NUTRITION in GROWING YEARS Subdiv.of Nutrition and Metabolic Diseases Dept of Child Health Medical Faculty, Univ of North Sumatera
NUTRITION in GROWING YEARS
Subdiv.of Nutrition and Metabolic Diseases
Dept of Child HealthMedical Faculty, Univ of North Sumatera
Growth and Development
• Children == small adults• Children : grow and develop
- body size- maturity of organs- psychomotor- mental / psychosocial- cognitive
• Nutritional requirements : >>
Normal Nutrition during Infancy
• Very important for future health, G & D• Rapid G & D :
- physical : - BW : 3.0 10.0 kg - BL : 50 75 cm
- psychomotor : recumbent walking, etc.
- mental & cognitive
• Nutritional req. : the highest - Energy : 110 - 120 kcal/kgBW/d - Protein : 2.5 - 3.0 g/kgBW/d
Normal Nutrition during Infancy• Breastfeeding : - recommend to all infants
- the best nutrition for infants - exclusive BF : up to 4-6 mos
• Advantages : - superior nutritional composition - provision of immunologic and enzymatic components - health benefits for mothers - lower cost and increased convenience - enhanced infant-mother bonding
- respiratory & gastrointestinal infections - leaner body composition at 1 yr
- improved cognitive development
Breastmilk composition
• Changing / vary : - individually- stage of lactation- time of day- time into feeding- maternal diet
• 4 stages of BM expression :- colostrum - transitional- mature- extended lactation
4 stages of BM expression :
• Colostrum : - produced during the first few days - fat & energy : lower
- protein, fat soluble vit, mineral and electrolytes : higher - rich source of antibodies
• Transition : - 7 - 14 days postpartum - protein & Ig :
- lactose, fat & energy : • Mature milk : throughout lactation, until 7-8
mos
• Extended lactation : 7 mos 2 yrs
Effects of Changes in Maternal Diet
Changes + : Vitamin : A, D, E, K
ThiamineRiboflavinNiacinBiotin PyridoxinePantothenicFolateCyanocobalamin
Minerals : Mn, I, F, Se
Changes - : Vitamin : -
Minerals : Na, Ca, P, Mg, Fe, Zn, Cu
Breastfeeding Management
• Factors infuencing successful lactation :- motivation & confidence of the mother
- support from those around her- capability of the infants to suckle
• To establish and sustain lactation :- Initial BF : soon after delivery- Positioning : comfortable for both (baby &
mother) - Latching on : - Timing : every 2-3 hrs or 8-12 x/d- Assessing adequacy
•
Posisi ibu & bayi
Benar Salah
Mata menatap, bibir ‘dower’
Benar Salah
Mulut bayi mencakup areola
Benar Salah
Breastfeeding Management
• Assessing adequacy : “How do I know if my baby is getting enough? “
• Signs that a baby is receiving adequate fluid and calories : - have at least 6-8 thoroughly wet diapers/day - have regular bowel movements
- nurse 8 - 12 times/day- seem satisfied after nursing- grow at a relatively predictable rate
Weaning
• Introducing solids into an infant’s diet• Should balance nutrient needs with a
variety of foods and textures• Encouraging feeding skills development• Goal : transition from a liquid diet into a
well- balanced table food diet• Readiness : - 4 - 6 mos
- physical and psychologic development
Weaning
• Nutrient needs :- 4-6 mos : physical activity >>
- Caloric distribution during infancy : fat : 40 - 50%
protein : 7 - 11%CHO : the remainder
- Water/Energy ratio : 1.5 ml/kcal- Vitamin & mineral : affected by
introducing solid foods - Age 6 mos : 80% BM/formula, 20% beikost 8- 10 mos : 50% BM/formula, 50% beikost 12 mos : 20% BM/formula, 80% beikost
Tahapan penyapihan
Ciri bayi siap menerima MP-ASI
Weaning
• Physical readiness : - extrusion
reflex < / - - oral motor
skills : - from suck
to swallow solids - transfer
food from front to back of the tongue - able to hold the head up without support - sitting independently and maintaining balance
while using hands to reach and grasp objects
Weaning• Psychologic readiness :
- advanced eating behaviour : from refllexive and imitative to more independent and exploratory - by 6 mos : the infant is able to indicate : - a desire for food by opening mouth - hunger by leaning forward - disinterest or satiety by leaning back and turn away
• Encouraged to develop more independence :- self-feeding of soft finger foods
- sipping from a cup by 6-8 mos- holding the cup or bottle
independently - controlling the timing of feeds to promote self-regulation of hunger and satiety
Tahapan penyapihan :
R.hisapR.telan
R.ekstrusi </ -
MengunyahMenggigit
Gerak memutarRahang stabilKoordinasitangan baik
M,cair M.lumat M.Lunak/ padat M.keluarga
Weaning foods
• Commercial baby foods :- prepared without sodium, many without
sugar - enriched with vitamin and Fe, Ca, P - ‘first food’ = single ingredient foods - textures from strained to chunky - time efficient
• Home-made baby foods :- more economics
- greater flexibility in consistency and variability - time consuming
Frekwensi makan
Tujuan akhir praktek pemberian makan (periode 3)
Susu
Susu
(Susu)
Normal nutrition from infancy through adolescence
• Preschool and school children : slowing in physical growth
• Elementary school years = ‘latent period’ prior to pubertal growth spurt of adolescence
• Growth pattern ( spurt and slow/no growth ) : correspond to similar changes in appetite and food intake
• Developmental progress during the growing years influences many aspects of food and eating
Normal nutrition from infancy through adolescence
• Nutrient needs : determinants factors are :- rate and stage of growth
- activity- body size - BEE - onset of puberty- state of illness
• The DRIs (Dietary Reference Intakes) include RDA and AI :
- as a guide to prevent deficiency- to provide positive health
benefits - data are extrapolated values
Normal nutrition from infancy through adolescence
• ENERGY : - RDA : based on reference weight for each age group
- using doubly labeled water : RDA for children was overestimate as much as 25%
- up to age 10 yrs no distinction between sexes - 11 yrs and above : allowance for energy are based on sex and puberty
- age is not good criterion for determining energy needs especially in pubertal years ( growth spurt occur at varying times) - height is a useful reference in determining appropriate energy intakes
Factors influencing adolescence nutritional status and eating behaviour
- Irregular meals - Snacking
- Media - Family
- Peers - Body image
- Fast foods