GROUP 4

NUTRITION AND DIET

THERAPY

Providing children the best chance to grow and develop to their full potential
The term infant refers to a person not more than 12 months of age. A healthy
full-term infant weight 2.7 to 3.2 kg and measures 48 to 50 cm in length.
His/her head circumference average 35 cm. His/her skin is moist, elastic,
and not wrinkled.
BREASTFEEDING
a. has physiologic and psychologic value for mother and infant
b. meets nutrient needs of early months
c. provides immunity factor and reduces chances for infection

BOTTLE FEEDING
a. formula designed to match nutritional ratio of breast milk
composition, water dilution to reduce protein and mineral
concentration, added carbohydrate to increase energy value
b. may meet needs of working mother
c. must be prepared under clean conditions and sterilized to prevent
contamination
The calorie requirements of the infant are high because the proportionately larger skin
surface leads to large heat loss. A rapid rate of growth necessitates considerable storage of
energy for the activity of the infant is great. Since the activity of the infant varies even
more widely, more than half of the adult, the stated allowances can serve only as an
approximation.

Some infants who are relatively inactive might show excessive weight gains it they receive
the recommended daily allowances while others who are energetic might require more
calories than the levels recommended. The healthy baby, given an appropriate formula
without having it forced upon him, regulates his appetite according to his needs
surprisingly well.
Allowances of 1.5 to 2.5 gm of protein per kg in the body weight from 0 to 6 months of age, and 1.5 to 2
gm per kg in the weight from6 to 12 months of age are recommended by the FAO/WHO Expert Group.

In early infancy, milk from the mother, cow or goat comprises the only protein food. Since the protein
of milk contains all the amino acids essential tor growth, the protein needs of the infant are not
automatically met through the provision of sufficient milk.

One and a half oz. of cow's milk per pound body weight equals 1.5 gm. of protein per pound, which
equals one-tenth of the body weight. An excess of protein is well tolerated.
Whole cow's milk contains satisfactory levels of the essential fatty acids, linoleic and arachidonic acids
required by the infant. Low fat milk used for a short period of time presents no problems since the infant
has generous reserves of the essential fatty acids.

When low fat milk is used for a prolonged period of time or when milk substitutes are used because of
allergy, consideration must be given to the inclusion of the essential fatty acids.

Vegetable oils such as corn, soybean and cottonseed oils are good sources.

About 3 to 5 percent 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.

An allowance of 1/10 ounce per lb. of body wt. Equals 1 ounce per 10 oz. of milk is
prescribed, which also equals one percent 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.
When compared with the needs of the adults, all minerals and vitamins are required in
proportionately greater amounts by the infant. During the first four months a 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 one and one-half ounces of milk
per pound of body weight are given. Enough iron is stored in the liver of the normal infant,
sufficient until the fourth or fifth month.

This deficiency is usually fulfilled by the addition of solid food supplements (egg yolk, fortified
cereals, vegetables, and fruits) which are usually added before this time, except in the case of the
completely milked infant who refuses or is not offered these iron-containing foods in the first year.
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 adequate. 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 human infants. It has been revealed, both experimentally and
clinically, that a pyridoxine deficiency may result in a syndrome characterized primarily by convulsions.

The minimum daily requirement of this vitamin is believed to be between 60 and 100 micrograms. Since this vitamin is
associated with essential fatty acid metabolism, requirements for each may have a relationship to the dietary intake of
the other.

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.
The daily fluid needs of the infant are approximately 2.5 ounces per pound of body weight. His water
balance is more easily disturbed than that of the adult because of the large fluid losses through the
Skin and respiration, and because of the needs for elimination.

The requirement for water varies from 10 to 15 percent of the body weight, or one and one-half to two
and one-half ounces per pound of body weight. This is supplied in the diluents of the milk mixture
itself and supplemented, according to instinctive demands, by offerings of water and fruit juices
between feedings.

