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By: Sharad Mohip
Rajiv Kissoon
Vashisht Ramlogan
Wh  
| trition is the intake of food, considered in
relation to the body·s dietary needs. Good
n trition ² an adeq ate, well balanced diet
combined with reg lar physical activity ² is a
cornerstone of good health. Poor n trition
can lead to red ced imm nity, increased
s sceptibility to disease, impaired physical
and mental development, and red ced
prod ctivity.

W.H.O
Why   

| trition is necessary to attain optimal growth


and development and to prevent the expression
of n tritionally related diseases at a later age.
| 
Œeterminants:
‡ Age
Age-- needs vary with age
‡ Weight

‡ Height

‡ Body composition

‡ Physical activity-
activity- metabolic req irements
‡ State of health-
health- convalescence
ÿ | trition and n rt ring d ring the first three
years are both cr cial for lifelong health and
well--being. In infancy, no gift is more precio s
well
than breastfeeding.
| 
     

         



   

V     


á
h
y
|RGY-- req irements
|RGY
depend on many
factors.
ÿ Basal Metabolic Rate

ÿ Basal nergy xpendit re

ÿ Physical Activity Level

ÿ Thermic ffect of Food

ÿ Thermoreg lation

ÿ nergy deposition
á
h
y
ÿ Reference val es for energy and protein req irements

Age nergy [kcal/kg/day] Protein [g/kg/day]

0-6 mths 115 1.52


6-12 mths 95 1.5
1-3 yrs 95 0.95
4-6 yrs 90 1.5

Ill strated texbook of paediatrics. Lissa er, Clayden.


   



yhh
ÿ 
 newborns, partic larly
w   
 

preterm babies, have poor stores of fat and
protein. The smaller the child the less his calorie
reserve.
ÿ  beca se of the
G    
   
rapid growth that occ rs d ring infancy, there is
a high n tritional demand.
ÿ a       ² at birth the brain
acco nts for abo t two thirds of basal metabolic
rate and at 1 year for abo t 50%.
2   á |  |


Protein
ÿ Protein req irement changes thro gho t the growth
period.

ÿ Intake sho ld be reflected by proper imm nological,


ne rological and developmental o tcomes.

ÿ Œietary intake m st allow tiss e synthesis and growth


rates consistent with good health.


Protein

ÿ The importance of q ality and


q antity of protein provided to
the growing child is critical.

ÿ Protein is req ired in the diet


for both as a so rce of essential
amino acids and as a so rce of
nitrogen for the synthesis of
non essential amino acids.


ÿ Reference val es for energy and protein req irements

Age nergy [kcal/kg/day] Protein [g/kg/day]

0-6 mths 115 1.52


6-12 mths 95 1.5
1-3 yrs 95 0.95
4-6 yrs 90 1.5
hyd

ÿ Carbohydrate intake is highly dependant on
adeq ate energy and protein
ÿ Approximately 45% of energy tho gh sho ld be
provided by carbohydrates
W

ÿ ssential for existence. Water req irements for low birth
weight infants are estimated at
85 ² 170 mL/kg/day
ÿ Infants have a relatively
higher water content
than ad lts.

Infant body weight Ad lt body weight

75 ² 80% 55 ² 60%
W


Age Average Body Total Water in


Weight [Kg] 24hrs [mL]
3 days 3.0 250-
250-300
10 days 3.2 400-
400-500
3 mths 5.5 750-
750-850
6 mths 7.3 950-
950-1100
9 mths 8.6 1100-
1100-1250
1 yr 9.5 1250-
1250-1300
2 yr 11.8 1350-
1350-1500
4 yr 16.2 1600-
1600-1800
m
ÿ Serve as vehicles for FSV

ÿ Concentrated so rce of energy

ÿ Physical protection for vessels, nerves, organs

ÿ Ins lation against temp changes

ÿ Cell membrane formation


Age Total Fat Linoleic Acid å  
g/day g/day 

0-6 mths 31 4.1 0.5

7-12 mths 30 4.6 0.5

1-3 yrs 7 0.7


|á
m  
W
á 

ÿ Vit A ÿ Vit C
ÿ Vit Œ ÿ Biotin
ÿ Vit  ÿ Cobalamin
ÿ Vit K ÿ Folacin
ÿ |iacin
ÿ Pantothenic Acid
ÿ Pyridoxine
ÿ Riboflavin
ÿ Thiamine
| á
ÿ Calci m
ÿ Magnesi m
ÿ Phosphoro s
ÿ Chromi m
ÿ Copper
ÿ Flo ride
ÿ Iodine
ÿ Iron
ÿ Manganese
 
