NUTRITION IN THE LIFE STAGE 1

LECTURE / SECOND SEMESTER / MIDTERM TOPIC WEEK

NUTRITION IN INFANCY
GROWTH AND DEVELOPMENT OF INFANTS

OBJECTIVES ● Growth does not continue ● Development is a wider

● Identify the infant’s physical, emotional, and social growth throughout life. It stops and comprehensive term
when maturity has been and refers to overall
and development.
attained. changes in the individual.
● Discuss the energy and nutrients needs of infants. It continues through life
● Explain the nutrition-related problems that affect the infants. ● Growth involves body and is progressive.
● Discuss the nutrition management of infants. changes.
● Development involves
● The changes produced by changes of an orderly,
growth are the subject of coherent type tending
DEFINITION
measurement. They may towards the goal of
be quantified. maturity.
GROWTH
● Development implies
● The term growth denotes a net increase in the size, or mass of improvement in functioning
the tissue. It is largely attributed to multiplication of cells and and behavior and hence
increase in the intracellular substance. bring qualitative changes
which are difficult to be
ACCORDING TO HURLOCK measured directly.
● Growth is change in size, in proportion, disappearance of old
features and acquisition of new ones.
PRINCIPLES OF GROWTH AND DEVELOPMENT
DEVELOPMENT
● Development specifies maturation of functions. It is related to Development is a continuous process from conception to
the maturation and myelination of the nervous system and maturity.
indicates acquisition of a variety of skills for optimal functioning
of the individual.
DEVELOPMENTAL AGE PERIODS
ACCORDING TO HURLOCK (1959)
● Development means a progressive series of changes that
1. Infancy
occur in an orderly predictable pattern as a result of
● Neonate
maturation and experience.
- birth to 1 month
● Infancy
ACCORDING TO J.E. ANDERSON (1950)
- 1 month to 1 year
● Development is concerned with growth as well as those
changes in behavior which results from environmental
2. Early Childhood
situations.
● Toddler
- 1-3 years
ACCORDING TO LIEBERT, POULOS AND MARMOR (1979)
● Preschool
● Development refers to a process of change in growth and
- 3-6 years
capability over time, as function of both maturation and
interaction with the environment INFANT DEVELOPMENT

DIFFERENCE BETWEEN GROWTH AND DEVELOPMENT 1. Motor Development

GROWTH
● The term is used in a
purely physical sense. It
generally refers to
increase in size, length.
● Changes in the
quantitative aspects come
into the domain of growth.
● It is a part of development
process. Development in
its quantitative aspect is
termed as growth.
DEVELOPMENT
● Development implies
overall change in shape,
form or structure resulting
in improved working or
functioning.
● Changes in the quality or
character rather than the
quantitative aspects come
in this domain.
● It is a comprehensive and
wider term and refers to
overall changes in the
individual
● Ability to control voluntary muscles
● Motor development is top down-controls head first and lower
legs last
2. Muscles development
● From central to peripheral
● Influences ability to feed self & the amount of energy
expanded
● Critical periods
- A fixed period of time in which certain behaviors or
developments emerge
- Necessary for sequential behaviors or
developments
- If the critical period is missed, there may be difficulty
later on
3. Cognitive development
● Factors that impact cognition
1
 - Sensorimotor development
First Molar 16 Years 16 Years
- Interactions with the environment
- Adequate energy and protein
Second Molar 29 Years 27 Years
- Stimulation of social and emotional growth
- Genetics
PERMANENT TEETH
4. Digestive System Development
● Fetus swallows amniotic fluid which stimulates intestinal
maturation and growth
MOLAR 6 to 7 Years
● At birth the healthy newborn can digest fats, protein and
simple sugars.
Central and lateral incisors 6 to 8 Years
● Common problems include gastroesophageal reflux (GER),
diarrhea, and constipation
Canines and premolars 9 to 12 Years
● Factors that impact rate of passage in colon
- Osmolarity of foods or liquids Second molars 12 Years
- Colon bacterial flora
- Water and fluid balance in the body Third molars 18 Years or later

PHYSICAL GROWTH & DEVELOPMENT

FACTORS AFFECTING GROWTH AND DEVELOPMENT

● Baby grows more while he is an infant than at any other time.
● Caregivers keep a record of how your baby is growing on a
“growth chart” during your baby’s regular check-ups. Feral Growth
● Genetic potential
● Sex
AGE BIRTH WEIGHT ● Fetal hormones
(MONTHS) ● Fetal growth factors
● Placental factors
4 to 6 Double ● Maternal factors

12 Triple
POSTNATAL PERIOD

GROWTH AGE ● Sex

(INCHES) (MONTHS) ● IUGR
● Genetic factors
Grow about 1 to 1 ½ inches each Two times longer than at birth by ● Hormonal influences
month the time by 10 to 12 months old ● Nutrition
● Infections
Head will continue to look large compared to the rest of his body. But, ● Chemical agents
with time his body’s growth catches up. ● Traumate

Head will grow about ½ inch Every month for the first 6
months SOCIAL FACTORS

● Socioeconomic level
● Poverty
AGE TEETH
(MONTHS) ● Natural resources
● Climate
4 to 6 2 lower center teeth ● Emotional factors
● Cultural factors
7 Upper center teeth ● Parental education

9 to 11 Upper and lower side teeth

MOVEMENT - GROSS MOTOR
st
(BODY CONTROL AND SKILLS)
End of 1 year 6 to 8 teeth

Movement - Gross Motor

ERUPTION OF PRIMARY TEETH
AGE BODY CONTROL / SKILLS
(MONTHS)
UPPER ARCH LOWER ARCH
2 Automatic reflexes, like the grasp
Central Incisors 10 Months 8 Months reflex start to disappear

Lateral Incisors 11 Months 13 Months 2-3 Lift his head up when he is on his
stomach
Canine 19 Months 20 Months

2

4 Continue to support his head
until his neck muscles are
stronger
4 to 6 Sit with some support roll over
from his back to his side and
from stomach to back
6 to 8 Hold his head up without support
8 to 10 Crawl
- Pulling himself to a standing
position while holding onto
furniture
10 to 12 Start to “cruise” which means
walking while holding onto
furniture. Walk alone but may not
have very good balance
HEARING
● Children begin exploring the environment around
them and will often imitate the observed behavior of
others.
● The understanding of objects also begins during this
time and children begin to recognize certain objects
as having specific qualities.
● For example, a child might realize that a rattle will
make a sound when shaken.
5. Tertiary Circular Reactions (12 - 18 months):
● Children begin a period of trial-and-error
experimentation during the fifth substage.
● For example, a child may try out different sounds or
actions as a way of getting attention from a
caregiver.
6. Early Representational Thought (18 - 24 months):
● Children begin to develop symbols to represent
events or objects in the world in the final
sensorimotor substage.
● During this time, children begin to move towards
understanding the world through mental operations
rather than purely through actions.

3 - 4 Months: child turns his head towards the source of sound MOVEMENT - FINE MOTOR
5 - 6 Months: child turns the head to one side and then downward if a (HAND AND FINGER SKILLS)
sound is made below the level of ears.
10 Months: child directly looks at the source of diagonally Fine motor movements are when your baby can control his
fingers with purpose.
Gross Motor Skills

AGE HAND AND FINGER SKILLS

(MONTHS)

After 1 Grasp reflex starts to disappear and your

infant will start to open his hands

3 Hold a rattle but he will not reach for it

4 to 6 Developed some hand-eye coordination

grabs at objects close to his face to mouth
opens and closes his hands so that he can
pick up and look at objects

