Childhood Nutrition
Chetali Agarwal
Consultant Dietician, Westminster Hospital, London.
First Created: 09/15/2014  Last Updated: 09/15/2014

Patient Education

Introduction

Because children are growing and developing bones, teeth, muscles, and blood, they need more nutritious food in proportion to their weight in comparison to an adult.

Malnutrition hence becomes very common when they have a prolonged poor appetite or are fed with a limited number of foods which may be nutritionally poor foods.

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
5.4
8.6
108/kg
98/kg
2.05/kg
1.65/kg
  500
  350 1200
Children
1-3 years
4-6 years
7-9 years
12.2
19.0
26.9
1240
1690
1950
22
30
41
25
25
25
400
400
400
12
18
26
400
400
600
1600
1600
2400
Boys
10-12 years
35.4
2190
54
22
600
34
600
2400


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
5.4
8.6
55µg/kg
50µg/kg
65µg/kg
60µg/kg
710µg/kg
650µg/kg
0.1
0.4
25
25
0.2
Children
1-3 years
4-6 years
7-9 years
12.2
19.0
26.9
0.6
0.9
1.0
0.7
1.0
1. 2
8
11
13
0.9
0.9
1.6
40
40
40
30
40
60
0.2-1.0
0.2-1.0
0.2-1.0
Boys
10-12 years
35.4
1.1
1. 3
15
1. 6
40
70
0.2-1.0

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 insufficient quality.

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 proved that infants receiving human milk absorbed 50 - 60 percent of the total calcium, whereas those receiving commercial formula absorbed 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 humans 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.

Breast Feeding 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.

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.

Advantages of Breast Feeding

  • Provides optimum nutrition required by the newborn.

  • Provide anti-infective factors through breast milk especially colostrum.

  • Safer due to reduced chance of infection as compared to artificial feeding.

  • Involves close contact of mother with infant which facilitates bonding.

  • Prevents neonatal health problems like hypoglycemia, allergies, diarrhea & malnutrition

  • For mother 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 fats of long chain fatty acids.
3. It has fats of short chain fatty acids which acts as irritants to the intestinal tract.
4. It has low 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 convulsion known as neonatal tetany about the sixth day of life. This is believed to be due to high blood phosphorus level.
5. Ash content it 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 co-ordination, involving the tongue & swallowing reflex to be able to eat solid foods, they may be introduced gradually.

Introduction of New Foods

Some do's and dont's about introducing solid foods are as follows:

  • Introduce only one new food at a time to allow the infant to become familiar with that food before trying to give another.

  • Give very small amounts of any new food: one teaspoonful or two.

  • Use a very thin consistency when starting solid foods. Gradually consistency is more solid as the infant learns how to use his tongue in propelling the food back.
  • Never force an infant to eat more of a food than he takes willingly.

  • If after several times, it is apparent that a baby has an acute dislike for food, omit that item for a week or two and then try it again.

    Food should be only slightly seasoned with salt, other seasonings are avoided.

  • Variety in choice of foods in important.

  • The mother or anyone feeding the infant should be careful to avoid showing dislike for a food given

  • Check that the temperature of the food is neither too hot nor too cold.

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.
5 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 5 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 (nach nil, 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 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.

Other foods that may be introduced are biscuits, chapati soaked in thin dal or in milk, and mixed meat but without spice.

The nutritive value of commercial weaning foods compared to supplementary foods that are readily available food commodities at home is the same however, they are much more expensive.

Home-cooked supplementary foods also prepare the child for normal meals which they will soon be consuming along with the other family members.


Childhood Nutrition Childhood Nutrition 09/15/2014
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