Nutrition and Feeding

营养和喂养

Guiyang children's Hospital

Child Healthcare Department
Xiaoying Shao
 Objective 目标

1. Familiar with the characteristics and nutr

itional needs of children’s metabolism.
熟悉儿童新陈代谢的特点和营养需求

2. Mastering the method of infant feeding.

掌握婴童喂养的方法
 Section 1
Nutrition basis 营养基础

• Nutrition 营养 : The process of obtaining and

utilizing food. 获得和利用食物的过程

• Nutrients 营养素 : Substance in food which can

maintains human life activity 食物中能够维持生命
活动的物质

• Essential nutrients: 必须营养素： Nutrients that

cannot be synthesized in the body 不能在体内合
成的营养素
Nutrient reference intake
营养素参考摄入量

• Recommended nutrient intake RNI 推荐摄入量：

It meets the needs of the majority (97% - 98%) o
f individuals in a particular sex, age, and phys
iological group. 可以满足某一特定性别、年龄及生理状
况群体中绝大多数（ 97%--98% ）个体的需要

• Estimated average requirement EAR 平均需要量

： 50%
Nutrient reference intake
营养素参考摄入量

• Adequate intake, AI 适宜摄入量： The intake

of certain nutrients by healthy people thro
ugh observation or experiment. It may be hi
gher than RNI, not as accurate as RNI.
是通过观察或实验获得的健康人群某种营养素的摄入量，
可能高于 RNI ，不如 RNI 精确。
Nutrient reference intake
营养素参考摄入量

• Tolerable upper intake level ， UL 可耐受最高

摄入量： It is the highest daily intake of t
he nutrient.
是平均每日可以摄入该营养素的最高量。
中国居民膳食中几种常量和微量元素的参考摄入量（DRI s）
年龄 钙/(mg/d) 铁/（mg/d） 锌/( mg/d) 碘/(μg/d)
（岁） RNI UL RNI ULb RNI UL RNI UL
男 女 男 女
0~ 200(AI) 1000 0.3(AI) — 2.0（AI） — 85(AI) —
0.5~ 250(AI) 1500 10 — 3.5 — 115(AI) —
1~ 600 1500 9 25 4.0 8 90 —
4~ 800 2000 10 30 5.5 12 90 200
7~ 1000 2000 13 35 7.0 19 90 300
11~ 1200 2000 15 18 40 10.0 9.0 28 110 400
14~17 1000 2000 16 18 40 11.5 8.5 35 120 500
a:未制定参考值者用“—”表示
b:有些营养素未制定可耐受最高摄入量，主要是因为研究资料不充分，并不表示过量摄入没有健康风险。
Energy composition of the body
机体能量组成

• 1. basic metabolism 基础代谢： 50%

• 2. the thermic effect of feeding TEF 食物热力作用

• 3. physical activity 活动消耗

• 4. excreta 排泄消耗 : 10%

• 5. growth 生长所需： are peculiar to children 为

儿童所特有，随年龄增长逐渐减少。
 Nutrients 营养素

• Macronutrients: protein, lipid, carbohydrat

e
宏量营养素： 蛋白质、脂类、碳水化合物

• Micronutrients ： minerals, vitamins

微量营养素： 矿物质、维生素

• Other nutrients ： cellulose, water

其他营养素： 纤维素、水
 Macronutrient 宏量营养素
Protein 蛋白质

• accounts for 8-15% of the total energy. 占总能量的

8-15% ，

• 9 kinds of essential amino acids 9 种必需氨基酸

• Function: (primary )structure and repair tissue

， supply energy 功能：组成和修复组织，供能

• High quality protein (over 50%) mainly from anima

l protein(liver, meat, fish, cheese, milk) and so
y protein 高品质蛋白（婴幼儿所需应超过 50% ）主要来自
动物和植物蛋白
RNI of Protein
age RNI
0 – 12m 1.5-3g/kg.d
1y- 35g/d
2y- 40g/d
3y- 45g/d
4y- 50g/d
5y- 55g/d
6y- 55g/d
7y- 60g/d
 Macronutrient 宏量营养素
Lipid 脂类 机体第二供能营养素

