bottles and sterilized together
• Disadvantage:
• Scum formation can clog the nipple holes.
•
Do throw out any unused formula
within 1 hour after feeding
•
Do toss out mixed formula that has
been at room temperature for more
than 1 hour
Dos of bottle
Do: Stock up.
feeding
Do: Try different varieties.
Do: Invest in good bottles.
Do: Invest in time-saving gadgets.
Donts of bottle feeding
•
Don’t leave the bottle in baby’s mouth while sleeping
• Don’t give cows milk to baby before 12 months
• Don’t put cereal in bottle
•
Don’t microwave baby formula
•
Don’t: Leave formula out or prepare too much ahead of time.
• Don’t: Stress about buying name brand.
• Don’t: Stress about getting formula to the perfect
temperature.
Why cant infants drink Cows milk?
ANSWERS:
• Your baby’s digestive system doesn’t
contain the enzyme to digest cow’s milk
• It can cause intestinal bleeding
• It contains incomplete nutrition
NURSING IMPLICATIONS: Teach mother of a
bottle-feeding infant to:
•
Investigate various types of formulas available and their
preparation.
•
Make sure the hole of the nipple is large enough for milk to
drip out.
•
Hold infant position similar to that used for breast-feeding.
•
Hold infant during feeding do not prop the bottle.
•
Point nipple directly to the infants mouth
•
Feed infant usually every 4 hours
Nursing Implications:
•
Make sure infant retains 3-4 oz. Of milk
each feeding
•
Hold infant upright against the shoulder for
burping
•
Burp infant at regular intervals
•
Discourage overfeeding
•
Discourage unscheduled feeding.
• Solid foodsMay be added in the may be
added in the diet 4-6 mos
•
Should not be delayed beyond ages 7-9
mos
•
Should be strained, pureed or mashed
SOLID FOODS • Each meal should progress ¼ to ½ cup
as infant grows
• Can start eating “finger foods” at 6-7
mos
•
Can start eating chopped table foods
at 9-12 mos
Feeding Infants 4-6 months
•
Breast milk and formula provide main source of nutrition
•
4-month-olds usually consume 4 to 6 ounces of breast
milk or formula every four to five hours a day.
• 5-month-olds may be eating 6 to 7 ounces of breast milk or
formula every four to five hours a day.
• 6-month-olds can eat 7 to 8 ounces of breast milk or
formula every four to five hours a day, as well as 1 to 9
tablespoons of solids such as cereals, fruits and
vegetables.
Feeding infants 4-6mos
•
Cereal (rice) can be eaten in bowl with
baby spoon
•
Add vegetables (cooked, soft, mashed) if baby
tolerates cereal
•
Introduce new foods one at a time
• No honey until baby is 12 months old
• Infant Botulism: a food borne illness
causing symptoms such as constipation,
weakness and decreased ability to move
which can lead to death.
Question:
How do you know
your baby is ready
for cereal?
Answer:
Baby sits up
with
some support
•
Holds up his head by
himself
•
Does not push food out
of his mouth with his
Feeding infants 7-9 months
•
Breast milk and • Well-cooked,
•
formula strained or finely
mashed meats
•
Cooked or soft
vegetables • Egg yolk
•
Cooked or soft fruit
• Finger foods
• 9- to 10-month-olds may be
eating about 24 to 30
• 7- and 8-month-
olds may be eating about 24 to
ounces of breast milk
36 ounces of breast milk or and/or formula a day
formula each day (four to six (three to five nursing
nursing sessions, if you're sessions, if you're
breastfeeding), plus 4 to 9
tablespoons of cereal, fruit
breastfeeding), along
and vegetables daily as well with 1/4 to 1/2 cup each
as 1 to 6 tablespoons of of grains, fruit,
meat/proteins. vegetables, dairy
products and
Question:
How do I know when my baby is
ready to use a sippy cup?
Answer:
When the baby is able to
sit up and hold objects on
his own.
Finger foods
•
Dry cereal
•
Pancakes or French toast cut into strips
•
Cooked rice and chopped noodles
•
Banana cut into small pieces
•
Cooked fruit or chopped canned fruit
or vegetables
•
To prevent choking, give your baby foods
that soften in the mouth and cannot be
swallowed in chunks.
