Nutrition from Infancy Through Adolescence

Chapter 18BIOL1400

Dr. Mohamad H. Termos

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

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

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

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.

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

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

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

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

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

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)

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

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

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

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

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

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

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

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)

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"

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

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

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

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

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

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

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

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

The teenage years

Nutritional problems and concerns of teens

1. Anorexia and bulimia2. Sodium intake often high3. Iron-deficiency anemia