FEEDING_OF_NEWBORNS_AND_INFANTS_FOR_OPTIMUM_GR (1)

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infant and newborn nutrition

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FEEDING FOR OPTIMUM GROWTH AND DEVELOPMENT OF INFANTS:

FEEDING FOR OPTIMUM GROWTH AND DEVELOPMENT OF INFANTS DR.RAMESH.S.IYER SHREE SIDHIVINAYAK HOSPITAL AND NICU JUPITER HOSPITAL THANE MAHARASHTRA

DISCLAIMER:

DISCLAIMER INFANT FEEDING IS A VAST TOPIC SO ITMAY NOT BE POSSIBLE TO COVER THE WHOLE SUBJECT IN THE STIPULATED TIME. THE SPEAKER IS NOT RESPONSIBLE IF U FALL ASLEEP. THE CAUSES FOR THE SAME MAY BE MULTIFACTORIAL, 1) CEPHALIC PHASE B4 GOOD FOOD 2)TOPIC BUT BEWARE IT’S A SMALL GATHRING U MAY BE CAUGHT NAPPING UNLIKE,AS IN MAJOR CONFERANCES.

Role of Nutrition :

Role of Nutrition Difference between children and adults is that children exhibit continuous growth and development till maturity. Growth defined as increase in anthropometric measurements is dependent on optimum nutrition and absence of disease. Development defined as maturation of functions of different body organs and systems that is genetically programmed but could be adversely affected by nutritional deficiencies

Measurements of growth (Anthropometry):

Measurements of growth (Anthropometry) Weight for age Height for age Weight for height Head circumference Mid-arm circumference

Growth- Anthropometry:

Growth- Anthropometry Normal Full term newborn child: Weight: 2.6 – 2.8 kg ( 5 1/2- 6 lbs ) 3.0 – 3.5 kg in affluent class Length: 50cms ( 20 inches ) Head circumference: 34cms ( 13 inches ) Upper/ lower segment ratio: 1.7/1

Growth- follow up- Weight:

Growth- follow up- Weight 0 to 3 months: 30gms/ day: 750gms/ month 3 to 9 months: 20gms/ day: 600gms/ month 9 to 12 months: 10gms/ day: 300gms/ month 3kg at birth Doubles birth weight by 5 months 6kg Triples birth weight by 1 year 9kg Quadruples birth weight by 2 years 12kg 2.5kg per year thereafter.

Growth- follow up- Length:

Growth- follow up- Length 0 to 3 months: 3.5cms / month  60cms at 3 months 3 to 6 months: 2.0cms / month 66cms at 6 months 6 to 9 months: 1.5cms / months  70cms at 9 months 9 to 12 months: 1.25cms/ month  75cms at 1 year 50cms at birth 75cms at 1 year 12.5cms in 2 nd year  87.5cms at 2 years 6.25cms per year in next 2 years  100cms at 4 years

Growth- Follow up Head circumference:

Growth- Follow up Head circumference 0 to 3 months: 2cms per month 3 months to 1 year: 2cm/3mths 1 to 3 years: 1cms / 6 months 3 to 5 years: 1 cm per year 34cms at birth 44-46cms at 1 year 48-52 at 2 years

Growth charts:

Growth charts

Types of food:

Types of food Energy giving foods: Carbohydrates, Fats Body building foods: Proteins, Fats Protective foods: Proteins, Vitamins, Minerals Carbohydrates make 1% of body mass but make for 55-65% of calories consumed. Proteins make 20% of body mass but make for 10-15% of calories consumed. Fats make up for 35% of calories consumed .

Types of food- Sources:

Types of food- Sources Milk: Breast milk Unmodified bovine milk ( UBM ): cow’s, buffalo's, goat’s milk Infant milk formulae ( IMF ) Milk products: curds, whey, buttermilk Cereals: Rice, Wheat, millets Pulses and lentils Vegetables & nuts, seeds Fruits, sugars, honey Meats & poultry Fats: Ghee, butter, Oils

Breast milk as source of nutrition:

Breast milk as source of nutrition Breast milk is the ideal source of nutrition Calories 67 cal / dl Carbohydrate (lactose ): 7 gm (28 cal) / dl i.e. 42 % of calories Proteins (Lactalbumin, lactglobulin): 1.5 gm (6 cal)/dl i.e. 9 % of calories. contains all essential a. a. ideal whey cesin ratio . Fats 3.5 gm (31.5 cal) / dl i.e.42.5 % of calories & provide 4-5 % of calories as linoleic acid . Adequate source of most vitamins & minerals in early infancy if mother in good nutritional state. Available iron is optimally absorbed.

