facilitate physical and mental development.
On the
WEEK 5: NUTRITION ACROSS THE
LIFESPAN (PREGNANCY, INFACY,
TODDLER AND PRE-SCHOOL
LECTURE MODULE
TERMINOLOGIES
🦖 remainder of childhood years.
• DAWDLING - to spend time wastefully on eating,
the child is playing while eating
• LACTATING WOMEN - women who are pregnant or
recently gave birth, lactation is normal with the
process of producing breast milk.
• NEWBORN SCREENING ACT - – illustrates a
procedure to detect a genetic and metabolic
disorder in newborns that may lead to mental
retardation and even death if left untreated.
• SUPPLEMENTARY FOODS - refer to the food that is
used to complement breast milk or the food that
complements and / or supplements other foods
used during weaning period.
• TOXEMIA OF PREGNANCY - – a condition in
pregnancy, also known as preeclampsia
characterized by abrupt hypertension (a sharp rise
in blood pressure), albuminuria (leakage of large
amounts of the protein albumin into the urine) and
edema (swelling) of the hands, feet, and face.
• TOTAL ENERGY REQUIREMENT - is the average
dietary energy intake that is predicted to maintain
energy balance in healthy, normal weight
individuals of a defined age, gender, weight, height,
and level of physical activity consistent with good
health
• "Nutrition through the Life Cycle: From Pregnancy
to the Pre-school Years", all people need the same
basic nutrients—essential amino acids,
carbohydrates, essential fatty acids, and
twenty eight vitamins and minerals—to maintain
life and health. However, the amounts of needed
nutrients change as we pass from one stage of the
human life cycle to the next. Young children require
a higher caloric intake relative to body size to
Page 1 of 12 NCMA 215 WEEK 5
other hand, inactive senior citizens need fewer
calories than other adults to maintain their weight
and stay healthy. Psychological, emotional, and
social issues over the span of a human life can also
influence diet and nutrition. Therefore, it is
important to weigh a number of considerations
when examining how nutrient needs change. In this
course unit, we will focus on diet, nutrition, and the
human life cycle from pregnancy to the the
A. NUTRITION IN PREGNANCY AND LACTATION
• Nutrition is what the pregnant women eat and how
the body uses it to maintain life by allowing one to
grow and be in state of optimum health. It ensures
optimum nutrition before, during and after
pregnancy and during lactation. The characteristics
of pregnancy started from the fertilization of ovum
and implantation in the uterus; human pregnancy
lasted for a period of 266 to 280 days (37-40 weeks);
consists of three trimesters and has three main
phases – implantation, organogenesis, growth
• In Nutrition in Pregnancy, the nurse always starts
with diet history when it comes to giving nutritional
instruction to the mother. Ask for any PICA –
persistent ingestion of inedible substances of little
nutritional value. If the pregnant mother is
vegetarians – there will be lack of essential protein
and minerals, need Vitamin B12 supplementation.
The calories requirements for non-pregnant
requirements is 1,800 to 2,200 Kcal/day with
additional caloric requirement per day is 300
Kcal/day for pregnant mother and 500/day for
lactating mother, and the usual daily caloric need in
pregnancy – 2,100 to 2,500; never less than 1,800
Kcal/day. Even an obese pregnant woman can never
consume less than 1,500 kcal per day. The
nutritional requirements for lactating women are
greater than in pregnancy to ensure enough supply
of milk for the baby. Weight is the most indicator if
the woman has adequate caloric intake. for The
nurse weighs the mother every clinic visits with 1 lb
per month during the first trimester and 1 lb per
week during the second and third trimester
increasing per visit and the usual maternal weight
gain is 24 to 35 lbs. The maternal underweight
causes having high risk of low birth weight, preterm
Annotated by: C. Danting
 and infant deaths while the maternal over weight
causes having risk of complications in labor and
delivery, hypertension, gestational DM, post
partum infections. The pregnant must have a
protein allowances and needs to serve body-
building foods. The nurse can provide additional 30
g/day of protein to ensure 74 to 76 g/day intake.
The nurse can give the pregnant mother with rich
food sources includes milk, meat, fish, poultry, eggs
and legumes. This provides for the storage of
nitrogen, protects the mother from any
complications, for healthy growth of maternal
uterus, mammary tissues and placenta, needs for
fetal growth and repair and hormonal preparation
for lactation.
• There must be sufficient intake of carbohydrates
necessary for added energy and avoid “empty”
calories like soft drinks, fiber can be taken from
fruits and vegetables to prevent constipation. Nurse
