TOPIC: LIFE CYCLE

COVERAGE:
LIFE CYCLE
Pregnancy
Lactation
Infancy
Breastfeeding
Weaning
Childhood
Pre school age
School age
Adolescense
Aged
Their characteristics, dietary management

SPECIFIC OBJECTIVE:
At the end of this session, you are expected to:
1. identify the characteristics of each stage of life cycle
2. relate the importance of nutrition in every stage of life cycle
3. make a dietary management for every stage of life cycle

SPECIFIC ACTIVITY: REPORTING, GROUPDISCUSSION AND ROLE PLAYING

Nutrition during pregnancy and lactation

Pregnancy starts when a fertilized ovum is implanted in the uterus and ends with expulsion
of the fetus. The duration of human pregnancy averages about 280 days or 40 weeks.
There are three physiological stages of pregnancy:
1. Implantation – take place during the first two weeks of gestation which the
fertilized ovum becomes embedded in the walls of the uterus. The embryo is
nourished from the outer layers of the uterus and the placenta develops.
2. Organogenesis – is from 2nd to the 8th week of gestation. During this period, the
fetus undergoes differentiation. The various individual organs such as the heart,
lungs, liver and kidney and the various aspects of skeletal formation start to form.
Nourishment is obtained from the blood and from the degenerating cells in the
space between the embryo and the uterus. The presence or absence of many
nutrients at this stage maybe crucial for the continued growth of a normal fetus.
3. Growth – constitutes the remaining seven months of pregnancy, the fetus
continues to grow until it reaches a functional size capable of supporting life after
birth. Nutrients needs at this time are high both quantitatively and qualitatively.
Physiological Adjustments:
1. Hematological changes – Plasma volume begins to rise at the end of the 3rd month
reaching a maximum increase of 1250-1500 ml by the 34th week of pregnancy. Red
cell volume also increases from the end of the first trimester of pregnancy until term
at an average of 250 ml. To facilitate the circulation of the larger amount of blood,
the capacity of the heart to pump fluid is increased.
Since the increase red cell volume during pregnancy is proportionately less that
increases in plasma volume, the concentration of red blood cells in the blood as well
as hemoglobin falls. This is referred as physiological anemia of pregnancy.
2. Gastrointestinal changes – a decrease in gastric motility and intestinal tonus
commonly observed during pregnancy. This has the advantage of slowing the
passage of food through the gastrointestinal tract and enhancing the possibility of
absorption of nutrients
However it causes loss of appetite, nausea and vomiting during the first trimester and
may lead to discomfort when it results to constipation in the

latter stage of pregnancy. There is a decrease in the secretion of hydrochloric

acid resulting to reduced gastric acidity that may impairs calcium and iron
absorption. However it can be counterbalanced by other factors that lead to
increased absorption of these two elements in the last trimester of pregnancy.
3. Hormonal changes – the hormones produced during pregnancy affect the entire
system.
Human chorionic gonadotropin (HCG) detected in the serum and urine a few days
after the first missed menstrual period increase rapidly reaching the maximum I about
50-70 days. They play an important role in organogenesis and growth of the fetus until
about the 4th month of pregnancy.
Progesterone, the corpus luteum hormone increases until the 3rd month of pregnancy.
Its main function is to prepare the uterus for the reception and development of the
fertilized ovum.
Estrogen – does not increase until the 3rd month of pregnancy. The greatest increase
occurs in the last half of pregnancy. Its main function is to stimulate growth and
functional changes in the breast and suppresses the lactogenic function of the
pituitary gland until delivery.
Other hormonal changes associated with pregnancy that have nutritional
implications are increased secretion of the following:
1. aldosterone ( the salt conserving hormone) by the adrenal gland.
2. growth hormone by the pituitary
3. thyroxin which regulates metabolism by the thyroid
4. parathyroid hormone which controls calcium and magnesium metabolism
5. the increase uptake of iodine by the thyroid gland.
4. Excretory- glomerular filtration rate increases with the expanding circulation
resulting in an additional filtered load of sodium. Thus, the rate of urine formation
and the tendency to retain water are enhanced.
5. Respiratory – Late pregnancy impedes the lungs so that breathing becomes deeper
and more frequent. Amount of oxygen utilized is 20% above normal shortly before
delivery.
6. Skeletal – Mineral storage in the maternal structure and fatal skeletal growth and
maturation increase the concentration of alkaline phosphatase enzymes in the blood
of the pregnant woman. Hence bones and teeth of the mother is vulnerable.
7. Muscular – Pelvis joints soften and become more movable. Owing to the extra load,
muscle movements increase with consequent added heat production and
discomfort.
Nutrient adjustments:
1. Energy – during the 1st trimester, because of loss of appetite, increasing calorie
intake is difficult. But during the 2nd and 3rd trimesters, an average of 300 calories is
needed:
a. to compensate for the increase in basal metabolic rate
b. for better utilization of protein
c. for growth of the fetus, placenta and maternal tissues
d. for the increased maternal tissues and for the increased muscular activity
of the mother
2. Protein- an additional average of 10 grams per day :
a. to increase nitrogen content of the fetus and its membrane and maternal
tissues
b. added protection of the mother against complications
c. for hormonal preparation for lactation
3. Vitamins:
a. B complex especially B1 and B2 – increase for proper carbohydrate and
protein metabolism.
b. Niacin – 3 mg /day
c. Folate – 350 mcg/day – for synthesis of red blood cells
d. Vit. C – increase 10 mg/day – to support fetal tissue structure
e. Vt. A – 475 RE /day increase for the important role in the epithelial cells
during organogenesis and needed to insure good vision.
f. Vit. D increase for proper calcium and phosphorus metabolism

