1 lb./ wk.

– 3rd trimester = 12
Olita , Ma. Fornielynza A. 27
BSN2A
105 Nutrition PREGNANCY & LACTATION
Ma'am Delarmente OBJECTIVES:
1. Ensure optimum nutrition before, during and after
pregnancy & during lactation
NUTRITION ACROSS THE LIFESPAN/ LIFE 2. Provide adequate nutrition to meet increased
maternal and fetal nutrient demands.
STAGES
- Ways in which nutritional needs & considerations change
A. PHYSIOLOGICAL BASIS OF NUTRITIONAL
throughout life
NEEDS
- growth & dev’t through the stages of life
- nutritional needs unique to each stage of life
Characteristics of Pregnancy:
- nutritional problems common in each stage of life
- Pregnancy or gestation – lasts for a period of 266 –
280 days (37 – 40 wks.)
A. Nutrition in Pregnancy - consists of 3 trimesters – corresponding to three
Of all the periods in the human life cycle, the period of main phases: - implantation
pregnancy is the most critical & unique. - Organogenesis growth
-
- CRITICAL – because the foundations of new life is Nutrition in Pregnancy
being laid that will influence the future of succeeding CALORIE ALLOWANCES
generations - during the course of pregnancy,
- Pregnancy has social importance affecting not only o total energy cost of storage - 300 kcal/ day
individuals but also their families & society as a – intake should be 36 kcal/ kg of pregnant
whole. weight/ day
o plus maintenance (additional work for
- UNIQUE – at NO other time in life does the well being of an maternal heart & uterus) -
individual depends so much on the well being of another o & a steady rise in basal metabolism
- mother & infant in the womb have an intimate & inseparable
relationship - amounts to approximately 80, 000 kcal.
- Health of the mother before & during pregnancy has
profound effects on the status of her child in the womb &
at birth WEIGHT GAIN
- therefore efforts are directed to the mother to ensure a safe - average gain during pregnancy = 24lbs.
& successful delivery & that her infant will be born well - a sudden gain in wt. after the 20th week – may
indicate water retention & possible onset of pre-
- A woman’s body changes dramatically during
eclempsia.
pregnancy --- everything is increased - size &
strength of uterus & its supporting muscles Components of weight gain during pregnancy
- blood volume ↑ by half – to carry the additional nutrients &
COMPONENT WT GAIN WT GAIN
other materials
(Kg) (lbs)
- her joints become more flexible in preparation for childbirth
Fetus 3 – 3.2 7-8
- breast grow in preparation for lactation
Placenta 0.5 – 0.7 1 – 1.5
- to best prepare to handle these changes – have nutritious
diet Amniotic fluid 0.9 2 – 2.5
- regular physical activity Blood volume 1.4 – 1.8 3-4
- plenty of rest Extracellular fluid 1.8 – 2.3 4-5
- caring companions/ support system Breast tissue 0.5 1
- diet --- increase --- ↑ Calories/ CHON Enlargement of uterus 0.9 – 1.4 2-3
- ↑ vitamin – folic acid, ascorbic acid, Vit. B vitamins Maternal stores (mostly 2.3 – 3.6 5-8
fats)
TOTAL 11.3 – 14.9 25 – 35lbs.
Garantisadong pambata – April + Oct. because of Vit. A kg
supplements of every 6 months.
Maternal Weight
LACTATING 1. Underweight
↑ CHON (+10g then 12g) a. High risk of having low birth weight infants
↑ Caloriers (+500) b. Higher rates of pre-term deaths & infant death
↑ minerals + ↑ vitamins
2. Overweight & Obesity
DBW – pregnant = a. High risk of complications like hypertension,
1lb/ mo. – first trimester = 3 – ( total of 1.5 – 3 lbs) gestational diabetes, and post partum infections
1 lb/ wk – 2nd trimester = 12 – ( 0.8 lbs / wk for the b. Complications of labor & delivery
remaining period)
 c. Large newborns increase the likelihood of a difficult
labor & delivery, birth trauma and caesarian section
