Nutrition

Infancy

during

Infant refers to a person not more than 12 months of age.

Nutritional Objectives:
1. Provide nutritional base for rapid growth and

development of the child during first year of life.

2. Establish the foundation for good food habits and attitudes.

Nutritional Requirements

CALORIES
The calorie requirements of the infant are high because the proportionately larger skin surface

needs to large heat loss.

During infancy the baby grows faster than at any other time of life and the calorie requirements per unit of the body weight are high.

The needs of the infant increase from month to month. At birth: One year: 2nd to 7th month: 7th to 12th month: 350-500 calories 800-1,200 calories 120 calories per kilogram 100 calories per kilogram

Average requirement for growth in the 1st year is 50 calories per pound of expected weight, 2/3 of this needs being supplied by the milk and 1/3 by the added carbohydrates.

PROTEINS
FAO/WHO Expert Group recommends; 0 to 6 months: 1.5-2.5 gm per kilogram of body weight. 1.5-2.0 gm per kilogram in the body weight.

6 to 12 months:

FAT
Whole cows milk contains satisfactory levels of the essential fatty acids, linoleic and arachidonic acids required by the infant. An excess of fat is not desired.

CARBOHYDRATES
An allowance of 1/10 oz. per lb. of body weight equals one oz. per 10 oz. of milk is prescribed w/c also equals to 1% of the body weight. One-third of the carbohydrate should be derived from the milk of the mixture, and the remainder added in the form of starch or sugar. Later in the 1st year, the carbohydrate is given in the form of starch cereal, and the carbohydrate in the milk formula maybe reduced.

MINERALS
All minerals and vitamins are required in proportionately great amounts by the infant. During the 1st four months a liberal status of iron of the healthy infant may suffice for the rapidly expanding blood circulation but thereafter, special emphasis must be placed on the inclusion of ironrich foods lest anemia will result.

VITAMINS
If the diet of a nursing mother is nutritionally adequate, the vitamins necessary for the infant will be contained in the milk, with the exception of vitamin D and possibly Ascorbic Acid. Therefore, it is desirable to administer tomato or orange juice very early in life, regardless of whether the baby is breastfed or formula-fed. Pyridoxine is essential in the diets of human infants. A pyridoxine deficiency may result in a syndrome characterized by convulsions. The minimum daily requirement of this vitamin is believed to be between 60-100 micrograms.

 Any normal infant ingesting 18 oz of cows milk, or a comparable amount in a bottle-fed milk food,receives all the vitamin A and all the vitamin B fractions neede for optimum growth.

WATER
The daily fluid needs of the infant are approximately 2.5 ounces per pound of body weight. His water balance is more easily disturbed than that of the adult because of the large fluid losses through the skin and respiration, and because of the needs for elimination.

Breastfeeding and Bottlefeeding

Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or more, without the addition of infant formula or solid food. After the addition of solid food, mothers are advised to continue breastfeeding for at least a year, and can continue for two years or more.

 Human breast milk is the healthiest form of milk for babies.

There are few exceptions, such as when the mother is taking certain drugs or is infected with human Tlymphotropic virus, HIV if not taking ARVs, or has active untreated tuberculosis. Breastfeeding promotes health and helps to prevent disease.
Experts agree that breastfeeding is beneficial, and have concerns about artificial formulas but there are conflicting views about how long exclusive breastfeeding remains beneficial.

 The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) emphasize the value of breastfeeding for mothers as well as children. Both recommend exclusive breastfeeding for the first six months of life. The AAP recommends that this be followed by supplemented breastfeeding for at least one year, while WHO recommends that supplemented breastfeeding continue up to two years or more.

Breastmilk
Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from nutrients in the mother's bloodstream. Breast milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development. The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the age of the child. The quality of a mother's breast milk may be compromised by smoking, alcoholic beverages, caffeinated drinks, marijuana, methamphetamine, heroin, and methadone.

