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Breast feeding problems: allow BF with: DM , multiple sclerosis, systemic lupus, HPN,
Hep. C without con-infection, chrohn’s disease, ulcerative colitis, hyperlipoproteinemia,
cystic fibrosis, kidney transplant, benign breast cyst, galactosemia, phenylketonuria.
BF Contraindicated to: breast cancer detected during pregnancy , HIV , Active
tuberculosis.
Nutrition in Pregnancy
Nutrient allowances
Factors that determine individual needs for nutrients includes: age, gender, body size ,
rate of growth and physical activity
Energy: from metabolism of fat, carbohydrates and protein
: energy requirement is very high per unit of body size in the first few months of
life but declines as rate of growth decreases
: Higher basal metabolic demands is due to larger loss of heat because of greater
body surface and larger proportion of metabolic tissue
: best evaluation of the sufficiency of the infant or child energy intake is adequacy
of their growth rates in length and weight
Protein: for synthesis of new tissues and nitrogen for the maturation on existing tissues
: 3.5 gm/day for first 4 months and 3.1 gm/day for the next 8 months
: body protein increase from 11% to 14.6% in the first year
: human milk or formula provides the major protein source during infancy
: inadequate protein intake due to: poverty, excessive dilution of formula,
continuation of regimen designed to treat diarrhea after an enteric illness, multiple food
allergies or extreme vegetarian food patterns
: peanut butter and whole wheat bread, sandwiches beans and rice, eggs and
powdered milk are in inexpensive high quality protein sources.
Fat/lipids: supplies 40-50% of energy during infancy
: provide by human milk, cow’s milk and formula (50%)
: can lead to obesity
: linoliec is essential for growth and dermal health and should provide 4-5
percent of total Kcal
Carbohydrates should supply to 60% of the energy intake during the infancy
: 37% in human milk and 40- 50% of energy from commercial formulas is derived from
lactose and other carbohydrates
Water: transport nutrients and helps to regulate body temperature
• water requirement of an infants is deternmined by the amount of lost from the skin,
lungs, urine and feces.
• 1.5 ml/kcal/day
• Infants are vulnerable to water imbalance due to insensible water loss and renal
concentrating ability is less
• in hot environment infants needs more water
• monitor for diarrhea and vomiting
• water intoxication
Vitamins: milk from lactating mothers supply all the vitamin than that full term baby
needs Vit. D
• Humans milk contains only 40-50 lu/ l so breastfed infants need a Vit. D supplements or
be exposed to sunlight for at least 30 minutes per week for those wearing only diaper or 2
hours/ week for those fully clothe without hat
• evaporized and homogeniezed cow’s milk contains little Vit. C
• fresh goat’s milk is deficient in Vit. C, D and folate
• vegetarian mothers may have vit. B12 deficient milk
• hemorrhagic disease of the newborn is more common among breastfeed infants because
human milk contains only 15 ug/L of vit. K
Minerals:
Calcium: during the first 2-3 days of life, the level of plasma calcium and phosphorus fall
significantly
• Calcium level stabilize at 10th day
• serum calcium concentrations I infants on breastmilk are grater than formula fed infant
• formula fed infant retains 25-30% of calcium in cow’s milk. Breastfed infants ingests
less calcium but retain approximately 2/3 of intake (240 from 750 ml of milk)
• Iron; signs of anemia appears after 12 months age
• recommended 6 mg/day during the first 6 months to 10 mg/day until 3 years of age
• breastfed infants are at risk fro negative iron balance starting at 4-6 months and may
deplete their reserves by 6-9 months
• Formula fed and breastfed infants should receive supplement such as iron fortified
cereals by 4-6 months of age
Zinc= normal infants do not have zinc reserves
• human milk and infant formulas provide adequate zinc, o.3 –o.5 mg/kg body weight
during the first year of life.
Fluoride: 4- 1000 mg/day can cause fluorosis
: breastmilk has a very low fluoride content
• powdered formula have increase concentrations than concentrated formula
• powdered formula have higher concentrations than concentrated formula
• commercially prepared infants cereals, wet pack cereals and fruit juice produced from
fluoridated water are good sources of fluoride
• after tooth eruption fluoridated water can be offered
Nutritional assessment
Anthropometry; assess physical size and growth by wt., length and head circumference
• wt. should be measured to nearest 10g for infants
• length is measured in the recumbent position on a measuring board that has a
fixed head board.
• Head circumference confirms that the growth is proceeding normally
Dietary assessment: provide information in the adequacy of an infants diet and can be
used to develop plans for resolving concerns or problem about food and nutrient patterns
- interview is the most important aspect of any of the tools used
Clinical examination:
Formula milk:
Soy based formulas are available for infants that do not tolerate cow’s milk indicating of
soy based formulas:
1. children of vegetarian families
2. Children with galactosemia and primary lactose deficiency
3. allergic to cow’s milk
LBW
Definition:
term infant: born between the 37 and 42 week of gestation
preterm or premature infants: born before the 37th week of gestation
post term infant: born after 42nd week of gestation
LBW: infant who weigh less than 2500g
Very LBW: weighs less than 1500 g
Extremely low birth weight infant: birthweight less than 1000g
SGA: birth weight less than 10th percentile
AGA: birth weight between 10th -90th percentile
LGA: birth weight above 90th percentile.