d. May double the risk of neural tube defects.
NUTRIENT NEEDS/ REQUIREMENT
- During the total pregnancy period, the basal
metabolic rate increases from 6 – 14%
- Calorie requirements proportionately increase
- Mother’s nutrition & health status influences the
growth & development of the fetus
- It can even affect the ability to conceive a
pregnancy
FETAL DEVELOPMENT
1st TRIMESTER – Embryo - Critical stage
- organs develop (4 – 12 weeks) – formation of
organs occurs – heart, brain, liver, intestinal tract –
nutritional counseling should cover the
preconception & postpartum period
- CNS develops (4 – 12)
- Skeletal structure hardens from cartilage to bone (4
weeks)
2nd TRIMESTER – FETUS
- growth & development continue (13 – 40) teeth
calcify (20 weeks)
- fetus can survive outside womb (24 wks)
3rd TRIMESTER – BIRTH
- growth & dev’t continue
- storage of iron & other nutrients (36 – 40 wks) –
premature babies are often deficient in IRON
- development of necessary fat tissue
Adequate nutrition – help prevent some birth defects
EX: - spina bifida – associated with inadequate folate (a form
of folic acid – should be consumed within the 1st few weeks
of pregnancy when the spinal column closes) intake
- neural tube defects – are among the most common
& serious birth defects
- food fortification with folate & Vit. B12 began & has
resulted in decrease incidence of neural tube
defects
- Vit. B12 – deficiency interferes with the cellular use
of folate
- Choline – important for normal development of the
brain & is essential for the normal function of all
body cells
- Deficiency is also associated w/ Down syndrome
- Orofacial clefts (lip / palate) – appears related to
adequate iontake of the B vitamins folic acid,
thiamin, niacin, & pyridoxine at the time of
conception
COMMON problems/ concerns/ complications:
1. Appetite is usually lessened during 1st
trimester – may be difficult to maintain
calorie requirements.
2. Nausea & vomiting
- morning sickness – commonly occurs in the first
trimester – some throughout pregnancy
- probably related to hormonal changes during
pregnancy
- NAUSEA – related to low blood glucose levels
- Eat dry toast or crackers before getting out of bed –
helpful
3. Constipation – reduced motility throughout
the GIT occurs - to allow for the increased
absorption of nutrients
- can also lead to feeling of fullness & nausea.
- High fat food should be avoided unless tolerated –
further slows the movement of food through the
GIT.
- Also related to Iron supplementation
- ↓ peristalsis – is 2° to increased production of the
hormone progesterone
- Adequate fiber & fluid intake (2li) + appropriate
exercise
4. ANEMIA
- from Iron deficiency may occur during pregnancy
when iron intake & stores do not meet the demand.
- Preventable & treatable by daily supplements of 30
– 60mg of ferrous salts
- PHYSIOLOGIC ANEMIA – results from expanded
blood volume
5. Heartburn
- Believed to be caused by the pressure of the
growing fetus on the stomach – resulting in HCL
acid being forced into the esophagus.
- Eat small, frequent meals
- Avoid reclining position after eating
- Excess fat intake can contribute by causing food to
remain in the stomach for longer periods
- Advise to ↓ fat intake
6. PICA ( eating nonfood items, especially
clay or laundry starch)
- a carry over of the tradition in Africa
- clay can provide Calcium, Iron and other
minerals – however it can also provide toxic
contaminants
- consumption – can interfere with absorption of
adequate nutrients – should be discouraged.
7. Closely Spaced Pregnancies
- at least 12 – 18 months apart
- longer spacing helps the mother reestablish good
nutritional stores & recover from childbirth.
8. Pregnancy – Induced Hypertension (PIH)
