Nutrition

PEDIATRIC NUTRITION AND NUTRITIONAL DISORDER

PEDIATRIC NUTRITION AND NUTRITIONAL DISORDER

BY

Arsal Mehmood

CONTENTSDefinition of nutritionCaloric requirementsBreast feedingVitaminsProtein Calories Malnutrtion

NUTRITIONNutritionis the science that interprets the interaction ofnutrientsand other substances infood(e.g.phytonutrients,anthocyanins,tannins, etc) in relation to maintenance, growth, reproduction, health and disease of an organism. It includes food intake, absorption,assimilation,biosynthesis,catabolismand excretion.

CALORIC REQIREMENT OF CHILREN OF VARIOUS AGESAGECALORIES/KG/DAYInfants1101- 3 years1004-6 years907-9 years8010-12 years7013-15 years60

FORMULA TO CALCULATE CALORIC REQUIREMENTUpto 10 Kg -> 100 kcal / kg

11 20 kg -> 1000kcal + 50 kcal/kg for each kg above 10 kg

Above 20 kg -> 1500kcal + 20 kcal /kg for each kg above 20 kg.

SOURCES OF CALORIC SUPPLYCarbohydrates 50 55%

Fats 30-35%

Proteins 10-15%

UTILIZATION OF CALORIES IN BODY

Basal metabolic rate 50%Physical activity25%Growth12%Fecal loss8%Specific dynamic actions of blood 5%

PROTEIN REQUIREMENTAGEPROTEIN(gm/kg/day)Infants2.51-3 years 2.04-6 years1.57-12 years1.013-15 years0.5

BREAST FEEDING

STRUCTUREThe breast is a mass of glandular, fatty and connective tissue. The breast is made up of:lobules glands that produce milkducts tubes that carry milk from the lobules to the nipplefatty and connective tissue surrounds and protects the ducts and lobules and gives shape to the breastareola the pink or brown, circular area around the nipple that contains small sweat glands, which release (secrete) moisture as a lubricant during breast-feedingnipple the area at the centre of the areola where the milk comes outLigaments support the breast. They run from the skin through the breast and attach to muscles on the chest.There are several major nerves in the breast area, including nerves in the chest and arm. There are also sensory nerves in the skin of the chest and axilla.

FUNCTION

The breasts main function is to produce, store and release milk to feed a baby. Milk is produced in lobules throughout the breast when they are stimulated by hormones in a womans body after giving birth. The ducts carry the milk to the nipple. Milk passes from the nipple to the baby during breast-feeding.

DEFINITION OF BREASTFEEDING

Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts (i.e., via lactation) not from a baby bottle or other container.

The Prolactin Reflex

1. (Long arrow) Nerve impulses from sucking go to brain2. (Short arrow) The pituitary gland releases prolactin into the blood3. (Breast) This causes the alveolar cells to secrete milk and swells the alveoli

The Milk Ejection Reflex1. (Long arrow) Nerve impulses from sucking go to the brain2. (Short arow) The pituitary gland releases oxytocin into the bloodstream3. (Breast) This causes muscles around the alveoli in the breast to squeez milk to the nippleThe milk ejection reflex

HOW BREAST MILK IS PRODUCEDThe let-down reflexHow body responds to babys suckling:Infant suckling stimulates the nerve endings in the nipple and areola, which signal the pituitary gland in the brain to release two hormones, prolactin and oxytocin.How Breast Responds to Babys Suckling:Prolactin causes alveoli to take nutrients (proteins, sugars) from blood supply and turn them into breast milk. Oxytocin causes the cells around the alveoli to contract and eject milk down the milk ducts. This passing of the milk down the ducts is called the let-down (milk ejection) reflex.

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CONTLet-down is experienced in numerous ways including: Infant begins to actively suck and swallow. Milk may drip from the opposite breast. Mother may feel a tingling or a full sensation (after the first week of nursing) in breasts or uterine cramping. May feel thirsty.

10 Steps to Successful Breastfeeding

Have a written breastfeeding policy that is routinely communicated to all health care staff. Train all health care staff in skills necessary to implement this policy. Inform all pregnant women about the benefits and management of breastfeeding. Help mothers initiate breastfeeding within half an hour of birth. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.

