Nutritional requirements for 3rd year nurses.ppt

Nutritional needs and
feeding of infants and
children
By Ayichew A.
october 6/2021 BY:Ayichew A. 1

Objective
At the end of this lecture the students should be able
to:
•Describe the nutritional requirement of infants
and children
•Identify common problems encountered during
feeding of infants
2
october 6/2021 BY:Ayichew A.

Breast feeding
 Initiated as soon as after
birth as possible unless
problems occured.
•Maintains normal
metabolism during
transition
•Promotes maternal-infant
bonding
Provides ideal food for
healthy growth and
development of all infants.
•8-12 times feeding per
24 hours) or more.
3
october
6/2021
BY:Ayichew A.

Conti…
The first milk - colostrum - is of particular
nutritional and health value to the infant because
of its high content of proteins, vitamins and its
anti-infective properties.
october 6/2021 4
BY:Ayichew A.

Colostrum…
Full of antibodies, white blood cells, and other
immune properties—it functions like your child's first
immunization.
High levels of immunoglobulin A (IgA) found in
colostrum protect the baby's GI tract and helps to kill
off viruses and bacteria.
Natural laxative: helps the infant move their bowels
and get rid of the meconium.

Conti…
Optimal feeding
Exclusive breastfeeding from birth to about six months,
followed by an introduction of complementary foods
drawn from the local diet at about six months.
BF should be sustained well into or beyond the 2nd year
of life with increasing amounts of complementary foods.
If Breast milk is not available an alternative infant
formula should be used
october 6/2021
6
BY:Ayichew A.

Physiology of breast feeding
BF requires the presence
of reflexes /maternal and
infant/
oReflexes of the baby
A. rooting reflex: w/n the
nipple of the breast touches
the lips / cheeks/ of the
baby the baby turns his
head towards the touch,
and opens and shuts his/her
mouth
B. sucking reflex: the baby
milks the breast by
pressing the nipple with his
tongue against his/her hard
palate
C/ swallowing reflex : after
the milk is in the mouth, it
is swallowed by a
coordinated reflex.
october 6/2021
7
BY:Ayichew A.

Reflexes of the mother
oProlactin reflex
Suckling impulse to anterior pituitary gland
 increase secretion of prolactin hormone 
prolactin to alveolus of the breast  increase
milk production in the breasts
october 6/2021 8
BY:Ayichew A.

Conti…
Letdown reflex
Sucking (cry of a baby)  impulse to
posterior pituitary gland  increase in
secretion of the oxytocin hormone 
oxytocin to myoepithelial cells of the breast 
milk ejection
october 6/2021 9
BY:Ayichew A.

Golden rules for breast feeding
Put the infant to the breast immediately after birth in
the 1st 30minutes
Correct positioning of the baby
Bedding in :encourage the mother and the baby to
be in one bed
Feeding on demand but the mother should awaken
the infant who may spent most of the day sleeping.
october 6/2021
10
BY:Ayichew A.

Conti…
Mother should be informed on the importance of
hygiene/cleansing her hands b/c touching the breasts
The breasts should be well emptied to avoid
problems /i.e. Breast engorgement
If problems arise, she should seek; advice and
continue breastfeeding .
october 6/2021
11
BY:Ayichew A.

Signs of good positioning during suckling
The mother should be sitting
comfortably relaxed
 Neck straight or bent slightly back
 Body is turned towards the mother
 Body is close to the mother
 Baby facing the breast with nose
opposite the nipple.
 Whole body is supported
october 6/2021
12
BY:Ayichew A.

Signs of good position…
Touch the baby's lips with her
nipple.
Wait until baby opens mouth
wide.
Attach the baby to the breast.
Move the baby quickly to the breast
with the baby's lower lip well below the
nipple.