7 Can let go of an object in his hand can move

an object from one hand to the other

9 Tell if your baby is right of left handed

SENSORIMOTOR STAGE OF DEVELOPMENT
12 Put an object into a container and can turn
pages in a book
1. Reflexes (0 - 1 month):
● During this substage, the child understands the
environment purely through inborn reflexes such as DAILY LIVING ACTIVITIES
sucking and looking.
2. Primary Circular Reactions (1 - 4 months)
● Set up a routine (regular schedule) of sleeping and eating.
● This substage involves coordination sensation and
● A routine is very important to make sure you and your baby
new schemas.
get enough rest and sleep.
● For example, a child may such his suck his or her
thumb by accident and then later intentionally repeat
the action. AGE ACTIVITIES
● These actions are repeated because the infant finds (MONTHS)
them pleasurable.
3. Sensory Circular Reactions (4 - 8 months) (primary color) 3 Regular schedule of sleeping, eating, and
● During this substage, the child becomes more playing begin to sleep 7 to 8 hours through
the night spends more time awake during the
focused on the world and begins to intentionally
day
repeat an action in order to trigger a response in the
environment.
10 May nap 2 times a day but still sleeping 10
● For example, a child will purposefully pick up a toy hours at night
in order to put it in his or her mouth,
4. Coordination of Reactions (8-12 months):
● During this substage, the child starts to show clearly ● Habits and rituals, like reading a story or bathing before bed,
international actions. are important.
3
● These rituals help your baby feel safe and let him know what
should happen.
● Having rituals may help your baby if he has a hard time going
to sleep.
AGE ACTIVITIES
(MONTHS)
Age baby slowly increases the amount of milk he drinks
2 4 to 5 ounces may be enough during each
feeding
4 5 to 6 ounces for each feeding
6 Need solid food, breast milk or formula is
enough nourishment (calories, protein, and
vitamins) until this age, your baby will want to
feed himself. May be messy until your baby’s
hand-eye coordination improves.
LANGUAGE DEVELOPMENT
● Learn to talk by copying the words and sounds you make.
● Talk, read, and sing to your baby using a soft, gentle voice.
- use different tones of voice also
● Learned some basic language skills by the end of his 1st year.
- speak few simple words
AGE LANGUAGE DEVELOPMENT
(MONTHS)
Early infancy Gets your attention by crying, smiling,
laughing, and using body movements.
2 Tries sounding out vowels, like a, e, i, o, and
u
4 Cooing and babbling, copying the sounds of
consonants, like n, k, g, p, and b
6 Imitate sounds in one syllable words, like
example, ma, da, and hi. Soon your baby can
put 2 syllables together, like dada, mama,
baba.
9 to 12 Understood the meaning of some simple
words and commands. Soon understands
what you mean when you say ‘no’ or ‘give it
to me.’ knows what some objects are by their
name, like a ball or cup.
● 1 month- alerts to sound
● 3 months- coos (musical vowel sounds)
● 4 months- laugh aloud
● 6 months- monosyllables (ba - pa - da), ah-goo sounds
● 9 months- disyllables (mama, baba, dada)
● 12 months- 1-2 words with meaning
INTELLECTUAL DEVELOPMENT
st
● Your baby’s brain grows and develops faster during this 1
year than at any other time.
● Give your baby different things to look at, listen to, and feel.
● Make eye contact when you are talking to your baby.
● Limit how much time you put your infant in front of the TV.
● Playing with and reading to your baby is a much better way to
help him learn than starting at a TV.
● Try playing with your baby by showing him a toy, hiding it, and
then helping him find it. Or, show him how a toy works.
● Your baby should be able to do the following things by the end
of his 1st year.
AGE LANGUAGE DEVELOPMENT
(MONTHS)
2 Eyes are more coordinated and can focus on
objects
3 Follow objects with his eyes as you move
them. Grab or bat at objects in front of him
very interested in things around him and is
able to recognize familiar sounds. Smiles at
the sound of your voice and turns his head
toward a familiar sound
4 Hand-eye coordination begins. Give your
baby bright color toys or pictures to look at
6 Recognize familiar objects and react to
strange or unfamiliar situations or people.
Learns that objects are permanent
(long-term) and looks around for something
he drops. Enjoys games, like peek-a-boo.
Understand that he is an individual, separate
from you and others. Knowing this makes
your baby feel “separation anxiety”
6 to 7 Stranger anxiety. Afraid of strangers at this
age. Have the “new” person come toward
your baby quietly without looking right at your
baby. Try not to leave your baby with
strangers if possible.
7 Recognize his own name.
PERSONALITY AND EMOTIONAL DEVELOPMENT
● You are telling your baby that his thoughts and feelings are
important when you react to his cues (signs).
- helps build your baby’s self-esteem (how he thinks
about himself).
● Do not worry about spoiling your baby by giving him too much
attention.
- give your baby a feeling of safety and trust when
you quickly and consistently comfort your baby
when “demanded.”
INFANT NUTRITION MANAGEMENT
CHARACTERISTICS OF THE FULL TERM INFANT
● A healthy full term infant weighs 2.7 - 3.2 kgs (6 - 7 lbs)
● Measures in length - 48-50 cm (19 - 20 inches)
● Head circumference -averages 35 cm (14 inches)
● Skin is moist, elastic and not wrinkled
CHARACTERISTICS OF A PREMATURE INFANT
● Has a higher basal metabolism, energy requirements are 30 -
50% greater than those of the full term infant.
● Immaturity of the digestive and nervous systems complicates
his feeding. In the absence of normal sucking and swallowing
reflexes, food is administered parenterally or through a tube.
● They tolerates fat very poorly.
4
 ● Immaturity if the liver accounts in part of the premature poor
resistance to infections.
● His liver cannot adequately clear the blood of the pigments
which result from the normal postnatal destruction of
circulating RBC.
● Immaturity of kidneys contributes to his limited tolerance for
salt, to his proneness to edema, and to the mild state of
acidosis.
● The ideal milk for premature and low birth weight infants is
breast milk.
WHY IS NUTRITION IMPORTANT?
FEEDING IN EARLY INFANCY
Breast Milk and Formula
● Recommend exclusive breastfeeding for first 6 months and
continuation to 1 year
● Initiate breastfeeding right after birth
● Growth rate and health status indicate adequacy of milk
volume
● Standard infant formula provide 20 cal/fl oz
● Preterm formula provides 22-24 cal/fl oz
BREAST MILK

● Energy of daily living ● Perfect food for infants

● Maintenance of all body functions ● Energy nutrients- protein, carbohydrates, and fats
● Vital to growth and development ● Protein- main protein is alpha-lactalbumin
● Therapeutic benefits - well-digested, absorbed, less stress on immature kidneys.
- healing ● Carbohydrates- disaccharide lactose
- prevention - easily digested, enhances calcium absorption
● Fats - main source of energy
- EFA, linoleic, linolenic acids, generous amount
ENERGY AND NUTRIENT NEEDS
● Immunological protection
● Allergy/Disease protection
Energy (calories): ● Vitamins
● 108 kcal/kg/day from birth to 6 months (range from 80 to 120) - Vitamin D content - low, supplementation recommended for
● 98 kcal/kg/day from 6 to 12 months breastfed infants
- Vitamin K - injection at birth for both breast and bottle fed
Factors that influence calorie needs infants
● Weight and growth rate ● Minerals
● Sleep/wake cycle - Calcium is well absorbed
● Temperature and climate - High bioavailability of iron and zinc
● Physical activity - Low in sodium and fluoride
● Metabolic response to food
INFANT FORMULA
● Health status/recovery from illness

Protein needs: ● Composition attempts to copy breast milk composition

● 2.2 g/kg/day from birth to 6 months ● Recommended- iron fortified formula
● 1.6 g/kg/day from 6 to 12 months ● Risks- no protective antibodies
● FDA- mandates safety nutrition quality of infant formulas
How much is that? ● Nursing bottle- tooth decay, don’t sleep with bottle
● Newborn weighing 4 kg needs 2.2 x 4 = 8.8 g protein
● 6-month-old weighing 8 kg needs 1.6 x 8 = 12.8 g protein
HOW INFANT FORMULAS ARE MODIFIED COMPARED TO
BREAST MILK
Protein needs are similar to that of energy but are also
influenced by body composition
1. Breast Milk
Fat needs: ● 7% of calories from protein
● no specific recommended intake level for infants ● 38% calories from carbohydrates
● breast milk contains about 55% calories from fat ● 55% calories from fat
● infants need cholesterol for gonad and brain development 2. Cow’s Milk-Based Formula
● breast milk contains short-chain and medium-chain fatty acids ● 9-12% calories from protein
(in addition to the long-chain) ● 41-43% calories from carbohydrates
- easier to digest and utilize than long-chain fatty acids ● 48%-50% calories from fat

