Pediatric Nutrition

1
Pediatric Nutrition

• Ricci, chapters 25-29

2
Energy and Nutrient Needs of Infants

• First year of life is a time of very rapid growth
  and development
• High growth rate leads to high basal metabolic
  rate
• Need 98-108 kcal/kg/day of body weight depending
  on age-same as about 7,000/day in adults. See
  Table 25.7

3
Energy and Nutrient Needs of Infants

• Fat and carbs in the diet provides energy and are
  needed for brain development
• Protein important due to physical growth rate
• Vitamin and mineral needs are very high

4
Energy and Nutrient Needs of Infants

• Infants have a higher percentage of body water
  than adults, leading to greater risk of
  dehydration therefore, encourage water intake
• For fluid needs see Table 25.7
• Breast milk or formula only for first 4-6 months
• Introduce cup at 6-8 mos.

5
Breast Milk

• Carbohydrate is in the form of lactose which
  enhances calcium absorption
• Protein is in a form that is easily digested and
  absorbed
• Fat is generous in essential fatty acids
• High bioavailability of iron and zinc
• Not recommended for mothers with HIV, active TB,
  drug abuse. And not for infants with
  galactosemia (intolerance to galactose).

6
Breast Milk

• Due to their low content in breast milk, infants
  who are breast fed need
• Vitamin D supplements
• Iron supplements (after 4-6 mos)
• Fluoride supplements (after 6 mos)

7
Infant Formula

• Copies breast milk through artificial methods
• Must be iron-fortified
• Special formulas may be needed
• Hypoallergenic formulas for infants with
  allergies
• Soy formulas for lactose intolerance

8
Risks of Formula and Other Milks

• Contaminated water
• Contains no antibodies
• Improper food handling techniques
• Bottle caries
• Goat, cow, and soy milk are nutritionally
  incomplete and can cause allergic reactions

9
Introducing Solid Foods

• Begin at 4-6 months of age
• Introduce single-ingredient foods, one at a time
  q 4-7d to assess for food allergies.
• Rice cereal, then oat and barley (Fe fortified)
  fruit juice (Vit C). Limit juice to 2-4 oz/d
• Vegetables first then fruit may be best.
• Finger foods 8 mos.
• Egg yolks, meats about 10 mos.

10
Foods to Avoid

• Concentrated sweets
• Products with sugar alcohols may cause diarrhea
• Honey and corn syrup-botulism risk
• Carrots, cherries, gum, hard or gel-like candies,
  hot dogs, marshmallows, nuts, pnut butter,
  popcorn, raw celery, whole beans, and whole
  grapes (choking hazards)
• Citrus, strawberries, wheat, cows milk, egg
  whites, pnut butter (allergy)

11
Toddler Nutrition

• 2-3 cups of regular cows milk and other sources
  of calcium (need 500 mg/d)not low-fat until age
  2
• Be careful of milk anemiasome may need iron
  supplement
• Balance and variety from all food groups
• Drink liquids from a cup not a bottle

12
Toddler Nutrition

• Physiologic anorexia
• Picky, fussy eaters ritualistic
• Give 1-2 TBSP likes finger foods
• Limit sweets
• Buy child-designed utensils
• Refusing food is a form of control
• Wean from bottle by 14 mos

13
Mealtimes With Toddlers

• High chair with foot support
• Discourage unacceptable behavior
• Let toddlers explore and enjoy food
• Dont force foods
• Let children choose nutritious foods
• Introduce new foods with favorite ones and more
  than once.
• Make mealtimes pleasant.
• Remember food habits and choices in
  adulthood start here!
• Never leave them unattended!

14
Nutrition During Childhood (3-12 yr)

• Needs and appetites change during childhood
  because of growth and physical activity
  inactivityobesity
• Adults and schools need to assist children in
  choosing nutrient-dense foods
• Need variety and less than adult portions

15
Nutrition During Childhood

• Carbohydrate recommendations adults
• Fiber intake should be about 15-20 g
• Fat intakes should be 20-30 of total energy
  intake (the older the child the lower the fat
  intake should be)
• Protein needs are increased with age-especially
  important during high growth times

16
Nutrition During Childhood

• Calories, vitamin and mineral needs increase with
  age.
• Balanced diet meets all vitamin and mineral needs
  except iron
• No supplements should be needed with balanced
  diet that includes iron fortified foods
• Never require the child to clean his plate and
  never use food as reward.

17
School Age/Adolescence

• Nutritional problems include anorexia and obesity
• Rapid growth period raises need for calcium,
  protein, calories, iron, Vit D for bone, teeth,
  and muscle development, and menstrual periods

18
Adolescent Food Choices

• Eating habits and behaviorsskipping breakfast,
  snacking, dieting, eating hi-fat fast food and
  very little fruits and vegs
• Beverages-generally tend to want soft drinks
  (high in sugar and caffeine)
• Eating away from home-1/3 of meals are consumed
  away from home and tend to come from fast-food
  restaurants

19
Adolescent Food Choices

• Peer influence is strong
• Drug and alcohol abuse-changes appetite, leads to
  poor absorption of some nutrients, causes
  decreased money, may provide energy but no
  nutrients
• Smoking-eases feelings of hunger, lowers vitamin
  intake (Half of teens who continue to smoke will
  die of smoking related causes)

20
School Age/Adolescence

• Teaching good nutrition is not enough
• Must also have access to quality foods and snacks
  _at_ home and school
• Relationship between attractive appearance and
  healthy lifestyle may be effective
• Provide info, role model, and involve teendont
  dictate and judge

21
Nutritional Assessment

• Especially important for children with evidence
  of nutritional problems
• Dietary recalls are frequently unreliable
• Most common is 24h but is only useful if day is
  typical 3 day diaries are more helpful (one day
  should be weekend day)

22
Nutritional Assessment

• Look at hair, teeth, skin, mm, build
• Assess ht, wt, BMI
• IBW (current wt/IBW x 100)
• Waist to hip ratio
• TSFextent of obesity
• H/H, Fe, pre-albumin, lipids, glucose

23
Hunger and Malnutrition in Children

• Regular meal times and routines are important for
  children
• Missing meals, especially breakfast, affects
  behavior, academic performance
• In iron deficiency, brain is affected before the
  blood which leads to
• Behavior changes
• Decreased intellectual performance
• Decreased attention span

24
Effects of Childhood Obesity

• Physical healthabnormal lipid levels, high blood
  pressure, type 2 diabetes, sleep apnea,
  orthopedic issues
• Psychological developmentemotional and social
  problems, stereotypes and discrimination, and
  body image issues

25
Food Allergies

• Adverse food reactions include-stomachaches,
  headaches, rapid pulse rate, nausea, wheezing,
  hives, bronchial irritation, cough
• Common foods that cause problems-eggs, milk, soy,
  peanuts, wheat, food coloring
• Food labeling may help identify hidden
  allergens

26
Tips for Parents

• Honor childrens preferences.
• Set children up to make good food decisions while
  allowing for choices
• Avoid power struggles regarding food children
  should regulate their own food intake and
  dislikes with adult supervision

27
Tips for Parents

• Limit high fat and high sugar snacks
• Choking prevention-be alert to foods that are
  common causes of choking, and make sure children
  are sitting still while eating
• Brush and floss after meals and snacks
• Be a good role model with healthy eating and
  exercise.