can also recommended fats - high energy foods for
absorption of vitamins ADEK and avoid too much
fats to prevent vomiting and heartburn. Iron is the
most important mineral that must be taken in
supplementary amount which is 30-60mg per day to
prevent iron deficiency anemia and needed to
increase maternal RBC and for fetal liver storage in
the third trimester.
• Calcium needs for maternal calcium and
phosphorous metabolism and fetal bone and
skeletal growth which is 1,200 mg/day, equivalent
to 1 quart of milk a day (4 glasses). Provide sodium
which is most abundant cat-ion in extracellular fluid
needed for tissue growth and development and
should not be restricted without serious indications.
Folic acid is for production of blood products and
prevents fetal anomalies and neural defect. Iodine
is needed for fetal development and avoid
cretinism. Pregnant mother can also provide
vitamins – water and fat soluble vitamins. Vitamin A
can be given to pregnant mother with a preparation
of 10,000IU a dose of 1 capsule twice a week
starting from 4th month of pregnancy until delivery
and never be given on the first trimester to prevent
any complications from the baby. Post-partum
women can be given 200,000 IU 1 capsule within 4
weeks after delivery. Vitamin 9 can be also
prescribed for pregnant women 60 mg iron/400
mcg folic acid 1 tablet once a day for 6 months or
Page 2 of 12 NCMA 215 WEEK 5
180 days during the pregnancy period and lactating
women 60 mg iron/400 mcg folic acid 1 tablet once
a day for 3 months or 90 days.
• Aside from the vitamins, minerals can also be given
to pregnant women with phosphorous by eating
high amount of protein for skeletal fetal skeleton
and tooth formation. Provide iodine of 175
microgram daily during pregnancy with Iodized salt
and serving of seafood at least once a week for
essential for formation of thyroxine and zinc 15 mg
necessary for the synthesis of DNA and RNA.
• Some complication of pregnancy with dietary
modifications are (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; and (8)
alcohol, caffeine and nicotine.
B. NUTRITION IN INFANCY
• Early childhood encompasses infancy and the
toddler years, from birth through age three. The
remaining part of childhood is the period from ages
four through eight and is the time when children
enter school. A number of critical physiological and
emotional changes take place during this life stage.
• Infancy refers to a person not more than 12 months;
weighs 2.7 to 3.2kg (6 to 7 lbs); measures 48 to 50
cm (19-20 inches) in length; skin is moist, elastic and
not wrinkled; doubled the birth weight at 6 months;
tripled the birth weight at 12 months; meet the oral
needs of the infant (psychosexual-Freud’s Theory);
provide safe and washable toy such as pacifier;
remove small objects that the infant can choke on;
burp the baby after each feeding to prevent colic;
alone in playing (solitary); sucking gives
gratification.
• If the baby is vaginal delivery, breastfeeding may be
done as early as 30 minutes after birth and CS
delivery breastfeeding be done 4 hours after
delivery. Demand feeding is the best rule to observe
when feeding the baby. The mother must practice
exclusive breastfeeding for the first 6 months.
When doing breastfeeding, the mother should
provide a relaxed, warm and supportive
environment as the letdown reflex is affected by
negative emotions of the mother. Provide
reinforcement for positive behavior or successful
actions.
Annotated by: C. Danting
• The following are the benefits of breastfeeding to
the mother:
o (1) Promotes maternal-infant bonding;
o (2) Promotes uterine contraction and
provided less incidence of
thrombophlebitis;
o (3) Reduces rate of ovarian cancer and
premenopausal breast cancer;
o (4) Decreases maternal morbidity and
mortality;
o (5) Save time, money, effort and
economical;
o (6) Delays fertility; and
o (7) Provide social and economic benefits;
• while the benefits for the baby are:
o (1) Promote attachment;
o (2) Provide perfect food that contains all
necessary nutrients;
o (3) Easily digested, has the right
temperature and free from harmful
bacteria;
o (4) Provides passive antibody transfer to
the newborn;
o (5) It has colostrums, high protein content
contains antibodies which help resist
infection;
o (6) Causes fewer incidences of allergies,
vomiting, diarrhea, constipation and
aspiration;
o (7) Enhances brain development because of
taurine content; and
o (8) Decreases infant morbidity and
mortality.
• Breast milk is higher in CHO, fat and water content
but lower in protein, vitamins and minerals. It has
lactalbumin – human milk protein which is easy to
digest and hypoallergenic and cow’s milk protein
called casein causes allergy. Breast milk is higher in
lactose than cow’s milk.
• The following are breastfeeding misconceptions
