TOTAL CALORIC REQUIREMENT

RDA (Age)
Wt
Kcal/kg
0-5 mos
3-6
115
6-11 mos
7-9
110
1-2 y
10-12
110
3-6 y
14-18
90-100
7-9 y
22-24
80-90
10-12 y
28-32
70-80
13-15 y
36-44
55-65
16-19 y
48-55
45-50

CHON (g/kg)
3.5
3
2.5
2
1.5
1.5
1.5
1.2

TCR= Wt (kg) x cal (kcal/kg)

Conversion factors to calories (kcal/g)
CHON 4, CHO 4, Fats 9
Determine TCR in grams, then convert to calories
TCR CHON= CHON (g/kg) x ABW (kg)
Subtract TCR CHON from TCT TOT then get fraction of
CHON & fats (60:40)
Order: ex 1100 kcal=
25 g
150g
45 g
TCR
CHON CHO
fats

RDA ADJUSTMENT (MALNOURISHED) CATCH UP

CALORIES
Adjusted RDA= RDA for age x wt at 50%-ile or
IBW for ht
actual
weight
Adjusted TCR= adjusted RDA x actual weight
Total Caloric intake= cal x amount of intake (oz)
Gastric capacity= age (mos) + 2
Gastric emptying time= 2-3 hours
Other caloric values
1 oz= 30 cc
1 tbsp= 15 cc
1 tsp= 5 cc
Cane/ table sugar 20 kcal/ 5 cc/ 120 kcal/oz
D5W 20 kcal/100 cc
D10W 40 kcal/100 cc
Karo 4 kcal/cc

BREASTMILK
Colostrum- 1st 2-4 days post partum
High in CHON (globulin), vit, salt, Ig
Low in fat and sugar
Foremilk
Clear, thin, bluish, low salt, high H20
Hindmilk
Thick, creamy, high fat (peaks at
daytime)
Contraindication to BREASTFEEDING
ABSOLUTE: galactosemia, tyrosinemia
RELATIVE: psychosis, Active PTB

HUMAN MILK vs COWS MILK

HUMAN
COW
Whey: casein
60:40
20:80
cystein
High
methionine
Low
Fatty Acid
PUFA and long
Saturated
chain
Linoleic Acid
HIh
Lipase
+
Digestion
Efficient
Stool
losses
Lactose
7% (sweetener)
4.8%
Bifidus
+
Minerals
less

kcal/oz
CHON g/100
CHO g/100
Fat g/100
Na meq/L
K meq/L
Cl meq/L
Ca++ mg/L
P+ mg/L
Fe mg/L

NATURAL MILK vs
Averag
Cows
e
marke
Huma
t ave
n
Matur
e
22
20
1.1
3.3
7
4.8
3.8
3.7
6.5
25
14
35
12
29
340
1.17
150
920
1.5
1.0

MILK SUBS
Cows
Prep
cvap
cows

Soy
based

40
3.8
5.4
4.0
28
39
32
1.3
1.1
1.0

20
1.7
7
3.7
13
18
15
710
510
12

20
2.0
7.3
3.2
8.6
15.0
13.0
594
396
7.9

RDA vitamins and minerals

FAT SOLUBLE
Vit A (retinol)
1800 IU/day
Vit D (cholecalciferol)
400 IU/day
Vit E (tocopherol)
4-5 IU/day
Vit K (phytoquinone)
1-2 mg/day
WATER SOLUBLE
Vit B1 (thiamine)
0.5 mg/day
Vit B2 (riboflavin)
0.5 mg/day
Vit B3 (niacin)
6 mg/day
Vit B4 (folacin)
50-100 ug
Vit B5 (biotin)
Vit B6 (pyridoxine)
1-2 mg/day
Vit B12
0.3 ug/day
(cyanocobalamine)
Vit C
1st yr: 30 mg
>1 yr: 35-75 mg
MINERALS
Calcium
<1 yr: 0.6 g
1-9 y: 0.5 g
>10 y: 0.7 g
Chloride
0.5 g/day
Magnesium
150-300 mg/day
Phosphorus
Same as calcium
Potassium
1-2 g/1.5 meq/kg (or
40 meqs/m2)
Sodium
1-2 g or 2 meq/kg or
50 mg/m2
Iodine
35-45 ug
Iron
Infant: 1 mg/kg
Kids: 10-18 mg

PROTEIN-CALORIE MALNUTRITION
MARASMUS
KWASHIORKOR
Etiology
Low CHON and
Low CHON
cal
Age
0-2 y
1-3 y
Edema
+
Wasting
Gross loss of SC
Sometimes
fat
hidden
Growth
++
+/Retardation
Mental
Apathetic,
Irritable,
changes
quiets
moaning
Appetite
Good
Poor
Skin Changes
Seldom
Diffuse
pigmentation
Paint
dermatosis
Hair changes
seldom
Flag sign
Facies
Old man
Moon facies
Others
Pot belly
hepatomegaly
Winged
scapulae
Albumin
normal
low
Anemia
uncommon
Megaloblastic
Iron deficiency

IBW
At birth
3-12 mos
1-6 y
7-12 y

BODY WEIGHT
Kg
LBS
3 kg
Age 9mos) +
Age (mos) + 10
9/2
Age (y) x 2+8
Age (y) 5+17
[Age (y) x 7Age (y) x 7 +5
5]/2
IBW given BW

Age
<6 mos
Age (mos) x 600 + BW (gm)
6-12 mos
Age (mos) x 500 + BW (gm)
EXPECTED WEIGHT (up to 1 mos old)
Term
EBW= [age (d)-10] x 20 + BW (g)
Pre-term
EBW= [age (d)-14] x 15 + BW (g)
Where:

10= # of days to recover over physiologic weight

loss
20= g/day gained
USUAL CHANGES in wt at Diff Ages
4-5 mos
2x BW
1y
3x BW
2y
4x BW
3y
5x BW
5y
6x BW
7y
7x BW
10 y
10x BW