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Infants need energy for growth, and normal development. infant’s energy or caloric requirement depends: 1.body size and composition. 2. metabolic rate. 3. physical activity 4. medical conditions. 5.growth rate. Recommended energy intake is: 108 kcal/kg in first 6 months. 95 kcal/kg from 6-12 months.
Energy Intake and Growth Rate: A general indicator of whether an infant is consuming an adequate number of kilocalories per day is the infant’s growth rate in length,weight, and head circumference.
Should supply 30-60% of energy intake. RDA: 0–6 months 60 g/day. 7–12 months 95 g/day. Sources: The major type of carbohydrate normally consumed by young infants is lactose. Some infants cannot tolerate lactose (due to lactase enzyme deficiency in the small intestines) and required a modified formula.
Older infants derive CHO from additional Sources: legums ,cereals, fruits, vegetables.
( avoid some fruit juices for infants< 6 months as: apple, pear, prune).
The current recommendation for the infant’s protein requirement are: 2.2g/kg for first 6 months. 1.7 g/kg form 6-12 months. The infant needs all the eight essential amino acids plus histidine. Under certain conditions other amino acids become essential: 1.infant has phenylketonuria cannot metabolize phenylalanine to tyrosine so tyrosine become essential. 2.premature infants require an external source of tyrosine and cystine.
The amount of protein in breast milk& infant formula is adequate for the first 6 months. In the next 6 months diet of infant should be supplemented with additional source of protein such as: meats, egg yolks, yogurt, legums, cereals.
During the first 6 months of life, fat should account for approximately 50% of the infant's total calorie intake. Between months 7-12 this percentage drops somewhat, but a range of 35-40% is still recommended for fat intake as a percent of total calories. RDA: 30g/day Infants need essential fatty acids that are required for normal brain development, healthy skin and hair, normal eye development, and resistance to infection and disease.
Breast milk & infant formula provide about 50% of their calories from lipids. Breast milk provides approximately 5.6 g/liter of linoleic acid. Infant formulas currently provide 3.3– 8.6 g/liter. older infants derive lipids from diet as: meat, egg yolks, dairy products, oils added to home prepared foods.
The requirements for water are: 0-6 month 0.7L/day 7-12 month 0.8L/day - Infant is vulnerable to water imbalance due to immature kidney. - Water deficit lead to hypernatremic deyhration and neurological consequences. - Water intoxication result in hyponatremia ,nausea, vomiting ,diarrhea, irritabilty this occur if water is fed as a replacement for milk or if the formula is excessively diluted. - Under normal conditions,infants fed breast milk or infant formula don’t need additional water.
RDA: 0-6 months:400mg/day. 7-12 months:600mgday. The recommended intake of calcium is planned to meet the needs of formula fed infants as they retain less than half of the calcium intake. Breast fed infants retain two third of their calcium intake. Sources: 1-adequate amounts of breast milk or infant formula. 2-from complementary foods such as: yogurt, cheese, fortified grain products, green leafy vegetables.
RDA: First 6 months:6 mg/day. 7-12 months: 10mg/day. full-term infants are born with adequate iron stores that are not depleted until about 4 to 6 months of age. 94% of iron in human milk , 10% of iron in cow’s milk, 4% of iron in iron fortified formula’s is absorbed. Sources: 1.Breast milk , infants formula. 2.meat, liver; legumes; fortified grain products; and dark green vegetables.
RDA: 5mg during first year. The infant is born without zinc body stores therefore become rapidly dependant on a dietary source. Sources: 1-breast milk; infant formula. 2- meat; poultry; liver; egg yolks; cheese; yogurt; legumes; and cereals.
RDA: 0–6 months 0.1 mg/day. 7–12 months 0.5 mg/day. The major dietary sources for infants are fluoridated water, infant formulas made with fluoridated water.
RDA: 0–6 months 400 μg/day. 7–12 months 500 μg/day. Sources: 1-Breast milk and infant formula are major food sources of vitamin A. 2-for infants consuming complementary foods : liver, egg yolks, dark green leafy vegetables and fruits.
Vitamin D :
RDA: 200 IU/day. Sources: 1-Adequate sunlight exposure. 2- fortified infant formulas. 3-Breast milk contains a small amount of vitamin D(25 IU/L or less) 4- the major dietary sources: Fish, liver, and egg yolk.
RDA: 0-6 months: 5 μg /day. 7-12 months: 10 μg/day. Adequate intake can be supplied by mature breast milk but not in the first week so it is recommended that all infants should be given an intramuscular injection(0.5 mg) of vitamin K at birth. Sources: 1-mature breast milk, infant formula.
2-green leafy vegetables, and liver.
RDA: 0–6 months 4mg/day. 7–12months 5mg/day. -The requirement of for this vitamin depend on the degree of saturation of fats in the diet. Sources: 1-Infants receive vitamin E from breast milk and infant formula. 2- green leafy vegetables; wheat germ; cereals, butter; liver; and egg yolks.
