NUTRITION IN INFANCY Infant Next to fetal period, the infants first year is the time of most rapid growth.

. Digestion, absorption and metabolism is similar to older children except: o Pancreatic amylase deficient until around 4th month. o Fat absorption is inadequate. o Stomach acidity is low Healthy child double his birth weight (3.2 kg) by six months and triple by 11 months and increase its length by 50%. To support the rapid growth and development, the appropriate balance of all nutrients is essential. Energy and Nutrient Needs during Infancy A. Energy Receive: 108 kcal/kg/day for the first months of life 98 kcal/kg/day from 6 months until the first birthday. (WHO) Reasons for increased need: o Rapid growth rate. o Great heat loss due to large body surface area. o Activity of the infant. Adequate energy intake will be reflected in satisfactory gains in length and weight.

B. Protein Requirement: highest during the first 4 months of life when growth is most rapid. Receive: 2.2 g/kg/day from birth to 6 months of age 1.6 g/kg/day for the second half of the first year Has significant influence on renal solute load. Increasing a normal infants protein intake above the recommended amount should be avoided. Disadvantages: o Increase blood urea. o High renal solute load. o AA pattern different from human milk. Deficiency: o Marasmus o Mental retardation Irreversible Poor reading/ writing skills Less able to grasp knowledge

C. Carbohydrates Human milk= 42% of total caloric value Cows milk= 20% Advantages o Prevent hypoglycemia and ketosis.

o Lactose: sole source o Improves CHON, Ca2+ & Mg2+ absorption o Provides galactosides: brain and nerve cell formation o Laxative D. Fat Breastmilk= 30-40 mg/ml Cows milk= 10-15 mg/ml Must constitute 35-55% of TER Essential fatty acids: linoleic and alpha-linoleic acid (Omega-3 series) Ratio of linoleic to alpha-linoleic: 5-15 E. Vitamins Breast milk or commercial formula should provide infants with all the vitamins and minerals needed for proper growth and development. a. Vitamin A RDA is 325g retinol equivalents Adequate: 850 ml BM with 170 IU/100 ml Formulas: 750 IU/ 100 kcal b. Vitamin C General low content in both CM & BM BM: 5 mg/ml Vitamin C: rich beverages at 6 months to get at least 30 mcg daily. c. Vitamin D Sunlight exposure Breast milk contains vitamin D, but it may not be present in levels sufficient to prevent vitamin D-related rickets. d. Thiamine RDA: 0.4 mg/day e. Riboflavin RDA: 0.4 mg/day f. Niacin 0.25/ 100 kcal g. Vitamin B12 0.5 mcg during 1st 5 months of life h. Vitamin E 1/3 of adult RDA 0.7 IU/100 kcal for artificially-fed infants i. Vitamin K All infants: single IM/oral dose ASAP post-partum Newborns are vulnerable to vitamin K deficiency in part because they lack intestinal bacteria to synthesize the vitamin.

As a preventive measure, hospitals routinely give infants 0.5 to 1 mg of vitamin K by injection or 1 to 2 mg orally, once shortly after birth.

F. Minerals a. Iron 0.15-0.2 mg/100 ml 4th month: RDA 15 mg/day Iron fortification of milk formula after 4-6 months The fetus stores iron in its liver to be used during the postnatal period during the 3rd trimester of pregnancy. b. Calcium Breast Milk= 33 mg/100 ml; Ca:P ratio is 2.3 Milk formula= 1.2 only c. Phosphorus Intake of infants is quite low. d. Fluoride Preventive measure against tooth decay. G. Water and Electrolytes 70-75% of body weight Mostly extracellular: prone to dehydration Special attention: fever, polyuria, diarrhea and during hot weather Na+: K+ not 1.0 Na+: K+ = not at least 1.5 Cl-

Introduction of Solid Foods Solid foods may be added to the infants diet between the ages of 4 and 6 months. Infants who are introduced to solid foods before this time may be prone to excessive kcal intake, food allergies and GI upset. Two basic issues when considering the introduction of solid foods to the infants diet: 1. How to introduce them 2. What to introduce How to Introduce Solid Foods 1. Infant should be able to sit with some support. 2. Move the jaw, lips, and tongue independently. 3. Be able to roll the tongue to the back of the mouth to facilitate a food bolus entering the esophagus. 4. Show interest in what the rest of the family is eating. 5. To indicate fullness the infant may turn the head to the side, refuse to open mouth, or grimace when the spoon comes close to the mouth. 6. Infant should never be force-fed. 7. At the age of 9 to 12 months, an infant may enjoy self-feeding.