• The energy supply the baby that under 6months of age a

ccounts for 45 to 50% of the total energy. 对于 6 个月以
下婴儿，占总能量的 55-65%

• It is an important component of human tissue and cells

人体组织和细胞的重要成分

• Plant oils contain more essential fatty acids than ani

mal oils 植物油比动物油含有更多的必需脂肪酸

• Linoleic acid is the most important essential fatty ac

id 亚油酸是最重要的必需脂肪酸
 Macronutrient 宏量营养素
Lipid 脂类 source

• Linolenic acid & linoleic acid: plant oil

• EPA 、 DHA: fish oil

• AA ： animal food– egg yolk,meat,liver

• Breast milk: optimal ratio of DHA &AA

 Macronutrient 宏量营养素

Carbohydrate 碳水化合物

• accounts for 55-65% of the total energy. 占总

能量的 55-65%

• Energy storage and energy supply 储能和供能

• Constitute tissue and life substance 构成组织和

生命物质
 Macronutrient 宏量营养素

• To meet the needs of children‘s growth and

development, First to ensure supply energy,
second is protein. 为满足儿童生长发育需要，应首
先保证能量供给，其次是蛋白质。
 Micronutrient 微量营养素

Micronutrient 微量营养素

• Constant elements: 常量元素

Calcium 钙 , phosphorus 磷、 sodium 钠、 potassium
钾
Participation in human body tissue 参与人体组织
形成

• Trace elements: 微量元素

iron 铁、 iodine 碘 , copper 铜 , zinc 锌、 Influen
ce enzymes 影响酶 , vitamins 维生素 , hormones 激素
Vitamins RNI During Infancy
婴儿期维生素 RNI

• Vit A: 400 µgRE /d Liver, milk, carrot

• Vit D: 10 µg /d Sun exposure, fish liver oil

• Vit C: 40-50 mg /d Fruit & fresh vegetable

• Vit B1: 0.2-0.3 mg /d Rice bran, bean, peanu

t
Mineral RNI / Al during infancy
Age Ca Fe I Zn
(mg/d) (mg/d) (ug/d) (mg/d)
(m) (AI) (AI)

0- 6 300 0.3 50 1.5

8.0
6-12 400 10 50 9.0

Source Milk, Liver, Marine Meat,fish,

12-24 600 12 50
bean egg yolk products milk
 Other nutrients 其他营养素

Other nutrients
• Dietary fiber 膳食纤维

• Water 水 :
Baby: 100-150ml/ (Kg.d) ， reduce 25ml/ (Kg
.d) at the age of 3
 Section 2
Infant feeding 婴童喂养
• Optimal infant and young child feeding practi
ces rank among the most effective interventio
ns to improve child health. Infancy, especial
ly the first 6 months, is a period of excepti
onally rapid growth and high nutrient require
ments relative to body weight. Recommended in
fant and young child feeding WHO and UNICEF´s
global recommendations for optimal infant fee
ding as set out in the Global Strategy are:
合理的婴童喂养是促进儿童健康最有效的手段之一。婴儿期，尤其是最
初 6 个月是体重快速增长和营养需求高峰期。 WHO 和 UNICEF 推荐的婴童
喂养方式为：
 Infant feeding Strategy
婴童喂养策略
• Exclusive breast feeding （纯母乳喂养） for 6 m
onths （ 180 days ）．

• Nutritionally adequate and safe complementar

y feedings starting from the age of 6 months
with continued breastfeeding up to 2 years o
f age or beyond.
6 个月加入保证营养的辅食，母乳喂养持续至 2 岁或以上。
 Diet of the normal Infant
常规婴儿饮食

