NUTRITION AFTER BIRTH

“Nutrition and growth of children affects not only their

survival but also their quality of life.”

Rama Bhat, M.D.Professor of Pediatrics.UIC Medical Center.

Learning Objectives

• Nutritional Requirement from Birth to Adolescence.

• Breast Milk and Breast Feeding.• Evaluation of Nutritional Status.• Nutrients Inadequately supplied in

Children.• Nutrition related problems in

Childhood.

Pediatric Nutrition

Nutritional requirements can be considered on the basis of:

a). Age.b). Body size.c). Growth rate.d). Caloric intake.e). Physiologic losses.

Days required to double birth weight

Species Days Lactose (%) Fat(%) Protein(%)

Human 180 7.0 3.8 0.9

Horse 60 6.2 1.9 2.5

Cow 47 4.8 3.7 3.4

Goat 19 4.1 4.5 2.9

Rat 6 3.0 15.0 12.0

ENERGY

AGE (YRS) WT (KG) HT ( CM ) ENERGY (Kcal/KG)

0 – 0.5 6 60 108

0.5 –1.0 9 71 98

1.0 – 3.0 13 90 102

4.0 –6.0 20 112 90

7.0 – 10.0 28 132 70

ENRGY EXPENDITURE

0

20

40

60

80

100

120

1 3 6 9 12 15 18

TOTAL

BASAL

ACTIVITY

GROWTH

THERMIC

WASTE

CHANGE IN ENERGY EXPENDITURE WITH AGE.

AGE (YRS)

CA

LO

RIE

S P

ER

KG

OF

BO

DY

WE

IGH

T

ENERGY DISTRIBUTION

CARBOHYDRATE 50% - 60%

FAT 30%- 40%

PROTIEN 10% - 15%

PROTEIN

• Dietary protein provides energy and amino acids for the synthesis of body proteins and other tissue constituents.

• Many factors affect dietary protein requirement

• 95% of animal and 60- 80% of vegetable protein is digestible.

• In a mixed diet, proteins supply 10-15% of daily energy requirement.

RECOMMENDED DIETARY INTAKE (RDI)FOR PROTEIN

0 - 1 2.6 2.2

1 - 2 2.2 2.0

2 - 3 1.8 1.8

3 - 4 1.5 1.6

RDI

Age ( months) g/kg/d g/100 kcal

PROTEIN REQUIREMENT(RDA)

Age in years Weight (kg) Protein (gm)0.0 - 0.5 6 130.5 - 1.0 9 14

1 – 3 13 164 – 6 20 247 - 10 28 28

11 - 14 45 4515 - 18 66 59

PROTEIN REQUIREMENT

0

0.5

1

1.5

2

2.5

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Age (yrs)

Pro

tein

gm

/kg

BODY FAT ( KG)

Age in years Male female Birth 0.49 (14%) 0.49 (15%)

1.0 2.3 (22%) 2.2 4 2.7 2.8 8 3.3 (13%) 4.3 (17%)

12 8 10 14 10 13 18 9 (13%) 13 (23%)

FAT• A concentrated form of energy.

• EFA is necessary for the synthesis of various Eicosanoids (prostaglandins,Thromboxanes & Leukotrienes).

• Necessary for the formation of cell membranes.

• Total intake should not exceed >30% of total calories (for children over 2 years old).

• Intake of dietary cholesterol should not exceed 300 mg/day.

Range of average Water Requirements of Childrenat Different Ages under Ordinary Conditions

Age Avg. body Water per kgweight (kg) of body wt in

24 hr(ml) 3 d 3.0 80-10010 d 3.2 125-150 3 mo 5.4 140-160 6 mo 7.3 130-155 9 mo 8.6 125-145 1 yr. 9.5 120-135 2 yr. 11.8 115-125 4 yr. 16.2 100-110 6 yr. 20.0 90-100 10 yr. 28.7 70-85 14yr. 45.0 50-60 18 yr. 54.0 40-50

ENERGY, PROTEIN, AND FLUID NEEDS IN PEDIATRIC PATIENTS

50 - 600.840 (GIRLS)

50 - 600.94515 – 18 (BOYS)

70 - 851.047 (GIRLS)

70 - 851.05511 – 14 (BOYS)

70 - 851.0707 – 10

114 - 1151.21021 - 3

120 - 1502.21080.0 – 0.5

Fluid Requirement (ml/kg)

Protein Requirement (g/kg)

Average Energy

Allowance (kcal/kg)

Age (yrs)

CURRENT RECOMMENDATIONS FORFEEDING INFANTS

• Nursing period (4-6M): Human milk or formula only.