Wait until the baby’s
mouth is wide open

Signs of good attachment (mouth to
breast)
1. The baby’s chin touching breast
2. Lower lip turned out ward
3. Mouth wide open
4. More areola visible above than below the
mouth of the baby.
october 6/2021 15
BY:Ayichew A.

Nose very close or
touching breast
Chin deeply into
breast
Observe to make sure:
•Cheeks DO NOT suck in
•Breast moves toward the
mouth and not away
Lips flanged

Signs of milk transfer
Sustained suck/swallow pattern with
occasional pauses
Audible swallowing
Relaxed arms and hands
Moist mouth
Satisfied after feeding
Jeanette
Panchula
-
BSW,
RN,
PHN,
IBCLC
-
Solano
County
Health
and
Social
Services

Advantages of BF
Is easy to digest and nutrients are well absorbed.
Contains enough fluids for the first 6 months of life
It quenches thirst.
Protects the baby from disease.
 Is always clean.
october 6/2021 18
BY:Ayichew A.

Conti…
Is available 24 hours a day and requires no special
preparation
Does not cost anything.
Makes a special relationship between mother and
baby that leads to better psychomotor and social
development.
october 6/2021
19
BY:Ayichew A.

Benefits of breast-feeding for the mother
An efficient contraceptive method during the first 6
months if breast-feeding is exclusive and frequent.
Reduces the risk of post-partum hemorrhage.
Prevent breast engorgement and its consequences.
Reduces the mother workload since breast milk is
available at anytime and anywhere and it does not
need any processing.
october 6/2021
20
BY:Ayichew A.

Factors affecting breast feeding
Neonatal problem
Pre maturity
Asphyxia
Congenital abnormality
 E.G. Cleft lip
Maternal problem
Local inflammation e.g. mastitis
Psychological unready ness due
to anxiety or stress, maternal
illness, pain etc.
Breast CA
Chronic infection like HIV
Maternal drug intake may affect
the infant(anti
Ca,psychotic,deppresant
october 6/2021
22
BY:Ayichew A.

Limitations of BF
Transmission of infections like HIV
Contains low vitamin D (intake should be 200 IU/day,
starting at 2 mo. of age for all breast-fed infants)
 Iron content of human milk is low(supplement at 4-6
months)
Low content of vitamin K (parenteral administration of
1 mg of vitamin K1 for term and 0.5mg for preterm IM at birth is
recommended for all infants).

Formula feeding
Option to mothers who fail to breast feed for any
reason or because of contraindications to BF.
Hiv-infected women for PMTCT when
replacement feeding is affordable, feasible,
acceptable, sustainable, and safe(AFASS).

AFASS
• Acceptable: The mother perceives no problem in replacement
feeding. Potential problems may be cultural, social, or due to
fear of stigma and discrimination.
• Feasible: The mother (or family) has adequate time,
knowledge, skills, resources and support to correctly mix
formula or milk and feed the infant up to 12 times in 24 hours.
• Affordable: The mother and family, with community or health
system support if necessary, can pay the cost of replacement
feeding without harming the health or nutrition status of the
family.
• Sustainable: Availability of a continuous supply of all
ingredients needed for safe replacement feeding for up to one
year of age or longer.
• Safe: Replacement foods are correctly and hygienically
prepared and stored, and fed preferably by cup.

Weaning
An introduction of food to the infant other than breast
milk after the 1st 6 months
Stage of weaning
Stage 1 at 6month - use fluid & semi fluids e.g. cow
milk, Atmit, porriage.
Stage 2 at 7-9 months - use mashed foods
Stage 3 at 10 -12 month - use family foods
october 6/2021 26
BY:Ayichew A.

.
Weaning should be
stepwise to both breast fed
and formula fed infants
•Cereals, a good source
of iron, usually should
be the first food
•Vegetable & fruits are
introduced next
•Meats follows shortly
•Finally eggs
•One new food should be
introduced at a time
•Additional new foods
should be spaced by 3-4
days to see the adverse
effects
27
october 6/2021 BY:Ayichew A.

