Presented By: Areej Elhaj Naji M elfatih Ghada osman

To recognize the changing nutritional needs of developing children. To understand that nutritional recommendations for children vary by age, stage of development, and gender. To recognize that nutritional and dietary behaviors learned in children can have a significant impact on adult health concerns such as obesity, cardiovascular disease, and osteoporosis.

Energy of daily living Maintenance of all body functions Vital to growth and development Therapeutic benefits

Healing Prevention

Rapid rate of growth Large amount of metabolic active tissue Increase incidence of occurrence of disease

Adult find the food they need Children need others to find food for them

Culture Habits Taboos Food avalability

Imaturity of digestive ,absorptive , metabolic or excretary fuctions limit nutrient supply in young children and infants
In old children supply of nutrients may be limited by illness which Increase demand Derease appetite or Increase losses

THE SMALLER THE CHILD THE SMALL THE STORE OF NUTIENTS IN HIS BODY

Infancy
(from birth to 1 year) This is a critical period the rate of growth and development is more rapid than at any time in the life cycle Birth weight doubles by the age of 4 to 6 months and triples toward the end of the first year.

High growth rate necessitates supporting the infants high need for nutrients and calories Although the total amount of calorie and nutrients needed by an infant is much less than that needed by an adult, the amount per kg of body weight for calories and most nutrients is higher at birth than at any other time.

Requirements for macronutrients and micronutrients are higher on a perkilogram basis during infancy and childhood than at any other developmental stage. These needs are influenced by the rapid cell division occurring during growth, which requires protein, energy, and nutrients involved in DNA synthesis and metabolism of protein, calories, and fat.

While most adults require 25 to 30 calories per kg, a 4 kg infant requires more than 100 kcals/kg (430 calories/day). Infants 4 to 6 months who weigh 6 kg require roughly 82 kcals/kg (490 calories/day). Energy needs remain high through the early formative years. Children 1 to 3 years of age require approximately 83 kcals/kg (990 kcals/day). Energy requirements decline thereafter and are based on weight, height, and physical activity.

Age 3 months 3-5 months 6-8 months 9-11 months Average during 1styear

Kcal/Kg 120 115 110 105 112

Total water requirements (from beverages and foods) are also higher in infants and children than for adults. Children have larger body surface area per unit of body weight and a reduced capacity for sweating when compared with adults, and therefore are at greater risk of morbidity and mortality from dehydration. Parents may underestimate these fluid needs, especially if infants and children are experiencing fever, diarrhea, or exposure to extreme temperatures (eg, in vehicles during summer).

Requirements for fatty acids on a perkilogram basis are higher in infants than adults Through desaturation and elongation, linolenic and alphalinolenic acids are converted to longchain fatty acids (arachidonic and docosahexanoic acids) that play key roles in the central nervous system. Since both saturated fats and trans fatty acids inhibit these pathways, infants and children should not ingest foods that contain a predominance of these fats.

Optimal infant and young child feeding recommendations

Early initiation of breastfeeding (within 1 hour of birth)

Exclusive breastfeeding (0-<6m) Continued breastfeeding (2 years or beyond)

Complementary feeding (6-<24m) Complementary foods

Early initiation of breastfeeding

Exclusive breastfeeding within one hour of birth saves infant and mothers lives

Exclusive breastfeeding
Only breastmilk, no other liquids or solids, not even water, with the exception of necessary vitamins, mineral supplements or medicines.
0-<6 months

Carbohydrate

Lactose is primary Carbohydrate in milk

lactose 7 (g/100 ml)

oligosaccharides 0.5 (g/100 ml)

 Protein Total 1.1 (g/100 ml) casein 0.4 0.3 (g/100 ml) a-lactalbumin 0.3 (g/100 ml) lactoferrin (apo-lactoferrin) 0.2(g/100 ml) IgA 0.1(g/100 ml) IgG 0.001 (g/100 ml) lysozyme 0.05 (g/100 ml) serum albumin 0.05(g/100 ml) -lactoglobulin

casein:lactalbumin ratio (40:60)