4. Minerals:
a. calcium – 400 mg/day- for skeletal structure
b. phosphorus- if protein is adequate, P requirement will be met.
c. Iron - 69 mg/day for the formation of hemoglobin
d. Iodine 25 mcg/day for fetal development.
5. Fluids – increase to 6 – 8 glasses /day
Factors that affect maternal nutritional status:
A. Complications of pregnancy
1. mild nausea and vomiting – dietary mgt. small frequent feeding – hi CHO,
low Fat diet, dry diet
2. rapid weight gain or loss – increase or loss of 3 kg per month in the 2nd and
3rd trimester is an indication of rapid weight gain or loss.
Weight gain - * decrease calorie intake
 mild restriction of fats and cHO
 avoid sugar and empty calorie foods
 adequate protein, vitamins and mineals
3. toxemia – blood contains toxic substances
 optimum nutrition is the fundamental aspect of therapy
 increase protein which is high in biological value.
 Salt is restricted if edema is present
4. anemia – combined deficiency of Fe and folic acid
 increase intake of food rich in iron
 increase vit. C to enhanced iron absorption
 Supplement of 60 mg iron and 400-600 mg folic acid
5. diabetes
 dietary allowance is the same as normal
 even distribution of calories
 snack is suggested
 insulin and diet should be synchronized
6. constipation – increase fluids and high fiber foods.
B. Socio-economic cultural factors
 low income group
 big families
 fallacies
C. Alcohol, caffeine, nicotine
D. Repeated pregnancies
E. Food supplementation

Nutrition in Lactation
Lactation is the period of milk production initiated by the mammary hormone in
the mammary glands.
The first thick yellowish fluid that comes out from the 2nd to the 5th day after delivery
is called colostrums.
General characteristics of a colostrum:
1. It is higher in protein content compared to the later milk production.
2. It contain antibodies which give natural immunity to the infants.
3. carbohydrate and fat are low but beta carotene, riboflavin, niacin, sodium, zinc,
cartinine and taurine are high
4. it is a mild laxative which cleans out the baby’s digestive organs.

After delivery, lactation is controlled by two reflexes:

1. Prolactin reflex or milk production reflex
When the baby sucks, the sensory nerve endings in the nipple are stimulated,
sending impulses to the brain.
The anterior gland releases the hormone prolactin to the breast which causes the
cells in the alveoli to produce milk.
2. Let down reflex or milk ejection reflex
The baby’s suckling also stimulates the production of the posterior pituitary gland
of another hormone called oxytocin.
This hormone makes the myoepithelial cells around the alveoli and milk ducts to
contract. The contraction of the muscle cells squeezes the milk from the alveoli,
milk ducts and lactiferous sinuses towards the nipple.
Reflexes of the infant:
1. Rooting reflex – means if anything touches the infant’s lips, he opens his mouth and
tries to find a nipple to suck.
2. The suckling reflex is started by something – usually the nipple touching the infant’s
palate deep in the mouth. If the infant cannot get the nipple far enough into his
mouth ( to stimulate the suckling reflex) he may not be able to get enough milk.
The presence of milk in the baby’s mouth causes him to swallow and enabling him
to continue suckling.
Human milk is bluish and watery. It has approximately 67 cal/100 ml or 20 cal/oz and
1.2 grams protein/100 ml. An average of 850 ml is produced in a day.
Nutrient adjustments:
1. calorie- the extra calorie required fo lactation allows 500 calories/day for the 6
mos. Of nursing. Reasons:
a. milk content of 0.67 cal/ ml.
b. milk production where approximately 90 cal are required to produce 100
ml of milk.
c. Maternal efficiency of conversion of dietary to milk energy which is 80-90%.
d. For extra work in the care of newborn.
2. Protein – the quantity of milk secreted and the protein content of the milk serve
as the basis for estimation of the protein adjustment for lactation (17 grams of
protein)
3. Vitamins There is an increase demand for Vit A, niacin, B1 and B2 and ascorbic
acid during lactation.
4. minerals- The demand for calcium, phosphorus and iron is high as compared to
pregnant woman.
5. Fluids – 6 cups or more of fluids is recommended as large amount of fluids tend to
increase volume of milk.

Factors affecting milk production :

1. Diet – fluid intake and nutritious good are encouraged during lactation period.
Meat and vegetable soup especially ca-rich food such as milk, fruit juices have
been referred as “galactogogues”- milk secretion stimulating food.
Note: water should not be drunk beyond the natural thirst since this suppresses milk
secretion through its action on the hormones of the pituitary that regulates milk
production.
2. Nutritional state of the mother – sufficient nutrient reserves in the mother’s tissues
before conception and during pregnancy influence milk secretion. Malnutrition
and illnesses such as cardiac and kidney disorders, anemia, beri-beri, tuberculosis
and infection can lessen the quality and quantity of milk flow.
3. Emotional and physical state of the mother – attitude affects milk secretion. When
mother worries or frets about the sufficiency of her milk, about her contour, about
being tied down in the home the flow of milk stops.
When the mother feels frustrated and impatient at the start because breast-
feeding seems unsuccessful, chances are the infant will refuse to suck.
A relaxed temperament, pleasant surroundings, lots of rest and good sleep
enhances milk production.
4. Suckling- the presence of the baby and suckling, immediately after delivery
stimulates the milk producing glands.
For the first 3 days- 3 to 5 minutes at a breast is advised as the baby will “empty
the breast”.
5. The use of contraceptive – Stud of Osteria showed that women using
contraceptive while breastfeeding infers that pills depress the milk flow and the
insufficiency of milk flow triggers the cessation of milk.
Nutrition during infancy:
The term infant means a person not more than 12 months of age. The immediate
newborn period is one adjustment to an independent form of life. Most of these
adjustments are accomplished in the first week or so thus the first month of life is described
as the neonatal period.
Characteristics of a full term infant:
Based on Filipino standards, a healthy full term infant weighs 2.7 – 3.2 kg and measures
48-5- cm in length. His head circumference averages 35 cm. his skin is moist, elastic and
not wrinkled.

Nutritional requirement during infancy:

1. Energy – The calorie requirement of the infant is high in terms of his body weight
because of proportionately larger skin surface which leads to a larger heat loss.
The rapid rate of growth represents considerable storage of energy and the
activity of the infant is great. At birth, a baby requires about 350-500 calories, and
at one year from 800-1000 calories.
2. Protein – The RDA for infants is 1.5-2.5 grams /kg DBW from 0-6 months and 1.5-2.0
from 6-12 months.
3. Vitamins – All vitamins are required in proportionately greater amounts by the
infants. All vitamins are provided adequately in human milk.
4. Minerals – all minerals are required in proportionately greater amounts by the
infants. During the first 4 months, the liberal iron store of the healthy infant suffices
for the rapidly expanding blood circulation but 5 months onwards supplement
should be added to prevent anemia.
5. Fluids – The infant’s need for water is greater than that of adult. The infant’s body
content of water is 70-75% of his body weight.