Metabolic Rate, Calories, Fats and Protein

COW’S MILK DURING INFANCY
● Metabolic rate of infants is highest of any time after birth
● The higher rate is related to rapid growth and high proportion
of muscle ● Whole, reduced-fat or skim cow’s milk should not be used in
● Low carbohydrate and/or energy intake results in protein infancy
catabolism impacting growth ● Iron-deficiency anemia linked to early introduction of cow’s
milk
Other nutrients and nonnutrients ● Anemia linked to:
● Fluoride - 0.1 - 0.5 mg/d depending on age (too much may - GI blood loss
cause tooth discoloration) - Low absorption of calcium & phosphorus
● Vitamin D - 400 IU/day - Displacement of iron-rich foods
● Sodium - 120-200 mg/day
● Iron - 11 mg for infants 7-12 months
● Fiber - no recommendations SOY PROTEIN-BASED FORMULA DURING INFANCY
● Lead - none - may be toxic
5
 ● Soy protein in place of milk protein should be limited in its use
● The use of soy formula is not recommended
- For managing infantile colic
- Lactose free and hydrolyzed formulas are better for
infants unable to breastfeed or be fed cow’s milk
formulas
DEVELOPMENT OF INFANT FEEDING SKILLS
● Infants born with reflexes & food intake regulatory mechanism
● Inherent preference for sweet taste
● At 4-6 weeks, reflexes fade; infant begins to purposely signal
wants & needs
● Cues infants may give for feeding readiness include:
- Watching the food being opened in anticipation of
eating
- Tight fists if feeding too slow or stops temporarily
- Playing with food or spoon
- Slowing intake or turning away when full
- Stop eating or spit out food when full
INTRODUCTION OF SOLID FOODS
● Food offered from spoon stimulates mouth muscle
development
● At 6 months, offers small portions of semi soft food on a spoon
once or twice each day
HAND TO MOUTH COORDINATION
● 6 months: child take a biscuit to his mouth and chew
● 1 year: tries to feed self from a cup but spills some of the
content
FEEDING TIPS FOR INFANTS
● Introduce one food at a time, single-ingredients items
● Allows 4-5 days between
● Allergic reactions - skin rash, digestive upset, respiratory
discomfort
RECOMMENDATIONS FOR INTRODUCTION OF SOLID FOODS
● Infant should not be overly tired or hungry
● Use small spoon with shallow bowl
● Allow infant to open mouth & extend tongue
● Place spoon on front of tongue with gentle pressure
● Avoid scraping spoon on infant’s gums
● Pace feeding to allow infant to swallow
● First meals may be 5-6 spoons over 10 minutes
FEEDING PROGRESSION
● 6 - 8 months
- Breads / other cereals textures
- Vegetables / fruits, plain
- Unsweetened fruit juice from cup
● 8 - 10 months
- Bread / cereals - soft
- Yogurt
- Cooked vegetables
- Finely cut meats, fish, casseroles
- Cheese, egg yolks, legumes
● 10 - 12 months
- Most foods - whole milk and egg whites
● 12 months
- Do not give honey until 12 months
● Foods to avoid
- Concentrated sweets
- Canned vegetables (high in sodium)
- Honey corn syrup
FIRST FOODS
● 6 months- iron-fortified baby cereal
- rice cereal is hypoallergenic
● 6 months- fruits and vegetables
● Only one new food over 2-3 days
● Commercial baby foods are not necessary but do provide
sanitary and convenient choices
● 9-12 months soft table foods
FOODS AT ONE YEAR
● 2-3 cups cows milk
● Use whole milk until age 2, then low-fat (recommended)
● Excessive milk intake can contribute to anemia (milk not a
good source of iron)
● Balance and variety from all food groups
● Drink liquids from a cup, not a bottle
THE IMPORTANCE OF INFANT FEEDING POSITION
● Improper positioning may cause choking, discomfort, and ear
infections
● Position young bottle-fed infants in a semi-upright position
● Spoon-feeding should be with infant seated with back and feet
supported
● Adults feeding infants should be directly in front of infant
making eye contact
PREPARING FOR DRINKING FROM A CUP
● Offer water or juice from cup after 6 months
● Wean to a cup at 12 to 24 months
● First portion from cup is 1-2 oz
● Early weaning may result in plateau in weight (due to reduced
calories) and/or constipation (from low fluid intake)
● Changing from a bottle to a covered “sippy” cup with a small
spout is not the same development step as weaning to an
open cup
● Open cup drinking skills also encourage speech development
FOOD TEXTURE AND DEVELOPMENT
● Can swallow pureed foods at 6 months
● Early introduction of lumpy foods may cause choking
● Can swallow very soft, lumpy foods at 6-8 months
● By 8-10 months, can eat soft mashed foods
WATER
● Breast milk formula provide adequate water for healthy infants
up to 6 months
● All forms of fluids contribute to water intake
● Additional plain water needed in hot, humid climates
● Dehydration is common infants
6
 ● Pedialyte or sports drinks provide electrolytes but lower in ● Viral and bacterial infections
calories than formula or breast milk ● Food intolerance
● Limit juice ● Changes in fluid intake
● AAP recommends juice is not needed to meet the fluid needs
before the age or 6 months Prevention:
● Avoid colas and tea ● To avoid constipation assure adequate fluids
● Continue to feed the usual diet during diarrhea

HOW MUCH FOOD IS ENOUGH FOR INFANTS?

Prevention of baby bottles caries and ear infections:
● are linked to feeding practices
● Infants vary in temperament ● Risk for ear infections is also correlated with excessive use of
● Crying or fussiness may be interpreted as hunger resulting in a baby bottle as a bedtime practice, as a result of the feeding
overfeeding position.
● First foods may appear to be rejected due to immature tongue ● Feeding techniques to reduce caries and ear infections
movement 1. Limit use of bedtime bottle
● Infants learn food preferences based on experiences with 2. Offer juice in cup
foods 3. Only give water bottles at bedtime
● Flavor of breast milk influenced by mother’s diet 4. Examine and clean emerging teeth
● Genetic predisposition to sweet taste FEEDING ALLERGIES AND INTOLERANCES
● Food preference form infancy sets stage for lifelong food
habits
Allergies:
● About 6-8% of children <4 yrs have allergies
COMMON NUTRITIONAL PROBLEMS AND CONCERNS ● Absorption of intact proteins causes allergic reactions
● Common symptoms are wheezing or skin rashes
1. Failure to thrive, ● Treatment may consist of formula with hydrolyzed proteins
2. Colic
3. Iron-deficiency anemia, constipation Lactose intolerance:
4. Dental caries, and ● Inability to digest the disaccharide lactose
5. Food allergies ● Characterized by cramps, nausea and pain and alternating
diarrhea and constipation
FAILURE TO THRIVE (FTT) ● Lactose intolerance in uncommon and tends to be
overestimated
● Inadequate weight or height gain
● Energy deficit is suspected FEEDING WITH LOVE

Organic FTT:
● Inadequate weight or height gain resulting from a health ● Avoid finish your plate or food as reward
problem, such as iron-deficiency anemia or a cardiac or ● Allow child to explore and enjoy food
genetic disease. ● Don’t force food on children
Inorganic FTT: ● Discourage unacceptable behavior
● Inadequate weight or height gain without an identifiable
biological cause, so that an environmental cause, so that an PHYSICAL GROWTH ASSESSMENT
environmental cause is suspected (maternal depression,
mental illness, alcohol or drug abuse in the home, feeding
delegated to siblings or others unable to respond to the infant, ● Newborns grow faster than any other time of life
and over dilution of formula) ● Growth reflects:
- Nutritional adequacy
COLIC
- Health status
- Economic & environmental adequacy
● The sudden onset of irritability, fussiness or crying - There is a wide range of growth - normal
● Episodes may appear at the same time each day - Calibrated scales & recumbent length measurement
● Disappear at 3rd and 4th month board required for accurate measures
● Cause unknown but associated with GI upset, infant feeding ● Healthy newborns double their birth weight by age 4 - 6
practices months and triple it by 1 year.

IRON-DEFICIENCY ANEMIA

● Less common in infants than in toddlers

● Iron stores in the infant reflect the iron stores of the mother
● More common in low-income families
● Breastfed infants may be given iron supplements and
iron-fortified cereals at 6 months
● Iron- fortified versus “low-iron” formula

DIARRHEA AND CONSTIPATION

● Infants typically have 2-6 stools per day

Causes of diarrhea & constipation:

7
 2. Plateau in weight, length or head circumference for
>1 month
3. Drop in weight without regain in few weeks

HOW CAN YOU KEEP YOUR BABY SAFE DURING THIS FIRST
YEAR?

SAFETY FIRST

● Be sure to make and keep appointments with your child’s

caregivers for routine medical checkups and vaccinations.
● Put your baby in his back for sleeping
● Keep all medicines, cleaning products and other household
chemicals locked and out of reach
● Keep small objects that may cause choking away from your
child.
- This includes food, such as hotdogs, whole grapes,
whole raw carrots, raw celery, peanuts, popcorn,
chips or candy
- Cut all foods into small size bites.
● Keep matches, cigarette lighters, guns locked and out of reach
● Never leave your child home alone.
- Never leave your baby alone in the car. The
temperature inside the car can change a lot.
- Never leave your toddler alone near water.
● Never leave your baby alone up high like on a changing table,
the couch, a chair or the bed.
- Always keep a hand on your baby and never walk
away when your baby is in a high place.
● Do not use walkers
- They are dangerous and have caused serious
injuries and even death when they fall down stairs.
● Use approved car seats correctly
● Before you choose a child safety seat for your child, check the
age and weight limits for the seats.
● Put the car seat in the back seat of the car and secure it facing
backwards.
● Never put your child in a front seat with a safety airbag.