- Gestational hypertension-preeclampsia & toxemia
- May occur during the third trimester of pregnancy
- Cause is unknown – leading cause of maternal &
fetal morbidity & mortality
- Risk to the fetus include premature delivery, growth
retardation, & death
- Characterized by proteinuria, ↑ BP, rapid weight
gain
2
 - Regular physical activity during pregnancy is  FOLATE – daily
advised recommended intake =
- Avoid excessive salt intake 600µg
- 2300 - 2400mg of Na – appropriate for women who - Sources: oranges, orange juice, pineapple juice
are pregnant
 CALCIUM – needed for
9. DIABETES – gestational Diabetes the formation of fetal skeleton & teeth
- usually develops during the second half of - Additional 300mg is recommended – for a total of
pregnancy, with subsequent return to normal after 1,300 mg/ day (women 14 – 18 y/o)
childbirth. - 1,000 mg/ day for women ages 18 – 50
VIT. D – regular sunlight exposure – DO NOT need vit D
NUTRITIONAL ADVICE supplements.
1. Weight gain - ONLY w/ the approval of a health care provider –
- ideal wt. gain – 25 – 35 lbs. for normal weight high doses can be toxic
women ( those w/ BMI of 20 – 26) - Some fortified foods – like some soy milk, orange
- FALLACY: Because a pregnant woman is “eating juice & some cereals – are one way to meet VIT. D
for 2” – she should eat twice as much needs.
- FACT: overall caloric need should increase by only
15% amounting to about 150 kcal/ day – for the 1st  IODINE – essential for
trimester the production of thyroxine ( the thyroid hormone
responsible for controlling the increased metabolic rate
 ENERGY: 200 - 300 - that occurs during pregnancy)
350 kcal/day (THIS
EQUALS ONLY 2  IRON – prenant woman
EXTRA CUPS OF LOW- needs an extra 30mg/ day during the last 2 trimesters
FAT MILK & 1 SLICE OF (twice the requirement of a nonpregnant woman
BREAD) for the - because of the increase in the amount of the
remainder of the mother’s blood & because of blood formed for the
pregnancy baby
- SOURCES: whole grains, dried beans, tofu & green
 TOTAL = 2,700 – 3000 leafy vegetables
Kcal/ DAY
- Therefore it is important that a pregnant woman –  VITAMIN B12
consume mainly nutrient-dense foods (foods having - plays an important role in the developing fetus
lots of nutrients for the number of kcal)
LACTATING/ BREASTFEEDING MOTHERS
2. encourage to consume at least the minimum
number of servings recommended by the food guide - have almost the same nutritional needs
pyramid - Folate & Iron – decreases after birth
- focus on the use of whole grains, unprocessed
foods  ENERGY – 2300 – 2700
kcal/ day when breastfeeding
 adequate CHO intake –  Adequate hydration –
to prevent low birth encourages ample milk production
weight – at least 100g/ - 2 – 3 L/ day
day - 8 oz. glass – every after nursing
- Avoid beverages w/ alcohol & caffeine
 adequate CHON intake – - Check with the pediatritian before taking in any
EXTRA 6 – 10/ day (51 - medication
60g (increase 10 – 15g/
day) to ensure a healthy LACTATION MANAGEMENT GOALS & CONCERNS:
pregnancy - adequate diet becomes more critical
- caloric intake can affect the quantity of milk
 FAT – 30g – required to produced
provide all the essential - the food requirements – are NOT uniform during the
fatty acids for fetal entire period of lactation
growth & dev’t - depend on the demands of the infant
- Vegetarians can be advised to consume – walnuts, - generally suggested – extra food calories should be
canola oil, flax, or seaweeds (for alternative sources about twice those secreted in the milk of
of omega-3 fatty acids) approximately 700 – 1500 calories of food for 500 –
1000 calories above the normal requirement for an
average production of 850 ml of milk – w/ an energy
value of about 600 calories
