Nutritional Assessment PDF

Chapter 8 NUTRITIONAL ASSESSMENT Let's Talk About Your Plate: Your Guide to a Healthier You  RECOMMENDED DIETARY ALLOWANCES AND ADEQUATE DIET ADEQUATE DIET composed of various nutrients which the body needs for maintenance, repair, living processes, and growth or deve...

Chapter 8 NUTRITIONAL ASSESSMENT Let's Talk About Your Plate: Your Guide to a Healthier You  RECOMMENDED DIETARY ALLOWANCES AND ADEQUATE DIET ADEQUATE DIET composed of various nutrients which the body needs for maintenance, repair, living processes, and growth or development. a diet which meets in full all the nutritional needs of a person.  RECOMMENDED DIETARY ALLOWANCES AND ADEQUATE DIET FACTORS TO CONSIDER FOR NUTRITIOUS MEAL PLANNING: Regional availability of foods Socio-economic conditions Taste preferences Food habits Age of family members Storage and preparation facilities Cooking skills  RECOMMENDED and ENERGY NUTRIENT INTAKES Emphasizes the standard is in terms of nutrients and not foods or diet. Levels of intakes of energy and nutrients which are considered adequate for the maintenance of health and well-being of nearly all healthy persons in the population.  ADEQUATE DIET 1 ESSENTIALS THE MILK GROUP 2 THE MEAT GROUP of an 3 THE BREAD AND CEREAL GROUP 4 THE VEGETABLE-FRUIT GROUP The Milk Group Key source of calcium Provides most of the calcium requirement Provides riboflavin, high-quality protein, vitamins and minerals Contains carbohydrates and fats Used in the form of fluid, whole or skim milk, buttermilk, evaporated milk, dry milk, and cheese. Can be used in cooking The Meat Group Key source of protein Provides high-quality protein Rich in iron, thiamine, riboflavin, niacin, phosphorus, and zinc It’s recommended to include liver, kidney, and saltwater fish like salmon, oysters, and mackerel at least once a week. Non-meat alternative: grains, legumes, nuts/seeds Vegetarians can combine plant sources for protein Bread and Cereal Group Provides thiamine, protein, iron, niacin, carbohydrate and cellulose Cost-effective source of nutrients Contributes significantly to dietary needs Vegetable-fruit Group Important supplier of: Fiber Minerals Vitamin A Vitamin C  ASSESSMENT OF NUTRITIONAL STATUS NUTRITIONAL STATUS OR NUTRITURE The degree to which the individual’s psychological need for nutrients is being met by the food the person eats. The state of balance in the individual between the nutrient intake and the nutrient expenditure or need. ASPECTS CONSIDERED IN ATHOROUGH NUTRITIONAL ASSESSMENT 1 DIETARY HISTORY AND INTAKE DATA 2 BIOCHEMICAL DATA 3 CLINICAL EXAMINATION 4 ANTHROPOMETHRIC DATA 5 PSYCHOSOCIAL DATA  METHODS OF ASSESSING DIETARY INTAKE 1 24-HOUR RECALL 2 FOOD FREQUNECY QUESTIONNAIRE 3 DIETARY HISTORY 4 FOOD DIARY OR RECORD 5 OBSERVATION OF FOOD INTAKE  METHODS OF ASSESSING DIETARY INTAKE 24-HOUR RECALL The individual completes a questionnaire or is interviewed by a dietitian/nutritionist or a nurse, and is asked to recall everything that he/she ate within the last 24 hours or the previous day.  METHODS OF ASSESSING DIETARY INTAKE FOOD FREQUENCY QUESTIONNAIRE For frequency of food use, a pattern of questions may be useful. Questions should be modified based on the information from the 24-hour recall.  METHODS OF ASSESSING DIETARY INTAKE DIETARY HISTORY More complete than either the 24-hour recall or food frequency questionnaire, although includes both of these sources. Additional Information: Economics Allergies. Intolerances, and Food Avoidances Physical Activity Dental and Oral Health Ethnic and Cultural Background Gastrointestinal Concerns Home Life and Meal Patterns Chronic Diseases Appetite Medication  METHODS OF ASSESSING DIETARY INTAKE FOOD DIARY OR RECORD This method involves time, understanding, and motivation on the part of the patient or client. The subject is asked to write down everything he/she eats or drinks for a certain period.  