BACHELOR OF SCIENCE IN NURSING

NUTRITION AND DIET THERAPY

COURSE MODULE COURSE UNIT WEEK
1 5 5
Nutrition Across the Lifespan (Pregnancy, Infancy, Toddler and Pre-school

Read course and unit objectives

Read study guide prior to class attendance
Read required learning resources and refer to unit terminologies for jargons
Proactively participates in chat room discussions
Participate in weekly discussion
Answer and submit course unit tasks

Module, Reference Books, Laptop, Internet, Headset

At the end of the course unit, learners will be able to:

Cognitive:
1. Apply appropriate concepts of nutrition and diet therapy holistically and comprehensively.
2. Ensures a working relationship with the client and health care team based on trust,
respect and shared decision-making in achieving the desired outcomes of nutritional care.
 3. Collaborate with other members of the health team in the implementation of programs
and services related to nutritional care.

Affective:
1. Listen attentively during class discussions
2. Demonstrate tact and respect when challenging other people’s opinions and ideas
3. Accept comments and reactions of classmates on one’s opinions openly and graciously.
4. Develop heightened interest in studying Nutrition and Diet Therapy

Psychomotor:
1. Participate actively during class discussions and group activities
2. Express opinion and thoughts during class

Dawdling – to spend time wastefully on eating, the child is playing while eating

Lactating women – women who are pregnant or recently gave birth, lactation is normal with the
process of producing breast milk.

Letdown Reflex – an involuntary reflex during the period of time when a women is breastfeeding
which causes the milk to flow freely

Newborn Screening Act – illustrates a procedure to detect a genetic and metabolic disorder in
newborns that may lead to mental retardation and even death if left untreated.

Supplementary foods – refer to the food that is used to complement breast milk or the food
that complements and / or supplements other foods used during weaning period.

Toxemia of Pregnancy – a condition in pregnancy, also known as preeclampsia characterized

by abrupt hypertension (a sharp rise in blood pressure), albuminuria (leakage of large amounts
of the protein albumin into the urine) and edema (swelling) of the hands, feet, and face.

Total Energy Requirement – is the average dietary energy intake that is predicted to maintain
energy balance in healthy, normal weight individuals of a defined age, gender, weight, height,
and level of physical activity consistent with good health.
"Nutrition through the Life Cycle: From Pregnancy to the Pre-school Years", all people need the
same basic nutrients—essential amino acids, carbohydrates, essential fatty acids, and twenty-
eight vitamins and minerals—to maintain life and health. However, the amounts of needed
nutrients change as we pass from one stage of the human life cycle to the next. Young children
require a higher caloric intake relative to body size to facilitate physical and mental development.
On the other hand, inactive senior citizens need fewer calories than other adults to maintain their
weight and stay healthy. Psychological, emotional, and social issues over the span of a human
life can also influence diet and nutrition. Therefore, it is important to weigh a number of
considerations when examining how nutrient needs change. In this course unit, we will focus on
diet, nutrition, and the human life cycle from pregnancy to the the remainder of childhood years.

A. Nutrition in Pregnancy and Lactation

Nutrition is what the pregnant women eat and how the body uses it to maintain life by allowing
one to grow and be in state of optimum health. It ensures optimum nutrition before, during and
after pregnancy and during lactation. The characteristics of pregnancy started from the
fertilization of ovum and implantation in the uterus; human pregnancy lasted for a period of 266
to 280 days (37-40 weeks); consists of three trimesters and has three main phases –
implantation, organogenesis, growth

In Nutrition in Pregnancy, the nurse always starts with diet history when it comes to giving
nutritional instruction to the mother. Ask for any PICA – persistent ingestion of inedible
substances of little nutritional value. If the pregnant mother is vegetarians – there will be lack of
essential protein and minerals, need Vitamin B12 supplementation. The calories requirements
for non-pregnant requirements is 1,800 to 2,200 Kcal/day with additional caloric requirement per
day is 300 Kcal/day for pregnant mother and 500/day for lactating mother, and the usual daily
caloric need in pregnancy – 2,100 to 2,500; never less than 1,800 Kcal/day. Even an obese
pregnant woman can never consume less than 1,500 kcal per day. The nutritional requirements
for lactating women are greater than in pregnancy to ensure enough supply of milk for the baby.
Weight is the most indicator if the woman has adequate caloric intake. for The nurse weighs the
mother every clinic visits with 1 lb per month during the first trimester and 1 lb per week during
the second and third trimester increasing per visit and the usual maternal weight gain is 24 to 35
lbs. The maternal underweight causes having high risk of low birth weight, preterm and infant
deaths while the maternal over weight causes having risk of complications in labor and delivery,
hypertension, gestational DM, post partum infections. The pregnant must have a protein
allowances and needs to serve body-building foods. The nurse can provide additional 30 g/day
of protein to ensure 74 to 76 g/day intake. The nurse can give the pregnant mother with rich food
sources includes milk, meat, fish, poultry, eggs and legumes. This provides for the storage of
nitrogen, protects the mother from any complications, for healthy growth of maternal uterus,
mammary tissues and placenta, needs for fetal growth and repair and hormonal preparation for
lactation.