CONT6.Give newborn infants no food or drink other than breast milk, unless medically indicated. 7.Practise rooming-in - that is, allow mothers and infants to remain together - 24 hours a day. 8.Encourage breastfeeding on demand. 9.Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. 10.Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

BREAST MILK CONTENTSProteins

Human milk contains two types of proteins: whey and casein. Approximately 60% is whey, while 40% is casein.

Lactoferrin inhibits the growth of iron-dependent bacteria in the gastrointestinal tract.

Secretory IgA also works to protect the infant from viruses and bacteria, specifically those that the baby, mom, and family are exposed to. It also helps to protect against E. Coli and possibly allergies. Other immunoglobulins, including IgG and IgM, in breast milk also help protect against bacterial and viral infections.

BREAST MILK CONTENTSLysozyme is an enzyme that protects the infant against E. Coli and Salmonella. It also promotes the growth of healthy intestinal flora and has anti-inflammatory functions.

Bifidus factor supports the growth of lactobacillus that protects the baby against harmful bacteria by creating an acidic environment where it cannot survive.

CONTFats

It is necessary for brain development, absorption of fat-soluble vitamins, and is a primary calorie source. Long chain fatty acids are needed for brain, retina, and nervous system development. They are deposited in the brain during the last trimester of pregnancy and are also found in breast milk.

CONTVitamins

The amount and types of vitamins in breast milk is directly related to the mothers vitamin intake. Fat-soluble vitamins, including vitamins A, D, E, and K, are all vital to the infants health. Water-soluble vitamins such as vitamin C, riboflavin, niacin, and panthothenic acid are also essential. Carbohydrates

Lactose is the primary carbohydrate found in human milk.. Lactose helps to decrease the amount of unhealthy bacteria in the stomach, which improves the absorption of calcium, phosphorus, and magnesium. It helps to fight disease and promotes the growth of healthy bacteria in the stomach.

BENEFITS OF BREASTFEEDING TO MOTHER

This promotes mother and child bonding.It prevens uterine bleeding in the mother after delivery.This is a natural form of Family Planning.This reduces the risks of breast and ovarian cancer in the mother.This saves time and precious expenses need not be used for buying milk powder and health care.

BENEFITS BREASTFEEDING FOR BABY

This provides the best possible nutrion to the young child.It reduces the incidence of coughs and colds,ear infections,bronchitis,pneumonia,meningitis and diarrhoea through its protective factors.It protects the child from colic,asthma,eczema, nose and food allergies.It is essential for the optimal physical,emotional and mental development of the child.Breastfed child are also smarter.

HOW LONG TO BREASTFEEDNewborns can nurse for 5 to 10 minute per breast; every 2 to 3 hours. This comes to about 10 to 12 feedings per day. In the beginning, there is only colostrum, and theres not very much of it, so be ready to feed often but for short durations.

One month or more: as baby gets older, his stomach will get larger. He will nurse less frequently but for a longer duration at each feeding session. For example, he may nurse 20 to 40 minute per breast every 3 to 4 hours.

By 6 months, Baby may breastfeed for 20 to 40 minutes per breast; 3 to 5 times per day.

CONTRAINDICATION TO BREASTFEEDINGActive /untreated TB

Mom takes radioactive compound(cancer for chemo)

Mom take illegal drug

HIV infection

THE PROPER WAY TO BREASTFEEDStimulate the baby mouth to open by touching the nipple.Let the baby open the mouth wider.Bring the baby near to the breastLatch the baby to the breast

PROPER LATCH-ONBaby open the mouth wider.The chin touching the breastThe chick looked flatulent.The lip are flanged out.The breast looked full and roundCan hear the sound suck and swallowThe nipple looked long and round after breastfeed.

DISLATCH BABY AFTER BREASTFEEDINGUsed little finger press on the gum to open the baby mouth to dislatch from the nipple

POSITIONING OF BREASTFEEDING

The Football HoldHold baby at your side face up and lengthwise, supported by pillows. If nursing on your right side, use your right arm to support baby at your side, and guide her head to your breast.

Football hold position

The CradleSit with baby lengthwise across your abdomen with your elbow supporting his head and your hand supporting his bottom. Your other hand supports the breast.