METHODS OF ASSESSING DIETARY INTAKE OBSERVATION OF FOOD INTAKE Most accurate method of dietary intake assessment but also the most time-consuming, expensive, and difficult. It requires knowing the amount and kind of food presented to the person and the record of the amount actually eaten. EVALUATION OF THE FOOD INTAKE DATA  EVALUATION BY FOOD GROUP METHOD The simplest, fastest, yet crudest way to evaluate food intake data is to determine how many servings from each of the four food groups were consumed during the recorded day. The number of servings is suggested in the basic four or seven food plans.  MENU PLANNING GENERAL RULES 1 Use the whole day as a unit rather than the individual meal. Make breakfast relatively simple and standardized, then plan dinner. Lastly, plan lunch and snacks to supplement the other for two meals. 2 Use some food from each of the food groups daily (energy- giving foods, body-building foods, and body-regulating foods).  MENU PLANNING GENERAL RULES 3 Use some raw fruits and vegetables at least once a day. for 4 Plan to have for each meal at least one food with staying power or high in satiety value, one which contains roughage, and generally some hot foods and drinks. 5 Combine or alternate foods of bland from with those of a more pronounced flavor.  MENU PLANNING GENERAL RULES 6 Combine and alternate soft and crisp foods 7 Have a variety of color, food, and for food arrangement. 8 When more foods are served at one meal, decrease the size of portions and use fewer rich foods.  Avoid using the same kind of SOME food twice a day without varying the form in which it is DON’TS served except staples like rice, bread, and milk. FOR Do not use the same food MENU twice in the same meal even in different forms. PLANNING Do not use the same food too often from day to day. Other Considerations MEAL PATTERNS PLANNING FOR EXAMPLES: THE WEEK Traditional pattern for breakfast: In hospitals, the practice of the fruit dietitians is to prepare a so-called egg or substitute bread or rice CYCLE MENU hot beverage a type of menu that features a list of Good menu guide for lunch and dishes that are rotated over a specific dinner: period, such as weekly or monthly. meat, fish, or poultry vegetable rice fruit or dessert  Nutrition Survey is an epidemiological investigations of the nutritional status of the population by various methods together with an evaluation of the ecological factors of the community.  Significance of Nutritional Assessment 1. It is the first essential in nutritional planning. 2. It provides data and information for planning and evaluation. 3. It helps define priorities and responsibilities of public health system at the national, regional, provincial, city, municipal, and barangay levels.  Methods of Nutrition Assessment DIRECT INFORMATION 1. Clinical Examination 2. Biochemical Examination 3. Anthropometric Measurements INDIRECT 4. Biophysical Technique INFORMATION 1. Studies on food consumption 2. Studies on health conditions and vital statistics 3. Studies on food supply situation 4. Studies on socio-economic conditions 5. Studies on cultural and anthropological influences Factors Considered in the Selection of Nutrition Survey Method 1. Unit to be surveyed 2. Types of information required 3. Degree of reliability and accuracy acquired 4. Facilities and equipment available 5. Human resources 6. Time reference 7. Funding or financial support CHAPTER 8 HOME ABOUT CONTENT OTHERS Page 01 F ea tures o f Me th od s && R e f e Referencr e n c e e S S t t a a n n d daar r d d s s U s e d CHAPTER 8 FEATURES OF METHODS Page 02 C Clliinniiccaall A Asss seesss smmeenntt It deals with the examination of changes that can be seen or felt in superficial tissues such as skin, hair and eyes Advantages More Can identify issues 1 2 3 Inexpensive; coverage in a that may not be no need for short period evident through sophisticated other assessment of time equipment methods FEATURES OF METHODS Page 03 C Clliinniiccaall A Asss seesss smmeenntt It deals with the examination of changes that