Patient Education
Introduction
Children have actively growing and developing bones, teeth, muscles, and blood. Thus, they require more nutritious food in proportion to their weight compared to adults. Malnutrition, hence, becomes very common when children experience a prolonged poor appetite or are fed with a limited variety of foods, which may be nutritionally inadequate.
Nutritional Requirements for Infants
The Recommended Dietary Allowances (RDA) are based on the current knowledge of nutrient intakes needed by children of different ages for optimal health.
Recommended Dietary Allowances for Indians (Ref Nin)
|
|
Group
|
Particulars
|
Body Wt Kg
|
Net energy kcal/d
|
Protein g/d
|
Fat g/d
|
Calcium mg/d
|
Iron mg/d
|
Vit.A. µpg/d
retinol
|
Vit.A. pg/d
ß-carotene
|
|
Infants
|
0-6 months
6-12 months
|
5.8
8.5
|
90/kg
80/kg
|
1.16/kg
1.04/kg
|
|
|
|
350
350 |
1200 |
|
Children
|
1-3 years
4-6 years
7-9 years
|
12.9
18.3
25.3
|
1110
1360
1700
|
10
13
19
|
25
25
25
|
400
450
500
|
6
8
10
|
390
510
630
|
1600
1600
2400
|
|
Boys
|
10-12 years
|
34.9
|
2220
|
27
|
22
|
650
|
12
|
770
|
2400 |
|
Girls
|
10-12 years
|
36.4
|
20
|
27
|
|
650
|
16
|
790
|
|
|
Boys
|
13-15 years
|
50.5
|
2860
|
36
|
|
800
|
15
|
930
|
|
|
Girls
|
13-15 years
|
49.6
|
2400
|
35
|
|
800
|
17
|
890
|
|
|
Boys
|
16-18 years
|
64.4
|
3320
|
45
|
|
850
|
18
|
1000
|
|
|
Girls
|
16-18 years
|
55.7
|
2500
|
37
|
|
850
|
18
|
860
|
|
Group
|
Particulars
|
Body Wt Kg
|
Thiamine mg/d
|
Riboflavin mg/d
|
Nicotinic acid mg/d
|
Pyridoxine mg/d
|
Ascorbic acids mg/d
|
Folic acid µg/d
|
Vit. B-12 µg/d
|
|
Infants
|
0-6 months
6-12 months
|
5.8
8.5
|
55µg/kg
50µg/kg
|
65µg/kg
60µg/kg
|
710µg/kg
650µg/kg
|
0.1
0.5
|
25
|
25
71
|
0.2
1
|
|
Children
|
1-3 years
4-6 years
7-9 years
|
12.9
18.3
25.3
|
0.6
0.8
1.0
|
0.8
1.1
1.3
|
6
8
10
|
0.8
1.0
1.3
|
24
27
36
|
97
111
142
|
1
2
2
|
|
Boys
|
10-12 years
|
34.9
|
1.3
|
1.7
|
12
|
1.7
|
45
|
180
|
2 |
|
Girls
|
10-12 years
|
36.4
|
1.2
|
1.6
|
12
|
1.6
|
44
|
186
|
2 |
|
Boys
|
13-15 years
|
50.5
|
1.6
|
2.2
|
16
|
2.2
|
60
|
238
|
2 |
|
Girls
|
13-15 years
|
49.6
|
1.3
|
1.9
|
13
|
1.8
|
55
|
204
|
2 |
|
Boys
|
16-18 years
|
64.4
|
1.9
|
2.5
|
19
|
2.5
|
70
|
286
|
2 |
|
Girls
|
16-18 years
|
55.7
|
1.4
|
1.9
|
14
|
1.9
|
57
|
223
|
2 |
The Food and Nutrition Board has recognized that human milk is the best food for infants and will meet the nutritive requirements early in life when it is supplied in a sufficient quantity.
The nutrient allowances are stated.
Energy
The caloric need in an infant is high in terms of his body weight. The allowance of 130-150 Kcal per Kilogram for the infant at birth is necessary.
Eg: 130 Kcal/Kg
Infant's birth weight = 3 kg
130 x 3 = 390 Kcals,
Hence, the caloric need should be approximately 450-500 Kcal.
Since the activity of infants varies widely, an allowance that is correct for one infant may be too high or too low for others,
Protein
The infant adds about 2.5 gm protein to his body after about 1.65 gm/kg per day for the rest of the year.