• Transitional period: Specially prepared foods are introduced

• Modified Adult period: Mostly table food.

HEALTHY PEOPLE 2000

Goals:

• 75 % of moms to breast feed their infants in early post partum period

• 50 % of moms to breast feed until theirbabies are 5 - 6 months old.

Rates of Breast feeding in USA

1971 24.7% 1984 59.7% 1989 52.2% 2001 69.5%

Racial &Ethnic Disparities In Breast Feeding

Days required to double birth weight

Species Days Lactose (%) Fat(%) Protein(%)

Human 180 7.0 3.8 0.9

Horse 60 6.2 1.9 2.5

Cow 47 4.8 3.7 3.4

Goat 19 4.1 4.5 2.9

Rat 6 3.0 15.0 12.0

BENEFITS OF HUMAN MILK VS COW’S MILK

Proteins Lipids

More Whey proteins Less sat. fatsLess casein More medium chain FAHigher cysteine/methionine More lipase enzymeLess phenylalanine More Linoleic acidMore taurine More fat in hind milkMore peptidase

Minerals

Less calciumLess sodiumHigher Ca/phosphorusMore bioavailable Fe & Zn.

DEFENSE FACTORS IN HUMAN MILK

Antimicrobial Antiinflammatory

Secretory IgA Antioxidants, vitE vit ALactoferrin EGF Lysozyme CatalaseOligosaccharides G-peroxideComplement C 3 AntiproteasesFibronectinMucins

Healthy people 2010

• Goals: - Breast feeding initiation: 75% - Breast feeding at 6 months: 50% - breast feeding at 12 months: 25%

DEFENSE FACTORS IN HUMAN MILK

Immunodulators Leukocytes

Nucleotides NeutrophilsCytokines Macrophages

Lymphocytes

HOSPITAL ADMISSIONS FOR 100 INFANTSFOR THE FIRST 18 MONTHS BY FEEDING TYPE

Feeding Type

Breast ( N=670) Artificial ( N = 388)Diagnosis

Respiratory infect. 7.0 13.7

Gastroenteritis 3.6 5.2

Other infections 1.5 2.1

FEEDING DURING 1st YEAR

Age(months) # of feedings /24 hrs

0 - 1 6 - 8 2 - 6 4 - 5 7 - 10 3 - 4 11 - 12 3 Age(months) Volume / feed (ozs) 1 2 - 4 2 5 3 5 - 6 4 6 - 7 5 - 12 8

Social Impact of Breast feeding

• Savings/year $ 750 - 1200 / yr.

• National savings $ 950 Million/yr.

Breast Feeding

Contraindications:

•Galactosemia•Maternal drug abuse•Maternal tuberculosis•HIV positive mother•Medications: Cancer chemotherapy

Radioactive isotopes

OBSTACLES TO BREAST FEEDING

•Physician apathy and misinformation•Lack of prenatal education•Disruptive hospital policies•Early hospital discharge•Lack of appropriate followup•Maternal employment•Commercial promotions of formulas•Television and magazine advertising

Month Food Items

1 - 4 Breast milk or formula4 - 6 Iron-fortified cereal6 - 7 Strained fruits; begin

introducing cup7 - 8 Strained vegetables8 - 9 Start finger foods and

chopped (junior) foods 9 Meats, citrus juice 10 Bite -sized cooked

foods 12 All table foods

USE OF COW’S MILK

Cow’s milk should not be used until the infantreaches 1 year of age.

• Feeding Cow’s milk may cause:

• Increases renal solute load.

• Low vitamin C and iron.

• Low EFA

• Increased incidence.