Feeding Infants10-12months
• Breast milk and/or Formula given
in sippy cup
• Water, 100% fruit juice in sippy cup
•
Don’t give high sugar drinks
• Chopped or soft table foods
11-month-olds
• 11-month-olds
• =16 to 24 ounces a day of breast milk
or formula a day (three to five nursing
sessions, if you're breastfeeding),
• their diet will include more solids: 1/4
to 1/2 cup each of grains, fruit,
vegetables, dairy products and
meat/protein foods.
12-month-olds
= 24 ounces a day of breast milk or
formula (three to five nursing sessions, if
you're breastfeeding),
• =many will start weaning from the bottle
or breast around now and start drinking
cow’s milk.
• = eat 1/4 to 1/2 cup each of grains, fruit,
vegetables, dairy products and
meat/protein foods.
Nursing Implications: Teach the mother to:
•
Mix cereal with breast milk, formula or water
•
Offer new foods one at a time
•
Start with generally tolerated fruits
•
Offer fruit juice on cup not on feeding bottle
•
Prepare foods by baking, broiling, steaming or poaching
•
Include organ meats
•
Introduced egg in small quantities
•
Supervised all meals
•
Be aware that candy, nuts grapes, and popcorn are associated
with choking.
•
Cook foods until tender, make it easy to chew, and must be
serve in small pieces.
NURSING IMPLICATION FOR COMMON NUTRITION RELATED PROBLEMS:
REGURGITATION OR VOMITTING – forcible
ejection of gastric contents
•
Assess for possible GI abnormalities
•
Encourage mother to feed infant slowly and to
pause several times during feeding
•
Burp infant often
•
Hold infant upright position during feeding
•
Place infant in his stomach of right side lying
position to prevent aspiration
•
Notify the physician if condition persists.
NURSING IMPLICATION FOR COMMON NUTRITION RELATED PROBLEMS:
CONSTIPATION - infrequent bowel
movement.
•
Assess the amount & frequency of milk and
water feedings
•
With physicians approval; encourage mother to
increase feeding and to add high fiber foods in
the diet.
•
Provide a quite, relaxed atmosphere during
feeding
•
Notify physician if constipation persist.
NURSING IMPLICATION FOR COMMON NUTRITION RELATED PROBLEMS:
DIARRHEA – frequent loose stools
•
Assess amount and character of stools
•
Assess infant’s skin turgor as indication of his
hydration status
•
Evaluate feeding patterns and suggest changes as
necessary
•
Notify physician if diarrhea persist
• HICCUPS
•
Encourage mother to offer water in between
feedings
•
Burp infant often during feedings
•
Quite and relaxed atmosphere
NURSING IMPLICATION FOR COMMON :
NUTRITION RELATED PROBLEMS
• COLIC – acute paroxysm of pain
•
Quite and relaxed atmosphere
•
Feed infant slowly and pause several
times during
•
Burp infant often during feeding
•
Teach mother measures to promote
infant comfort such, as stroking
caressing and rocking.
FOOD ALLERGY
•
Should introduce singly and with
intervals [3days] to allow detection.
•
Food that causes allergy should be
discontinued before introducing another
food.
•
Foods that often cause allergies: eggs,
fish, milk, peanuts, shellfish, soybeans
and wheat.
Foods to be avoided:
Too much
sweets [has
high calories Canned
Raw carrots;
but little vegetables
honey [risk of
essential [often high in
salt] botulism]
nutrients]
Nutrition in
children
• TODDLER
•
Refers to a child between infancy and pre-
school ages 1-3 years.
•
The best time to introduce good food
habits.
PRE-SCHOOL
•
Refers to a child between 3-6 years old.
•
High activity levels but slowed growth
rate.
• Nutritional Requirements:
• Energy
•
12-18 months of life is 55 kcal/kg and
after that it declines to an adult level of
23-30 kcal/kg.
•
Deficiencies: lack of calorie intake that
leads to CHON utilization = PEM and;
adequate calorie intake but low CHON
in the diet = kwashiorkor.
• Protein
Nutritional •
Increase from age 1-6;
requirements recommends some 10%-
15% CHON/kg; 2/3
should be of high
biological value
•
For increase skeletal and
muscle tissue and
protector against
infection.
• Lipids
Nutritional •
30-50% daily caloric intake of
requirements fats for both toddlers and pre-
schools.
Carbohydrates
•
Authorities recommend 50%-
60% of the total daily calories
intake be supplied by
carbohydrates.