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.
Food for Infants
(3-12 months old)
Mother's milk is the best for the baby. But
breast milk alone cannot meet the baby's
needs after 6 months. Earlier, at 3 months
of age, start familiarizing the baby with the
taste and texture of the other foods that
he/she will eventually need for normal
growth and development.
Simple Tips on how
to help infants eat
better
1. Beware of baby dinners or creamed products that contain
nutritionally incomplete refined starches.
2. Drain off the syrup from canned fruits before serving. It
is usually rich in sugar-something the infant does not need.
3. Watch the number of egg yolks the child consumes per
week. Three or four is plenty.
4. If the doctor says its okay, give him 2% low fat milk
instead of whole milk. It contains substantially less fat.
TIPS ON GIVING NEW
FOODS
1. After his third month birthday, test the readiness of your
baby to accept new foods by placing a teaspoon between his lips.
a. If he tends to close his lips or push the teaspoon away
continually, then he is not ready. Avoid forcing him to eat.
b. But it he accepts the food from a teaspoon give liquid or
semi-liquid food first. Begin with thin lugaw, on to thicker
lugaw, and then add step-by-step mashed, chopped and thinly
sliced food as your baby grows older.
2. Start any new food with 1/2 teaspoon on the first day and
add as your baby takes to the new taste.
 TIPS ON GIVING NEW
FOODS
3. Never start two new foods at the same time. Let the baby
get used to a new food about two or three days before
trying him out on new one.
4. Show pleasure when giving a new food. This will make
him like to eat a variety of foods.
5. Give water between feeds to provide enough liquid to
remove waste from his body and to help regulate body
functions.
TIPS ON GIVING NEW
FOODS
6. At about seven months of age, teach your baby to
drink water and other liquids from a cup. By using a
teaspoon and later a cup, you can avoid the use of
feeding bottle which is often the source of a baby's
infection.
7. Give finely-chopped foods when your baby starts
teething. Biskotso or any hard toast is also good at
this time.
 TIPS ON GIVING NEW
FOODS
8. Offer bland foods to your baby.
a. Highly salted foods may injure his kidneys.
b. Too much sugar and sweets may develop in the baby a strong liking
for these foods which may lead to tooth decay and obesity.

9. Handle baby's food properly.

a. Wash hand 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 food away from flies and insects.
d. Boil liquids and cook food thoroughly.
TIPS ON GIVING NEW
FOODS
10. Feed baby only with freshly-cooked foods or
fruits freshly-peeled. Avoid giving left-over
foods to babies.
11. If necessary, divide the recommended
amount of supplementary foods listed on next
page, into several feedings during the day.
 EASY-TO-PREPARE
BABY FOODS
You can easily prepare baby's food from dishes cooked for the family. These are just as
nutritious and much cheaper than the commercial ones in jars or in cans.

Get your vegetable water for your three-month old baby from the family dishes like sinuwam,
nilaga and other vegetable dishes.

Prepare your lugaw and soft-cooked rice from already boiled family rice. Mix the following
proportions and boil for the given time.

By ten months, your baby may share the family rice.

Get your boiled flaked fish for your 4 months old baby from the family dishes like sinigang, pesa,
tocho, sinuwam.
 EASY-TO-PREPARE
BABY FOODS
You can easily prepare baby's food from dishes cooked for the family. These are just as
nutritious and much cheaper than the commercial ones in jars or in cans.

For your pureed vegetables needed by babies 5 months of age, set aside a small amount of
vegetables like squash from bulanglang, potatoes trom nilaga, munggo from munggo guisado.
Mash the unseasoned vegetables and mix with lugaw. Season with Iittle salt. You may also try the
following

Use the meat from the family dishes like nilaga, sinigang, for your 6-month-old baby. Chop finely
and mix with lugaw.
 EASY-TO-PREPARE
BABY FOODS
You can easily prepare baby's food from dishes cooked for the family. These are just as
nutritious and much cheaper than the commercial ones in jars or in cans.

For younger babies, meat may be given "scraped as follows:

a. Before cooking the nilaga, scrape 1 side of a lean meat (i.e., beef) with edge of spoon.
b. Turn meat and scrape other side.
c. Season scraped meat and form into patties.
d. Cook in hot ungreased pan until scraped meat grayish.
 EASY-TO-PREPARE
BABY FOODS
You can easily prepare baby's food from dishes cooked for the family. These are just as
nutritious and much cheaper than the commercial ones in jars or in cans.

When fish like dilis is abundant and cheap, make it into fish powder using the recipes on "More
recipes for your baby." Add the powder to the lugaw for your 6th-month-old baby or older.

