Nutrition Across the Lifespan AL Ub heIt ensures optimum nutrition before, during and after pregnancy and during lactation Characteristics of Pregnancy: fertilized ovum implants itself to the uterus shuman pregnancy lasted for a period of 266 to 280 days (37-40 weeks) sconsists of three trimesters shas three main phases > implantation > organogenesis > growth 2 Agabin, M.. eee Ceo Pace vAlways start with diet history when it comes to giving nutritional instruction to the mother. Perea *PICA — persistent ingestion of inedible substances of little nutritional value eee *Vegetarians — lack essential protein and minerals, need Vitamin B12 supplement *Calorie Allowances » Non-pregnant requirements ~ 1,800 to 2,200 Kcal/day 2-Tn, John. > Additional caloric requirement per day ~ 300 Kcal/day aan > Usual daily caloric need in pregnancy — 2,100 to ~ - 2,500; never less than 1,800 Keallday2 (0-1.3) toe sunt 1 (0.8-1) Ibe/wke 0.6 (0.5-0.7) Ibs/wk 0.5 (0.4-0.6) Iba/wk ea Pacey Eos Paces*Maternal weight gain — 25 to 35 Ibs. +Maternal underweight causes having high risk of low birth weight, preterm and infant deaths 2 Agabin, M.. «Maternal overweight causes having risk of complications in labor and delivery: Raper > hypertension =m > gestational DM | > post partum infections. Pace vExpected Weight Gain During Pregnancy we 6 pounds in the first 3 months pound each week is normal 1 Ib per month during FIRST trimester 1 Ib per week during 2" and 3" trimester 3-12-12 2 Agabin, M.. Pacey Pace as v*PROTEIN ALLOWANCES (body-building foods) additional 30 g/day to enSure 74 to 76 g/day rich food sources includes milk, meat, fish, poultry and eggs provide for the storage of nitrogen protect the mother from any complications growth for maternal uterus, mammary tissues and placenta needs for fetal growth and repair hormonal preparation for lactation 2 Agabin, M.. eee Ceo Pace v*CARBOHYDRATES (sufficient intake is necessary for added energy) o Avoid “empty” calories like soft drinks Ea acli ee *EATS (high energy foods for absorption of vitamins ADEK) o AVOID too much fats to prevent vomiting and Poona heartburn vIron - most important mineral that must be taken in supplementary amount - supplementary in pregnancy is 30-60mg per day - needed to increase maternal RBC and for fetal liver storage in the third trimester 2 Agabin, M.. Calcium - needed for maternal calcium and phosphorous metabolism and fetal bone and skeletal growth Beery - 1,200 mg/day, equivalent to 1 quart of milk a day (4 glasses) Sodium - most abundant cation in extracellular fluid - needed for tissue growth and development - should not be restricted without serious indications lodine - needs for fetal development and avoid cretinism Pace Vitamins - water and fat soluble vitaminsTHINK TWICE BEFORE EATING FOR TWO — a our preananey ea Perea Poa cty v2 Agabin, M.. come coatPregnant | —10,0001U Women Postpartum 200,000 1U Women Pregnant 10,0001U women with Night blindness 1 capsule (10,000 1) ‘TWICE a week 1 capsule 200,000 1U 1 capsule ‘Once a day Start from 4" month of pregnancy until delivery 1 dose within 4 weeks after delivery 4 weeks upon diagnosis 2- Agabin.M.. NOT giv woman is taking micronutrient supplements with Vitamin A NOT given to PREGNANT women Can be GIVEN regardless of AOG 26- Rodrigue. if the woman has nightblindnessVitamin BS 60mgiron/ 1 tablet 400meg Once a day folic acid 6Omgiron/ 1 tablet 4oomcg Once a day folic acid 6 months or 180 days during pregnancy period 3 months or 90 days A dose of 800 meg folic acid is still SAFE to a pregnant woman 2 Agabin, M.. Perea come coat vCalcium, Phosphorus lodine Ca : 1,200 - 1,500 mg Phosphorus — eat HIGH CHON 175 ug daily during pregnancy lodized salt Serving of seafood at least once aweek 30 mg - OB (accdg to Pilliteri) 60 mg — CHN (DOH) 15 mg For fetal skeleton and teeth formation Essential for formation of thyroxine Prevents IDA in pregnancy Necessary for the synthesis of DNA and RNA 2 Agabin, M.. Perea come ECRa) Nausea and Vomiting Perea - Eat dry crackers before rising in bed - High CHO, Low FAT diet ce - Small frequent feedings - NEVER self medicate esp. antacids Ly ECR vb) Heartburn (Pyrosis) aia - Small frequent meals - Don’t lie down immediately after eating - Amphojel (Aluminum hydroxide) or Maalox may be prescribed Mendoza...COMPLICATIONS OF PREGNANCY AND DIETARY MODIFICATIONS 2 Agabin, M.. 