Premature Infant Vitamins= 2x dosage for full terms Ca:P= 2.0 Iron supplements at 2 months= 2 mg/kg/day. Milk from own mother: more appropriate than term milk/pooled human milk. Pre-term HM: higher CHON, Na, Cl, Mg and Fe contemt but lower Ca and P content. Factors affecting Nutritional Status Mothers attributes State of nutrition during pregnancy Feeding pattern Weaning and supplementation Illness Breast Milk: rich in long-chain polyunsaturated fatty acids.

Feeding Method a. Breastfeeding Contains antibodies vs. bacteria The ideal food for the first months of life is exclusively use of breast milk. Breast should be offered at least 10 to 12 times per 24 hours in the first several weeks. 3000x more lysozymes than CM 49% Fe is absorbed vs. 449% Fe is absorbed vs. 4--10% in MF10% in MF Easily digested Non-allergenic Beneficial to mothers health Lactoferrin, Transferrin, Lactoperoxidase system Economical & convenient b. Bottle feeding Risk of contamination Prone to over-dilution o infective diarrhea o nutritional marasmus o heightened susceptibility to respiratory infections Costly Association with infantile obesity or protein-calorie malnutrition plus

c. Mixed Feeding Combination of BM and BF, either one predomination Complemental: bottle is given because mothers milk is insufficient

Supplemental: bottle is given to replace one or more feeding when mother is away for periods longer than feeding intervals Given at 4-6 months

Types of Supplementary Foods A. Liquid supplements Started around 4th month Juices of fresh fruits - Oranges, tomatoes, sweet lime, grapes etc. Soup from green leafy vegetables -strained soup in the beginning. Fish liver oil - it is a good source of vit. A & D. Infants should be given few drops to tsp / day mixed in small quantity of milk. B. Solid supplements (mashed) It should be started around 7th or 8th month. Cereal and starchy gruels. Vegetable & cooked, mashed veg. Like potato, green leafy veg., Carrots etc. Fruits - All fruits, except banana (which is mashed) must be stewed for one year old baby. Pulses - khichri, porridges etc. C. Solid supplements (Unmashed) When baby start cutting his teeth, it is time to start chopped and lumpy foods. Solid like chapati, rice, dal, idli, vegetables etc.

Feeding Time Should be regular o 2.5-2.7 kg= every 3 hours o 3.6-4.0 kg= every 4 hours 2 months= baby sleeps thru the night after 10 pm feeding 2-3 months= 4-5 feeding schedule Best clock: babys hunger 6 months and below o As often as the child wants o At least 8 times in 24 hours o Hunger signs:

Begins to fuss Sucking fingers Moving the lips Indications of Good Nutrition 1. Developed motor coordination 2. Well-formed muscles 3. Graves study a. Vigor in any activity

b. Establishes interaction with mother at a distance c. Less irritable

The Nymphs reply to the shepherd If all the world and love were young, And truth in every shepherd's tongue, These pretty pleasures might me move To live with thee and be thy love. Time drives the flocks from field to fold, When rivers rage and rocks grow cold; And Philomel becometh dumb; The rest complains of cares to come. The flowers do fade, and wanton fields To wayward winter reckoning yields: A honey tongue, a heart of gall, Is fancy's spring, but sorrow's fall. The gowns, thy shoes, thy beds of roses, Thy cap, thy kirtle, and thy posies Soon break, soon wither, soon forgotten, In folly ripe, in reason rotten. Thy belt of straw and ivy buds, Thy coral clasps and amber studs, All these in me no means can move To come to thee and be thy love. But could youth last and love still breed, Had joys no date nor age no need, Then these delights my mind might move To live with thee and be thy love.