The premature infant

The premature infant is characterized by a large number of biochemical handicaps.
These arise from his extremely rapid growth rate, immaturity of his major organs such as
liver, kidneys.
Premature infant has higher basal metabolism. He requires a large amount of food to
supply building material and energy.
The immaturity of his digestive tract complicates his feeding.. He does not receive food
for about 24 hours after birth.
In the absence of normal suckling and swallowing reflexes, food is administered
parentally or through a tube. Feedings are small and frequent, amount is gradually
increasing until food intake reaches 120-140 cal/ kg and 3-4 gram protein/kg body
weight.
The limited capacity of his stomach must not exceeded to avoid vomiting, aspiration of
food

Factors that affect the nutritional status of the infant:

1. Mother’s attributes and nutritional state - maternal nutrition affects the newborn
directly through:
a. the birth weight
b. levels of fetal stores of nutrients
c. the laying down during pregnancy of 4 kg subcutaneous fat needed as a
major source of calories and fatty acids for milk production.
d. Maternal diet affects the volume of milk secretion, consequently the
nutrient intake of the infant.
2. Feeding the infant - feeding the infant is dyadic in nature : it has nutritional,
psychological and biological interaction between mother and offspring.
3 ways to feed an infant:
A. Breastfeeding- the oldest and the natural way of feeding the infant,
meeting an infant’s nutritional needs for his first 6 mos. of life.

Advantages:
1. Breast milk is clean. It lower the risk of intestinal illness and general infection.:
Immunologlobulins – mainly IgA are present in large amount in colostrum and to a
lesser extent in mature human milk. IgA is not absorbed but acts in the intestines
against certain bacteria (e.g. E.coli and viruses). It lines the G>I> tract serving as
a protective lining which destroys the bacteria.
Lactoferrin, a protein which binds iron is found in human milk.
2. Human milk contains about3000 times the concentration of lysozymes found in
cow’s milk. They act in vitro to destroy E. coli in the GI tract of the infant.
3. Human milk is easily digested. Protein is in the form of lactalbumin which is superior
to casein and is readily digested by the infants
4. Breast milk is non-allergenic. It does not have the B-lacoglobulin or the albumin of
cow’s milk to which bottle fed babies are allergic.
5. Breast milk is economical and convenient.

Other benefits of Breast feeding

1. Breastfeeding helps in the evolution of the mother’s uterus. The baby’s suckling
stimulates the uterus to contract and prevent post-delivery bleeding. The uterus
also returns more quickly to normal size.
2. Breastfeeding delays ovulation, thus providing a normal form of contraception.
3. Breastfeeding brings the mother and the baby closer together. The psychological
and emotional bonds built between the mother and the child is strengthened by
breastfeeding.
Management of breastfeeding:
Breastfeeding is successful when the baby suckles frequently and the mother wants to
breastfeed and is confident in her ability to do so. The following guidelines maybe used
in giving support and helping mothers to successfully breastfeed their infants:
1. Preparing the breastfeeding
When the baby sucks, the nipples are stretched and pulled strongly and repeatedly.
This can result in soreness, cracks and even bleeding.
One way to avoid this is to prepare the nipples during pregnancy, by imitating the
sucking action of the infant. By gently pulling and stretching the nipples repeatedly
during the last month of pregnancy should help accustom the nipples to the suckling
action.
2. Starting the breastfeeding
Breastfeeding should begin as soon as both mother and the baby can nurse,
preferably immediately after birth. After delivery, the baby should be allowed to
suckle at the breast as soon as possible within the first hour. Although there is not much
milk yet, early suckling helps milk production to start sooner and encourages the
important psychological bonding of the mother and her newborn through a close,
warm contact. Once the nipples are accustomed to the sucking, the baby can suck
longer. A hungry child usually empties the breast in a few minutes. It takes up to 3
minutes for the milk to let down and 5-10 minutes for the baby to suck most of the milk
from a breast.
3. Feeding schedule
There should be a flexible on-demand feeding schedule. Small infants should be given
breast whenever they cry. Breastfeeding schedules should not be based on the clock
but rather on the needs of the child. Each baby has his own schedule. Feed the baby
whenever he is hungry. If the infant seems especially hungry, he needs to be nursed
more often. He may take in large quantities of milk at each feeding and feed less
often than he did in earlier months
4. Duration of breastfeeding
Breastfeed for as long as possible. Breast milk will be sufficient for the needs of the
infant until about 4-6 months of age. Even with the introduction of solid foods,
breastfeeding should continue for at least 12 months or longer since it provides useful
amounts of fat, protein and other nutrients.

5. Supplementary milk and other fluids

Under normal conditions, no other additional food or fluid is necessary during the few
days even when milk flow is still limited. It takes a few days for the milk to “come in”
and for lactation to established. Most babies will get all that they need for these first
few days in colostrums. Also, the normal infant has nutrient and water stores to carry
him over this period of temporary starvation. If the climate is very hot, cooled boiled
water can be given.
6. Cleaning the nipples
Daily bath is necessary to keep the nipples clean. It is not necessary to wash the nipple
before each feeding. They are naturally cleaned by the oily secretion produced by
the breast. After feeding, a few drops of expressed milk maybe allowed to dry on the
nipple. This helps protect it against infection because human milk is bacteriostatic.
Avoid using soap, lotion or alcohol as they may lead to cracking of the skin, sore
nipples and infection.
7. Keeping the breast in good shape
Breastfeeding is often mistaken to cause the breast to sag. Mothers must be reassured
that this is not the case. Breast sag if they are not well supported during pregnancy
when they start to enlarge and during lactation. Exercise and good supporting
brassiere will help support the breast.
8. Breastfeeding and the working mother
If the mother needs to go back to work after the baby is born, she can express her
milk and have it fed to the baby instead of an infant formula.