Prepare your mashed dried beans for your 7-month-old baby when you are serving munggo
guisado to the family. Set aside a small amount of boiled, unseasoned monggo and make it into:
 FEEDIN N T
G THE INFA
Infant feeding is dyadic in nature, it has nutritional,
pyschologcical and biological interaction between mother and
offspring with each one affecting the other.

An infant may be breast-fed, bottle-fed or given combined

breast and bottle-feeding.
 BREASTFEEDING
Breast milk is clean.

Protein in the form of lactalbumin is superior to casein

and is readily digested by the infant's enzymes because it
forms small amount of flocculent curds

Breast milk is non-allergenic.

Breastfeeding is beneficial to the health of the mother.

 BOTTLE FEEDING

Recommended only when breastfeeding is

contraindicated.

Artificial feeding is costly.

Artificial feeding is associated with infantile obesity or

"protein-calorie malnutrition plus".
 MIXED FEEDING
a combination of breast and bottle feeding with either
one predominating.

When the bottle is used to replace when one or more

breast feeding as when the mother is away from home for
periods longer than feeding intervals, this method is
called supplemental.

Mix feeding is not encourage as it may lead to lactation

failure.
FORMULA
PREPARATION
Milk formulas are sterilized in order to reduce
curd size and to prevent the growth of harmful
bacteria.
Two Methods of Formula Preparation
1. Aseptic Method
2. Terminal Method
FORMULA
PREPARATION
Milk formulas are sterilized in order to reduce
curd size and to prevent the growth of harmful
bacteria.
Two Methods of Formula Preparation
1. Aseptic Method
2. Terminal Method
METHODS OF FORMULA
PREPARATION
1. Aseptic Method
The equipment and ingredients are sterilized separately either by
steam or by boiling water for at least 25 minutes.
Next step is to funnel the sterile formula into sterile bottles,
nippled and then capped.
METHODS OF FORMULA
PREPARATION
2. Terminal Method
The formulas are poured into clean but unsterilized bottles and
are sterilized together.
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.
FEEDING TIME
A 2.5 to 2.7 kg baby usually feeds every 3 hours.
A 3.6 to 4 kg baby usually feeds every 4 hours.
At 2 months old, the baby sleeps through the night after the 10
pm feeding.
Between 2 to 3 months old, the baby is on a 4 to 5 feeding
schedule.
SUPPLEMENTARY
FOODS
1. Second Month - liquids like rice water, vegetable water or
"calamansi" juice may be introduced depending upon infant's
acceptance and tolerance.
2. Fourth Month - scraped banana or papaya or thin lugaw or
commercial cereal pop like "cerelac" and "ceresoy". Iron rich foods
like egg yolk, liver, meat, fish, poultry must be gradually
introduced when iron stores are low.
SUPPLEMENTARY
FOODS
3. Fifth to Sixth Month - full diet consisting of pureed meat,
egg, fruit, vegetables and cereals
*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 the art of self feeding.
SUPPLEMENTARY
FOODS
4. Seventh 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 leafyvegetables, "misua" soup with
beaten egg, peanut banana mash, "kamote" cubes in meat broth and
mashed liver in green leafy vegetables
 SUPPLEMENTARY
FOODS
5. Ninth to Twelfth Month - whole tender foods or foods
chopped coarsely are given.
 COMMON DISORDER
Diarrhea, allergy, vomiting, constipation and colic are disorders that affect the
nutritional status of the infant. When such condition arise
1. determine the underlying causes e.g over or underfeeding, bacterial infections,
unsuitable food, etc.
2. maintain water and electrolyte balance, and
3. modify milk formula to suit digestive capacity.
 DIARRHEA
Diarrhea is most frequently caused by bacteria and viruses although both overfeeding
and underfeeding can also cause diarrhea. Cow's milk causes allergy to some infants
leading also to diarrhea. Rice water suffices for mild diarrhea but in case of
dehydration, parenteral and/or oral fluids should be given, like a locally developed oral
rehydrating therapy labeled "SI oralyte", Oresol, a pre-mixed oral rehydration powder
available in government health institutions. 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 latundan and bayabas.
 VOMITING
Vomiting is commonly seen in normal infants during the first few days. As in diarrhea,
special attention must be given to fluid replacement. Other modifications may include
reducing number of feedings, acidifying milk, or making it a point to burp the infant
after every feeding.
 ALLERGY
Eczema is the most common sign of allergy before 9 months of age. When protein of
milk is the offending ingredient, it is referred to as milk allergy. In lactose
intolerance, the enzyme that hydrolyzes the carbohydrate lactose in milk into glucose
and galactose is present, increasing the gut fluid volume. Bacteria in colon ferment the
lactose and a variety of gastrointestinal symptoms occur with varying severity.
 CONSTIPATION
Infrequent bowel movements is not really the problem in infants but the pain on the
passage of stools, inability to complete a movement though the urge is strong, blood in
the stools and involuntary soiling of the clothes between movements. To overcome
constipation, the following measures may be taken:
1. Moderately restrict milk intake,
2. Increase fruit, vegetable, and fluid intake, change sugar in the formula to laxative
brown sugar and
3. Check reconstitution of milk formula.
 COLIC
Colic is an acute paroxysm of pain, fussing, crying and irritability which lasts for 3
months. Causes are psychologic factors, maternal and family tensions, gastrointestinal
hypermotility, functional immaturity of the central nervous system and GI tract.