Cradle hold position

The Cross CradleLay baby on her side, well supported (consider a nursing pillow) and touching you. If you're feeding on your left breast, use your right arm to support baby's body and your right hand to support her head. Your fingers support the left breast.

Cross cradle hold position

The saddle position involves the baby sitting astride the mothers leg, facing the mother. It is useful for mothers who have a particularly forceful letdown reflex as they can lean back a little (called a reclining feed) so that gravity isn't increasing that letdown. - See more at: http://www.breastfeeding-babies.com/saddle-position.html#sthash.kIRdNA8N.dpuf

Saddle Hold

SIGNS THAT THE BABY IS GETTING ENOUGH BREAST MILKHe is contented for 1-2 hours after a feedHe passes clear dilute urine 5-6 times a dayHe passes bright yellow watery stools 6-8 times a dayHe regains birth weight after 2weeks

BREAST MILK SUPPLY CAN BE INCREASED BY:Frequent feeds day and nightAllowing unlimited breastfeeding to satisfy babys suckling needsMother to eat and drink sufficient quantities to satisfy babys suckling her hunger and thirstCultural foods like ginger and rice wine are compatible with breastfeeding.

VITAMINS

VITAMINSOrganic molecules with a wide variety of functions Cofactors for enzymatic reactions Essential, supplied in the diet Two distinct types: Fat soluble (A, D, E, K) Water soluble (B complex, C)

Protein-Energy Malnutrition

MALNUTRITION WHO defines Malnutrition as "the cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions.Malnutrition is the condition that develops when the body does not get the right amount of thevitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function.St.Ann's Degree College for WomenDefinitions

Protein-Energy malnutritionSt.Anns Degree College for Women

PROTEIN ENERGY MALNUTRITION It is a group of body depletion disorders which include kwashiorkor, marasmus and the intermediate stages MARASMUS Represents simple starvation . The body adapts to a chronic state of insufficient caloric intakeKWASHIORKOR It is the bodys response to insufficient protein intake but usually sufficient calories for energy

St.Ann's Degree College for Women


St.Ann's Degree College for WomenProtein-Energy MalnutritionPEM is also referred to as protein-calorie malnutrition. It is considered as the primary nutritional problem in India. Also called the 1st National Nutritional Disorder.The term protein-energy malnutrition (PEM) applies to a group of related disorders that includemarasmus, kwashiorkor, and intermediate states of marasmus-kwashiorkor.PEM is due to food gap between the intake and requirement.


AETIOLOGY:Different combinations of many aetiological factors can lead to PEM in children. They are:Social and Economic FactorsBiological factorsEnvironmental factorsRole of Free Radicals & AflatoxinAge of the Host



Amongst the Social, Economic, Biological and Environmental Factors the common causes are:Lack of breast feeding and giving diluted formulaImproper complementary feedingOver crowding in familyIgnoranceIlliteracyLack of health educationPovertyInfectionFamilial disharmony


St.Ann's Degree College for WomenRole of Free Radicals & Aflatoxin: Two new theories have been postulated recently to explain the pathogenesis of kwashiorkor. These include Free Radical Damage & Aflatoxin Poisoning . These may damage liver cells giving rise to kwashiorkor.Age Of Host : Frequent in Infants & young children whose rapid growth increases nutritional requirement.PEM in pregnant and lactating women can affect the growth, nutritional status & survival rates of their fetuses, new born and infants.Elderly can also suffer from PEM due to alteration of GI System


St.Ann's Degree College for WomenThe clinical presentation depends upon the type , severity and duration of the dietary deficiencies. The five forms of PEM are :

KwashiorkorMarasmic-kwashiorkor Marasmus Nutritional dwarfingUnderweight child

Classification of PEM Water low classificaitionUses height for age and weight for age as indexHeight for AgeWeight for AgeBelow 80%b/w 80%- 119%Above 120%Below 90%Chronic MalnutritionStuntedObese and StuntedAbove 90%Acute MalnutrtionNormalObese


WHO ClassificationIt uses weight for height and height for age as indexMODERATE MALNUTRITIONSEVERE MALNUTRTIONSYMMETRICAL EDEMANoYesWEIGHT FOR HEIGHT(MEASURE OF WASTING)SD score b/w -2 to -3 70-79% of expectedSD score

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Nutrition