Complementary feeding practices…
Continue frequent and on-demand breastfeeding until
24 months or above .
Increase food quantity and feeding frequency as the
child gets older.
•A healthy breastfed child need:
•2-3 meals per day at 6-8 months
october 6/2021
28
BY:Ayichew A.

Cont.…
Feed infants directly and assist older children when
they feed themselves
If they refuse, experiment with different food
combinations, tastes, textures and methods.
Feed slowly and patiently.
Do not force
october 6/2021 29
BY:Ayichew A.

Cont..
Practice good hygiene and proper handling of foods
Wash caregivers’ and children’s hands before and
after food preparation and feeding.
Serve foods immediately after preparation
Use clean utensils to prepare and serve food
Serve using clean cups and bowls, and never use
feeding bottles
october 6/2021 30
BY:Ayichew A.

Nutrients
 Macronutrients
•Type of food required in
large amounts in the diet
•Includes :-
oCarbohydrates
oFats
 Proteins like Meat,
fish, eggs, and
milk(complete)
 Beans, grains, and
nuts(incomplete)
Micronutrients
•Vitamins and minerals
needed by the body in
very small amounts.

Energy
Calorie – used to measure
energy in foods.
•1 kilocalorie= 1,000
calories
•1 Calorie (Cal)(upper
case) =1000 calories
(cal)(lower case)
•1 gram of CHO= 4 Kcal
•Water = 0 Calories per
gram
•1 gram of Protein = 4 Kcal
•1 gram of fat = 9 Kcal
•1 gram of alcohol = 7 Kcal

Caloric requirement..
Formula to calculate the calories:
Up to 10 Kg: 100Kcal/kg/day
11-20 Kg :1000 Kcal+50 Kcal/kg for each Kg above 10
Kg.
Above 20 Kg: 1500 Kcal + 20 kcal/kg for each Kg
above 20 Kg.
Sources of caloric supply :
• Carbohydrate 50 - 55 %
• Fat 30-35%
• Protein 10-15%

VITAMINS

Vitamin Requirements
Body processes including growth, immunity,
RBC production, and neuronal functioning.
 Both breast-fed and formula-fed and infants
consistently protected from sunlight are at
risk of rickets if not supplemented with
vitamin D.

 Routine peri-natal administration of vitamin K
is recommended as prophylaxis against
hemorrhagic disease of the newborn.
 Vitamin A supplementation is recommended
from 6 months onwards.

Nutrient that helps the body use CHO, proteins,
and fats
Body cannot break them down to release energy
Classified into two groups:
Fat-soluble and water soluble

Fat-Soluble Vitamins
Dissolved in fats and stored in the body
Taking large doses(excess) can be toxic!
Extra amounts are not easy to eliminate from the
body in urine
Instead stored in liver or body fat until needed,
therefore potentially toxic
Vitamins A, D, E, K

Vitamin A
Age of 6-12 months 100,000 units
Age of 12-59 month s 200, 000 units
Ideally vitamin A should be administered
every six months.

Vitamin A
No routine dose is required in infants
of age less than 6 months( vitamin A can concentrate in
breast milk and excessive amounts of vitamin A can be
harmful to a baby)
 But in case of measles epidemics, malnutrition, AGE
50,000 IU of Vitamin A are given in infants age less
than 6 months.
If a child shows symptoms and signs of
the deficiency should receive 200,000 IU
(100,000 IU in less than 1 year age) on day 1,
3, and 14

Vitamin A deficiency
Night blindness
Conjunctival xerosis
Bitot's spots (triangular
dry, whitish, foamy
appearing lesions which
are located more
commonly on the
temporal side)
Corneal xerosis
 Photophobia.

