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Nutrition from Infancy Through Adolescence
Chapter 18BIOL1400
Dr. Mohamad H. Termos
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Infant growth and nutrition needs
The growing infant
- Infant weight doubles within 6 months of age and triples within the first year of age.
- This rapid growth requires a very high amount of nutrients because otherwise growth would slows or cease
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Infant growth and nutrition needsUnder-nutrition- Half of the world's children
short and underweight for age because of poor nutrition
- Child does not receive breast milk, instead high carbohydrate, low protein and other nutrients
- The best indicator of nutritional status is growth
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Infant growth and nutrition needsInfant growth and development
can be assessed using growth charts which give ratios of weight Vs height, height Vs age, weight Vs age.
- 10th percentile means a child is smaller than 90 out of 100
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Infant growth and nutrition needs
Adipose (fat) tissue growth- It is very unwise to greatly
restrict diet and fat intake before age 2. This is because restricting fat cells development would mean a reduction in energy intake which would affect growth of other organ systems.
- Effects of overfeeding in infancy are speculative. Most overweight infants become normal-weight preschoolers without excessive diet restrition.
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Infant nutritional needs
1. Calorie or Energy needs: a. 0 - 3 months: (89 Kcal x wt in kg) + 75b. 4 - 6 months: (89 Kcal x wt in kg) + 44c. 7 - 12 months: (89 Kcal x wt in kg) - 78d. Human milk and formula provide about 640
kcalories / quart2. Carbohydrates: a. 0 - 6 months: 60 grams/dayb. 7 - 12 months: 95 g/dayc. These goals are easily met by proper diet3. Protein: a. 0 - 6 months: 9 grams/dayb. 7 - 12 months: 14 g/dayc. These goals are easily met by breast milk or
formula
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Infant nutritional needs4. Fat: a. 30 g/day with 15% (~5g) of total kcal
as essential fatty acidsb. Essential fatty acids (DHA and AA)
are vital to the development of the eyes and nervous system
5. Vitamins of special interest: a. Vitamin K given by injection to all
newbornsb. Breastfed infants need Vitamin D
supplementation until they are weaned.
c. Vitamin B12 supplement if breastfeeding mother is vegan
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Infant nutritional needs6. Minerals of special interest: a. Iron - Stores generally depleted by age 4 to 6 months- Infant > 6 months need dietary iron sourceb. Iodine and zinc generally met if energy needs
metc. Fluoride supplement if water not fluoridated7. Water: a. 700-800 ml (3 c) needed per dayb. Human milk and formula usually meet this
needc. More required in hot, humid weather or with
vomiting, diarrhea, feverd. Limit supplemental fluids to 4 ounces per day.
Excessive fluid can be harmful especially to the brain
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Formula feeding for infants
Formula composition- Carbohydrate: generally lactose or
sucrose- Protein: heat-protein from cow's milk- Fat: vegetable oils- Soybean-based for lactose or cows
milk intolerant- Predigested (hydrolyzed) protein:
protein easier to digest
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Formula feeding for infants
Formula preparation- Use clean bottles and mixing utensils- Mix formula with clean, cool water as hot
water may contain more lead from pipes
- Boiled, cooled well-water is OK if it has been tested for contaminates like nitrates
- Prepared formula can be kept in refrigerator for 1 day.