Benefits for the Infant

Greater immune health During breastfeeding, approximately 0.25-0.5 grams per day of secretory IgA antibodies pass to the baby via the milk. The main target for these antibodies are probably microorganisms in the baby's intestine. There is a some uptake of IgA to the rest of the body, but this amount is relatively small. Also, breast milk contains several antiinfective factors such as bile salt stimulated lipase (protecting against amoebic infections), lactoferrin (which binds to iron and inhibits the growth of intestinal bacteria).

Benefits for the Infant

Fewer infections Reduced sudden infant death syndrome Less diabetes Less childhood obesity Less tendency to develop allergic diseases (atopy) Less necrotizing enterocolitis in premature infants

Benefits for mothers

Bonding Hormone release Weight loss Gestational changes Natural postpartum infertility Long-term health effects Postpartum changes Long-term effects of lactation on health and body composition

Methods and Considerations

Early breastfeeding
In the half hour after birth, the baby's suckling reflex is strongest, and the baby is more alert, so it is the ideal time to start breastfeeding. Breastfeeding also releases hormones that contract the uterus to reduce post-partum bleeding. Early breastfeeding is associated with fewer nighttime feeding problems.

Methods and considerations

Exclusive breastfeeding
Exclusive breastfeeding is defined as "an infant's consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medications.

Expressing breast milk

When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or using a breast pump, a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use.

Bottlefeeding

 Bottle or artificial feeding with cows milk or other proprietary milk preparations is recommended only when breast feeding is contraindicated. Artificial feeding is costly. Besides the milk formula, money is spent on the bottles and nipples, cooking utensils, fuel, cold storage and even medical care because infection seems frequent and often severe. Artificial feeding is associated with infantile obesity or protein-calorie malnutrition plus. The reason is that double feeding often takes place. The mother usually controls the volume and the schedule of feeding.

SupplementaryFoods Supplementary Foods

Breast milk is the best nutrient source for babies. But breast milk alone is not sufficient to meet the needs of growing babies after 6 months.

Introduction of solid foods before the age of four to six months is not recommended because it is thought to increase possibility of overfeeding and development of food allergies.

An infants readiness for solid foods will be demonstrated by: 1. The physical ability to pull food into the mouth rather than always pushing the tongue and food out of the mouth, 2. willingness to participate in the process, 3. the ability to sit up with support 4. having head and neck control 5. the need for additional nutrients.

Earlier as three months, parents can start familiarizing the baby with the taste and texture of other foods the he will eventually need for normal growth and development. Solid foods must be introduced gradually and individually. One food is introduced and then no new other food for four or five days.

The typical order of introduction begins with: Cereal, usually iron-fortified rice,

Oat, wheat and mixed cereals,

Cooked and pureed vegetables,

Cooked and pureed fruits,

Egg yolk,

Finely ground meats.

Between 6-12 months, toast, zwieback, teething biscuits, custards, puddings, and ice cream can be added. Honey should never be given to infants because it could be contaminated with Clostridium botulinum bacteria.

Simple tips on how to help infants eat better. 1. Beware of baby dinners or creamed products that contain nutritionally incomplete starches 2. Drain off the syrup from the canned fruits before serving. It is usually rich in sugar something the infant doesnt need. 3. Watch the number of egg yolks the child consumes per week. Three or four is plenty. 4. If the doctor says its okay, give him 2% low fat milk instead of whole milk. It contains substantially less fat.

Parents may try to overfeed infants when solid food is introduced. The Food Guide Pyramid provides excellent help in determining the babys menu. Its use is to supply the appropriate nutrients and develop good eating habits.

SPECIAL NUTRITIONAL NEEDS

 PREMATURE INFANT
An infant born before 37 weeks gestation is considered premature. These babies have special needs: The sucking reflex is not developed until 34 weeks gestation, and infants born earlier must be fed by total parenteral nutrition, tube feedings, or bolus feedings. The best food for a premature infant is its mothers breast milk which contains more protein, sodium, and some other minerals than does the milk produced by mothers of full term infants.