RDA: 0–6 months 30mg/day. 7–12 months 40 mg/day. Sources: 1-breast milk and infant formulas are major sources. 2-vegetables and fruits.
RDA: 0–6 months 0.4 μg/day. 7–12 months 0.5 μg/day. -An infant’s vitamin B12 stores at birth generally supply his or her needs for approximately 8 months. Sources: 2- Major food sources of vitamin B12 are breast milk and infant formulas. 3-Complementary foods such as meat, egg yolks, and dairy products provide this vitamin later in infancy.
RDA: 0-6 months:25 μg/day. 7-12 months:35 μg/day. Body stores of folate at birth are small and rapidly depleted . Sources: 1-breast milk; infant formula. 2-green leafy vegetables; fruits cereals, and legumes,egg yolks; and liver.
Vitamin B6 (Pyridoxine):
RDA: 0–6 months 0.3 mg/day. 7–12 months 0.6 mg/day. Sources: 1-breast milk; infant formula. 2-liver; meat, cereals, legumes; and potatoes.
RDA: 0-6 months:0.4 mg/day. 7-12 momths:0.6 mg/day. sources: dairy products, lean meats, poultry, fish, grains, broccoli.
T h ia m in ( V ita m in B 1 ) :
RDA: 0 –6 m o n th s 0 . 2 m g / d a y. 7 –1 2 m o n th s 0 . 3 m g / d a y. R e q u i m e n t fo r th i m i re l te d to e n e rg y i ta ke re a n a n ( since itsfunctions as vitalcoenzyme factor in e n e rg y m e ta b o l sm ). i S o u rce s : 1 - b re a st m i k ; i fa n t fo rm u l . l n a 2 - w h o l -g ra i b re a d s, ce re a l , l g u m e s; a n d e n s e p o ta to e s.
N ia cin :
RDA: 0 –6 m o n th s 2 m g / d a y. 7 –1 2 m o n th s 4 m g / d a y. S o u rce s : 1 -b re a st m i k ; i fa n t fo rm u l . l n a 2 -e g g yo l ; p o u l ; m e a t; fi ; ce re a l , a n d fo rti e d ks try sh s fi g ra i p ro d u cts. n 3 -N i ci ca n b e fo rm e d i th e b o d y fro m th e a n n tryp to p h a n .
1-A supplement of vit D is recommended for : a- breastfed infants who are not exposed to adequate sunlight . b-infants who are consuming less than 500 mL per day of vitamin D-fortified infant formula 2-Breast fed and formula fed infants should receive additional source of iron at 6 months (iron fortified cereals and formula are common sources). 3-At 6 months both breast fed and formula fed infants who receive water low in flouride (< 0.3 ppm) needs supplements.
Composition of breast milk
• The nutritional composition of breast milk begins with fat. If you take all the water out of breast milk, half of what's left behind is fat. And, there's lots of cholesterol too. • infants, and young children need fats for the development of the nervous system. • In breast milk, there is an enzyme called lipase. Lipase breaks down fat so that the fat is in small globules. This allows for better digestion and absorption in Baby’s stomach. • In contrast, the fat globules in babyformula are large because they are from cow’s milk.
• The next big component of breast milk is carbohydrates (37%). • most of the carbohydrates are in the form of lactose. • Lactose provides Baby with energy. • Lactose is converted to lactic acid by the Lactobacillus. The lactic acid makes Baby’s stomach acidic. This in turn prevents the growth of harmful bacteria. • Cow’s milk has less than 10% lactose. Formulas manufacturers try to match the nutritional composition of breast milk by adding more lactose
• There are high levels of protein in colostrum and these levels decrease as baby grows older and older. • At 6 months of age baby should receive an external source of protein. • Whey and casein are the two main types: • Whey is smooth , liquidy and easily digested.it represent about 60-80%of proteins in breast milk. • Casein is coarse and not easily digested ,present in formula so delay hungry sensation.
