Pediatric Nutrition and

Nutritional Disorders

Prepared By
Dr Hodan Jama MD
Pediatric Nutrition and
Nutritional Disorders
 Pediatric Nutrition and
Nutritional Disorders

• Good Nutrition
• Nutritional Disorders/malnutrition
 Good Nutrition

DIET OF THE NORMAL

INFANT

DIET OF THE NORMAL

CHILD ANDADOLESCENT
 BREASTFEEDING

• The American Academy of Pediatrics

recommends human milk as the sole
source of nutrition for the first 6 months of
life, with continue intake for the first year,
• Breastfeeding has short- and long-term
advantages for infant neurodevelopment.
• Breastfeeding should continue with the
addition of complementary foods
throughout the second half of the first year.
• Breastfeeding beyond the first year offers
considerable benefits to both mother and
child, and should continue as long as
mutually desired
Breastfeeding has
benefits for:
• Infants
• Mothers
• Family
• Society
 benefits for:
Infants
Decreased morbidity and mortality from
infections
• Respiratory

• Gastrointestinal
Optimal nutrition
• Species-specific nutrients

• No overfeeding

Improved outcomes for premature infants

• Fewer infections

• Decreased risk of NEC

• Earlier discharge
 benifts for older child

Functional competent immune system

• Protective effect against type-2 diabetes
• Decreased risk of some childhood
leukemias (with longer duration)
 benifts for older child

Optimal growth and development

• Decreased prevalence of
overweight/obesity – 10% reduction
• Increased IQ
Normal development of the mouth and jaws
• Decreased risk of dental occlusion
 Benefit for the mother

immediately after birth

• Decreased risk of postpartum
hemorrhage
• Delayed onset of menses
- Decreased incidence of iron deficiency
- Child spacing
 Benefit for mothers

Long-term health
• Decreased risk of breast, ovarian, and
uterine cancers
• Decreased risk of central obesity and
metabolic syndrome
 Economic benefit

Financial costs
• Breastfeeding is free vs. the cost of
formula and accessories
• Decreased medical care costs
• Less lost work time
 benefit for society

Lower health care costs

Higher work productivity

Environmentally friendly
• No waste
• No product transportation or packaging
• No grazing lan
 Who will continue breast feeding safely ?

• Mothers with HIV

• Mothers with human T-cell lymph tropic
virus type I or II
• Mothers with active herpes lesions on the
breast
– Until heeling
• Mothers with untreated active tuberculosis
or varicella
– infant should be separated from mother but
can be fed breastmilk
 10 steps to successful breastfeeding

Written breastfeeding policy

Staff trained to implement the policy

All pregnant women informed about

benefits and management of breastfeeding
4.Help mothers initiate
breastfeeding within 30 minutes
after birth

5.Show mothers how to

breastfeed and how to maintain
lactation when separated
Give newborns no food or drink besides breastmilk unless
medically indicated

Practice rooming in

Encourage breastfeeding on demand

Give no pacifiers or artificial nipples to breastfeeding infants

Foster breastfeeding support groups and refer mothers to them

on discharge
 Positioning is Critical

• The infant needs access to the breast.

• Both mother and infant need to be
comfortable.
• Commonly recommended positions
include
– the cradle, cross-cradle, football, and side-
lying.
• More recently, biological nurturing or
laidback breastfeeding has been promoted
 Mom’s Positioning

Back support
• Roll bed or sit in supportive chair

Elbow support
• Lots of pillows

Prevent back strain

• Foot stool
Cross-Cradle Position
Side-lying Position
 Supplement

• Remember, colostrum is adequate in the

first newborn days.
• Supplement only if medically necessary.
• Ideally supplement with colostrum.
• Colostrum has more calories than D5
 Good sing for breast feeding

• Frequent feedings, at least eight times in

24-hour period
• Episodes of rhythmic sucking with audible
swallows
 To make sure enough intake