SAFETY FIRST: PREVENT CHOKING

● Do not attach pacifiers or other objects to the crib or body with

a string or cord.
● Keep small objects away from your baby.
- This includes toys or stuffed animals that have small
breakaway parts.
- Baby’s can suffocate if they play with plastic bags.
● Never leave plastic bags or wrappings where your baby can
reach them.
● Always keep your baby in a smoke-free area. Do not allow
people to smoke around your baby.

SAFETY FIRST: PREVENT BURNS

● Do not hold your baby when smoking, drink hot liquids or

when cooking.
● Do not heat formula or breast milk in a microwave.
● Your baby skin is also very sensitive to the sun.
- Keep your baby out of direct sunlight to prevent
sunburn.
● Check the water temperature before putting your child in the
tab.
INTERPRETATION OF GROWTH DATA
- Have your water heater set less than 120 F to
lessen the chance of an accidental burning.
● Measures over time identify change in growth rate and need ● Never leave your baby alone in the water.
for intervention ● Do not leave your baby to answer the phone or doorbell.
● Warning signs: - Either let it ring or wrap your baby in a towel and
1. Lack of weight or length gain take your baby with you.
8
 ● Keep anyone with a cough, cold, or infectious disease
(separate illness) away from your newborn.
● Call caregivers if your baby seems sick.
- Fever, refusing to eat, vomiting (throwing up), or
diarrhea (runny, watery BMs) are good reasons to
call.
- Also call if your baby is more fussy or quieter than
usual or looks jaundiced (yellow skin and eyes).
HOW DO INFANTS REACT TO BEING SICK OR IN THE
HOSPITAL?
4. The priority is energy needs first; protein and carbohydrates
will be converted to meet energy news if sufficient calories are
not consumed, slowing growth over time.
5. Growth as weight, length, and head circumference accretion is
monitored and interpreted over the first year.
6. Introduction of solid foods is also a development stage for
parents in learning to read signs of hunger, fullness and
preferences in their infants and to know safe food choices
7. Common nutrition problems in the first year such as failure to
thrive, colic, iron deficiency anemia, and baby bottle caries are
usually solved by combining parent educational, nutritional,
and medical approaches.

Infants react to being sick or in the hospital”

● Separation and stranger anxiety are very strong by the time
your baby is 6 months.
● Your baby cannot describe his pain, like where it is and how
bad it hurts
● Breathing and heartbeat are very fast.
● Eating poorly or regurgitating (food keeps coming up and
vomiting).
● Does not look at you or he keeps looking away and doesn’t
want to be touched. Fussier than normal or listlessness (not
moving much at all).
● Hiccoughs, sneezing, and yawning a lot.
● Shaking.
● Skin changes from his normal color to red, pale, gray or blue.

HOW CAN YOU HELP YOUR INFANT WHEN HE IS SICK OR IN

THE HOSPITAL?

Help your infant when he is sick or in the hospital:

● Be involved in caring for babies each day, like helping with
feedings, baths, dressing, and diapering.
- Try to keep your baby’s schedule as much like it is
at home as possible.
● Ask for the same caregiver to lessen the number of people
caring for your baby.
- Soon your baby will recognize his caregivers and
won’t be so afraid.
● Always try to be present when your baby is getting medical
care.
- Hold your baby in your lap during procedures if at all
possible
- This helps calm your baby and make him feel safe.
● Comfort your baby and provide support by stroking (touch)
your baby and talking in a soothing way.
● Make sure your baby has things that remind him of you and
make him feel safe, like his blanket.
- Leave a picture of you or a recording of your voice
to be played if you can’t be with him.
● Praise your baby as often as possible.

KEY POINTS

1. Infants born full-term and preterm infants born between 34

weeks and 38 weeks of gestation are the same in their
milestones of growth, development, and feeding in the first
year of life.
2. The ability of infants to feed and eat is based on
developmental skills that show readiness for the next step;
parents learn to read the signals of readiness from their infants
over time.
3. Energy and nutrient needs of infants are modulated by
individual differences in sleep/wake cycle, exposure to
temperatures, and state of health, among other factors

9
 NUTRITION IN THE LIFE STAGE 1
LECTURE / SECOND SEMESTER / MIDTERM TOPIC WEEK

INFANT WEANING PERIOD

● The transition of food pattern has to keep pace with the child's
OBJECTIVES
growth who triples his birth weight and 1 ½ times his birth
● By the end of the class the student will be able to
length by the end of one year- Time of introduction of food
understand the weaning.
type.
● Define weaning
● Consistency, frequency of food, calorie density and nutrient
● Enlist the aims of weaning
density need to be monitored closely
● Enumerate the principles of weaning
● Hygiene
● Illustrate the steps of introducing solid foods
● List down the foods to be avoided during weaning HOW TO INITIATE WEANING PROGRESS

● Consistency: Introduction of the right consistency of food at

DEFINITION
Weaning is the process of gradual and progressive transfer of
the baby from breastfeeding to the usual family diet.
UNICEF, 1984 ‘The systematic process of introduction of
suitable food at the right time in addition to mother’s milk in order to
provide needed nutrients to the baby’
AIMS OF WEANING
● With growth, the baby requires more food items, minerals and
vitamins, which cannot be all supplied by milk alone.
● To educate the child independence by using spoon and cup.
IMPORTANCE OF WEANING
● Increase needs for energy (calories).
● Growing baby requires more minerals & vitamins
● To train the child on spoon feeding, chewing, and swallowing
of solid food
● To train the gastrointestinal tract to digest starch and other
solid food
the right age is important to develop good food behaviors.
Essentially follow the sequence:
- Breast feeds (0-6 months)
- Semi-liquid (after 5-6 months) easy to digest,
smooth and gentle on baby’s stomach.
- Semi-solid (after 8-9 months) baby now needs
food with taste and texture.
- Semi solid (after 10 months) baby now needs food
that satisfy his urge to chew-complex taste and
texture
- Solid diet including a variety of food items (1-1.2
yrs.)
HOW TO INITIATE WEANING AND PROGRESS
● Calorie density & nutrient density:
1. As the consistency thickens, frequency reduced and
volume per feed increases.
2. Babies cannot consume large bulky foods- to
provide enough calories in less volume, increase
calorie density by adding fat- usually true in case of
malnourished children
DISADVANTAGE OF EARLY WEANING

1. Reduced production of breast milk

PRINCIPLES OF INTRODUCTION OF WEANING FOODS 2. The risk of insufficient energy and nutrient intake by the infant.
3. Infants will benefit less of the productive factors in breast milk.
4. Infants are exposed to microbial pathogens present in foods.
● Milk is the main food of infants, so additional feeds should
5. Increase the risk of diarrheal disease and consequently
provide extra requirements as per needs of the baby that must
malnutrition.
be obtained from good quality food items and should be home
6. The risks of food allergies are increased
made.
● A small amount of new foods to be given in the beginning and
gradually the amount at food to be increased during the LATE WEANING
course of the week.
● During introduction of weaning foods, following principles to be
remembered: ● Can cause:
- Weaning foods should provide extra requirements ➔ Fall in weight gain
as per need of the baby. ● Growth Retardation due to PEM
● Breastfeeding to be continued with weaning up to 2 year or ➔ Fe & Vitamin requirements not fulfilled
beyond ➔ Reflexes are developed enough to manage
● No strict rules semisolids
● Food should be given when the infant is hungry but never
force the child to take the food FEEDING CHILDREN
PRINCIPLES OF PROCESS
● Exclusive breast feeding (0-4 months)
● Process of introducing semi-liquid to semi-liquid foods other ● Juice, fruit, vegetable, cereals 2/day (4-5 months)
than breast milk. ● Butter, meat etc. more food 3-4/day (5-7 months)

1
 ● Can eat family diet fish, egg small frequent feed (12 months) 1. Salt - this will lead to other complications such as kidney
disorders, liver damage, etc.
2. Sugar- lead to tooth decay and/or too much weight gain
TECHNIQUE OF WEANING
3. Honey (concentrated sugar)
4. Eggs
1. Weaning starts at the age of 6 months by replacing milk feed 5. Tea, coffee, and soft drinks
by semi-solid food. 6. Nuts
2. This should be continued gradually by replacing other milk 7. Low fat foods
feeds by foreign food until all food is replaced at the age of 1-2 8. Fish and shellfish
years.