• Vitamins
Nutritional
•
Requirements for
requirements toddlers and pre-
schools are slightly
greater than those of
infants.
•
Vitamin D for proper
skeletal growth and
calcium metabolism.
• Minerals
Nutritional •
Adequate calcium and
requirements phosphorus are needed for
bone mineralization
•
Toddler’s daily iron [IDA],
calcium and phosphorus may
be difficult to meet due to
poor eating habits.
•
Calcium requirements
remain steady throughout the
two age groups.
• Fluids
Nutritional
•
Approximately 115ml/kg
requirements of fluids daily.
•
Exact requirements
depend on activity level,
climate and health
status.
Provide fuel for muscular
FUNCTIONS OF 1.
activity
DIET FOR A CHILD 2. Supply necessary chemical
elements and compounds that
the child’s body requires for
building materials and
repairing worn out tissues
3. Gives pleasure and
satisfaction to the child
COMMON
•
Protein Energy
Malnutrition [PEM]
NUTRITION •
Iron Deficiency Anemia
PROBLEMS [IDA] decrease hemoglobin
and decrease hematocrit.
•
due to parasitism
•
Lack of Iron S/S :
paleness of eyes, lips,
fingernails, palms, skin,
reduce ability to learn,
fatigability, irritability.
Anemic children do poorly
COMMON
•
in vocabulary, reading,
NUTRITION mathematics, problem
solving and psychological
PROBLEMS test.
•
Vitamin A Deficiency
Xerophthalmia = dryness of
the eyes; Vit. A deficiency.
Night blindness, rough dry
skin and dry membrane of
the nose and throat; increase
susceptibility to infection.
Iodine Deficiency Disorder
COMMON
•
S/S mental retardation,
NUTRITION deaf mutes, difficulty in
standing and running.
PROBLEMS •
Obesity
•
Dental Caries 98% of
children has tooth decay;
caused by sticky sugar-
containing foods that cling
to teeth
FACTORS AFFECTING
PRE-SCHOOL
NUTRITIONAL STATUS
FACTORS AFFECTING •
FAMILY ENVIRONMENT
PRE-SCHOOL can provide appropriate role
models and reinforcements.
NUTRITIONAL
Set-up at home
STATUS environment that fosters
development of desirable
eating patterns in young
children.
•
SOCIAL TRENDS some
mother’s are employed
outside the home and do not
have much time to prepare
meals or teach children
about good eating habits.
FACTORS AFFECTING •
MEDIA T.V. affects
PRE-SCHOOL children request for and
NUTRITIONAL attitude toward food.
Parents should not be
STATUS persuaded to buy the non-
nutritious foods seen on T.V.
•
ILLNESS AND DISEASE
ill children have decrease
appetite and limited food
intake.
•
They require increase fluid
intake, CHON and other
nutrients.
FEEDING • EATING TOO LITTLE as
long as the child eats the right
PROBLEMS foods, go slow in adding new
foods on the diet start meals
with food that they like best.
• EATING TOO MUCH due
to heredity, temperament,
appetite or mother’s
insistence on a “clean plate”.
The only danger is
overweight and indigestion.
FEEDING PROBLEMS • DAWDLING child who lingers
or dillydallies with their food is
maybe trying to get attention or
may not feel well or are given
portion, which are too large.
• GAGGING a child who feels
like vomiting especially when
being fed by coarse foods.
Sometimes this is due to
negligence in training the infant
to eat chopped foods.
• AVERSION TOWARD SOME FOODS
FEEDING milk and vegetable are just two foods
PROBLEMS being refused by some children. Fruits
are good substitutes for vegetables and
for milk they can be given in forms of
leche flan, cream soup, cheese and
cereals.
• ALLERGY food allergy is common
especially seafoods and eggs decrease the
intake of protein rich foods. Chemicals
in the air, food preservatives and dyes are
found to worsen the allergy condition.
So nutrient intake must be monitored
and substitutions must be made when
necessary.
FamilyID=Office_ArchiveTorn
INDICATION
OF GOOD
NUTRITION
Indication of good nutrition
•
A healthy pre-school child exudes a feeling of well
being, of interest in all activities usual for their age.
•
Posture is erect, arms & legs straight, abdomen pulled
in and chest out.
•
Head is normal size and shape, skeleton with no
malformation.
•
Teeth are straight without crowding in the well-shaped
jaw. [6 years old 24 sets of teeth]
•
Skin is smooth, slightly moist with health glow.
