2. Table of contents
1.The National Nutrition Week
2. History of national nutritional week
3. Current status of India
4. The theme
5. Feeding during the 1st year of life
6. Inadequate milk intake
7. Complementary feeding
8. Feeding toddlers
9. Food safety
3. National Nutrition Week is observed from September 1 to September 7
annually in India.
The theme of the 2021 National Nutrition Week is 'feeding smart right
from start'.
The week is observed to raise awareness about nutritional and adaptive
eating habits.
4. In 1975, the members of the American Dietetic Association
(ADA), started the National Nutrition Week in March.
It was observed to raise public awareness about good nutrition
and also to promote the profession of dietitian.
In India, the history of National Nutrition Week dates back to
1982 when the government launched a campaign in 1982 to
educate individuals about the importance of nutrition and urged
them to maintain a healthy and sustainable lifestyle.
5. The government of India
launched 'POSHAN Abhiyan'
in 2018 to educate people
about health and nutrition as
they play a significant role in
overall human development
and social infrastructure.
6.
7. Current status of India
In the 2020 Global Hunger Index, India ranks 94th out of 107 countries.
As per the reports, 14 percent of the population in India is undernourished.
With a score of 27.2, India has a level of hunger that is worrisome and
serious.
8.
9. Feeding smart right from the start
Hunger starts from the womb, malnutrition in the
first 1000 days of life can lead to irreversible
damage to the mind and body.
From 2nd week of conception, mother needs extra
energy, protein, iron, calcium and other
micronutrients.
1st 6 months of life- exclusive breast feeding.
From six months of age your baby needs breast
milk and solid foods; to promote health, support
growth and enhance development.
From six months on, introduce new foods to your
baby every few days
10. FEEDING DURING THE FIRST YEAR OF LIFE
Feedings should be initiated soon after birth
unless medical conditions preclude them.
Mothers should be encouraged to nurse at
each breast at each feeding starting with the
breast offered second at the last feeding.
It is not unusual for an infant to fall asleep
after the first breast and refuse the second.
It is preferable to empty the first breast before
offering the second in order to allow complete
emptying of both breasts and therefore better
milk production.
14. Inadequate Milk Intake
Signs of insufficient milk intake include: lethargy, delayed stooling,
decreased urine output, weight loss >7% of birth weight, dehydration,
inconsolable crying and increased hunger.
Insufficient milk intake may be caused by insufficient milk production,
failure of established breast feeding, and health conditions in the infant
that prevent proper breast stimulation.
15. Parents should be counselled that
breastfed neonates feed 8-12 times a day
with a minimum of 8 times per day.
Late preterm infants (34-36 wk) are at risk
for insufficient milk syndrome because of
poor suck and swallow patterns or medical
issues.
16. Growth of the Breastfed Infant
The rate of weight gain of the
breastfed infant differs from that
of the formula-fed infant, and the
infant’s risk for excess weight
gain during late infancy may be
associated with bottle feeding.
17.
18.
19. Formula Feeding
Despite efforts to promote
exclusive breastfeeding
through 6 months, less than
50% of women continue to
breastfeed at 6 months.
Most women make their
infant feeding choices early
in pregnancy. Parental
preference is the most
common reason for using
infant formula.
20. Infant formula is also indicated in infants whose intake of breast milk is
contraindicated for infant factors (e.g. inborn errors of metabolism), and maternal
factors.
In addition infant formula is used as a supplement to support inadequate weight gain
in breastfed infants
Infant formulas are available in ready-to-feed, concentrated liquid or powder forms.
Ready-to-feed products generally provide 20 kcal/30 mL (1 oz) and approximately 67
kcal/dL.
The usual intake to allow a weight gain of 25-30 g/day will be 140-200 mL/kg/ day in
the first 3 months of life. The rate of weight gain declines from 3-12 months of age.
22. FEEDING TODDLERS AND
PRESCHOOL-AGE CHILDREN
Toddlerhood is a period when eating
behaviour and healthful habits can be
established and is often a confusing and
anxiety-generating period.
Growth after the 1st yr slows, motor
activity increases, and appetite
decreases. Birth weight triples during the
1st year of life and quadruples by 2 yr of
age, reflecting this slowing in growth
velocity.
Eating behaviour is erratic, and the child appears
distracted as the child explores the environment.
Children consume a limited variety of foods and
often only “like” a particular food for a period of
time and then reject the favoured food.
23. The period starting after 6 months until 15 months is characterised by the
acquisition of self-feeding skills.
The infant can grasp foods, learn to use a spoon, and eat soft foods.
Around 12 months of age, the child learns to drink from a cup and may
still breastfeed or desire formula bottle feeding.
Bottle weaning should begin around 12-15 months and bedtime bottles
should be discouraged because of the association with dental caries.
In the 2nd year of life, self-feeding becomes a norm and provides the
opportunity for the family to eat together with less stress.
Self-feeding allows the child to limit the child’s intake. Child feeding is an
interactive process. Children receive cues regarding appropriate feeding
behaviours from parents.
24. The 2 year old child should progress from small pieces of soft food to prepared
table foods with precautions. At this stage, the child is not capable of completely
chewing and swallowing foods, and particular attention should be paid to foods
with a choking risk.
Hard candies, nuts, and raw carrots should be avoided.
Eating in the presence of distractions such as television, tablets, mobile
devices, and other screens, or eating in a car where an adult cannot adequately
observe the child is highly discouraged.
Young children have a natural preference for sweetened foods and beverages
that begins in infancy. Reluctance to accept new foods is a common
developmental phase.