There must be sufficient intake of carbohydrates necessary for added energy and avoid “empty”
calories like soft drinks, fiber can be taken from fruits and vegetables to prevent constipation.
Nurse can also recommended fats - high energy foods for absorption of vitamins ADEK and
avoid too much fats to prevent vomiting and heartburn. Iron is the most important mineral that
must be taken in supplementary amount which is 30-60mg per day to prevent iron deficiency
anemia and needed to increase maternal RBC and for fetal liver storage in the third trimester.

Calcium needs for maternal calcium and phosphorous metabolism and fetal bone and skeletal
growth which is 1,200 mg/day, equivalent to 1 quart of milk a day (4 glasses). Provide sodium
which is most abundant cat-ion in extracellular fluid needed for tissue growth and development
and should not be restricted without serious indications. Folic acid is for production of blood
products and prevents fetal anomalies and neural defect. Iodine is needed for fetal development
and avoid cretinism. Pregnant mother can also provide vitamins – water and fat soluble vitamins.
Vitamin A can be given to pregnant mother with a preparation of 10,000IU a dose of 1 capsule
twice a week starting from 4th month of pregnancy until delivery and never be given on the first
trimester to prevent any complications from the baby. Post-partum women can be given 200,000
IU 1 capsule within 4 weeks after delivery. Vitamin 9 can be also prescribed for pregnant women
60 mg iron/400 mcg folic acid 1 tablet once a day for 6 months or 180 days during the pregnancy
period and lactating women 60 mg iron/400 mcg folic acid 1 tablet once a day for 3 months or
90 days.

Aside from the vitamins, minerals can also be given to pregnant women with phosphorous by
eating high amount of protein for skeletal fetal skeleton and tooth formation. Provide iodine of
175 microgram daily during pregnancy with Iodized salt and serving of seafood at least once a
week for essential for formation of thyroxine and zinc 15 mg necessary for the synthesis of
DNA and RNA.

Some complication of pregnancy with dietary modifications are (1) morning sickness; (2) rapid
weight gain or loss; (3) toxemia of pregnancy; (4) anemia; (5) Gestational DM; (6) constipation;
(7) socio-economic and cultural factors; and (8) alcohol, caffeine and nicotine.

B. Nutrition in Infancy

Early childhood encompasses infancy and the toddler years, from birth through age three. The
remaining part of childhood is the period from ages four through eight and is the time when
children enter school. A number of critical physiological and emotional changes take place during
this life stage.

Infancy refers to a person not more than 12 months; weighs 2.7 to 3.2kg (6 to 7 lbs); measures
48 to 50 cm (19-20 inches) in length; skin is moist, elastic and not wrinkled; doubled the birth
weight at 6 months; tripled the birth weight at 12 months; meet the oral needs of the infant
(psychosexual-Freud’s Theory); provide safe and washable toy such as pacifier; remove small
objects that the infant can choke on; burp the baby after each feeding to prevent colic; alone in
playing (solitary); sucking gives gratification.

If the baby is vaginal delivery, breastfeeding may be done as early as 30 minutes after birth and
CS delivery breastfeeding be done 4 hours after delivery. Demand feeding is the best rule to
observe when feeding the baby. The mother must practice exclusive breastfeeding for the first
6 months. When doing breastfeeding, the mother should provide a relaxed, warm and supportive
environment as the letdown reflex is affected by negative emotions of the mother. Provide
reinforcement for positive behavior or successful actions.
The following are the benefits of breastfeeding to the mother: (1) Promotes maternal-infant
bonding; (2) Promotes uterine contraction and provided less incidence of thrombophlebitis; (3)
Reduces rate of ovarian cancer and premenopausal breast cancer; (4) Decreases maternal
morbidity and mortality; (5) Save time, money, effort and economical; (6) Delays fertility; and (7)
Provide social and economic benefits; while the benefits for the baby are: (1) Promote
attachment; (2) Provide perfect food that contains all necessary nutrients; (3) Easily digested,
has the right temperature and free from harmful bacteria; (4) Provides passive antibody transfer
to the newborn; (5) It has colostrums, high protein content contains antibodies which help resist
infection; (6) Causes fewer incidences of allergies, vomiting, diarrhea, constipation and
aspiration; (7) Enhances brain development because of taurine content; and (8) Decreases
infant morbidity and mortality.