3
 - human milk is approximately 0.70 calories/ ml or
approx’ly 20 cal/ ounce & it contains 1.2gms
CHON / 100 ml.
 Calories – additional
1000 calories
- 120 cal – required to produce 100ml of milk
- 1000 cal – to produce 850 ml (daily production)
 CHON
- average CHON allowance = additional 20.2 gms to
her normal requirement
- 2 gms of food protein – required to produce 1 gm of
milk protein
- Sources; milk, eggs, animal protein & legumes
 Calcium, Phosphorus &
Vit. D allowances
- Ca + phosphorus = + ↑ 0.5mg
 Calcium = 1.0 gm/ day
for milk production
 Vit. D = 400 I.U remains
the same as during
pregnancy
 VIT. B! – additional
thiamin – needed for
thiamin secreted in milk
- “GLYOXALIN” – toxic substance secreted by a
mother w/ a diet very low in thiamin, which
accumulates in thiamin deficiency
- Unpolished rice, legumes, veggies, milk
 VIT. A = additional 2000
IU – to provide amount
of Vit. A secreted in milk
- green leafy veg, yellow veg, milk, eggs
 Iron – some tend to be
anemic
- same as during pregnancy
 Riboflavin, Vit. C –
additional allowance
 FLUIDS
HEALTH BENEFITS ASSOCIATED W/ LACTATION
1. Jaundice – a condition that turns eyes and skin
yellow from buildup of bile pigments & bilirubin that
comes from the breakdown of hemoglobin & RBCs.
- Frequent bowel movements assoc’d w/
breastfeeding reduces the risk of jaundice through
increased excretion of bilirubin
- Withhold supplementary feedings
B- R- E- A- S- T- F- E- E- D- I- N- G
- Breast-fed babies have been shown to spend about
half as much time receiving antibiotics during THE 1ST
YEAR OF LIFE – COMPARED to FORMULA- fed
babies.
- result of transferal of the mother’s immune factors
through
 COLOSTRUM ( the substance that precedes
breast milk)
- first 3 – 4 days
- has high protein content
- Acts as laxative
- Contains antibodies – help resist infection
- substance called IMMUNOGLOBULIN A - IgA – helps
guard against intestinal organisms & antigens,
the latter of which are cause of allergy development.
- prevents diarrhea – through increased immunity,
reduced inflammation, & other factors
- Cognitive & intellectual development
- Breast milk varies in flavor depending on the mother’s
diet
- Primary rule of thumb – the more frequently a woman
nurses, the more breast milk she will produce
- “supply & demand”
- weight gain of infant = 1 -2 lb/ month ( 8 – 12 nursings/
24 hours; at least 6 wet diapers per 24-hour period
– infant NOT given any bottles of water
- Formula milk – is dominant in CASEIN (protein in milk)
- forms curds when exposed to acid & is difficult to
digest by the infants
- BM – in WHEY – proteins lactalbumin that form soft
light curds
“let-down reflex” – occurs when the milk descends from
the upper parts of the breast (hind milk) & comes down
to the areola
Oxytocin ( a hormone) – promotes this reflex
Lactating woman – can usually identify when the let-
down reflex is occurring – there is a momentary “pins-
and-needles” feeling in the breast area.
CALCIUM
- deposition – 30 – 35 y/o
- in bones & teeth – 99%
- serum – 1%
- 6 – 10 y/o – peak of Calcium absorption
- 16 – 18 – highest need of Calcium
Proper positioning
1. Football/ the clutch
2. Cradling
3. Cross-over/cross cradle hold
4. Lying down/ reclining/ side-lying
WEANING
- accustomizing the baby to nourishment other than breast
milk
NUTRITIONAL CONCERNS
1. Artificial sweeteners
- low-nutrient foods- poor substitute for nutrient-rich
food
2. Alcohol
- can easily cross maternal-fetal pathway – may
cause birth defects, mental retardation, &
developmental disorders
3. Caffeine
- may cause miscarriage, increased heart rate,
stimulation of the CNS, acts as diuretics
4. Supplements
4
 - Iron – only recommended supplement during
pregnancy

