1. Normal childhood nutrition Prof MaLian

2. Nutritional requirements A satisfactory dietary intake should meet the normal requirements of the following –Energy –Lipids: linolenic acid ; linoleic acid; arachidonic acid ;DHA carbohydrate: glucoprotein; glucolipide; proteoglycan –protein –Vitamin –Trace elements –water – meal fiber

3. Energy The major determinants of energy expenditure: –Basic metabolism –Thermic effect of food –Physical activity –Excreta –Growth

4. Energy expenditure

5. Total energy need <1y 100~120 (average 110) Kcal / kg / d 1~3y 100 Kcal / kg / d 15y 50~60 Kcal /kg / d

6. Distribution of Calories ProteinLipid Carbohydrate 15%35%50% (4 Kcal / g)(9 Kcal / g)(4 Kcal / g)

7. Infant feeding Incorrect, inadequate and/or overfeeding can all be harmful. Forms of Feeding: ⅰ. Breast Feeding ⅱ. Bottle/Artificial Feeding ⅲ. Addition of Solids

8. Breastfeeding This is the preferred method for most infants. In general, there is no doubt that breast is best. Breastfeeding in early infancy may be life-saving in developing countries, and is subject to fashion and custom in developed countries.

9. Advantages of breastfeeding Quality –Anti-infective properties secretory IgA, lysozyme, phagocytic cells, lactoferrin(irron-binding agent), promotes growth of non-pathogenic flora

10. Advantages of breastfeeding –Better nutritional qualities Easily digested protein Low renal solute load A favourable calcium to phosphate ratio Nutrition protein: fat: sugar others: growth regulation factor

11. Advantages of breastfeeding Emotional --- if successful, promotes maternal-infant bonding Reduction of the mortality rate Reduction in the risk of maternal breast cancer Economy, convenience, temperature propriety

12. Disadvantages of breastfeeding Volume of intake uncertain Transmission of drugs, e.g. laxatives, anticoagulants, antineoplastics Nutrient deficiencies: –Insufficient vitamin K to prevent haemorrhagic disease of the newborn –Vitamin D deficiency (rickerts) may occur if there is prolonged breast-feeding and delayed weaning Emotiona--- failure to establish breastfeeding may be a cause of emotional upset

13. Feeding Methods Start feeding within 30 min after delivery mother-baby in the same room, feed on demand, but not more frequent than 3 hourly Feed on both breasts, to stimulate the milk production

14. Feeding Methods put nipple and most of the mammary areola into baby’s mouth After feeding, hold baby vertical, pat baby on the back, to encourage burping, and prevent milk regurgitation

15. Bottle/Artificial Feeding If breast feeding is contraindicated, or inadequate breast milk Can be exclusive bottle feeding, or mixed breast ﹠ bottle

16. Bottle/Artificial Feeding Types of milk powder(formula) : cow milk-based, goat milk-based, soya-based, others Select milk products appropriate for age & weight, avoid hypoconcentration or hyperconcentration.

17. Bottle/Artificial Feeding Nutrition protein: fat: sugar: others: Quantity of milk/day:150ml/kg/day (30ml milk has 20- 22kcal,150ml has 110kcal), divided into 6-8 feeds/24 hours

18. Bottle/Artificial Feeding Milk: Make up milk from milk powder - read instructions on the can e.g. milk powder:water-1:4 by volume,1:8 by weight 8% sugar milk:100kcal/100ml; Energy:100-120kcal/kg; Water :150ml/kg.

19. Bottle/Artificial Feeding Sterilize bottle, nipple etc properly Feeding frequency and interval are like breast feeding. During feeding, tilt milk bottle upwards to fill the nipple with milk to avoid sucking air. Drop the milk on your hand before feeding to test the temperature.

20. Weaning Weaning, the introduction of solid food is usually initiated between the age of 3 and 6 months. At this stage the infant can coordinate swallowing and has reasonable head control. After 6 months, breastfeeding alone becomes nutritional inadequate and continued breastfeeding without introduction of solids will lead to energy, vitamin andiron deficiency.

21. Addition of solids “solids” are food other than milk -starts from 4-6 months Rule: -from less to more -from thin to thick -from fine to rough -gradually from simple/one type, to varied/many types

22. Introduction of solids agesfeeding 3—4 monthsCereals. E.g baby rice 4—5 monthsPureed fruit and vegetables, meat 6—7 monthsAble to chew,e.g. rusks introduce lumpy foods and variety of tastes and textures 8—9 monthsBread and butter, fruid 12 monthsReal food in small bits

23. procedure 1-3m fruit juice greens water VitAD 4-6m rice brei, gruel, egg yolk, peloid fish, bean curd, animal blood, peloid vegatable, fruit 7-9m mash noodles, steamed bread, biscuit, powder meat, peloid liver 10-12m thick gruel, soft rice, steamed bread, bread, smash vegatable, smash meat, oil, bean goods

24. Thank you