CHILDHOOD NUTRITION

Chetali Agarwal*
Consultant Dietician, Westminster Hospital, London. *
INTRODUCTION
Because children are growing and developing bones, teeth, muscles and blood, they need more nutritious food in proportion to their weight in comparison to an adult.

Malnutrition

, hence becomes very common when they have a prolonged poor appetite, or are fed with a limited number of foods which may be nutritionally poor foods.

NUTRITIONAL REQUIREMENTS FOR INFANTS

.
The

Recommended Dietary Allowances (RDA)

are based on the current knowledge of nutrient intakes needed by children of different ages for optimal health.

RECOMMENDED DIETARY ALLOWANCES FOR INDIANS (Ref Nin)
Group
Particulars
Body

WtKg
Net energy

kcal/d
Protein

g/d
Fat

g/d
Calcium

mg/d
Iron

mg/d
Vit.A.

µpg/d
retinol
Vit.A. pg/d

ß-carotene
Infants
0-6 months
6-12 months
5.4
8.6
108/kg
98/kg
2.05/kg
1.65/kg
  500
  350 1200
Children
1-3 years
4-6years
7-9 years
12.2
19.0
26.9
1240
1690
1950
22
30
41
25
400
12
18
26
400
400
600
1600
25
400
25
400
2400
Boys
10-12 years
35.4
2190
54
22
600
34
600
2400


Group
Particulars
Body

WtKg
Thiamine

mg/d
Riboflavin

mg/d
Nicotinic

acid mg/d
Pyridoxine

mg/d
Ascorbic

acid smg/d
Folic

acid µg/d
Vit.

B-12 µg/d
Infants
0-6 months
6-12 months
5.4
8.6
55µg/kg
50µg/kg
65µg/kg
60µg/kg
710µg/kg
650µg/kg
0.1
0.4
25
25
0.2
Children
1-3 years
4-6years
7-9 years
12.2
19.0
26.9
0.6
0.9
1.0
0.7
1.0
1. 2
8
11
13
0.9
40
30
40
60
0.2-1.0
40
0.2-1.0
1. 6
40
0.2-1.0
Boys
10-12 years
35.4
1.1
1. 3
15
1. 6
40
70
0.2-1.0


The
Food and Nutrition
Board has recognized that human milk is the best food for infants and will meet the nutritive requirements early in life when it is supplied in sufficient quality.

The nutrient allowances are stated.|

ENERGY :-
The caloric need in an infant is high in terms of his body weight. The allowance of 130-150 Kcal per Kilogram for the infant at birth is necessary.

Eg : 130 Kcal/Kg.

Infant's birth weight = 3Kg.|

=> 130 x 3 = 390 Kcals.

Hence, the caloric need should be approximately 450 - 500 Kcal.

Since the activity of infants varies widely, an allowance that is correct for one infant may be too high or too low for others
PROTEIN :-
The infant adds about 2.5 gm protein to his body after about 1.65 gm/kg per day for the rest of the year.

WATER :-
The water loss from the skin is large because of the greater surface area in relation to body weight. Infants require about 150 ml water per 100 calories. This requirement is met by breast milk.

MINERALS :-
Studies have proved that infants receiving human milk absorbed 50 - 60 percent of the total calcium, where as those receiving commercial formula absorbed about 25 - 30 percent of the total calcium.

The circulating hemoglobin of the well nourished infant is ample during the first three months, after which foods providing iron must be added in order to meet the needs of the expanding blood volume. The incidence of anemia is high in infants, usually appearing by the age of six months.

Although many trace elements are needed by the infant, the exact requirements have not been determined. It is safe to assure that humans milk will supply adequate amounts.

VITAMINS :-
Human milk will furnish sufficient vitamin A & vitamin E

Human milk from the well - nourished mother supplies sufficient ascorbic acid for the infants needs, although supplements are generally introduced early.

The allowances for thiamine (B1), riboflavin (B2) and niacin (B3) have been set up proportionate to the caloric intake. These allowances are easily met by human milk.

The infant is born with a store of vitamin B6 that protects him during the neonatal period as human milk is very low in this vitamin.

BREAST FEEDING
IS THE BEST FEEDING FOR BABY

Mother's milk is nature's gift to infants. Practically all mothers produce sufficient milk to meet the food requirementss of the normal infant for first three months. There is really no condition where breast- feeding is contraindicated. By and large from the time of birth upto the age of 3 months breast milk alone is adequate for the needs of the growing baby.

COLOSTRUM IS VITAL
The thick yellowish breast milk, which is produced during the first 2-3 days after birth, is called colostrum. The colostrum contains less fat and lactose than mature milk and more sodium, chloride and zinc. It is rich in antibody protein especially immunoglobulin A(IgA) and lactoferrin. It guards the infant against infection. Feeding of colostrum is wrongly believed to be unhygienic in certain communities, perhaps due to its yellowish colour. Such practices should be stopped as it deprives the infant of its natural resources of nutrients and antibodies.

FEEDING THE INFANT
Feeding on demand is recommended each time the baby is hungry. Duration of feeding varies from infant to infant and may range from 5-30 minutes and, or even more. The mother should be as comfortable as possible while Breast feeding. She should ensure that the baby's nostrils are not obstructed by the breast.The mother should feed the baby at one breast till the milk is totally sucked and then if the baby is still hungry,the baby should be fed at the other breast.This ensures increased milk production and also the baby recieves hindmilk which is rich in fat.