B. Artificial feeding
Uses milk other than human milk including cow, carabao, camel, sheep, goat etc.
milk. Cow’s milk is the most popular substitute for breast milk here and broad.
The requirements of a satisfactory milk formula are:
1. provide sufficient calories
2. provide sufficient protein, carbohydrate, fats, minerals and water
3. does not contain harmful bacteria
4. it is easily digested
To meet these requirements, cow’s milk used for infant feeding are modified on order to:
1. Reduce protein content. Cow’s milk contains three times as much protein as human
milk. Reducing protein content lowers the solute load, reduces gastric pH, improves
water balance, minimize putrefactive intestinal flora, and may relate to lower
incidence of infection.
2. Alter protein composition. Protein composed of 60% lactalbumin and 40% casein
provides better ratio of essential amino acids, improve absorption of calcium and
other minerals, shortens gastric emptying time, increase serum protein levels,
especially in gammaglobulin fractions, provides lower blood urea nitrogen levels and
decreased obligatory renal excretion of water.
3. Increase lactose content. Lactose provides the same caloric energy per unit as
vegetable carbohydrates of the infant formula. It improves nitrogen retention, alters
stool flora favorably and lowers intestinal pH thereby providing an unfavorable
intestinal environment for the growth of putrefactive organisms including pathogens.
Lactose has also been shown to improve absorption of protein, calcium and
magnesium, provide galactosides which may be utilized in brain and nerve cells
formation, favor production of riboflavin and pyridoxine in the intestines, and increase
mineral content of the bones.
4. Provide additional vitamins
5. Increase percentage of essential and unsaturated fatty acids. Linoleic, linolenic and
arachidonic acid are essential to the infant but are present in marginal amounts in
cow’s milk. If the cow’s milk formula’s are adjusted to provide 4% of calories form
essential fatty acids, symptoms of deficiency will be prevented and efficiency of
caloric utilization will be improved.
6. Reduce percentage of saturated fatty acids. Saturated fatty acids are less well
absorbed by the infant. Replacement of part of the butterfat with vegetable oil tends
to minimize feeding difficulties due to fat intolerance and improves fat utilization.
7. Reduce total mineral levels. Cow’s milk provides higher levels of most minerals than
are necessary in infant nutrition. Cow’s milk therefore should be adjusted to provide
minerals levels which suits the infant’s requirements without taxing his excretory
system. An exception is iron, which is provided in low levels in cow’s milk. Iron may be
supplemented either in the formula or separately.
8. Modify caloric distribution. The caloric distribution of cow’s milk is altered by the
above modification, resulting in few calories from protein and more calories from fats
and carbohydrates. This also provides for lower renal solute load.
9. Caloric concentration. When the above modifications have been affected, the final
formula should provide 20 calories per ounce. This concentration provides enough
water for obligatory needs, with an adequate margin for normal variations in water
need.
General, there are four principal types of formulas:
1. Cow’s milk, sugar and water
This is the oldest formula of infants and is the most widely used substitute for human
milk. This type of formula may use whole cow’s milk, evaporated milk or powered
whole cow’s milk. The addition of water is intended to reduce the high protein and
mineral content of cow’s milk. Sugar is added to raise the caloric concentration
to 20 calories per ounce as in human milk.
2. Partial modification of constituents
These formulas alter some of their constituents in qualitative respects to improve
the tolerance or acceptance of the formula by infants, raise nitrogen retention,
and provide nutrients required to support growth and development. Examples are
(1) acidified milk which improves digestion and lowers bacterial infection; (2) skim
or non-fat milk where butterfat is removed (Note: Skimmed milk is not suited for
infants below 12 months because of its high protein content which increases renal
solute load and its low fat and linoleic acid content) (3) milk with partial or
complete replacement of butterfat and (4) milk where lactose is replaced with
glucose for infants intolerant to disaccharides.
3. Modification of all constituents
This type of formula includes replacement of butterfat with a mixture of vegetable
oils and animal fats, use of lactose as the sole resource of carbohydrates,
supplementation of iron and Vitamin C, D and other vitamins, and provides
improved tolerance and better nitrogen retention. An example of this type is the
expensive single formula mixture.
4. Non-cow’s milk formulas
Some formulas supply proteins, fats and carbohydrates from other source
other than cow’s milk and are generally used when cow’s milk allergy is
considered the because of food intolerance. Examples include Soyalac from
soybeans, Probana and Sobee from banana and Lambase from goat’s milk. These
types of formula are very expensive.

Method of sterilization:
1. Terminal Technique – by this procedure, the bottles, nipples and covers are
washed. The formula is prepared and poured before sterilizing the bottles.
The nipples are applied to the bottles and a cap or cover is placed over
the nipple in a manner that will permit exposure of the nipple to the steam.
The completed nurser is then placed in the sterilizer to be boiled for 15-25
minutes. After sterilization the nipple and bottle contents are sealed and
untouched until the moment of feeding, thereby eliminating the possibility
of contamination and break in the technique. The sterilized formula should
be kept in a refrigerator until needed.
2. Aseptic techniques – by this method, the nipples, bottles, caps and all
utensils are washed and sterilized by boiling in an open vessel for 15-25
minutes. The formula is then prepared and poured into the sterilized bottles
which are then closed by the sterile nipples with cover, ready for
refrigeration until needed.
 C. Interval of feeding – the self-demand concept is not feeding the baby whever
he is awake or start to cry. It is the observance of a regular feeding schedule without
being rigid of time. For example, it has been observed that newborns want to be fed
every three hours and at one month every four hours. By two and three months, he is on
a 4-5 feeding schedule.

PROBLEMS ASSOCIATED WITH ARTIFICIAL FEEDING

1. Colic
Colic is characterized by an acute abdominal pain resulting from muscular spasms
near the colon. The baby cries a lot, fussy and irritable. Common causes of colic in infants
include over feeding, underfeeding, too frequent feeding or the food is not suited to the
particular infant. Appropriate management of colic can only be done after identification
of the underlying cause.

