Kmu slides of nutrition 2nd chapter name as nutritional consideration in infancy and preschool ages written by kmu lecturer miss shabnam.

1. Nutritional Consideration in
Infancy and Preschool Years
Applied Nutrition Unit-II
Shabnam
Faculty INS-KMU
Acknowledgement: Imran Waheed
1

2. Objectives
• At the end of this session students will be able
to:
• Identify the best feeding options for infants in
different circumstances in Pakistan.
• Identify the major nutritional risk factors and
strategies to prevent or manage them in the first
years of life and during the pre-school years.
• Weaning, Pre lacteal feeds, food introduce with
quantity and type.
• Counsel mothers regarding nutritional care of
the children.

3. Best Feeding Option
• Breast milk is best for the
baby and should be the
first choice.
• Formula feeding is also an
option if there are social,
medical or other constraints.
• Mothers should try to breast feed at least in the
initial 3-4 weeks, as most healthy antibodies are
transferred in the initial days.

4. Cont….
• If formula feeding is to be done, combining it
with breast feeding should be considered.
• Breast feeding should be done first, followed
by formula feeding in this case.
• If you plan to use formula for occasional
feedings, limit bottles to one per 24 hours to
avoid slowing your milk production.
• Cow or Buffalo milk should not be introduced
to the baby before at least one year of age.

5. Developmental Pattern
• Neonate: Birth to 28 days
• Infant: 1 month-1 year
• Toddlers: 1-3 years
• Preschool children: 3-5 years
• School- age children: 5-12 years
• Adolescence: 12-18 years

6. About Early Childhood Care
• Healthy habits are taught to the child right from
birth.
• In fact, health of the baby is decided even before his
birth.
• Healthy child is born to the mother who kept to
healthy food habits during her pregnancy.
• Children often take the attitudes and habits formed
during their initial years, into adulthood.
• Learning healthy eating behavior at an early age is
very important to lay a good foundation for the
future health of the child.

7. Conti…
• At all ages, children are not eating diets with
enough nutrients or diversity, and they are eating
too much sugar, salt and fat.
• The risks at each age can lead to one or more
forms of malnutrition: stunting, wasting, hidden
hunger or overweight and obesity.
• These conditions can affect school performance
and lifelong economic opportunities, and present
health risks into adulthood.

8. Conti…
• The vast majority of young children(6-23
months) consume breast milk, they are not
eating enough animal source foods, fruits,
legumes or vegetables and rely too heavily on
grains.
• 59% of children worldwide are not being
fed much-needed nutrients from animal
source foods.
• 44% of children worldwide are not fed any
fruits or vegetables.

9. Malnutrition refers to deficiencies or excesses in
nutrient intake, imbalance of essential nutrients or
impaired nutrient utilization. The double burden of
malnutrition consists of both undernutrition and
overweight and obesity, as well as diet-related non
communicable diseases. Undernutrition manifests in
four broad forms: wasting, stunting, underweight, and
micronutrient deficiencies.

10. Wasting is defined as low weight-for-height. It
often indicates recent and severe weight loss, although
it can also persist for a long time. It usually occurs
when a person has not had food of adequate quality and
quantity and/or they have had frequent or prolonged
illnesses. Wasting in children is associated with a
higher risk of death if not treated properly. Stunting is
defined as low height-for-age. It is the result of chronic
or recurrent undernutrition, usually associated with
poverty, poor maternal health and nutrition, frequent
illness and/or inappropriate feeding and care in early
life.

11. Stunting prevents children from reaching their
physical and cognitive potential. Underweight is
defined as low weight-for-age. A child who is
underweight may be stunted, wasted or both.
Micronutrient deficiencies are a lack of vitamins and
minerals that are essential for body functions such as
producing enzymes, hormones and other substances
needed for growth and development.