WHY START WEANING AT 6 MONTHS

● Breast milk sufficient for the growth of the baby only till 6
months of age.
● Breast milk output starts to decline thereafter but baby’s
physical + mental development continues at a very fast pace
till the end of 2 years
● Weaning latest by 6 months - failing which will lead to
malnutrition
● The rate of increase in length and weight declines but still the
child is growing in size. Other activities like learning to turn,
crawl, standing with support, walking, running, vocabulary,
teething, learning to eat by himself, grasp, etc.
● Food contain complex form of nutrients. Child is ready to
digest these complex CHO, protein, and fats by 6 months of
age. Enzymes to digest complex nutrients are fully activated
now.

STAGES OF WEANING

Stage 1: Weaning at 6 months

● Choose a quiet time of day, half way through a feed:
- Smooth mash or purees
- Your baby’s tongue will push forward and food will
come back out at first
- Small amounts once a day
Stage 2: My baby is 6-9 months
● Increase the quantity according your infant’s interest and
appetite - offer foods from all 4 food groups
● Your infant may need to try many times before learning to like
new food/taste
● As the amount of solids increases the volume of
breast/formula milk will decrease
Stage 3: My baby is 9-12 months
● Your infant is now biting and chewing onto family foods and
family meals
● You can now cut out early morning milk feeds
● Cut out bottles and change to open cups or free flow beakers
● Reduce milk feeds one by one to 2 feeds per day at 11-12
months

COMPLEMENTARY FEEDING

As an infant turns six months, it is very important to introduce

in a timely manner age-appropriate complementary foods with continued
breastfeeding.

Complementary foods “complement” breastfeeding with

additional nutrients for proper nutrition, to promote health, growth and
development.

FOODS TO AVOID WHEN WEANING A BABY

2
NUTRITION IN THE LIFE STAGE 1
LECTURE / SECOND SEMESTER / MIDTERM TOPIC WEEK
PRESCHOOL CHILD NUTRITION MANAGEMENT
OUTLINE
● Introduction
○ Normal growth and development
○ Physiological and cognitive development
● Nutrition Recommendations
○ Energy and nutrient needs
○ Common nutrition problems
○ Prevention of nutrition-related disorders
○ Dietary and physical activity recommendations
● Key Nutrition Programs
● Key Nutrition Resources
● Conclusion
IMPORTANCE OF NUTRITION
● The eating habits established now impact food habits and
health later in life.
● Toddlers and preschoolers need adequate intake in order to
achieve full growth and development potential
● Undernutrition impairs children’s cognitive development as
well as their ability to explore their environments
● Long-term effects of undernutrition (FTT, cognitive impairment)
may be prevented or reduced with adequate nutrition and
environmental support.
NORMAL GROWTH AND DEVELOPMENT
● Infants triple birth weight in first 12 months, but growth slows
after that
● Toddlers gain 0.5 lbs. and 0.4 per month
● Preschoolers gain 4.4 lbs. and 2.75 per year
● Decease in growth rate accompanied by decrease in appetite
and food intake
PHYSIOLOGICAL DEVELOPMENT- TODDLERS
● Most children begin to walk independent by 1st birthday
● Gross motor skills, such as sitting on a small chair, climbing on
furniture, walking up and down stairs, jumping in place ,
develop rapidly at this age
● Increasingly mobile and independent, can explore
environment
● By 36 months, can ride tricycle
COGNITIVE DEVELOPMENT- TODDLERS
● develop new relationship, imitate others, learn about family’s
cultural customs
● Fears emerge during these period
● Vocabulary is 100+ words at 2 years of age
● By 36 months, child can use 3-word sentences
● Increased determination to express their own will (temper
tantrums). Can easily become frustrated and negative
DEVELOPMENT OF FEEDING SKILLS IN TODDLERS
● Toddlers can handle chopped or soft table foods
● At 18-24 months, toddlers are able to use the tongue to clean
the lips and have well-developed rotary chew movements.
Now the toddler can handle meats, raw fruits and vegetables,
and multiple textures of food.
● Strong need for independence and self-feeding
● Increasing fine motor and visual motor coordination skills allow
toddlers to use cups and spoons more effectively, though may
prefer to eat with their hands
TIPS FOR PARENTS
● Keep distractions (i.e.: TV) to a minimum during mealtimes
● Allow their toddlers to practice self-feeding skills and to
experience new foods and textures (no matter how messy!)
● Risk of choking high at this age
○ Toddlers should always be seated during meals and
snacks ( high chair or booster seat with the family)
○ Foods that may cause choking: hard candy,
popcorn, nuts, whole grapes, and hotdogs should
not be served to children less than 2 years of age.
FEEDING BEHAVIORS OF TODDLERS
● Many toddlers demonstrate strong food preference and
dislikes
● Food jags
○ Prolonged periods of refusing a particular food or
foods they previously liked
● To circumvent food jags:
○ Serve new foods along with familiar foods
○ Serve new foods when child is hungry
○ Other family members should eat new foods in front
of toddler
● Mealtime an opportunity for parents to model healthy eating
behaviors, toddlers to practice language and social skills,
develop positive self-image
○ Not the time for battles or “force feedings”
FOOD INTAKE IN TODDLERS
● Rule of thumb: serving size is 1 tablespoon of food per year of
age.
○ So a serving for a 2 year old child would be about 2
tablespoons.
● Toddlers can’t eat a large amount of food at one time, snacks
are vital in meeting the child’s nutritional needs.
● Toddlers should not be allowed to “graze” throughout the day
on sweetened beverages and foods such as cookies and
chips
○ These foods can lower their appetite for basic foods
at meals
● Establish regular but flexible meal and snack times to allow
enough time in between for child to get hungry
DEVELOPMENTS IN PRESCHOOL AGE CHILDREN
● Gross and fine motor capabilities expand
● At age 4, child can hop, jump on one foot, climb, ride a tricycle
or bicycle with training wheels, and can throw a ball overhand
● Magical thinking & egocentrism (not able to accept another’s
point of view)
● Play moves toward more organized group play, such as tag or
“house”
● Temper tantrums peak between the ages of 2-4 years
1
 ● Between ages 2-5, vocabulary increases from 50-100 words to
more than 2000 words, and complete sentences.
DEVELOPMENT OF FEEDING SKILLS IN
PRESCHOOL-AGE CHILDREN
● Use a fork, spoon, and cup well
● Cutting and spreading with a knife may need some refinement
● Eating not as messy as in toddlerhood
● Unintentional spills
● Modify foods to minimize risk of choking-cut grapes in half
lengthwise and cut hotdogs in quarters lengthwise and cutting
into small bites.
○ Strongly flavored vegetables
○ Spicy, sour, or bitter food
○ Food touching or mixed together (casseroles,
salads)
● Children naturally prefer sweet and slightly salty tastes
● Food served on a limited basis but used as a rewards become
highly desirable
● Coercing or forcing children to eat foods can have a long-term
negative impact on their preference for these foods.
NUTRITION RECOMMENDATIONS

FEEDING BEHAVIORS OF PRESCHOOL-AGE CHILDREN Energy and nutrient needs, common nutrition problems, prevention of
nutrition-related disorders, dietary and physical activity
recommendations
● Children want to be helpful and to please their parents and
caretakers ENERGY RECOMMENDATIONS
● Good time teach children about food, food selection, and
preparation Given: Age = 4 years old
○ Get them involved!