can be seen or felt in superficial tissues such as skin, hair and eyes Disadvantages Non-specificity Overlapping of Bias of the Clinical signs 1 2 3 4 of signs (signs deficiency states observer known to be of may be due to (dietary (observations of value in non-nutritional deficiencies are two examiners are nutrition surveys causes) not restricted to most often not and their an isolated consistent with interpretations nutrient) each other) COMMON NUTRITIONAL PROBLEMS Page 04 1 PROTEIN ENERGY MALNUTRITION XEROPTHALMA 2 3 ANEMIA GOITER 4 5 VITAMIN B2 OR RIBOFLAVIN DEFICIENCY CLINICAL SYMPTOMS OF COMMON NUTRITIONAL PROBLEMS Page 05 1 PROTEIN ENERGY MALNUTRITION A STATE OF NUTRITION IN WHICH A DEFICIENCY OR EXCESS OF ENERGY, PROTEIN, AND OTHER NUTRIENTS CAUSES MEASURABLE ADVERSE EFFECTS ON TISSUE/BODY FORM (BODY SHAPE, SIZE AND COMPOSITION) AND FUNCTION, AND CLINICAL OUTCOME PROTEIN ENERGY MALNUTRITION Page 06 Marasmus Thin and Brittle A severe form of malnutrition that occurs when the body doesn't have enough calories, fats, carbohydrates, or Loss of muscle mass protein to function normally. It is characterized by extreme weight loss, muscle and fat wasting, and stunted growth PROTEIN ENERGY MALNUTRITION Page 07 Kwashiorkor Thin and Brittle A condition resulting from inadequate protein intake. Early symptoms include fatigue, irritability, and lethargy. As protein deprivation continues, one sees growth failure, loss of muscle mass, generalized swelling (edema), and Bulging decreased immunity. A large, protuberant belly is Abdomen common. (ascites) PROTEIN ENERGY MALNUTRITION Page 08 Marasmic Kwashiorkor The third form of protein-energy malnutrition that combines features and symptoms of both marasmus and kwashiorkor. A person with marasmic kwashiorkor may: – be extremely thin. – show signs of wasting in areas of the body. – have excessive fluid buildup in other parts. CLINICAL SIGNS AND THEIR INTERPRETATIONS Page 09 AREA SIGNS ASSOCIATED DISORDER OR NUTRIENT lack of luster; thinness and sparseness; kwashiorkor; less commonly 1. hair straightness, dyspigmentation, flag sign ;easy- marasmus pluck ability nasolabial dyssebacea riboflavin 2. face moon face kwashiorkor pale conjunctiva anemia (iron, etc.) bilot’s spot vitamin a conjunctiva xeroxis 3. eyes corneal xerosis keratomalacia angular palpebritis riboflavin; pyridoxine CLINICAL SIGNS AND THEIR INTERPRETATIONS Page 10 AREA SIGNS ASSOCIATED DISORDER OR NUTRIENT angular stomatitis 4. LIPS riboflavin angular scars cheilosis 5. teeth mottled enamel fluorosis ascorbic acid 6. gums spongy bleeding gums thyroid enlargement iodine 7. glands parotid enlargement starvation scarlet and raw tongue nicotinic acid 8. tongue magenta tongue riboflavin CLINICAL SIGNS AND THEIR INTERPRETATIONS Page 11 AREA SIGNS ASSOCIATED DISORDER OR NUTRIENT xerosis vitamin a perifollicular hyperkeratosis ascorbic acid petichiae 9. skin nicotinic acid pellagrous dermatosis kwashiorkor flaky paint dermatosis riboflavin scrotal and vulval dermatosis 10. Nails koilonychia iron edema kwashiorkor 11. subcutaneous tissue fat: decreased starvation; marasmus increased obesity CLINICAL SIGNS AND THEIR INTERPRETATIONS Page 12 AREA SIGNS ASSOCIATED DISORDER OR NUTRIENT muscle wasting starvation; marasmus; and kwashiorkor frontal and parietal bossing ephyseal enlargement vitamin d beading of ribs 12. muscular and skeletal system persistently open anterior fontanella knock-knees or bow legs thoracic rosary musculoskeletal hemorrhages HEPATOMEGALY KWASHIORKOR PYSCHOMOTOR CHANGES 13. internal systems MENTAL CONFUSION KWASHIORKOR a.) gastrointestinal SENSORY LOSS THIAMINE;NICOTINIC ACID MOTOR WEAKNESS B.) NERVOUS LOSS OF POSITION SENSE THIAMINE LOSS OF VIBRATION LOSS OF ANKLE AND KNEE JERKS CALF TENDERNESS THIAMINE CLINICAL SYMPTOMS OF COMMON NUTRITIONAL PROBLEMS Page 13 2 XEROPHTHALMIA IT AFFECTS THE EYES, GRADUALLY BEGINNING WITH AN IMPAIRMENT OF NIGHT VISION. INITIAL STAGES MAY BE TREATED BY SUPPLEMENTATION OF THE DAILY