OTHER CONCERNS:
Low birthweight Under developed lungs Immature GI tract Inadequate bone mineralization Lack of fat reserves

CYSTIC FIBROSIS
Cystic fibrosis(CF) is a hereditary disease. CF causes the body to produce abnormally thick sticky secretions(mucus) due to the faulty transport of chloride within cells lining organs such as the lungs and pancreas to their outer surfaces. The thick mucus also obstructs the pancreas, preventing enzymes from reading the intestines to help break down and digest food. 85% of CF children have exocrine pancreatic insufficiency (PI)and are at nutritional risk due to decreased production of digestive enzymes.

 Malabsorption of fat is also associated withCF; therefore the recommendation is 35-40% of total calorie intake to be fat.

Digestive enzymes are taken in capsule form when food is eaten and supplementation of fat soluble vitamins should also be done at mealtime. There is a water soluble form of fat-soluble vitamins that can be administered if normal levels cannot be maintained with the use of only fat-soluble vitamins. Nightime tube feedings are necessary to supplement oral intake; if adequate nutrition and weight cannot be maintained.

 FAILURE TO THRIVE
Failure to thrive (FTT) can be determined by plotting the infant on the growth chart.
Weight for height is the 1st parameter affected when determining FTT. Later, height and head circumference are affected.

Other Signs Slow development Lack of physical skills such as standing , sitting , rolling over, and walking. Delayed mental and social skills. Causes: Watering down formula(poverty) Congenital abnormalities AIDS Lack of bonding Child abuse or neglect

COMMON DISORDERS

Diarrhea
Diarrhea is most frequently caused by bacteria and viruses

although both overfeeding and underfeeding can also cause

diarrhea. Cows milk causes allergy to some infants leading also to diarrhea.

Rice water suffices for mild diarrhea but in case of

dehydration, parenteral and/or oral fluids should be given, like a locally developed oral rehydrating therapy labeled

SI oralyte, Oresol, a pre-mixed oral rehydration powder

available in government health institutions.

In acute diarrhea, food can be given as early as 8 hours after the beginning of rehydration.

Breastfeeding should be maintained, with only

a few hours interruption during the early phases of therapy. As stool volume decreases, foods rich in protein are generally added like latundan and bayabas.

Vomiting
Vomiting is commonly seen in normal infants during the first few days. As in diarrhea, special attention must be given to fluid replacement. Other modifications may include reducing number of feedings, acidifying milk, or making it a point to

burp the infant after every feeding.

Allergy
Eczema is the most common sign of allergy before 9 months of age. When protein of milk is the offending ingredient, it is referred to as milk allergy. In lactose intolerance, the enzyme that hydrolyzes the carbohydrate lactose in milk into glucose and galactose is present, increasing the gut fluid volume. Bacteria in colon ferment the lactose and a variety of gastrointestinal symptoms occur with varying severity.

Constipation
Infrequent bowel movements is not really the problem in infants but the pain on the passage of stools, inability to complete a movement

though the urge is strong, blood in the stools

and involuntary soiling of the clothes between

movements..

Colic
Colic is an acute paroxysm of pain, fussing, crying and irritability which lasts for 3 months. Causes are physiologic factors, maternal and family tensions, gastrointestinal hypermotility, functional immaturity of the central nervous system and GI tract. Changing the formula may bring about some improvement but noy in most cases. Physical measures such as providing a cozy warm environment, placing the baby prone on a hot water bottle, or a drink of warm water may at times subdue paroxysm of crying.

INDICATIONS OF GOOD NUTRITION

WEIGHT GAIN
A steady weight gain of 150 to 240 gm/week
that slows down toward the end of the 1st year to

about 120 gm/week is considered as the proper

weight gain (doubled birth weight at the end of 5 months and tripled at the end of 1 year)

LENGTH
Baby length increases by about 25.4 cm or 50% more at the end of the 1st year.

BEHAVIORAL DEVELOPMENT
0-1 month = suckles and smiles 2-3 months = vocalizes and controls head 4-5 months = controls hand and rolls over 6-7 months = sits briefly and crawls 8-9 months = grasps and pulls 10-11 months = walks with support and stands alone 12 months = starts to walk alone

 Bowel movement = normal without green or red

streaks
Sleeping habits = regular

Tooth formation = average

Motor coordination = developing

Muscles = firm and well formed wuth moderate

subcutaneous fat.