INFANCY

ENRIQUEZ R. CAYABAN, RN, LPT, MAN

Instructor
 Objectives

• Identify the nutritional requirements for infants;

and
• Come up with their own versions of
complementary foods for infants which are both
nutritious and affordable.

ERC/2020
 INFANCY

• The term infant refers to a person not more than 12 months of

age.
• A healthy full-term infant weighs 2.7 to 3.2 kg (6 to 7 lbs) and
measures 48 to 50 cm (19 to 20 inches) in length.
• His/Her head circumference averages 35 cm (14 inches).
• His/Her skin is moist, elastic, and not wrinkled.

ERC/2020
 Nutritional Objectives

• 1. Provide nutritional base for rapid growth and

development of the child during the first year of
life
• 2. Establish the foundation for good food habits
and attitudes

ERC/2020
 NUTRITIONAL REQUIREMENT

• Calories
• The calorie requirements of the infant are high because the proportionately
larger skin surface leads to large heat loss.
• A rate of growth necessitates a considerable storage of energy for the
activity of the infant is great.
• The calorie needs of the infant increase from month to month.
• At birth, a baby requires about 350 to 500 calories, and
• in one year from 800 to 1,200 calories:
• 120 calories per kilogram body weight from the 2nd to the 7th month and
• 100 calories per kilogram from the 7th to the 12th month.
• The average requirement for growth in the first year is 50 calories, per
pound of expected weight, 2/3 of this amount of needed calorie, being
supplied by the milk and 1/2 by the added carbohydrates.
ERC/2020
 NUTRITIONAL REQUIREMENT

• Protein
• Allowances of 1.5 to 2.5g of protein per kg in the body weight
from 0 to 6 months of age, and 1.5 to 2 g per kg in the body
weight from 6 to 12 months of age are recommended by the
FAO/WHO Exert Group.
• In early infancy, milk from the mother, cow, or goat comprises
the only protein food.
• One and a half oz of cow's milk per lb body weight equals 1.5 g
of protein per lb, which equals 1/10 of the body weight. An
excess of protein is well-tolerated.

ERC/2020
 NUTRITIONAL REQUIREMENT

• Fats
• Whole cow's milk contains satisfactory levels of the essential
fatty acids, linoleic acid, and arachidonic acid required by the
infant. Vegetable oils such as corn, soybean, and cottonseed
oils are good sources.
• About 3% to 5% of fat is included when no specific amount is
stipulated. If the fats are restricted, a larger amount of
protein or sugar, or both, is required for energy sources. The
suitable quantity of fat is supplied in quantities of milk which
furnish the required amounts of proteins. An excess of fat is
not desired.
ERC/2020
 NUTRITIONAL REQUIREMENT

• Carbohydrates
• An allowance of 1/2 oz per lb of body weight which equals 1
oz per 10 oz of milk is prescribed, which also equals 1% of the
body weight.
• One-third of the carbohydrate should be derived from the milk
of the mixture, and the remainder added in the form of starch
or sugar.
• Later in the first year, the carbohydrate is given in the form of
a starch cereal, and the carbohydrate in the milk formula may
be reduced.

ERC/2020
 NUTRITIONAL REQUIREMENT

• Minerals
• During the first four months, liberal status of iron of the
healthy infant may suffice for the rapidly expanding blood
circulation, but thereafter, special emphasis must be placed on
the inclusion of iron-rich foods lest anemia will result.
• An adequate mineral-salt intake is supplied to any infant when
1 1/2 oz of milk per lb of body weight is given. Enough iron is
stored in the liver of the normal infant, sufficient until the 4th
or 5th month.
• This deficiency is usually overcome by the addition of solid
food supplements (egg yolk, fortified cereals, vegetables, and
fruits).
ERC/2020
 NUTRITIONAL REQUIREMENT

