General overview of feeding in paeditaric age group

1. Weaning and Feeding Practices for
Toddlers, School-aged Children &
Adolescents
HEE YAN HAN
BMS 14091168

2. Malaysian Dietary Guidelines for Children and
Adolescents – 15 Key notes
1. Practise exclusive breastfeeding from birth
until 6 months and continue to breastfeed until
2 years of age
2. Give appropriate complementary foods to
children between the age of 6 months to 2 years
3. Eat a variety of foods within your
recommended intake
4. Attain healthy weight for optimum growth
5. Be physically active everyday
6. Eat adequate amount of rice, cereals or tubers
7. Eat fruit and vegetables everyday

3. 8. Consume moderate amounts of fish, meat,
poultry, egg, legumes and nuts
9.Consume milk and milk products everyday
10.Include appropriate amounts and types of
fats in the diets
11.Limit intake of salt and sauce
12.Consume foods and beverages low in sugar
13.Drink plenty of water daily
14.Consume safe and clean foods and beverages
15. Educate children on the use of nutrition
information on food labels

4. Weaning
• Natural (Infant-led) / Planned (Mother-led)
• Not to be confused with ‘nursing strike’
• Complementary food should be introduced by 26
weeks but not before 17 weeks
Signs of readiness to wean
- Sits without support and has good head and neck
control
- No longer has extrusion reflex
- Brings hands and toys to the mouth for exploration
- Indicates a desire for food

6. Feeding of complementary foods
according to age
Age Meal texture Meal frequency/
day
Nutritious snacks/
day
6 to 8 months Blended, mashed
and soft foods
2 to 3 times 1 to 2 times
9 to 11 months Chopped foods,
fruits
3 to 4 times 1 to 2 times
1 to 2 years Family foods 4 to 5 times 1 to 2 times
• Avoid giving chunks of hard food >0.5 cm
• Supervise children during mealtimes to avoid
choking.
• Breastfeeding on-demand till 2 years

7. Feeding Practices for Toddlers
• Responsive feeding – hunger / satiety cues
• Establishment of long-term dietary habits
• 2 – 3 servings of milk or other dairy products per day.*
• Fats: <2 years – no restriction>2 years – 30% of total
energy
• Whole fruits and vegetables instead of juices.
• Good nutritional habits - sitting at the table, turning off
the television, and interacting socially.
• Exposure to foods variations, healthy foods, and
parental model of healthy eating behaviours.
*Daily supplementation with 200 IU of vitamin D is recommended for toddlers who consume
<2 cups of milk daily or do not get regular sunlight exposure.

8. Feeding Practices for School-Aged
Children
• Adequate nutrition to promote growth and
without excessive weight gain
• Increased opportunities to make food choices
• Meal-planning, regular meal times, keeping a
diverse diet, positive parental examples
• Involve children in age-appropriate tasks
• Habits formed in childhood are likely to carry into
adult years
• Physical activity – >1h/day

9. Feeding Practices for Adolescents
Importance of adequate nutrition during adolescence
1) Sexual maturation
2) Linear growth
3) Prevent adult diet-related chronic diseases
• Gender-specific nutrient needs occur during and
after puberty
• Peak onset for eating disorders
- Dieting and concerns about body size
- Food restriction

10. Daily Estimated Calories and Recommended
Servings by Age and Gender
1 y 2–3 y 4–8 y 9–13 y 14–18 y
Kilocalories 900 1000
Female 1200 1600 1800
Male 1400 1800 2200
Fat, % of total kcal 30–40 30–35 25–35 25–35 25–35
Milk/dairy, cups 2 2 2 3 3
Lean meat/beans, oz 1.5 2 5
Female 3 5
Male 4 6
Fruits, cups 1 1 1.5 1.5
Female 1.5
Male 2
Vegetables, cups ¾ 1
Female 1 2 2.5
Male 1.5 2.5 3
Grains, oz 2 3
Female 4 5 6
Male 5 6 7

11. References
• Rudolph, C. D., & Rudolph, A. M. (2011). Rudolphs pediatrics. New York: McGraw
Hill Medical.
• The Heinz Handbook of Nutrition. (1959). London: McGraw Hill Book Co. Inc.
• Koletzko, B. (2015). Pediatric nutrition in practice. Basel: Karger.
• Weaning from the breast. (2004). Paediatrics & Child Health, 9(4), 249–253.
• Behrman, R. E., & Nelson, W. E. (2004). Nelson textbook of pediatrics. Philadelphia,
Pa.: Saunders.
• Malaysian dietary guidelines for children and adolescents. (2013). Putrajaya:
Technical Working Group on Nutritional Guidelines (for National Coordinating
Committee on Food and Nutrition).
• SS, Dennison BA, Birch LL, et al. Dietary Recommendations for Children and
Adolescents: A Guide for Practitioners. Gidding Pediatrics. 2006;117 :544– 559
• M. Story, J. Tang. Nutrition Needs of Adolescents (Chap. 3)
• Dietary Guidelines for Children and Adolescents (2003), National Health and
Research Council, Australia