A new food should be offered multiple times (8-15) before being considered
rejected by the child.
25. Toddlers need to eat 3 healthy meals and 2 snacks daily.
Milk continues to be an important source of nutrition. Guidelines for vitamin D
supplementation recommend a daily vitamin D intake of 600 IU/ day for all
infants beginning in the first few days of life, and for children and adolescents
who are ingesting <1000 mL/day of vitamin D-fortified milk or formula.
Toddlers and preschool children often fail to meet the recommended servings of
fruits, vegetables, and fibre, whereas intakes of food with fat and added sugar
are high.
Giving vegetables at the beginning of the meal and increasing the portion size
of vegetables served during meals can be an effective strategy for increasing
vegetable consumption in preschool children.
26. Using Food as Reward
It is a prevalent habit to use food as a reward
or sometimes withdraw food as punishment.
Although it might be a good idea to limit some
unhealthy but desirable food categories to
special occasions, using food as a reward is
problematic.
Parents should be counselled on such issues
and encouraged to choose items other than
food as reward, such as inexpensive toys or
sporting equipment, family time, special family
events, or collectable items.
27. Limiting access to some foods and
making its access contingent on a
particular accomplishment increases the
desirability of that type of food.
Conversely, encouraging the
consumption of some foods renders
them less desirable. Therefore, phrases
such as “finish your vegetables, and
you will get ice cream for dessert”
can result in establishing unhealthy
eating habits once the child has more
autonomy in food choices.
28. Vegetarianism
There are many different variations in vegetarianism:
◆ Veganism: excludes all animal products. It may be part of a larger practice of
abstaining from the use of animals products for any purpose.
◆ Ovovegetarianism: includes eggs but not dairy products.
◆ Lactovegetarianism: includes dairy products but excludes eggs.
◆ Lactoovovegetarianism: includes eggs and dairy products.
◆ Flexitarian: recent term referring to a vegetarian who will
occasionally eat meat.
Another expression used for vegetarianism and veganism is “plant- based diets.”
29. Other dietary practices commonly associated with
vegetarianism include fruitarian diet (fruits, nuts, seeds, and
other plant matter gathered without harm to the plant);
Su vegetarian diet (a diet that excludes all animal products as
well as onion, garlic, scallions, leeks, or shallots);
Macrobiotic diet (whole grains and beans and, in some cases,
fish);
Raw vegan diet (fresh and uncooked fruits, nuts, seeds, and
vegetables).
30. The safety of these restrictive diets has not been studied in children.
These diets can be very limited in macro- and micronutrients and are not
recommended for children.
Implementing vegetarian diets in teenage girls may be a sign of an
eating disorder.
Compared with non-vegetarian diets, vegetarian diets have low levels of
saturated fat, cholesterol, and animal protein, and relatively higher levels
of complex carbohydrates, fiber, magnesium, potassium, folate, vitamins
C and E, and phytochemicals.
Vegetarians have a lower body mass index, cholesterol, and blood
pressure, and are at decreased risk for cancer and ischemic heart
disease.
31. Specific nutrients of concern
in vegetarian diets include:
◆ Iron: Vegetarian diets
have similar levels of iron
compared to nonvegetarian
diets, but the iron has lower
bioavailability than iron from
meat sources, and iron
absorption may be inhibited
by other dietary constituents,
such as phytate.
32. Iron stores are lower in
vegetarians and vegans than in
nonvegetarians; and iron
deficiency is more common in
vegetarian and vegan women and
children.
Foods rich in iron include iron-
fortified cereals, black beans,
cashews, kidney beans, lentils,
oatmeal, raisins, black-eyed peas,
soybeans, sunflower seeds,
chickpeas, molasses, chocolates.
33. ◆ Vitamin B12: Plants are not a
good source of B12. Additional
vitamin B12 can be obtained through
dairy products and eggs; vegans
need fortified foods or supplements.
Breastfeeding by vegan mothers can
place an infant at risk for vitamin B12
deficiency.
◆ Fatty acids: Vegetarians and
vegans may be at risk for low levels
of eicosapentaenoic acid (EPA) and
DHA. The inclusion of sources of
linolenic acid (precursor of EPA and
DHA), such as walnuts, soy products,
flaxseed, and canola oils, are
recommended.
34. ◆ Calcium and vitamin D: Without
supplementation, vegan diets are
low in calcium and vitamin D putting
vegans at risk for impaired bone
mineralization. Vitamin D-OH levels
should be monitored in vegans and
supplemented for levels <30 dL.
Calcium sources include leafy
greens (with low oxalate: broccoli,
kale, or Chinese cabbage). Calcium
and vitamin D are found in almond
and soy milk, and fortified orange
juice.
◆ Zinc: The bioavailability of zinc in plant
sources tends to be low because of the
presence of phytates and fiber that inhibit
zinc absorption. Zinc is found in soy
products, legumes, grains, cheese, and
nuts.
35. In addition to choking hazards and food allergies, paediatricians and parents should be
aware of food safety issues related to infectious agents and environmental contaminants.
Food poisoning with bacteria, viruses, or their toxins are most common with raw or
undercooked food, such as oysters, beef, and eggs, or cooked foods that have not been
handled or stored properly.
Many chemical contaminants, such as heavy metals, pesticides, and organic
compounds, are present in various foods, usually in small amounts.
36. Nelson’s paediatrics 21st Edition
OP Ghai Essentials of Paediatrics 9th Edition
World Health Organisation
Ministry of Health and Family Welfare/ www.mohfw.gov.in
Poshan Abhiyaan / www.poshanabiyaan.gov.in