INNATE ABILITY TO CONTROL ENERGY INTAKE DBW / IBW

(age x 2) + 8 ➡ kg
● Ability yo self-regulate food intake =4x2+8
● If allowed to decide when to eat and when to stop eating = 16 kg (2.2 lbs)
without outside interference, children will eat as much as they = 35.2 lbs
need.
● Can adjust their caloric intake meet energy needs TER
● Avoid using food as rewards or forcing child to “clean their = 1,000 + (100 x age)
plate” = 1,000 + (100 x 4)
= 1,400 kcal
3 YEAR OLD VS 5 YEAR OLD STUDY

● Children served either small, medium, or large portions of

macaroni and cheese, along with standard amounts of other
foods.
● Analysis of amount of food eaten showed that portion size did Descriptions:
not affect the younger children’s intakes - their intakes + 21% or more = Obese
remained the same despite the amount of food served to them + 11 to 20 % = Overweight
● 5-year-old children’s increased significantly with larger portions - + 10% = Normal
sizes - 11 to - 20% = Underweight
● By 5 years of age, children are influenced by external factors - 21 or more = Severe underweight
rather than internal cues (hunger & satiety signals)
PROTEIN NEEDS
APPETITE AND FOOD INTAKE OF
PRESCHOOLS-PICKY EATERS
● Ingestion of high-quality protein (such as milk and other animal
products) lowers the amount of total protein needed in the diet
● Familiar foods may be comforting to the child to provide the essential amino acids
● Child may be trying to exert control over this aspect of her/his
life
● Suggestion include:
○ Serve child-sized portions
○ Serve food in attractive way
○ Limit snacking and drinks between meals as to not
“kill” appetite at mealtime
● May take 8-10 exposures to new food before it is accepted
● RDA- Recommended dietary allowances - average daily
● Children raised in an environment where all members of the
dietary intake levels sufficient to meet the nutrient
family eat a variety of foods are more likely to eat a variety of
requirements of nearly all (97% - 98%) healthy individuals in a
foods.
population group.
FOOD PREFERENCES
FATS

● Their own food habits and food preferences are established at

● Appropriate amount of fat in diet needed to meet needs for
this time
calories, essential fatty acids, and fat-soluble vitamins.
○ Influenced by parents, caretakers, peers, siblings,
● Foods high in fat should be used sparingly, especially those
TV
high in saturated and trans fat
○ Spending more time away from home (day care,
● Good sources of essential fatty acid linoleic acid: peanut,
preschool)
canola, corn, safflower, other vegetables oils
● At this age, children generally do not like:
2
 ● Good sources of essential fatty acid alpha-linolenic acid:
flaxseed, soy, canola oil
● Vitamin E: corn, soybean, safflower oils
VITAMINS AND MINERALS
● Most children from birth to 5 years are meeting targeted levels
of consumption of most nutrients (analysis from NHANES I, II,
III)
● … with the exception of iron, calcium, and zinc
● Some parents say that their child just stops eating when
they’ve had enough, but others find that their child will go on
eating and eating until they are told to stop. All children are
different and may need different amounts of food depending
on how they feel and what they have been doing that day -
e.g. a child who has been running around all day will need
more food than one who isn’t feeling very well.
COMMON NUTRITION PROBLEMS IN
TODDLERS & PRESCHOOLERS

Iron-deficiency anemia, dental caries, constipation, diarrhea, lead

poisoning, food security, food safety

IRON-DEFICIENCY ANEMIA
IRON
● NWS-21.1
○ Reduce iron deficiency among children aged 1-2
● Good sources of iron
years; 15.9% in 2005-2008 to 14.3%
● NWS-21.2
○ Reduce iron deficiency among children aged 3-4
years; 5.3% in 2005-2008 to 4.3%
● For children 2-5 years, hemoglobin value <11.1 g/dL or
hematocrit <33.0% is diagnostic of iron deficiency anemia.
● Rapid growth rate coupled with frequently inadequate intake of
dietary iron, place toddlers (especially 9-18 month olds) at the
highest risk for iron deficiency
● Iron deficiency anemia in young children appears to cause
long-term delays in cognitive development and behavioral
disturbances.

PREVENTING IRON DEFICIENCY

ZINC

● Children at high risk for iron deficiency should be tested

● Good sources of zinc
between ages of 9-12 months, 6 months later, then annually
from ages 2-5
○ Children at risk:
■ Low income children
■ Recently arrived refugee children
■ Low-iron diet
■ Consume >24 oz of milk/day
■ Limited access to food due to
poverty/neglect
■ Special healthcare needs (chronic illness,
IEM)
● Treatment:
○ Supplementation with iron drops, 3 mg/kg/day
○ Counsel parents or caretakers about diet

DENTAL CARIES

CALCIUM
● 1 in 5 children ages 2-4 years have decay in the primary or
permanent teeth
● Adequate calcium intake in childhood affects peak bone mass ● Primary cause- habitual use of a bottle with milk or fruit juice at
● 21% of children 2-8 years consume less than their DRI for bedtime or throughout the day
calcium ○ “Baby-bottle tooth decay”
● Milk & milk products ● Incidence is highest among Hispanic, American Indian, and
○ Low Fat yogurt, milk, cheese, pudding, ice cream, Alaska Native children, and among children whose parents
frozen yogurt, cottage cheese have less than a high school education
● Vegetables
○ Spinach, kale, broccoli FLUORIDE
● Legumes
○ Tofu, beans ● If water supply is not adequately fluoridated, then a
● Foods fortified with calcium supplement is recommended.
○ OJ, frozen waffles, soymilk, breakfast cereals ● American Dental Association, American Academy of
Pediatrics, and American Academy of Pediatric Dentistry:
HEALTH PORTIONS
○ Children 6 months - 3 years need 0.25 mg/day if
water supply has <0.3 pp, of fluoride

3
 ○ Children 3-6 years need 0.5 mg/day if water supply
has <0.3 ppm, or 0.25 mg/day if 0.3-0.6 ppm of
fluoride in water supply
● Fluorosis
○ Excessive fluoride supplementation, consumption of
fluoride toothpaste, and high fluoride levels in water
supply, leads to permanent staining of enamel of
teeth
CONSTIPATION
● Hard & dry stools associated with painful bowel movements
● diet is adequate in total or dietary fiber guard against
constipation
● Whole grain breads and cereals, legumes, fruits and
vegetables
● Avoid too much fiber, however, as it can easily cause diarrhea
in young children
DIARRHEA
● Acute Diarrhea
○ Goes along with an infection or from contamination
of food or drinking water
○ Fever, vomiting
○ Dangerous because child will likely feel ill and
nauseated and will refuse fluids & foods and sleep
more (cause dehydration)
● Chronic Nonspecific Diarrhea
○ Child is not sick
○ Eats well, normal pattern of growth and
development
○ Excessively frequent or watery bowel pattern
○ Can last a day or several months or as long as 3
years
○ Can be caused by distortion in their diet, a cold,
change in water or schedule, antibiotics
Managing Acute Diarrhea
● Maintain an adequate fluid intake to correct the fluid loss
○ Tiny sips of fluid (water, fruit juices, soda pop, ginger
ale, jello, clear broth)
○ Crushed ice or popsicles
○ Limit fruit and juice intake
○ Hold down on sugar
○ Avoid artificial sweeteners
○ Make sure the diet has enough fat in it
○ Include yogurt
LEAD POISONING
● 2.2% of children ages 1-5 have high blood lead levels,
exceeding 10 mcg/dL
● High blood lead levels affect brain and kidney function
● Low-level exposure to lead associated with behavioral
problems, decreased IQ, decreased growth
● lead -based paint chips, lead-soldered water pipes, canned
goods from other countries, dirt, lead weights, ceramic glazes,
pewter
● Screening in children living in houses built before 1950, living
poverty, having a sibling with high blood lead levels, Medicaid,
WIC
● Adequate dietary calcium intake appears to protect against
high blood lead levels by decreasing absorption of lead.
FOOD SECURITY
● NWS-12
○ Eliminate very low food security among children:
1.3& of households with children had very low food
security among children in 2008 to 0.2%
● Children who are hungry and have multiple experiences with
food insufficiency are more likely to exhibit behavioral,
emotional, and academic problems as compared to other
children who do not experience hunger repeatedly.
PHILIPPINE FOOD SECURITY
● The Bureau of Food and Drugs or BFAD of the Department of
Health, has identified several food safety
concerns-microbiological contamination, presence of food
contaminants, use of non-permissible food additives and use
of food additives beyond allowable limits.
● DOH through the Bureau of Food and Drugs (BFAD)
undertakes measures to address concerns - continues
assessment of Good Manufacturing Practices and the Hazard
Analysis Critical Control Points of HACCP for compliance.
● The BFAD is also engaged in the review and development of
food standards.
FOOD SAFETY
● Young children especially vulnerable to food poisoning
because they can become ill from smaller doses of organisms
● Campylobacter, Salmonella, E.Coli 0157:H7, Listeria
monocytogenes
○ Campylobacter: raw poultry, undercooked poultry,
raw milk, non chlorinated water, handling infected
animal or human feces
○ Salmonella: raw/undercooked eggs, raw cookie
dough
○ E.coli 0157:H7: contaminated undercooked
hamburger meat, unpasteurized apple cider/juice,
unpasteurized milk
FIGHTBAC
● Contamination of food can occur at any point along the way
from production to consumption
● Food safety education program, FightBAC, developed by the
Partnership for Food Safety Education
PREVENTION OF NUTRITION-RELATED DISORDERS
Overweight/Obesity, Cardiovascular Disease, Vitamin and Mineral
Supplements
OVERWEIGHT / OBESITY
● Maintaining weight while gaining height can be the best
treatment for obese children between the ages of 2 and 7.
● If a child already exhibits secondary complications, such as
htn, high cholesterol, or triglyceride levels, gradual weight loss
may be indicated.
● Sufficient nutrients must be provided for children to reach full
height potential and to remain healthy.
● Family education & involvement
● Increasing physical activity, offering nutrient-dense snacks,
focusing on behavior change not weight changes.
4