12. Risk Factors in Infants and
Young Children
• Inappropriate growth
Weight gain too slow or too rapid for length
• Inappropriate or inadequate diet
Formula not prepared properly (too concentrated
or diluted, addition of solids or cereal)
Solids given before developmental age of 4-6
months
Excessive solids given in infancy so that breast
milk or formula is significantly reduced

13. Conti…
• Food is not appropriate to support
developmental progress
Finger foods and textured foods are not
offered by developmental age of 6-8 months
Cup and spoon are not offered by 9-12
months developmentally
Bottle use continued after 18 months

14. Conti…
• Inappropriate feeding behaviors or
environment
Infant not allowed to feed on demand
Lack of routine meals and snacks; child allowed
to “graze”
Caregiver pressure to get child to eat, including
forcing, bribing and rewarding
Meals take less than 10 minutes or more than
40 minutes

15. Conti…
• Health factors impacting nutrition and feeding
Child who is tube-fed
Oral motor problems or delays
Food/formula allergies or intolerance
Medical condition or diagnosis that alters
nutrient needs or feeding
Use of medications that alter appetite and/or
nutrient absorption and metabolism

16. Strategies
• Promoting food with adequate micronutrient
content.
• Strengthening political commitment,
legislation and multisectoral approaches to
ensure healthy and sustainable food supply.
• Providing comprehensive information and
education to the public
• Ensuring a safe, healthy and sustainable food
supply

17. Conti…
• Promoting implementation of the WHO global
strategy on diet, physical activity and health.
• Promoting and protecting the nutritional well-
being of women and children and ensuring
good nutrition throughout the life-cycle for all
age groups.
• Strengthening food safety
• Research, monitoring and evaluation

18. Recommended Energy Intakes
for Children
S.No Age (Years) Kcal/Kg/Day Kcal/Day
1. 1-3 102 1300
2. 4-6 90 1800
3. 7-10 70 2000
* 1 calorie = 4.2 joules

19. Breast Feeding
• Exclusive till 6 months of age
• Species specific - suitable, natural, warm, free of bacteria
and readily available.
• Colostrum - rich in antibodies. Baby develops immunity.
• Contains easily digestible proteins, CHO and fats.
• Very rich in vitamins compared to cow’s milk
• Stimulates development of personality and behavior
( brain dev./ cognitive dev.)

20. Composition of Milk (Per100 ml)
S.No Nutrients
(gm)
Human Cow Buffalo
1. CHO 6.8 5.0 4.5
2. Protein 1.5 3.5 4.3
3. Fat 4.0 3.5 7.5
4. Energy 68 66 103
 Carbohydrates provide 4 calories per gram
 Protein provides 4 calories per gram
 Fat provides 9 calories per gram

21. Prelacteal Feeds
• Prelacteal feeds are those foods given to
newborns before breastfeeding is established
or before breast milk "comes in," usually on
the first day of life.
• Prelacteals include honey, jaggery (brown
sugar from sugar cane) ghee (clarified butter),
ghutti (herbal paste) and green tea.
• The choice of prelacteals may be specific to a
caste ,family or culture.

22. Conti…
• Newborns are given Prelacteal feeds for
different reasons including the following:
• To clean baby’s bowels
• To keep mouth and throat moist
• To keep baby warm
• To soothe the baby
• To relieve pain
• To allow stool to be passed

23. Conti…
• Prelacteal feeds may delay the production of
breast milk and the perceived lack of breast
milk may encourage the use of prelacteal feeds.
• Prelacteal feeds have lesser nutrient and
immunological value; and are often likely to
introduce contaminants
• For these reasons WHO/UNICEF discourages the
use of prelacteal feeds unless medically
indicated.

24. Conti…
• The best practice in infant feeding is to put the
infant at the breast as soon as practicable
after delivery and to offer colostrum to the
infant.
• Avoid pre-lacteal feeding and practice
exclusive Breastfeeding
* Your body will produce colostrum exclusively for about
2-5 days after birth (According to American Pregnancy Association)

25. Weaning
• The process of introducing semi-liquid to semi-
solid foods other than breast milk.
• Consistency, frequency of food, calorie density
and nutrient density need to be monitored
closely.
• Hygiene
 Calorie Density: The number of calories in a given volume or weight of food.
Usually expressed as calories per pound.
 Nutrient Density: The ratio of nutrient content to the total energy content.
Nutrient dense food provides substantial amounts of vitamins and
minerals and relatively few calories.

