Nutrition.pdf

Nutrition & Nutritional Disorders Objectives: 1-State the components of a routine dietary history for infants, children and adolescents. 2-Discuss the nutritional requirements in infancy, childhood and adolescence. 3-Explore the principles of infant feeding, including appropriate introduc...

Nutrition & Nutritional Disorders Objectives: 1-State the components of a routine dietary history for infants, children and adolescents. 2-Discuss the nutritional requirements in infancy, childhood and adolescence. 3-Explore the principles of infant feeding, including appropriate introduction of solids into the diet. 4-Identify the major differences between human milk and commonly available formulas. 5-Describe the advantages of breastfeeding and recognize common difficulties experienced by breastfeeding mothers. 6-Recognize that chronically ill children may have special nutritional needs often requiring the assistance of a nutritionist. 7-List the consequences of common vitamin deficiencies and excesses and indicate which vitamins and minerals may require supplementation in infants, children and adolescents. 8-Recognize nutritional factors that contribute to the development of childhood obesity and to failure to thrive. 9-Discuss the etiology, clinical presentation and management of protein energy malnutrition. Done by :Alanoud Bin Suayb Blue: Main Category Orange: Subcategory. Black: Original slides content. Red: Important information. Green: Doctor notes. Blue highlight: Info that came in previous batches questions. q Overview Nutrition should provide for : maintenance of current weight and support normal growth and development. Infancy growth period is rapid, and bears higher requirements, relative to body size than other periods of growth. Infancy growth period is critical for neurocognitive development. Nutrient deficiencies potentially affect growth, impair immunity, and increase morbidity and mortality. q Energy Requirement For Children: o Depending on the child age the number of calories will be : 0-12 months >> 110 kcal 1-6 years >> 90 kcal 7-10 years >> 70 kcal o How to calculate the energy requirement for 24 hours ? Child’s Weight X No. of kcal depending on his age = Energy Requirement for 24 hour o Example : Child’s age is 6 months and his weight is 3kg how many kcal he needs per 24hrs ? 3kg X 110 = 330 kcal o In which situation Calorie requirements increase? o 1- Fever 2- Cardiac diseases 3- Major surgery o 4- Sever sepsis 5- Long term growth failure 6- Burn Energy is provided through 3 primary Macronutrients, what are they ? Carbs , Proteins, Fats. In Children aged 1 year and above , Carbs will be the main source ( 45%-65%). In Infancy, the Fat is the main source ( it’s important for the brain , breast and formula milk are rich in fat) Numbers you should keep it in your mind : ‫ ﻣﻞ‬٣٠ ‫رﻗﻢ واﺣﺪ ﺑﺎﻟﺮﺿﻌﺔ ﺗﻘﺮﯾﺒﺎ ﻓﯿﮫ‬ 100 ml of milk = 67 kcal  Breastfeeding q Benefits of Breastfeeding § Major protective and anti-inflammatory factors in human milk : - Immunoglobulins (A, M, G ), Lactoferrin, Lysozyme, Prostaglandins, Lymphocytes. § Doctors should encourage breastfeeding, ( place the newborn and mother skin to skin, and initiate breastfeeding within 1hr of birth ). Benefits of Breastfeeding To The Baby To The Mother To The Planet 1- Higher immunity 1- Lower risk of: breast & ovarian Reduce packaging, production, marketing 2- More protection against some Acute cancer, type 2 DM, coronary heart waste. and Chronic conditions (DM, Celiac, disease, postpartum bleeding, and Allergies, Eczema, lymphoma, leukemia). osteoporosis. 3- Lower risk of sudden infant death syndrome. 