INFANCY

INFANCY
• The term infancy refers to a person not more than 12 months of age. A
healthy full-term infant weighs 2.7 kg to 3.2 kg (6-7lbs) and measures
48-50 cm (19-20 inches) in length. His/her head circumference averages
35 cm (14 inches).
NUTRITIONAL REQUIREMENTS
CALORIES

• The calorie requirements of the infant are high because the

proportionately large skin surface leads to large heat loss. A rapid rate of
growth necessitates a considerable storage of energy for the activity for
the infant is great. Since the activity of the infant varies even more
widely, more than half of that of the adult, the allowances can serve
only as an approximation
CALORIES
• The calorie needs of the infant increase from month to month. At birth,
a baby requires about 350 to 500 calories, and in one year, from 800 to
1,200 calories: 120 calories per kilogram body weight from the 2nd to
the 7th month and 100 calories per kilogram from the 7th to the 12th
month.
PROTEINS
• Allowances of 1.5 to 2.5 g of protein per kg in the body weight from 0-6
months of age, and 1.5 to 2 g per kg in the body weight from 6 to 12
months of age are recommended by the FAO/WHO Expert Group.
• In early infancy, milk from the mother, cow, or goat comprises the only
protein food. Since the protein of milk contains all the amino acid
essential for growth, the protein needs of the infant are not
automatically met through the provision of sufficient milk.
FATS
• Whole cow’s milk contains satisfactory levels of the essential fatty acids,
linoleic acid, and arachidonic acid required by the infant. Low-fat milk
used for a short period of time presents no problems since the infant
has generous reserves of the essential fatty acids, when low-fat milk is
used for a prolonged period of time or when milk substitutes are used
because of allergy, consideration must be given to the inclusion of the
essential fatty acids. Vegetable oils such as corn, soybean, and
cottonseed oils are good sources.
CARBOHYDRATES
• An allowance of 1/10 oz per lb of body weight which equals 1 oz per 10
oz of milk is prescribed, which also equals 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 first year, the carbohydrate is given in the form of a starch cereal,
and the carbohydrate in the milk formula may be produced.
MINERALS
• When compared with the needs of the adults, all minerals and vitamins
are required in proportionately greater amounts by the infant. During
the first four months, 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 iron-rich foods lest anemia
will result.
• An adequate mineral-salt intake is supplied to any infant when 1 1/2 oz
of milk per lb of body weight is given. Enough iron is stored in the liver
of the normal infant, sufficient until the 4th or 5th month.
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. The same is true for cow’s milk,
except that ascorbic acid is rarely sufficient. Therefore, it is desirable to
administer tomato or orange juice very early in life, regardless of
whether the baby is breastfed or formula-fed.
VITAMINS
• Vitamin B6 (pyridoxine) is essential in the diet of infants. It has been
revealed, both experimentally and clinically, that a pyridoxine deficiency
may result in a syndrome characterized primarily by convulsions
WATER
• The daily fluid needs of the infant are approximately 2.5 oz per lb of
body weight. His/her 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 need for elimination.
• The requirement for water varies from 10% to 15% of the body weight,
or 1 1/2 - 2 1/2 oz per lb of body weight. This is supplied in the diluents
of the milk mixture itself and supplemented, according to instinctive
demands, by offerings of water and fruit juices between feedings.
FEEDING THE INFANT
• Infant feeding is dyadic in nature; it has nutritional, psychological and
biological interaction between the mother and her offspring with each
one affecting the other.
• An infant may be breastfed, bottle-fed or given combined breastfeeding
and bottle feeding.
BREAST FEEDING
• Breastfeeding has physiologic and psychologic value for the mother and her
infant. It generally meets the infant’s nutrient needs during his/her early months.
It also provides immunity factor and reduces chances of infection.
• Breastmilk is clean.
• Breastmilk is easily ingested.
• Breastmilk is non-allergenic.
• Breastfeeding is beneficial to the health of the mother.
BOTTLE FEEDING
• Bottle feeding is feeding the infant with formula designed to match the
nutritional ratio of breast milk composition, diluted with water to
reduce protein and mineral concentration, and added with carbohydrate
to increase energy value. Bottle feeding may meet the needs of a
working mother. the formula must be prepared under clean conditions
and sterilized to prevent contamination.
• However, bottle or artificial feeding with cow’s milk or other proprietary
milk preparations is recommended only when breastfeeding is
contraindicated.
BOTTLE FEEDING
• Artificial feeding is costly.
• Artificial feeding is associated with infantile obesity or “protein-calorie
malnutrition plus.”
MIXED FEEDING
• Mixed feeding is a combination of breastfeeding and bottle feeding, with
either one predominating.
• Mixed feeding, however, is not encouraged as it may lead to lactation
failure.
FORMULA PREPARATION
• Milk formulas are sterilized in order to reduce curd size and to prevent
the growth of harmful bacteria.