5. Smoking
- may result to low birth weight

6. food-borne illness
- more prone to food-borne illnesses because of high
progesterone levels
- avoid raw fish, oysters, soft cheeses, raw or
uncooked meat, unpasteurized milk

7. Socio- economic & Cultural Factors

- Low income groups tend to have big families, one
reason for the decrease in kind & amount of food
available to the pregnant mother
- Unusual eating habits – frequent snacks rich in
CHO, irregular meals, special cravings (raw white
rice/ green mangoes) – deprive the mother of
wholesome foods
- Fallacies – eating eggplant – causes beri-beri in the
mother
- Dark food results in dark complexion of babies
- Crabs produce physical abnormalities
- ALL of these should be ignored

8. Adolescent Pregnancy
- may be perfectly normal or extremely high risk
- dietary habits – foods low in essential nutrients
- concerns about body image – may result in
inadequate weight gain
- offer social support, encouragement to seek good
medical care
- assistance in completion of school

TEACHING POINTS
1. Avoid too much fried foods, pickles & highly-
seasoned foods
2. Avoid stimulants – drugs, nicotine, caffeine, theo-
bromide, morphine & alcohol
3. exude a calm, happy spirit
4. live a quiet, contented life
5. exercise in the fresh air
6. do some pleasant work
7. promote successful breastfeeding – esp 1st few
hours of delivery
8. have periods of rest & relaxation, both physical &
mental
9. we should be aware of potential biopsychosocial
barriers to adequate nourishment during pregnancy
- poor attitude ( denial of pregnancy or desire to
maintain slimness)
- misinformation
- insufficient money for food
- lack of/ inadequate preparation facilities

5
B. Nutrition in Infancy
- refers to a person NOT more than 12 months of age
- a healthy full term infant weighs 2.7 – 3.2 (6 – 7 lbs)
& measures 48 – 50 cm (14 in)
- w/ skin – moist, elastic & not wrinkled
- rapid growth & development during the 1st year of
life – provide nutritional base – the baby grows
faster than at any other time of life
- stomach capacity = 20 – 30 ml (90 ml)
o gastric emptying = 2.5 – 3 hours
- recommend small, frequent feeding
- digestive enzymes are produced in small quantities
at birth --- breast ilk & formula milk are only given
- 3 mos. – begins the secretion of digestive enzymes
--- sufficient to digest starches in cereals
o 6 mos. – bile & lipase are produced which
can aid in FAT digestion
- Allows solid foods to be introduced to infants
- each infant has an individual rate of growth, but all
grow faster in weight than in length
- ASSESS – growth = height-to-weight ratio
- Should be consistent
- Infant growth follows the curve --- nutrition is most
likely adequate
o Birth Wt. – doubles during 4 – 6 mos. Of
life
o Triples by end of the 1st year
o Infants increase their wt. by 50% during
the first year & double by 4 y/o