that every lactating woman should know like:
o (1) A mother sick with PTB cannot
breastfeed;
o (2) Breast milk is not good if the mother has
stayed long under the sun;
o (3) A mother cannot breastfeed during
pregnancy;
Page 3 of 12 NCMA 215 WEEK 5
o (4) A mother cannot breastfeed with only
one breast if the other breast is painful;
o (5) A mother cannot breastfeed if she has a
cold, flu or diarrhea; and
o (6) Breast milk is not good if the mother has
been caught in a sudden shower.
• Breastfeeding contraindications are:
o (1) Breastfeeding may not be advisable
when mother has syphilis, AIDS, DM or any
severe infections;
o (2) Breastfeeding is not encouraged when
the mother is under emotional and mental
stress;
o (3) Mother who smokes;
o (4) Mother who takes contraceptive pills or
drugs;
o (5) Other contraindication includes
metabolic abnormalities or severe
prematurity of the newborn which require
the use of special therapeutic formulas.
• Some of the factors affecting milk secretion are diet,
nutritional state of the mothers, emotional and
physical state of the mother, sucking of the baby
and use of contraceptives and drugs
• The daily caloric requirement of infant is 1200
Kcal/day (100-115 kcal/kg/day). The diet is
breastfeeding / breast milk is best be given until 18
months to 2 years of age; can be given with bottle
feeding, considered as artificial feeding with cow’s
milk, costly, associated with infantile obesity or
“protein-calorie malnutrition plus”, or can be mixed
feeding which is complemented with insufficient
supply of breast milk and supplemented if the
mother is away from home for feeding
• The feeding time being practice by the mother are
if the baby weighs 5 to 2.7 kg baby usually feeds
every 3 hours (8 feedings); 6 to 4 kg baby usually
feeds every 4 hours (6 feedings) and 2 to 3 months
old, the baby is on 4 to 5 feedings, the baby sleeps
through The night after 10 pm feeding. Weaning can
be done 6 months from breast to bottle and 12
months: bottle to cup
• The supplementary foods of the infant begins at 2
months with liquids like rice water, calamansi juice
may be introduced depending upon infant’s
tolerance and acceptance; then when the infant
reaches 4 months be given with first solid foods (rice
cereals). Then for the 5th to 6th months – teething
Annotated by: C. Danting
 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; at 7-8
months – foods are mashed or chopped finely, not
strained to teach mastication, soft cooked egg with
rice porridge, boiled fish, banana and camote mash
and the like; at 9-12 months – whole tender foods
or foods chopped coarsely are given, finger foods
like cottage cheese, crackers, plain meats and egg
yolks
• There are foods that needs to avoid by the mother
and be given to the infant in the first year of life such
as honey that causes clostridium botulinum leading
to infantile poisoning; choking hazards like hotdogs,
grapes, hard candies, raw carrots, pop corns, nuts,
peanut butter; insufficient calories like skim milk
and potential allergen like cow’s milk and egg
whites.
• The following cues that the mother should know for
the infant has readiness to take solids like:
o (1) sucking reflexes is intact;
o (2) ability to sit with support;
o (3) avoid feeding an infant lying supine to
prevent aspiration;
o (4) present salivary glands and intestinal
enzymes that aids in digestion;
o (5) fetal iron reserve in the liver usually
consumed by 4-6 months.
• When the mother is trying to introduce
supplemental foods, there must be rules to follow
such as:
o (1) introduce one food at a time;
o (2) show pleasure when giving new food at
the same time, make gesture;
o 3) give a small amount (1 tsp) at a time;
o (4) offer bland foods to the baby (not too
salty, not too sweets);
o (5) do not mix with formula;
o (6) feed when newborn is hungry after a
few sucks of milk to increase his patience
for a new food;
o (7) never start two new foods at the same
time; (8) allow an interval of 4-7 days
between new foods; (9) feed baby only with
freshly-cooked foods or fruits freshly
peeled. Avoid giving left-over foods to
Page 4 of 12 NCMA 215 WEEK 5
babies and (10) do not bribe, plead,
threaten or force the infant.
• The common disorders among infants are diarrhea
which is the most frequently caused by bacteria and
viruses; vomiting; allergy in infant with milk
intolerance; constipation and colic which is the
most common. Some metabolic health problems
with infancy like Galactosemia, Phenylketonuria
(PKU), Maple Syrup Urine Disease (MSUD), and
Congenital Hypothyroidism that can be screen with
Newborn Screening Act (RA 9288).
C. NUTRITION IN CHILDHOOD
• Toddler is a period of life from 1-3 years old;
• with daily caloric requirement of 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; experience temper tantrum; mother can offer