26. When to Start
Weaning
• At 6 months of age (WHO recommends)
Complementary feeding initiated and
Supplementary to breast milk started.
• Less milk output (malnourished mother) results
underweight child hence initiate weaning early
(at 5 or 6 months of age).
• Continue breast feeding (frequency and amount
reduced).

27. Reasons for Starting Weaning at
6 Months
• Breast-feeding becomes inadequate to meet the
child nutritional needs particularly in relation to
iron and vit.C.
• Enzymes necessary to digest the complex structure
of solid food are developed.
• Biting is an accomplishment that becomes possible
at about 6 months of age.
• It is a good chance for child to learn independency
by using cup and spoon to feed himself.
• To accustom the infant to chew and swallow solid
food.

28. Critical/ Crucial Period
• Each month is different till one year of age.
• Weaning at proper time
• Transition from liquid to solids – gradually
• Frequency from 10 feeds per day (breast feeding)
to 6-7 feeds per day – gradually
• Small amount but frequently.
• Once the critical stage of learning a particular
behavior is over, it is difficult to teach that
behavior at a later stage.

29. Principles of Weaning
• Start weaning when the child is free from any disease
particularly from any G.I.T. troubles.
• Don’t start in summer because of the high susceptibility to
gastro-enteritis.
• One-food item is introduced at intervals of 4-7 days to
allow for identification of food allergies and to allow the
child to get used to it.
• New foods are fed in small amounts, from one teaspoon to
a few tablespoons, put the spoon midway back on tongue
to facilitate swallowing of semi-solid food.

30. How To Initiate Weaning And
Progress
•Consistency: Introduction of
right consistency of food at the
right age is important to develop
good food behaviors.
Essentially follow the sequence:
• Breast feeds (0-6 months)
• Semi-liquid (after 5-6 months) Easy to digest,
smooth and gentle on baby’s stomach.

31. Conti…
• Semi-solid (after 8-9 months) Baby now needs
food with taste and texture.
• Semi solid (after 10 months) Baby now needs
food that satisfy his urge to chew-complex
taste and texture
• Solid diet including variety of food items (1-1.2
years)

32. How To Initiate Weaning And
Progress
Frequency:
• Energy requirement on a per kg basis, is 3 times
more than the adults in infants and 2 times more
than the adults in case of children till 2 years of
age.
• Children have to be fed frequently since they can
eat small amount at a time due to their little
capacity.

33. Cont…
• Till 5-6 months - child is given breast feeds on
demand i.e. 9-10 times over 24 hours.
• From 6- 8 months - As the child grows, his
requirements increases and he starts to accept larger
volume and thicker consistency at a time - feed him
7-8 times per day.
• From 9- 12 months - child normally eats 6-7 times
per day.
• By 12 - 15 months - child eats at least 6 times per
day.

34. Conti…
• By 18 months - child’s eating schedule of 5-6
times /day gets fixed.i.e
 3 Regular meals:
i) Breakfast ii) Lunch iii) Dinner
 3 In-between healthy snacks:
i) Midmorning (recess time) ii) Evening
iii) Bedtime

35. What To Feed?
• Liquid supplements - Supplement breast
milk with undiluted cow’s milk, buffalo’s
milk, or what ever is easily available.
• Semi liquid to semisolid supplements -
Powdered rice, mashed banana, boiled &
mashed potato, suji, daliya, boiled &
mashed vegetables, mashed dals, khichri
etc.

