1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman...
-
Upload
clarissa-walters -
Category
Documents
-
view
216 -
download
1
Transcript of 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman...
![Page 1: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/1.jpg)
1
Nutritional requirements for small Children
Matthias Brandis
Prof. of Paediatrics
Former Chairman of Paediatrics
Senator of the National Academy of Science
Department of Paediatrics and Adolescent Medicine
University Hospital
Freiburg, Germany
![Page 2: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/2.jpg)
2
Nutritional requirementsin infants and small children
• The averagre need for any child in the world is known since 150 years and can be expressed as– Energy intake per day– Divided in
• Protein• Crabohydrates• Fat
– Micronutrients like Ca, Fe, Znc, Vit D
![Page 3: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/3.jpg)
3
Consequences of longstanding malnourishment
• Children suffering from chronic malnourishment tend to adapt to the reduced amount of food
• The consequences are lethargy, motoric inactivity, diminshed muscular strength
• Retarded psychomotor development
![Page 4: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/4.jpg)
4
Health consequences of nutrition in early childhood
long time, secondary sequelae
• Metabolic program• Metabolic diseases like Obesity,
hypertension and cardiovascular diseases are correlated to birth weight, growth and feeding patterns
• Fat content should not exceed 25% of energy intake
• Protein should not exceed 15%
![Page 5: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/5.jpg)
5
Health consequences of nutritioan in early childhood
• Breastfeeding of 4-6 month exclusively leads to ideal serum lipid profile, reduced incidence of atopic dermatitis
• Neuro-cognitive development is correlated to long chain polyunsaturated fatty acids content of the diet
• Meat intake has proven to be beneficial to psychomotoric development. In Ghana only 6% of the children have regularly meat as part of their diet
![Page 6: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/6.jpg)
6
Nutrition and health development in women and children
What are the questions?• Are the basic nutritional needs guaranteed
for pregnant mothers?• Are the Basic principles of feeding an infant
and small child adequately known?• Are the parents educated enough to
understand the real necessities?• What are the reasonable measures to be
taken routinely and in emergency situations• Emergencies are e.g. wars and droughts
![Page 7: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/7.jpg)
7
Age Kcal/
Kg /d
Protein
g/kg
Fe
Mg/d
J
ug/d
0-4 m 91 1,5-2,7 0,5 40
4-12m 90/ 1,1-1,3 8. 80
4-7 y 82 1,0 8 100
Nutritional needs for infants and children
![Page 8: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/8.jpg)
8
Breastfeedingas basic nutrition in infants
adequate propagation
• Advantages– Sterility– Adequate ratio between protein, carbohydraes and fat– Feeding by demand– Continuation of breast milk to toddlers diet up to 30%
guarantees adequate supplement of fat and Vitamin A– Breast feeding might contribute to birth control
![Page 9: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/9.jpg)
9
Nutritional mixaccording to regional ressources
• Agricultural local products– E.g. Maize, Millet, Sorghum, Cassava– Nuts,peanuts, beans, Yam et al.
• Animal products– Meat– Milk
• F100: Substitute for micronutrients, where necessary
![Page 10: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/10.jpg)
10
Consequences
• The first goal is:– Feed the mother adequately– Teach the mother by simple information about
her own demands during pregnancy and while breastfeeding
– Teach the parents about the local availibility of agricultural and animal products as well as micronutrients
![Page 11: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/11.jpg)
11
Preharvest
Controlled study in school children in Benin, 2002(Mitchipkeet al. Public Health Nutr. 2009, 12, 414 )
![Page 12: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/12.jpg)
12
Postharvest
Controlled study in school children in Benin, 2002(Mitchipk et al. Public Health Nutr. 2009, 12, 414 )
![Page 13: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/13.jpg)
13
Controlled study in school children in Benin, 2002(Mitchipke et al. Public Health Nutr. 2009, 12,
414 )
![Page 14: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/14.jpg)
14 Controlled study in school children in Benin, 2002(Mitchipke et al. Public Health Nutr. 2009, 12, 414 )
![Page 15: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/15.jpg)
15 Controlled study in school children in Benin, 2002(Mitchipke t al. Public Health Nutr. 2009, 12, 414 )
![Page 16: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/16.jpg)
