Nutrition during infancy and early childhood

Nutrient needs of infancy reflect the rate of growth, energy expended in activity and basal
metabolic needs and the interaction of nutrients consumed. New borns receive needed nutrients
through breastfeeding or alternative feeding. Solid foods are usually not needed until after 6
months. Even when solids are added to the diet, breast milk or formula form the basis of an
infant’s diet until about 1 year of age. The nutrient needs of the infants differ from those of
adults in both amount and relative proportion.

Energy
Infants require 85-95 kcal/ kg body daily to supply them with adequate energy compared with
adults 40 kcal/kg body weight. At 6 months of age an infant weighing about 7 kg needs about
700 kcal of energy per day. Infants need an ease way to consume this amount of energy. The
basal and total energy requirements are higher than those of adults per unit body weight. The
composition of either breast milk or formula is ideal for meeting infant’s energy needs during the
first six months. Both are high in fat and supply about 650 kcal/ litre. After this initial period, the
use of solid food along with breast milk or formula can provide the additional energy as the
infant gets older. The energy needs of infants are driven by their rapid growth and high
metabolic rate. The high metabolic rate is caused in part by their high ratio of body surface area
to weight. More body surface allows more heat loss from the skin; therefore the body must use
extra energy to replace that heat.

Proteins
The RDA for protein in infancy ranges from 1.6 to 2.2 g/kg of body weight. This is required for
tissue growth and replacement. Over 40% of total protein intake should come from essential
amino acids. The recommendations are based on the composition of breast milk whereby it is
assumed that the mother’s milk is 100% utilized. Breast milk is adequate during the first 6
months and provides about 2.2 g of protein per kg body weight. During the next 6 months an
infant requires 1.6 g of protein kg body weight and between 1-3 years about 1.2 gm /kg body
weights. In the second 6 months of life the diet of infants should be supplemented with high
quality proteins.
Lipids
The RDA for fats is 3.8g/ 100 kcal (minimum) and a maximum of 6g/ 100kcal. This is
adequately presented in breast milk. Skimmed milk has a significantly low fat content. Essential
fatty acids such as linoleic acid should make up at least 3% of total energy intake. Fat is an
important part of the infant’s diet because it is energy dense and vital to the development of the
nervous system. Deficiency could lead to skin lesions, diarrhea and growth retardation.

Carbohydrates
Carbohydrates should supply 30 to 60% of the total energy intake during infancy. Lactose in
breast milk provides 37% of the kilocalories in breast milk.

Water
The water requirements are determined by the amount lost from the skin, lungs, faeces and urine
and the small amount needed for growth. Human milk supplies water in amounts adequate under
ordinary conditions. Additional water may be required if the weather is hot and humid and due to
losses such as during diarrhea and vomiting.

Calcium
An RDA of 400-800 mg/ day is recommended. Large percentage of calcium from breast milk is
retained by the infant. Rapid rate of calcification of bones is needed to support the weight of the
body by the time the baby walks. Inadequate intake of calcium leads to delayed motor
development.
Iron
Iron in breast milk is highly bioavailable. Iron stores of infants get depleted from 4-6 months.
There is need to introduce other iron rich foods after 6 months. Milk other than breast milk is a
poor source of iron and also has factors that inhibit absorption. The RDA for infants is set at 6
mg/ day.

Zinc
Zinc is necessary for growth and normal brain development. Breast milk provides adequate
amounts of zinc for the first year of life. The zinc content of breast milk is however dependent on
the mothers stores. Zinc is found in high amounts in the colostrums at 4 mg/ litre but reduces to
0.5 mg/litre at one year. The RDA is 5mg/ day for the first year and 10 mg/ day between 1-3
years.

Vitamins of special interest

Breast milk is an adequate source for all the vitamins with the exception of vitamin D. Vitamin D
is essential for the utilization of phosphorous and calcium and is obtained in great measures
through exposure to adequate sunlight. Deficiency of vitamin K may result in bleeding or
hemorrhaging disease of new borns. Breast milk contains 15 micrograms of vitamin K and it is
recommended that all formulas contain a minimum of 4 micrograms of vitamin K.

Complementary feeding
This is period of introducing solid foods into an infants diet. The time to introduce solid foods
hinges on four factors: physical readiness and willingness to participate in feeding process;
nutritional need; physiological readiness; and decreased risk of allergies to protein. Solid foods
should therefore not be introduced before 6 months of age. By this age most infants are ready to
expand their culinary horizons and the body can safely handle solid foods. Breastfeeding or use
of formula should be continued during this period.

Factors influencing when to introduce solid foods

To understand why solid foods are not appropriate for very young infants, lets look more at the
those factors that determine the best time to introduce solid foods.
 i) Physical ability and feeding skills take time to develop
The physical markers tha indicate that an infant is ready for solid foods include disappearance of
the extrusion reflex ( thrusting the tongue forward and pushing food out), head and neck control
and the ability to sit up with support.
ii) Nutritional needs
The nutritional needs hinges on iron needs. Infant iron stores are exhausted by about 6 months of
age. Breastfeed infants need solid foods to meet their iron needs.

iii) Physiological capabilities take time to develop

Before 3 months of age, infants cannot readily digest starch. Kidney function likewise is quite
limited until about 4 to 6 months of age. Until then waste products from high amounts of dietary
proteins or minerals are difficult to excrete.

iv) Reduced risk of allergic reactions to food proteins

An infant’s intestinal tract readily absorbs whole proteins from birth until 4 to 5 months of age.
Absorption of intact proteins during this period, especially proteins from cow’s milk and egg
white may predispose a child to future food allergies. As the intestinal tract develops, dietary
proteins are broken down in the stomach and small intestines into small dipeptides, aminos acids
that do not cause allergies.

Sequence for introducing complementary foods

Age in Food to be added

months
6 Iron fortified cereals, followed by other single grain cereals
Breast feeding
6-8 Mashed vegetables and fruits and their juices. Pureed vegetables and fruits,
one by one (perhaps vegetables before fruits, so that the baby will learn
their less sweet flavour.
Continue breast feeding.
8-10 Breads and cereals from the table. Soft, cooked vegetables and fruit from
the table. Finely cut meats, fish, chicken, cheese, casseroles, yoghurt, eggs
and legumes.
Continue breastfeeding
10-12 Continue to provide a variety of nutritive food.

Advantages of breast milk

i) stool easier to pass
ii) complex carbohydrates in breast milk protect infants from disease causing agents in the
intestines
iii) sialic acid, found in breast milk, is important in brain development
iv) Perfect nutrients
v) Easily digested;
vi) efficiently used
vii) Protects against infection
viii) Helps bonding and development
ix) Helps delay a new pregnancy
x) Protects mothers’ health
xi) Costs less than artificial feeding
xii) close, loving relationship between mother and baby
xiii) mother more emotionally satisfied
xiv) baby cries less
xv) baby may be more emotionally secure
xvi) children perform better on intelligence tests

Disadvantages of artificial feeding

i) Interferes with bonding
ii) More diarrhoea and persistent diarrhoea
iii) More frequent respiratory infections
iv) Malnutrition; Vitamin A deficiency
v) More allergy and milk intolerance
vi) Increased risk of some chronic diseases
vii) Obesity
viii) Lower scores on intelligence tests
ix) Mother may become pregnant sooner
x) Increased risk of anaemia, ovarian cancer, and breast cancer in mother