Changing the formula may bring about some improvement but not in most cases.
Physical measures such as providing a cozy warm environment, placing the baby prone
on a hot water bottle, or a drink of warm water may at times subdue paroxysm of
crying
 INDICATIONS OF GOOD
NUTRITION

WEIGHT GAIN

A steady weight gain of 150 to 240 gm/week that slows down

toward the end of the first year to about 120 gm/week is
considered as the proper weight gain (doubled birth weight at the
end of 5 months and tripled at the end of 1 year).
 INDICATIONS OF GOOD
NUTRITION

LENGTH
Baby length increases by about 25.4 cnm or 50% more at the
end of the first year.
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
0-11 months = walks with support and stands alone
12 months = starts to walk alone
 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
 There is a critical window of
opportunity – from conception to two
years of age – to prevent child
stunting. During these 1,000 days, 10
proven interventions offer South Asian
children the best chance to grow and
develop to their full potential.

 Breastfeeding, within one hour

of life, protects the newborn
from infections and reduces the
risk of death. Proper positioning
and attachment helps the
mother produce more milk for
her child and favors exclusive
and a longer duration of
breastfeeding.
 Infants who are exclusively
breastfed in the first six
months of life do not need
water or any other food or
liquids even in hot climates.
Mother’s milk is all they need
for survival and optimal growth
and development
After six months, infants need
both breastmilk and
complementary foods.
Complementary foods –solid,
semi-solid or soft foods given
with mother’s milk – ensure
that infants grow and develop
to their full potential.
Children 6 to 24 months old need to
eat sufficient amounts of age-
appropriate foods. Foods from
different food groups such as grains,
eggs, poultry, fish, meat, dairy
products, fruits and vegetables
provide children with the variety of
nutrients they need to grow healthy
and develop fully.
 Washing caregivers’ and
children’s hands with soap
before preparing and eating
foods is one of the most
important ways of preventing
germs from getting into food
and avoiding diarrhoea and
poor growth in young children.
 Regular intake of vitamin A
supplements after six months of age
can reduce death in under-fives by
almost one quarter in vitamin A-
deficient areas. Regular intake of
iron supplements and regular
deworming protect children against
iron deficiency, anaemia and poor
development.
 Sick children, despite poor
appetite, need increased
amounts of food and fluids.
Feeding them nutritious foods
in small quantities and giving
them fluids frequently,
including breastmilk, help
children recover faster.

A simple color-coded tape can be

used to identify children with
severe acute malnutrition (SAM).
Most children with SAM - if
identified before they develop
medical problems - can be treated
at home with appropriate
therapeutic foods and counselling.

 Adolescent girls can be protected

against poor nutrition and anaemia
through supervised weekly iron and
folic acid supplementation, twice-
yearly deworming, counselling to
improve their diets, and
empowerment to stay in school and
avoid early marriage and
pregnancy.
 Pregnant women need to eat a
varied diet to ensure that their
children are born healthy and have
a lower risk of being stunted,
developing poorly, or dying.
Breastfeeding mothers need to eat a
plentiful diet to store the energy
and nutrients they require to
breastfeed successfully.