choices; diet preference unpredictable but able to
feed self; dental examination at 2-3 years (2y/o -16
3y/o -30); safety is priority; with no-no-no attitude;
ensures increase Calcium, Phosphorus and Ferrous;
elimination training (bladder training and bowel
training); drinks 16-24 oz milk/day; experience
separation anxiety; autonomy versus shame and
doubt; parallel play; performs rituals, routines and
dawdling; accident – prone; involve parents in child
care; sibling rivalry; and explain procedures
• Nutrition is important at every age. The children
need proper nutrients stay healthy and strong, and
grow up healthy and strong. Nutrition for children
can also help establish a foundation for healthy
eating habits and nutritional knowledge that the
child can apply throughout life. The toddlers require
to be fed every two to three hours or five to six
meals in a day. The nutrient allowances for toddlers:
Calories – determined by his age, activity and BMR;
Protein – 1.5 to 2 gm/kg of body weight is required;
Vitamins and minerals – essential for growth and
development; and total fluid requirements is 4-6
glasses, 1 to 1.5 liters/day. It is important to avoid
foods that may cause choking such as slippery foods
such as whole grapes; large pieces of meats,
poultry, and hot dogs; candy and cough drops; small
and hard foods such as nuts, seeds, popcorn, chips,
pretzels, raw carrots, and raisins; and sticky foods
such as peanut butter and marshmallows.
Annotated by: C. Danting
• Nutrition in Pre-school is period from 3-6 years old;
larger 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; 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; fear of mutilation,
abandonment and dark; associative play; growth
rate is slow and erratic; initiative versus guilt; no
new teeth develops; appetite is not large; oedipal
and electra complex; needs explanation; and seen
pleasures on touching of genitals.
• Good nutrition – is important during pre-school
years, needs adequate food for growth and builds
his body, gives plenty of energy for play, helps him
to fight common infections, helps keep the child
healthy, happy and physically fit as well as mentally
alert. The toddlers require to be fed every two to
three hours or five to six meals in a day. The nutrient
allowances for toddlers: Calories – determined by
his age, activity and BMR; Protein – 1.5 to 2 gm/kg
of body weight is required; Vitamins and minerals –
essential for growth and development; and total
fluid requirements is 4-6 glasses, 1 to 1.5 liters/day.
The pre-school kids need about four meals in a day.
• The feeding problems with pre-school are:
o (1) child is eating too little;
o (2) child is eating too much;
o (3) child is dawdling during mealtime;
o (4) child is gagging especially when fed
course foods;
o (5) child has aversion towards some foods;
and child has allergies.
• The fluid need of the young children is water which
is good for thirst. Too much fruit juices may cause
diarrhea and may reduce child’s appetite for foods.
Sodas are not suitable for the children. Teas and
coffee reduce iron absorption. A small drink will
satisfy a child’s thirst during meals. A non breastfed
child (6-24 months) needs 2-3 cups of water in a
temperate day or 4-6 cups in a hot climate.
The computation for total energy requirement
Page 5 of 12 NCMA 215 WEEK 5
TER = 1000 + (100 x no. of years).
• For example, if the age of a child is 6 years old so the
computation will be:
TER = 1000 + (100 x 6) = 1,600 kcal/per day
• which is around the normal range of childhood TER
which is 1,300-1,400 for toddler and 1,700-1,800 for
pre-school
NUTRITION AND PREGNANCY
PPT
PREGNANCY AND LACTATION
• It ensures optimum nutrition before, during and
after pregnancy and during lactation
CHARACTERISTICS OF PREGNANCY
• fertilized ovum implants itself to the uterus
• human pregnancy lasted for a period of 266 to 280
days (37-40 weeks)
• consists of three trimesters
• has three main phases – implantation,
organogenesis, growth
NUTRITION IN PREGNANCY
• Always start with diet history when it comes to
giving nutritional instruction to the mother.
• PICA – persistent ingestion of inedible substances of
little nutritional value
• Vegetarians – lack essential protein and minerals,
need Vitamin B12 supplement
CALORIE ALLOWANCES
• Non-pregnant requirements – 1,800 to 2,200
Kcal/day
• Additional caloric requirement per day – 300
Kcal/day
• Usual daily caloric need in pregnancy – 2,100 to
2,500; never less than 1,800 Kcal/day
• Maternal weight gain – 25 to 35 lbs
• Maternal under weight causes having high risk of
low birth weight, preterm and infant deaths
• Maternal over weight causes having risk of
complications in labor and delivery, hypertension,
gestational DM, post partum infections.
Annotated by: C. Danting
 PROTEIN ALLOWANCES WEIGHT GAIN