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 8. Alcohol, caffeine and nicotine Fiala vThe nutritional requirements in lactation are greater than in pregnancy to ensure enough supply of milk for the baby. +Mother's milk is the best food for baby (Executive Order 51) If vaginal delivery — breastfeeding may done as early as 30 minutes after birth IfCS delivery — 4 hours after delivery -Demand feeding — best rule to observe when feeding the baby -Provide a relaxed, warm and supportive environment as the letdown reflex is affected by negative emotions of the mother. Pears ea PaO Paes@} WHAT IS A LETDOWN 2-Hemande ea Paces Paes Coens vWatch the If your baby is following their ets growth curve... ‘Trust them te wake on their own to eat! Baby will... @latch easier at more efficiently have better brain growth allow parents to sleep earn, more! Paces flourishingtots.comBreastfeeding benefits to the MOTHER «Promotes maternal-infant bonding «Promotes uterine contraction and provided less incidence of thrombophlebitis “Reduces rate of ovarian cancer and premenopausal breast cancer «Decreases maternal morbidity and mortality «Save time, money, effort; very economical Delays fertility +Provide social and economic benefits Pears ea PaO Paes Coens vBreastfeeding benefits for the BABY +Promote attachment ane «Provide perfect food that contains all necessary nutrients Easily digested, has the right temperature and free from harmful bacteria Provides passive antibody transfer to the - newborn 9 ae +ithas colostrum, high protein content contains antibodies which help resist infection *Causes fewer incidences of allergies, vomiting, diarthea, constipation and aspiration. +Enhances brain development because of taurine content BneAST Mux PROEN sDecreases infant morbidity and mortality THE BABYS DEVELOPAdvantages of BREASTMILK than COW’S MILK Breast milk is higher in CHO, fat and water content but lower in protein, vitamins and minerals. 2 Agabin, M.. *It has lactalbumin — human milk protein — easy to digest and hypoallergenic and cow's milk protein called casein which causes allergy Si 1 Breast milk is higher in lactose than cow's milk. OTS TT eS PaceBreastfeeding Misconceptions: -A mother sick with PTB cannot breastfeed. «Breast milk is not good if the mother has stayed long under the sun +A mother cannot breastfeed during pregnancy *A mother cannot breastfeed with only one breast if the other breast is painful -A mother cannot breastfeed if she has a cold, flu or diarrhea *Breast milk is not good if the mother has been caught in a sudden shower Pace7 0 Breastfeeding Contraindications: -Breastfeeding may not be advisable when mother has syphilis, AIDS, DM or any severe infections. Ec “Breastfeeding is not encouraged when the mother is under emotional and mental stress. «Mother who smokes. aera *Mother who takes contraceptive pills or drugs Other contraindication includes metabolic abnormalities or severe prematurity of the newborn which require the use of special therapeutic formulas.Factors affecting milk secretion *Diet Nutritional State of mothers *Emotional and Physical State *Suckling -Use of contraceptives and drugs cee Po Pace as Poe Coens vhild Health Progr (NEWBORNS, INFANTS, CHILDREW) , Poe 26 - LAWRE.. Coes naNewborn Screening EPI IMCI Pace Dental Health Early Child Development Child Health InjuriesINFANT AND YOUNG CHILD FEEDING * Initiate breastfeeding EXCLUSIVE BREASTFEEDING for the COMPLEMENTARY FEEDING for — TIMELY — ADEQUATE — SAFE — PROPERLY FED le Za after birth 2 Agabin, M.. Ea La Pvblic Health Nursingin the Pils Chapter 5, Page 135Diet: * breastfeeding / breast milk is best be given until 18 months to 