Two methods of formula preparation:

1. Aseptic Method
 The equipment and ingredients are sterilized separately either by
steam or by boiling water for at least 25 minutes. The next step is
to funnel the sterile formula into sterile bottles, nipple, and then
capped.
FORMULA PREPARATION

2. Terminal Method
The formulas are poured into clean but sterilized bottles and are
sterilized together.
Disadvantage: Scum formation can clog the nipple hole.
a. All formulas (sterilized) are slowly cooled without shaking and
stored immediately in the refrigerator.
b. Left-over formulas should not be used again or reheated.
FEEDING TIME
• A baby weighing 2.5 to 2.7 kg usually feeds every 3 hours.
• A baby weighing 3.6 to 4 kg usually feeds every 4 hours.
• A two-month-old baby sleeps through the night after the 10 pm feeding.
• Between 2 and 3 months of age, a baby is on a 4 to 5 feeding schedule.
SUPPLEMENTARY FOOD

Mother’s milk is the best for the baby. However, breast milk alone cannot
meet the baby’s needs after 6 months. Earlier, when the baby is 3 months
of age, his/her mother should start familiarizing him/her with the taste
and texture of other foods that he/she will eventually need for normal
growth and development.
1. Second Month - liquids like rice water, vegetable water, or kalamansi
juice may be introduced depending on the infant’s acceptance and
tolerance.
SUPPLEMENTARY FOOD
2. Fourth Month - scraped banana or papaya or thin lugaw or commercial cereal
pop like Cerelac and Ceresoy may be given to the 4-month-old infant.
• Iron-rich foods like egg yolk, liver, meat, fish, and poultry must be gradually
introduced when iron stores are low.
3. Fifth Month to Six Month - full diet consisting of puréed meat, egg, fruit,
vegetables, and cereals can be introduced to the baby.
• Weaning should take place. High calorie-high protein supplements are
called for.
• When teething begins, chewy foods such as crackers and biskotso are given
not only to soothe the sensitive gums but also to teach the baby self-
feeding.
SUPPLEMENTARY FOOD

4. Seventh Month to Eight Month - foods are chopped finely-not strained-

to teach mastication.
• Examples are soft-cooked egg with rice porridge, soft-cooked rice
with boiled fish, munggo and leafy vegetables, misua soup with
beaten egg, peanut-banana mash, camote cubes in meat broth, and
mashed liver in green leafy vegetables.
5. Ninth Month to Twelfth Month - whole tender foods or foods chopped
coarsely are given.
EASY TO PREPARE FOODS

Egg Custard (Leche Flan)

• 1 egg beaten
• 1 tbsp sugar
• 1/4 cup evaporated milk
• 1/4 cup warm water
Mix the above ingredients. Strain into a clean tin can or heat-resistant
container and place it on top of steaming rice when water is almost
absorbed. When rice is cooked, custard will be ready for the baby.
EASY TO PREPARE FOODS

Use meat broth to prepare the following nutritious recipe for babies aged
5 months or older.
Egg yolk/Rice Soup
• 1 1/2 cup meat or chicken broth
• 2 tbsp boiled rice
• 1 egg yolk, beaten
• 1 tbsp evaporated milk (if available)
• 1/4 tsp salt
EASY TO PREPARE FOODS
Munggo Mash
• 4 tbsp boiled munggo, mashed
• 1 tbsp sugar
• 1 tbsp evaporated milk
• 1 tbsp water
Combine all the ingredients and blend well. Cook for 3 minutes over
medium heat, stirring constantly. Serve warm.
COMMON DISORDERS
Diarrhea, allergy, vomiting, constipation, and colic are disorders that affect
the nutritional status of the infant. When such conditions arise:
1. Determine the underlying causes
2. Maintain water and electrolyte balance, and
3. Modify the milk formula to suit the digestive capacity.
INDICATION OF GOOD NUTRITION

