2. Introduction
Nutrition is the process of taking in food and using it for
maintenance, growth ,metabolism and repair.
Nutrient is a substance in food used by an organism to make
energy,grow,develop and reproduce.
Macronutrients are nutrients that are needed in large amount. These
are carbohydrate,protien and fat.
Micronutrients are those required in very small amount. these are
vitamins and minerals.
3. Essential nutrients are nutrients that are not produced by the body.
so they should be supplemented from food.
Non essential nutrients are those can be produced by the body.
• Infants and children have a genetic potential for physical, mental, and
emotional growth. Optimal nutrition is required to achieve this growth.
•Both inadequate intake and excess intake are described as
malnutrition.
•An optimal feeding should contain five food types .
Carbohydrates,protiens,fats and oils,vitamins and minerals, and water.
4. Water
Water is essential for existence.
Water comprises ~ 50 to 60% of body weight in
young adults and 70 to 75% of body weight in
infants.
Water is taken as food and fluid and also
produced in the body during metabolism of
nutrients.
5. Human needs for water are related to caloric
consumption, to insensible loss and to specific
gravity of urine.
The daily consumption of fluid by the healthy
infant is equivalent to 10-15% of body weight
compared with 2-4% in the adult
Evaporation from the lung and skin accounts for
40-50% of intake and renal excretion for 40-50%
of intake.
6. Energy The 3 components of energy expenditure in adults
are
Basal metabolic rate
The thermal effect of food (energy required for digestion
and absorption)
Energy for physical activity
Additional energy intake and expenditure are required to
support growth and development for children
Energy is measured in Joules or calorie
Kilocalorie
The amount of heat necessary to raise the temp. of 1 kg
of water from 14.5 to 15.5 C or by 1c
1Joule= 4200 calories , 1kcalorie= 1000calories
7. The nutrients that provide energy intake in the
child's diet are
Fats contribute ∼ 9 kcal/g
Carbohydrates contribute ∼ 4 kcal/g
Proteins contribute ∼ 4 kcal/g)
8. Energy expenditure in children
1- Basal metabolism 50%
2- Physical activity 25%
3- Growth 12%
3- Fecal loss 8%
4- Thermic effect of food 5%
9. Energy requirement based on age
0-6mn 108kcal/kg/day
6-12mn 98kcal/kg/day
1-3 yr 102kcal/kg/day
4-6yr 90kcal/kg/day
7-10yr 70kcal/kg/day
11-14yr male 55kcal/kg/day
female 45kcal/kg/day
15-18 male 47kcal/kg/day
female 40kcal/kg/day
10. Fat The main dietary sources of fat include
Animal products (meat, butter, milk, cheese, egg yolk)
Vegetable oils, margarine and fried foods
Dietary fats are composed of a various mix of
saturated fats, monounsaturated fat, PUFA,
trans fat, and cholesterol.
11. Function of fat in the body
Energy-dense macronutrients
Cholesterol moieties are precursors for cell
membranes, hormones, and bile acids
Fat intake also facilitates absorption of the fat-
soluble vitamins a, d, e, and k
Dietary intakes of mono- and polyunsaturated
fats have been associated with positive health
outcomes.
12. Humans are incapable of synthesizing the precursor
ω3 (α–linolenic; ALA) and ω6 (linoleic; LA) PUFAs
and are dependent on dietary sources for these
essential fatty acids
Essential fatty acid (EFA) deficiency can be
associated with desquamating skin rashes, alopecia,
and growth deficits
Essential fatty acids are present in breast milk, are
often supplemented in infant formulae, and are
required for normal growth and development
13. Protiens
Protein intake is required to supply nitrogen and
amino acids for the synthesis of constituent
proteins and other nitrogen-containing
compounds such as polypeptide hormones.
Are major structural component of all cells in the
body.
Functions as enzymes, in membranes, as
transport carriers, and as some hormones.
14. Amino acids are categorized in to 3
Indispensable/essential AA humans depend on
dietary sources to meet adequacy and prevent
deficiency
Threonine, valine, leucine, isoleucine, lysine,
tryptpophan, phenylalanine, methionine, and histidine
Conditional essential/indispensable AA are
essential only at certain life stages
e.g. in infants cysteine, tyrosine perhaps arginine
Despensable/ nonessential AA available in foods
Alanine,Aspartic acid, Asparagine, Glutamic acid, Serine
15. Carbohydrates
Dietary carbohydrates include
Monosaccharides (glucose, fructose)
Disaccharides (sucrose, lactose)
Oligosaccharides and polysaccharides (starch)
The primary function of carbohydrates is to serve as
an energy source for all cells, with the central
nervous system and erythrocytes depending most on
glucose as an energy substrate.
16. vitamins
Are important micro nutrints.
Classified as :
- water soluble-vB complex & c
- fat soluble vitamins-vitamin A,D,E,K(adek)
vitamin A
21. Vitamin D
Forms of vitamin D
Vitamin D2
Available as irradiated ergosterol
Serves as dietary and therapeutic source
of vit D
22. Vitamin D3
Naturally present in human skin as 7-
dehydrocholestrole activated photochemically
to cholecalciferol and transferred to the liver
In the liver by 25-hydroxylase to 25-
OH cholecalciferol then
In the renal cortical cells by1,25 hydroxylase
to 1,25
dehydroxycholecalciferol
23. Functions of 1,25-dehydroxycholecalciferol
Facilitates intestinal absorption of calcium and
phosphorus
Reabsorption of phosphorus in the kidney
Control serum ca and P together with
parathyroid hrn and calcitonin.