DIET WITH VITAMIN A. SEVERE CASES NEED LARGE SUPPLEMENTS AND SIMULTANEOUS ANTIBIOTICS. PREVALENCE CRITERIA FOR DETERMINING PUBLIC HEALTH Page 14 SIGNIFICANCE OF XEROPHTHALMIA AND VITAMIN A indicator mINIMUM PREVALENCE, % night blindness >1 bitot spots >0.5 corneal/xerosis/corneal >0.01 ulceration/keratomalacia Corneal scar >0.05 CLINICAL SYMPTOMS OF COMMON NUTRITIONAL PROBLEMS Page 15 3 ANEMIA SOLE RELIANCE ON BREAST MILK FOR CHILDREN BEYOND SIX MONTHS LEADS TO ANEMIA. SINCE BLOOD CELLS REQUIRE BOTH PROTEIN AND IRON FOR THEIR FORMATION, TREATMENT SHOULD CONCENTRATE ON SUPPLEMENTING THESE NUTRIENTS ON THE DIET. CLINICAL SYMPTOMS OF COMMON NUTRITIONAL PROBLEMS Page 16 4 GOITER THE ENLARGEMENT OF THE THYROID GLANDS IS DUE TO ITS NEED FOR IODINE. IF IODINE IS SHORT IN SUPPLY, THE GLAND GROWS AND TRY TO OFFSET THE DEFIICT  Page 17 CLASSIFICATION OF GOITER BY PALPATION grade mINIMUM PREVALENCE, % 0 >no palpable or visible goiter a goiter that is palpable but not visible when the neck is in the normal position (i.e., the thyroid gland is not 1 visibly enlarged). nodules in a thyroid that is otherwise not enlarged fall into this category a swelling in the neck that is clearly visible when the 2 neck is in a normal position and is consistent with an enlarged thyroid gland when the neck is palpated CLINICAL SYMPTOMS OF COMMON NUTRITIONAL PROBLEMS Page 18 5 VITAMIN BR OR RIBOFLAVIN DEFICIENCY RIBOFLAVIN DEFICIENCY USUALLY OCCURS WITH DEFICIENCIES OF OTHER B VITAMINS DUE TO A DIET LOW IN VITAMINS OR AN ABSORPTION DISORDER. PEOPLE HAVE PAINFUL CRACKS IN THE CORNERS OF THE MOUTH AND ON THE LIPS, SCALY PATCHES ON THE HEAD, AND A MAGENTA MOUTH AND TONGUE. FEATURES OF METHODS Page 19 B Biiooc c h h e e m m iiccaall A Asss seess ssm m e e nntt Estimation of time desaturation, enzyme activity, or blood composition Objectivity, Advantages independent of the Can detect early 1 emotional and subjective factors 2 subclinical states of nutritional that usually affect deficienc the investigator FEATURES OF METHODS Page 20 B Biiooc c h h e e m m iiccaall A Asss seess ssm m e e nntt Estimation of time desaturation, enzyme activity, or blood composition Disadvantages Costly, usually 1 requiring expensive 2 Time-consuming equipment  FEATURES OF METHODS Page 21 B Biiooc c h h e e m m iiccaall A Asss seesss smmeenntt Estimation of time desaturation, enzyme activity, or blood composition Factors affecting accuracy of results 1 2 3 Standards of Method of Techniques transport and employed collection storage of samples COMMON BIOCHEMICAL PARAMETERS/ TESTS Page 22 Fluid parameter nutrition deficiency SERUM ALBUMIN protein deficiency AMINO ACID IMBALANCE protein deficiency SERUM VITAMIN A vitamin a deficiency SERUM CAROTENE vitamin a deficiency Blood SERUM ALKALINE PHOSPHATASE vitamin d deficiency SERUM ASCORBIC ACID vitamin c deficiency iron and vitamin b12 HEMOGLOBIN deficiency HEMATOCRIT iron deficiency  Page 23 COMMON BIOCHEMICAL PARAMETERS/ TESTS Fluid parameter nutrition deficiency hydroxyproline excretion PROTEIN Deficiency urinary ures protein deficiency URINE urinary creatinine protein deficiency urinary thiamine thiamine deficiency urinary riboflavin riboflavin deficiency BIOCHEMICAL TESTS APPLICABLE AND INTERPRETATION Page 24 1 PROTEIN IRON 2 3 VITAMIN A PROTEIN Page 25 Urea Urea N/ N/ Creatinine Creatinine N N Ratio Ratio Index of dietary adequacy From over two- to 24-hour urine sample Index of 30 or lower in a random sample indicative of malnutrition PROTEIN Page 26 Amino Acid Imbalance Test Ratio of four dispensable amino acid and four indispensable amino acids in serum by paper chromatography High (5-10) in kwashiorkor and low (less than 2) in well-fed children PROTEIN Page 27 Hydroxyproline Excretion Hydroxyproline Excretion in in Random Random Urine Urine Low (0.5 -1.5) in clinically malnourished children: 2.0 to 5.0 PROTEIN Page 28 Serum Serum Albumin Albumin Lowered in severe protein depletion Guide to Interpretation (g/100mL): High 4.25 