• Breastfeeding 母乳喂养

• Formula feeding 配方奶喂养

• Complementary foods 辅食
 Breastfeeding 母乳喂养

• Component and quantity 成分和量

• Advantages 优点

• Establishment and skill 建立和技巧

• Contraindication 禁忌症
 Component and quantity
成分和量

• Less VitD, E, K 缺少 VitD, E, K

• Colostrum, transitional milk, mature milk

初乳 , 过渡乳 , 成熟乳

• 每一次哺乳过程中的乳汁成分变化 ( 前奶、后奶 )
• 蛋白含量逐渐下降，脂肪含量逐渐增多
 Component and quantity
成分和量
• Colostrum 初乳

• A high -protein, low-fat fluid, is produced

in small amounts during the fist few postpa
rtum days. It has some nutritional vale but
primarily has important immunologic and mat
urational properties. 产后几天产生的高蛋白低脂
乳，含有少量营养物质和重要的免疫和促发育物质。
 Component and quantity
成分和量

• Transition milk: 5~14 day milk ， high fat,

500 -- 700ml/ days 过渡乳

• Mature milk: 14 days after postpartum,700

-- 1000ml / day 成熟乳
Advantages of breastfeeding
母乳喂养的好处

• Anti-infective properties 抗体

• Nutritional properties 营养物质

• Growth factors 生长因子

 Other Advantages 其他好处

• Economical, clean ， convenient

经济，清洁，方便

• Promote mother and infant’s feelings

增进母子感情

• Mother can recovery soon

母亲恢复快
 How to do 母乳喂养的诀窍

Three conditions: 三点

• Sufficient milk 泌乳充足

• Effective reflex 有效反射

• A baby‘s powerful sucking 有力吮吸

Establishment and skill 建立和技

巧
• Prenatal preparation ： confidence 、 rational nutriti
on for pregnant woman 产前准备：信心，合理营养

• Nipple health care 乳头保健

• Breastfeed early and feed on demand: 15 minutes to

2 hours after delivery 尽早开始，充分喂养：产后 15 分
钟至 2 小时内进行喂养

• Promotion of breast secretion 催乳

• Correct feeding skills 正确的喂养技巧

• Having good mood 好心情

Breastfeeding contraindication
母乳喂养禁忌
• HIV

• Serious illness 重症
 Exclusive breastfeeding
纯母乳喂养
• Exclusive breastfeeding is fed no foods or
fluids, even water. 纯母乳喂养：不喂其他食物包
括水

• The WHO recommended exclusive B.M. for the

first 6 mo of life. WHO 推荐 6 个月前纯母乳喂养
 Partial breast feeding
部分母乳喂养

Babies within 4-6 months 4-6 个月婴儿 :

• 补授法 : Adding milk after each breast milk 每次

母乳喂养后补充其他奶

• 代授法 : Complete replacement of breastfeeding o

ne to several times a day 每天一次或多次用其他奶
完全代替母乳
 Artificial feeding 人工喂养

• Babies within 4-6 months are unable to brea

stfeed ， all use formula or animal milk.
4-6 个月婴儿不能母乳喂养的，采用配方奶或动物奶喂养
 Milk 牛奶

• Low lactose content 低乳糖

• Improper proportion of macronutrients 宏量营

养素比例不合理

• There are many minerals, but the proportion

is improper 大量矿物质，但比例不合理

• Heavy renal load 肾负荷重

• Deficiency of immune factors 缺少抗体

 Formula 配方奶

• Similar to breast milk, but the active immu

ne substance in breast milk is difficult to
add. 成分与母乳相似，但难以添加活性抗体

• Babies are first chosen when they can‘t be

breastfed 不能母乳喂养时的首选
Requirements of formula fed infants
配方奶喂养的需求

• The infant’s appetite determines the volume a

nd number of feeds required. Demand feeding fo
r formula infants is appropriate in early infa
ncy. 婴儿的食量需求决定了喂养量和次数。早期宜采用需求
喂养法。

• The number of feeds per day changes as the inf

ant grows, and the number of feeds per day dec
reases with increased feed volumes. 随着婴儿生长
，每日喂养次数会改变，如果喂养量增长，喂养次数会变少。
Estimation of the formula intake
配方奶摄入量估算
• Energy requirement 100kcal/kg· d
• Formula powder 500kcal/100g

• How much formula powder is needed per kg pe

r day?