2. Overfeeding
An overfed baby is characterized by weight gain of an ounce or more per day
but is irritable and looks disturbed in the first two hours after feeding. Usually he has colic
accompanied by regurgitation or vomiting after feeding. He has frequent and larger
stools. Overfeeding can avoided by lengthening the interval of feedings or giving water
between feedings.

3. Underfeeding
The underfed baby cries after feeding, has colic and weight gain in inadequate.
The baby is usually constipated and has small stools. More often than not, underfeeding
is due to overdiluted formula. Feeding a shorter intervals or concentrating the formula
can remedy this problem.

4. Allergy
Artificial milk, unlike breastmilk does not offer protection against allergic diseases
such as infantile eczema to the infants. Thus, allergic diseases and some cases of colic
may be provoked by an early introduction of cow’s milk. When the sensitivity of the infant
is extreme, they produce symptoms such as diarrhea, colic and infantile eczema.
Changing the formula to non-cow’s milk will alleviate the symptoms.

WEANING PERIOD

The term to “wean” means to accustom. “Weaning” is the process by which the
infant gradually becomes accustomed to the full adult diet. Thus, during the weaning
period, the young child’s diet changes from milk to one based on the regular family
meals. The weaning period extends from the time the baby is solely breastfeed or formula
fed until he is eating the regular family meals. The period may range from a few months
to 1-2 years.

By the time a child is weaned from the breast, he should be consuming cereals,
fruits, vegetables and some protein rich food in small quantities. However, breastfeeding
or artificial feeding should be continued long after additional foods have been
introduced.
Management of Weaning

Proper management of weaning means knowing what foods to give and how to
prepare it, how much to give and how often to give weaning foods. Usually mothers
know very well how to introduce new foods, which present no problem if they are
properly selected and properly prepared.

Introduction of weaning foods

The first weaning food should be introduced at about 4-5 months. The amount and
variety of foods is slowly increased so that by six months, when milk alone cannot meet
the infant’s nutritional requirements, the infant is already accustomed to eating solid
foods. The following information may be useful in introducing weaning foods.
1. Give half a teaspoonful of the prepared new food on the first occasion.
2. Give the new food before breastfeeding or bottle feeding.
3. The second trial of the new food should be given a day or later, and the quantity
increased to one teaspoonful.
4. The amount and variety of new foods should be increased to one teaspoonful.
5. New foods should be introduced one at a time, waiting several days before
another is added.
6. Once the child has acquired a taste for a new food, it should be given fairly
frequently so that the liking for the food is not lost.
7. Once they are accepted, weaning foods should be given after breastfeeding.
The infant will then continue to suckle strongly at the breast. The same is true for
bottlefed babies.
In introducing weaning foods, the mother needs to be aware of the following:
1. The baby may spit out the new food during his first experience with it because new
foods will be different in both taste and feel. It is advisable not to force him to eat
the new food if he rejects it. Forcing a bay to eat may cause him to reject the food
altogether, or may not take the full amount.
2. Some babies are slow to accept new innovations – some may have a general
dislike of even minor variations from the regular routine of feeding.
3. When additional new foods are introduced, the baby may refuse the new food;
or may not take the full amount offered.
4. As supplementary foods increase in variety, the child will take more interest in this
food and also in his surroundings and attendants. This interests is to be encouraged
by:
 letting him see the new food
 allowing him to handle the feeding bowl to see what its is like and how it feels
 giving him a spoon and encouraging him to feed himself by the eighth or ninth
month
 not discouraging his early messy efforts, recognizing that this helps the baby to
be able to manage his feeding sooner by himself
 realizing that sometimes a child will refuse food because he wants to take it
himself and not to be fed – the solution may be for the mother and the child
both to have spoons and to spoon up the food alternately
 permitting the baby to try to pick some food and carry it to his mouth, when
more solid foods are being introduced

It is also important to watch for changes in the baby’s stool. If the stools are loose
and bowel movements are more frequent, the feeding of the last introduced food
should be reduced. Withholding food altogether is not advisable. If these
symptoms continue or are getting worse, or if skin eruptions occur, the mother
should seek medical advice.
Frequency of Giving Supplementary Foods
Once a child is accustomed to new tastes and textures it is important that he consumes
enough food to fulfill his requirements.
Young children need more than one meal a day to complement the milk they are
having. Because their stomachs are small, the volume of the meal must not be too large
so small children must be fed more often than the adults. At first, supplementary foods
are given once a day; then gradually the frequency should be increased so that by
about six months of age, complementary meals are being given 2-4 times a day. An
infant over six months need to be fed about 4-6 times a day in addition to the milk he is
taking.

Age Group : Frequency of Feeding

4–6 months : 2 -3 times a day until accustomed
to
new tastes
6 – 12 months : 3 – 5 times a day after
breastfeeding
1–2 years : 5 meals a day
2–3 years : 4 meals a day
>-3 years : 3 meals a day

What Foods to Give and How to prepare Them

The best way of planning a nutritious, weaning food is to use a mixture of ingredients
designed to complement each other to ensure the intake of all essential nutrients. The
basic principle in planning weaning foods is that “the wider the range of foods included
and the greater the variety, the less the likelihood of nutritional deficiency.
How much good to give
As discussed earlier, the child’s stomach is small so that volume of the meal must not be
too large.

Age in months
Type of food 4- 5 6 -12 > 12
CEREALS 4 – 5 Tbsp. ½ - ¾ cup ¾ - 1 cup
PROTEIN FOOD
Animal source 1 -3 tsp. 2 -4 Tbsp. 3 – 5 Tbsp.
Legumes 3 -5 Tbsp. 5 – 7 Tbsp.
GREEN LEAFY 1 Tbsp. 2 -4 Tbsp. 3 -5 Tbsp.
VEG. or FRUITS
OIL 1 tsp. 2 tsp. 2 tsp.