o 6 – 7 mos. – learn to chew
NUTRITIONAL REQUIREMENTS/ FEEDING GUIDELINES
 Calories – high bec. The proportionately larger skin
surface leads to large heat loss.
- at birth – baby requires about 350 – 500 cal
- 1 year – 800 – 1200 cal.
- 2nd – 7th month – 120 cal/ kg body weight
- ↓ 6 mos. = 108 cal/kg BW
- 6 – 12 mos. = 98 cal/kg
- 7th – 12th months – 100 cal/ kg
- AVERAGE requirement for growth in the 1st year –
50 cal/ lb of expected weight
- 2/3 of this calorie needs supplied by milk
- 1/3 – by added carbohydrates
 CHON
- allowances of 1.5 – 2.5 gm of CHON/ kg BW from 6
– 12 mos
- ↓ 6 mos. = 2.2 g/kg BW
- 6 -12 mos. = 1.6 g/kg
 FAT – 3 – 5 % of fat
 FLUID – infants need
about 2 oz. of fluid/ lb of
BW
 VIT. K – injected to all
infants at birth
 VIT. D – recommended
for breast milk-fed
infants
 CHO – 1/10 ounce/ lb
BW = 1 ounce/ 10 oz. of
milk = 1% of the BW
- 1/3 CHO should be derived from milk
TEACHING POINTS:
1. Importance of Breastfeeding
- teachings on proper & successful breastfeeding
2. GUIDELINES FOR THE INTRODUCTION OF SOLID
FOODS:
1. Introduce iron-fortified baby rice cereal at about 6
mos. (no earlier than 4 mos.)
- avoid wheat-based cereals
2. add pureed vegetables & fruits, one at a time, at
about 7 – 8 mos (starting w/ veg. may help to
increase acceptance by the infant not yet exposed
to the sweet taste of fruits)
- one at a time – waiting 5 – 7 days between foods
- to gauge food preferences
- observe for food intolerance & allergies
3. Add pureed meats at about 8 – 9 mos.
4. Add juice when the infant is old enough to drink
from a cup, at about 9 – 10 mos.
5. add foods w/ more texture & finger foods at about 9
-10 mos. (chopped meats, crackers)
6. add allergenic foods, such as egg whites ( or whole
eggs), whole milk, wheat products, & orange juice,
after 1 year (especially important for the infant w/
family history of allergies or asthma)
7. keep baby in upright position when feeding
- let baby decide on how much to eat
3. INAPPROPRIATE FOODS:
1. avoid Honey & corn syrup– contain botulism spores
2. very salty & sweet foods
- canned foods – high Na content – can be detrimental
to the immature renal functioning of infants
- Renal system – 6 weeks - ability to concentrate urine
3. avoid foods that have a hard texture (ex: raw apple
or carrot, hotdog) – prevent choking – until the child
is old enough to chew adequately
- act as plugs in the air passage until they develop
adequate chewing & swallowing skills
4. SIGNS OF WELL-NOURISHED INFANT:
1. steady gain in weight & length ( w/ some
fluctuations from week-to-week)
2. happy & vigorous
3. sleeps well
4. has firm muscles
5. has some tooth eruption at about 5 – 6 months
(about 6 – 12 teeth will have erupted by 12 mos.)
6. good elimination characteristic
5. NUTRITIONAL CONCERNS
a. Iron deficiency anemia
b. dental health
6
c. colic
d. diarrhea
e. constipation
f. food allergies