- Do not use microwave to heat as hot spots can occur
- Discard formula left over from a feeding (might be contaminated by saliva bacteria and enzymes
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Formula feeding for infantsFeeding technique- Burp infants during feeding every 1 to
2 ounces or every 10 minutes- Burp again at end of feeding- Stop feeding when infant indicates
he/she is full- Place infants to sleep on their back- Time on stomach while awake to
prevent flattening of the head- Sleeping on stomach linked to
sudden death syndrome (SIDS)
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Expanding the infants mealtime choices
- By about 6 months infants are ready to begin eating solids
- By 1 year infants consume a variety of meat, grain, fruit and vegetable
- Respond to infant cues of hunger and satiety
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Expanding the infants mealtime choices
- Until 6 mo nutrient needs met by breast milk or formula
- Other nutrients and additional kcal needed after 6 months
- Iron stores depleted by 6 moPhysiological capabilities of infant:- Ability to digest starch after 3 months- At about 4 to 6 months the following
develop: A)Tongue thrust controlB)Head and neck controlC)Ability to sit with support
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Infant growth and nutrition needsFoods to match needs and developmental ability
during the first year:
- < 6 months, primary goal meet iron needs
- Start with tsp serving of single food, gradually increase portion size
- Feed same food for 1 week then add another food
- Introduce vegetables before fruits
- One food at a time helps identify possible allergies
- Common allergy-causing foods to avoid during infancy: Egg whites, Chocolate, Nuts, Cow’s milk
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Infant growth and nutrition needs
By 9-10 months- Infants explore, experience, and play
with food- Present new food for several
consecutive days to aid acceptance of the food
By 1 year- Finger feeding is more efficient- Give baby sized spoon- Breast and bottle feed in more upright
position for easier swallowing- Maintain calm and casual tone during
mealtimes- Infant may take only 2 or three bits at
some meals
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Weaning from breast to bottle
- Sippy cup can be introduced at 6 months
- Drinking from cup not bottle helps prevent early childhood carries
- Continual bottle-feeding baths teeth in carbohydrate rich fluid. Ideal growth medium for bacteria that make acid that decays teeth
- Wean night feedings by giving pacifier or water
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Dietary Guidelines for Infant Feeding
Statements from American Academy of Pediatrics- Include variety of foods- Pay attention to signs of hunger and satiety- Infants need fat in the diet- Include fruits, vegetables and grains but not too
much fiber- Avoid artificial sweeteners, include natural sugars
for calories- Include foods containing zinc, iron and calcium
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Food Allergies and Intolerances
Allergies and intolerances broadly defined as adverse reactions to foods. Symptoms Include:
1.Sneezing2.Coughing3.Nausea or vomiting4.Diarrhea5.Hives, other rashes
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Food Allergies
- Immune system response, occurs when the body mistakes an ingredient in food as harmful and creates a defense system to fight.
- Symptoms develop after interaction between our antibodies and the food (mostly proteins)
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Food AllergiesTypes of reactions: - Itching, asthma, and swelling - Nausea, diarrhea, and
indigestion- Headache and skin reactions- Anything milder than the
above symptoms is called a "food sensitivity"
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Food IntolerancesFood Intolerances: - Adverse reactions not involving
allergic mechanism- Digestive system response, occurs
when a constituent in food irritates the digestive system.
- Other causes include: Certain synthetic compounds added to foods, Food contaminants, Toxic contaminants, Deficiencies in digestive enzymes
Treatment: Avoidance or consume smaller amounts
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Preschool children: Nutrition concerns - Between 2 - 5 years old growth rate slows, average
weight gain is 4.5 - 6.6 pounds per year, and average height gain is 3" to 4"
- Rapid development of food habits and development of life- long eating patterns
- Decreased appetite associated with decreased growth rate
- Emphasize fruit, vegetables and whole grains and limit fatty and sweet foods choices
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Preschool children: Nutrition concernsNutritional problems in preschool children1- Iron-deficiency anemia- Occurrence most likely from 6 to 24 mo- Decreased stamina and learning ability- Emphasize sources of iron in the diet
with vitamin C sources2- Constipation- Can be associated with more serious
condition- Eat more dietary fiber, fruits,
vegetables, whole-grain breads and cereals, and beans
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Preschool children: Nutrition concerns
3- Dental caries- Begin oral hygiene when teeth
appear- Seek early pediatric dental care- Drink fluoridated water- Use small amounts of fluoridated
toothpaste twice daily- Avoid sticky, high-sugar snacks4- Vegetarianism in Childhood:Risks include: a. Iron deficiencyb. B-12 deficiencyc. Vitamin D deficiency
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School-age children
- Generally, nutritional concerns and goals are the same as preschoolers
- Serving size increases as energy needs increase
- Children who eat breakfast are more likely to meet their daily nutritional needs than children who do not eat breakfast
- Areas of diet needing improvement: increase fruit, vegetable, whole-grain, and dairy choices and reduced soda consumption
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School-age children
Type 2 diabetes
1. Primarily due to obesity coupled with inactivity
2. Blood glucose screening in at risk children every 2 years starting at age 10
3. Intervention: proper diet and physical activity
4. Medications may be necessary
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School-age childrenObesity- In the US, 15% of school-age children are
overweight.Effects: Cardiovascular disease, type 2
diabetes, hypertension in adulthood- 40% of obese children become obese adults- Potential causes: Heredity, diet, and
inactivityTreatment: - 60 minutes or more of planned physical
activity per day- Moderate energy intake
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The teenage years
Rapid growth spurtAge: - Girls: 10 to 13; Boys: 12 to 15Height gains:Girls: gain 10 inches, Boys: gain 12 inchesBody composition - Girls gain fat and lean tissue - Boys gain mostly lean tissue- During growth spurts teenagers eat more - Chose nutritious food to meet nutrient needs
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The teenage years
Nutritional problems and concerns of teens
1. Anorexia and bulimia2. Sodium intake often high3. Iron-deficiency anemia