• Vitamins
• If the diet of a nursing mother is nutritionally adequate, the vitamins necessary for
the infant will be contained in the milk, with the exception of vitamin D and
possibly ascorbic acid. The same is true for cow’s milk except that ascorbic acid is
rarely sufficient. Therefore, it is desirable to administer tomato or orange juice very
early in life, regardless of whether the baby is breastfed or formula-fed.
• Vitamin B6 (pyridoxine) is essential in the diet of infants. Pyridoxine is destroyed
during sterilization in ratio to the degree of temperature and the length of the time
of the heat. Infants whose mothers received large doses of vitamin B during
pregnancy for treatment of nausea and vomiting may require more vitamin B6.
• Unnecessary and excessive vitamin prescription and ingestion are to be deprecated.
Infants given a daily dose of 2,000 IU of vitamin D achieve less growth than infants
receiving 135 IU and far less than those given 4.00 IU.
• Any normal infant ingesting 18 oz of cow's milk, or a comparable amount in a
bottled-fed milk food, or its equivalent of human milk (24 oz), receives all the
vitamin A and all the vitamin B fractions (including vitamin B12) needed for optimum
ERC/2020 growth.
 NUTRITIONAL REQUIREMENT

• Water
• The daily fluid needs of the infant are approximately 2.5 oz per lb
by weight.
• The requirement for water varies from 10% to 15% of the body
weight, or 1 ½ - 2 ½ oz per lb of body weight.
• The needs for the various nutrients, the requirement of which
increases with age, are met chiefly by the milk diet during the
first few months of life and later by the supplementary foods
included in the milk diet.

ERC/2020
FEEDING THE INFANT

• Infant feeding is dyadic in nature;

• it has nutritional, psychological and biological interaction between
the mother and her offspring with each one affecting the other.
• An infant may be:
• breastfed,
• bottle-fed or
• given combined breastfeeding and bottle feeding.
 Breastfeeding

Breastfeeding has physiologic and psychologic value for the mother and her infant.

Breast milk is clean.

Breast milk is easily digested.

Breast milk is non- allergenic.

Breastfeeding is beneficial to the health of the mother.

ERC/2020
 Considerations on Breastfeeding

• Breastfeeding may not be advisable when the mother has syphilis,

diabetes, AIDS, or any severe acute infections.
• It is not encouraged when the mother is under emotional and
mental stress or if another pregnancy follows.
• Mother who smoke heavily and who take contraceptive pills and
drugs should from breastfeeding.
• Other contraindications include metabolic abnormalities or severe
prematurity of the newborn which requires the use of special
therapeutic formulas.

ERC/2020
 Bottle Feeding

• Bottle feeding is feeding the infant with formula designed to match the
nutritional ratio of breast milk composition, diluted with water to
reduce protein and mineral concentration, and added with carbohydrate
to increase energy value.
• Bottle feeding may meet the needs of a working mother.
• Bottle or artificial feeding with cow's milk or other proprietary milk
preparations is recommended only when breastfeeding is
contraindicated.
• Artificial feeding is costly.
• Artificial feeding is associated with infantile obesity or "protein-calorie
malnutrition plus."

ERC/2020
 Mixed Feeding

• Mixed feeding is a combination of breastfeeding and bottle

feeding, with either one predominating.
• When bottle is given to complete a single breastfeeding because
of insufficiency of the mother’s milk, it is referred to as
complemented.
• The method is called supplemental when the bottle is used to
replace one or more breastfeeding sessions
• Mixed feeding, however, is not encouraged as it may lead to
lactation failure.

ERC/2020
 FORMULA PREPARATION (Two Methods)

Aseptic Method Terminal Method

• The equipment and ingredients are • The formulas are poured into clean
sterilized separately either by steam but unsterilized bottles and are
or by boiling water for at least 25 sterilized together.
minutes.
• The next step is to funnel the sterile
formula into sterile bottles, nippled,
and then capped.

ERC/2020
 Terminal Method

• Disadvantage: Scum formation can clog the nipple holes.

• a. All formulas (sterilized) are slowly cooled without shaking and
stored immediately in the refrigerator.
• b. Left-over formulas should not be used again or re-heated.

