Nutrition for Infancy

8/9/2019 Nutrition for Infancy

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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

Nutritional requirements

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.

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.

Carbohydrates :

Should supply 30-60% of energy intake.

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.

Older infants derive CHO from

additionalSources: legums ,cereals, fruits,

vegetables.

( avoid some fruit juices for infants< 6months as: apple, pear, prune).

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.

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.

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.

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.

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.

Minerals

1-calcium:

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.

2-Iron:

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.

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.

Vitamins

Vitamin A:

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.

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.

Vitamin k:

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.

Vitamin E:

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.

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.

Vitamin B12:

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.

Folate:

0-6 months:25 μg/day.

7-12 months:35 μg/day.

Body stores of folate at birth are small and rapidlydepleted .

Sources:

2-green leafy vegetables; fruits cereals, andlegumes,egg yolks; and liver.

Vitamin B6 (Pyridoxine):

0–6 months 0.3 mg/day.

7–12 months 0.6 mg/day.

Sources:

2-liver; meat, cereals, legumes; and potatoes.Riboflavin:

0-6 months:0.4 mg/day.

7-12 momths:0.6 mg/day.

sources: dairy products, lean meats, poultry, fish,grains, broccoli.

( ) :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

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

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.

Composition of breast milk

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.•

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

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.

Other important proteins:

Vitamins, Minerals

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 :

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

3. Enhances Development andIntelligence

. :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

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

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.

Complementary feeding

&weaning

l f di

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.

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

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

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.

Introduction of the different newfood items:

At 6 months:- sieved or pureed vegetables given by

-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.

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

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.

Feeding problems during

infancy

1.Spitting up

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.

2.Vomiting

3.Overfeeding

4.Underfeeding

5.Dehydration

6.Constipation

The following measures are recommended toimprove bowel movement:-

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

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.Milk allergy

- 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.

H A N K Y O UH A N K Y O U

Nutrition for Infancy

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