2 years of age Pe bottle feeding — artificial feeding with cow's milk, costly, associated with infantile obesity or “protein-calorie malnutrition plus Ea La * mixed feeding -complemented - insufficient supply of breastmilk -supplemented - mother is away from home for feeding eaSteps for Preparing Baby Formula 2 Agabin, M.. 2 Methods of Formula Preparation: oa 1. Aseptic method 2 a — equipment and ingredients are Weahing_ sterilized separately 6 months: breast to bottle | > 12 months: bottle tocup | 2. Terminal method ad ~— ae — formulas are poured into clean but unsterilized bottles and are sterilized togetherFeeding Time: +2.5 to 2.7 kg baby usually feeds every 3 hours (8 feedings) ce *3.6 to 4 kg baby usually feeds every 4 hours (6 feedings) +2 to 3 months old, the baby is cay on 4 to 5 feedings, the baby sleeps through the night after 10 pm feedingSUPPLEMENTARY FOODS 2 months — liquids like rice water, calamansi juice may be introduced depending upon infant's tolerance and acceptance 2 Agabin, M.. 4 months - first solid foods (rice cereals) Ea La 5-6 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7-8 months — foods are mashed or chopped finely, not strained to teach mastication, soft cooked egg with rice porridge, boiled fish, banana and ave kamote mash and the like. 9-12 months — whole tender foods or foods chopped coarsely are given, finger foods like cottage cheese, crackers, plain meats and egg yolks Ea La Sequence of introducing solids: cereal, fruit, vegetable, meat, fishFoods to avoid in the first year of lfe: Pee Infantile poisoning — honey Pee (clostridium botulinum) -Choking hazards *hotdogs, grapes, hard candies, raw carrots, pop hao corns, nuts, peanut butter -Insufficient calories_ skim milk -Potential allergen_ cow's Ik, whitesREADY FOR SOLID FOODS @BumpBubNBeyond 4] pie. Is able ~O Can sit with é co-ordinate eyes, little or no support, bandland route) = y oy 4AIs eager to participate Has good head =>» in mealtime & may & neck control I U/ try to grab food 3 4 Has lost tongue Opens mouth when thrust reflex food is offered Paes er Uue PearsRULES TO FOLLOW WHEN INTRODUCING SUPPLEMENTAL FOODS: «Introduce one food at a time Po «Show pleasure when giving new food at the same time, make gesture. ———— «Give a small amount (1 tsp) out at a time *Offer bland foods to the baby (not too salty, not too sweets) *Do not mix with formula*Feed when newborn is hungry after a few sucks of milk to increase his patience for a new food «Never start two new foods at the same time *Allow an interval of 4-7 days between new foods *Feed baby only with freshly- cooked foods or fruits freshly peeled. Avoid giving left- over foods to babies. *Do not bribe, plead, threaten ery aCommon Disorders: Diarrhea — most frequently caused by bacteria and viruses “Vomiting Allergy — milk intolerance *Constipation *Colic — most common eee 2 Agabin, M.. er Uue Perea Coens vYOUNG CHILD Fluid needs: WATER is good for thirst. Pe Too much FRUIT JUICE may cause diarrhea and may reduce child’s appetite for foods eee SODAS are not suitable TEAS and COFFEE reduce iron absorption. neilles A SMALL DRINK will satisfy a child’s thirst during meals Anon breastfed child (6-24 mons) needs 2-3 cups of water in a temperate day or 4-6 cups in a hot climate PereaFeeding the CHILD WHOIS ILL * Encourage to eat and drink with lots of patience * Feed small amounts frequently * Give food that the child likes * Give a variety of nutrient rich foods * Continue to breastfeed eee 2 Agabin, M.. er Uue Perea Coens vNUTRITION PROGRAM Common nutritional deficiencies Ovitamina @iron Olodine 2 Agabin, M.. Micronutrient supplementation * Araw ng Sangkap Pinoy / Garantisadong Pambata / Child Health Week — twice a year distribution of Vitamin A capsule. Pree a Food Fortification (RA 8976) * mandatory fortification of staples: (flour, cooking oil, refined sugar, rice and processed foods) through SANGKAP PINOY SealPPAN 2017-2022 Nutrition-Specific Program: Micronutrient Supplementation Paes ea er Uue Pears CoensPaes ea er Uue Pears Coens vInfants (6-11 months) Children (21-71 months) Infants (6-11 months) Children (1-5 years old) Adolescent Girls Children of school age Adult 100,000 1U 200,000 1U Drops: 15 mg iron /0.6 ml Syrup: 30 mg iron /5 mi Tablet: 30 mg iron with 400 meg folic a 1 dose only usually given with measles at 9 months 1 capsule every 6 months 0.6 ml once a day for 3 months. 