Constituent Total protein Casein -Lactalbumin Lactoferrin IgA

Measure G mg mg mg mg

Colostrum (1-5 days) 23 1400 2180 3300 3640

Mature Milk (>30 days) 9-10.5 1870 1610 1670 1420

From: Worthington-Roberts B, Williams SR. Nutrition in Pregnancy and Lactation, 5th ed. St. Louis, MO, Times Mirror/Mosby College Publishing, p. 350, 1993. Slide 4.4.7

 Amino

Acids

Breast milk low in phenylalanine and methionine high in taurine and cystine

Fats

higher in breast milk of 2.64.5% . breast milk has more: Cholesterol amounts of 200650 mg/100 g fat (essential fatty acid) Long chain fatty acids are needed for brain, retina, and nervous system development human milk phospholipids contained more long chain polyunsaturated fatty acids than triacylglycerols carnitine vitamin like substance (important in fatty acid metabolism) lipases (enzyme for digestion of fats)

Linolenic acid and docosahexaenoic acid (DHA) are omega-3 fatty acids present in breast milk Linoleic acid and arachidonic acid (AHA) are omega-6 fatty acids present in breast milk. Linoleic acid is considered essential Read more: http://www.livestrong.com/article/31137-listessential-fatty-acids-found/#ixzz2Xh37aGVV

Minerals

Generally lower in breast milk

calcium 0.03 (g/100 ml) phosphorus 0.014 (g/100 ml) sodium 0.015 (g/100 ml) potassium 0.055 (g/100 ml) chlorine 0.043(g/100 ml)
iron is however low in milk and infant needs alternative source after 6 months

Vitamins

variable in breast milk depends on maternal diet and drug use Vitamin E high in breast milk and Vitamin K low RDA for most vitamins greater during lactation than pregnancy except Vit. D & B12 (same); & B6 & Folate (lower)

Non-protein nitrogen-containing compounds, making up 25% of the milk's nitrogen, include urea, uric acid, creatine, creatinine, , and nucleotides

Anti-Infectious Factors
Bifidus factor, lactobifidus, kills enteropathogenic organisms by the production of lactic and acetic acids IgA, IgM, IgE, IgD, IgG bacteria & virus Lactoferrin (binds iron which bacteria need) Lysozyme & Lactoperoxidase (bacteria) Interferon (inhibits viral replication)

Breastfeeding is important

Nutritional

Immunological/Physiological

Psychological Practical Physical

Mateltrnal heah

Immunologic benefits (>100 components) Decreased incidence of ear infections, UTI, gastroenteritis, respiratory illnesses, and bacteremia. Convenient and ready to eat. Reduced chance of overfeeding Fosters mother-infant bonding.

Available any time

fresh

Easy digested

emotinonal satisfaction

Self regulated protective

Decrease nutritional anemias Anti inflamatory Natural balanced Decrease rickets diet

Anti allergic

May delay return of ovulation. Loss of pregnancy-associated adipose tissue and weight gain. Suppresses post-partum bleeding. Decreased breast cancer & ovarian cancer rate.

Infant formula is a manufactured food designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid TYPES OF FORMULA FEEDING Subistitutive to breast milk Complementary suplementary

All contraindication of breast feeding Mother death Insufficent of breast milk Employment of mother

Why artificial feeding is always risky

No active protection

Infant formula powder is not sterile

Increases food insecurity and dependency

Costly in time, resources and care

Bottle and teats Bottle feeding extra source of increases risk infection

Artificial feeding is even riskier

Bacterial contamination

Contaminated water

Limited supplies and poosr resource

Complementary feeding

6-<24 month olds

Support for continued breastfeeding for 2 years or beyond Introduce safe and appropriate complementary foods Frequent feeding, adequate food, appropriate texture and variety, active feeding, hygienically prepared (FATVAH)

Weaning

The term weaning means gradually introducing semisolid and solid foods to the infant until s(h)e is accustomed to the regular family diet.

Or It is the process of introducing breast milk substitutes and/or complementary foods thereby decreasing lactation stimulation and milk production and eventually ending lactation and breastfeeding

Breast feeding should not stop.