CARDIOVASCULAR DISEASE
● Children with familial hyperlipidemia and obese children can
have high levels of LDL cholesterol.
● Fatty streaks, which can be precursors to the buildup of fat
deposits in blood vessels, have been found in the arteries of
young children.
● AHA & AAP recommend children 2-3 to have 30-35% of fat
energy from fat
● Children 4+, 25-35% of total energy from fat
● Children with familial hyperlipidemia need periodic screening,
saturated fat <7%, <200 mg cholesterol/day
INSULIN RESISTANCE
● Acanthosis Nigricans
○ Indicative of positive insulin resistance
FLUIDS
○ Dark, velvety rash on back of neck
○ People who are overweight or obese are more likely
to develop AN, and it often lessens or goes away
with weight loss
● CARDIAC Project in WV
○ An screening began in 2006-2007 for
kindergarteners
○ Total of 189 (1.6%) has confirmed AN from ‘06-’07
to ‘11-’12
VITAMIN AND MINERAL SUPPLEMENTS
VEGETARIAN DIETS
● Children who consume a variety of basic foods can meet all of
their nutrient needs without vitamin or mineral supplements.
● AAP recommends vitamin and mineral supplementation for
children who are at high risk of developing of have one or
more nutrient deficiencies:
○ From deprived families/abuse/neglect
○ Anorexia/poor appetite/poor eating habits
○ “Fad diet” or only consumes a few types of foods
○ Vegetarians without dairy products
● NHANES III: Approximately 50% of 3-years-olds in the US are
given a vitamin and mineral supplement by their parents.
● Mother who give supplements to their children:
○ Non-Hispanic white, older, more years of education,
married, have life insurance, greater household
income, took prenatal vitamins during pregnancy,
receive care from a private health care provider
FOOD ALLERGIES
DIETARY RECOMMENDATIONS
● My pyramid:
○ 4 year old male, 60+ minutes of physical activity
■ 5 oz grains
■ 2 cups vegetables
■ 1 ½ cup fruits
■ 3 cups milk
■ 5 oz meat/beans
■ 5 tsps oil/day
■ Limit extras (solid fats and sugars to 130
calories per day.)
KEY DIETARY RECOMMENDATIONS
● Variety, variety, variety!
● ½ of grains should be whole
● Children 2-8 years should drink 2 cups per day of fat-free or
low-fat milk or equivalent milk products
● Most fats should come from unsaturated sources - fish, nuts,
vegetables oils
● beans , lean meats, poultry added as appropriate
● Foods high in fat and sugar should be limited in diet
● AHA recommends introducing and regularly serving fish to
children
○ EPA and FDA advise fish and shellfish lower in
mercury
● Provide them with small frequent meals rather than three large
meals provide adequate green leafy vegetables, other
vegetables and fruits for good sources of vitamins, minerals
(specially iron) and fiber.
● Provide enough dairy sources for calcium intake.
● Provide food in a colorful and appealing way,
● Encourage the child to play actively each day.
● Don’t force to eat or bribe the child with sweets or treats
● Limit television watching to 1 to 2 hours a day
● Healthy toddlers and preschoolers will consume enough fluid
through beverages, foods, and sips and glasses of water.
● Fluid requirements increase with fever, vomiting, diarrhea, and
when children are in hot, dry, or humid conditions.
Approximately 50% of 2-5 year olds consume soft drinks
● Children who consume >9 oz of soft drinks per day consume
more calories and less milk and fruit juice than those with
lower consumption of regular soft drinks.
● Young children need energy-dense foods to reduce the total
amount of food required
● Guidelines:
○ Allow the child to eat several times a day (i.e. 3
meals, 2 snacks)
○ Avoid serving the child bran and an excessive
amount of bulky foods, such as bran muffins raw
fruits and vegetables
○ Include in the diet some sources of energy-dense
foods such as cheese and avocado
○ Include enough fat (at least 30% of total calories)
and a source of omega-3 fatty acids, such as canola
or soybean oils
○ Include sources of vitamin B12, D, and calcium, or
supplement if required
● Estimated to be present in 2-8% of children
● Usually identified in toddlers and preschoolers because allergy
testing in infancy is not useful due to the incomplete
development of the immune system
● Anaphylaxis
○ Sudden onset of a reaction with mild to severe
symptoms, including a decrease in ability to breathe,
which may severe enough to cause a come
■ Milk, eggs, wheat, peanuts, walnuts, soy,
fish
● Strict and complete avoidance of the food that causes the
allergy is required
PHYSICAL ACTIVITY
● 60+ minutes on most, preferably all, days of the week
○ Taking a nature walk
○ Riding a tricycle or bicycle
○ Walking, skipping, running
○ Free play outdoors
5
 ○ Running, swimming, tumbling, catching under adult
supervision for preschoolers

SCREEN TIME

● PA-8.2.1
○ Increase the proportion of children ages 2-5 who
view TV, videos, or played video games for no more
than 2 hours a day; 75.6% in 2005-2008 to 83.2%
● No TV viewing for children less than 2 years of age
● Screen time limited to less than 2 hours a day for all other
ages

BIG CONCERN IN MALNUTRITION

3 TYPES:
1. Marasmus Epidemiology of child nutrition:
2. Kwashiorkor
a. Marasmic Kwashiorkor

PEM (protein energy malnutrition) affected child:

Children’s nutrition: 10 tips for picky eaters

● Respect your child’s appetite- or lack of one
● Stick to the routine
● Be patient with new foods
● Make it fun
Take a look: ● Recruit your child’s help
● Set a good example
● Be creative
● Minimize distractions
● Don’t offer dessert as a reward
● Don’t be a short-order cook

CONCLUSION

● The eating habits established in toddler & preschool years

impact food habits and health later in life.
○ Variety of food
○ Helping with preparation, choosing, cooking of
meals
Big concern in malnutrition: ○ Making mealtime pleasant
○ Good nutrition (iron, calcium, zinc)
○ Staying physically active
● Common nutrition problems/disorders include:
○ Dental caries
○ Iron-deficiency anemia
○ constipation /diarrhea
○ Lead poisoning
○ overweight /obesity
○ Insulin resistance
○ Cardiovascular disease

TOP TIPS FOR PARENTS

● Don’t forget! Children aged 1-4 years don’t eat set portion
sizes like many adults do
Fate of malnutrition:
● How much they eat varies widely from day to day and meal to
meal. In general, if you 1-4 year old is taller or more active

6
 he/she will eat larger portions of some foods than if he/she is
smaller or less active.
● Allow your child to eat to his/her appetite. Don’t urge young
children to finish everything on the plate or to eat more than
they wish to.
● Be careful about how much milk and milk products your
toddler/child consumes, as too much can reduce appetites for
iron-containing foods. Also, small portions sizes have been
recommended for the foods high in fat and sugar because
these low nutrient, energy-dense foods should be limited to
prevent toddlers becoming overweight or obese.