Acceptable 3.25-4.24 Low 2.80-3.51 Deficient less than 2.80 IRON Page 29 Hemoglobin Hemoglobin Determination Determination Cyanmethemoglobin Method By Spectrophotometry A.O Hemoglobinometer - Simple technique Others: Sahli’s method , Tallquist method IRON Page 30 Hematocrit Hematocrit Obtained from a finger prick A measure of red cell volume IRON ABOUT Page 31 Values Valuesbelow below which which Anemia Anemia is said to exist exist Hemoglobin Hemoglobin (Grams (Grams %) %) 6 months to 6 years 11 6 YEARS TO 14 YEARS 12 ADULT MALES 13 ADULT FEMALES - NON - PREGNANT 12 ADULT FEMALES - PREGNANT 11 VITAMIN A Page 32 Serum Vitamin A and serum carotene level by spectrophotometry using micro and macro methods Low serum Vitamin A reflects prolonged severe, dietary deficiency probably up to 1 year in adults and up to 4 months in young children Serum carotene level is not indicative of Vitamin A status per se but it is useful because it reflects recent ingestion of carotene-containing foods. FEATURES OF METHODS Page 33 An t h r opom e t r i c Me a su r e m en ts The measurement of variations of the physical dimensions and gross composition of the human body at different age levels and degrees of nutrition. COMMON ANTHROPOMETRIC MEASUREMENTS Page 34 1 WEIGHT (FOR AGE) HEIGHT (FOR AGE) 2 3 WEIGHT FOR HEIGHT/LENGTH SKINFOLD THICKNESS 4 5 BODY CIRCUMFERENCE BIRTH WEIGHT 6 COMMON ANTHROPOMETRIC MEASURES Page 35 Weight (for age) Uses weighing scales such as beam balance scales or clinical scales which are ideal or a bar scale in the absence of the scales initially mentioned Assesses body mass A sensitive indicator of current nutritional status Uses reference values for age or height or both of the population Key anthropometric measurement COMMON ANTHROPOMETRIC MEASURES Page 36 W Weeiigghhtt (( ffo orr aaggee)) Advantages Weight can be determines fairly 1 2 It is as simple as it accurately by is commonly used personnel with minimum training COMMON ANTHROPOMETRIC MEASURES Page 37 W Weeiigghhtt (( ffo orr aaggee)) Disadvantages Weight can be determines fairly 1 2 It is as simple as it accurately by is commonly used personnel with minimum training COMMON ANTHROPOMETRIC MEASURES Page 38 W Weeiigghhtt (( ffo orr aaggee)) Disadvantages 3 It does not distinguish between acute and chronic malnutrition but useful when serial measurements are taken; but also in children less than 1 year old COMMON ANTHROPOMETRIC MEASURES Page 39 Height (for age) Assesses linear dimensions of the following: legs, pelvis, spine, and the skull Less sensitive and generally an indicator of past nutritional status (chronicity of malnutrition) Uses statiometer, anthropometric steel rods fixed accurately and vertically to the wall; for infants (below 2 years old), an infantometer is used COMMON ANTHROPOMETRIC MEASURES Page 40 He i g h t (for a g e ) Advantages 1 2 Inexpensive tools It is simple to do in may be used the field COMMON ANTHROPOMETRIC MEASURES Page 41 He i g h t (for a g e ) Disadvantages 2 3 It is less sensitive to 1 Errors in Other factors play a change in growth measurement are role rate easily made COMMON ANTHROPOMETRIC MEASURES Page 42 Weight (for height/length) Most accurate indicator of present or current state of nutrition An expression of leanness or wasting COMMON ANTHROPOMETRIC MEASURES Page 43 W Weeiigghh t t for h e i g h t /l e n gth Advantages It is nearly It is also probably 1 independent of age from 1 to 10 2 independent of ethnic group especially in ages 1 to years 5 years COMMON ANTHROPOMETRIC MEASURES Page 44 W Weeiigghh t t for h e i g h t /l e n gth Disadvantages 1 Height (for age) is a disadvantage COMMON ANTHROPOMETRIC MEASURES Page 45 Skinfold Thickness Assesses body composition, fat distribution, and, hence reserve of calories Must be compared against Standards for age and sex at all ages Uses a reliable caliper (Harpenden, Lange, or USAMRNL) COMMON ANTHROPOMETRIC MEASURES Page 46 Birth Weight It is related to maternal nutrition and socio