• body-building food • 11. 2 – 16 kg (25 – 35 lb)

• additional 30 g/day to ensure 74 to 76 g/day • recommended as an average weight gain in
• Rich food sources includes milk, meat, fish, poultry pregnancy
and eggs • 1 lb per month during FIRST trimester
• provide for the storage of nitrogen • 1 lb per week during 2nd and 3rd trimester
• protect the mother from any complications • 3 – 12 -12
• growth for maternal uterus, mammary tissues and
CALORIE NEEDS
placenta
• needs for fetal growth and repair • 2,200 women in childbearing age
• hormonal preparation for lactation • + 300 in pregnancy = 2,500 calories
• ↓ CHO INTAKE ↑ CHON BREAKDOWN
CARBOHYDRATES
• Mother – Ketoacidosis
• Sufficient intake is necessary for added energy • Fetus – deprivation of essential CHON –
• Avoid “empty” calories like soft drinks • Neurologic defects, Death
• Even an OBESE pregnant should never consume
FATS
LESS than 1,500 calories per day.
• high energy foods for absorption of vitamins ADEK • Weight is the most accurate indicator if the woman
• AVOID too much fats to prevent vomiting and has adequate caloric intake
heartburn
PROTEIN NEEDS
IRON
• 44g – 46g women in childbearing age
• most important mineral that must be taken in • 60g in pregnancy
supplementary amount
• supplementary in pregnancy is 30-60mg per day • Iron
• needed to increase maternal RBC and for fetal liver • B complex especially B12
storage in the third trimester • Calcium
• Phosphorus
CALCIUM