7
 NUTRITION IN THE LIFE STAGE 1
LECTURE / SECOND SEMESTER / MIDTERM TOPIC WEEK
INFANT’S MILK FORMULA / BOTTLE FEEDING
NUTRITION AND SAFETY
OBJECTIVES
● Learn the starter or first formula of feeding given for infants.
● Identify the different milk formula or infants
● Apply the principles of nutrition and safety in preparations
and feeding the infants.
INTRODUCTION
● Breastmilk or a suitable infant formula is recommended as the
main source of nutrition for all babies less than 12 months of
age.
● Breastmilk is the feeding option of choice, but commercial
infant formula is the only suitable alternative when breastmilk
is not available.
Babies under 12 months of age should not be fed:
1. Regular, low-fat or skim cow's milk
2. Evaporated or powdered milk, sweetened condensed milk
3. Cereal and legume-based beverages (such as rice, oat, or
soy)
4. Nut and seed-based beverages (such as almond or pumpkin
seed)
5. Any do-it-yourself preparations using homemade recipes.
COMMERCIAL INFANT FORMULAS
● These have been developed to contain similar nutrition to
breastmilk.
● They provide all the nutrition the baby needs until introducing
solids at around 6 months.
● There is little difference between differently priced brands.
● The composition of infant formula continues to change as
research provides a greater understanding of the role of the
unique ingredients contained in breastmilk.
● A variety of new ingredients have been added to infant in
recent years.
1. Starter of first formula
● There is a variety of starter formulas based on cow’s milk
protein (whey or casein).
● Formulas based on soy or goat’s milk are also available.
These formulas are suitable for babies from birth to 12
months.
Read the label carefully because:
● Formulas developed for toddlers as well as pregnant women
can look very similar, so check the label carefully to ensure
your baby gets a formula that is safe and for their age.
● The label may list a number of additions such as LCPUFAs
(long chain polyunsaturated fatty acids or omega-3 fatty
acids), probiotics or prebiotics. These ingredients are added
because they are found naturally in breastmilk.
2. Soy Formula
● Infant soy formula is suitable for babies with a medical reason
to use them, such as an allergy to cow’s milk.
● This formula must not be confused with regular soy milk,
which does not provide suitable nutrition for babies.
3. “Follow on” Formula
● ‘Follow on’ formula is suitable for babies 6 months of age and
over.
● It is your choice whether you use one.
● ‘Follow on’ formula is available based on cow’s milk, soy or
goat’s milk.
● They are made for babies over 6 months of age and contain
higher protein and mineral content than starter formula.
4. Specialized Infant Formula
Infant formula can be modified in a variety of ways, including
changes to the fat, carbohydrates or protein content.
● Specialised infant formula is sometimes necessary for babies
with certain medical conditions and may be prescribed by
pediatricians through the pharmaceutical benefits scheme
(PBS).
Reasons for using one of these formulas might include:
● Severe allergy or intolerance
● Fat or carbohydrates malabsorption
● Severe digestive disorders
Note: Seek medical advice before using a specialised formula.
Some examples of specialised infant formula and when they are
used:
a. Low lactose- is used for lactose (milk sugar) intolerance.
b. Modified protein content- in some formula, the cow’s milk
protein is broken down into smaller units. In other formulas,
the whole protein is replaced by amino acids.
● These preparations are used for severe allergy,
malabsorption and digestive disorders or metabolic
conditions.
c. Modified fat content- this includes formula with a high
concentration of triglycerides and lower levels of fatty acids,
which may be used for babies with liver or gastrointestinal
conditions.
d. Thickened Formula- it is sometimes recommended for babies
who frequently regurgitate (vomit or cough up) large amounts
after feeding, although a thickened formula may not solve this
problem. Only use under medical advice.
e. Premature infant formula- it is designed for preterm (born
premature) babies while they are preterm.
● Premature babies need a formula with additional
energy and mineral content. This is not suitable for
full-term babies or for preterm babies who are now
full term, unless under medical use.
AMOUNT OF FORMULA REQUIRED
● From five days to three months, a full-term, healthy baby will
need about 150 ml of prepared formula per kilogram of body
weight, every day.
- Example: a baby who weighs 3 kg will need 450 ml
of prepared infant formula each day.
● From three to six months, this falls to 120 ml of infant formula
per kilogram of body weight each day.
● From 6 to 12 months, it falls again to between 90 and 120 ml
of infant formula per kilogram of body weight each day.
1
 ● Premature babies need more formula. At first, they usually
need about 160 - 180 ml of formula per kilogram of body
weight per day. Your neonatal doctor or maternal and child
health nurse will advise you.
Note: See your doctor or maternal and child health nurse if you are
worried about your baby’s appetite or growth.
9. Level the powder with a sterilised knife of spatula (do not pack
it down). Add this powder to the bottle of boiled water.
10. Place the disc and cap on the bottle, and shake until
thoroughly mixed.
11. Make up only one bottle at a time. Germs can easily grow in
prepared formula, and can make the baby ill.
12. Never warm a bottle in a microwave oven. This is unsafe as it
does not heat evenly and there may be ‘hot spots’ in the bottle
that can burn the baby’s mouth.
13. Warm a bottle by standing it in a container of hot (not boiling)
water for 10 minutes.
14. Test the temperature by dripping some milk onto the inside of
your wrist. It should feel the same temperature as your skin. If
it is too warm, then cool the bottle under running water or in a
container of cool water. Re-test on your wrist before giving to
the baby.
15. If you are going out for the day, carry hot water in a hot water
flask and the formula separately, then prepare it just before it
is needed.
16. When the tin of formula is empty, discard the scoop that was
provided with the tin of the infant formula.
17. Read the instructions carefully if you change formula brands to
ensure you use the correct amount of water and powder.
18. Throw out any leftover mixture or expressed breastmilk
following the feed, never give your baby leftovers.

EQUIPMENT FOR BOTTLE FEEDING

Whether using a bottle for expressed breastmilk or infant formula,

the equipment need includes:

● Infant formula or expressed breastmilk

● Clean water
● Bottles
● Teats
● Sterilising equipment (and possibly sterilising chemicals)

Bottles for expressed breastmilk or infant formula

When buying bottles, remember that:
1. You will need at least 3 large bottles with leak- proof caps,
discs (bottle collar) and teats (nipple).

PREPARING THE FORMULA

Always remember to:

Teats Size Guide
1. Wash your hands thoroughly and make sure your preparation
area is clean.
2. Check the date on the bottom of the tin or on the sachet to
ensure the formula has not passed its expiry (use-by) date.
3. Use the powder within one month of opening the tin.
4. Follow the manufacturer's instructions strictly. Accuracy is
important to make sure your baby receives the right nutrition.
5. Boil fresh, clean water in a kettle or saucepan.
6. Do not let the water cool for longer than 30 minutes before
making up infant formula. Hot water helps kill any bacteria in
the powder.
7. Pour the recommended amount of boiled water into the bottle.
8. Use the scoop that came with the formula to measure the
exact amount of powder. A scoop from another brand might be
larger or smaller. Never use a half-scoop as it may not be
accurate, make up the full volume.
2
Bottles for expressed breastmilk or infant formula:
● Plastic bottles are better, because glass breaks more easily.
● Bottles should be smooth on the inside surface (no ribbing or
indentation), so they are easy to clean properly.
● Bottles should have clearly marked measurement guides that
will not wear off over time.
● Put the lid on the steam equipment for the recommended time.
● Leave the lid on the steriliser until the bottles are needed.
● Wipe and dry the inside of the container once a day to keep it
clean.

Safety measures for bottle feeding

● Sterilise all bottle-feeding equipment until the baby is 12
months old. This is very important.
● Avoid unnecessary handling of sterilised equipment and do
not touch the inner surfaces of bottles or teats.
● Wash all the equipment in warm, soap water. Use a clean
bottle brush to thoroughly remove all traces of milk, then rinse,
then sterilize.

STERILIZING METHODS FOR BOTTLE FEEDING

Microwave steam sterilising bottle - feeding equipment
Boiling bottle- feeding equipment ● This is used in a microwave oven. Follow the instructions
● Put all equipment in a large pot and cover with tap water carefully.
(make sure the water meets the drinking water guidelines in ● Check the microwave power needed - not all microwave ovens
not using town water). are the same.
● Make sure there are no air bubbles trapped inside the bottles. ● Do not put any metal inside the steriliser.
● Put the saucepan lid on and bring to boil. Allow five minutes of
rapid boiling.
● Turn off heat and allow it to cool.
● Always wash hands thoroughly with soap and water before
handling the equipment.
● Store the sterilized equipment in a clean container in the fridge
and re-boil after 24 hours if it has not been used before then.

Chemical sterilising bottle - feeding equipment

● Sterilising chemicals usually come in liquid or tablet form.
● Follow the manufacturer’s instructions to get correct strength.
Mix the chemicals with water in a large plastic or glass bowl.
● Place all equipment in the solution.
● Soak for at least 1 hour. Remove the equipment and shake off
excess solution, but do not rinse.
● Use only glass or plastic equipment, as metal will rust in the
solution. Change the solution every 24 hours.
● Scrub the container with warm soapy water and rinse
thoroughly before refilling with a new solution.

Steam sterilising bottle - feeding equipment

● A steam steriliser plugs into an electrical power. It works
automatically once you switch it on.
● Place the equipment in the steriliser and add the correct
amount of water.
3