•
Eyes are clean, bright with no signs of fatigue.
Hair is shiny, muscles firm; gums
Indication of Good
•
light pink, lips moist and tongue
Nutrition without lesions.
•
Has good attention span for their
age, not easily irritated and
restless
•
Appetite, digestion and
elimination are regular.
•
Able to communicate and handle
abstract materials in thinking.
•
Social and outgoing, loving and
affectionate.
Nutrition in School
age
• Is generally considered to be
Nutrition in School 6-12 years old.
age children • Consistent in maturity but slow in
growth rate, maturation of fine and
gross motor skills, gains cognitive
and social – emotional growth.
•
• NUTRIENT ALLOWANCE
Nutrition in School
Children need more nutritious
age children
•
foods in proportion to their
weight than adults do because
they are growing and developing
bones, teeth, muscles and blood.
ENERGY
•
80-90 kcal/kg 7-9 years old
•
70-80 kcal/kg 10-12 years old
Nutrient allowance • PROTEIN
•
35 gm/day 7-9 years old
•
45-49 gm/day 10-12 years
old
VITAMINS & MINERALS
•
Generally increase and the
most important is Calcium
for bone mineralization and
prevention of osteoporosis.
And Iron for essential growth
and development and
prevention of anemia.
Common Nutritional 1. Malnutrition and
Learning
concerns 2. Iron DeficiencyAnemia
3. Obesity
4. Dental Caries
5. Constipation
Feeding Problems • 1. Inadequate meals
• 2. Poor appetite
• ex. Tired, demanding
school work
• 3. Sweet tooth
• 4. prolonged
mealtimes
• 5. food refusal
• 6. disruptive and
stressful mealtimes
• 7. lack of appropriate
independent feeding
FACTORS AFFECTING •
Family
FOOD INTAKE •
Peers
•
Schools
•
Societal Trends
PROPER FEEDING FOR •
Furnishing energy needed for
SCHOOLERS vigorous activity;
INCLUDES •
Helping maintain resistance
to infection;
•
Providing building materials
for growth and
•
Providing adequate nutrient
stores to assist in adolescent
growth.
Food equivalent •
1 cup cooked rice [160 gms] =
5 pcs. Pandesal, 4 slices of
bread 1-1/3 cup corn meal, 1
cup cooked camote.
•
1 serving meat [60 gms] = 1/3
cup raw dried beans, 2
medium sized fish 55-60 gms,
2 medium sized egg 50 gms
each.
•
1 serving of fruit = 1 medium
sized fruit or 1 slice of big
fruit.
Nutrition in
Adolescence
• is a transition of human
ADOLESCENCE development that occurs
between childhood and
adulthood
Americal Psychological Association
Nutrient Allowance • Calories are the measurement
used to express the energy
delivered by food. The body
demands more calories
during early adolescence than
at any other time of life.
• Boys require an average of
2,800 calories per day.
• Girls require an average of
2,200 calories per day.
• 310 kcal more dan girls with
Nutrient Allowance same wgt and age - intense
physical activity=increase
thiamine, riboflavin and
niacin.
• 0.5mg/1000calories-
thiamine and 6.6
mg/1000calories.
Protein-59 grams
boys and girls.
• Vitamins A and C.
• Minerals. Calcium -700mg
iron-300mg
Nutrition in
adulthood
• Daily reference intakes
Nutritional for adults are:
management • Energy:
8,400kJ/2,000kcal
• Total fat: less than 70g
• Saturates: less than
20g
• Carbohydrate: 260g
• Total sugars: 90g
• Protein: 50g
• Salt: less than 6g
• 56kg for men and 48 kg
Nutritional women. 12gms form
management protein, 1.2gms/kg
[Link] adult. Vitamin
C enhances iron
absorption -70mg F
75mgM.
• Vitamin D from sun
1200-1500
• calcium and excercise
•
To stay healthy, these must
feeding the •
be observed and followed:
1. Eat variety of foods.
adult •
2. Maintain ideal wgt.
•
3. Avoid too much fat,
saturated fat and
cholesterol
•
4. Eat foods with adequate
starch and fiber
•
5. Avoid too much sugar
•
6. Avoid too much sodium.
•
7. If you drink alcohol, do
so in moderation
Reminders:
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Indication of Good
Nutrition
Indication of Good
Nutrition
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