• needed for maternal calcium and phosphorous

metabolism and fetal bone and skeletal growth • Cholesterol
• 1,200 mg/day, equivalent to 1 quart of milk a day (4
glasses)

SODIUM
VITAMIN NEEDS
• most abundant cation in extracellular fluid
VITAMIN A
• needed for tissue growth and development
• should not be restricted without serious indications TARGET PREP DOSE DURATIO REMARKS
N
IODINE Pregna 10,000 1 Start NOT give if
• needs for fetal development and avoid cretinism nt IU capsul from 4th woman is
Women e month taking
VITAMINS (10,00 of micronutrie
0 IU) pregnan nt
• water and fat soluble vitamins TWICE cy until supplement
a delivery s with
week Vitamin A
Page 6 of 12 NCMA 215 WEEK 5 Annotated by: C. Danting
 Post- 200,00 1 1 dose NOT given 60 mg – CHN
partum 0 IU capsul within 4 to (DOH)
Women e weeks PREGNANT
200,00 after women Zinc 15 mg Necessary for
0 IU delivery the synthesis of
DNA and RNA
Pregna 10,000 1 4 weeks Can be
nt IU capsul upon GIVEN
women e diagnosi regardless
with Once a s of AOG if DISCOMFORTS
Night day the woman NAUSEA AND VOMITING
blindne has
ss nightblindn • Eat dry crackers before rising in bed
ess • High CHO, Low FAT diet
• Small frequent feedings
• NEVER self medicate esp. antacids
VITAMIN B9 • Antacids contains Na -> Fluid retention -> Edema,
HPN
TARGET PREP DOSE DURATION REMARKS
Pregnant 60mg 1 6 months A dose of HEART BURN (PYROSIS)
Women iron/ tablet or 180 800 mcg
400mcg Once days folic acid • Small frequent meals
folic a day during is still • Don’t lie down immediately after eating
acid pregnancy SAFE to a • Amphojel (Aluminum hydroxide) or Maalox may be
period pregnant prescribed
woman • Maalox = Aluminum hydroxide + Magnesium
hydroxide
Lactating 60mg 1 3 months
Women iron/ tablet or 90 days COMPLICATIONS OF PREGNANCY AND DIETARY
400mcg Once MODIFICATIONS
folic a day
1. Morning Sickness
acid
2. Rapid weight gain or loss
3. Toxemia of Pregnancy
4. Anemia
MINERAL NEEDS 5. Gestational DM
6. Constipation
Calcium, Ca : 1,200 – For fetal
7. Socio-economic and cultural factors
Phosphorus 1,500 mg skeleton and
Phosphorus – teeth formation 8. Alcohol, caffeine and nicotine
eat HIGH CHON NUTRITIONAL REQUIREMENTS FOR LACTATING
MOTHERS
Iodine 175 ug daily Essential for
during formation of • the nutritional requirements in lactation are greater
pregnancy thyroxine than in pregnancy to ensure enough supply of milk
Iodized salt for the baby.
Serving of • Mother’s milk is the best food for baby (Executive
seafood at least
Order 51)
once a week
o If vaginal delivery – breastfeeding may done
as early as 30 minutes after birth
Iron 30 mg - OB Prevents IDA in
(Piliteri) pregnancy o If CS delivery – 4 hours after delivery

Page 7 of 12 NCMA 215 WEEK 5 Annotated by: C. Danting

• 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. Provide
reinforcement for positive behavior or successful
actions.
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 and economical
• Delays fertility
• Provide social and economic benefits
• 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
BREASTFEEDING CONTRAINDICATIONS
• Breastfeeding may not be advisable when mother
has syphilis, AIDS, DM or any severe infections.
• Breastfeeding is not encouraged when the mother
is under emotional and mental stress.
• Mother who smokes.
• 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.

BREASTFEEDING BENEFITS FOR THE BABY FACTORS AFFECTING MILK SECRETION

• Promote attachment • Diet

• Provide perfect food that contains all necessary • Nutritional State of mothers
nutrients • Emotional and Physical State
• Easily digested, has the right temperature and free • Suckling
from harmful bacteria • Use of contraceptives and drugs
• Provides passive antibody transfer to the newborn
• It has colostrums, high protein content contains
antibodies which help resist infection CHILD HEALTH PROGRAMS
• Causes fewer incidences of allergies, vomiting, (NEWBORNS, INFANTS, CHILDREN)
diarrhea, constipation and aspiration.
INFANT AND YOUNG CHILD FEEDING
• Enhances brain development because of taurine
content • Newborn Screening
• Decreases infant morbidity and mortality • EPI
• IMCI
ADVANTAGES OF BREAST MILK THAN COW’S MILK
MICRONUTRIENT SUPPLEMENTATION
• Breast milk is higher in CHO, fat and water content
but lower in protein, vitamins and minerals. • Dental Health
• It has lactalbumin – human milk protein – easy to • Early Child Development
digest and hypoallergenic and cow’s milk protein • Child Health Injuries
called casein causes allergy
• Breast milk is higher in lactose than cow’s milk. INFANT AND YOUNG CHILD FEEDING