2- Promote the bonding between the 4-lower risk of : lower respiratory tract mother and the infant. disease, GI infections, Asthma, obesity, Acute ear infection, atopic dermatitis q Breastfeeding Positions: § Correct Infant Latch on position: 1. Lips are flanged out 2. Mouth covers areola 3. Free nose 4. The tongue should be under the nipple q Colostrum : § A High protein, low fat fluid, is produced in small amount during the first few postpartum days. § Rich in immunoglobulins, small amounts approximately 10ml. § Not getting breast milk at the first 2 day is normal , The onset of breast milk feeding usually stars at day 3-4. § Human Breast milk has more Fat and Glucose levels compared to human colostrum. § Human Colostrum has more Protein and Immunoglobulins levels compared to human breast milk. q Baby’s Weight After Birth: In the first few days the baby will loss 7% or less of his weight , that is due to the loss of extracellular fluids. The baby will return to his birth weight by at least 2 weeks ( within 10 days -2 weeks ). During the first 3 postnatal months, the baby’s weight gain should be 20 to 30 gram per day. q Markers of Successful Breastfeeding: If the baby came for follow up after 2 weeks of birth and his weight is same as his birth weight, that indicates a successful breastfeeding. ‫ﻋﻮض اﻟﻲ ﺧﺴﺮه‬ The baby is gaining the 20 to 30 gram per day. Lactation is established in mother by 2-4 days after birth. At least 8 breastfeeding events every 24hrs. Baby is latching onto breast easily. 3-6 stools and 4-6 voids by 5-7 days of age. Hydration status through the urine and stool, if they are good that means the baby is in a good status. ( day 1 we expect the baby to urine once , day 2 we expect him to urine twice , same goes for the stool). q Markers of Poor Intake : Jaundice ( biliary tract Is not moving > baby is not using his intestine which means poor intake) Pink dipper syndrome ( concentrated urine which indicated dehydration.) q Baby Feeding Cues ( Sings) : Baby being active ( head and rooting movement ) and Mouth opening and yawning. Crying is the lattes sign of being hungry. q Contraindications of Breastfeeding : Infant conditions Maternal conditions 1- HIV 1 infection ( if replacement feeding is acceptable). 1- Classic Galactosemia. 2- Human T- Lymphotropic virus 1 and 2 infection. 2-Maple Syrup Urine Disease 3-Tubercolosis 3-Phenylketonuria ( partial ( Active, untreated ) until effective maternal treatment for the initial 2 weeks OR the infant is receiving Isoniazid. breastfeeding is possible) 4- Herpes simplex virus infection on the breast ( until the lesions are clear). 5- Medications ( Those of concern ) Examples: Drug of abuse, Radioactive, and immunosuppressive, lithium and some anti thyroid meds. q Conditions Secondary To Breastfeeding: They are NOT contradistinction for breastfeeding because we have solutions. Condition Management 1- Breast Engorgement 1- Apply Pressure. 2- Continue pumping milk using the machine. 3- Alternate breastfeeding. 2- Nipple Tenderness and Cracking 1- Proper latch-on and positioning. 2- Applying lanolin cream after each session. 3- Mastitis and abscesses 1-Antibioitc q Storage of Expressed Breast Milk (EBM): We don’t recommend using Microwave. There are 2 sources of storage guidelines : It’s preferred that you take it out of the freezer 1- CDC ( Centers for Diseases Control an prevention ) a day before using it, and the put it in the refrigerator then in bowl of hot water. 2- AAP ( American Academy of Pediatrics ) Source Room Temp Refrigerator Freezer Deep Freezer CDC 6-8 Hours 5 Days 3-6 Months 6-12 Months AAP 4 Hours 48 hours 3-6 Months - q Storage of Formula Milk: Already used Prepared but Unused Refrigerator Dispose Immediately 1 hour 24 hours q Additional Supplement Needed For Breast-Feed Infants: Vitamin D intake Vitamin K Vitamin D intake should be 400 IU/Day for All Vitamin K content of human milk is also low and Exclusively breast-fed infants. may contribute to hemorrhagic disease of the newborn, If the mother’s Vit D is perfect OR if the baby is (HDN ). having both breast and formula milk should also give the vit D drops ? YES IM administration of 1mg of vitamin K at birth is recommended for ALL infants. If the baby is only having formula milk should also give Vit D drops? Here it may differ, however, We give Vit K to prevent late-onset of Hemorrhagic according to the doctor he said he will give them until disease of newborn ( HDN). at least 6 months of age. q Types of Formula : 