Water
The water loss from the skin is large because of the greater surface area in relation to body weight. Infants require about 150 ml of water per 100 calories. This requirement is met by breast milk.
Minerals
Studies have proven that infants receiving human milk absorb 50 - 60 percent of the total calcium, whereas those receiving commercial formula absorb about 25 - 30 percent of the total calcium.
The circulating hemoglobin of the well-nourished infant is ample during the first three months, after which foods providing iron must be added in order to meet the needs of the expanding blood volume. The incidence of anemia is high in infants, usually appearing by the age of six months.
Although many trace elements are needed by the infant, the exact requirements have not been determined. It is safe to assume that human milk will supply adequate amounts.
Vitamins
Human milk will furnish sufficient vitamin A & vitamin E
Human milk from the well-nourished mother supplies sufficient ascorbic acid for the infant's needs, although supplements are generally introduced early.
The allowances for thiamine (B1), riboflavin (B2), and niacin (B3) have been set up proportionate to the caloric intake. These allowances are easily met by human milk.
The infant is born with a store of vitamin B6 that protects him during the neonatal period as human milk is very low in this vitamin.
Breastfeeding is the Best Feeding for Baby
Mother's milk is nature's gift to infants. Practically all mothers produce sufficient milk to meet the food requirements of the normal infant for the first three months. There is really no condition where breastfeeding is contraindicated. By and large from the time of birth up to the age of 3 months breast milk alone is adequate for the needs of the growing baby. Exclusive breastfeeding is recommended till 6 months of age. During the first 6 months of age, no other fluids, food or water should be given. However, vitamin supplements can be given.[2]
Colostrum is Vital
The thick yellowish breast milk, which is produced during the first 2-3 days after birth, is called colostrum. The colostrum contains less fat and lactose than mature milk and more sodium, chloride, and zinc. It is rich in antibody-protein especially immunoglobulin A(IgA) and lactoferrin. It guards the infant against infection. Feeding of colostrum is wrongly believed to be unhygienic in certain communities, perhaps due to its yellowish color. Such practices should be stopped as it deprives the infant of its natural resources of nutrients and antibodies.
Feeding the Infant
Feeding on demand is recommended each time the baby is hungry. Duration of feeding varies from infant to infant and may range from 5-30 minutes and, or even more. The mother should be as comfortable as possible while Breastfeeding. She should ensure that the baby's nostrils are not obstructed by the breast. The mother should feed the baby at one breast till the milk is totally sucked and then if the baby is still hungry, the baby should be fed at the other breast. This ensures increased milk production and also the baby receives hindmilk which is rich in fat.
Position of the mother
The mother can take any position comfortable to her (sitting or lying down). Her back should be supported and she should not bend forwards or put her weight on the baby. Football hold position can also be used. Also, for twin babies, double football hold positions can be used.[2]
Position of the baby
Four signs of good positioning:
- Baby’s entire body is supported, with good support given to the neck.
- Baby’s head and body are aligned taking care that the baby’s body is not twisted.
- Baby’s body is facing the mother, such that both their abdomens are touching each other.
- Baby’s nose is at the same level as the nipple.
Four signs of good attachment:
- Baby’s mouth is wide open.
- Baby’s mouth covers the maximum part of the areola, such that only some part of the upper areola is visible.
- Baby’s chin is in contact with the breast.
- Baby’s lower lip is turned outwards.
Advantages of Breastfeeding
- Provides optimum nutrition required by the newborn.
- Provides anti-infective factors through breast milk especially colostrum.
- Safer due to reduced chances of infection as compared to artificial feeding.
- Involves close contact of the mother with the infant which facilitates bonding.
- Prevents neonatal health problems like hypoglycemia, allergies, diarrhea & malnutrition
- For mothers, it contributes to natural contraception and thus helps in child spacing.