BREASTFEEDING MISCONCEPCTIONS • Initiate breastfeeding WITHIN 1 HOUR after birth

• EXCLUSIVE BREASTFEEDING for the first 6 months
• A mother sick with PTB cannot breastfeed. • COMPLEMENTARY FEEDING for age 6 months up to
• Breast milk is not good if the mother has stayed long 2 years or beyond.
under the sun o Timely
• A mother cannot breastfeed during pregnancy o Adequate
Page 8 of 12 NCMA 215 WEEK 5 Annotated by: C. Danting
 o Safe
o Properly fed
• DIET - breastfeeding / breast milk is best be given
until 18 months to 2 years of age
• BOTTLE FEEDING - artificial feeding with cow’s milk,
costly, associated with infantile obesity or “protein-
calorie malnutrition plus”
• MIXED FEEDING
o COMPLEMENTED - insufficient supply of
breast milk
o SUPPLEMENTED - mother is away from
home for feeding
TWO METHODS OF FORMULA PREPARATION
• ASEPTIC METHOD – equipments and ingredient are
sterilized separately
• TERMINAL METHOD - formulas are poured into
clean but unsterilized bottles and are sterilized
together
• WEANING: 6 months: Breast to bottle; 12 months:
bottle to cup
FEEDING TIME
• 2.5 to 2.7 kg baby usually feeds every 3 hours (8
feedings)
• 3.6 to 4 kg baby usually feeds every 4 hours (6
feedings)
• 2 to 3 months old, the baby is 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
• 4 months – first solid foods (rice cereals)
• 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 camote
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
Page 9 of 12 NCMA 215 WEEK 5
• Sequence of introducing solids
o cereal, fruit, vegetable, meat, fish
• Foods to avoid in the first year of life
o Infantile poisoning – honey (clostridium
botulinum)
CHOKING HAZARDS
• hotdogs, grapes, hard candies, raw carrots, pop
corns, nuts, peanut butter
• Insufficient calories - skim milk
• Potential allergen – cow’s milk, egg whites
CUES TO READINESS TO SOLIDS
• Sucking reflexes is intact
• Ability to sit with support
• Avoid feeding an infant lying supine to prevent
aspiration
• Present salivary glands and intestinal enzymes that
aids in digestion
• Fetal iron reserve in the liver usually consumed by
4-6 months
RULES TO FOLLOW HEN INTRODUCING SUPPLEMENTAL
FOODS:
• Introduce one food at a time
• Show pleasure when giving new food at the same
time, make gesture.
• Give a small amount (1 tsp) 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 or force the infant
COMMON DISORDERS:
• Diarrhea – most frequently caused by bacteria and
viruses
• Vomiting
• Allergy – milk intolerance
• Constipation
Annotated by: C. Danting
• Colic – most common Children 200,000 IU 1 capsule every
(21 – 71 6 months
HEALTH PROBLEMS WITH INFANCY: months)
• Galactosemia
• Phenylketonuria (PKU) IRON
• Maple Syrup Urine Disease (MSUD) Infants Drops: 0.6 ml once a
(6-11 months) 15 mg iron /0.6 day for 3
FLUID NEEDS OF THE YOUNG CHILD
ml months
• WATER is good for thirst. Children Syrup: 1 tbsp once a
• Too much FRUIT JUICE may cause diarrhea and may (1-5 years old) 30 mg iron /5 day for 3
reduce child’s appetite for foods ml months
Adolescent Tablet: One table once
• SODAS are not suitable
Girls 30 mg iron with a day
• TEAS and COFFEE reduce iron absorption.
400 mcg folic
• A SMALL DRINK will satisfy a child’s thirst during acid
meals
• A non breastfed child (6-24 mons) needs 2-3 cups of
water in a temperate day or 4-6 cups in a hot IODINE
climate Children of Iodized oil 1 capsule for 1
school age capsule with year
FEEDING THE CHILD WHO IS ILL 200 mg iodine
• Encourage to eat and drink with lots of patience
Adult Iodized oil 1 capsule for 1
• Feed small amounts frequently capsule with year
• Give food that the child likes 200 mg iodine
• Give a variety of nutrient rich foods
• Continue to breastfeed