1- Ready to Feed ( most expensive, doesn't’t require water ) 2- Concentrate ( require mixing with water in equal parts) 3- Powder ( requires mixing with water ) q Composition of Breast Milk and Representative Infant Formulas. ‫ ﺑﺲ ھﻨﺎ ﻛﺘﺒﺖ اﻟﻨﻘﺎط اﻟﻲ رﻛﺰ ﻋﻠﯿﮭﺎ‬، ٢٣‫ھﺬا اﻟﺠﺪول ﻣﻮﺟﻮد ﻛﺎﻣﻞ ﺑﺴﻼﯾﺪ‬ dL = 100ml Breast milk Standard Premature Soy Formula Formula Formula Calories 67 67 67-81 67 Protein ( Whey ‫ﻧﻮﻋﯿﻦ ﺑﺮوﺗﯿﻦ‬ ‫ﻋﻨﺪﻧﺎ‬ Soy protein, to casein protein Methionine. ratio) Whey Protein: Fast Absorption ( Not whey nor Casein Protein : Slow Absorption, From Cheese. casein) Fat ( g) (% ( 55%) ( 50%) (45%) (38%) calories ) MCT (%) 0 0 40-50 0 Carbohydrate Lactose. Lactose. Lactose. Corn Corn syrup, sucrose. Source syrup. Preterm formula Fat comes from MCT because they don’t have matured biliary tract, they can’t produce the bile acid, so we need fast fat that gets directly absorbed. Preterm formula contains high amount of minerals, to prevent osteopenia of prematurity. Whey Protein: Fast Absorption Casein Protein : Slow Absorption, From Cheese. q Indications For Each Type of formula : Type of Formula Indications Doctor’s Notes -Fortified ( Preterm Formula ) 1-Low birth weight 2- Premature babies Can’t be taken before age of 6 -Soy Protein 1- Galactosemia months. 2- lactose intolerance Could cause a cross reactivity with cow milk protein. -Partially hydrolyzed proteins All with Cow Milk Allergy Cow milk Allergy manifestations: -Protein hydrolysate Crying, rectal bleeding , urticaria, -Amino acid Amino acid formula with Short gut frequent vomiting and Proctocolitits ( common ) q Important Principles For Weaning : 1. Begin at 4-6 months of age ( the ideal is 6 months ) 6. zinc intake should be encourage 2. Energy density should exceed that of breast milk 7. Breast milk should continue to 12 months 3. Iron containing food are required 8. Give no more than 4-6 oz./ day of fruit juices 4. Give no more than 24 oz./ day of cow’s milk 9. Introduce 1 food at a time 5. Phytate intake should be low to enhance mineral absorption. q Foods To Avoid : If less than 6 months : - Water and Juices ( New guidelines said don't give Juices for less than 1 year ) If under 12 months : - Whole cow’s milk ( Renal concerns, doesn’t contain adequate iron ) - Hard or round foods ( can cause choking ) - Honey ( Risk of bacterial toxin “ Botulism poisoning ”) q 2 Types of Malnutrition : Marasmus Kwashiorkor Appetite/ Appearance/ Irritable, Fearful Apathetic. Listless mental statues weight Wasting Masked Skin + hair Thin, dry, sparse hair Flaking paint Flag sign Muscle Obvious wasting Masked wasting Fat Sever loss Often retained Abdomen - Distended ( edema, hepatomegaly ) q Stages of Malnutrition Treatment: Rehab Stages : preventing the electrolyte imbalance, hypotension, dehydration and treatment of the acute infection in case of sepsis by starting antibiotics. Catch up stage: enhancing the feeding gradually NOT SUDDEN because it will lead to Refeeding Syndrome. q Refeeding Syndrome: Can Lead to: -Hypokalemia, Hypomagnesaemia, Hypophosphatemia, -Thiamine Deficiency, Salt and Water Retention- Oedema q Principles of Management : 1. Correct Electrolyte Abnormalities. 2. Institute oral or enteral nitration: - Start at a calculated intake of approximately 50% of targeted energy consumption. - Advance energy and volume intake SLOWLY 3. Closely monitor vital signs, intake and output, and serum electrolyte levels. 4. Provide appropriate Vitamin Supplementation for age q Characteristics of Vitamin Deficiencies : ‫ ھﻨﺎ ﻛﺘﺒﺖ اﻷھﻢ‬،‫ھﺬوﻻ اﻟﺠﺪاول ﻣﻮﺟﻮدة ﻛﺎﻣﻠﮫ ﺑﺎﺧﺮ اﻟﺴﻼﯾﺪات‬ Fat Soluble Vitamin Its Deficiency will cause. A Blindness D Rickets E Hemolysis, Ataxia K Hemorrhage Water soluble Vitamin Its Deficiency will cause.. Notes Thiamine B1 Beriberi. Riboflavin B2 Mucositis. Niacin B3 Dermatitis, Dementia, Diarrhea, Death ( 4 Ds). Pyridoxine B6 Seizures. B 12 ( common) Megaloblastic Anemia, Neuropathy Vegans, short gut syndrome are at risk Folate Megaloblastic Anemia, Goat milk is not a good source of folate. Ascorbic Acid ( C ) Scurvy Found in Citrus fruits