ERC/2020
 Feeding Time

• A baby weighing 2.5 to 2.7 kg usually feeds every 3

hours.
• A baby weighing 3.6 to 4 kg usually feeds every 4 hours.
• A two-month-old baby sleeps through the night after the
10 PM feeding.
• Between 2 to 3 months of age, a baby is on a 4 to 5
feeding schedule

ERC/2020
 Simple Tips to Help Infants Eat Better

• Beware of baby dinners or creamed products that contains

nutritionally incomplete refined startches.
• Drain off the syrup from canned fruits before serving. It is usually
rich in sugar- something the infant does not need.
• Watch the number of egg yolks the child consumes per week,
three or four egg yolks are a lot.
• If it is fine with the doctor, give the baby 2% low-fat milk instead
of whole milk. It contains substantially less fat.

ERC/2020
 Lugaw is a good food for the baby.

• a. Banana (especially ripe latundan at first), ripe papaya, ripe mango, and tiesa provide
a variety of nutrients for good health. Papaya, mango, and other citrus fruits like
dalanghita are good sources of vitamin C which the baby needs to keep gums healthy, to
prevent easy bruising, and to help the body fight infections
• b. Eggs, fish, meat, liver, munggo, soybeans, garbanzos, and peanuts are good body-
builders that will help make the baby grow faster and healthier, build strong muscles,
keep blood healthy, and give the body heat.
• c. Green leafy, and yellow vegetables like kamote tops, kangkong, malunggay, petsay,
carrot, and squash contain vitamins and minerals that the baby needs for good eyesight,
clear skin, glossy hair, and good growth. These vegetables also help keep away colds.
• d. Other vegetables like abitsuwelas, sitaw, and potatoes have added vitamins and
minerals that promote growth and make the body fit.
• e. other cereals like oatmeal, biscuits, and boiled root crops like mashed kamote, gabi,
etc. should likewise be included for more energy.

ERC/2020
 Supplementary Foods

Second Month - Liquids like rice water, vegetable water, or

kalamansi juice may be introduced depending on the infant's
acceptance and tolerance.
Fourth Month - Scraped banana or papaya or thin lugaw or
commercial cereal pop like Cerelac and Ceresoy may be given to the
4-month-old infant.
• Iron-rich foods like egg yolk, liver, meat, fish, and poultry must be
gradually introduced when iron stores are low.

ERC/2020
 Supplementary Foods

Fifth Month to Sixth Month - Full diet consisting of puréed meat, egg, fruit,
vegetables, and cereals can be introduced to the baby.
• • Weaning should take place. High calorie-high protein supplements are called
for.
• • When teething begins, chewy foods such as crackers and biskotso are given
not only to soothe the sensitive gums but also to teach the baby self-feeding.
Seventh Month to Eighth Month - Foods are chopped finely—not strained—to teach
mastication.
• • Examples are soft-cooked egg with rice porridge, soft-cooked rice with boiled
fish, munggo and leafy vegetables, misua soup with beaten egg, peanut-banana
mash, kamote cubes in meat broth, and mashed liver in green leafy vegetables.
Ninth Month to Twelfth Month - Whole tender foods or foods chopped coarsely are
given.

ERC/2020
 Tips on Giving New Foods

• 1. After the baby's 3rd month, test his/her readiness to accept new
foods by placing a teaspoon between the lips.
• a. If he/she tends to close his/her lips or push the teaspoon, away
continually, then the baby is not ready. Avoid forcing him/her to eat.
• b. But if the baby accepts the food from a teaspoon, give liquid or semi-
liquid food first. Begin with thin lugaw, move on to thicker lugaw, and
then add step-by-step mashed, chopped, and thinly sliced food as the
baby grows older.
• 2. Start any new food with 1/2 teaspoon on the first day and add as the
baby takes to new taste.

ERC/2020
 Tips on Giving New Foods

• 3. Never start two foods at the same time. Let the baby get used to a
new food about two or three days before trying him/her out on a new
one.
• 4. Show pleasure when giving a new food. This will make him/he: like to
eat a variety of foods.
• 5. Give water between feeds to provide enough liquid to remove waste
from his/her body and to help regulate bodily functions.
• 6. When the baby is about seven months of age, teach him/her drink
water and other liquids from a cup. By using a teaspoon and later a cup,
the use of a feeding bottle which is often source of a baby's infection
can be avoided.

ERC/2020
 Tips on Giving New Foods

• 7. Give finely-chopped foods when the baby starts teething.

