Nutrition in New born and Kids Calorie requirement of newborn and growing kids Protein energy malnutrition Vitamin deficiency disorders in kids Ricketts Scurvy Kwashiorkor Marasmus

1. NUTRITION IN
NEWBORN & KIDS
-By Dr. Rima M Jani (MPT Pediatric Science)

2. How Many Calories Should a Baby Eat?
◦ Beginning at birth, your baby needs about 515 calories or more
each day, a number that changes according to his age and needs.
◦ In addition to calories, his diet should also consist of fat,
protein, vitamins and minerals and come from healthy sources.
◦ Allow at least 2 hours between feedings to be sure your baby is
hungry and ready to eat.

3. Birth to 3 Months
◦ Kids and Nutrition states that from birth to 3 months of age,
babies need between 515 to 690 calories a day.
◦ At this age, their only source of nutrition should be 18 to 32
ounces of breast milk or formula daily.

4. 4 to 6 Months
◦ Between 4 and 6 months of age, babies still need between 515
and 690 calories a day.
◦ They get this intake from 28 to 40 ounces of formula or breast
milk.
◦ If babies can hold up their heads, sit with support and show an
interest in foods, than they may begin eating solid foods.

5. 7 to 12 Months
◦ Beginning at 7 months of age, babies need 795 to 920 calories a
day.
◦ Their intake will consist of 24 to 36 ounces daily of breast milk
or formula until they are 9 months old, and decrease to 18 to 30
ounces daily from 10 to 12 months of age.
◦ Babies also need 1 cup of fruit or vegetables a day and two cups
daily of other soft foods such as mashed potatoes, pasta or
bread.

6. What Is the Difference in Nutrition for
Infants v/s Other Stages of Life?
◦ Babies grow at a faster rate than people at any other stage of
life. Because of this phenomenal growth, infant's nutritional
needs are different from those of an adult or older child.
◦ In addition, the rapid development of baby's brain needs more of
particular nutrients, but his small size requires that some
nutrients are provided in smaller quantities.

7. Calories
◦ Your baby needs approx 116 calories per kilogram for the first
three months of life and about 100 calories per kilogram for the
rest of the first year.
◦ In contrast, a child between the ages of 4 and 6 needs about 90
calories per kilogram and a child between 7 and 11 needs about
70 calories per kilogram.
◦ In adolescence and adulthood, this requirement drops to 45 or
fewer calories per kilogram of weight.

8. Macronutrients
◦ The composition of baby's diet differs from that of older
children and one should focus on providing higher levels of fat
and lower levels of proteins.
◦ Infant needs to get about 40 to 50 percent of his daily calories
from fat, about 10 percent of his diet to be protein and 40
percent to be made up of carbohydrates

9. Vitamins and Minerals
◦ Baby needs all of the essential vitamins and minerals that adults
do, including vitamins C, A, D, E and K, calcium, iron, potassium
and folic acid. The recommended amounts of these nutrients are
typically smaller than those needed by older children and adults.
◦ Vitamin D, might be lacking in breast-fed babies.
◦ Baby must get an adequate supply of omega-3 fatty acids to
ensure proper brain growth. These fats are found in breast milk
and many formulas.

10. Special concerns
◦ During the first four to six months of life, your baby should get
all of his nutrients from breast milk or formula.
◦ The American Academy of Pediatrics recommends exclusive
breast-feeding throughout the first six months. After
introduction of solid foods, breast milk or formula should
continue to be the primary source of nutrition until at least one
year of age.

11. Malnutrition
◦ Malnutrition, at its core, is a dietary deficiency that results in
poor health conditions.
◦ Results from a diet deficient in vital nutrients, vitamins and
minerals.
◦ Over long term or even over a short term this may lead to severe
debility and damage to the vital functions of the body.
◦ It relates to children not eating enough of the right foods.
However, it can also occur when children eat too much of the
wrong foods.

12. Causes of Malnutrition in Children
◦ Poor qualify of diet
◦ Poor maternal health
◦ Socioeconomic status
◦ War and conflict

13. Poor Quality of Diet
◦ Malnutrition can occur in children of all ages, but young children
are the most vulnerable.
◦ The World Health Organization has stated that malnutrition is
the single most dangerous threat to global public health
◦ Chronic malnutrition or stunting—when children are too short for
their age because they have not been adequately nourished,
received inadequate care and/or live in unhygienic
environments—can leave a devastating and permeant impact on a
child’s physical and cognitive capabilities.