Breast milk provides one-third to two thirds of the average total energy intake in the latter part of the first year;
is an important source of essential fatty acids.

provides significant amounts of vitamin A and pro vitamin A carotenoids as well as calcium and riboflavin. Morbidity and mortality rates remain lower in children who are breastfeeding into their second and third year.

Prolonged breast feeding without supplements will lead to poor growth rate, wasting and iron deficiency anemia

The foods to be added should be rich in iron and vitamin D.

How to introduce weaning food

Start by a small amount of 1-2 teaspoonful once daily then increase gradually. The food should be smooth in texture Do not give two new foods together

Do not offer new food if the baby is unwell Some infants refuse or spit out the food at the start. Dont worry, try again and again Gradually increase the frequency of meals Teach the mother about proper hygiene

When should it begin?

GI Tract Kidneys CardioVascular Immune System PsychoSocial

Metabolic Organs

Infant Development and Readiness to Begin Weaning

Brain

Oral Motor

When should Breastfeeding End?

WHO (1995): up to two years of age and beyond while receiving nutritionally adequate and safe complementary foods
American Academy of Pediatrics There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer

Underfeeding. Overfeeding Regurgitation and Vomiting Loose or Diarrheal Stools Constipation Colic.

Between Infancy and Childhood

The period between age 1 and 2 is a transition between infancy and childhood

After age 1 growth rate slows Body continues to change rapidly Bones grow longer; muscles gain size & strength

Childrens appetites Decline markedly around the first birthday Thereafter, they fluctuate Food energy intakes vary from meal to meal Daily energy remains constant

Energy Kcal needs depend on growth & activity 1 year = 800/day 6 years = 1600/day 10 years = 2000/day 9 million children over age 6 are obese Vegans may have trouble meeting energy needs

Nutrients Are steadily increased Important to accumulate stores of nutrients before adolescence Influences nutritional health for a lifetime

Food Patterns Variety of foods from each food group Increased calcium & fiber

By the end of the first year the child should be drinking from a cup and eating many of the same foods as the rest of the family although in smaller amounts.

Around the age of 15 months, food jags may develop reflecting autonomy and independence food jags a child will only eat one food item meal after meal. Some other common childhood eating behaviors that can cause alarm in many parents include fear of new foods and refusal to eat what is served.

At 2 years of age children can completely self-feed and can seek food independently

Need to be nutritious and balanced Limit candy, cola, & other concentrated sweets Underweight children can have higher kcalorie foods such as ice cream, pudding, whole wheat or enriched crackers or pancakes

the Food Guide Pyramid has recently been adapted for 26 yr old children. The goal to support normal rates of weight gain without excessive fat deposition Most children, if not forced to eat more, will adjust intake to achieve this goal

Healthy Eating Pyramid

Foods high in fats and sugars: take only small amounts from this group

Meat, fish and dairy: take something from this group

Fruit and vegetables: take 5 portions a day from this group

Carbohydrates: take most food from this group (rice, pasta, bread, potatoes)

Children of ages from 1 to 3 require an energy supply of 1300 kcal/day to meet the need of . Growth, BMR, and Endless activity

Hunger, rather than adult meal schedules, guide the childs perception of time to eat

Young children do not have large stomachs to cope with big meals. Therefore, to achieve the relatively high energy intake for their age, foods should be eaten as part of small and frequent meals

Liver cannot store more than 4 hours worth of glycogen

Child must eat every 4-6 hours to maintain blood glucose

Children 4 to 6 years old Energy requirements increase to 1800 kcal/ day The energy requirements of children increase rapidly because they grow quickly and become more active. This means they have a high energy requirement for their size

Children can have their independent eating styles. They understand the time frame of meals and can save their appetite for meals

Children can develop a sense of responsibility for healthy food selection. They can understand that although all foods are fine, some (like fruits, vegetables, and low fat foods) can be eaten more often than others. Food jags may continue for a while

Snacks form an integral part of the childs nutrient intake