ÿ 
-formation and maintenance of
— 
-
skin and m co s membranes
ÿ Œ  --|ight Blindness
Π 
ÿ 

-fatig e,Alopecia,Increased Intracranial


 

-
press re
ÿ  -carrots,sweet potatoes,breast milk
   -
 
ÿ — 

promotes intestinal calci m and
phosphate absorption
ÿ Œ  Rickets,
Π 
osteomalacia
ÿ 

hypercalcemia
 


ÿ  fish,eggs,
    fish,eggs,
  

  
 
ÿ 
 anti oxidant
— 

ÿ Œ  hemolytic anaemia of newborn
Π 
ÿ    
 
 
 
 
ÿ 
 activation of blood clotting
— 

factors(prothrombin,factors V11,1X an X)
ÿ Œ  prolonged blood clotting time
Π 
ÿ 

hemolytic anaemia
 


ÿ  green leafy vegetables,cereals,breast
   
milk
W
  

  d

y
‡ Thiamine( Vitamin B1) -Beri Beri
‡ Riboflavin(Vitamin B2)-glossitis,
cheilosis
‡ |iacin(Vitamin B3) -Pellagra:
diarrhoea, dematitis, dementia, and
death
‡ Vitamin B6 -Œermatitis, anemia
‡ Folate -Megaoblastic (macrocytic)
anemia,
‡ Vitamin B12 -Pernicio s Anemia:
‡ Vitamin C-C-Sc rvy
m   
                   
  
Trace lements
ÿ Zinc

ÿ Copper

ÿ Seleni m

ÿ Iodine
d

y

ÿ Common deficiency for infants 6-


6-24 months

ÿ Œeficiency risk for early cons mption of cows milk


& low birth weight infants or older infants drinking
large vol mes of milk or j ice (eat less food)

ÿ Recommended se of iron fortified cereals + iron


rich foods

ÿ 10 mg/day are recommended to prevent


deficiencies.
 d

y
ÿ Major so rce is milk
ÿ Absorption depends on so rce and intake
ÿ 60% absorption from h man milk
ÿ 20
20--30% absorption from other so rces
ÿ Absorption is enhanced by lactose, gl cose and
protein
ÿ Absorption is impaired by fiber and oxolate.
m   
ÿ It is defined as a significant interr ption in the
expected rate of growth d ring early childhood.
ÿ The most common definition is weight less than
the third to fifth percentile for age on more than
one occasion or weight meas rements that fall 2
major percentile lines sing the standard growth
charts of the |ational Center for Health
Statistics (|CHS).
m   
ÿ It is important to determine whether fail re to
thrive res lts from medical problems or factors
in the environment, s ch as ab se or neglect.
ÿ Many times the ca se cannot be determined.
  
There are m ltiple medical ca ses of fail re to thrive. These incl de:
ÿ Chromosome abnormalities s ch as Œown syndrome and T rner syndrome

ÿ Œefects in major organ systems

ÿ Problems with the endocrine system, s ch as thyroid hormone deficiency, growth


hormone deficiency, or other hormone deficiencies
ÿ Œamage to the brain or central nervo s system, which may ca se feeding diffic lties in
an infant
ÿ Heart or l ng problems, which can affect how oxygen and n trients move thro gh the
body
ÿ Anemia or other blood disorders

ÿ Gastrointestinal problems that res lt in malabsorption or a lack of digestive enzymes

ÿ Long
Long--term gastroenteritis and gastroesophageal refl x ( s ally temporary)
ÿ Cerebral palsy

ÿ Long
Long--term (chronic) infections
ÿ Metabolic disorders

ÿ Complications of pregnancy and low birth weight


  
^ther factors that may lead to fail re to thrive:
ÿ motional deprivation as a res lt of parental
withdrawal, rejection, or hostility
ÿ conomic problems that affect n trition, living
conditions, and parental attit des
ÿ xpos re to infections, parasites, or toxins

