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NUTRITION AFTER BIRTH. “Nutrition and growth of children affects not only their survival but also their quality of life.” Rama Bhat, M.D. Professor of Pediatrics. UIC Medical Center. Learning Objectives. Nutritional Requirement from Birth to Adolescence.

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NUTRITION AFTER BIRTH


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slide1

NUTRITION AFTER BIRTH

“Nutrition and growth of children affects not only their

survival but also their quality of life.”

Rama Bhat, M.D.

Professor of Pediatrics.

UIC Medical Center.

learning objectives
Learning Objectives
  • Nutritional Requirement from Birth to Adolescence.
  • Breast Milk and Breast Feeding.
  • Evaluation of Nutritional Status.
  • Nutrients Inadequately supplied in Children.
  • Nutrition related problems in Childhood.
slide3

Pediatric Nutrition

Nutritional requirements can be considered

on the basis of:

a). Age.

b). Body size.

c). Growth rate.

d). Caloric intake.

e). Physiologic losses.

slide4

Days required to double birth weight

Species Days Lactose (%) Fat(%) Protein(%)

Human 180 7.0 3.8 0.9

Horse 60 6.2 1.9 2.5

Cow 47 4.8 3.7 3.4

Goat 19 4.1 4.5 2.9

Rat 6 3.0 15.0 12.0

enrgy expenditure
ENRGY EXPENDITURE

CALORIES PER KG OF BODY WEIGHT

AGE (YRS)

CHANGE IN ENERGY EXPENDITURE WITH AGE.

energy distribution
ENERGY DISTRIBUTION

CARBOHYDRATE 50% - 60%

FAT 30%- 40%

PROTIEN 10% - 15%

protein
PROTEIN
  • Dietary protein provides energy and amino acids for the synthesis of body proteins and other tissue constituents.
  • Many factors affect dietary protein requirement
  • 95% of animal and 60- 80% of vegetable protein is digestible.
  • In a mixed diet, proteins supply 10-15% of daily energy requirement.
slide9

RECOMMENDED DIETARY INTAKE (RDI)

FOR PROTEIN

RDI

Age ( months) g/kg/d g/100 kcal

0 - 1 2.6 2.2

1 - 2 2.2 2.0

2 - 3 1.8 1.8

3 - 4 1.5 1.6

protein requirement
PROTEIN REQUIREMENT

Protein gm/kg

Age (yrs)

slide13
FAT
  • A concentrated form of energy.
  • EFA is necessary for the synthesis of various Eicosanoids (prostaglandins,Thromboxanes & Leukotrienes).
  • Necessary for the formation of cell membranes.
  • Total intake should not exceed >30% of total calories (for children over 2 years old).
  • Intake of dietary cholesterol should not exceed 300 mg/day.
slide14

Range of average Water Requirements of Children

at Different Ages under Ordinary Conditions

Age Avg. body Water per kg

weight (kg) of body wt in

24 hr(ml)

3 d 3.0 80-100

10 d 3.2 125-150

3 mo 5.4 140-160

6 mo 7.3 130-155

9 mo 8.6 125-145

1 yr. 9.5 120-135

2 yr. 11.8 115-125

4 yr. 16.2 100-110

6 yr. 20.0 90-100

10 yr. 28.7 70-85

14yr. 45.0 50-60

18 yr. 54.0 40-50

energy protein and fluid needs in pediatric patients

Age (yrs)

Average Energy Allowance (kcal/kg)

Protein Requirement (g/kg)

Fluid Requirement (ml/kg)

0.0 – 0.5

108

2.2

120 - 150

1 - 3

102

1.2

114 - 115

7 – 10

70

1.0

70 - 85

11 – 14 (BOYS)

55

1.0

70 - 85

(GIRLS)

47

1.0

70 - 85

15 – 18 (BOYS)

45

0.9

50 - 60

(GIRLS)

