Nutrition

Nutrition

Human breast milk- the preferred food for fullterm babies Fetal advantages: •Immunologic factors (IgA, lactoglobulin, maternal macrophages) •Lower incidence of upper RTI and otitis media •Decreased incidence of allergic diseases Maternal advantages: •Faster uterine regression •Rapid return to pre-pregnancy wt. •Promotes maternal-infant bonding

Supplementation rarely needed •Vitamin K given at birth (Vitamin K present in low amount in breast milk) •Fluoride after 6 months of age •Vitamin D, if mother’s intake inadequate or if limited sun exposure •Iron-fortified foods introduced at 4-6 months

Contraindication: •Active or untreated tuberculosis •Syphilis •HIV •Galactosemia •Varicella •Herpes (if active lesion present on the breast) •Drugs (antineoplastics, radiopharmaceuticals, ergot alkaloids, iodides/mercurials, atropine, lithium, chloramphenicol, cyclosporine, nicotine, alcohol)

Relative C/I: Drugs: Neuroleptics, sedatives, tranquilizers, metronidazole, tetracycline, sulfonamides, steroids Mastitis not C/I to nursing; frequent nursing on the affected side to prevent engorgement

Used as a substitute for or to supplement breast milk Commercial formulas are: Cow milk-based with modifications to breast milk (contain 20 calories/ounce) Specialty formulas (soy, lactose-free, premature, elemental)

Can be given over 1 year of age Disadvantage: •Has a higher renal solute load (can be damaging to the kidney) •A potential for intolerance of whole milk protein •Increasing the incidence of iron deficiency anemia

Comparison of human milk and cow milk

Vitamins Vitamin D recommended only if • the formula does not contain vitamin D • the baby is low birth weight • there is poor milk intake Breast-fed babies do not require vitamin D supplementation, unless there is inadequate intake in the mother’s diet, inadequate sun exposure, or in dark-skinned infants Babies who drink goat milk should supplement with folate

Iron •Most formulas iron fortified •Breast milk iron easily absorbed Solids •Introduced at 4-6 months of age •New food introduced one at a time in small amounts •Honey to be avoided in the first year of life (because of increased risk of infantile botulism)

Development of feeding behavior in infants

•Unexplained crying •Not felt to have anything to do with abdominal pain •Self limited and benign •Some infants more sensitive to their environments and crying is a way of expressing discomfort

Presentation: •Episodes characterized by excessive, loud, highpitched crying •Lasts for several hours •Draw up his legs and pass flatus •Diagnosis purely made on the basis of history and physical exam

Treatment: •Gentle rocking motions, vibration, riding a car, or white noise may help •Episodes subside after 4 months of age D/D; Intussusception, hernia, otitis media, hair in the eye, intestinal obstruction,

hydrocephalus glaucoma gastroesophageal reflux anal fissures

Recommendations for Energy and Protein Intake Energy (kcal/kg/d)

Age

Based on Intake from Measurements of Human Milk Energy Expenditure

Protein (g/kg/d) Guidelines for Intake from Average Human Milk Requirements

Guidelines for Average Requirements

10 days to 1 month —

105

120

2.05

2.5

1–2 months

110

110

115

1.75

2.25

2–3 months

95

105

105

1.36

2.25

3–4 months

95

75–85

95

1.20

2.0

4–6 months

95

75–85

95

1.05

1.7

6–12 months

85

70

90

—

1.5

1–2 years

85

—

90

—

1.2

2–3 years

85

—

90

—

1.1

3–5 years

—

—

90

—

1.1

•Protein •Lipids •Carbohydrates •Major Minerals (Calcium, Phosphorus, Magnesium), electrolytes (Na+, K+, Cl-) •Trace Elements (Iron, Iodine, Zinc, Copper, Selenium, Manganese, Molybdenum, Chromium, Cobalt (as a component of vitamin B12 ), and Fluoride) •Vitamins (Fat soluble: Vitamins A, D, E, K; Water soluble: Vitamins B, C, Folic acid)

•Energy density of 4 kcal/g •80% dietary protein requirement of a premature infant is used for growth; only 20% in a 1 year-old child •No major stores of body protein, a regular dietary supply of protein is essential •Infants require 43% of protein as essential amino acids, and children require 36%

•Energy density of 9 kcal/g •Required for the absorption of fat-soluble vitamins and for myelination of the central nervous system •Essential fatty acids (EFAs) necessary for brain development, for phospholipids in cell membranes, and for the synthesis of prostaglandins and leukotrienes. •EFAs are linoleic acid and linolenic acid Arachidonic acid is derived from dietary linoleic acid and is present primarily in membrane phospholipids.

•Energy density of 4 kcal/g •After the first 2 years of life, 50–60% of energy requirements should be derived from carbohydrates

Called edematous malnutrition A result of a severe protein deficiency and inadequate caloric intake Risk factors/ etiology: •Decreased protein intake or abnormal protein losses •Associated vitamin deficiencies

Presentation: •Presents after weaning from the breast feeding •Lethargy, apathy, irritability •Muscle tone lost •Decrease in subcutaneous tissue •Edema from the los of oncotic pressure caused by hypoporteinemia •Dermatitis, sparse hair •Secondary infections

Kwashiorkor

Kwashiorkor

Diagnostic tools: •Serum albumin decreased •Blood glucose low •Essential amino acids low •Anemia •Vitamin and mineral deficiencies Treatment: •Slow feeding of dilute milk with supplementation of vitamins and minerals •Protein supplementation slowly increased to prevent liver problems •Dehydration and recurrent infections treated

Complications: •Mortality 30-40% •Mental and physical retardation D/D: •Chronic infections •Malabsorption •Nonedematous malnutrition (marasmus)

Vitamins

Vitamins

Vitamins