Conjunctival xerosis

 Breast milk alone does not provide infants with
an adequate amount of vitamin D.
Shortly after birth, most infants will need an
additional source of vitamin D.
Sun exposure is natural source of vitamin D

VITAMIN FUNCTION
FOOD
SOURCES
DEFICIENCIES TOXICITIES
VITAMIN FUNCTION
FOOD
SOURCES
A
(Fat Soluble)
D
(Fat Soluble)
-Vision
-Nerves
-Growth
-Milk is fortified
with it
-Liver
-Sweet
Potatoes
-Yellow fruits
and vegetables
-Blindness
-Stunted
Growth
-Impaired
immune
system
-Loss of
appetite
-Blurred
vision
-Abdominal
pain
-Hair loss
-Joint pain
-Helps body
absorb
calcium and
phosphorus
-Helps
strengthen
bones
-meat ,egg,
fish
-Milk
Products
-(Sunlight!)
-Rickets
(bowed legs)
-Bones
become too
weak to
support body
weight
-Most toxic
of all
vitamins!
-Appetite
loss
-Nausea &
vomiting
-Kidney
damage

Rickets

VITAMIN FUNCTION
FOOD
SOURCES
VITAMIN FUNCTION
FOOD
SOURCES
E
(Fat Soluble)
K
(Fat Soluble)
-Maintains
cell
membranes
-Fruits and
Veggies
-Vegetable
oils
-Fortified
grains and
cereals
-Nuts & seeds
-Nerve
deterioration
-Can cause
anemia in
pre-mature
babies
-Brain
hemorrhages
-Stroke
-Headaches
-Muscle
weakness
-Nausea
-Helps
blood
clot
normally
-Dark green
leafy
vegetables
-Liver
-Hemorrhaging
-Breakage of
red blood cells
which causes
skin to turn
yellow-
(called
jaundice in
infants-can lead
to brain
damage)

VITAMIN FUNCTION
FOOD
SOURCES
VITAMIN FUNCTION
FOOD
SOURCES
C
Ascorbic Acid
(Water Soluble)
-Maintains
connective
tissues
-Protects
body
against
infection
-Citrus fruits
-Orange juice
-Strawberries
-Scurvy
(spots on the
skin and
bleeding
gums)
-Breakdown
of collagen
-Kidney
stones
-Interferes
with actions
of Vitamin E
-COENZYME!
-Used for energy
metabolism
-Nerve function
-Helps digestive
system
-Milk
-Whole grains
-Poultry
-Fish
-Dried Beans
-Beriberi
(Swelling in
legs, sore
muscles,
stiffness and
weakness)
-None
B1
Thiamine
(Water Soluble)

Scurvy
Swollen and Bleeding Gums
Spots on Skin

VITAMIN FUNCTION
FOOD
SOURCES
VITAMIN FUNCTION
FOOD
SOURCES
B2
Riboflavin
(Water
Soluble)
-COENZYME!
-Promotes
growth
-Used for
energy
metabolism
-Milk
-Yogurt
-Cheese
-Green leafy
vegetables
-Premature
aging
-Cracks in the
corner of
mouth
-Inflammation
of tongue and
mouth
-None
-COENZYME!
-Maintains
nervous
system
-Used for
energy
metabolism
-Milk
-Eggs
-Meat, fish,
poultry
-Whole grains
-Enriched grains
-Pellagra
(Skin disorder)
-Dermatitis
-Diarrhea
-Heartburn
-Nausea
-Ulcers
B3
Niacin
(Water Soluble)

Pellagra

VITAMIN FUNCTION
FOOD
SOURCES
VITAMIN FUNCTION
FOOD
SOURCES
Folate
Folic Acid or
Folicin
(Water
Soluble)
-Makes new
cells
-Leafy green
vegetables
-Legumes
-Seeds
-Can lead to
neural tube
defects like
spina bifida
in infants
-Anemia
-Heartburn
-Diarrhea
-Helps make
red blood cells
-Good for
overall health
-Green leafy
vegetables
-Animal
protein
-Anemia
-Abnormal
brain wave
pattern
-Irritability
-Depression
-Fatigue
-Impaired
memory
B6
Pyriodoxine
(Water Soluble)

Spina Bifida
Spinal cord begins to develop
within the first 28 days of
pregnancy.
Since folate makes new cells,
it is vital that the mother’s
body already has a supply of
folate in her system to prevent
this tragic condition.

