Nutrition in Infancy and Childhood

1. Nutrition in Infancy and Childhood

2. 2 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

3. 3 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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5. 5 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.

6. 6 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.

7. 7 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.

8. 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.

9. 9 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

10. 10 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 ?????? of nutrients and offer substitute choices that the child can finally select from Energy requirements increase to 1800 kcal/ day

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12. 12 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.

13. 13 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.

14. 14 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

15. 15 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.

16. 16 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.