Breast milk is higher in CHO, fat and water content but lower in protein, vitamins and minerals.
It has lactalbumin – human milk protein which is easy to digest and hypoallergenic and cow’s
milk protein called casein causes allergy. Breast milk is higher in lactose than cow’s milk.

The following are breastfeeding misconceptions that every lactating woman should know like:
(1) A mother sick with PTB cannot breastfeed; (2) Breast milk is not good if the mother has
stayed long under the sun; (3) A mother cannot breastfeed during pregnancy; (4) A mother
cannot breastfeed with only one breast if the other breast is painful; (5) A mother cannot
breastfeed if she has a cold, flu or diarrhea; and (6) Breast milk is not good if the mother has
been caught in a sudden shower. Breastfeeding contraindications are: (1) Breastfeeding may
not be advisable when mother has syphilis, AIDS, DM or any severe infections; (2) Breastfeeding
is not encouraged when the mother is under emotional and mental stress; (3) Mother who
smokes; (4) Mother who takes contraceptive pills or drugs; (5) Other contraindication includes
metabolic abnormalities or severe prematurity of the newborn which require the use of special
therapeutic formulas.

Some of the factors affecting milk secretion are diet, nutritional state of the mothers, emotional
and physical state of the mother, sucking of the baby and use of contraceptives and drugs

The daily caloric requirement of infant is 1200 Kcal/day (100-115 kcal/kg/day). The diet is
breastfeeding / breast milk is best be given until 18 months to 2 years of age; can be given with
bottle feeding, considered as artificial feeding with cow’s milk, costly, associated with infantile
obesity or “protein-calorie malnutrition plus”, or can be mixed feeding which is complemented
with insufficient supply of breast milk and supplemented if the mother is away from home for
feeding

The feeding time being practice by the mother are if the baby weighs 5 to 2.7 kg baby usually
feeds every 3 hours (8 feedings); 6 to 4 kg baby usually feeds every 4 hours (6 feedings) and 2
to 3 months old, the baby is on 4 to 5 feedings, the baby sleeps through The night after 10 pm
feeding. Weaning can be done 6 months from breast to bottle and 12 months: bottle to cup

The supplementary foods of the infant begins at 2 months with liquids like rice water, calamansi
juice may be introduced depending upon infant’s tolerance and acceptance; then when the infant
reaches 4 months be given with first solid foods (rice cereals). Then for the 5th to 6th months –
teething foods; full diet consisting of pureed meat, egg, strained fruits and vegetables and chewy
foods be given not only to soothe the sensitive gums but also to teach the baby the art of self-
feeding; at 7-8 months – foods are mashed or chopped finely, not strained to teach mastication,
soft cooked egg with rice porridge, boiled fish, banana and camote mash and the like; at 9-12
months – whole tender foods or foods chopped coarsely are given, finger foods like cottage
cheese, crackers, plain meats and egg yolks

There are foods that needs to avoid by the mother and be given to the infant in the first year of
life such as honey that causes clostridium botulinum leading to infantile poisoning; choking
hazards like hotdogs, grapes, hard candies, raw carrots, pop corns, nuts, peanut butter;
insufficient calories like skim milk and potential allergen like cow’s milk and egg whites.

The following cues that the mother should know for the infant has readiness to take solids like:
(1) sucking reflexes is intact; (2) ability to sit with support; (3) avoid feeding an infant lying supine
to prevent aspiration; (4) present salivary glands and intestinal enzymes that aids in digestion;
(5) fetal iron reserve in the liver usually consumed by 4-6 months. When the mother is trying to
introduce supplemental foods, there must be rules to follow such as: (1) introduce one food at a
time; (2) show pleasure when giving new food at the same time, make gesture; 3) give a small
amount (1 tsp) at a time; (4) offer bland foods to the baby (not too salty, not too sweets); (5) do
not mix with formula; (6) feed when newborn is hungry after a few sucks of milk to increase his
patience for a new food; (7) never start two new foods at the same time; (8) allow an interval of
4-7 days between new foods; (9) feed baby only with freshly-cooked foods or fruits freshly
peeled. Avoid giving left-over foods to babies and (10) do not bribe, plead, threaten or force the
infant.

The common disorders among infants are diarrhea which is the most frequently caused by
bacteria and viruses; vomiting; allergy in infant with milk intolerance; constipation and colic which
is the most common. Some metabolic health problems with infancy like Galactosemia,
Phenylketonuria (PKU), Maple Syrup Urine Disease (MSUD), and Congenital Hypothyroidism
that can be screen with Newborn Screening Act (RA 9288).