VITAMIN FUNCTION
FOOD
SOURCES
B12
Cobalamin
(Water Soluble)
-Helps make
new cells
-Maintains
nerves and
cells
-Whole grains
-Animal foods
-Insomnia
-Fatigue
-Poor nerve
funcion
-Water
retention

MINERALS

MINERAL FUNCTION
FOOD
SOURCES
MINERAL FUNCTION
FOOD
SOURCES
Calcium
-Maintains
strength of
bones and
teeth
-Milk
-Milk & dairy
products
-Dark green
leafy
vegetables
-Osteoporosis -Kidney stones
-Helps build
body cells
-Works with
calcium
-Dairy products
-Grain products
-Meat
-Osteoporosis
-Can prevent
calcium from
working
Phosphorus

MINERAL FUNCTION
FOOD
SOURCES
MINERAL FUNCTION
FOOD
SOURCES
Magnesium
-Helps build
bones
-Helps nerves
and muscles
work normally
-Regulates
body
temperature
-Dark green
leafy
vegetables
-Whole grain
products
-Heart disease
-Heart spasms
-Diarrhea
-Lack of
Coordination
-Confusion
-Coma
-Helps carry
oxygen to the
blood
-Helps cells
use oxygen
-Red meat
-Dark green
leafy
vegetables
-Anemia
-Paleness
-Weakness
-Heart disease
-Elevated LDLs
Iron

MINERAL FUNCTION
FOOD
SOURCES
MINERAL FUNCTION
FOOD
SOURCES
Zinc
-Helps body
make proteins
-Heal wounds
-immune
function
-Meat
-Liver
-Fish
-Dairy
products
-Stunted
growth
-Rash
-Hair Loss
-Low copper
absorption
-Helps
strengthen
teeth and
prevent
cavities
-Fluoridated
water
-Toothpaste
-Tooth decay
-Staining of
teeth during
development
Fluorine

MINERAL FUNCTION
FOOD
SOURCES
MINERAL FUNCTION
FOOD
SOURCES
Copper -Helps iron
make red
blood cells
-Whole grain
products
-Weak bones
-Weak blood
vessels
-Vomiting
-Nervous
system
disorders
-Helps body
use energy
-Iodized salt
-Saltwater fish
-Some dairy
products
-Goiter
(Swelling of
the thyroid
gland in the
neck)
-Thyroid gland
stops working
Iodine

Goiters

MINERAL FUNCTION
FOOD
SOURCES
MINERAL FUNCTION
FOOD
SOURCES
Sodium
(Electrolyte)
-Maintains
fluid balance
in the body
-Salt
-Packaged
foods
-Muscle
cramps
-High blood
pressure
-Maintains
fluid balance
in the body
-Salt
-Can cause
convulsions in
infants
-High blood
pressure
Chloride
(Electrolyte)

MINERAL FUNCTION
FOOD
SOURCES
Potassium
(Electrolyte)
-Maintains
fluid balance
in the body
-Fruits,
especially
bananas and
oranges
-Meat, poultry
and fish
-Dry beans
-Dairy
products
-Irregular
heart beat
-Loss of
appetite
-Muscle
cramps
-Slowing of the
heart beat

Nutritional requirements for 3rd year nurses.ppt

Reference
 Nelson text book of pediatrics 21th edition
 Essentials of pediatrics nursing 2nd edition
 Current diagnosis and treatment of
pediatrics 19th edition
 Current essentials pediatrics

Nutritional requirements for 3rd year nurses.ppt

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