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# Management of Malnutrition Management consists of the following: ### Nutritional Program * Formula: Kcal per day = RDA for age in kcal/kg X ideal weight/actual weight. Include vitamin and mineral supplements. * Infants (young): Provide supplements to formula. Kcal per ounce of formula should n...

# Management of Malnutrition Management consists of the following: ### Nutritional Program * Formula: Kcal per day = RDA for age in kcal/kg X ideal weight/actual weight. Include vitamin and mineral supplements. * Infants (young): Provide supplements to formula. Kcal per ounce of formula should not exceed 24. * Toddlers: Provide high-caloric milk drink (PediaSure) ### Referrals * Referrals to social workers, welfare, child protective services as indicated. ### Behavior Modification * Behavior modification related to meal times, eating habits interfering with nutrition. ### Family Therapy & Education * Family therapy as indicated. * Family education. ### Structured Environment * Structured supportive environment for feeding, persistence in feeding and elimination of distractions. * Slow introduction of new foods. # Normal Growth and Development ## First Month * **Sleep:** Sleeps about 16 hours/day during the first month. * **Growth:** Loses 5-7% of birth weight and then gains 4-7 ounces per week (about 2 lbs/month). Head circumference increases 1.5cm/month and length 1.5cm. * **Mobility:** Makes fists and flexes arms and legs. Reflexes such as Moro, sucking, grasping startle, rooting, and asymmetric tonic neck are present. * **Feeding:** Nurses about every 2-3 hours with breastfeeding and 2-4 hours with bottle feeding. * **Urine/Feces:** Urination about 8 times/day. Breastfed babies may have frequent loose stools or may skip 2-3 days. If bottle-fed, stools are usually more firm. Color varies (yellow, tan, green, brown). * **Senses:** Follows items in line of vision and often prefers faces and contrasting geometric designs. Vision is somewhat blurry with ability to focus at about 8-15 inches. Color distinction is poor. Babies hear well and respond with startle reflex. Sense of smell is strong. * **Communication:** Signals distress with crying, gagging, and arching body and respond to comfort measures. ## 2-4 Months * **Sleep:** Infant continues to sleep much of the time but is often awake for periods in the morning, afternoon, and evening. * **Growth:** Gains 5-7 ounces/week and 1.5 cm length/month and 1.5cm head circumference/month. Posterior fontanel closes. * **Mobility:** Loses grasp reflex and hands start to stay open and grasp. Able to lift head while prone or supine and turn from side to side. Can roll stomach to back by 4 months. Moro reflex fades. Plays with hands * **Feeding:** Needs about 2 oz/lb/24 hours, usually feeding every 4 hours. Can be pulled to standing position. * **Urine-feces:** Urine is about 5-6 times/day. Stools vary from one each feeding to every 2-3 days, but usually are more firm and regular. * **Senses:** Infant can focus at about 12 inches and follows objects 180° with eyes.