24. Clinical feathers of vitamin D
deficiency
Craniotabes - softening of the cranial bones, can
be detected by applying pressure at the occiput
or over the parietal bones -earliest sign of rickets
Rachitic rosary -the beads of a rosary as the
examiner's fingers move along the costochondral
junctions
25. Growth plate widening is also responsible for the
enlargement at the wrists and ankles
Harrison groove horizontal depression along the
lower anterior chest
26. Large anterior fontanell
Caput quadratum
Pigeon chest
Delayed eruption of temporary teeth
Bow leg or knock knee
Greenstick fracture
Rachitic dwarfism
Hypotonia
Sweating
Delayed tooth eruption
28. Radiology
Generalized decrease in the skeletal
radiodensity
Widening, capping and fraying at the end distal
of the bones, best seen at the end of radius and
unla
31. Vitamin D adminstration
-Stoss dose of vit D 300,000-600,000 IU IM in 2-
4 doses over one day or,
Daily intake of 2000-5000IU of vit D for 4-6 wks
-Both should be accompanied by adequate
administration of Ca and P
-After treatment continue with the daily
requirement i.e 400IU of vit D daily
32. Most cases of nutritional rickets can be
prevented by universal administration of a daily
multivitamin containing 200–400 IU of vitamin D
to children who are breast-fed
Adequate sunlight exposure
33. Feeding in infancy
Breast milk is the best food for the newborn
It should be started immediately after birth with in
one hour of life
It should be given exclusively for the first 6 month
of life even water need not to be added
It contains all the nutrients required by the infant
34. The suckling newborn stimulates the mother's
pituitary to release prolactin and oxytocin, which
in turn stimulate the production and let-down of
breast milk (milk ejection reflex), respectively
Composition of breast milk varies at diffent stages
after birth
Colostrum is milk produced during the 1st week
after birth, yellow & thick and contains more
antibodies and WBC , secreted in small amount,
contains more protein than mature milk
35. Mature milk is secreted after the colostum thinner &
watery but contains all the nutrients required by the
baby
Foremilk is milk secreted at the start of feeding it is
watery rich in proteins, vitamins, minerals and water
Hind milk thicker richer in fat content
36. For effective breast feeding there should proper attachment
and positioning with effective suckling
Positioning
Supporting babies whole body
Neck and back on same plane with neck slightly extended
Babies entire body facing mother
Babies abdomen touching mothers abdomen
Attachment
Babies moth wide open
Lower lip turned outwards
Chin touching nipple
More areola visible on above than below
Effective suckling
Slow, deep suckling with pause in between
37. Optimal breast feeding practices
Have written breast feeding policy that is routinely
communicated to all health care staff
Counsel mother and discuss about feeding of the
newborn during pregnancy
Start breast feeding with in 1 hr of birth
Teach mother on breast feeding practices
Exclusive breast feeding for the first 4-6mns
Breast feeding should be given 8-12 times per day
including night feeds
38. Optimal breast feeding……….
It should be on demand and frequent
Empty one breast before switching to the other
Increase breast feeding during illness
Continue breast feeding for a total of 24 months
Start complementary feeding at 6months
Don’t give artificial teats or pacifiers
No supply or advertizing of breast milk substitutes to
mothers always tell about priority of breast milk
39. Advantages of breast feeding
Increases mother to infant bonding
Protects infants from infection
Lactational amenorrhea for the mother means of
family planning
If started immediately after birth facilitates uterine
contraction expulsion of placenta and prevent PPH
40. Natural food for full-term infants and is the
appropriate milk for the 1st year of life
Always available at the proper temperature and
requires no preparation time
Fresh and free of contaminating bacteria
Associated with fewer feeding difficulties incident to
allergy and/or intolerance to bovine milk which
include diarrhea, intestinal bleeding, occult melena,
“spitting up,” colic, and atopic eczema
41. Human milk contains bacterial and viral antibodies,
including relatively high concentrations of secretory
immunoglobulin A, that prevent microorganisms from
adhering to the intestinal mucosa
Macrophages in human milk may synthesize
complement, lysozyme, and lactoferrin
Lactoferrin an iron-binding whey protein has an inhibitory
effect on the growth of E. coli in the intestine
= lower incidence of diarrheal disease, otitis media,
pneumonia, bacteremia and meningitis than formula fed
infants
42. Supply all the necessary nutrients except fluoride
and vitamin D
Iron content is low, but most normal term infants
have sufficient iron stores for the 1st 4–6 mo of
life. Human milk iron is well absorbed
The vitamin K content also is low and may
contribute to hemorrhagic disease of the
newborn
43. The only disadvantage of breast feeding is transmission of
maternal infection to the newborn
HIV in case of maternal HIV infection follow countries policy
for breast feeding
HTLV infection is a contraindiation for breast feeding
HBV materal infection baby should receive Ig and HBV
vaccination immeditely after birth
CMV May be found in milk of mothers who are CMV
seropositive
Causing symptomatic illness in term infants is
uncommon
HSV If active lesion on breast don’t feed
44. Cow’s milk
Associated with milk protien allergy
Occult blood lose in the stool
3 times higher in protein , 2 times in Na, iron and
linoliec acid are lower
High ratio of casein to whey protein
Total amount of fat is equal with BM 3.5mg/dl
Calorie is comparable 67 calories/dl
Higher calcium and phosphorus in cows milk
=> Should be avoided in the 1st yr of life
45. Complementary feeding should be started at 4-6 mn
Initially with semi solid foods
One food at a time
Include all the five nutrition components
Weaning cessation of breast feeding should be at 24
months
If not possible it can be as early as 12mns
46. QZ
1. why infants &children have additional energy
expenditure?
2. which nutrients have the highest energy density?
3 .what are the 3 categories of amino acids?
4. the earliest lesion of vitamin A deficiency is _?
5. list criteria of optimal breast feeding practice
6. list advantages of breast feeding