economic status Usually taken as cut-off point for “low-birth weight babies” is 2, 500 grams COMMON ANTHROPOMETRIC MEASURES Page 47 weeiigghhtt B ir t hh w Advantages The advantage is 1 the same as that in weight for age COMMON ANTHROPOMETRIC MEASURES Page 48 Bi r t h we i g h t B Disadvantages Births are often Other factors play a role 1 unattended by health personnel 2 (gestational age, infectious and toxemic episodes during pregnancy, etc.) REFERENCE/STANDARDS USED Page 49 1 WEIGHT-FOR-AGE WEIGHT-FOR-HEIGHT 2 3 WEIGHT-FOR-HEIGHT & HEIGHT-FOR-AGE REFERENCE/STANDARDS USED Page 50 Weight-for-age Philippine classification of undernutrition (FNRI) (based on Gomez’ classification) Depending on how far a child’s weight compares with his/her standard weight, a child is classified as: normal, when the child’s weight is between 91% and 110% of his/her ideal weight REFERENCE/STANDARDS USED Page 51 Weight-for-age first degree or moderately underweight, when the child’s weight is only 76% to 90% of his/her ideal weight; second degree or moderately underweight, when the child’s weight is only 61% to 75% of his/her ideal weight; and third degree or severely underweight, when the child’s weight is only 60% or less of his/her ideal weight REFERENCE/STANDARDS USED Page 52 Weight-for-height Classification of nutritional status by McLaren and Read (1972) Overweight 110% of standard weight Normal 90-109% of standard weight Underweight, mild 85 - 89% of standard weight Undernourished, moderate 75-84% of standard weight Undernourished, severe 75% of standard weight REFERENCE/STANDARDS USED Page 53 Weight-for-height & height-for-age combination Permits further distinction between acute malnutrition (low weight-for-height, normal height-for-age) and chronic malnutrition (low weight-for-height, low height-for-age) as well as simple stunting. Thus, the diagram below shows classification of nutritional status using cut-off points for use in the Philippines REFERENCE/STANDARDS USED Page 54 Weight-for-height & height-for-age combination Permits further distinction between acute malnutrition (low weight-for-height, normal height-for-age) and chronic malnutrition (low weight-for-height, low height-for-age) as well as simple stunting. Thus, the diagram below shows classification of nutritional status using cut-off points for use in the Philippines REFERENCE/STANDARDS USED Page 55 Weight-for-height & height-for-age combination Permits further distinction between acute malnutrition (low weight-for-height, normal height-for-age) and chronic malnutrition (low weight-for-height, low height-for-age) as well as simple stunting. Thus, the diagram below shows classification of nutritional status using cut-off points for use in the Philippines REFERENCE/STANDARDS USED Page 56 Nutritional Status for Philippine Use Weight for Height (Wasting) 85% of Reference Standards 85% and above below 85% acute or recent malnutrition 90% and above normal (wasted) severe chronic malnutrition below 90% nutritional dwarfism (stunted) (stunted and wasted)  Chapter 10 Infancy Providing Nutritional Base for Rapid Growth and Development of the During the First Year of Life INFANCY Refers to a person not more than 12 months of age. Weighs 2.7 to 3.2 kg (6 to 7 lbs) and measures 48 to 50 cm (19 to 20 inches) in length. Head circumference averages 35 (14 inches). Skin is moist, elastic, and not wrinkled. NUTRITIONAL 1 CALORIES REQUIREMENT 2 PROTEINS 3 FATS 4 CARBOHYDRATES NUTRITIONAL REQUIREMENT 5 MINERALS 6 VITAMINS 7 WATER Nutritional Requirement CALORIES The calorie requirements of the infant are high because the proportionately larger skin surface leads to large heat loss. A rapid rate of growth necessitates a considerable storage of energy for the activity of infant is great. Nutritional Requirement CALORIES Calorie needs of the infant: At birth: about 350 to 500 calories One year: 800 to 1200 calories 2nd to 7th month: 120 calories per kg body weight 7th to 12th month: 100 calories