NUTRITION in GROWING

YEARS

Subdiv.of Nutrition and Metabolic Diseases

Dept of Child Health
Medical Faculty, Univ of North Sumatera

Growth and Development

Children == small adults
Children : grow and develop
- body size
- maturity of organs
- psychomotor
- mental / psychosocial
- cognitive

Nutritional requirements : >>

Normal Nutrition during Infancy

Very important for future health, G & D
Rapid G & D :
- physical : - BW : 3.0
10.0 kg
- BL : 50
75 cm
- psychomotor : recumbent
walking, etc.
- mental & cognitive

Nutritional req. : the highest

- Energy
- Protein

: 110 - 120 kcal/kgBW/d

: 2.5 - 3.0 g/kgBW/d

Normal Nutrition during Infancy

Breastfeeding : - recommend to all infants

- the best nutrition for infants

- exclusive BF : up to 4-6 mos

Advantages :
-

superior nutritional composition

provision of immunologic and enzymatic components
health benefits for mothers
lower cost and increased convenience
enhanced infant-mother bonding
respiratory & gastrointestinal infections
leaner body composition at 1 yr
improved cognitive development

Breastmilk composition
Changing / vary : - individually
-

stage of lactation
time of day
time into feeding
maternal diet

4 stages of BM expression :
-

colostrum
transitional
mature
extended lactation

4 stages of BM expression :
Colostrum : - produced during the first few days

- fat & energy : lower

- protein, fat soluble vit, mineral and
electrolytes : higher
- rich source of antibodies

Transition : - 7 - 14 days postpartum

- protein & Ig :
- lactose, fat & energy :

Mature milk : throughout lactation, until 7-8 mos

2 yrs
Extended lactation : 7 mos

Effects of Changes in Maternal Diet

Changes + :
Vitamin : A, D, E, K
Thiamine
Niacin
Pyridoxine
Folate

Riboflavin
Biotin
Pantothenic
Cyanocobalamin

Changes - :
Vitamin : -

Minerals : Mn, I, F, Se

Minerals : Na, Ca, P, Mg,

Fe, Zn, Cu

Breastfeeding Management
Factors infuencing successful lactation :

motivation & confidence of the mother - support from those

around her
- capability of the infants to suckle

To establish and sustain lactation :

soon after delivery
(baby & mother)
hrs or 8-12 x/d

- Initial BF :
- Positioning : comfortable for both
- Latching on :
- Timing : every 2-3
- Assessing adequacy

Posisi ibu & bayi

Benar

Salah

Mata menatap, bibir dower

Benar

Salah

Mulut bayi mencakup areola

Benar

Salah

Breastfeeding Management
Assessing adequacy :
How do I know if my baby is getting enough?
Signs that a baby is receiving adequate fluid and
calories :
-

have at least 6-8 thoroughly wet diapers/day

have regular bowel movements
nurse 8 - 12 times/day
seem satisfied after nursing
grow at a relatively predictable rate

Weaning
Introducing solids into an infants diet
Should balance nutrient needs with a variety
of foods and textures
Encouraging feeding skills development
Goal : transition from a liquid diet into a wellbalanced table food diet
Readiness : - 4 - 6 mos
- physical and psychologic
development

Weaning
Nutrient needs : - 4-6 mos : physical activity >>
- Caloric distribution during infancy :

fat
CHO
:

: 40 - 50%
protein : 7 - 11%
the remainder - Water/Energy ratio : 1.5 ml/kcal

- Vitamin & mineral : affected by introducing

solid foodsAge 6 mos : 80% BM/formula, 20% beikost
8- 10 mos : 50% BM/formula, 50% beikost
12
mos : 20% BM/formula, 80% beikost

Tahapan penyapihan

Ciri bayi siap menerima MP-ASI

Weaning
Physical readiness :
- extrusion reflex < / - oral motor skills :
- from suck to swallow solids
- transfer food from front to back of the tongue

- able to hold the head up without support

- sitting independently and maintaining balance
while using hands to reach and grasp objects

Weaning

Psychologic readiness :

- advanced eating behaviour : from refllexive and

imitative to more independent and exploratory
- by 6 mos : the infant is able to indicate :
- a desire for food by opening mouth
- hunger by leaning forward
- disinterest or satiety by leaning back
and turn away

Encouraged to develop more independence :

-

self-feeding of soft finger foods

sipping from a cup by 6-8 mos
holding the cup or bottle independently
controlling the timing of feeds to promote
self-regulation of hunger and satiety

Tahapan penyapihan :

R.hisap
R.telan

Mengunyah
Menggigit

R.ekstrusi </M,cair

M.lumat

M.Lunak/padat

Gerak memutar
Rahang stabil
Koordinasi
tangan baik
M.keluarga

Weaning foods
Commercial baby foods :
-

prepared without sodium, many without sugar

enriched with vitamin and Fe, Ca, P
first food = single ingredient foods
textures from strained to chunky
time efficient

Home-made baby foods :

- more economics
- greater flexibility in consistency and variability
- time consuming

Frekwensi makan

Tujuan akhir praktek pemberian makan

(periode 3)

Susu

Susu

(Susu)

Normal nutrition from infancy through adolescence

Preschool and school children : slowing in physical
growth
Elementary school years = latent period prior to
pubertal growth spurt of adolescence
Growth pattern ( spurt and slow/no growth ) :
correspond to similar changes in appetite and food
intake
Developmental progress during the growing years
influences many aspects of food and eating

Normal nutrition from infancy through adolescence

Nutrient needs : determinants factors are :
rate and stage of growth - activity
- BEE
- onset of puberty
illness

- body size
- state of

The DRIs (Dietary Reference Intakes) include RDA

and AI : - as a guide to prevent deficiency - to
provide positive health benefits
extrapolated values

- data are

Normal nutrition from infancy through adolescence

ENERGY :

- RDA : based on reference weight for each age group

- using doubly labeled water : RDA for children was
overestimate as much as 25%
- up to age 10 yrs no distinction between sexes
- 11 yrs and above : allowance for energy are
based on sex and puberty
- age is not good criterion for determining energy
needs
especially in pubertal years ( growth spurt occur
at
varying times)
- height is a useful reference in determining
appropriate
energy intakes

Factors influencing adolescence nutritional status

and eating behaviour
- Irregular meals
- Snacking
- Media
- Family
- Peers
- Body image
- Fast foods