The document provides information on feeding and nutrition for young children aged 0-5 years. It discusses the changing nutritional needs as children develop from infancy to age 5. Nutrition is important for energy, growth, development and health. Rapid growth occurs in the first year as weight doubles and brain weight increases. Breastmilk is recommended for infants under 6 months as it provides optimal nutrition for growth and brain development. Introduction of solid foods should start around 6 months once infants develop necessary skills. Healthy eating habits established in childhood can impact future health. The document provides guidelines on appropriate servings and components of meals at different ages.

1. FEEDING & NUTRITION
IN YOUNG CHILDREN
(0-5 Yrs)
Dr Somendra Shukla
MBBS, DNB (Pediatrics), MNAMS, MRCPCH (UK),
Fellow Neonatology
Sr. Consultant Pediatrics & Neonatology

2. Objectives
• To recognize the changing nutritional needs of developing children, from
infancy to 5 yrs of age.
• To understand that nutritional recommendations for children vary by age,
& stage of development.
• To recognize that nutritional and dietary behaviors learned in children can
have a significant impact on adult health concerns such as obesity,
cardiovascular disease, and osteoporosis.

3. Why is Nutrition Important?
• Energy of daily living - Carbohydrate
• Maintenance of all body functions- Minerals & vitamins
• Vital to growth and development- Protein & fats
• Therapeutic benefits
 Healing - Protein
 Prevention

4. Growth in Infants
Rapid body growth and brain development during the first year:
• Weight increases 200%
• Body length increases 55%
• Head circumference increases 40%
• Brain weight doubles

5. Nutrition for Infants < 6 months
Breast Milk vs. Formula
Convenience vs. health

6. Nutrition for Infants < 6 months
(Better Nutrition, 2000)
•Premature infants
•Long-chain polyunsaturated fatty acids
•Faster brainstem maturation

7. Nutrition in young children < 6 months
(Core, 2003)
Poor nutrition = hampered mental development
• Information processing
• Language
• Below average for age

8. Feeding the Newborn
What are the options?
Breast feeding
The Indian & American
Academy of
Pediatrics
recommends
exclusive breast
feeding for 6
months.
Formula feeding

9. Breast Feeding Questions
• Why should I breast feed my baby?
I thought formula was the identical alternative.
• How often and for how long will my baby nurse?
• How do I know if the baby is getting enough?
• How many months can I breast feed the baby ?

10. Breast Feeding : Advantages to Infants
• Immunologic benefits (>100 components)
• Decreased incidence of ear infections, UTI, gastroenteritis,
respiratory illnesses, and bacteremia.
• Convenient and ready to eat.
• Reduced chance of overfeeding?
• Fosters mother-infant bonding.

11. Breast Feeding :Advantages to Mothers
• May delay return of ovulation.
• Loss of pregnancy-associated adipose
tissue and weight gain.
• Suppresses post-partum bleeding.
• Decreased breast cancer rate.

13. Assessment of Breast Feeding
• Weight pattern - consistent weight gain.
• Voiding - # wet diapers/day, soaked?
• Stooling - generally more stools than formula.
• Feed-on-demand ~ every 2-3 hours.
• Duration of feedings - generally 10-20 min/side.
• Need for high fat hind milk.
• Activity and vigor of infant.

15. Assessing Readiness to Feed
• At what age it is best to introduce solid
foods?
• How do I know if he is ready to eat?
• What food should I give the baby first?

16. Feeding Skills Development
5-6 mos - experience new tastes.
6-7 mos - sits with minimal support.
8-9 mos - improved pincer grasp.
10-12 mos - pulls to stand, reaches for food.
12-18 mos - increased independence.
18 mos -2 yrs - growth slows, less interest in eating.
2-3 yrs - intake varies, exerts control.

17. NUTRITION 7 MONTHS ONWARDS

20. 6-7 mos - experience new tastes.
Give rice cereal .
7-8 mos - sits with minimal support.
Add fruits and vegetables.
8-9 mos - improved pincer grasp.
Add protein foods and finger foods.
10-12 mos - pulls to stand, reaches for food.
Add soft table food, allow to self-feed.

21. 12-18 mos - increased independence.
Stop bottle, practice eating from a spoon.
18 mos -2 yrs - growth slows, less interest in eating.
Encourage self-feeding with utensils.
2-3 yrs - intake varies, exerts control.

22. Pre-school (1 to 6 Years)
1-2 years: on average, grows 12 cm, gains 3.5 kg.
Rate of growth slows by 4 years.
6-8 cm/year
2-4 kg/year
Brain growth triples by 6 years.