ADVANTAGES OF BREAST FEEDING
1. Provides optimum nutrition required by the newborn.
2. Provide anti-infective factors through breast milk especially colostrum.
3. Safer due to reduced chance of infection as compared to artificial feeding.
4. Involves close contact of mother with infant which facilitates bonding.
5. Prevents neonatal health problems like hypoglycemia, allergies, diarrhea & malnutrition
6. For mother it contributes to natural contraception and thus helps in child spacing.

COMPOSITION OF BREAST MILK COMPARED TO COW'S MILK (Per 100gm)


HUMAN'S
MILK
COW'S
MILK
  HUMAN'S
MILK
COW'S
MILK
Water (gm)
85.2
87.4
Sodium (mg)
16.0
50.0
Energy (kcal)
77.0
65.0
Potassium (mg)
51.0
144.0
Protein (gm)
1.1
3.5
Vitamin A (IU)
240.0
140.0
Fat (gm)
4.0
3.5
Thiamine (mg)
0.01
0.03
CHO (gm)
9.5 4.9 Riboflavin (mg) 0.04 0.17
Total ash (gm)
0.2 0.7 Niacin (mg) 0.2 0.1
Calcium (mg)
33.0 118.0 Ascorbic acid (mg) 5.0 1.0
Phosphorus (mg)
14.0 93.0


HUMAN'S MILK COW'S MILK
1. 60% of protein is lactalbumin and the remaining is casein.
1. 15% of protein is lactalbumin and the remaining is casein.
2. It forms soft curds and is therefore    easily digestible.
2. It forms larger, tougher curds and    therefore slowly digestible.
3. It has fats of long chain fatty acids.
3. It has fats of short chain fatty acids    which acts as irritants to the intestinal    tract.
4. It has low contents of calcium,    phosphorus, sodium and potassium    but is easily absorbed.
4. It has higher contents of calcium,
   phosphorus Na & K. Some healthy    infants fed cow's milk have a    syndrome of convulsion known as    neonatal tetany about the sixth day    of life. This is believed to be due to    high blood phosphorus level.
5. Ash content it three times less than in cow's milk.
5. Cow's milk has three times more ash content than in human milk because of the lesser capacity of the infant's kidney to excrete wastes, the high ash content of cow's milk may prevent too high a solute load, which may cause diarrhoea.
6. It can meet the infant's ascorbic acid    requirements.
6. It cannot meet the infant's ascorbic    acid requirement & hence needs to    be supplemented.


WEANING FOODS (SUPPLEMENTARY FEEDING).
There is no fixed /set pattern for adding solid foods to the basic milk diet of the infant. Once the infant has developed sufficient muscular co-ordination, involving the tongue & swallowing reflex to be able to eat solid foods, they may be introduced gradually.

INTRODUCTION OF NEW FOOD'S : -
Some do's and dont's about introducing solid foods are as follows:

1 Introduce only one new food at a time to allow the infant to become familiar with that food before trying to give another.
2 Give very small amounts of any new food: one teaspoonful or two.
3 Use a very thin consistency when starting solid foods. Gradually consistency is more solid as the infant learns how to use his tongue in propelling the food back.
4 Never force an infant to eat more of a food than he takes willingly.
5 If after several times, it is apparent that a baby has an acute dislike for food, omit that item for a week or two and than try it again.
Food should be only slightly seasoned with salt, other seasonings are avoided.
7 Variety in choice of foods in important.
8 The mother or anyone feeding the infant should be careful to avoid showing dislike for a food given
9 Check that the temperature of the food is neither too hot nor too cold.

LIST OF SUPPLEMENTARY FOODS THAT ARE GIVEN:
NAME OF FOODSTUFF
AGE AT WHICH TO INTRODUCE
APPROXIMATE QUANTITY PER FEEDING
REMARK
1) Fruit juices & soups:-
prepared using tomato, onion, carrot, spinach, moong dal and a little rice.
5 months
1-2 tsp twice a day
All fruit juices may be given without adding sugar. Soups may be seasoned only with salt and a dash of pepper. A blob of butter may enhance the taste. Quantity may be increased slowly to the acceptable limits.
2) Mashed banana,     chickoo, stewed     apple (prepared     with cream, milk)    papaya-stewed,     or boiled pear,     mango
5 months
1-2 tsp twice a day
Banana or sour fruit may cause cough or cold especially in winter. Therefore, they may preferably be introduced in summer.
3) Porridge prepared using roasted rava with a little ghee and milk. Other cereals that can replace rava are dalia (broken wheat) ragi (nach nil, sago, rice powder and custard flavoured custard powder milk.
One week after starting banana or any other fruit listed above
1-2 tsps twice a day
Quantity may be increased every 3 or 4 days.
4) Soft boiled egg
1 week after introducing porridge
1 tsp yolk
Egg should be boiled for a minute and immediately cooled under running water to prevent discoloration. Gradually increase quantity of egg yolk and include egg white. By 4 weeks from the day the egg was introduced the child should be, able to eat one whole egg.
5) Mashed & well     cooked     vegetables
1 week after introducing egg.
1-2 tsps twice a day
Potato, pumpkin, green leafy vegetables, carrot and peas boiled to soften completely.
6) Curds
1 week after introducing vegetables.
2-4 tsps
Fruit yoghurts may also be given. Curds should be just enough set and not be too sour.
7) Mashed & well     cooked rice dal or     khichdi
1 week after introducing curds
1-2 tsps
Seasoned with a little oil or butter while serving.


Other foods that may be introduced are biscuits, chapati soaked in thin dal or in milk, and mixed meat but without spice.

The nutritive value of commercial weaning foods compared to supplementary foods which are readily available food commodities at home is same however, they are much more expensive.

Home - cooked supplementary foods also prepare the child for normal meals which they will soon be consuming along with the other family members.







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