1 thsp once a day for 3 months One tablet once a day 1 capsule for 1 year 1 capsule for 1 year Paes ea = UA er Uue PearsTotal Energy Requirement eee 2 Agabin, M.. — 50 to 70 % ery a — 10 to15 % Perea — 20 to 30% eal vOn AL 1& DEVELOP E & DEV ) s Sandy Sates) e =INFANT ‘refers to a person not more than 12 months *remove small objects that the infant can choke on sburp the baby after each feeding to prevent colic «daily caloric requirements: 1200 Kcal/day ery a Nutrition through breast milk Finger foods at 10-12 months Alone in playing (solitary) Note for weight 2x at 6, 3x at 12 months Teething begins at6 months ’ ifLength X 50% at 1 year Only mother as significant other Stranger Anxiety around 6-8 months Stands alone at 12 months Trust vs Mistrust Pincer grasp at 10" month Lower incisors erupt before Perv a upper incisors Allow cruising at 12 months Yells (cries) without parents (parent preference)TODDLER a period of life from 1-3 years old «daily caloric requirement: 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 Temper tantrum Offer choices Diet preference unpredictable, able to feed self Dental examination at 2-3 years eile -16 3y/o -30) 2 Agabin, M.. ery a‘No’ Attitude Ensures increase Ca, P and Fe Elimination training (bowel training) Drinks 16-24 oz milk/day eee Separation anxiety Autonomy vs shame and doubt Parallel play 1 dou’ Hae Rituals, routines and dawdling eae eu a Accident prone You hates Involve parents in child care nih Sibling rivalry i Explain procedures* 3-6 years old slarger 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 ery a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 Mutilation, abandonment and dark, fear of Associative play ‘ 2 Agabin, M.. Grow rate slows and erratic Initiative vs guilt No new teeth develops Appetite is not large Oedipus and electra-complex Needs explanation een pleasures on touching of genitals ery aCommon feeding problems in children and strategies to try 1.Problem: Eating only certain types of foods Strategies to try a. Offer finger foods. They are usually better accepted as they allow children to self-feed. b. As parents, you can set a good example by eating a variety of foods and not pass comments about your own likes and dislikes . Serve a small portion of your child's favorite food together with other foods you want to introduce 2. Problem: Refusing vegetables Strategies to t a. Vegetables don't have to be green and leafy. Try yellow, white or orange non-leafy vegetables such as corn, cauliflower, button mushrooms, pumpkin, carrots etc. b. Add vegetables to foods and sauces, rather than serving on its own, e.g. add shredded carrots and chopped button mushrooms to spaghetti sauce. ¢, For older children, serve skewers of fruit chunks with cherry tomatoes or sliced cucumber.3, Problem: Taking a long time to eat and keeping food in the mouth (rumination) Strategies to try: a. Ensure portion sizes are not too excessive. Try serving a smaller portion and then offering more when your child completes the meal ‘ b. Minimize distractions, e.g. TV, toys, running around. ©. Make sure he is hungry by not offering snacks, milk and drinks within an hour before meals.Mucus produced by the exocrine glands is abnormally THICK causing obstruction to small passageways of affected organs Common Problems — Pancreatic enzyme deficiency ~ Chronic lung diseases — High Na and Cl SWEAT concentration — Infant tastes SALTY when kissed + Administer pancreatic enzyme with meals to enhance palatability High CHON, High Calorie diet Vitamins A, D, E, K supplementation Salt supplements during hot weather or fever ‘* Intolerance to