- At least one to two wet cloth diapers in

the first two days,
- then six to eight wet cloth diapers every
24 hours
- Transitional stools first two days, yellow
by day four
- After day three, at least three bowel
movements >1 tablespoon in 24 hrs
- normal 4 to 10 times of bowel movement
 breast milk jaundice

• Ensure that infant has adequate intake

- Jaundice in breastfed infants most
commonly associated with inadequate
feeding
• More frequent and effective breastfeeding
prevents and treats jaundice.
• Breastmilk jaundice1-2
- Begins after day of life 5-7
- Total bilirubin >mg/dL
- Occurs in less than 1 in 200
- Increased bilirubin reabsorption from
intestine
- May last several weeks to months
 Common Breastfeeding Problems

•Painful nipples due to poor latch

•Engorgement
•Mastitis
 Painful nipples due to poor latch

• Normal latch-on pain

• Abnormal pain
• usually due to poor latch
• Persistent pain,
• cracks, and bleeding are not normal
• Ensure appropriate positioning and latch
• Applying lanolin cream or breast-milk to
nipples may be soothing
 Engorgement

• Development of swollen, tender breasts as

the mature milk “comes in”
• Combination of milk, as well as interstitial
edema, increased blood and lymphatic
flow
• Can cause difficulties with latching as
breast is full and nipple flattens
• A common time for women to stop nursing,
which can be managed preventively or
actively
 Treatment of Engorgement

• Prevention – anticipatory guidance

• Frequent nursing
• Cool compresses
• Warm breasts before nursing
• If trouble latching, express a small amount
prior to the infant latching on
• Breast inflammation with fever, breast
pain, erythema, and general malaise
• Estimated to occur in 20% of women
• If the breast is red and tender, but no fever
or systemic symptoms, then it is more
likely to be a plugged duct
Mastitis
 Mastitis

• Risk factors:
– Decreased feedings,
– poor latch with decreased milk removal and
possible trauma,
– rapid weaning,
– oversupply,
– pressure on the breast,
– maternal fatigue,
– malnutrition
• Most common organisms: Penicillin-
resistant S. aureus, followed by strep and
E. coli
• Treatment:
• Pencillinase-resistant penicillins such as
• dicloxacillin or flucloxacillin,
• cephalexin,
• clindamycin,
• erythromycin
• Important to continue regularly emptying
the breast
• Adequate fluids and nutrition
• Analgesia – consider anti-inflammatory
 Maternal Drug Use

• The factors that determine the effects of

maternal drug therapy on the nursing-
infant include:
– the route of administration
– dosage
– molecular weight
– pH
– protein binding
 FORMULA FEEDING

• Cow’s milk–based formulas are the vast

majority of commercial formulas.
• AAP recommends, and parents should
use only iron-fortified formula
• Soy-based formulas, may be used for
newborns who may be allergic to cow’s
milk.
• Specialized formulas are designed for
premature, low birth weight babies.
• The caloric density
of formulas is 20
kcal/oz (0.67
kcal/mL)
• Similar to that of
human milk
• Formula-fed infants
are at higher risk
for obesity later in
childhood
 COMPLEMENTARY FOODS

• Semisolid foods is suggested at 6 months

• an exclusively breastfed infant requires
additional nutrients,
• including
– protein,
– iron,
– zinc.
• Cereals are mixed
– with breast milk,
– formula,
– water
– later with fruits.
• To help identify possible allergies or
foodintolerances that
• juice should be started only after 6
months of age,
• limited to 4 oz daily of 100%
naturalunsweetened juice.
• If the introduction of solid foods is delayed,
nutritional deficiencies can develop,
• A tooth cavity is caused by a combination
of sugar and bacteria in the mouth.
• Eating a healthy diet and brushing
regularly will control sugar and bacteria.
• Rubbing infant gums with a wet washcloth
can be the first step in oral hygiene.
 DIET OF THE
NORMAL CHILD AND
ADOLESCENT
• Nutrition for kids is based on the same
principles as nutrition for adults.
• types of nutrients such as
– vitamins,
– minerals,
– carbohydrates,
– protein
– and fat.
 Consider these nutrient-dense foods