Other points to consider when making weaning foods

1. Food hygiene
1.1 always give cooked foods, or fruits freshly peeled
1.2 feed freshly cooked foods
1.3 protect the food from flies
1.4 leftover foods should not be given to babies
1.5 cleanliness of hands and utensils should be observed
- wash hands with soap before preparing foods and feeding the baby
(including the baby’s hands)
- utensils should be separated from general use
- keep utensils in a clean place
- wash all utensils after each use
- boil utensils after each use or at least once a day and keep them dry and
covered
2. Food selection
2.1 Use green leafy vegetables which are freshly produced if possible.
2.2 Select fresh eggs, fish and meat
2.3 If no animal food is available, use dried beans instead in greater quantity
2.4 use yellow fruits when available
Nutrition during the Pre-school Years
The period between 2-6 years old constitutes the pre-school years. This period is
characterized by:
 fluctuations in growth- although the pre-school child generally grow very
fast, the rate of growth is slower compared to infants
 this is considered the formative years because there is a fast rate of
intellectual, social and emotional development and this is the time when
he is most receptive to learning
 in relation to nutrition he becomes more selective and more independent
about food
 pre-school period is sometimes difficult to handle because appetite is poor,
growth is slow and irregular, weight decreases and the child has mre to
think other than food
 the GIT of the pre-school child is easily erritated by very sweet foods, fried
foods and by excessive amount of high fiber foods.

Nutrient adjustments:
There are 3 functions of the diet for a pre-school child:
1. provide enough energy for his activities
2. adequate protein for growth and repair of body tissues
3. enough vitamins and minerals to protect him from infections
1. Energy: RDA for Filipinos: 2 categories
1-3 years old 100 cal/kgDBW 4-6 years old 90 cal/KgDBW
* age, activities and basal metabolism determines the calorie needs of the child.
* 55% of his calorie needs – for metabolic activities
* 25% - for physical activities
* 12 % for growth
*8% for fecal loss
2. Protein - 1.5-2.0 g/kg DBW -2/3should be of high in biological value for
Increase in skeletal and muscle tissues and protection against infection
3. Vitamins and minerals are likewise essential for normal growth and
development. Thus, pre-school children need to eat more fruits and vegetables to
meet their vitamin and mineral requirement.

Guidelines in Feeding the Pre-school Child:

1. Set a good example by eating the a variety of foods. Avoid showing dislikes
towards certain foods.
2. Associate food with love and understanding. When a child learns to enjoy eating,
he has more chances to form good eating habits and attitude.
3. Respect his food likes and dislikes. If he rejects food, it does not necessarily mean
he does not like it altogether.
4. A child is sensitive to the taste, flavor, texture and temperature of food. The GIT of
the pre-school child is easily irritated by very rich tasting and oily food.
5. Introduce one new food at a time
6. Satisfy his curiosity by giving him an opportunity to handle ingredients and
acquainting him with names and picture of foodstuff.
Feeding between meals:
Snacks should be given?
Provided there is an allowance of about 2 hours before mealtime. It will not spoil
the appetite of the child
Snacks should be:
 more of fruits and juices, small sandwiches, cereal and milk
 avoid cakes, cookies, empty-calorie food and softdrink
What is important is also establishing a routine for the child. A regular time for eating ,
playing and sleeping.
Feeding problems:
1. Eating problems – serve food that he/she likes best. Serve less than he can eat.
2. Eating too much – danger is eating too much. The only danger is overweight and
indigestion. Refrain from serving foods such as cakes, pies, chocolate and ice
cream.
3. Dawdling – the one who lingers with his food during mealtime. He maybe trying to
get attention or may not be feeling well at all. Oftentimes he is given portions
which are too large. Have a regular check-up.
4. Gagging – one who feels like vomiting especially when fed coarse foods. This
situation can be remedied by encouraging self-feeding. Put him in a bright place
and with other children. Supply him with colorful plate, spoons and forks.
Sometimes gagging could also be due to negligence in training the infant to eat
chopped foods.
5. Aversion towards some foods
6. Allergy

Nutrition in school children ( between 7-12 years old)

Characterized by:
 slow steady growth
 increased in body proportions, enhanced by mental capabilities
 start to assert his individuality, less dependent on his parents and forms a
social life outside his family.
 School activities hold much time and interest and keep them busy at most
time.
 This is the right time that a child can be taught to see the relationship of
food and a healthy body.
Nutrient allowance varies depending on how large he is, how much his body needs, how
active he is.

His nutritional needs differ from the adult on the following points:
1. He is actively growing esp. the girl at the pre-puberty stage where she experiences
spurt of growth.
2. He is constantly active
3. He cannot afford to eat food poor in essential nutrients.
4. He is changeable in his attitudes towards food.
Dietary Recommendations
1. Energy- 7-9 years old – 80-90 cal/Kg DBW; 10-12 years old – 70-80 cal/KgDBW
2. Protein – 1.2 -1.5 g/Kg DBW
3. Vitamins and minerals:
Assessment of dietary intake, intelligence, physical growth and clinical signs of
malnutrition done on 600 school children from 5 Phil. Communities reveals the following:
1. With rice and corn staple – B1 and B2 are frequent deficiencies
2. With fish – ascorbic acids deficiency
3. With sweet potatoes and coconut – Ca, B1,B2 deficiencies
4. A positive correlation exists between intake of cal –CHO and intelligence, cal-CHO
and anthropometric measures and between intelligence and anthropometric
measures.
5. A very high incidence of eye changes – evident of vitamin A deficiency—even if vit.
A intake is adequate but low in vit. E. Protein enhances vit. A metabolism and storage.
6. Parasitism contributes to PEM.

Feeding the school Children

1. Psychological Factors – he is confident of himself, he is now in position where he can
express his food choices.
Has strong urge what his gang eats
Dietary measures; let him feel responsible for his well being with the guidance from
the parents he might cooperate by eating wholesome foods that he does not like.
2. School environment (school-student relationship) role of the canteen
3. Food preferences at this time the child eats a wider variety of foods and has more
food likes than dislikes.
Feeding Problems:
1. Inadequate meals – skippers and late bed riser are the factors that can cause
inadequate meals.
2. Poor appetite – school work that is too tiring and demanding, extra-curricular
activities that are too tiring, new experiences outside the home.
3. Sweet tooth – jam, jellies, chocolates and candies must not be seen around the
house. Limit them strictly to special occasion.
Indications of good nutrition:
1. Clinical examination (EENT) test; stools-parasites; urine –infection
2. Anthropometric examinations – height, weight, arm-chest-hip circumference
index
3. Dietary analysis- a diet history is done and eating habits are analyzed.