per kg Nutritional Requirement CALORIES The average requirement for growth in the first year is 50 calories per pound of expected weight, 2/3 of this amount of needed calories being supplied by the milk and 1/3 by the added carbohydrates. Nutritional Requirement PROTEINS Protein allowances recommended by the FAO/WHO Expert Group: 0 to 6 months: 1.5 to 2.5 g of protein per kg in the body weight 6 to 12 months: 1.5 to 2 g of protein per kg in the body weight Nutritional Requirement FATS Whole cow’s milk contains satisfactory levels of the essential fatty acids, linoleic acid, and arachidonic acid required by the infant. Low-fat milk used for a short period of time presents no problems. Vegetable oils such as corn, soybean, and cottonseed oils are good sources of fatty acids. Nutritional Requirement CARBOHYDRATES An allowance of 1/10 oz per lb of body weight which equals 1 oz per 10 oz of milk is prescribed, which also equals 1% of the body weight. One-third of the carbohydrate should be derived from the milk of the mixture, and the remainder added in the form of starch or sugar. Later in the first year, the carbohydrate is given in the form of a starch cereal, and the carbohydrate in the milk formula may be reduced. Nutritional Requirement MINERALS Compared to adults, infants need a proportionately greater amount of minerals. During the first four months, iron-rich foods must be included to avoid anemia. Enough iron is stored in the liver of the normal infant, sufficient until the 4th or 5th month. Nutritional Requirement MINERALS Mineral deficiency is usually overcome by the addition of solid food supplements (egg yolk, fortified cereals, vegetables, and fruits) Supplements are usually added before aforesaid time, except in the case of the completely milked infant who completely refuses or is not offered iron-containing foods in the first year. Nutritional Requirement VITAMINS Vitamin B6 (pyridoxine) is essential in the diet of infants. A pyridoxine deficiency may result in a syndrome characterized primarily by convulsions. Minimum daily requirement of Vit. B6: between 60 and 100 micrograms. Nutritional Requirement VITAMINS Infants whose mothers received large doses of vitamin B during pregnancy for treatment of nausea and vomiting may require more vitamin B6. Any normal infant ingesting 18 oz of cow’s milk, or a comparable amount in a bottle-fed milk food,, or 24 oz of milk receives all the vitamin A and all the vitamin B fractions needed for optimum growth. Nutritional Requirement WATER The daily fluid needs of the infant is approximately 2.5 oz per lb of body weight. The requirement for water varies from 10% to 15% of the weight. Supplied in the diluents of the milk mixture itself and supplemented, according to instinctive demands, by offering of water and fruit juices between feedings.  INFANT FEEDING Infant feeding is dyadic in nature; it has nutritional, psychological and biological interaction between the mother and her offspring with each one affecting the other.  BREAST FEEDING Has physiologic and psychologic value for the mother and her infant. Meets the infant’s nutrient needs during his/her early months. Provides immunity factors and reduces chances of infection.  BREAST FEEDING Breast milk is easily digested. Fat remains unbound and is readily digested. Breast milk is non-allergic. Beneficial to the health of the mother. Breastfeeding may not be advisable when the mother has syphilis, diabetes, AIDS, or any severe acute infections.  BREAST FEEDING Is not encouraged when the mother is under emotional and mental stress or if another pregnancy follows. Mothers who smoke heavily and who take contraceptive pills and drugs should refrain from breastfeeding  BOTTLE FEEDING Is feeding the infant with formula designed to match the nutritional ratio of breast milk composition, diluted with water to reduce protein and mineral concentration, and added with carbohydrate to increase energy value. Suits the needs of a working mother.  