Protein
•  Choose seafood
• lean meat and poultry,
• eggs
• beans
• Peas
• soy products
• unsalted nuts
• seeds
Fruits
•  Encourage your child to eat a variety of
fresh
– canned
– frozen or dried fruits
• If your child drinks juice, make sure it's
100 percent juice without added sugars
• Look for canned fruit that says it's light or
packed in its own juice
• Keep in mind that one-half cup of dried
fruit counts as one cup-equivalent of fruit.
• When consumed in excess, dried fruits
can contribute extra calories.
Vegetables 
• Serve a variety of fresh, canned, frozen or
dried vegetables.
• provide a variety of vegetables, including
dark green, red and orange, beans and
peas, starchy and others,
• When selecting canned or frozen
vegetables, look for options lower in
sodium
Grains 
• Choose whole grains, such as whole-
wheat bread, oatmeal, popcorn, quinoa, or
brown or wild rice.
• Limit refined grains.
Dairy
•  Encourage your child to eat and drink fat-
free or low-fat dairy products, such as
– milk,
– yogurt,
– cheese or
– fortified soy beverages.
 limit your child's calories from

Limit added sugars.

• Naturally occurring sugars, such as those
in fruit and milk, are not added sugars.
• Examples of added sugars include
– brown sugar,
– corn sweetener,
– corn syrup,
– honey
Saturated and trans fats.
•  Limit saturated fats fats come from animal
sources of food, such as
– red meat,
– poultry and full-fat dairy products.
• Look for ways to replace saturated fats
with vegetable and nut oils,
– which provide essential fatty acids and
vitamin E.
• Healthier fats are also naturally present in
olives, nuts, avocados and seafood.
• Limit trans fats by avoiding foods that
contain partially hydrogenated oil.
 Ages 2 to 3: Daily guidelines for girls and boys

Ages 2 to 3: Daily guidelines for girls and boys

Calories 1,000-1,400, depending on growth and activity level

Protein 2-4 ounces

Fruits 1-1.5 cups

Vegetables 1-1.5 cups

Grains 3-5 ounces

Dairy 2 cups
 Ages 4 to 8: Daily guidelines for girls

Ages 4 to 8: Daily guidelines for girls

Calories 1,200-1,800, depending on growth and activity level

Protein 3-5 ounces

Fruits 1-1.5 cups

Vegetables 1.5-2.5 cups

Grains 4-6 ounces

Dairy 2.5 cups

 Ages 4 to 8: Daily guidelines for boys

Ages 4 to 8: Daily guidelines for boys

Calories 1,200-2,000, depending on growth and activity level

Protein 3-5.5 ounces

Fruits 1-2 cups

Vegetables 1.5-2.5 cups

Grains 4-6 ounces

Dairy 2.5 cups

 Ages 9 to 13: Daily guidelines for girls

Ages 9 to 13: Daily guidelines for girls

Calories 1,400-2,200, depending on growth and activity level

Protein 4-6 ounces

Fruits 1.5-2 cups

Vegetables 1.5-3 cups

Grains 5-7 ounces

Dairy 3 cups
 Ages 14 to 18: Daily guidelines for girls

Ages 14 to 18: Daily guidelines for girls

Calories 1,800-2,400, depending on growth and activity level

Protein 5-6.5 ounces

Fruits 1.5-2 cups

Vegetables 2.5-3 cups

Grains 6-8 ounces

Dairy 3 cups
 Ages 14 to 18: Daily guidelines for boys

Ages 14 to 18: Daily guidelines for boys

Calories 2,000-3,200, depending on growth and activity level

Protein 5.5-7 ounces

Fruits 2-2.5 cups

Vegetables 2.5-4 cups

Grains 6-10 ounces

Dairy 3 cups