Notes on nutritional needs of children & infants

Nutritional needs
of children
& infants
By
Babitha K Devu,
Assistant Professor

Introduction
•Good nutrition is essential for maintaining life. The
objectives of good nutrition for children are to promote
optimal growth and development, to prevent nutritional
deficiency states, to help prevent acute and chronic
illnesses, and to provide reserves for stress.
•Nutritional needs can be met in the human being
through nutrients provided by the way of GI tract or
through parenteral feedings.

Introduction
• Human milk provides all the nutritional
substances infants need over a period of
time, but no other single food meets all
the essential requirements for human
beings.
• A varied diet must be eaten after 5-6
months of age, and it must include water,
calories, proteins, carbohydrates, fats,
vitamins, and minerals.

Breastfeeding
• Breastfeeding is the best natural feeding & breast milk is
the best milk.
• UNICEF stated that every year over one million infants
die & millions of others are impaired because they are
not adequately breastfed. Every day between 3000 to
4000 infants die from diarrhea & ARI because the ability
to feed them adequately has been taken away from
their mothers.

Breastfeeding
• Breastfeeding is the feeding of an infant or young child
with breast milk directly from female human breast via
lactation rather then using infant formula from a baby
bottle or container.
• Babies have sucking reflex that enables them to suck
and swallow milk.
• Experts recommend that children be breastfed within
one hour of birth, exclusively breastfed for the first 6
months, and then extended until two years of age.

Anatomy of Breast
The lactiferous sinus,
the duct widens before
nipple, to store milk at
areola

Breastfeeding
• The physiological basis of lactation is divided into four
phases :
1. Preparation of breasts (mammogenesis).
2. Synthesis and secretion from the breast alveoli (lacto
genesis).
3. Ejection of milk (galactokinesis).
4. Maintenance of lactation (galactopoiesis).

Breastfeeding
• Milk is produced as a
result of the interaction
between hormones &
reflexes. During pregnancy
& lactation the glandular
tissue is stimulated to
produce milk due to
various hormonal
influences.

Breastfeeding
• Two reflexes that regulate lactogenesis and
galactokinesis are:-
Prolactin reflex
Oxytocin reflex

Breastfeeding
• MILK PRODUCTION:
A healthy mother may produce about 500-800 ml of milk
a day to feed her infant with about 500 kcal /day
• REFLEXES IN THE BABY:
1. The rooting reflex
2. The suckling reflex
3. The swallowing reflex

Breastfeeding
• It varies at different stages in the postnatal period to fulfill
the needs of the baby.
– Colostrum: It is secreted during 1st 3 – 4 days after delivery.
It is
Thick, yellow colored
Small in quantity
Contains more antibodies, WBC, proteins &
fat soluble vitamins
Alkaline in nature

Breastfeeding
• Transitional Milk: It follows the colostrum & secrets
during next two weeks of postnatal period. This milk is
Increases in quantity & changes appearance
Immunoglobulin and protein content decreases
Fat and sugar content increases

Breastfeeding
• Fore Milk: It is secreted at the starting of the regular
breastfeeding. It is
More watery to satisfy the baby’s thirst
Contains more proteins, sugar (lactose), vitamins
and minerals
Little fat and calories
Color is white/clear

Breastfeeding
• Hindmilk: It is received at the end of the breastfeeding
session. It contains
More fat & calories
Color is white/cream
Quantity is less comparing to foremilk

Breastfeeding
• Mature Milk: It follows the transitional milk & secreted
usually from 10 – 12 days after delivery. This is a
mixture of both fore and hind milk. This milk is
Watery looking and more thinner
Contains all nutrients for optimal growth of the baby
Color is pear-like and can look creamier as
the breast empties.

Breastfeeding
• Pre-term Milk: The milk secreted by the mother who
has delivered a preterm baby is different from milk of a
mother who delivered full term baby. This contains
More proteins, minerals like sodium, iron and
calcium
Immunoglobulin's, which is appropriate for the
requirements of the preterm neonates.

Breastfeeding
• INITIATION:
Breast feeding should be started within half an
hour of birth as soon as possible after normal delivery
where as in case of caesarian section delivery, within 4
hours.
Rooming in and bedding should be done with
mother and baby to prevent separation and promote
breast feeding.

