THE BASIC PAEDIATRIC NUTRITION

Olowolekomo T.M(RDN)
(Nutrition & Dietitics Department)
Breastfeeding Facts.

• Breast-milk is also an important source of energy and nutrients

in children aged 6–23 months. It can provide half or more of a c
hild’s energy needs between the ages of 6 and 12 months, and
one third of energy needs between 12 and 24 months.

• Breastfeeding burns between 500-600 calories a day. That mea

ns some moms might end up losing weight without any additio
nal exercise.

The smell and taste of your breast milk changes depending on

the foods you eat. Exposing your little one to more flavors
during breastfeeding can lead them to be less picky eaters
once you begin introducing solids.
Breastfeeding facts
• However, many infants and children do not receive
optimal feeding. For example, only about 44% of inf
ants aged 0–6 months worldwide were exclusively b
reastfed over the period of 2015-2020.(WHO, 2021)

• Babies who are exclusively breastfed are 14times le

ss likely to die than babies who are not breastfed.(
WHO, 2021)
 The First 1000days
The first 1,000 days refers to a child's life
from the moment they are conceived until
they have reached 2 years of age (24
months). This is a time when their brain,
body and immune system grows and
develops significantly.
Importance and impact on nu
trition in the first 1,000
days
• The “First 1000 Days” are a period of rapid physical gro
wth and accelerated mental development and offers a
unique opportunity to build lifelong health and intellige
nce.

• It is a major contributor to growth faltering inclu

ding maternal factors.

• Ensuring babies have the right mix of nutrition in their

first 1,000 days helps them to better resist infections an
d allow their growing brain and bodies to realise their f
ull developmental potential.
Challenges and consequences
of the first 1,000 days
• The first 1,000 days are vulnerable period in human
development when poor nutrition can have short a
nd long lasting consequences on human health and
function.

• The first 1000 days are a window of opportunity be

cause this is when improvements in nutrition can h
ave the greatest impact in populations with poor nu
trition.
Physiological and development
al milestone

• Developmental milestones are things most children

can do by a certain age.

• Children reach milestones in how they play, learn, s

peak, act, and move.
Physiological and developme
ntal milestone at 6months
Copy some movements and facial expressions, like smilin
g or frowning
~ Like to look at self in a mirror & Reach for toy with one
hand
~ Attempt to reach and grasp a toy, using both hands and
eyes together
~ Follow moving things with eyes from side to side
~ Keep head steady, unsupported, when held upright
~ Can hold a toy and shake it & Bring hands to mouth
~
Physiological and developmental
milestone at 6months contd...
Push up to elbows, when lying on tummy
~ Smile spontaneously, especially at known people
~ Like to play with familiar people and might cry wh
en playing stops
~ Begin to babble (‘ah’, ee, oo, other than when cryi
ng), laughs aloud or
makes squealing sounds
~ Respond to affection and let you know if he or she
is happy or sad
Importance of breastfeeding
to infants
• According to the World Health Organization, “Bre
ast milk is the natural first food for babies, it provi
des all the energy and nutrients that the infant ne
eds for the first months of life, and it continues to
provide up to half or more of a child’s nutritional
needs during the second half of the first year, and
up to one-third during the second year of life.”

• Breastfeeding has both nutritional and physiologic

al benefits to babies.
 Importance of breastfeedin
g to infants
• supplies all the necessary nutrients in the proper pro
portions.
• It protects against infections, like ear infections, aller
gies, sickness, and obesity.
• It protects against diseases, like diabetes and cancer.
• It is easily digested – no constipation, diarrhea or ups
et stomach.
• Babies have healthier weights as they grow.
• Breastfed babies score higher on IQ tests.
Importance of breastfeeding
to infants contd...
Breastfeeding saves more than 800,000 lives each ye
ar( WHO, 2019).
Inappropriate breast milk subs
titutes and it's conseqjuences
• Inappropriate breast milk substitutes:

• If a baby is not breastfed or doesn’t receive breast

milk, the only suitable substitute is infant formula

• Evaporated milk was recommended in the early 190

0s but we now know it is not suitable.
Inappropriate breast milk substitutes
and it's conseqjuences contd...
• Unmodified Animal Milks such as unpasteurized a
nd pasteurized/ Adults milk.This includes milk from
a cow, goat, or sheep.
• Reasons:
• Differences in protein and electrolyte concentration
s.
• The use of such milk can place extra strain on infant
s' kidneys and lead to various nutrients deficiencies
etc.
Inappropriate breast milk substitutes
and it's conseqjuences contd...

• Plant-Based Milks.This includes soy, rice, almond, c

oconut and oat milks.
• Reason:
• The use of such milks as a substitute for breastmilk
can result in severe nutritional deficiencies.
• Non-Milk Drinks.This includes fruit juices, caffeinat
ed and sugar-sweetened drinks.
• Reason:
• It could lead to severe nutritional deficiencies.
Consequencies
This include:
Iron deficiency which can lead to anaemia
Malnutrition
Vitamin A deficiency that can result into blindness, in
fections, etc
Childhood obesity
Increase in infants morbidity and mortality rate
Complementary freding
• WHO and UNICEF recommend:
• early initiation of breastfeeding within 1 hour of birt
h;
• exclusive breastfeeding for the first 6 months of life;
and
• introduction of nutritionally-adequate and safe comp
lementary (solid) foods at 6 months together with co
ntinued breastfeeding up to 2 years of age or beyond
.
• Source: (WHO/UNICEF, 2020)
Definition:
• Complementary feeding is defined as the process st
arting when breast milk alone is no longer sufficient
to meet the nutritional requirements of infants, and
therefore other foods and liquids are needed, along
with breast milk(WHO, 2019)

• In Nigeria, only 21% of breastfed children receive th

e minimum acceptable complementary feeding diet
(UNICEF, 2011)
Importance of complementary
feeding
• From the age of 6 months a baby needs more energ
y and nutrients than can be provided by breast milk
alone.