14. Poor Maternal Health
◦ The largest window of opportunity for a child’s health occurs in
the first 1,000 days--from the start of a woman’s pregnancy to
her child’s second birthday.
◦ Mothers who are malnourished during their pregnancy can
experience complications giving birth.
◦ Many children are born small because their mothers are
undernourished. Severely malnourished mothers can also have
trouble breastfeeding their infants.

15. Socioeconomic Status
◦ Poverty is the number one cause of malnutrition in developing
countries.
◦ Chronic malnutrition is becoming concentrated in countries with
the fewest resources, where 1 in 3 children have stunted growth.

16. War and Conflict
◦ Chronic malnutrition has also become increasingly concentrated
in conflict-affected countries.
◦ At least 240 million children live in countries affected by
conflict and fragility.
◦ Access to food and water has become a challenge— leaving
thousands of these children at risk for malnutrition.
◦ These children are at heightened risk of death before age 5,
stunted growth due to malnutrition and so much more.

17. Symptoms of Malnutrition
• Growth failure. This may be manifested as failure to grow at a
normal expected rate in terms of weight, height or both
• Irritability, sluggishness and excessive crying along with
behavioral changes like anxiety, attention deficit are common in
children with malnutrition.
• The skin becomes dry and flaky and hair may turn dry, dull and
straw like in appearance. In addition, there may be hair loss as
well.
• Muscle wasting and lack of strength in the muscles. Limbs may
appear stick like.

18. Symptoms of Malnutrition
• Swelling of the abdomen and legs.
• The abdomen is swollen because of lack of strength of the
muscles of the abdomen. This causes the contents of the
abdomen to bulge out making the abdomen swollen.
• Legs are swollen due to edema. This is caused due to lack of vital
nutrients.
• These two symptoms are seen in children with severe
malnutrition.

19. PEM in Children
• There are classically two types of protein energy malnutrition
(PEM) in children.
• These are Marasmus and Kwashiorkor.

20. Marasmus
• In Marasmus there may be
obvious weight loss with
muscle wasting. There is
little or no fat beneath the
skin.
• “Balanced Starvation.”
• The skin folds are thin and
the face appears pinched
like an old man or monkey.
Hair is sparse or brittle.

21. Kwashiorkor
◦ It is a form of severe protein malnutrition
characterized by oedema and an enlarged liver
with fatty infiltrates.
◦ The child is between 1 and 2 with hair
changing color to a listless red, grey or blonde.
Face appears round with swollen abdomen and
legs. Skin is dry and dark with splits or
stretch marks like streaks where stretched.
◦ It is caused by sufficient calorie intake, but
with insufficient protein consumption, which
distinguishes it from marasmus.

22. Comparison Table

23. Vitamin C
◦ Vitamin C is essential for the robust health of skin,
cartilage tissue, bones and teeth.
◦ Children need Vitamin C for proper body and brain
development.
◦ Vitamin C (ascorbic acid) is a water-soluble vitamin essential in
the human diet because the body is unable to synthesize it.
◦ Sources: wide variety of fruits and vegetables…

24. Vitamin C
◦ It is essential for collagen formation and helps to maintain the
integrity of skin and connective tissue, bone, blood vessel walls
and dentine.
◦ It is essential for wound healing and facilitates recovery from
burns.
◦ It also facilitates the absorption of iron.
◦ Vitamin C is an antioxidant.

25. Vitamin C Deficiency
◦ The effects of Vitamin C deficiency are frequent cough and cold
problems along with regular flu attacks.
◦ The deterioration of skin and hair health.
◦ Unless proper diagnosis and treatment are sought the lack of
Vitamin C can lead to breathing problems, nerve disorder and
feverish spells.
◦ Vitamin C deficient kids are also known to suffer from convulsions.
In rare cases bleeding inside the brain and around the heart can
occur.

26. Vitamin C Deficiency & Scurvy
◦ Persistent Vitamin C deprivation means that new collagen cannot
form and this leads to tissue breakdown.
◦ Once this condition persists for more than 3 months a condition
called Scurvy develops and this is characterized by bleeding
gums and wounds that refuse to heal in the skin.