Breastfeeding
• Position: (For mother)
–Mother should be comfortable & relaxed both
physically & mentally. Use pillows to support your
back and arms.
–Maintain hygiene
–Can be in sitting or side lying position. Even mother
can be lying flat with infant on top of the mother,
especially after LSCS

Breastfeeding
• Position: (For baby)
–Baby’s head & body straight. (Slight head elevation can
be given)
–Baby’s body turned towards the mother, nose opposite
the nipple.
–Baby’s body touching mother’s abdomen.
–Baby’s whole body well supported not just neck or
shoulders.
–Mother should support her breast with her finger flat
against her chest wall under her breast.

• It is otherwise called tummy to
tummy.
• Popular breastfeeding position.
• Baby should be on his or her side,
resting on his or her shoulder and
hip with his or her nose in-line with
your nipple, and with you cradling or
holding baby across your lap.
• Mothers back should be straight.
• “Tummy to Mummy, nose to nips,
flex the hips to open the lips.”
Breastfeeding

• Support baby’s head with your hand
rather than elbow. In this position, baby
is supported on a pillow placed on lap to
help raise baby to nipple.
• Gently place mothers hand behind
baby’s ears and neck with your thumb
and index finger behind each ear. Baby’s
neck will rest between mother’s palm
and fingers for extra support. The free
hand can then be used to support
breast and help position the nipple
properly in baby’s mouth.
Breastfeeding

• Also known as Laidback breastfeeding.
• Not be completely flat
• lean back and feel well supported while
the front of baby’s body presses against
the mother. Because when leaning back,
baby can rest against mother in any way
that is mutually comfortable. Held skin
to skin in this position, most babies are
capable of finding your nipple and self
attaching
Breastfeeding

• Ideal for any mother who delivered via a
Cesarean birth as it keeps the baby away
from your stitches and healing incision.
• When using this position, support baby’s
head in hand with their back alongside
your arm. Pillows (breastfeeding pillows
or any regular pillow) can help bring baby
to the correct level, so her mouth aligns
with mother nipple.
Breastfeeding

• Many new mothers find nursing in a side-
lying position to be very comfortable,
especially in the evening or at night.
• In this breastfeeding position, both
mother and baby lie facing each other on
their sides. Your arm placed behind the
baby’s back will keep them close to you,
and pillows positioned at your back,
under your head or between your knees
you help you to get comfortable.
• This is a very restful nursing position,
perfect for tired mothers.
Breastfeeding
#5

Breastfeeding
• Latching/Good
Attachment:Latching.mp4
• Latch refers to how the baby fastens
onto the breast while breastfeeding.
A good latch promotes high milk flow
and minimizes nipple discomfort for
the mother, whereas
poor latch results in poor milk
transfer to the baby and can quickly
lead to sore and cracked nipples.

Breastfeeding
• Latching/Good Attachment:

Breastfeeding
• Burping:
• Burping is usually not necessary if
the baby is having good
attachment. Burping is needed to
make the air vent out which was
swallowed by the baby during
breastfeeding so that to prevent
spit out.

Breastfeeding
• Burping:
• How to do burping?
Over your shoulder Sitting on your lap Lying across your lap

Breastfeeding
• Advantages of Breastfeeding
• Breast milk is often referred to as “Liquid Gold”. It has
all the essential nutrients for a baby and is easily
digestible for them.
Provides optimal nutrition for the baby – Human milk
contains the right nutrients in right amount for the
baby. The nutrient composition even changes to
meet the changing needs of the baby over the course
of feeding , the day and the infant’s lifespan.

Breastfeeding
High water & electrolyte level – Water content is 88%
in breast milk with low osmolality which lowers the
solute load to kidney.
Breast milk protein is easily digestible – It also
contains aminoacids like taurine & cystine which is
necessary for neurotransmission & neuromodulation.
Helps in brain development – Fat in human milk is
rich in polyunsaturated FA aids in myelination.

Breastfeeding
Promotes healthy weight gain
Reduces the risk for allergies
Lower the risk of getting obesity, heart diseases,
tooth decay, asthma & urinary infections.