COMPARISION BETWEEN HUMAN& COW’S MILK:

COMPARISION BETWEEN HUMAN& COW’S MILK 1) No bacterial contamination. 2) anti-infective substances, lactoferrin,antibodies,complements,PABA. 3) Protein: total 1% caesin0.5% 4) Contains all essential Amino acids e.g. Cystine, taurine.( for growing brain) 1)Likely 2)Not available 3) total: 4% caesin 3% 4) Not enough

COMPARISION CTD:

COMPARISION CTD 5).fats enough linoleic,linolenic fatty acid for growing brain. Proper ratio of saturated and unsaturated f.a Lipase to digest fat. 6).lactose 7%. 7).salts sodium 6.5(normal) chloride 12 potassium 14 5) not enough Too much saturated fats Lipase not available 6). Lactose 4%. 7) sodium 25(high) chloride 29 potassium 35.

COMPARISION CTD:

COMPARISION CTD Calcium 350 Phosphate 150 Iron small amount but Absorbable. Vitamins enough MATERNAL BONDING! Calcium 1400 Phosphate 900 Iron small amount but not absorbable. Vitamin supplements needed.

BOVINE MILK ALLERGY:

BOVINE MILK ALLERGY Is due to the protein in the animal milk. Not due to the lactose, though signs of lactose intolerance is common with bovine milk allergy. Infants don't outgrow the problem. Presents with eczema, rash,vomitng,abd. Cramps ,diarrhea. Skin allergy testing doesn’t help.

“Mansala ani balala ekda batli chi savay lagli tar ti lawakar sutat nahi”:

“Mansala ani balala ekda batli chi savay lagli tar ti lawakar sutat nahi” In spite of the best and sincere efforts of the fraternity of paed and obs this still continues. We all know about its disadv.

ESSENTIAL FATTY ACIDS:

ESSENTIAL FATTY ACIDS Obviously called essential as they cannot be synthesized in body. Also called as PUFA. Basically consists of 2 families of fatty acids. OMEGA 3 & 6. Starts as SC-PUFA. OMEGA 3: sc-PUFA is alfa linolenic acid(ALA), gets further desaturated to eicosapentenoic acid(EPA), docosahexanoeic acid(DHA) OMEGA 6: sc-PUFA is linoleic acid, gets further desaturated to gama-linoleic & arachidonic acid(ARA) EPA, DHA,ARA are LC-PUFA.

FUCTIONS OF PUFA IN GROWING CHILD.:

FUCTIONS OF PUFA IN GROWING CHILD. DHA: is required for the development of photoreceptor membrane of retina and of gray matter, modulates cardiovascular functions. Arachidonic acid: is reqd for myelination,and is a precursor of eicosonoids which helps in development of immune and clotting system( prostaglandins & leukotreines). Diet rich in pufa helps in intestinal repair in patients with severe PEM Breast milk is abundant in Lc-pufa,whereas bovine milk is deficient.

Uses of LC-PUFA in children.:

Uses of LC-PUFA in children. Autism and ADHD. Macular degeneration Photo-sensitive dermatitis Better sugar control in IDDM’s.

UNTOWARD/ADVERSE EVENTS DURING BREAST FEEDING???:

UNTOWARD/ADVERSE EVENTS DURING BREAST FEEDING???

UNEXPECTED EVENTS DURING BREAST FEEDING:

UNEXPECTED EVENTS DURING BREAST FEEDING 1) Aspiration: suspect T-O fistula,laryngo-esophageal cleft, undiagnosed cleft palate. 2) Cyanosis: cardiac(CCHD), respiratory 3)Recurrent vomiting: surgical esp. if bilious IEM (pku,msud,galact) 4)Convulsions: hypoglycemia,hypocalcemia 5)Persistent jaundice: breast milk jaundice

CONTRAINDICATIONS:

CONTRAINDICATIONS HIV IN MOTHER. ACTIVE,DISSEMINATED T.B. IN SUCH ODD SITUATIONS PREFER FORMULA FEEDS OVER BREAST FEEDING.

Growth pattern in exclusively breastfed babies:

Growth pattern in exclusively breastfed babies Optimum growth till age 6 months Dramatic and steady decline in wt for age, ht for age and wt for ht after 6 months. This decline reduces and stops at 18 mos. This is related to non introduction of complementary diet after 6 months with energy, protein & micronutrient deficient.

What is Weaning :

What is Weaning Gradual transition from all-milk diet in a breast fed or alternative milk fed baby to a completely diversified semisolid to solid diet. It complements milk feeds( hence the name) It stops when the baby switches to predominantly solid diet

When to start weaning :

When to start weaning The introduction of weaning process is governed by baby’s gradually maturing neurological, muscular, digestive system & gut immunity. The ability to coordinate sucking & swallowing, chewing. The ability to hold neck in upright posture Beginning of teething allows physical breakdown of large size food pieces. The maturation of salivary & pancreatic amylase Maturation of gut lactase activity. The increasing stomach capacity. The ability to ward off potential allergens from food as well as pathogens. The ability of kidneys to dispose of high protein load from diet.

