Nutritional Needs of Children

Nutritional Needs of Children

• Breastfeeding provides all necessary nutrients in the right quantities for infants.
• Breastfeeding is the most suitable feeding method for infants, providing them with protective substances, easy digestion, and availability at the right temperature.
• Breastfeeding promotes a hygienic and cost-effective feeding method, enabling bonding between the mother and child.
• Breastfeeding helps reduce infant mortality, SIDS, necrotizing enterocolitis, ER visits, ear infections, diarrheal illnesses, inflammatory bowel disease, type 1 and 2 diabetes, leukemia, and lymphoma.
• Breast milk volume increases rapidly in the first 2-3 days after birth and then more slowly, reaching an average of 750-800 ml/day.
• The normal range of breast milk intake for exclusively breastfed infants is wide, between 550-1200 ml/day.
• Prolactin and oxytocin play a role in milk production and ejection.
• Colostrum: The first milk produced, rich in protein, sodium, zinc, vitamin A, immunoglobulins, and growth factors.
• Transitional milk: Produced between 3-5 days to 2-3 weeks after birth.
• Mature milk: Established within 2-3 weeks after birth.
• Signs of adequate breastfeeding: 6-8 wet diapers, 4+ bowel movements, audible swallowing, infant satisfaction, and weight gain after birth.

Formula Feeding

• Formula feeding is an alternative to breast milk when breastfeeding is not possible.
• Formula types include:
  • Cow milk-based.
  • Soy-based.
  • Goat milk-based.
• Formula preparation:
  • Cow or buffalo milk should be boiled properly.
  • Commercially available powdered formula is reconstituted by mixing one level measure with 30 ml of water.
• Formula forms:
  • Ready-to-use.
  • Liquid concentrate.
  • Powdered.
• Medicinal formula:
  • Soy-based for lactose intolerance.
  • Anti-reflux for gastroesophageal reflux.
  • Lactose-free for lactose intolerance and galactosemia.
  • Premature and LBW for low birth weight and premature infants.
  • Phenylalanine-free for phenylketonuria.
  • Amino acid-based for cow milk allergy.

Weaning

• Gradual introduction of solid foods marks the beginning of weaning.
• Weaning does not mean the complete cessation of breastfeeding; it is a gradual withdrawal of milk alongside the introduction of a wide range of non-milk foods.

Protein-Energy Malnutrition (PEM)

• Defined as an imbalance between the supply of protein and energy and the body's demand for them.
• Includes:
  • Overnutrition.
  • Undernutrition.
• Two basic types:
  • Protein-Energy Undernutrition (PEU): Lack of calories and protein.
  • Micronutrient deficiency: Lack of vitamins and minerals.
• Mortality: Undernutrition is responsible for 35% of deaths under 5 years.
• Etiology:
  • Primary: Poverty and ignorance, interaction of nutrition and infections.
  • Secondary: Result from other diseases, infections, lack of breastfeeding, inadequate child spacing, dietary practices, and cultural taboos.

Classifications of PEU

• Wellcome Classification: Based on body weight deficit and edema.

Kwashiorkor

• Onset is acute, within 1-2 weeks.
• Features:
  • Growth retardation.
  • Edema: Pitting, bilateral, starts in hands and feet, spreading to legs and eyelids, no ascites.
  • Muscle wasting with some retained subcutaneous fat.
  • Mental changes: Apathy, inactivity, misery, anorexia, radar gaze.
  • Variable features:
    • Ectodermal changes: Hair (lightening, flag sign, dryness, brittleness, sparseness), skin (flaky paint dermatosis, fissuring, ulceration).
    • Gastrointestinal manifestations: Hepatomegaly, anorexia, vomiting, diarrhea, abdominal distension.
    • Anemia.
    • Vitamin and mineral deficiencies:
      • Vitamin A: Keratomalacia.
      • Vitamin B2: Angular stomatitis, glossitis.
      • Vitamin D: Atrophic rickets.
      • Vitamin C: Scurvy.
      • Nicotinic acid: Pellagra.
      • Copper: Anemia, hair and mental changes.
      • Zinc: Hair, mental and skin changes.
    • Associated infections: Respiratory tract, GIT, skin and mouth, urinary tract infections.

Marasmus

• Onset is gradual between 6 months to 3 years.
• Features:
  • Growth retardation.
  • Loss of subcutaneous fat: Classified by degree (abdomen, limbs, face).
  • Decreased muscle bulk.
  • Skin manifestation: Loss of elasticity, folds.
  • Abdomen: Scaphoid, visible peristalsis.
  • Irritability due to hunger pain.
  • Hypothermia.
  • GI manifestations: Constipation, starvation stools, diarrhea.
  • CVS: Weak and slow pulse (unless with dehydration).
  • Respiratory system: Shallow breathing, chest infections.
  • Vitamin and mineral deficiencies.
  • Infections.

Complications of PEU

• Dehydration, acid-base disturbance, shock.
• Hypothermia.
• Bleeding tendencies, purpura.
• Heart failure.
• Renal failure.
• Metabolic complications:
  • Hypoglycemia.
  • Hypocalcemia.
  • Hyponatremia.
  • Hypokalemia.
  • Hypomagnesemia.