Nutrition in children

Howaida mohammed
Objectives
 By the end of lecture student will be able to:
 identify the types of breast milk
 Recognize position of baby during breast feeding
 Understand safe infant weaning
 To recognize the changing nutritional needs of

developing children, from infancy to adolescence.

Breast feeding
startfeeding as soon after
birth to promote maternal-
infant bonding, reduce the
risk of hypoglycemia.
Types of breast
milk
1- Colostrums

 - Colostrum, a thin, yellowish fluid the

breasts secretes it before milk production
begins.
 - It helps maintain the blood glucose level in

the breastfeeding infant.

 It is secreted during first three days after

delivery.
 -:Transition-2
produced from day 4 – 10 days is
lower in protein in comparison to
Colostrum.
 3-Mature milk:-

is produced from approximately

10 days after delivery up until
the termination of the
breastfeeding
Newborn nutrition
Breast milk remains the initial food resource and best
method of feeding the newborn from birth to 6 months.
and has the
following advantages :
 Breast milk is nutritionally balanced
Safest, cheapest, Breast milk is warm, ready, sterile
Nutritivevalue (contains all the nutrients in the right
proportion
Itis essential for brain growth and facilitates absorption of
calcium
 continue advantages to baby
 Digestibility

 Protective value
 Breast milk contains IgA , IgM
 It reduces the risk of infection especially in unhygienic situations
 Protects against diarrhoea and other infections in infancy
 Promotes mother-child bonding
 It helps in child spacing
 It is readily available
Assessment of breast Feeding

 Weight pattern - consistent weight

gain.
 Voiding - # wet diapers/day, soaked?
 Stooling - generally more stools than

formula.
 Feed-on-demand ~ every 2-3 hours.
 Duration of feedings - generally 10-

20 min/side.
 Activity and vigor of infant.
The absolute contraindications
to breast-feeding

• Phenylketonuria
• Lactose intolerance
 Neonatal galactosemia
 Maternal HIV infection
 Maternal drug abuse
 Some maternal medications
(chemotherapy, drugs containing
radioactive materials., etc.)
Other reasons why a mother
may not breastfeed her baby
 Orphan child
 Working mother
 sick mother (active TB)
 Mastitis
 Crack nipple

Breast feeding position
 prepared a woman was during her pregnancy
 Some positioning :
 Cross-Cradle Position: The most common breastfeeding
position used for newborns is the cross-cradle. Here are
details on how to latch a baby in this position.
 Football Hold: A wonderful position for a mother who
has very large breasts or who has had a c-section. This
position is also great for premature or very tiny babies.
 Cradle Hold: A comfortable, natural position for older
babies with better head control.
 Side-Lying Position: An excellent position for nursing in
bed. This position is also great for a mother who has
had a c-section
 Attaching to the breast
 When baby is not correctly attached and

just sucks the nipple, feeding is painful,

nipples can become damaged and the
breast won’t be properly drained.
Attaching to the
breast
 baby may need to burp after feeding from
each breast. To do this, sit her up or hold
her to your shoulder and gently rub or pat
her back.
 Exclusive Breast Feeding means that:
 - No food or drink other than breast milk is
offered to breast feed baby for up to 6 months.
 -Baby is fed on self demand,
 -Day and night with no restrictions on the
length or frequency of breast feeding.
 - Partial Breast Feeding is defined as feeding
the infant breast milk for some feedings while /
and supplementing or substituting feedings
with formula or glucose water at other times.
Criteria of Breast Feeding
 - Adequacy of breast feeding
 - Infant calm and satisfied after feeding.
 - Normal bowel motion.
 - Normal weight gain.
 - Under feeding….
 - Failure of weight gain.
 - Dehydration, constipation, sleepness, colic.
 - Over feeding
 - Regurgitation, vomiting, colic.
 - Large bulky stool, abdominal distension,
excessive sweating
 NURSING CONSIDERATIONS AND
PARENTAL GUIDANCE
*Help mother assume comfortable and satisfying
position for self and baby.

*Help mother to determine schedule, timing, and when

infant is satisfied.

*Provide specific information about:

-Feeding technique: position.‌
- Care of breasts.
-Manual expression of milk from breast.
-Maternal diet
Artificial feeding
Reasons for formula
feeding
include the following:
 Orphan child
 Working mother
 sick mother (active TB)
 Mastitis
 Crack nipple
Infant Formula

 3 Forms:
◦ Ready to feed - most expensive,
does not require water.
◦ Concentrate - requires mixing with
water in equal parts.
◦ Powder - requires mixing with
water.
Special Formulas
 Soy: used for vegetarians, lactase
deficiency, galactosemia.
 Lactose free: cow’s milk-based

formula.
 Protein hydrolysate: infants who can

not digest or are allergic to intact

protein.
 Free amino acids.
 What kind of formulas should avoid
 Avoid condensed milk preparations and

those that contain excessive sugar and

have poor nutritional value.
 Skimmed milk powders are not advisable

because of their low energy content

How do prepare a bottle feed using milk powder

 Put the necessary amount of boiled water in

the bottle. Add the required amount of milk
powder to the water. Remember to level the
spoonfuls with a knife.
 Once you have added the powder to the water