7
C. Nutrition in Childhood ( 1 – 3 y/o )
- toddler years – are a time of transition, esp’ly bet.
12 – 24 months
- when they’re learning to eat table food & accepting
new tastes & textures
- challenging when it comes to feeding
- several dev’tal changes occur at this time
- they strive for independence & control
- growth rate slows down - w/ this comes a decrease
in appetite
- easily distracted from eating
- offer small portions of food
- these changes can make meal time difficult
- important for parents to provide structure & set
limits
- Wt. gain = 0.5 lb/ mo.
- Ht. = 1 cm/ mo.
SUGGESTIONS FOR TODDLERS TO GET THE
NUTRITION THEY NEED:
1. Avoid battles over food & meals
2. provide regular meals & snacks
3. be flexible w/ food acceptance as toddlers are often
afraid of new things
4. be realistic about food amounts – should be ¼ size
of an adult portion
5. limit juice intake to about 4 – 6 oz./ day
6. dessert should not be used as rewards – try serving
it w/ the rest of the food
7. make food easy for them to eat
 cut food into bite size pieces
 make some foods soft & moist
 serve foods near room temperature
 use ground meat instead of steak or chops
 use a child-size spoon & fork w/ dull
prongs
 seat your child at a comfortable height in a
secure chair.
8. prevent choking by:
 slowly adding more difficult-to-chew foods
 avoiding foods that are hard to chew &/
swallow (nuts, raw carrots, gum drops, jelly
beans, peanut butter by itself)
 modifying high-risk foods
- cut hotdogs in quarters, cut grapes in quarters &
cook carrot until soft
- always superise your child when he/ she is eating
- keeping your child seated while eating
NUTRITIONAL GUIDELINES:
- regular daily meals – w/ demonstration of healthy
eating behaviors
- involve them in the selection & preparation of foods
& teach them to make healthy choices by providing
opportunities to select foods based on
theirnutritional value
 ENERGY
 CALCIUM – 500 mg/ day
- easily met w/ 2 servings of dairy foods every day
- an important part of a toddler’s diet
- milk provides Ca & Vit. D t help build strong bones
 IRON
- 7 mg/ day
- Cow’s milk is low in iron
- ↑ iron-rich foods : meat, poultry, fish, enriched
grains, beans, tofu
- Serve w/ Vit. C-rich foods : tomatoes, broccoli,
oranges, strawberries – for iron absorption
 CHON – 16 gms
 VIT. A – 400 µg RE
 VIT. C – 40 mg
 THIAMIN – 0.7 mg
 RIBOFLAVIN – 0.8 mg
 NIACIN – 9 mg
 VIT. B6 – 1.0 mg
 FOLATE – 50 µg
B. PRESCHOOLER – 3 – 5 Y/O
- Wt. gain = 4 – 5 lb (1.8 – 2.3 kg)
- Ht. = 5.1 cm/ mo.
- respond best to regular meals
- snacks are recommended as part of regular eating patterns
- Snack provide 20% of the children’s total caloric intake
- Involve children in meal- related activities
- food habits are formed – child is receptive to learning
COMMON NUTRITION PROBLEMS
1. Protein- Energy Malnutrition (PEM)
- 2° lack of protein 7 energy in the diet
2. Iron deficiency anemia (IDA)
3. Vit. A Deficiency – VAD
4. Iodine Deficiency Disorder – IDD
5. Obesity
6. Dental Caries
C. SCHOOL AGE – 6 – 10
- Wt. & Ht. should double on what was the wt. & ht. at age 1.
- more independent
- Marginally supervised at lunchtime
- Aware of peer’s behavior-exposed to different types of food
eating
- Begin to make choices on what food to eat
NUTRIENT NEEDS
Preschoolers = 1300 – 1500 cal/ day
School age = 72 – 92 cal/ kg/ day
 CALORIES
- allowances decline to about 80 – 90 kcal/ kg for
children 7 – 9 y/o
- 70 – 80 kcal/ kg = 10 – 12 y/o
 PROTEIN
- approximately 37 gm of protein daily = 7 – 9 y/ o
- 43 – 48 gm = 10 -12 y/o
 VITAMINS & MINERALS
- Vit. C = 55mg = 7 – 9 y/o; 65 – 70 mg = 10 -12 y/o
8
 - IRON = 1.4 mg/day – esp’ly for girls who starts to NUTRITIONAL CONCERN
menstruate at age 11 – 12 • Caffeine eg. Tea, chocolate & softdrinks
- Calcium = 500 – 1000 mg/ day • Irregular eating habits
- Iodine = 120 mcg – children 7 – 10 y/o • Overeating / Obesity
• Lead poisoning