Breastfeeding
Strong immune system – Human milk contains maternal
antibodies that are passed from mother to baby. They
helps to weaken or destroy harmful bacteria, helps to
generate antibodies & promote growth of friendly
bacteria in the infant gut. Antibodies, which are also
called immunoglobulins, take five basic forms, denoted as
IgG, IgA, IgM, IgD and IgE. All have been found in human
milk, but by far the most abundant type is IgA

Breastfeeding
Reduces the risk of various infection – The common
are: Middle ear infection, eczema, RTI, Cold & Cough,
Gut infection, SIDS, allergies, IBD and many more.
–It is said that breast fed baby is 14.2 times less likely
to die of diarrhea & 3.6 times less likely to die of RTI.
Also reduces other diseases like diabetes, leukemia
and other chronic diseases in later childhood.

Breastfeeding
Mental growth – Breast fed babies are better bonded
to their mother and have higher IQ & mental
development is also increased.
It is cheap/economical
No need of preparation
Reduces nutritional deficiency disorders

Breastfeeding
• Long term advantages of Breastfeeding for mother

Breastfeeding
• Problems of Breastfeeding
–Inverted nipple
–Sore nipple
–Breast engorgement
–Breast abscess
–Not enough milk
–Galactosemia & phenylketonuria

Breastfeeding
• Problems of Breastfeeding
–Maternal conditions like REAL – Radiotherapy, Ergot
therapy, Anti-metabolites therapy & Lithium therapy
–Mother with communicable diseases like AIDS,
Hepatitis and many more
–Baby with structure defects like cleft lips/palate
–High risk neonate like ELBW, Preterm, allergic to
lactose

Expressed
Breastfeeding
• Expressing milk means squeezing milk
out of your breast so you can store it and
feed it to your baby later.
•Expressed breastfeeding is for mother
–Have to be away from baby
–Breasts feel uncomfortably full
(engorged)
–Baby is not able to latch or suck well
–want to boost your milk supply

Expressed
Breastfeeding
• How to express the milk?
Mothers can express milk by hand or with a breast
pump.

Expressed
Breastfeeding
• How to
express
the milk?

Expressed
Breastfeeding
• How to store expressed milk?
• You can store breast milk in a sterilized container or in special breast
milk storage bags:
– in the fridge for up to 8 days at 4C or lower (you can buy fridge
thermometers online) – if you are not sure of the temperature of
your fridge, or it is higher than 4C, use it within 3 days
– for 2 weeks in the ice compartment of a fridge
– for up to 6 months in a freezer, if it is -18C or lower
– Breast milk that's been cooled in the fridge can be carried in a cool
bag with ice packs for up to 24 hours.
– Storing breast milk in small quantities will help to avoid waste. If
you're freezing it, make sure you label and date it first.

Expressed
Breastfeeding
• Warming breast milk
– You can feed expressed milk straight from the fridge
if your baby is happy to drink it cold. Or you can
warm the milk to body temperature by putting the
bottle in a jug of warm water or holding it under
running warm water.
– Do not use a microwave to heat up or defrost breast
milk. This can cause hot spots, which can burn your
baby's mouth.

Complementary Feeding
• Breastfeeding alone is not adequate & sufficient to
maintain optimum growth & development of an infant
from 4 to 6 months onwards. Therefore it is necessary
to introduce more concentrated energy yield food by
this age. Infant also required iron containing food
supplements after this age to prevent iron deficiency
anemia.
• Weaning means to free from a habit.

• Definition
• The systematic process of
introduction of suitable food
at right time in addition to
mother’s milk in order to
provide needed nutrients to
the baby.
(UNICEF, 1984)

• Definition
• It is the process of gradual
and progressive transfer of
the baby from breastfeeding
to the usual family diet.
Weaning foods are given in
addition of breast feed
when the amount of
breastfeeding is inadequate.

• Pre-requisites/Attributes/Qualities
• Liquid at starting then semi-solid and solid foods to be
introduced gradually.
• Clean, fresh & hygienic.
• Easy to prepare at home with the available food stuff
& not too costly.
• Easily digestible, acceptable & palatable for the infant.

• Pre-requisites/Attributes/Qualities
• High in energy density & low in bulk
viscosity & contains all the necessary
nutrients.
• Based on cultural practices and
traditional beliefs
• Well balanced, nourishing and
suitable for the infant.