Nutrition in Adolescence

Adolescence is the transition period between childhood and adulthood. The girls usually
mature earlier than the boys.
Three stages:
1. Prepubescence stage – includes early and hidden changes associated with the
beginning of altered endocrine activities.
2. Pubescence – start abruptly and characterized by rapid growth and physical
maturation. Weight and height changes are at the peak. The secondary sex
characteristics, physical, social, emotional and mental changes start to appear.
Girls exhibit an increased amount of subcutaneous fat deposit particularly in the
abdominal area. Width of the hip increases and the pelvis widens in preparation
for reproduction. For the boys there is an increased in muscle mass and long bone
growth.
3. Post- pubescence – is the final process in the attainment of adulthood and
characterized by terminal deceleration of growth. There is an increase in muscle
development and maturation of sex organ functions.

Nutrient requirement for adolescents

Because of the double demand of activity and growth during this period, nutrient
needs are high and eating adequately is extremely important. The diet of adolescents
must be high in all protective nutrients especially protein, calcium and iron to meet the
increased demands for accelerated growth and increase in bone and muscle mass. It
must also include calories for the increased physical activities.
The Philippine RDA categorizes adolescents into two age groups namely: 13-15
age group and 16 -19 age group. The similarities and differences in terms of nutrient
requirements are as follows:
1. Energy – The males for both age groups have higher energy allowance than their
female counterpart because of more intense physical activities and differences in
weight, body size and body composition. Boys have more muscle mass than the
girls so more energy is needed for cell metabolism.
2. Protein - For the 13-15 age group protein allowance for the male is slightly higher
than the female but for age group of 16-19, the protein allowance for the boys is
further increased while it remains the same for the females. The higher protein
allowance for the boys for this age group is due to increase in growth and for the
active body tissues.
3. Vitamins – Because of the higher energy requirement, thiamin, riboflavin and
niacin allowances are also increased. Vitamin A is the same at all age levels while
Vitamin C is constantly higher among boys than among girls because males have
more active metabolizing cells than females.
4. Minerals – Iron is constantly higher among girls to compensate for loss during
menstruation while allowance for other minerals are the same for both male and
female at all age level.
Feeding the adolescents:
Survey in Metro Manila indicates that female and male adolescents have the
lowest overall nutrient consumption among members of the households.
However some nutritionists believe that very good possibilities exist to be well fed;
1. They get hungry easily
2. They like to eat
3. They want energy and vigor
4. They are figure conscious

Factors that contribute to a teen-agers’ poor diet

1. Emotional and social pressures
2. Independence in the choice of food
3. Breakfast skippers – reasons: not hungry, late bed riser, watching weight and no
time.
Result:
*Poor performance in the classroom and in athletics.
*Dislike of school work
*Lack of endurance for job that require strength
*High caloric nibbling during the day which may lead to obesity.
4. Fear of becoming fat – sometimes even the underweight girls are afraid that they
will become overweight. They view themselves as overweight. So fad diets are
popular among them.
Examples:
 All fruits
 Liquid formula
 After six
Nutrient allowance for pregnant adolescents: TER for teen-age requirement plus margin
of safety (300-430 cal/day) for pregnant woman.
For mentally retarded adolescents: The nutritional requirements are the same as normal
adolescents. But the dietary problems can be traced back to the parents’ tendency to
infantilize them. Most of the time they give “pasalubong” or reward or bribe of good
behavior. E.g. candies, chocolate, cakes and pastries
The best approach toward improving the nutritional status is teaching him how to be
independent. Encourage him to participate in food preparation and other homemaking
activities that will develop their potential activities.
Nutrition education for better food habits:
Most studies done among teenagers show that no headway is made in improving their
food habits.
One survey discloses that 6 out of 10 teenagers are undernourished. In one country, results
of a questionnaire reveled that students who do not eat breakfast are not ignorant of the
nutritional value of the food but they are just lazy.

Guidelines to follow for good nutrition:

1. Eat at least three good meals a day. Breakfast gives teenagers pep and good
start for the day. It should not be missed.
2. Choose snack wisely. Snacks should provide not only energy but protein, vitamins
and minerals as well. Never take snacks close to mealtime as this spoils the
appetite for the next meal.
3. Eat enough of variety of foods everyday. Eating enough of a variety of foods
develops and maintains a good physique or a nice figure. Food helps make the
skin smooth and have good color and tone.
4. Availability and identification of “access points” can be a major factor in servicing
the physical and social needs of the adolescents.
 the home refrigerator and kitchen cupboards
 vending machine
 school canteen and cafeteria
 snack bars
 food chain
5. Teaching of nutrition in school should be flexible and contemporary
6. Teachers must not be concerned only with teaching what, why and how about
balanced diet but also with carrying the process to changed behavior.
Signs of good Nutrition among teen-agers:
1. Shiny and glossy hair
2. Smooth skin, slightly moist and of good color
3. Bright and clear eyes with no fatigue circles under them
4. Lips that are of good color
5. Pink gums with no swelling or bleeding
6. Tongue of good color and without lesions
7. Teeth that are straight and without crowding, clean well-shaped jaw without
discoloration.

Nutritional Considerations in Aging

The role of food in geriatrics is to conserve the health of the individual and delay the
onset of chronic degenerative diseases.
Definition of terms:
1. Elderly – persons in the age group 65 – 75 years old
2. Old – persons beyond the age of 75
3. Aged – term used to cover both elderly and old
4. Senescence – process of growing old or period of aging
5. Geriatrics – branch of medicine concerned with prolonging life, delaying the onset
of degenerative aspects of aging and treating the disease of the aged.
6. Gerontology – broader branch of science dealing with the psychological,
sociological, economic, physiological and medical aspects of aging.