GLUTEN, the protein component of Barley, Rye, Oat, Wheat * Common Problems — Accumulation of amino acid GLUTAMINE is toxic to intestinal mucosal cells a: + Gluten FREE Diet Foods allowed: RICE, CORN, Meat, Dairy | products | Not Allowed: BROW Pudding, Breads, Cookies, | Cakes, Crackers, Cereals, | Noodles, Beer and Ale* Genetic disorder that results in CNS damage from toxic levels of phenylalanine in the blood LOFENALAC Avoid high CHON = | meats and dairy products Breastmilk contains | LOW phenylalanine levels+ Eliminate ALL mi lactose contai including BREASTMILK An inborn error of CARBOHYDRATE ‘Avoid PENICILLIN because | it contains lactose as filler | ) metabolism Galactose 1-phosphate uridine transferase is ene : ‘aie « — Enzyme necessary for ‘a » conversion of pela Je yor ‘damage GALACTOSE to GLUCOSE ‘7 \ Mental retardationNUTRITION IN SCHOOL AGENUTRITION IN Ages 7-12 years old SCHOOL AGE AGE Daily caloric requirement: 2,100 to 2,400 keal/day \ Characterized by a slow, steady eo growth. increased body proportions, cS Expresses own food choices Strong urge to eat what his friends eat (peer relationship) Eats what most adults do‘ats a wider variety of foods and has more likes and dislikes NUTRITION IN SCHOOL AGE Develops fondness for food products of his movie ido! Should foster proper eating habit Obesity is common Oral Medications preferred Observe and explain pre-pubertal change Wants simple and plain dishes Ensure involvement in planning and preparing mealsNUTRITION IN SCHOOL AGE Problem solving develops industry Hangs out with same sex Grows steadily Behavior problems are common (bullying) Assume death as punishmentGrowth during the school age period is paralleled by a constant increase in food intake. Nutrition plays a role Furnishing energy needed for the vigorous activity of this age. & Helping to maintain resistance to infection. Providing adequate nutrient stores to assist in adolescent growthNutrient Allowances: 1. Calories - 80 to 90 kcal/kg for children Waged 7-9 yeats 267720.t0 80 kcal/kg for children aged 10- 12 years 4. 2. Protein - 37 gm daily for children 7-9 ® years old ¢- 43 to 48 gm daily for children to 10-12 years old 3.Vi @Werowth and development like iron, ascorbic acid and calciumFeeding Problems: 1. Inadequate meals - breakfast is often missed or hurriedly eaten by school children. Causes: Nothing to eat Late bed riser Fear of being late for school Rush is preparing oneself for school2. Poor Appetite Causes: Demanding school work Tiring extracurricular activities New outdoor experiences Soft drinks in school 3. The child has sweet tooth Cause: Parents give sweets as rewards or pasalubong to kindsUTRITION IN N ADOLESCENCE}NUTRITION IN ADOLESCENCE The period of greatest nutritional needs coincide with the peak rate growth during the adolescent spurt. Thus, the adolescents need more food from each of the food groups. Introducing and encouraging them to eat a wide variety of foods | can set the pattern of food habits that will be followed.NUTRITION IN ADOLESCENCE Itis a transition period of human development that occurs between childhood and adulthood. Girls go through this period earlier than boys do Teenagers lead an active life with gang or “barkada" Parents always wonder where the teenager gets their energy and vitality, so prepare mostly body builders and energy foods. This is the time when the adolescence needs more body building and energy boosting foods. Need to add more foods rich in protein, calories, irons, and vitamin C Daily caloric requirement: Girls - 2,200 keal/day, Boys — 2,700 kcal/dayProvide Iron and Zinc so that they would not develop anemia in adulthood Attachment to opposite sex Identity vs role confusion Acceptance through peers is needed, growth spurt, encourage decision making. Teach stress management and coping technique Respect independence Substance abused and early pregnancy must be addressed Teenage pregnancy is often the cause of malnutrition not only of the. ‘mother but also in the infant, and