Unit 2 Nutritional Consideration in Infancy and Preschool Years, Insta - Husain.z.kmu
Unit 2 Nutritional Consideration in Infancy and Preschool Years, Insta - Husain.z.kmu
Unit 2 Nutritional Consideration in Infancy and Preschool Years, Insta - Husain.z.kmu
Shabnam
Faculty INS-KMU
Acknowledgement: Imran
Waheed
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Objectives
• At the end of this session students will be able
to:
• Identify the best feeding options for infants in
different circumstances in Pakistan.
• Identify the major nutritional risk factors and
strategies to prevent or manage them in the first
years of life and during the pre-school years.
• Weaning, Pre lacteal feeds, food introduce with
quantity and type.
• Counsel mothers regarding nutritional care of
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the children.
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Best Feeding Option
• Breast milk is best for the
baby and should be the
first choice.
• Formula feeding is also an
option if there are social,
medical or other constraints.
• Mothers should try to breast feed at least in the
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initial 3-4 weeks, as most healthy antibodies are
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transferred in the initial days.
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Cont….
• If formula feeding is to be done, combining it
with breast feeding should be considered.
• Breast feeding should be done first, followed
by formula feeding in this case.
• If you plan to use formula for occasional
feedings, limit bottles to one per 24 hours to
avoid slowing your milk production.
• Cow or Buffalo milk should not be introduced
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to the baby before at least one year of age.
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Developmental Pattern
• Neonate: Birth to 28 days
• Infant: 1 month-1 year
• Toddlers: 1-3 years
• Preschool children: 3-5 years
• School- age children: 5-12 years
• Adolescence: 12-18 years
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About Early Childhood
Care
• Healthy habits are taught to the child right from
birth.
• In fact, health of the baby is decided even before his
birth.
• Healthy child is born to the mother who kept to
healthy food habits during her pregnancy.
• Children often take the attitudes and habits formed
during their initial years, into adulthood.
• Learning healthy eating behavior at an early age is
very important to lay a good foundation for the
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future health of the child.
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Conti…
• At all ages, children are not eating diets with
enough nutrients or diversity, and they are eating
too much sugar, salt and fat.
• The risks at each age can lead to one or more
forms of malnutrition: stunting, wasting, hidden
hunger or overweight and obesity.
• These conditions can affect school performance
and lifelong economic opportunities, and present
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health risks into adulthood.
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Conti…
• The vast majority of young children(6-23 months)
consume breast milk, they are not eating enough
animal source foods, fruits, legumes or
vegetables and rely too heavily on grains.
• 59% of children worldwide are not being fed
much-needed nutrients from animal source
foods.
• 44% of children worldwide are not fed any fruits
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or vegetables.
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Risk Factors in Infants and
Young Children
• Inappropriate growth
Weight gain too slow or too rapid for length
• Inappropriate or inadequate diet
Formula not prepared properly (too concentrated
or diluted, addition of solids or cereal)
Solids given before developmental age of 4-6
months
Excessive solids given in infancy so that breast
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milk or formula is significantly reduced
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Conti…
• Food is not appropriate to support
developmental progress
Finger foods and textured foods are not
offered by developmental age of 6-8 months
Cup and spoon are not offered by 9-12
months developmentally
Bottle use continued after 18 months
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Conti…
• Inappropriate feeding behaviors or
environment
Infant not allowed to feed on
demand
Lack of routine meals and snacks;
child allowed
to “graze”
Caregiver pressure to get child to eat, including
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forcing, bribing and rewarding
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Meals take less than
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Conti…
• Health factors impacting nutrition and feeding
Child who is tube-fed
Oral motor problems or delays
Food/formula allergies or intolerance
Medical condition or diagnosis that alters
nutrient needs or feeding
Use of medications that alter appetite and/or
nutrient absorption and metabolism
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Strategies
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supply
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Conti…
• Promoting implementation of the WHO global
strategy on diet, physical activity and health.
• Promoting and protecting the nutritional well-
being of women and children and ensuring
good nutrition throughout the life-cycle for all
age groups.
• Strengthening food safety
• Research, monitoring and evaluation
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Recommended Energy Intakes
for Children
S.No Age (Years) Kcal/Kg/Day Kcal/Day
2. 4-6 90 1800
3. 7-10 70 2000
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* 1 calorie = 4.2 joules
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Breast Feeding
• Exclusive till 6 months of age
• Species specific - suitable, natural, warm, free of bacteria
and readily available.
• Colostrum - rich in antibodies. Baby develops immunity.
• Contains easily digestible proteins, CHO and fats.
• Very rich in vitamins compared to cow’s milk
• Stimulates development of personality and behavior
( brain dev./ cognitive dev.)
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Composition of Milk (Per100 ml)
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Protein provides 4 calories per gram
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Fat provides 9 calories per gram
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Prelacteal Feeds
• Prelacteal feeds are those foods given to
newborns before breastfeeding is established
or before breast milk "comes in," usually on
the first day of life.
• Prelacteals include honey, jaggery (brown
sugar from sugar cane) ghee (clarified butter),
ghutti (herbal paste) and green tea.
• The choice of prelacteals may be specific to a
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caste ,family or culture.
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Conti…
• Newborns are given Prelacteal feeds for
different reasons including the following:
• To clean baby’s bowels
• To keep mouth and throat moist
• To keep baby warm
• To soothe the baby
• To relieve pain
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• To allow stool to be passed
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Conti…
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indicated.
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Conti…
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2-5 days after birth (According to American Pregnancy
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Association)
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Weaning
• The process of introducing semi-liquid to semi-
solid foods other than breast milk.