Other important proteins:
Benefits for Infants : 1. Protects Against Infection
a. Diarrhea Children less than 12 months of age had a lower incidence of acute diarrheal disease. b. Haemophilus Influenza breastfeeding was protective of infants less than 6 months of age.. c. Enhances Vaccine Response The antibody levels of immunized infants were significantly higher in the breastfed than the formula-fed group. d. NEC rare in those whose diet included breast milk; it was 20 times more common in those fed formula only.. e. Otitis Media f. Herpes Simplex
2. Protects Against Illnesses :
a. Immunologic Development by the presence of IgA in breast milk. b. Wheezing c.SIDS. d. General Morbidity e.AIDS the current WHO recommendation that breastfeeding should continue to be promoted in all developing countries, including those with high HIV-1 prevalence rates in women of child bearing age. F. Infant Survival There is an association between breastfeeding up to 6 months of age and survival of infants throughout the first year of life. G. Gastroesophageal Reflex Breastfed neonates demonstrate gastroesophageal
3. Enhances Development and Intelligence
4 . P ro te ctio n F ro m A lle rg ie s : a . A lle rg ic F a m ilie s B re a stfe e d i g , e ve n fo r sh o rt p e ri d s, w a s n o cl a rl a sso ci te d w i l w e r i ci e n ce o f e y a th o n d w h e e zi g , p ro l n g e d co l s, d i rrh e a , a n d n o d a vo m i n g . ti b . E cze m a E cze m a w a s l ss co m m o n a n d m i d e r i e l n b a b i s w h o w e re b re a stfe d ( 2 2 % ). I i fa n ts e n n fe d ca se i h yd ro l n ysa te , so ym i k o r co w s l m i k , 2 1 % , 6 3 % , a n d 7 0 % re sp e cti l , l ve y d e ve l p e d a to p i e cze m a . o c
Types of Formulas:
Standard infant formulas: Cow milk based formulas: AAP recommends iron fortified for all infants. Low iron formula is nutritionally deficient formula. Soy based formulas: It has no proven value in prevention of colic so should not used as routine formula. Step 2 formula: Cow or soy based provide nutients for babies 6 months and older. Contain higher levels of calcium. Toddler formulas: For toddlers between 1and3 years
Special infant formulas:
Allergy:Extensively hydrolysed formulas(predigested): Protein in these broken down. In more extreme cases completely predigested formula (aa based)is required. Acid reflux:Thickened formulas: Thicken by itself once it reaches stomach so,minimize possibility of regurgitation. Acute diarrhea:Lactose free formulas. Premature babies:premature discharge formulas Result in greater height and weight gain. Provide more calories,proteins,vitamins and minerals.
Complementary feeding &weaning
Weaning is the process of separation from the breast or bottle feeding Aim of weaning and complementary feeding: 1-the child cannot tolerate more than one liter of fluid /day so with his increasing needs for energy more solid foods should be added. 2-growing baby requires more minerals and vitamins which cannot be all supplied by milk alone.
Complementary feeding &weaning
3-to train the child on spoon feeding, chewing, and swallowing of solides. 4-to train GIT to digest starch and other solid foods. 5-to educate the child independence by using spoon and cup of feed himself.
1-weaning should be gradual to prevent GIT disturbances. 2-sudden weaning may predispose the young infant to psychological trauma.
Principles of weaning and complementry foods:
1- encourage exclusive breast feeding for the first 6 months 2-start by replacing one milk feed by any oter foreing food. 3-gradually replace milk by foreing food until all milk feeds are replaced at age of 2 years
4- the new food is given gradually and in small amounts at first (1-2 spoon) if accepted by the baby the amount can be increased
5-amout determined by baby’s appetite. 6-never force the baby to take anew food. 7- the presentation of food is important so better use colorful attractive spoons and plates to stimulate baby’s interest and appetite. 8- new food items should be introduced one at atime. 9- vegetables &non sweetened foods may be introduced before sweetened foods to reduce te tendency to develop desire for sweets.
Introduction of the different new food items:
At 6 months: - sieved or pureed vegetables given by spoon -Strained or pureed fruits (apple, banana, orange, pear) -Iron fortified cereals -Unsweetened tomato or orange juice by cup -Soft cheese At 7-8 months: -soft cooked vegetables in strips or slices -Minced chicken ,chicken liver,fish,rabbit.
At 9-11 months : -crusted cheese ,beans ,peas ,bread, -Sliced fruits (pear, apple, peach) At 1 year of age: -whole egg ,whole milk, red meat, cubed cheese yogurt -Cooked rice , noodles
Foods to avoid in infancy:
1- food that cause cocking e.g nuts. 2-common allergy producing foods especially in potentially atopic children . 3-food additives. 4-salted foods. 5-junk foods. 6-foods hard to digest. 7- honey.
Feeding problems during infancy
Spitting up can be managed with the following feeding practice modifications:
-feed smaller amounts more times per day
-burp the infant every 4_5 minutes during feeding -switch to hypoallergenic formula, as reflux can be the result of an allergy to soy or cow’s milk -position the infant upright during and after feeding.
The following measures are recommended to improve bowel movement:-
Paroxysm of irritability or crying lasting more than 3 hours/day Colic starts at two weeks of age and last till 3 month. Incidence: 20 % to 30 %.
contributing factors :
1-immature digestive system 2-Certain foods eaten by lactating mothers contain volatile chemicals and allergens that in a small percentage of infants result in colic discomfort and digestive upset. 3-Infants often swallow air while feeding or during strenuous crying, which increases gas and bloating, further adding to their discomfort
Treatment: 1-Do not overfeed. 2-Breastfeeding mothers should avoid caffeine, onions, cabbage, beans, broccoli and other gasproducing, irritating foods. 3-In the formula-fed baby, try a completely lowallergy formula 4-Homeopathic remedies : Homeopathy is safe and completely allergen-free and side-effect-free. 5- Colic Calm Gripe Water.
- Onset of milk allergy usually occurs in the first
4 months of infancy -Most children grow out of it by the age of 2 years.
-Treatment is done by elimination of milk proteins from the diet by switching to a soy or hypoallergenic formula.
TH A N K YO U