SERVINGS PER DAY

Women & some Children,teen girls Teen boys &older adults active women,men active men

Calorie level ~1600 ~2200 ~2800

Bread group 6 9 11

Veggie group 3 4 5

Fruit group 2 3 4

Milk group 2 - 3 2 - 3 2 - 3

Meat group 2 2 3 Total (ounces) 5 6 7

Source: US Department of Agriculture.

Adolescent Nutrition

17%(39 Million) of the population in United States are aged

between 10-19 years..Reasons for nutritional problems:

Anorexia, Physical Activity, Obesity, Food Habits, Pregnancy,

Growth spurts.

POLICIES DIRECTED TOWARDS IMPROVING THE

GROWTH OF CHILDREN• Promote and support breast feeding.• Monitor growth and development.• Introduce appropriate micronutrient

rich complementary food at 6 months of age.

• Prevention of obesity.• Identify infant at risk of growth failure.• Education of parents.

Adolescent Nutrition

• 14% ( 36.5/million) of US population are 10-19 years old.

• Reason for nutritional problems

Factors Influencing Nutritional needs in

Adolescents • Onset of puberty - Increase growth

rate• physical activity• changes in body composition.

- Increase in body fat in girls - Increase in lean body mass(LBM) in boys.

Nutritional Concerns During Adolescence

• Food habits: - skipping meals - snacking - consumption of fast

foods • Results of poor nutrition:

- protein intake- vegetarianism. - calcium needs. - iron and zinc - obesity - 14% (1999 survey)

Obesity

Definition:BMI 85-95th percentile - At risk for overweightBMI > 95th percentile - Overweight

BMI ( Kg.m2)Age in yrs 6 8 10 12 16

Male Female

16.5 17.8 16.1 17.5

18.1 20.2 18.2 20.4

19.7 20.5 20.2 23.0

21.3 25.0 22.3 26.0

24.6 28.7 24.7 29.1

Prevalence of Obesity (BMI>95th percentile

Age 6-11 years 12 -17 yearsGroups

male Female Male Femaleall 11.3±1.8 12.8±1.9 10.6±1.3 8.8±1.4white 10.4±2.4 14.4±2.7 9.8±2.0 8.3±3.1AA 13.4±2.3 9.3±2.4 16.9±2.8 14.4±3.1Hispanic 17.7±2.3 12.8±3.2 14.3±1.7 8.7±2.5

Management

• Goal: to diminish morbidity and mortality risk.

1- Diet: - Prepubertal: 300 - 400 cal/day lower than required.

- Older children: 500 - 700 cal/day lower. Goal is to loose 300- 500 gm weight loss/wk

2- exercise:3- Surgical:4- Pharmacotherapy:

INDICATORS OF NUTRITIONAL STATUS

Head circumference for age

<5th percentile>95th percentile

Stunting/ shortnessLength or height for age

<5th percentile

UnderweightWeight- for lengthBMI for age

<5th percentile

NEW IN THE CDC GROWTH CHARTS

charts extend to 20 years 3rd and 97th percentile available. Lower limits of length (45 vs. 49 cm)

and height (77 vs. 90 cm) extended. BMI-for- age charts (2-20 years) added. 85th percentile (at risk of overweight)

added.

Estimated protein intake of breast-fed infants

Age Milk consumption Protein intake(months) (ml/d) (g/kg/d)

0 - 1 630 2.09

1 - 2 773 1.59

2 - 3 787 1.15

3 - 4 810 1.06

WATER, FAT, PROTEIN CONTENT OF THE FETUS

Weight (gms)

GA (wk)

H2O (gms)

Fat ( gms)

Protein (gms)

500 22 433 6 43

1000 27 850 23 86

2000 32 1598 120 188

3000 38 2217 330 334

PROTEIN CONTENT OF MILKFROM SOME MAMMALS

Species Protein(%)

Humans 1.0Horse 2.5Goat 2.9Cow 3.4Sheep 5.5Reindeer 11.5

Distribution of energy in human milk

Stages of Fat Protein Lactose Total energylactation (%) (%) (%) (kcal/100ml)

Colostral 44 17 39 56

Transitional 48 9 43 60

Mature 50 7 43 61