therefore should be avoided. rr rr) =Nutrient Allowances: Calories - needs higher enerer expenciture brought about by mance pysica actvty Protein - Protein needs are high among teenagers because of the accelerated growth and dowsiopment 50 grams per da for 13.45 years oe; 65 grams for 1619, yearsold Vitamins - veamin ¢ atowance is constant higher among oy ong gs aged 15 to 10 years 6. Compared to female counterpart the older male acolescents have higher ‘recommended aliowance for vemin Minerals -aiowances for eaiium, ron ans iodine or Imoreased tyro activtyassoclated wih growthPossible Nutritional Problems: . Low intake of Calcium, Vitamin A and C . Low intake of iron for girls . Anorexia nervosa / Bulimia . Obesity or underweight . Skin problemsSPECIAL NUTRITIONAL CONCERN DURING ADOLESCENCE 1. Nutritional concern during adolescence are eating disorders, inappropriate food patterns including skipping of meals, practice of food fads and crash diets and used of alcohol and drugs. 2. Adolescent girls are also prone to dieting for fear of becoming fat. Awell- balanced varied diet spread ‘over three meals and small snacks will ensure adequate nutrition.HEALTH PROBLEMS: Smoking * Alcoholism Drug Addiction Sexually Transmitted diseases Adolescent PregnancyRegular Screening: Hemoglobin and hematocrit - detect Iron Deficiency Anemia Urinalysis - detect Urinary Tract Infection Physical Assessment and X-ray - detect scoliosis Breast examination for females - detection of breast CA Testicular examination for males - detection of testicular CA Gynecologic care for females- It is the period of life when one has attained full growth and maturity between 21- 50 years of ageFEEDING THE ADULT: To stay healthy, the following must be observed and followed: Eat variety of foods Eat food with adequate starch and fibers Maintain ideal weight Avoid too much fat, saturated fat and cholesterol Avoid alcohol, drink alcohol in moderation. Avoid too much sugar; avoid too much sodium,NUTRITIONAL ISSUE: 1, OSTEOPOROSIS is a silent enemy. Itis a bone disease that leads to an increased risk of fracture. It is less common in men than in women. Women who are at risk in developing osteoporosis are women whose ovaries are removed at an early age, and sedentary women. ‘Smokers and drinkers are also at risk. To prevent bone loss experts recommend 30 minutes of exercise 3 to 6 times a week and calcium supplement. 2. CANCER - Because of high i cancer in adulthood.Here are the recommended foods to fend off cancer: Fruits, vegetables, and whole grain cereals such as oatmeal, bran, wheat may help lower the risk of colorectal cancer. Carotene - a form of vitamin A present in cantaloupe, peaches, broccoli, spinach, all dark green leafy vegetables, sweet potatoes, carrots, pumpkins, tomatoes , citrus foods lowers the risk of cancer of the larynx and esophagus. Cabbage, broccoli, brussels sprouts, and cauliflower reduce the risk of GI and respiratory tract cancer. Foods high in fats, or nitrite-cured foods like ham and fish, and types of sausages smoked by traditional methods should be eaten in moderation. Milk, especially 2-3 cups of vitamin D fortified skim milk a day may help ward off colon cancer. Cabbage prevents cancer. In fact, all vegetables which fall into a group of plants known as Cruciferae ave an anti-cancer effect, cabbage,* ELDERLY- refers to the period being past middle age.oR 8 @ 4B 4, AGING Isa continuous process that starts in the Soo womb ends in the tomb. oc a: os 8 © Aging are believed to be caused by loss in he ton the number of cells, “@azshesu |. Collagen in the connective tissues aaa undergoes chemical changes with aging connate a = Sense of taste and sense of smell are less chong: with oping acute causing loss of appetite ees Less saliva is secreted so swallowing of Seaceans food is difficult tess sve Digestion is affected due to reductionod Seeewang of fod 8 ‘acidity and pepsin content q Se eel ». Fats are poorly tolerated because they in toredscon 98 retard gastric evacuation