NUTRITION in GROWING YEARS

Subdiv.of Nutrition and Metabolic Diseases

Dept of Child HealthMedical 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 : 110 - 120 kcal/kgBW/d - Protein : 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

• Extended lactation : 7 mos 2 yrs

Effects of Changes in Maternal Diet

Changes + : Vitamin : A, D, E, K

ThiamineRiboflavinNiacinBiotin PyridoxinePantothenicFolateCyanocobalamin

Minerals : Mn, I, F, Se

Changes - : Vitamin : -

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 :- Initial BF : soon after delivery- Positioning : comfortable for both (baby &

mother) - Latching on : - Timing : every 2-3 hrs or 8-12 x/d- 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 infant’s diet• Should balance nutrient needs with a

variety of foods and textures• Encouraging feeding skills development• Goal : transition from a liquid diet into a

well- balanced table food diet• Readiness : - 4 - 6 mos

- physical and psychologic development

Weaning

• Nutrient needs :- 4-6 mos : physical activity >>

- Caloric distribution during infancy : fat : 40 - 50%

protein : 7 - 11%CHO : the remainder

- Water/Energy ratio : 1.5 ml/kcal- Vitamin & mineral : affected by

introducing solid foods - Age 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.hisapR.telan

R.ekstrusi </ -

MengunyahMenggigit

Gerak memutarRahang stabilKoordinasitangan baik

M,cair M.lumat M.Lunak/ padat 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- body size - BEE - onset of puberty- state of illness

• The DRIs (Dietary Reference Intakes) include RDA and AI :

- as a guide to prevent deficiency- to provide positive health

benefits - data are extrapolated values

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