Pediatric NutritionPediatric NutritionPediatric NutritionPediatric Nutrition

Ricci, chapters 25-29Ricci, chapters 25-29

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

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

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.

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).

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)

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

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

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.

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, cow’s milk, egg whites, pnut butter (allergy)

Toddler Nutrition• 2-3 cups of regular cow’s milk and

other sources of calcium (need 500 mg/d)—not low-fat until age 2

• Be careful of milk anemia—some may need iron supplement

• Balance and variety from all food groups

• Drink liquids from a cup not a bottle

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

Mealtimes With Toddlers

• High chair with foot support• Discourage unacceptable behavior• Let toddlers explore and enjoy food• Don’t 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!

Nutrition During Childhood (3-12 yr)

• Needs and appetites change during childhood because of growth and physical activity; inactivity—obesity

• Adults and schools need to assist children in choosing nutrient-dense foods

• Need variety and less than adult portions

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

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.

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

Adolescent Food Choices

• Eating habits and behaviors—skipping 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

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)

School Age/Adolescence

• Teaching good nutrition is not enough• Must also have access to quality foods

and snacks @ home and school• Relationship between attractive

appearance and healthy lifestyle may be effective

• Provide info, role model, and involve teen—don’t dictate and judge

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)

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

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

Effects of Childhood Obesity

• Physical health—abnormal lipid levels, high blood pressure, type 2 diabetes, sleep apnea, orthopedic issues

• Psychological development—emotional and social problems, stereotypes and discrimination, and body image issues

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”

Tips for Parents• Honor children’s 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

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.