Nutrition in Infants

Nutrition in Infants

• Breastfeeding is recommended exclusively for infants during the first year, with the introduction of solid foods at six months.
• Iron-fortified formula is appropriate if breastfeeding is not possible; cow's milk should be avoided until after one year due to potential digestive issues.

Feeding Amounts

• First month: Feeds every 2-3 hours, 60-90 ml per feeding.
• 2-4 months: Feeds every 3-4 hours, 90-120 ml per feeding.
• 4-6 months: 4-5 feedings daily, 100-150 ml each, with rice cereal introduced at 4 months (1-2 tbsp before breast/formula).
• 6-12 months:
  • 6-8 months: 4 feedings, 160-225 ml each, solids introduced one at a time.
  • 8-10 months: Similar feeding schedule; meats and finger foods may be added.
  • 10-12 months: Transition to a "sippy" cup, eating soft foods with the family.

Nutrition for Toddlers and Preschoolers

• Growth slows, but nutritional needs are high; milk intake should not exceed 1 quart daily.
• Meal patterns typically include three meals and two snacks, adopting family eating habits.

Common Dietary Phenomena

• Physiologic anorexia may occur; reduced appetite is normal during growth slowing.
• Food jags manifest as restrictive eating patterns; it's important not to force diverse foods when this occurs.

Common Diet Deficiencies

• Calcium: Essential for bone health; intake often decreases as children opt for juice and sodas over milk.
• Folic Acid: Low intake among teens linked to congenital abnormalities; many cereals are fortified.
• Iron: Risk of anemia if infants are exclusively breastfed without supplementary iron; adolescent girls are also prone to deficiency.
• Vitamin D: Deficiencies rising due to limited sun exposure; breastfed infants might require supplements.

Hirschsprung Disease

• Congenital condition marked by lack of nerve cells in part of the bowel, leading to stool accumulation.
• Common symptoms include failure to pass meconium, chronic constipation, and abdominal distension.
• Treatment involves surgical resection of the affected bowel segment.

Ulcerative Colitis

• Affects mucosal lining of the colon, leading to ulcerations and bleeding; onset typically between ages 15-30.
• Symptoms include diarrhea (often bloody), abdominal pain, and systemic effects like arthritic and liver conditions.
• Management includes aminosalicylates, steroids, and dietary adjustments.

Diabetes Mellitus

• Most common metabolic disorder in children, types include Type 1 (autoimmune, insulin deficiency) and Type 2 (insulin resistance).

Type 1 Diabetes

• Need for insulin therapy; symptoms include polyuria, polydipsia, and potential ketoacidosis.
• Treatment includes glucose monitoring and carbohydrate management.

Type 2 Diabetes

• Often associated with obesity; treatment focuses on diet, exercise, and potentially oral medications.

Risk Reduction for Diabetes

• Increasing rates of Type 2 diabetes in children tied to growing obesity rates.
• Family-supported nutrition and exercise interventions are more effective than isolated strategies.

Ketoacidosis

• A serious complication of diabetes characterized by fat breakdown leading to ketone production and metabolic acidosis.
• Symptoms include Kussmaul respirations and electrolyte imbalances.
• Treatment necessitates insulin, hydration, and electrolyte management.

Acute Hypoglycemia

• Can significantly affect neurodevelopment; causes include insulin overdose or genetic defects.
• Symptoms include seizures, altered consciousness, and lethargy; treatment involves glucose administration and managing underlying issues.

Nephrotic Syndrome

• Marked by proteinuria and edema; primarily in children aged 2-7, typically responsive to corticosteroids.
• Symptoms include periorbital edema, hypertension, and frothy urine.
• Treatment involves corticosteroids and possible immunosuppressants for relapses.

Acute Renal Failure (ARF)

• Abrupt loss of kidney function, leading to waste retention and various symptoms.
• Treatment may include diuretics and dialysis based on underlying causes.

Renal Biopsy and Ultrasound

• Non-invasive ultrasound helps visualize kidney structures and function; biopsy aids in diagnosing renal disease.
• Post-procedure monitoring for complications is critical to manage bleeding risks.### Symptoms of Acute Renal Failure
• Initial symptoms may be non-specific, leading to life-threatening complications.
• Common signs include lethargy, nausea, and vomiting.
• Hypovolemia associated with low cardiac output and generalized vasodilation can occur.
• Fluid and electrolyte imbalances may lead to hypertension, central nervous system (CNS) abnormalities, metabolic acidosis, arrhythmias, edema, and congestive heart failure.
• Uremia can cause platelet destruction, bleeding, neurological deficits, and disseminated intravascular coagulopathy (DIC).

Treatment for Acute Renal Failure

• Focus on identifying and addressing the underlying cause of kidney failure.
• Supportive care is critical for patient stability.
• Loop diuretics, such as Lasix®, may be employed in some cases.
• Antibiotics are necessary for treating infections, including pericarditis and sepsis.
• Discontinuation of nephrotoxic agents is essential to prevent further kidney damage.
• Kidney dialysis may be required to assist in waste elimination.

Chronic Renal Failure Overview

• Chronic renal failure progresses to end-stage renal disease due to impaired kidney functions, including waste filtration, urine concentration, and electrolyte balance.
• Common causes include hypoxic conditions, kidney disease, and urinary tract obstructions.
• Initially leads to azotemia, progressing to uremia, which presents toxic symptoms due to waste accumulation.
• Significant loss (>50%) of functional renal capacity triggers progressive deterioration over months to years.
• In children, chronic renal failure can result from developmental kidney defects, hereditary diseases, infections, glomerulonephritis, or nephrotic syndrome progression.

Symptoms of Chronic Renal Failure

• Early symptoms often include non-specific signs such as loss of appetite and energy.
• Patients may experience weight loss, headaches, muscle cramps, and general malaise.
• Mental alertness decreases, with patients exhibiting bruising and dry or itchy skin.
• Elevated blood urea nitrogen (BUN) and creatinine levels are indicative.
• Sodium and fluid retention results in edema, while hyperkalemia and metabolic acidosis may develop.
• Calcium and phosphorus depletion affects bone metabolism, causing pain and retarded growth.
• Anemia arises from reduced red blood cell (RBC) production, leading to tachycardia and dyspnea.
• Increased susceptibility to infections and uremic syndrome is also common.

Nutritional Treatment in Chronic Renal Failure

• Nutrition focuses on increasing caloric intake while limiting phosphorus, potassium, and sodium as needed.
• Use of phosphate-binding agents is recommended.
• Calcitriol is used to maintain calcium levels.
• Epoetin alfa stimulates RBC production, while growth hormone aids in growth stimulation for children.
• ACE inhibitors and diuretics manage hypertension.
• Nutritional support, including NG or enteral feedings, ensures adequate protein intake, especially in pediatric patients.