Biskotso or any hard toast is also good at this time.
• 8. Offer bland foods to the baby.
• a. Highly salted foods may injure the kidneys.
• b. Too much sugar and sweets may develop in the baby strong
liking for these foods which may lead to tooth decay and obesity.

ERC/2020
 Tips on Giving New Foods

• 9. Handle baby's foods properly.

• a. Wash hands with soap and clean water before handling baby's foods.
• b. Dirty fingernails carry germs and eggs of worms which can cause worm
infestation.
• c. Use clean utensils and keep foods away from flies and insects.
• d. Boil liquids and cook all the baby's foods thoroughly.
• 10. Feed the baby only with freshly-cooked foods or fruits freshly-
peeled. Avoid giving him/her leftover foods.
• 11. If necessary, divide the recommended amount of supplementary
foods into several feedings during the day.

ERC/2020
 COMMON DISORDERS

Diarrhea

Allergy

Vomiting

Constipation

Colic

ERC/2020
 Diarrhea

• Diarrhea is most frequently caused by bacteria and viruses although both

overfeeding and underfeeding can also cause diarrhea.
• Rice water suffices for mild diarrhea but in case of dehydration,
parenteral and/or oral fluids should be given, such as "SI Oralyte, a
locally developed oral rehydrating therapy or Oresol, a pre-mixed oral
rehydration powder available in government health institution.
• In acute diarrhea, food can be given as early as 8 hours after the
beginning of rehydration.
• Breastfeeding should be maintained, with only a few hours interruption
during the early phases of therapy.
• As stool volume decreases, foods rich in protein are generally added like
banana (latundan) and guava.

ERC/2020
 Vomiting

• Vomiting is commonly seen in infants during the first few days.

• As in diarrhea, special attention must be given to fluid
replacement.
• Other modifications may include reducing the number of feedings,
acidifying milk, or making it a point to burp the infant after every
feeding.

ERC/2020
 Allergy

• Eczema is the most common sign of allergy in infants before 9

months of age.
• When protein of milk is the offending ingredients, it is referred to
as milk allergy.
• In lactose intolerance, the enzyme that hydrolyses the
carbohydrate lactose in milk into glucose and galactose is present,
increasing the gut fluid volume.

ERC/2020
 Constipation

• Infrequent bowel movements are not really the problem in infants

but the pain on the passage of stools, the inability to cornplete a
movement though the urge is strong, blood in the stools, and
involuntary soiling of clothes between movements.
• To overcome constipation, the following measures may be taken:
• 1. moderately restrict milk intake;
• 2. increase fruit, vegetable, and fluid intake;
• 3. change sugar in the formula to laxative brown sugar; and
• 4. check the reconstitution of milk formula.

ERC/2020
 Colic

• Colic is an acute paroxysm of pain, fussing, crying, and irritability

which lasts for 3 months.
• Causes are psychologic factors, maternal family tensions,
gastrointestinal hypermotility, and functional immaturity of the
central nervous system and the GI tract.
• Changing the formula may bring about some improvement but in
most cases.
• Physical measures such as providing a cozy and warm
environment, placing the baby prone on a hot water bottle, or a
drink of warm water may at times subdue paroxysm of crying.

ERC/2020
 INDICATIONS OF GOOD NUTRITION

Weight Gain
• A steady weight gain of 150 to 240 g/week that slows down and
the end of the first year to about 120 g/week is considered as
proper weight gain (doubled birth weight at the end of 5 months
tripled at the end of 1 year).
Length
• Baby length increases by about 25.4 cm or 50% more at the end
the first year.

ERC/2020
 INDICATIONS OF GOOD NUTRITION

Behavioral Development
• 0-1 month - suckles and smiles
• 2-3 months - vocalizes and controls head
• 4-5 months - controls hand and rolls over
• 6-7 months - sits briefly and crawls
• 8-9 months - grasps and pulls up
• 10-11 months - walks with support and stands alone
• 12 months - starts to walk alone

ERC/2020
 INDICATIONS OF GOOD NUTRITION

• Bowel movement - normal without green or red streaks

• Sleeping habits - regular
• Tooth formation - average
• Motor coordination - developing
• Muscles - firm and well-formed with moderate subcutaneous fat

ERC/2020
 THANK YOU

ERC/2020