NUTRITIONAL CONCERNS
1. Caffeine – tea, chocolates, soft drinks --- limit
2. irregular eating habits
- food jags – one preference of food
- physiologic anorexia – lack of interest in food
- skipping meals

3. overeating & obesity

- obesity – being 20% or more above the mean wt.
for children of the same height
- develops after age 3 – likelihood of lasting into
adulthood is increased
- lack of physical activity

4. lead poisoning

CHILDHOOD

1. TODDLER 2. PRESCHOOL-AGE 3.
SCHOOLAGE

I. TODDLER
ages 1-3, gain weight 0.2kg, grows
3/8” (1 cm)/month
- exploration & sense of individuality (develop)
- demonstrate change in appetite & easily distracted
from eating.

II. PRESCHOOL
ages 4-6, gains 4-5 lbs (1.8kg-2.3kg),
grows 2” (5.1 cm)/year
- responds best to regular mealtime, 3 meals aren’t
enough for this age-group
- snacks provide 20% of children total caloric intake.
-include to meal-related activities. Eg. Food
preparation

doubles weight ( to what it was at age 1)

III. SCHOOLAGE
- are more independent of adults
-nutrition needs must be balanced with their need
for decision making & peer acceptance.
-expose to different types of food & eating behavior.

ENSURING CHILDHOOD HEALTH

• Schedule mealtime & allow to
participate in planning,
preparation, serving & clean up.
• Maintain variety of foods
• Have nutritional snacks readily
available
• Prepare mildly flavored single
food dishes
• Children to wake up early
• Encourage physical activity

9
D. Nutrition in Adolescence
- More individualized than during other periods of life
- Depends on timing & duration of the growth Spurt
vary from person to person

Growth & Development ( growth spurt, body mass, skeletal

mass, body fat)
Girls Boys

Growth spurt: ages 10-11 12-13

Peak: 12 14
Stop: 15 19

Caloric needs: lower =more fat deposition

increase= muscle mass, bone &
lean body tissue

NUTRIENT NEEDS
• Niacin, Thiamin & riboflavin = participate in sports
• Zinc - sexual maturation = (male) growth failure
& delayed sexual
development
• Folate – DNA & RNA role decrease in female

NUTRITIONAL CONCERN
1. Dieting & eating disorder (peer acceptance)
2. Calcium Deficiency (osteoporosis)
3. Tobacco & Alcohol
4. Oral Contraceptive use
5. Special Diet (athletes, vegetarians)

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E. Nutrition in the Adult Years
- weight management is a key factor in achieving health &
wellness.
- in order to remain healthy, adults must be aware of
changes in their energy needs, based on their level of
physical activity --- and balance their energy intake
accordingly

19 y/o early adulthood

- Maintaining healthy body weight, physical fitness,
avoiding excess weight & continuing to build
strength.

Fighting illness before they begin

40 & 60 y/o
- Heart disease, HPN, DM
- Establishing healthful food & exercise habit,
reducing fat intake, eat fruits & vegetable

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F. Nutrition in Aging - Decrease Immunity eg. Pressure ulcers & other
- Have special nutritional needs because their tissue wounds.
& Organ system are aging
- Suffer from arthritis, HPN , heart disease, DM

PHYSIOLOGIC CHANGES
1. GI SYSTEM
• Loss of dentition
• Saliva production decrease
• Secretion of gastric digestive enzymes fall off (milk)
• degenerates absorption of nutrients in the intestine
• Intestinal motility slows
2. METABOLIC slows = glucose intolerance
3. CNS
• Tremors, slowed reaction time, shorter memory loss
• Cognitive deterioration (alzheimer’s Dse) &
depression
4. RENAL SYSTEM fails to regenerate renal tissue =
urinary incontinence,
males: prostate dysfunction
5. SENSORY
• Hearing loss develop at age 30
• Visual Acuity (low-light setting at 40)
• Smell / olfactory
• Taste buds decrease = risk for dehydration
=manifestation of confusion or lethargy.
6. ECONOMIC & SOCIAL CHANGES
• SPARES CHANGES limit a person’s ability to eat a
well balanced diet.
Eg. Meat, dairy product
• ISOLATING PROBLEM

NUTRIENTs NEED
- CALORIES
- PROTEIN = impaired GI tract function & medication
= decrease absorption of amino acids &
micronutrients = leading to increase requirement
- IRON - decrease to stomach acid
- blood loss from dse or medication
- CALCIUM 1,200mg …age 51 & older, Leads to
colon CA & HPN
MAGNESIUM =leads to irritability & aggressiveness, vertigo,
muscle spasm, weakness & seizure.
= over consumed = s/s diarrhea, dehydration, impaired
nerve activity.
VIT. D skin decrease ability to synthesize VIT.D, limited
exposure to sunlight
= less consume milk, cereals, liver, salmon & liver
VIT. B -leads to decrease secretion of gastric acid =
inability to breakdown foods

TEACHING POINTS
• Choose high fiber.
• Increase water absorption
• Supplements as recommended
Nutritional assessment for the OLDER ADULT
- P.A = bedridden or obese
- History of diet (social & economical)

NUTRITIONAL CONCERN
- Dehydration = cause lethargy & confusion

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