Behavioral Development
• 0-1 month - suckles and smiles
• 2-3 months - vocalizes nad controls heads
• 4-5 months - controls hand and rolls over
• 6-7 months - sits briefly and crawls
• 8-9 months - grasps and pulls up
• 10-11 months - walks with support and stands alone
• 12 months - starts to walk alone
CASE ANALYSIS
A lightly active 7 month old baby boy weighing 8 kilograms
is receiving breast milk and some complementary feeding.
Provide a diet plan requiring diet modifications of nutrients.
Procedure in calculating the diet prescription
First you need to follow steps in estimating desirable body weight (DBW)
and calculate your Total Energy Allowance (TEA).

1. Determine the age and height of an infant and proceed to find the
DBW
For example: Age - 7 months; Weight - 8 kg
Use: DBW =

Example: DBW= =
Procedure in calculating the diet prescription
2. Calculate your BASAL NEEDS
Basal Needs = __kcal per kg DBW/hr__ x __(DBW)__ x 24
= ____ kcal

Male = 1Kcal per kg DBW/hour Female = 0.9 Kcal per kg DBW/hour

Example: 1kcal (since the case analysis is a boy) x 6.5 x 24 = 156kcal

Procedure in calculating the diet prescription
3. Estimate PHYSICAL ACTIVITIES= ____ Kcal
Physical Activity: use the lower limit for female, higher for male
Bed rest 10-20%
Sedentary 30-40%
Light activity 50-60%
Moderate activity 70-80%
Severely active 90-100%

Light activity (male) = 60%

PA = ___Kcal x 60% Example: 156kcal x 0.60 =93.6kcal
= ___ Kcal
Procedure in calculating the diet prescription
4. Find the Total Energy Allowance (TEA) by adding the basal needs and
estimated physical activity.
TEA = __Basal Needs__+ __PA__ = ___kcal + Breastmilk

Example: 156kcal + 93.6 = 249.6kcal + breastmilk

5. Distribute Total Energy Allowance among Carbohydrate, Protein, Fat
as follows
Carbohydrate 50-70%
Protein 10-15%
Fats 20-30%
Procedure in calculating the diet prescription
6. For formula diet, allot 65% of the total energy allowance for
carbohydrates, 15% protein and 20% fat. Thus, the corresponding
energy contributions of the three nutrients in your diet are as follows:

Carbohydrate = __ kcal x 0.65 = ___ kcal

Protein = ___kcal x 0.15 = ___ kcal
Fats = ___ kcal x 0.20 = ___ kcal

Example: Carbohydrate = 249.6kcal x0.65 = 162.24kcal

Protein = 249.6kcal x 0.15= 37.44kcal
Fats = 249.6kcal x 0.20= 49.92kcal
Procedure in calculating the diet prescription
7. Calculate the number of grams of CHO, Pro, and Fats by dividing the
calories for each nutrient by the corresponding physiologic fuel values
(4 kcal/g CHO, 4kcal/g Pro, 9 kcal/g Fat)
Carbohydrate = ___kcal ÷ 4 = __ gms
Protein = ___ kcal ÷ 4 = ___ gms
Fats = ___ kcal ÷ 9 = ___ gms

Example: Carbohydrate= 162.24kcal ÷ 4 = 40.36 grams

Protein = 37.44kcal ÷ 4 = 9.36 grams
Fats = 49.92kcal ÷ 9 = 5.55 grams
Procedure in calculating the diet prescription

8. To simplify the diet prescription (Rx), round off calories to the nearest
50, and carbohydrates, proteins, and fats to the nearest 5 grams. Thus,
your diet prescription is:

Diet Rx: __ kcal CHO - __ grams Protein - __ grams Fat - __ grams

Example :
Diet Rx : 250 kcal CHO = 40 grams Protein = 10 grams Fats=5 grams