Composition of Breast Milk compared to Cow's Milk (Per 100 gm)
|
Human's Milk |
Cow's Milk |
|
Human's Milk |
Cow's Milk |
Water (gm) |
85.2 |
87.4 |
Sodium (mg) |
16.0 |
50.0 |
Energy (kcal) |
77.0 |
65.0 |
Potassium (mg) |
51.0 |
144.0 |
Protein (gm) |
1.1 |
3.5 |
Vitamin A (IU) |
240.0 |
140.0 |
Fat (gm) |
4.0 |
3.5 |
Thiamine (mg) |
0.01 |
0.03 |
CHO (gm) |
9.5 |
4.9 |
Riboflavin (mg) |
0.04 |
0.17 |
Total ash (gm) |
0.2 |
0.7 |
Niacin (mg) |
0.2 |
0.1 |
Calcium (mg) |
33.0 |
118.0 |
Ascorbic acid (mg) |
5.0 |
1.0 |
Phosphorus (mg) |
14.0 |
93.0 |
|
| Human's Milk |
Cow's Milk |
1. 60% of protein is lactalbumin and the remaining is casein. |
1. 15% of protein is lactalbumin and the remaining is casein. |
2. It forms soft curds and is therefore easily digestible. |
2. It forms larger, tougher curds and therefore slowly digestible. |
3. It has more long chain fatty acids. |
3. It has more short chain fatty acids which act as irritants to the intestinal tract. |
4. It has lower contents of calcium, phosphorus, sodium and potassium but is easily absorbed. |
4. It has higher contents of calcium, phosphorus Na & K. Some healthy infants fed cow's milk have a syndrome of convulsions known as neonatal tetany on about the sixth day of life. This is believed to be due to high blood phosphorus levels. |
5. Ash content is three times less than in cow's milk. |
5. Cow's milk has three times more ash content than in human milk because of the lesser capacity of
the infant's kidney to excrete wastes, the high ash content of cow's milk may prevent too high a solute load, which may cause diarrhoea. |
6. It can meet the infant's ascorbic acid requirements. |
6. It cannot meet the infant's ascorbic acid requirement & hence needs to be supplemented. |
Weaning Foods (Supplementary Feeding)
There is no fixed/set pattern for adding solid foods to the basic milk diet of the infant. Once the infant has developed sufficient muscular coordination, involving the tongue & swallowing reflex to be able to eat solid foods, they may be introduced gradually.
However, it is recommended that complementary feeding should be started after 6 months of exclusive breastfeeding.[2]
Introduction of New Foods
Some do's and don'ts about introducing solid foods are as follows:
List of Supplementary Foods that are given:
| Name of Foodstuff |
Age at Which to Introduce |
Approximate Quantity per Feeding |
Remark |
1) Fruit juices & soups:
prepared using tomato, onion, carrot, spinach, moong dal and a little rice. |
6 months |
1-2 tsp twice a day |
All fruit juices may be given without adding sugar. Soups may be seasoned only with salt and a dash of pepper. A blob of butter may enhance the taste. Quantity may be increased slowly to the acceptable limits. |
| 2) Mashed banana, chickoo, stewed apple (prepared with cream, milk) papaya-stewed, or boiled pear, mango |
6 months |
1-2 tsp twice a day |
Banana or sour fruit may cause cough or cold especially in winter. Therefore, they may preferably be introduced in summer. |
| 3) Porridge prepared using roasted rava with a little ghee and milk. Other cereals that can replace rava are dalia (broken wheat) ragi nachni, sago, rice powder and custard flavoured custard, powder milk. |
One week after starting banana or any other fruit listed above |
1-2 tsps twice a day |
Quantity may be increased every 3 or 4 days. |
| 4) Soft boiled egg |
1 week after introducing porridge |
1 tsp yolk |
Egg should be boiled for a minute and immediately cooled under running water to prevent discoloration. Gradually increase the quantity of egg yolk and include egg white. By 4 weeks from the day the egg was introduced, the child should be able to eat one whole egg. |
| 5) Mashed & well cooked vegetables |
1 week after introducing egg. |
1-2 tsps twice a day |
Potato, pumpkin, green leafy vegetables, carrot and peas boiled to soften completely. |
| 6) Curds |
1 week after introducing vegetables. |
2-4 tsps |
Fruit yoghurts may also be given. Curds should be just enough set and not be too sour. |
| 7) Mashed & well cooked rice dal or khichdi |
1 week after introducing curds |
1-2 tsps |
Seasoned with a little oil or butter while serving. |
Family pot feeding
After one year of age, the child should be given food that the other members of the family eat. This is known as ‘family pot feeding’.[2]
Other foods that may be introduced include biscuits, chapati soaked in thin dal or milk, and mixed meat without spices. The nutritive value of commercial weaning foods is similar to that of supplementary foods made from readily available household food commodities; however, commercial options are much more expensive. Home-cooked supplementary foods also help prepare the child for regular family meals, which they will soon begin to consume with other family members.