BOTTLE FEEDING Formula must be prepared under clean conditions and sterilized to prevent contamination. Recommended only when breastfeeding is contraindicated. Artificial feeding is costly. Associated with infantile obesity or “protein- calorie malnutrition plus”  MIXED FEEDING A combination of breastfeeding and bottle feeding, with either one predominating. Complemented: bottle is given to complete a single breastfeeding because of insufficiency of the mother’s milk.  MIXED FEEDING Supplemental: when the bottle is used to replace one or more breastfeeding sessions. Is not encouraged as it may lead to lactation failure  FORMULA PREPARATION ASEPTIC TERMINAL The formulas are poured into clean The equipment and ingredients but unsterilized bottles and are are sterilized separately either by sterilized together. steam or by boiling water for at Disadvantage: Scum formation can least 25 minutes. clog the nipple holes  FEEDING TIME A baby weighing 2.5 to 2.7 kg usually feeds every 3 hours. A baby weighing 3.6 to 4 kg usually feeds every 4 hours. A two-month-old baby sleeps through the night after the 10 pm feeding. Between 2 and 3 months of age, a baby is on a 4 to 5 feeding schedule.  HELP INFANTS SIMPLE TIPS Beware of baby dinners or EAT BETTER 1 creamed products that contain nutritionally incomplete refined starches. on how to Drain off the syrup from 2 canned fruits before serving. It is usually rich in sugar (something the infant does not need).  HELP INFANTS SIMPLE TIPS EAT BETTER Watch the number of egg yolks on how to 3 the child consumes per week. three or four egg yolks are a lot If it is fine with the doctor, give 4 the baby 2% low-fat milk instead of whole milk. It contains substantially less fat  Supplementary Foods 2ND MONTH 4TH MONTH 5TH/6TH MONTH Liquids depending Banana, Thin Full diet of pureed food, on the infant’s calorie-high protein Lugaw, Cereal, acceptance and supplements for weaning, Iron-rich foods chewy foods for teething tolerance Supplementary Foods 7TH-8TH MONTH 9TH-12TH MONTH Food chopped finely, Whole tender foods or not strained to teach foods chopped mastication coarsely SIMPLE TIPS After the baby’s 3rd month, test 1 his/her readiness to accept new NEW FOODS foods by placing a teaspoon between her lips on giving Start any new food with one-half teaspoon on the first day and 2 add as the baby takes to the new taste 3 Never start two new foods at the same time SIMPLE TIPS Show pleasure when giving him 4 new foods. NEW FOODS Give water between feeds to on giving 5 provide enough liquid to remove waste from his/her body and to help regulate bodily functions When the baby is about seven 6 months of age, teach him /her to drink water and other liquids from a cap  Give finely-chopped foods when 7 SIMPLE TIPS the baby starts teething NEW FOODS 8 Offer bland foods to the baby on giving 9 Handle baby’s foods properly 10 Avoid giving the baby leftover foods If necessary, divide the reccommended 11 amount of supplementary foods into several feedings throughout the day Easy to Prepare Baby Foods Easy to Prepare Baby Foods Easy to Prepare Baby Foods Easy to Prepare Baby Foods Easy to Prepare Baby Foods Easy to Prepare Baby Foods Easy to Prepare Baby Foods  1 DIARRHEA DISORDERS COMMON 2 VOMITING 3 ALLERGY 4 CONSTIPATION 5 COLIC  GOOD NUTRITION INDICATION 1 WEIGHT 2 LENGTH of 3 BEHAVIORAL DEVELOPMENT  Weight Gain Proper Weight Gain - A steady weight gain of 150 to 240 grams per week that slows down towards the end of the first year to about 120 grams per week - doubled birth weight at the end of 5 months and tripled at the end of 1 year  Length Baby length increases about 25.4 cm or 50% more at the end of the first year Behavioral Development 0-1 month: suckles and smiles 2-3 months : vocalizes and controls head 4-5 months: controls hand and rolls over 6-7 months: sits briefly and crawls 8-9 months: grasps and pulls up 10-11 months: walks with support and stands alone 12 months: starts to walk alone FOR