NUTRITION in GROWING YEARS
Subdiv.of Nutrition and Metabolic Diseases
Dept of Child HealthMedical Faculty, Univ of North Sumatera
Growth and Development
• Children == small adults• Children : grow and develop
- body size- maturity of organs- psychomotor- mental / psychosocial- cognitive
• Nutritional requirements : >>
Normal Nutrition during Infancy
• Very important for future health, G & D• Rapid G & D :
- physical : - BW : 3.0 10.0 kg - BL : 50 75 cm
- psychomotor : recumbent walking, etc.
- mental & cognitive
• Nutritional req. : the highest - Energy : 110 - 120 kcal/kgBW/d - Protein : 2.5 - 3.0 g/kgBW/d
Normal Nutrition during Infancy• Breastfeeding : - recommend to all infants
- the best nutrition for infants - exclusive BF : up to 4-6 mos
• Advantages : - superior nutritional composition - provision of immunologic and enzymatic components - health benefits for mothers - lower cost and increased convenience - enhanced infant-mother bonding
- respiratory & gastrointestinal infections - leaner body composition at 1 yr
- improved cognitive development
Breastmilk composition
• Changing / vary : - individually- stage of lactation- time of day- time into feeding- maternal diet
• 4 stages of BM expression :- colostrum - transitional- mature- extended lactation
4 stages of BM expression :
• Colostrum : - produced during the first few days - fat & energy : lower
- protein, fat soluble vit, mineral and electrolytes : higher - rich source of antibodies
• Transition : - 7 - 14 days postpartum - protein & Ig :
- lactose, fat & energy : • Mature milk : throughout lactation, until 7-8
mos
• Extended lactation : 7 mos 2 yrs
Effects of Changes in Maternal Diet
Changes + : Vitamin : A, D, E, K
ThiamineRiboflavinNiacinBiotin PyridoxinePantothenicFolateCyanocobalamin
Minerals : Mn, I, F, Se
Changes - : Vitamin : -
Minerals : Na, Ca, P, Mg, Fe, Zn, Cu
Breastfeeding Management
• Factors infuencing successful lactation :- motivation & confidence of the mother
- support from those around her- capability of the infants to suckle
• To establish and sustain lactation :- Initial BF : soon after delivery- Positioning : comfortable for both (baby &
mother) - Latching on : - Timing : every 2-3 hrs or 8-12 x/d- Assessing adequacy
•
Posisi ibu & bayi
Benar Salah
Mata menatap, bibir ‘dower’
Benar Salah
Mulut bayi mencakup areola
Benar Salah
Breastfeeding Management
• Assessing adequacy : “How do I know if my baby is getting enough? “
• Signs that a baby is receiving adequate fluid and calories : - have at least 6-8 thoroughly wet diapers/day - have regular bowel movements
- nurse 8 - 12 times/day- seem satisfied after nursing- grow at a relatively predictable rate
Weaning
• Introducing solids into an infant’s diet• Should balance nutrient needs with a
variety of foods and textures• Encouraging feeding skills development• Goal : transition from a liquid diet into a
well- balanced table food diet• Readiness : - 4 - 6 mos
- physical and psychologic development
Weaning
• Nutrient needs :- 4-6 mos : physical activity >>
- Caloric distribution during infancy : fat : 40 - 50%
protein : 7 - 11%CHO : the remainder
- Water/Energy ratio : 1.5 ml/kcal- Vitamin & mineral : affected by
introducing solid foods - Age 6 mos : 80% BM/formula, 20% beikost 8- 10 mos : 50% BM/formula, 50% beikost 12 mos : 20% BM/formula, 80% beikost
Tahapan penyapihan
Ciri bayi siap menerima MP-ASI
Weaning
• Physical readiness : - extrusion
reflex < / - - oral motor
skills : - from suck
to swallow solids - transfer
food from front to back of the tongue - able to hold the head up without support - sitting independently and maintaining balance
while using hands to reach and grasp objects
Weaning• Psychologic readiness :
- advanced eating behaviour : from refllexive and imitative to more independent and exploratory - by 6 mos : the infant is able to indicate : - a desire for food by opening mouth - hunger by leaning forward - disinterest or satiety by leaning back and turn away
• Encouraged to develop more independence :- self-feeding of soft finger foods
- sipping from a cup by 6-8 mos- holding the cup or bottle
independently - controlling the timing of feeds to promote self-regulation of hunger and satiety
Tahapan penyapihan :
R.hisapR.telan
R.ekstrusi </ -
MengunyahMenggigit
Gerak memutarRahang stabilKoordinasitangan baik
M,cair M.lumat M.Lunak/ padat M.keluarga
Weaning foods
• Commercial baby foods :- prepared without sodium, many without
sugar - enriched with vitamin and Fe, Ca, P - ‘first food’ = single ingredient foods - textures from strained to chunky - time efficient
• Home-made baby foods :- more economics
- greater flexibility in consistency and variability - time consuming
Frekwensi makan
Tujuan akhir praktek pemberian makan (periode 3)
Susu
Susu
(Susu)
Normal nutrition from infancy through adolescence
• Preschool and school children : slowing in physical growth
• Elementary school years = ‘latent period’ prior to pubertal growth spurt of adolescence
• Growth pattern ( spurt and slow/no growth ) : correspond to similar changes in appetite and food intake
• Developmental progress during the growing years influences many aspects of food and eating
Normal nutrition from infancy through adolescence
• Nutrient needs : determinants factors are :- rate and stage of growth
- activity- body size - BEE - onset of puberty- state of illness
• The DRIs (Dietary Reference Intakes) include RDA and AI :
- as a guide to prevent deficiency- to provide positive health
benefits - data are extrapolated values
Normal nutrition from infancy through adolescence
• ENERGY : - RDA : based on reference weight for each age group
- using doubly labeled water : RDA for children was overestimate as much as 25%
- up to age 10 yrs no distinction between sexes - 11 yrs and above : allowance for energy are based on sex and puberty
- age is not good criterion for determining energy needs especially in pubertal years ( growth spurt occur at varying times) - height is a useful reference in determining appropriate energy intakes
Factors influencing adolescence nutritional status and eating behaviour
- Irregular meals - Snacking
- Media - Family
- Peers - Body image
- Fast foods