• Principles of introduction of weaning food
Additional feeds should provide extra requirements as per
needs of the baby, that must be obtained from good
quality food item & should be home made.
Small feeding at the beginning & gradually the amount of
food to be increased.
New food to be placed over the tongue of the baby to get
the taste of the food & to feel the consistency. The baby
may spit the food out but with patience the feed to be
given again to get accustomed with it.

• Principles of introduction of weaning food
Weaning food can be given at day time.
New foods should be given when the infant is hungry but
never force the child.
Observe the problems related weaning process.
Breastfeeding should be continued up to 2 years/beyond.
Delayed weaning result in malnutrition & growth failure.

• Complementary feeding at different age
(4 to 6 months)
Initiate with fruit juices (Clear).
Milk & soups can be given
REMEMBER TO…
*Never leave baby alone when he is eating!
Make sure he doesn’t choke on his food.
*Foods should be smooth, soft and fine in
texture.
*Offer foods that have been sieved, mashed,
puréed or scraped.
* Cool food before serving.

(7 to 9 months)
After 8 months, you may introduce soft
lumpy foods that require some form of
chewing.
Avoid foods that can cause choking –
whole nuts, raisins and corn kernel.
Choose scraped or mashed foods.
Egg yolk can be given from 6 to 7 months
onwards

(10 to 12 months)
Serve roughly chopped or minced dishes as she
shouldn’t be eating blended food anymore;
Have your child eat what the family eats as long as
the dishes aren’t seasoned or have excessive sugar
and salt.
No need to mash but should be cooked well & soft.

Artificial /Formula Feeding
• Artificial feeding means to feed the child
other than breast milk. It involves the use
of breast milk substitutes in the form of
liquid milk i.e. fresh cow milk or buffalo
milk or commercially available dried
whole milk.
• Although breast milk is the ideal food for
babies during the first 6 months of life,
sometimes breastfeeding is not possible,
in these cases, there are modified
formulas adapted to the needs of infants

• Indications
Death/absence of mother
Prolonged maternal illness like AIDS, TB
etc.
Complete failure of breast milk
production.
Allergic/contraindicated for
breastfeeding.
EBM/surrogate mother to breast feed is
not available.
Adopted babies

• Factors contributing to increase AF
Lack of interest in BF
Wrong beliefs & ignorance related to BF
Increasing no. of working mothers
Aping western countries
Changing lifestyle
Availability of alternatives
Urge to be sophisticated
Publicity & appealing advertisements

• Principles
Decision of giving artificial feeding must be taken after failure of all
efforts to BF.
• The aims of AF must be
• Provide adequate nutrition
• Free from contamination
• Be economical
• According to the needs of the child
AF should be given by spoon & bowl/cup or glass. In sick & preterm
by dropper/paladai & in hospitalized with oro-gastric/NG tube.

• Principles
Bottle feed must be avoided & mother must be made
aware about hazards of it.
• Strict cleanliness in the preparation & feeding.
• Left over milk should not be used again.
Feeding must be given with the calculated amount of fluid
& calories according to the bay’s expected weight.
Correct technique of feeding to be followed.
The milk must be warm, not too hot or cold.

• Principles
Time taken to feed depends on the baby.
• Cow milk is considered as cheaper alternative. But
diluted cow milk is recommended during 1st 2 months in
order to reduce the solute load on neonatal kidneys.
• Sugar can be added to provide extra calories.
If dried milk is used, it should be prepared as per the
direction given by the manufacturer.
• During illness calorie need is increased.
• Hence need to adjust accordingly

• Principles
Burping may be needed to allow the air to vent out.
• Supplementation of vitamins & minerals may be needed
to prevent deficiency conditions.
No.of feeds varies with the need & age of the child.

• Feed requirements

Complications
Contamina
tion
Deficiency
Costly
Long term
sequelae

• Feeding Problems
Regurgitation
Vomiting
Dehydration
Sucking & swallowing difficulties
Fever
Excessive crying
Abdominal colic
Underfeeding & overfeeding
Change in bowel habits/paterns

Notes on nutritional needs of children & infants

Notes on nutritional needs of children & infants

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