20g/kg· d
Complementary foods 辅食
Aims of complementary feeding
辅食喂养的意义

• To meet the increasing nutrient needs of gr

owing infants 满足婴儿成长的营养需求

• To encourage the development of feeding ski

lls 提升进食技巧
 Three main questions arise in co
nnection with the introduction o
f solid foods: 喂养辅食的三个问题
• When should complementary foods be introduced
? 何时加入辅食

• What foods should be introduced? 加入什么辅食

• How should foods be introduced? 怎么喂养辅食

 When
• There is almost universal agreement that so
lids should not be started before the age o
f 6 months.
普遍共识是应在 6 个月后开始辅食喂养。
Introducing complementary foods too
soon can lead to several problems: 辅食
喂养太早会带来一些问题

• Reduce breastfeeding 减少母乳

• under-nutrition 营养不足

• Food allergies 食物过敏

• Diarrhoea diseases and other problems 腹泻

和其他问题
 Introducing complementary food
s too late can also cause problems
: 辅食喂养过晚同样有问题
• Growth can falter 影响生长发育

• Micronutrient deficiencies—especially of ir
on and zinc. 微量元素缺乏 - 尤其是铁和锌

• Optimal development of motor skills such as

chewing can be delayed and the infant may be
unwilling to accept new tastes and textures.
影响咀嚼等运动功能，影响婴儿对新口味和口感的接受。
 What
• iron fortified cereals firstly 首先是加铁米
糊

• vegetable and fruits secondly 然后蔬菜水果

• meat, poultry, Yogurt and cheese, egg yolk

lastly 最后是肉类，家禽，酸奶，奶酪和蛋黄
 顺序：过渡期食物的引入
餐 数
月龄 食物性状 种类 主餐 辅餐 进食技能

6月 泥状 菜泥、水果 6 次奶 逐渐加 用勺喂

食物 泥、含铁配 ( 断夜 间 奶 ) 至1
方米粉、配 次
方奶

7~9 月 末状食物 软饭（面） 4 次奶 1 餐饭 学用杯

、肉末、菜 1 次水果
末、蛋、鱼
泥、豆腐、
配方米粉、
水果
10~ 碎 软饭（面） 3 次奶 2 餐饭 抓食
、碎肉、碎 1 次水果
12 月 食物 菜、蛋、鱼 断奶瓶
肉、豆制品 自用勺
水果
 How
• no salt, sugar or other flavourings 不加盐、
糖或其他调味品

• Individually, one food at a time 一次喂一种

辅食

• Avoid potential allergy-producing foods 避

免过敏食物

• Vary consistency 不同稠度

• Vary tastes and texture 不同口味和口感

 Change food’s texture 变化口感

• soft and smooth-textured foods 细软食物

• mashed foods 泥状食物
• finger foods 手抓食物
• small pieces 小块食物
Feeding skills training
进食技巧训练

• Using spoon 用勺

• Using cup 用杯子

• Self-feeding 自己吃
 Diet changes over time
食谱变化
• Complementary foods usually accounts for 20
% total caloric intake at 6 months of age,
and increase to 50% by 1 year of age.
6 个月时辅食一般占总热量摄入的 20% ， 1 年时增长到 50
%。
 Infant food conversion
• From less to more 由少到多

• From dilute to thick 由稀到稠

• From thin to thick 由细到粗

• From one to many 由一种到多种

 Self Assessment 1
Based on WHO and UNICEF's global recommendati
ons for optimal infant feeding, how long shou
ld the exclusive breastfeeding last?

• 4 months
• 4-6 months
• 6 months
• 8 months
 Self Assessment 2
• Describe the composition of Breast-milk.
• Breast milk contains all the nutrients that
an infant needs in the first 6 months of li
fe, including fat, carbohydrates, proteins,
vitamins, minerals and water, It is easily
digested and efficiently used Breast milk a
lso contains bioactive factors that augment
the infant's immature immune system, provid
ing protection against infection, and other
factors that help digestion and absorption
of nutrients
Thanks !~