Process of aging:
Theoretically, aging begins at conception and ends in death. The characteristics of
aging however differ at various stages of the life cycle.
During the period of growth, the anabolic or building up processes exceed the catabolic
or degenerative changes so that the net result is one of growth and increased functional
capabilities of the organs and tissues of the body. Upon physiologic maturity, the process
is reversed. Anabolism starts to exceed catabolism although the rate of reversal is slow.
This results to slowing down of functional capabilities. During senescence, catabolism
greatly exceeds anabolism, which results to impaired functioning of many organs of the
body.
Physiological changes during aging
1. Decrease in the efficiency of the organs caused by loss of cells and decreased
functioning level of the remaining cells.
2. Decrease in the number and functional capabilities of the cells resulting to
decreased ability of the cells to synthesize and breakdown proteins and also
decreased ability to use energy because of the decrease number of the
mitochondria of the cells.
3. There are changes associated with collagen
Nutrient adjustments among elderly
Since aging starts at conception, the best preparation for a healthy old age starts at
conception. Observing proper nutritional habits and also of a healthy lifestyle should be
a decorum at all ages of the life cycle. The nutritional needs of the elderly persons are
basically the same as those of a younger individual with only minor modifications.

1. Energy. The demand of calories is decreased because of the decreases in basal

metabolism and decreased physical activities. The average change in caloric
allowance are as follows:
Age group change in caloric allowance
(compared to adult RDA 20-39 years old)
50-59 years decreased by 10%
60-69 years decreased by 20%
70 above decreased by 25 %

Since caloric requirement is reduced, carbohydrate and fat sources must be chosen with
considerable care. Carbohydrate should be in the form of starches or complex forms
rather than refined carbohydrate. Fat must be mainly composed of PUFA. Such
recommendation is made because of the relationship of the form of carbohydrate and
saturated fatty acid with the occurrence of coronary heart disease.
 2. Protein – is necessary for the prevention of progressive tissue wasting and
susceptibility to disease and infection. The allowance of 1.1 gram per kilogram
DBW is still applicable to this age group. However, the aged who have had poor
dietary habits or is ill, will benefit from an increased protein intake.
3. Vitamins and minerals – Special emphasis must be placed on the adequacy of
calcium, iron and ascorbic acid. Researchers have shown that an increases
calcium intake will relieve the symptoms of osteoporosis. Vitamin C will facilitate
the absorption of calcium and iron.
4. Water and Fiber – About 6-8 glasses of fluid should be consumed to enable the
kidneys to efficiently eliminate waste solids. Also water stimulates peristalsis thus
preventing constipation. Fiber also encourages peristalsis but rough fiber is not
recommended. The aged must be given tender fruits and vegetables.

AGE-RELATED BIOLOGICAL CHANGES IMPORTANT IN NUTRITION

Biological change Nutritional implications
Atrophy of salivary glands May cause difficulty in swallowing, especially
dry foods
Loss of taste buds May make eating less pleasurable. May
elderly people use increased amounts of
seasoning because food is tasteless
Loss of teeth Although not inevitable, very common with
aging. Diet need not suffer if properly fitted
dentures are worn. However, if the necessary
dental treatment cannot or will not be
obtained, the diet may be limited to soft
foods that do not require chewing. Such diets
are commonly inadequate unless the person
knows about nutrition.
Decreased secretion of stomach Common but far from universal in old age.
acid Certain minerals are absorbed less efficiently
when stomach acid secretion declines
Decline in basal metabolic rate It is common for the elderly to feel cold at
temperatures comfortable to younger
people. Energy needs also decreases
Decreased size and activity of Probably a response to decrease need for
thyroid gland thyroxine to regulate body lean mass
Increased proportion of fat to lean Universal in aging as dying cells are
progressively replaced with fat cells rather
than with type of cell that died.
Decreased in physical activity This results from impaired coordination,
decreased speed and strength of
neuromuscular reactions. However, the basis
may also be social and psychological:
retirement from work, lack of opportunities for
previously enjoyed group activities and loss
of companions with whom activities were
formerly shared an lead to a sedentary
lifestyle
Loss of neuromuscular The ability to maintain fine neuromuscular
coordination coordination declines with the aging
process. This poses a problem among aged
because they will have harder time in
manipulating eating utensils. Thus, rather
than take the risk of embarrassment, that
would come with spilled food or inability to
cut meat, they will just avoid eating foods
which they find hard to manage.
Onset of many degenerative Diseases can impair digestion, absorption
diseases sucg as cardiovascular and metabolism of nutrient. Drugs necessary
diseases, diabetes, osteoporosis to treat the disease may have further
and arthritis adverse effects on nutrient utilization.
Presence of degenerative diseases calls for
modification of diet and change of lifestyle.
Ensuring adequate Nutrition among Elderly
1. Difficulty in chewing due to loss of teeth and poor dentures – meat, fish, poultry
and vegetables can be sliced or chopped into small bite-sized pieces for easy
chewing.
2. Lack of appetite – use of appetizer such as soup will stimulate better appetite.
Finger foods have been found to be liked by the aged because it requires less
effort and easier to handle. It is also better to serve familiar foods served
attractively by varying the color, shape, and size can make meals enjoyable. Light
exercise like walking can improve appetite and keep the body fit.
3. Poor digestion leading to constipation, gas pain or diarrhea – inclusion of fruits and
vegetables in the daily meals will prevent constipation for those with sensitive
digestive system, something hot at each meal will be beneficial. Frequent but
small meals are often more acceptable than three big meals. The heaviest meal
should be eaten during lunch rather than at supper. Fats may retard digestion so
fatty meat and desserts containing coconut milk should be avoided.
4. Poor absorption leading to anemia and other vitamin deficiencies – anemia can
be prevented be eating iron-rich foods like liver, lean meat, egg yolk and other
green leafy vegetables. Vitamin C rich foods will also help absorb iron. Enough
sunshine and foods like milk, cheese and other milk products, dilis, alamang and
leafy vegetables contain calcium needed for strong bones.
5. Obesity due to lack of physical activity and or overeating – It is recommended to
take only moderate amount of energy foods. Eat only the lean part of meat or
poultry and fish. The fatty portion should be avoided. Steamed, boiled or broiled
foods are better than fried foods. Rich sauces, salad dressing, pastries and cakes
with heavy icing should be avoided.