40

0.8

50 - 60

ENERGY, PROTEIN, AND FLUID NEEDS IN PEDIATRIC PATIENTS
slide16

CURRENT RECOMMENDATIONS FOR

FEEDING INFANTS

  • Nursing period (4-6M): Human milk or formula only.
  • Transitional period: Specially prepared foods are introduced
  • Modified Adult period: Mostly table food.
slide17

HEALTHY PEOPLE 2000

Goals:

  • 75 % of moms to breast feed their infants
  • in early post partum period
  • 50 % of moms to breast feed until their
  • babies are 5 - 6 months old.
rates of breast feeding in usa
Rates of Breast feeding in USA

1971 24.7%

1984 59.7%

1989 52.2%

2001 69.5%

slide21

Days required to double birth weight

Species Days Lactose (%) Fat(%) Protein(%)

Human 180 7.0 3.8 0.9

Horse 60 6.2 1.9 2.5

Cow 47 4.8 3.7 3.4

Goat 19 4.1 4.5 2.9

Rat 6 3.0 15.0 12.0

slide23

DEFENSE FACTORS IN HUMAN MILK

AntimicrobialAntiinflammatory

Secretory IgA Antioxidants, vitE vit A

Lactoferrin EGF Lysozyme Catalase

Oligosaccharides G-peroxide

Complement C 3 Antiproteases

Fibronectin

Mucins

healthy people 2010
Healthy people 2010
  • Goals: - Breast feeding initiation: 75% - Breast feeding at 6 months: 50% - breast feeding at 12 months: 25%
slide25

DEFENSE FACTORS IN HUMAN MILK

Immunodulators Leukocytes

Nucleotides Neutrophils

CytokinesMacrophages Lymphocytes

slide26

HOSPITAL ADMISSIONS FOR 100 INFANTS

FOR THE FIRST 18 MONTHS BY FEEDING TYPE

Feeding Type

Diagnosis

Breast ( N=670)

Artificial ( N = 388)

Respiratory infect. 7.0 13.7

Gastroenteritis 3.6 5.2

Other infections 1.5 2.1

slide27

FEEDING DURING 1st YEAR

Age(months)# of feedings /24 hrs

0 - 1 6 - 8

2 - 6 4 - 5

7 - 10 3 - 4

11 - 12 3

Age(months)Volume / feed (ozs)

1 2 - 4

2 5

3 5 - 6

4 6 - 7

5 - 12 8

social impact of breast feeding
Social Impact of Breast feeding
  • Savings/year $ 750 - 1200 / yr.
  • National savings $ 950 Million/yr.
slide29

Breast Feeding

  • Contraindications:
      • Galactosemia
      • Maternal drug abuse
      • Maternal tuberculosis
      • HIV positive mother
      • Medications: Cancer chemotherapy
  • Radioactive isotopes
slide30

OBSTACLES TO BREAST FEEDING

  • Physician apathy and misinformation
  • Lack of prenatal education
  • Disruptive hospital policies
  • Early hospital discharge
  • Lack of appropriate followup
  • Maternal employment
  • Commercial promotions of formulas
  • Television and magazine advertising
slide31

Month Food Items

1 - 4 Breast milk or formula

4 - 6 Iron-fortified cereal

6 - 7 Strained fruits; begin introducing cup

7 - 8 Strained vegetables

8 - 9 Start finger foods and chopped (junior) foods

9 Meats, citrus juice

10 Bite -sized cooked foods

12 All table foods

slide32

USE OF COW’S MILK

  • Cow’s milk should not be used until the infant
  • reaches 1 year of age.
  • Feeding Cow’s milk may cause:
  • Increases renal solute load.
  • Low vitamin C and iron.
  • Low EFA
  • Increased incidence.
slide33

SERVINGS PER DAY

Women & some Children,teen girls Teen boys &

older adults active women,men active men

Calorie level

~1600 ~2200 ~2800

Bread group 6 9 11

Veggie group 3 4 5

Fruit group 2 3 4

Milk group 2 - 3 2 - 3 2 - 3

Meat group 2 2 3

Total (ounces) 5 6 7

Source: US Department of Agriculture.

adolescent nutrition

Adolescent Nutrition

17%(39 Million) of the population in United States are aged between 10-19 years.