C. Nutrition in Childhood

Toddler is a period of life from 1-3 years old; with daily caloric requirement of 1,300 to 1,400
kcal/day or 100 cal/kg/day; physiologic anorexia (decrease in appetite) because toddler is busy
at play; weight quadruple at 2 years old; experience temper tantrum; mother can offer choices;
diet preference unpredictable but able to feed self; dental examination at 2-3 years (2y/o -16
3y/o -30); safety is priority; with no-no-no attitude; ensures increase Calcium, Phosphorus and
Ferrous; elimination training (bladder training and bowel training); drinks 16-24 oz milk/day;
experience separation anxiety; autonomy versus shame and doubt; parallel play; performs
rituals, routines and dawdling; accident – prone; involve parents in child care; sibling rivalry;
and explain procedures.

Nutrition is important at every age. The children need proper nutrients stay healthy and strong,
and grow up healthy and strong. Nutrition for children can also help establish a foundation for
healthy eating habits and nutritional knowledge that the child can apply throughout life. The
toddlers require to be fed every two to three hours or five to six meals in a day. The nutrient
allowances for toddlers: Calories – determined by his age, activity and BMR; Protein – 1.5 to 2
gm/kg of body weight is required; Vitamins and minerals – essential for growth and development;
and total fluid requirements is 4-6 glasses, 1 to 1.5 liters/day. It is important to avoid foods that
may cause choking such as slippery foods such as whole grapes; large pieces of meats, poultry,
and hot dogs; candy and cough drops; small and hard foods such as nuts, seeds, popcorn,
chips, pretzels, raw carrots, and raisins; and sticky foods such as peanut butter and
marshmallows.

Nutrition in Pre-school is period from 3-6 years old; larger requirements for growth so there is a
greater need for protein, vitamins and minerals; period of food habits and preferences, selective,
making him more vulnerable to nutritional deficiencies; won’t eat era - appears thinner than a
toddler; decrease in weight, desire for food is erratic; parents must be careful not to foster poor
eating habits by urging, forcing, or even bribing the child to eat; fear of punishment, family as
significant others; obesity is a risk; kcal of 85/kg/day or daily calorie of 1,700 – 1,800; eating junk
food is a problem; imaginative thinking; imaginary playmates; fear of mutilation, abandonment
and dark; associative play; growth rate is slow and erratic; initiative versus guilt; no new teeth
develops; appetite is not large; oedipal and electra complex; needs explanation; and seen
pleasures on touching of genitals.

Good nutrition – is important during pre-school years, needs adequate food for growth and builds
his body, gives plenty of energy for play, helps him to fight common infections, helps keep the
child healthy, happy and physically fit as well as mentally alert. The toddlers require to be fed
every two to three hours or five to six meals in a day. The nutrient allowances for toddlers:
Calories – determined by his age, activity and BMR; Protein – 1.5 to 2 gm/kg of body weight is
required; Vitamins and minerals – essential for growth and development; and total fluid
requirements is 4-6 glasses, 1 to 1.5 liters/day. The pre-school kids need about four meals in a
day.

The feeding problems with pre-school are: (1) child is eating too little; (2) child is eating too much;
(3) child is dawdling during mealtime; (4) child is gagging especially when fed course foods; (5)
child has aversion towards some foods; and child has allergies.

The fluid need of the young children is water which is good for thirst. Too much fruit juices may
cause diarrhea and may reduce child’s appetite for foods. Sodas are not suitable for the children.
Teas and coffee reduce iron absorption. A small drink will satisfy a child’s thirst during meals. A
non breastfed child (6-24 months) needs 2-3 cups of water in a temperate day or 4-6 cups in a
hot climate.

The computation for total energy requirement TER = 1000 + (100 x no. of years). For example,
if the age of a child is 6 years old so the computation will be TER = 1000 + (100 x 6) = 1,600
kcal/per day which is around the normal range of childhood TER which is 1,300-1,400 for toddler
and 1,700-1,800 for pre-school.
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Berman, Audrey, et al (2015). Kozier & Erb's Fundamentals of Nursing: Concepts, Process,
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Grodner, Michelle (2020). Nutrition Foundations and Clinical Applications: A Nursing

Approach.
Pullman, Dan (2019). Essentials of Nutrition and Dietetics for Nursing.
Dudek, Susan G. (2018). Nutrition Essentials for Nursing Practice, 8 th edition. Wolters Kluwer.
Lean, Mike. (2017). Barasi's human nutrition: a health perspective, 3rd ed. Boca Raton: CRC
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Stephenson, Tammy J. (2016). Human nutrition: science for health living. New York: McGraw-
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Check with Googles for further readings

Study Questions

Make your own video presentation about nutritional needs of a pregnant

mother, infancy, toddler and pre-schooler (choose one) and upload.
Download a research article on the topic related to nutritional needs of
pregnant mother, infancy, toddler or preschooler macronutrients or
micronutrients deficiency’ from ScienceDirect. Submit a 200-300-word
essay reflection.