©2000 University of Pennsylvania School of Medicine Objectives  To recognize the changing nutritional needs of developing children.  To understand that nutritional recommendations for children vary by age, stage of development.  To recognize that nutritional and dietary behaviors learned in children can have a significant impact on adult health concerns (obesity, cardiovascular disease, and osteoporosis).

©2000 University of Pennsylvania School of Medicine Why is Nutrition Important?  Energy of daily living  Maintenance of all body functions  Vital to growth and development  Therapeutic benefits  Healing  Prevention

©2000 University of Pennsylvania School of Medicine Growth in Infants  Rapid body growth and brain development during the first year:  Weight increases 200%  Body length increases 55%  Head circumference increases 40%  Brain weight doubles

©2000 University of Pennsylvania School of Medicine Major Determinants of Caloric Needs  Basal metabolic rate (BMR)  Activity level  Growth (2x BMR during first year)  Stress (infection, surgery, illness)  Misc. (thermic effect of food)

©2000 University of Pennsylvania School of Medicine Feeding the Newborn  What are the options?  Breast feeding  The American Academy of Pediatrics recommends exclusive breast feeding for 6 months.  Formula feeding

©2000 University of Pennsylvania School of Medicine Breast Feeding Questions  Why should I breast feed my baby? I thought formula was the identical alternative.  How often and for how long will my baby nurse?  How do I know if the baby is getting enough?  How many months can I breast feed the baby and when can I add formula?

©2000 University of Pennsylvania School of Medicine Breast Feeding Advantages to Infants  Immunologic benefits (>100 components)  Decreased incidence of ear infections, UTI, gastroenteritis, respiratory illnesses, and bacteremia.  Convenient and ready to eat.  Reduced chance of overfeeding?  Fosters mother-infant bonding.

©2000 University of Pennsylvania School of Medicine Breast Feeding Advantages to Mothers  May delay return of ovulation.  Loss of pregnancy-associated adipose tissue and weight gain.  Suppresses post-partum bleeding.  Decreased breast cancer rate.

©2000 University of Pennsylvania School of Medicine Assessment of Breast Feeding  Weight pattern - consistent weight gain.  Voiding - # wet diapers/day, soaked?  Stooling - generally more stools than formula.  Feed-on-demand ~ every 2-3 hours.  Duration of feedings - generally min/side.  Need for high fat hind milk.  Activity and vigor of infant.

©2000 University of Pennsylvania School of Medicine What should I do? - cont.  Discontinue the iron formula, it may be constipating.  Give 1 tsp of mineral oil per day until he goes.  Give a suppository each day until he goes.  Add cereal to the bottle to help his bowels and to sleep.  Dilute the formula to give more water.  Give 1 oz apple juice per day until he goes.  Do nothing, breast fed infants may not have a bowel movement for up to 7 days.

©2000 University of Pennsylvania School of Medicine Infant Formula  3 Forms:  Ready to feed - most expensive, does not require water.  Concentrate - requires mixing with water in equal parts.  Powder - requires mixing with water.

©2000 University of Pennsylvania School of Medicine Special Formulas  Soy: used for vegetarians, lactase deficiency, galactosemia.  Lactose free: cow’s milk-based formula.  Protein hydrolysate: infants who can not digest or are allergic to intact protein.  Free amino acids.  Pre-term infant: unique for premies, predominant whey protein, cow’s milk based, higher protein and calcium, 20-50% MCT.  Pre-term follow up

©2000 University of Pennsylvania School of Medicine Assessing Readiness to Feed  At what age it is best to introduce solid foods? How do I know if he is ready to eat?  What food should I give the baby first?  Should I put cereal in the bottle? It seems to help the baby sleep at night.  My baby likes to go to sleep in the crib with a bottle. Is that OK?

©2000 University of Pennsylvania School of Medicine Feeding Skills Development  4-6 mos - experience new tastes.  Give rice cereal with iron.  6-7 mos - sits with minimal support.  Add fruits and vegetables.  8-9 mos - improved pincer grasp.  Add protein foods and finger foods.  mos - pulls to stand, reaches for food.  Add soft table food, allow to self-feed.

©2000 University of Pennsylvania School of Medicine Feeding Skills Development  mos - increased independence.  Stop bottle, practice eating from a spoon.  18 mos -2 yrs - growth slows, less interest in eating.  Encourage self-feeding with utensils.  2-3 yrs - intake varies, exerts control.

©2000 University of Pennsylvania School of Medicine Cow’s Milk  My son is 9 mos and formula is so expensive. Can I start giving him whole milk now?  My daughter is 14 mos and we drink skim milk. Can I give her skim milk so I only have to buy one type of milk for the family?