in the bottle, place the teat in reverse and

tighten the cap of the bottle. Shake the bottle
well until the powder is completely dissolved.
 Cool the bottle under running water and

ensure that the temperature of the milk is

lukewarm before feeding the baby
 tips for bottle-feeding
 Check the expiry date on the can
 Clean the can before opening so that the

powder does not get infected with germs

 The hole of the teat should be of the correct

size so that the baby does not choke on a

big hole, or get frustrated and not feel
satisfied with a small hole
 Avoid feeding babies in their sleep; with
support cane this lead to aspiration .
 Position the baby in the your arm so that

she is very close to you and in a semi-

upright position;
 Discard leftover milk (or formula) to prevent

breeding of bacteria
 Rinse bottles and teats after use for easier

cleaning.
 Complementary and
supplementary feeding in children
 Definition of Complementary feeding
• The process of giving an infant other
foods and liquids along with breast
milk or non-human milk as breast
milk alone is no longer sufficient to
meet the nutritional requirements.

• These foods should complement

rather than replace breast milk.
• Can call also weaning process
 Appropriate Complementary Feeding
• Timely: Introduced when need for energy and
nutrients exceeds that provided by BF
• Adequate: Should provide sufficient energy,
protein, and micronutrients
• Properly Fed: Active feeding method and
proper frequency according for age
• Safe: Should be hygienically prepared and
stored and fed
 Other Attributes of
Complementary Foods
• Right consistency
• Soft
• Easy to digest
• Inexpensive
• Locally available
• Culturally acceptable
• Easily prepared at home
Safe weaning
 Weaning is the process in which an infant is taken out
from the breast milk to a mixed diet or process through
which a baby's dependence on mother's milk is slowly
reduced
 The ideal time to start weaning is after 6 months of age.
 The weaning must be

gradual
Infant nutrition
 After 6 months, breast milk does not provide all the
nutrients that growing baby needs ( in particular iron and
calories) that solid foods provide.
Points to be considered while introducing weaning foods:
 Introduce only one food at a time for 3-5 days
 Allow the infant to become familiar with the food before

trying to give another

 Give very small amounts of any new food at the

beginning
ints to be considered while introducing
w:
 Infant( from 1-12
months)
*Number of feedings per day
decreases through the first
year.

*By 6 months, the digestive

system is able to handle more
complex nutrition and less than
susceptible to food allergens.
Which food should start
 Cereals
 Rice, maize, wheat, oats, barley, sorghum,

millet
 Roots

Yam, cocoyam, cassava, potato

 Starchy fruits

Banana, plantain, breadfruit

Baby food should be soft/mushy so it can be
gummed
feed with a spoon
 Variety in choice of foods is important
 Infant should observe for allergic reaction when new

food are added

Like white egg, cow's milk ,citrus juice, peanut ,these
food should be avoided till 12months
Which foods should be
avoided?
 Salt
 Sugar
 Nuts
 Gluten
Allergenic Foods
 Eggs are in the top 8 of all allergens
but recommendations for introducing eggs
to babies have been changing. It is the
white of the egg that is allergenic and not
the yolk.
 Fish .oat .wheat . cow's milk , peanut ,soy

 introduce after age of one year

Toddler nutrition(1-3)
 Growth slow at the end of the first year, the slower growth rate
is reflected in a decreased appetite. Appetite is sporadic
 Because body tissues especially muscles continue to

grow ,protein needs are high

Diet should include :
- Milk ,meat , fruits , vegetables , No sugar,
Provide foods with variety of color and flavor offer small
portion child will ask for more parents should be calm ,avoid
to force child to eat it will lead to negative behavior
Preschools nutrition (3-6)
Slower growth rate and increased
interest in exploring his environment
decrease the preschoolers interest in
eating .the appetite tend to be
sporadic ,
Preschool need protein &fluids
100ml/kg/day
Food preferences and pattern
-reject vegetables - mixed dishes -
favorite food include: cereal, fruits and
sweets
*Measures to increase food intake:
-Allow child to help with preparations,
planning menu, setting table, and other
simple chores.
Maintain calm environment with no
distractions.
-Avoid between-meal snacks.
-Provide rest period before meal.
-Avoid coaxing, bribing, threatening.
School age nutrition
 At this age energy need increase and food practice
are well established always busy with other affairs to
take time out to eat ,play take priority unless
mealtime is relaxed and enjoyable
School age nutrition
At this age energy need increase and food practice
are well established always busy with other affairs
to take time out to eat ,play take priority unless
mealtime is relaxed and enjoyable
Picky eater ,dislike vegetable
Make poor choices
Adolescence:
Period of rapid growth and sexual maturation
Need milk (calcium) and protein for formation of
bone and muscle
Like soft drink
Common dietary deficiency include iron ,folate
zinc
Negative dietary behavior anorexia nervosa and
bulimia nervosa
Females need food high in iron
Adolescent (11-17 years)
*Dietary requirements vary according to
stage of sexual maturation, rate of
physical growth, and extent of athletic
and social activity.
*When rapid growth of puberty appears,
there is a corresponding increase in
energy requirements and appetite.
*Menstruating teen is particularly
susceptible to iron-deficiency anemia
Any questions