16
The Importance of Micronutrients
• Micronutrients are– Iron– Calcium– Zinc– Vitamins
• Any local traditional diet may be deficient in micronutrients which lead to anemia and rickets, which are frequent diseases in central Africa
![Page 17: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/17.jpg)
17
![Page 18: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/18.jpg)
18
Micronutrient deficiency
• Iron deficiency: – Leads to anemia , retarded pschomotor development
and stunting
• Calcium and Vit D deficiency: – leads to the world wide persisting prevalence of
rickets, with growth stunting
• Iodine deficiency:– Leads to neuro- intellectual retardation
• Zinc deficiency– Leads to stunting, diarreha, skin disease:
![Page 19: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/19.jpg)
19
Zotor,FB and Amuna,P, Proc.Nutr.Soc.,2008. 67, 98
![Page 20: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/20.jpg)
20Zotor,FB and Amuna,P, Proc.Nutr.Soc.,2008. 67, 98
![Page 21: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/21.jpg)
21
Hypernatremia
• Hypernatremia: Na > 150 mEq/L (Serum-osmolality increase by 20 mosmol/L)– causes:
• Water loss > than salt• Salt ingestion(very rare)
• Rehydratation slowly: Lowering of the elevated osmolality not faster than 5 mosmol/L in 6-12 hours
• Restitution can last up to 48 hours!• Salt ingestion has to be treated by emergency PD
Finberg et al.1979Finberg et al.1979
![Page 22: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/22.jpg)
22
700 mlIntake
700 mlExcretion
1400 ml ECV
Fluidexchange in an 7kg infant per day= 50 % of ECV
2000 ml intake 2000 ml excretion14000 ml ECV
Fluidexchange in adult(70 kg)= 14 % of ECV
![Page 23: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/23.jpg)
23
• Calculation of salt and water needs for a child of 10 kg BW– 100ml / kg BW= 1000ml– 2 mEq/ kg Na = 20 mEq
• All commercial infusion solutions have a 2 to 3 times higher sodium concentration
• Calory intake: e.g. 50 -70 Kcal/KG– Glucose- containing solutions have 200 Kcal/L, that is 20 Kcal/KG– During parenteral fluid therapy for several days additional calory
intake might be necessary, e.g. 2o% Glucose, Amino Acids, Fat
![Page 24: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/24.jpg)
24
Oral Rehydration
• Oral Salt solutions– Na-content 60-90 mmol/L– Glucose content 5 g%– Tube feeding– Up to 100 ml/kg/ day in small fractions or
continuous infusions
![Page 25: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/25.jpg)
25
Salt and Water regulationSummary
• In General it is practical experience to start to treat a child in an emergency situation with clear indications of a volume deficit with the following regime:– 20ml /kg BW in 1 hour Isotonic solution, if not plasma
or blood substution is needed.– In this 1 hour all necessary calculations and lab
results can be achieved and the next steps can be taken under the safe knowledge of the diagnosis
![Page 26: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/26.jpg)
26
Conclusions
• There is an overwhelming global evidence about the nutritional needs and demands in pregnant and lactating women as well as in infants and toddlers
• A high percentage up to 50% of children are malnourished and may suffer from stunting, anemia, rickets and retarded neuro-intellectual development
![Page 27: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/27.jpg)
27
Conclusions
• After decades of concern by local governments and international organisations the situation is as prevalent as ever or even worse.
• Severe droughts, ongoing wars with millions of children living in refugee camps have worsened the situation particularly for children and are not adequately compensated.
![Page 28: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/28.jpg)
28
Conclusions
• Which steps can be successfull and are mandatory:
–1 Teaching the families about the basic principles of diets
– 2 Rely on the local accessablilty of the agricultural products
– 3 Define the potential needs for supplementation of micronutrients(F100)
– Emergency situationas have to be undertaken in sitiations of humanitarian need, but should always lead to early reinstitution of the local food culture.
![Page 29: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/29.jpg)
29
Conclusions
• Education of children and parents seems after so many years of support programs the prominent task for any government, to guarantee a better future for the society
![Page 30: 1 Nutritional requirements for small Children Matthias Brandis Prof. of Paediatrics Former Chairman of Paediatrics Senator of the National Academy of Science.](https://reader030.fdocuments.net/reader030/viewer/2022032604/56649e595503460f94b52eeb/html5/thumbnails/30.jpg)
30
• Thank You for Listening