ÿ Poor eating habits, s ch as eating in front of the


television and not having formal meal times
||má |á
ÿ Infants or children who fail to thrive have a height, weight, and
head circ mference that do not match standard growth charts.
The person's weight falls lower than 3rd percentile (as o tlined in
standard growth charts) or 20% below the ideal weight for their
height. Growing may have slowed or stopped after a previo sly
established growth c rve.
ÿ The following are delayed or slow to develop:
1. Physical skills s ch as rolling over, sitting, standing and walking
2. Mental and social skills
3. Secondary sex al characteristics (delayed in adolescents)
||
ÿ Most children with fail re to thrive (FTT) can be treated as
o tpatients. However, serial visits are mandatory, with
doc mentation of weight gain and/or daily caloric intake.
ÿ Home visits can help determine the nderlying reason for the
nonorganic fail re to thrive and can help s pport the caregiver.
ÿ If o tpatient trials do not lead to doc mented weight gain, then
hospitalization is necessary for diagnostic and therape tic
reasons. Œiagnostic benefits of admission may incl de
observation of feeding, parental-
parental-child interaction, and dietary
habits.
ÿ Ac te needs, s ch as dehydration, infection, anemia,
anemia, or
electrolyte imbalance, can be addressed and managed with
intraveno s fl ids, systemic antibiotic therapy, and transf sion
||
ÿ Children born with congenital anomalies of their GI tract req ire
s rgical corrective proced res to provide for a contin o s patent
system to digest and absorb n trition. Unfort nately, the
s rgically corrected system is often problematic and can interfere
with adeq ate growth.
ÿ The long-
long-term goal for every child with fail re to thrive is to
provide adeq ate energy intake for growth. For a child with
organic fail re to thrive, aggressive dietary management is the
cornerstone of therapy.
ÿ If fail re to thrive is ca sed by parental inexperience or
psychological problems, recovery is possible with ed cation and
co nselling for the parents.
 | áá
ÿ Long-term prognosis in children with fail re to
Long-
thrive d e to environmental deprivation is not
enco raging. Many children remain small, and
may present with developmental and
ed cational deficiencies. ^nly one-
one-third will
ltimately become normal.
| 


| tritional assessment can be:

ÿ Œietary assessment
ÿ Clinical
ÿ Biochemical meas rements
ÿ Anthropometric meas rements

y


A record of all the food that a child eats
d ring several days can give a reasonably
acc rate assessment of the child·s habit al
food intake.



skin
hair
eyes
lips
tong e
g ms
pallor
glands
edema
2h


 


Red blood cells
Hg
MCV
White blood cells
gl cose
Alb min
Total protein
cholesterol
h

 



ÿ Length for age


ÿ Height for age
ÿ Weight--for age & for height
Weight
ÿ Mid-- pper arm circ mference
Mid
ÿ Head circ mference
ÿ Skinfold thickness

h

ÿ Length for age < 5th percentile indicates severe


deficit

ÿ Meas rements that range between the 5th & 10th


percentile sho ld be eval ated f rther

ÿ Length assesses growth fail re & chronic


ndern trition, esp in early childhood
W
h

ÿ Good index of ac te & chronic n tritional stat s

ÿ Weight for age < 10th percentile«.deficit


ÿ Weight for age > 90th percentile«..excessive

> 5% weight loss in 1 month is considered


abnormal in children
W
hh
h
ÿ More acc rately assesses body b ild &
disting ishes wasting (ac te maln trition) from
st nting (chronic maln trition)

ÿ Meas rements that fall within 50th percentile are


appropriate
ÿ The greater the deviation, the more over-
over- or
nderno rished the individ al
d 
  



ÿ Reflects skeletal protein reserves ² lean body


mass

d 



ÿ Infl enced by n tritional stat s ntil 36 months


old, b t deficiencies are manifest in weight &
height before being seen in brain growth
ÿ Meas rement < 5th percentile may indicate
chronic ndern trition d ring fetal life & early
childhood
ádh

ÿ Biceps
ÿ Triceps
ÿ S bscap lar
ÿ Assesses c rrent n tritional stat s & body
composition

ÿ Provides an index of body energy stores

ÿ Can be sed in conj nction with weight or


height to determine chronic nder n trition