• Consistency, frequency of food, calorie density
and nutrient density need to be monitored
closely.
• Hygiene
Calorie Density: The number of calories in a given volume or weight of food.
Usually expressed as calories per pound.
Nutrient Density: The ratio of nutrient content to the total energy content.
Nutrient dense food provides substantial amounts of vitamins and
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minerals and relatively few calories.
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When to
Start
Weaning
• At 6 months of age (WHO recommends)
Complementary feeding initiated
and Supplementary to breast milk
started.
• Less milk output (malnourished mother) results
underweight child hence initiate weaning early
(at 5 or 6 months of age).
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• Continue breast feeding (frequency and amount
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reduced).
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Reasons for Starting Weaning at
6 Months
• Breast-feeding becomes inadequate to meet the
child nutritional needs particularly in relation to
iron and vit.C.
• Enzymes necessary to digest the complex structure
of solid food are developed.
• Biting is an accomplishment that becomes possible
at about 6 months of age.
• It is a good chance for child to learn independency
by using cup and spoon to feed himself.
• To accustom the infant to chew and swallow solid
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Critical/ Crucial Period
• Each month is different till one year of age.
• Weaning at proper time
• Transition from liquid to solids – gradually
• Frequency from 10 feeds per day (breast feeding)
to 6-7 feeds per day – gradually
• Small amount but frequently.
• Once the critical stage of learning a particular
behavior is over, it is difficult to teach that
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behavior at a later stage.
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Principles of Weaning
• Start weaning when the child is free from any disease
particularly from any G.I.T. troubles.
• Don’t start in summer because of the high
susceptibility to
gastro-enteritis.
• One-food item is introduced at intervals of 4-7 days to
allow for identification of food allergies and to allow the
child to get used to it.
• New foods are fed in small amounts, from one teaspoon to
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a few tablespoons, put the spoon midway back on tongue
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semi-solid food.
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How To Initiate
Weaning And
Progress
•Consistency: Introduction of
right consistency of food at the
right age is important to develop
good food behaviors.
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Easy to digest,
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Conti…
• Semi-solid (after 8-9 months) Baby now needs
food with taste and texture.
• Semi solid (after 10 months) Baby now needs
food that satisfy his urge to chew-complex
taste and texture
• Solid diet including variety of food items (1-1.2
years)
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How To Initiate
Weaning And
Frequency: Progress
• Energy requirement on a per kg basis, is 3 times
more than the adults in infants and 2 times more
than the adults in case of children till 2 years of
age.
• Children have to be fed frequently since they can
eat small amount at a time due to their little
capacity.
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Cont…
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day.
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Conti…
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What To Feed?
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Things to Remember
Nutrition Plan
• Develop the baby’s taste buds gradually.
• Easy to digest -- consistency
• Well-balanced diet
• Convenient: Easy to prepare & affordable
• Hygienic
• Availability of food items
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Conti…
Nutrition Plan
• Likes and dislikes of the child - nothing is a must.
Allow your child to dislike certain foods.
• Introduce one food at a time
• Food fads - hot and cold foods/light and heavy
foods
• Food fads - fats and sweets - not to be
restricted
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• Artificial milk formulas/ commercial formulas
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are
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not e ssarily nutritious. (Lehninger
insta 1982, page
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Counseling Mothers Regarding
Children’s Nutrition
• Nutrition counseling is a process of finding the
solution to the child’s nutritional problem
together with their mother or caregiver.
• Unlike nutrition education, nutrition counseling is
a two-way process during which the mother is
actively involved in describing the child’s
problems as well as participating in analyzing the
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causes and identifying the available resources
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and solutions.
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Counseling Mothers Regarding
Children’s Nutrition
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How To Bring About Positive
Behavioral Change
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solution.
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A Appoint her for reassessment.
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Essential
Nutrition
Key Message
Actions (ENA)
Component
1. Optimal • Initiate breast feeding within one hour after delivery
Breastfeedin • Exclusive breast feed for the first six months
• The mother breastfeeds, frequently day and night
g • Mother allows infant to breast feed on demand
(as often as the infants want) every two to three
hours (8-12 hours per 24 hours)
• Mother breast feed more frequently (or expresses
her milk if the infant cannot breast feed)
• The mother positions and attaches infant correctly
at
the breast
• The mother offers second breast after infant
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• The mother should eat more than usual
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2. Optimal • At six months, mother or care giver introduces
Complemen soft , appropriate foods and continue breast
tary feeding on demand
Feeding • The mother or caregiver increases the
frequency of feeding and the amount of food, as
the child gets older
• Increase the food thickness (density) and variety
as the child gets older
• Increase the amount of food as the child gets
older
• Good hygiene and safe food preparation
• Active responsive feeding
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3. Sick Child Feeding • Breast Feed more frequently (or
express milk if the infant cannot breast
feed)
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Reference
s
• Smith, E. R., Hurt, L., Chowdhury, R., Sinha, B.,Fawzi, W. and
Edmond, K. M. (2017). ‘Delayed breastfeeding initiation and
infant survival: A systematic review and met analysis’, PLoS
ONE12(7).
• ibid; Ballard, O. and Morrow, A. L. (2013). ‘Human milk
composition nutrients and bioactive factors’, Pediatric Clinics
of North America, 60(1), pp. 49–74.
• De Cosmi, V., Scaglioni, S. and Agostoni, C. (2017). ‘Early taste
experiences and later food choices’, Nutrients, 9(2), p. 107.
• UNICEF, Children, food and nutrition, 2019.
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• WHO (2017). Global Nutrition Policy Review 2016-2017. WHO,
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Geneva, Switzerland, p11.
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