When NOT to start weaning Not before 4 months – Not later than 6 months!:

When NOT to start weaning Not before 4 months – Not later than 6 months! Problems with early weaning Breast milk failure Alteration of bowel movements Diarrhea Constipation Flatulence & colic Food allergies Obesity Problems with late weaning Energy malnutrition Protein malnutrition Micronutrient malnutrition Growth stunting with poor catch up growth

Guidelines to weaning:

Guidelines to weaning Milk consumption should be at least 500 ml/ day Complementary food should comprise only 50% of total calories till 6 months Consistency to change from semi liquid to semi solid to solid. Texture to change from grainy to pasty to lumpy Start with carbohydrates  fats  proteins Rice based cereals should precede wheat based cereals Single component CFs to precede multi component CFs New item in CF should be continued for a few days before switching to another food item Avoid salty, spicy foods and foods rich in nitrites, MSG Avoid artificial colors, preservatives IT SHOULD GIVE BALANCE NUTRITN MEETING ALL DAILY REQMTS

Home-prepared weaning foods:

Home-prepared weaning foods Advantages Unlimited variety Freshly prepared Varying consistency as per baby’s likes & tolerance Culturally acceptable Economical Preferred by most of our parents Disadvantages Empirically proportioned, improperly prepared Inadequate supplements of micronutrients Chances of poor hygiene in preparation & storage Chances of chemical & microbial contamination Time consuming

WEANING RECOMDATNS 6 TO 9 MNTHS:

WEANING RECOMDATNS 6 TO 9 MNTHS START WITH CEREAL BASED PORRIDGE(SUJI,WHEAT,RICE,RAGI), 1-2 TSF TO START WITH AND INC SLOWLY ENRICH WITH OIL/GHEE/ANIMAL MILK INTIALLY THEN ADD MASHED BANANA,PAPAYA OR OTHER SEASONAL FRUITS.

WEANING RECOMANDATNS 9-12 MNTHS:

WEANING RECOMANDATNS 9-12 MNTHS BY NOW THE CHILDS STARTS CHEWING SO FOOD NEED NOT BE MASHED. FAMILY POT FEEDING IS HIGHLY RECOMMENDED. BY FIRST BDAY CHILD SHUD BE HAVING 4-5 FEEDS PER DAY. EGG,FISH,MEAT MAY BE ADDED IF CULTURALLY ACCEPTABLE TO INCREASE THE CALORIC CONTENT.

STANDARD WEANING PRACTICES:

STANDARD WEANING PRACTICES Cereal based porridge is the main complementary food. Main ingredients: rice/ wheat, sorghum, millets & certain starchy tubers Cooking leads to gelatinization & needs dilution to make palatable, leading to dilution of calories & macronutrients like proteins & micro nutrients like iron, zinc, vit A & vit C.The energy content of such food is as low as 50 cal /100gm..

PowerPoint Presentation:

HIGH DIEATRY BULK OF CEREAL BASED PORRIDGES IS DUE TO NUTRITION DIVISION/TRNG/RK 2002

Methods to improve digestibility of cereals:

Methods to improve digestibility of cereals Roasting: Dry heating of cereals: Improves digestibility of proteins, kills micro- organisms. Does not help in decreasing viscosity. Does not reduce phytates content. Germination: Soaking of cereals: Improves Vit C & amylase content better digestion of starches. Improves protein availability, reduces phytic acid content. Improves viscosity on cooking. Increased chances of microbial contamination. Fermentation: Use of Lactic bacteria & yeast cells: Improves protein digestibility, reduces phytates, reduces pH to prevent contamination. The bacteria also colonize the gut to improve gut immunity. Does not improve viscosity on cooking .

Methods to improve energy density in cereals (minimum of 1 Kcal / gm):

Methods to improve energy density in cereals (minimum of 1 Kcal / gm) Germination of cereals to improve viscosity. Addition of high energy ingredients like fats & sugar. Fats also improves the viscosity & give fat sol vitamins Addition of vegetables, pulses & animal products incl fish & meat & milk.

Methods to improve nutrient density:

Methods to improve nutrient density Enzyme hydrolysis of starch TO CONVERT IT TO DEXTRINS Addition of animal products like fish, meat & milk in powdered form Addition of micronutrients like Vit C, iron, zinc & Vit A

Enzyme hydrolysis of starch:

Enzyme hydrolysis of starch

SAMPLE DIETS,HIGH ON ENERGY AND PROTEINS:

SAMPLE DIETS,HIGH ON ENERGY AND PROTEINS LADDOO MADE OF BENGAL GRAM FLOUR, WHEAT FLOUR,JAGGERY,GHEE..CALS 500/100GMS..PROTEINS 9/100GMS SOOJI KHEER..TONED MILK 750ML,SUGAR 100GMS, SOOJI 25G.,OIL 5G.. CALS 1432, PROTEINS 28.4 WHOLE WHEAT 40GMS, BENGAL GRAM 16G,GROUNDNUTS10G,JAGGERY20G,CALS330 PROTEINS 11.3/86G

PowerPoint Presentation:

! THANK U ! MERRY CHRISTMAS AND HAPPY NEW YEAR

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