• Complementary feeding is needed to provide energ

y and essential nutrients required for continued gro
wth and development.
Nutritional gap filling by complementary
feed with focus on iron and energy densi
ty
• The gap between nutritional requirement and amount obtaine
d from breast milk increases with age.

• The gaps are mostly attributed to either poor dietary quality or

poor feeding practices(if not both) of homemade complement
ary foods
• For energy, 200, 300, and 550 kcal per day is expected to be co
vered by complementary foods at 6–8, 9–11, and 12–23 month
s, respectively.
• In addition, the complementary foods must provide relatively l
arge proportions of micronutrients such as vitamin A, iron, zinc
, and calcium
Nutritional gap filling by complementary
feed with focus on iron and energy densi
ty
• unfortified plant-based complementary foods provi
de insufficient key micronutrients (especially, iron, z
inc, and calcium) during the age of 6–23 months.
Energy Requirement
• Complementary foods are expected to have sufficie
nt energy density to provide a growing child with ad
equate daily energy requirement.

• Breast milk contains an energy density of about 0.7 

kcal/ml(WHO, 2002).
Energy Requirement cont'd..
.
• The total energy requirement estimated for healthy
breastfed infants is approximately 615 kcal/day at 6
–8 months, 686 kcal/day at 9–11 months, and 894 k
cal/day at 12–23 months
Protein Requirement
• They are major sources of essential amino acids an
d energy at times of energy deprivation.
• Adequate supply of dietary protein is vital for maint
aining cellular function and integrity and for ensurin
g normalcy of health and growth.

• On the other hand, the combined effect of protein

deficiency and low energy intake leads to protein–e
nergy (PE) malnutrition, the commonest forms of m
alnutrition worldwide
Protein Requirement con
t'd...
• The amount of protein (in grams per day) required t
o satisfy their daily nutritional requirement is 9.1 g f
or 6–8 months, 9.6 g for 9–11 months, and 10.9 g fo
r 12–23 months.

• When average breast-milk intake is assumed, the a

mount of protein needed from complementary foo
ds is 1.9 g/day at 6–8 months (21%), 4.0 g/day at 9–
11 months (42%), and 6.2 g/day (57%) at 12–23 mo
nths
Micronutrients
• Micronutrients are essential for growth, developme
nt, and prevention of illness in young children.

• Adequate intakes of micronutrients, such as iron, zi

nc, and calcium, are important for ensuring optimal
health, growth, and development of infants and yo
ung children
Micronutrients cont'd...
• The percentage of total daily requirement for micro
nutrients needed from complementary foods range
s from 30 to 97%. For instance, 97% of iron, 86% of
zinc, 81% of phosphorus, 76% of magnesium, 73% o
f sodium, and 72% of calcium during 9–11 months a
re expected from complementary foods
Iron deficiency
• Iron deficiency can affect child's health and growth
and can even lead to anaemia.
• Children are at increased risk especially low birth w
eight infants delivered to iron deficient mothers.
• A fullterm newborn infant has about 10% of the ad
ult iron value, most of which is transferred from the
mother in the 3rd trimester, preterm infants have lo
wer values.
Effect of iron deficiency -
Long term
• 6- to 24-month-old infants with iron-deficiency ane
mia are at risk for poorer cognitive, motor, social-e
motional, and neurophysiologic development in the
short- and long-term outcome.

• New findings also point to the need for more atten

tion to the developmental effects of prenatal iron d
eficiency.
Importance of fortified com
plementary feeds
• Complementary foods should provide sufficient ene
rgy, protein and micronutrients to cover a child's en
ergy and nutrient gaps, so that together with breast
milk, they meet all his or her needs.

• Fortification of commonly used food vehicles provid

es an opportunity for increasing nutrient intake duri
ng infancy and has the potential to improve growth
and development dimensions.
Concept of complementary fe
eding

• FATVAH
• F- Frequency
• A - Amount
• T - Thickness
• V - Varieties
• A - Active/responsive feeding
• H - Hygiene
Guiding principles for appropriate co
mplementary feeding

• gradually increase food consistency and variety;

• increase the number of times that the child is fed: 2–
3 meals per day for infants 6–8 months of age and 3
–4 meals per day for infants 9–23 months of age, wit
h 1–2 additional snacks as required;
• use fortified complementary foods or vitamin-miner
al supplements as needed; and
• during illness, increase fluid intake including more br
eastfeeding, and offer soft, favourite foods.
• Source: (WHO/UNICEF, 2021)
Guiding principles for appropriate complementary feeding

• Introduction of complementary foods should not be too early omnor late

.a
• Breastfeed first before giving other foods.
• Give the baby adequate water for hydration.
• continue frequent, on-demand breastfeeding until 2 years of age or beyo
nd;
• practise responsive feeding (for example, feed infants directly and assist
older children. Feed slowly and patiently, encourage them to eat but do
not force them, talk to the child and maintain eye contact);
• practise good hygiene and proper food handling;
• start at 6 months with small amounts of food and increase gradually as t
he child gets older;