23. Common Complaints

24. UNCOMMON COMPLAINT WHICH IS
MORE COMMON

25. Whats eating your child

26. HOW TO DIAGNOSE OBESITY

27. BODY MASS INDEX (BMI)

29. Meal Components
Milk (fluid)
Fruits & vegetables
Breads & grains
Rice
Bread
Meats & meat alternates
Meat (e.g., chicken, turkey, fish)
Eggs
Cheese
Beans
Yogurt
Nuts and nut butters

30. Meal Component Requirements for
Children
Breakfast
One serving each:
• fluid milk
• 100% juice, fruit, or vegetable
• bread or cereal
Lunch or Supper
One serving each:
• fluid milk
• meat or acceptable meat alternate
• bread or acceptable bread alternate
Plus:
• two servings of fruit and/or vegetables
Snacks
Total of two servings:
• fluid milk
• meat or acceptable
meat alternate
• bread or acceptable
bread alternate
• 100% juice, fruit, or
vegetable

31. Serving Sizes
Start with the recommended
serving for age and food group
If children are still hungry, allow
them more food
Encourage them to
check in with their
tummy (cues)
Encourage fruits and
vegetables first
Serving sizes are a min, not a max!

32. Milk – Infants
Infants under 12 months should receive only
breast milk or iron-fortified formula – no
cow’s milk.
Whole cow’s milk does not provide enough
Vitamin E, iron, and essential fatty acids for
infants.
Whole cow's milk protein and fat are more
difficult for an infant to digest and absorb.

33. Milk served to children 12-23 months
should be whole.
Milk served to children 2 years and older
should be fat-free (skim) or 1% (low-
fat).
Flavored milk should not be served
Milk – Children

34. Rationale – Milk
Children 12 through 23
months need the fat in
whole milk for healthy
weight gain, growth and
development.
Children 2 years and older
do not need the extra fat
and calories in whole
milk.

35. Juice – Infants
Infants should not be served juice.

36. Juice – Children
Limit 100% juice to 1 serving per day
in a size appropriate to age (4-6
oz.), or don’t serve at all.
All juice served should be 100% fruit
or vegetable.
Non-100% juice (e.g., juice “cocktail”
or juice “drink”) is a sugary
beverage and should not be
served at all.

37. Sugary Beverages
Sugary drinks should never be offered
Juices that are not 100% juice
Fruit drinks (cocktails/-ades)
Sports drinks
Sweet tea
Soda
Energy drinks
Coffee drinks

38. Rationale: Juice & Sugary Beverages
They are high in sugar and calories which can cause…
overweight/obesity
tooth decay
diarrhea
May displace healthier beverages (like milk)
Whole fruits and vegetables provide more nutrients and
fiber than even 100% juice

39. Fruits & Vegetables
Avoid Fried or pre-fried fruits or vegetables
French fries, tater tots, hash browns,
potato chips; fried apples or okra
Serve a fruit (not juice) and/or a vegetable at every meal
and snack
French fries, tator tots, and hash
browns don’t count as vegetables!

40. Rationale – Fruits & Vegetables
Fried or pre-fried fruits/vegetables should be avoided
because…
They are high in calories and fat.
Example:
VS.
57 calories, 0.06 grams fat 180 calories, 5.35 grams fat

41. Fruits & Vegetables
Are rarely or never prepared with added:
Meat fat
Butter
Margarine
Sugar

42. Breads & Grains
Cereals should contain no more than 6 grams of
sugar per serving.
At least half of grains served should be whole
grains.
Serve whole grains whenever possible.
Grains high in fat or sugar should be served rarely
or never.
Donuts, Danishes, cupcakes, toaster pastries, granola
bars, etc.
Ingredients:
WHOLE WHEAT
FLOUR, WATER,
SUGAR, WHEAT
GLUTEN, CANE
REFINERY SYRUP,
YEAST, CONTAINS
2% OR LESS OF
EACH OF THE
FOLLOWING…

43. Rationale – Breads & Grains
Whole grains are good sources of
dietary fiber, several B
vitamins and minerals.
Added sugars supply calories but
few or no nutrients.
Fried baked goods are high in
calories and fat and low in
nutrients.
Example:

44. Meats & Meat Alternates
Fried/pre-fried and processed meats
E.g., chicken
nuggets/tenders, fish
sticks, hot dogs,
bologna, sausage,
salami, spam
Limit to 1x per fortnight
or less
Choose a variety of beans and lean
meats (whitemeat/ boiled) each week

45. Cheese & Other Dairy Products
Serve only real cheese – no
cheese food or cheese
product.
(e.g., Velveeta®, Cheez Whiz®)
Serve low-fat or fat-free dairy
milk, cheese, yogurt, cream
cheese, etc.

46. Rationale: Meats & Cheese
Processed and fried meats and fish are
typically high in total and saturated fat
and sodium.
In general, cheese products contain more
sodium and fewer nutrients than real
cheese.

47. Water
Drinking water is
visible,
available to children
inside and outside,
available for self serve.

48. Developing Healthy Habits
Offer a variety of healthy foods and snacks.
Encourage fruit and vegetable intake.
No junk food snacking.
Limit intake of juices ( 4 oz per day).
Increase intake of water (no soda).
Encourage low fat dairy products (3-4 servings/ day).
Make fun physical activity a habit.
Limit TV to no more than 1 to 2 hours per day.
Track growth and development carefully.
Be a good role model.

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