.Reasons for nutritional problems:

Anorexia, Physical Activity, Obesity, Food Habits, Pregnancy, Growth spurts.

policies directed towards improving the growth of children
POLICIES DIRECTED TOWARDS IMPROVING THE GROWTH OF CHILDREN
  • Promote and support breast feeding.
  • Monitor growth and development.
  • Introduce appropriate micronutrient rich complementary food at 6 months of age.
  • Prevention of obesity.
  • Identify infant at risk of growth failure.
  • Education of parents.
adolescent nutrition1
Adolescent Nutrition
  • 14% ( 36.5/million) of US population are 10-19 years old.
  • Reason for nutritional problems
factors influencing nutritional needs in adolescents
Factors Influencing Nutritional needs in Adolescents
  • Onset of puberty - Increase growth rate
  • physical activity
  • changes in body composition. -Increase in body fat in girls - Increase in lean body mass(LBM) in boys.
nutritional concerns during adolescence
Nutritional Concerns During Adolescence
  • Food habits: - skipping meals - snacking - consumption of fast foods
  • Results of poor nutrition: - protein intake- vegetarianism. - calcium needs. - iron and zinc - obesity - 14% (1999 survey)
obesity
Obesity

Definition:

BMI 85-95th percentile - At risk for overweight

BMI > 95th percentile - Overweight

BMI ( Kg.m2)

prevalence of obesity bmi 95th percentile
Prevalence of Obesity (BMI>95th percentile

Age 6-11 years 12 -17 years

Groups

male Female Male Female

all 11.3±1.8 12.8±1.9 10.6±1.3 8.8±1.4

white 10.4±2.4 14.4±2.7 9.8±2.0 8.3±3.1

AA 13.4±2.3 9.3±2.4 16.9±2.8 14.4±3.1

Hispanic 17.7±2.3 12.8±3.2 14.3±1.7 8.7±2.5

management
Management
  • Goal: to diminish morbidity and mortality risk.

1- Diet: - Prepubertal: 300 - 400 cal/day lower than required.

- Older children: 500 - 700 cal/day lower.

Goal is to loose 300- 500 gm weight loss/wk

2- exercise:

3- Surgical:

4- Pharmacotherapy:

indicators of nutritional status
INDICATORS OF NUTRITIONAL STATUS

Head circumference

for age

<5th percentile

>95th percentile

Stunting/ shortness

Length or height for age

<5th percentile

Underweight

Weight- for length

BMI for age

<5th percentile

new in the cdc growth charts
NEW IN THE CDC GROWTH CHARTS
  • charts extend to 20 years
  • 3rd and 97th percentile available.
  • Lower limits of length (45 vs. 49 cm) and height (77 vs. 90 cm) extended.
  • BMI-for- age charts (2-20 years) added.
  • 85th percentile (at risk of overweight) added.
slide47

Estimated protein intake of breast-fed infants

Age Milk consumption Protein intake

(months) (ml/d) (g/kg/d)

0 - 1 630 2.09

1 - 2 773 1.59

2 - 3 787 1.15

3 - 4 810 1.06

slide49

PROTEIN CONTENT OF MILK

FROM SOME MAMMALS

Species Protein(%)

Humans 1.0

Horse 2.5

Goat 2.9

Cow 3.4

Sheep 5.5

Reindeer 11.5

slide50

Distribution of energy in human milk

Stages of Fat Protein Lactose Total energy

lactation (%) (%) (%) (kcal/100ml)

Colostral 44 17 39 56

Transitional 48 9 43 60

Mature 50 7 43 61