27. Scurvy
◦ Lack of vitamin C, or ascorbic acid. The deficiency leads to symptoms of
weakness, anemia, gum disease, and skin problems.
◦ Symptoms of vitamin C deficiency can start to appear after 8 to 12
weeks. Early signs include a loss of appetite, weight loss, fatigue,
irritability, and lethargy.
◦ Within 1 to 3 months, there may be signs of:
• anemia
• myalgia, or pain, including bone pain
• swelling, or edema
• petechiae, or small red spots resulting from bleeding under the skin
• gum disease and loss of teeth
• poor wound healing
• shortness of breath
• mood changes, and depression

28. Scurvy
◦ In time, the person will show signs of generalized edema, severe
jaundice, destruction of red blood cells, known as hemolysis,
sudden and spontaneous bleeding, neuropathy, fever, and
convulsions. It can be fatal.
◦ Infants with scurvy will become anxious and irritable. They may
experience pain that causes them to assume a frog-leg posture
for comfort.
◦ There may also be subperiosteal hemorrhage, a type of bleeding
that occurs at the ends of the long bones.

29. Causes
◦ A deficiency may result from:
• a poor diet lacking in fresh fruits and vegetables, possibly due to
low income or famine
• illnesses such as anorexia
• restrictive diets, due to allergies, difficulty orally ingesting
foods, or other reasons
• Late or unsuccessful weaning of infants can also lead to scurvy.

30. Prevention
◦ The United States (U.S.) Office of Dietary Supplements (ODS) recommend
the following intake of vitamin C:
• Up to 6 months: 40 mg, as normally supplied though breastfeeding
• 7 to 12 months: 50 mg
• 1 to 3 years: 15 mg
• 4 to 8 years: 25 mg
• 9 to 13 years: 45 mg
• 14 to 18 years: 75 mg for men and 65 mg for women
• 19 years and above: 90 mg for men, 75 mg and women
◦ During pregnancy, women should consume 85 mg of vitamin C, rising to 120 mg
while breastfeeding.

31. Treatment
◦ Treatment involves administering vitamin C supplements by mouth or
by injection.
◦ The recommended dosage is:
• 1 to 2 grams (g) per day for 2 to 3 days
• 500 milligrams (mg) for the next 7 days
• 100 mg for 1 to 3 months
◦ Within 24 hours, patients can expect to see an improvement in fatigue,
lethargy, pain, anorexia, and confusion. Bruising, bleeding, and
weakness start to resolve within 1 to 2 weeks.

32. Rickets
Rickets is a condition of bone disorder
caused by a deficiency of Vitamin D,
calcium, or phosphate. It leads to
tenderness and weakness in the bones.
Bones tend to become weak due to an
inadequate supply of nutrients, Vitamin
D3 in particular. Weak bones can lead
to bone deformities.

33. Physiology
◦ Vitamin D helps your child's body absorb calcium and phosphorus
from food. Not enough vitamin D makes it difficult to maintain
proper calcium and phosphorus levels in bones, which can cause
rickets.
◦ Adding vitamin D or calcium to the diet generally corrects the
bone problems associated with rickets.
◦ Rare inherited disorders related to low levels of phosphorus, the
other mineral component in bone, may require other medications.

34. Causes
◦ Children who don't get enough vitamin D from these two sources
can develop a deficiency:
• Sunlight. Your child's skin produces vitamin D when it's exposed
to sunlight. But children in developed countries tend to spend
less time outdoors. They're also more likely to use sunscreen,
which blocks the sun's rays that trigger the skin's production of
vitamin D.
• Food. Fish oil, egg yolks and fatty fish such as salmon and
mackerel contain vitamin D. Vitamin D has also been added to
some foods and beverages, such as milk, cereal and some fruit
juices.

35. Causes
◦ Problems with absorption
◦ Some children are born with or develop medical conditions that
affect the way their bodies absorb vitamin D. Some examples
include:
• Celiac disease
• Inflammatory bowel disease
• Cystic fibrosis
• Kidney problems

36. Symptoms
• Bone pain and tenderness
• Poor growth and development (short height and low weight)
• Increased susceptibility to bone fractures
• Bow legs
• Knock knees
• Increased curvature of the spine
• Muscle spasms
• Dental problems
• Pelvic, spinal or cranial bone deformities

37. Complications
◦ Because rickets softens the areas of growing tissue at the
ends of a child's bones (growth plates), it can cause skeletal
deformities such as:
• Bowed legs or knock knees
• Thickened wrists and ankles
• Breastbone projection
◦ Bone fractures, muscle spasms, an abnormally curved spine,
or intellectual disability.

38. Treatment
◦ Rickets treatment involves increasing the individual’s intake of
the missing minerals or vitamins in the body.
◦ Depending on the cause of the disorder, vitamin D supplements
are recommended.
◦ Vitamin D fortified foods, including milk, many kinds of cereal,
some juices, some soy milk products.

39. THANK YOU