NUTRITION PROGRAM • GLUCONEOGENESIS

o converting protein (glucogenic amino acids)
• COMMON NUTRITIONAL DEFICIENCIES
to carbohydrates a release of cortisol, the
o Vitamin A
so called "stress" hormone.
o Iron
• GLYCOGENESIS
o Iodine
o formation of glycogen to glucose
• MACROUTRIENT SUPPLEMENTATION
• GLYCOGENOLYSIS
o Araw ng Sangkap Pinoy / Garantisadong
o breakdown of glycogen to glucose; The
Pambata / Child Health Week – twice a year
process is caused by the hormones
distribution of Vitamin A capsule.
glucagon and epinephrine which stimulate
• FOOD FORTIFICATION (RA 8976)
glycogenolysis and which are produced in
o mandatory fortification of staples: (flour,
response to low blood glucose levels. It
cooking oil, refined sugar, rice and
takes place in the muscle and liver tissue
processed foods) through SANGKAP PINOY
which is where glycogen is stored.
Seal
TOTAL ENERGY REQUIREMENT
VITAMIN A
Infants 100,000 IU 1 dose only • Carbohydrates (CHO)
(6-11 months) usually given o 50 to 70 %
with measles at • Protein (CHON)
9 months o 10 to15 %
• Fats (CHO with glycerol base)
o 20 to 30%
Page 10 of 12 NCMA 215 WEEK 5 Annotated by: C. Danting
 NUTRITIONAL GROWTH AND DEVELOPMENT
INFANTS
• refers to a person not more than 12 months
• remove small objects that the infant can choke on
• burp the baby after each feeding to prevent colic
• daily caloric requirements: 1200 Kcal/day
• 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 at 6 months
• Sucking gives gratification
• Length X 50% at 1 year
• Only mother as significant others
• Estranger Anxiety around 6-8 months
• Stands alone at 12 months
• Trust vs Mistrust
• Pincer grasp at 10th month
• Lower incisors erupt before upper incisors
• Allow cruising at 12 months
• Yells (cries) without parents (parent preference)
TODDLERS
• 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 (2y/o -16 3y/o -30)
• Safety is priority
• No Attitude
• Ensures increase Ca, P and Fe
• Elimination training (bowel training)
• Drinks 16-24 oz milk/day
• Separation anxiety
• Autonomy vs shame and doubt
• Parallel play
• Rituals, routines and dawdling
• Accident – prone
Page 11 of 12 NCMA 215 WEEK 5
• Involve parents in child care
• Sibling rivalry
• Explain procedures
PRESCHOOLERS
• 3-6 years old
• larger 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
• 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
• Grow rate slows and erratic
• Initiative vs guilt
• No new teeth develops
• Appetite is not large
• Oedipus and electra complex
• Needs explanation
• Seen pleasures on touching of genitals
• GOOD NUTRITION
o is important during pre-school years, needs
adequate food for growth and builds his
body, gives plenty of energy for play, helps
him to fight common infections, helps keep
the child healthy, happy and physically fit as
well as mentally alert.
FEEDING PROBLEMS (CAUSES AND REMEDIES)
• Child is eating too little.
• Child is eating too much.
• Child is dawdling during mealtime.
• Child is gagging especially when fed course foods.
• Child has aversion towards some foods.
• Child has allergies.
Annotated by: C. Danting
 CYSTIC FIBROSIS GALACTOSEMIA

• Mucus produced by the exocrine glands is • An inborn error of CARBOHYDRATE metabolism

abnormally THICK causing obstruction to small • Galactose 1-phosphate uridine transferase is absent
passageways of affected organs o Enzyme necessary for conversion of
GALACTOSE to GLUCOSE
COMMON PROBLEMS
DIETARY MANAGEMENT
• Pancreatic enzyme deficiency
• Chronic lung diseases • Eliminate ALL milk and lactose containing foods
• High Na and Cl SWEAT concentration including BREASTMILK
• Infant tastes SALTY when kissed • Avoid PENICILLIN because it contains lactose as filler
•
DIETARY MANAGEMENT

• 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

CELIAC DISEASE

• Intolerance to GLUTEN, the protein component of

Barley, Rye, Oat, Wheat

COMMON PROBLEMS

• Accumulation of amino acid GLUTAMINE is toxic to

intestinal mucosal cells

DIETARY MANAGEMENT

• Gluten FREE Diet

• Foods allowed:
o RICE, CORN, Meat, Dairy products
• Not Allowed: BROW
• Pudding, Breads, Cookies, Cakes, Crackers, Cereals,
Noodles, Beer and Ale

PHENYLKETONURIA

• Genetic disorder that results in CNS damage from

toxic levels of phenylalanine in the blood

DIETARY MANAGEMENT

• LOFENALAC
• Avoid high CHON – meats and dairy products
• Breastmilk contains LOW phenylalanine levels

Page 12 of 12 NCMA 215 WEEK 5 Annotated by: C. Danting