36. Things to Remember
Nutrition Plan
• Develop the baby’s taste buds gradually.
• Easy to digest -- consistency
• Well-balanced diet
• Convenient: Easy to prepare & affordable
• Hygienic
• Availability of food items

37. Conti…
Nutrition Plan
• Likes and dislikes of the child - nothing is a must.
Allow your child to dislike certain foods.
• Introduce one food at a time
• Food fads - hot and cold foods/light and heavy
foods
• Food fads - fats and sweets - not to be restricted
• Artificial milk formulas/ commercial formulas are
not recommended
 Food Fads : Diets which become fashionable, but which are not
n9/7e/2c02e1ssarilynutritious. (Lehninger 1982, page 484) 34

38. Counseling Mothers Regarding
Children’s Nutrition
• Nutrition counseling is a process of finding the
solution to the child’s nutritional problem
together with their mother or caregiver.
• Unlike nutrition education, nutrition counseling is
a two-way process during which the mother is
actively involved in describing the child’s
problems as well as participating in analyzing the
causes and identifying the available resources
and solutions.
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39. Counseling Mothers Regarding
Children’s Nutrition
• The nutritional status of women when becoming
pregnant and during pregnancy can have
significant influence on both fetal, infant and
maternal health outcomes.
• Micronutrient deficiencies such as calcium, iron,
vitamin A and iodine can lead to poor maternal
health outcomes and pregnancy complications
which put the mother and baby at risk.
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40. Conti…
• Poor maternal weight gain in pregnancy due
to an inadequate diet, increases the risk of
premature delivery, low birth weight and birth
defects.
• Nutrition education and counseling strategies
have beneficial outcomes on maternal and
fetal outcomes.
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41. How To Bring About Positive
Behavioral Change
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42. GALIDRA Steps Fit Into The
Triple A Cycle
GALIDRA
G Greet the mother.
A Ask her about the feeding practices of the
child.
L Listen to what the mother says.
I Identify the problem and resources.
D Discuss the feeding difficulty she has and
the cause of malnutrition in the child and
decide on the alternative actions that the
mothers agree to undertake.
R Recommend the alternative doable
solution.
A Appoint her for reassessment.
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43. Essential
Nutrition
Actions (ENA)
Component
Key Message
1. Optimal
Breastfeeding
• Initiate breast feeding within one hour after delivery
• Exclusive breast feed for the first six months
• The mother breastfeeds, frequently day and night
• Mother allows infant to breast feed on demand (as
often as the infants want) every two to three hours
(8-12 hours per 24 hours)
• Mother breast feed more frequently (or expresses
her milk if the infant cannot breast feed)
• The mother positions and attaches infant correctly at
the breast
• The mother offers second breast after infant
releases the first
• The mother should eat more than usual meal (one
additional meal)
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44. 2. Optimal
Complemen
tary Feeding
• At six months, mother or care giver introduces
soft , appropriate foods and continue breast
feeding on demand
• The mother or caregiver increases the
frequency of feeding and the amount of food, as
the child gets older
• Increase the food thickness (density) and variety
as the child gets older
• Increase the amount of food as the child gets
older
• Good hygiene and safe food preparation
• Active responsive feeding
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45. 3. Sick Child Feeding • Breast Feed more frequently (or
express milk if the infant cannot breast
feed)
4. Maternal
Nutrition During
pregnancy and
Lactation
• Iron and folic acid supplementation
• Treatment and prevention of malaria
• Increase food intake
• One extra meal each day during
pregnancy
• Two extra meal each day during
lactation
• De-worming during the 3rd trimester of
pregnancy (Tab: Albendazole 400 mg or
Tab: Mebendazole 500 mg)
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46. References
• Smith, E. R., Hurt, L., Chowdhury, R., Sinha, B.,Fawzi, W. and
Edmond, K. M. (2017). ‘Delayed breastfeeding initiation and
infant survival: A systematic review and met analysis’, PLoS
ONE12(7).
• ibid; Ballard, O. and Morrow, A. L. (2013). ‘Human milk
composition nutrients and bioactive factors’, Pediatric Clinics
of North America, 60(1), pp. 49–74.
• De Cosmi, V., Scaglioni, S. and Agostoni, C. (2017). ‘Early taste
experiences and later food choices’, Nutrients, 9(2), p. 107.
• UNICEF, Children, food and nutrition, 2019.
• WHO (2017). Global Nutrition Policy Review 2016-2017. WHO,
Geneva, Switzerland, p11.
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