Pediatrics

                                                                                                            Lec: -1-

28-Sep-06

Pediatric Nutrition and Nutritional Disorders

Proper nutrition is central in promoting normal growth and development of children .

The basic goals are achievement of satisfactory growth and avoidance of deficiency states .

Nutritional disorders are not confined to children living in areas of famine and starvation , they are common also in developed and developing countries .

** Nutritional Requirements :

Water:-

Water content of infant is relatively higher than adult ( 75-80% in infant , 55-60% of body wt in adult ) . Water provided mainly from dietary source and some obtained from oxidation of foods. The needs for water are related to caloric consumption , to insensible loss and to specific gravity of urine . The daily consumption of fluid by the healthy infant is equivalent to 10-15% of body wt compared to 2-4 % in the adult .

Energy:-

Energy needs of children at different ages and under various conditions are differ greatly . The basal requirement in infant is about 55 kcal /kg/24 hr , it decrease to 23-30 kcal/kg/24 hr .

Proteins:-     

Protein constitutes about 20% 0f adult body wt . Protein requirement are differ from age to age and from condition to other .

Amino acids are essential nutrients in forming cell protoplasm , there are 9 essential A.A. which are essential for the growth . Arginine , cystine , taurine are essential for low birth wt infants .

Carbohydrates:-

They supply most of the body energy needs . They are stored chiefly as glycogen in the liver and muscles . Carbohydrates probably constitutes no more than 1% of body wt , because the size of the infants liver is 10 % that of the adult and the muscle mass is 2% that of adult .

    some glucose may be oxidized directly , such as in the brain and heart .

    most of absorbed sugar is converted to glycogen in the liver and in other tissues .

Fats:-

Fats or their metabolic products form an integral part of cellular membranes and are efficient stores of energy .

They serves as vehicles for fat-soluble vitamins ( A,D,E and K ) .

About 98% of natural fats are triglycerides .

Minerals:-

Include cations ( calcium , magnesium , potassium and sodium ) and anions ( phosphorous , sulfur and chloride ) .

Vitamins :-

Include water soluble vitamins ( B1,B2,B6,B12 ,C and biotin ) , and fat soluble vitamins ( A,D,E and K ) .

The feeding of infant and children:-

ِِAs soon as after birth an infant can safely tolerate oral nutrition , as judged by normal activity , alertness , suck and cry . Feeding should be initiated to maintain normal metabolism and growth during the transition from fetal to extra-uterine life; to promote maternal-infant bonding and to decrease the risk of metabolic problems (hypoglycemia, hyperkalaemia, hyperbilirubinemia, and azotemia)

Most infant may start breast feeding shortly after birth and others with in 4-6 hr.

Successful infant feeding requires cooperation between the mother and her baby.

Term infants will rapidly increase their intake from 30ml to 80-90 ml every 3-4hr at 4-5 days of life.

It is important to appreciate that infant cry for reasons other than hunger and they need not to be fed every time they cry. Some infants are placid, some are unusually active and some are irritable.

In the first 4-6 month of life, human milk or various infant formulas can provide complete nutrition to the growing infant. However, breast milk is the recommended source of nutrition for almost all children.

Every effort should be made to encourage and promote breast feeding.

Breast Feeding

Breast feeding have practical and psychological advantages that should be considered when the mother selects the method for feeding.

Advantages of breast feeding

1)      Emotionally better for both mother and infant, encourage maternal-infant bonding.

2)      Easier for infant to take milk from the breast than take it from bottle.

3)      Breast milk is the natural food for full term infant during first month of life, it is readily available, need no preparation , at proper temperature and does not need a clean water or sterilization .

4)      Breast feeding is safer because chance of contamination is less and many diseases are less associated with breast feeding like gastroenteritis, respiratory infection and other type of infections.

5)      Some problems are less likely to associated with breast feeding like eczema, cows milk allergy, neonatal tetany , hypernatremic dehydration and others .

6)      Human milk contains bacterial and viral antibodies, like high concentration of secretory IgA antibodies which prevents microorganism from adhering to the intestinal mucosa.

7)      Breast milk and especially colostrum contains macrophages that may be able to synthesize complements, lysozome and lactoferrin.

      8) Breast milk associated with bacterial flora mainly of lactobacilli, while those of        bottle feeding is E.coli . Lactose in breast milk may result in decrease PH of stool and this will inhibit the growth of pathological microorganisms.

      9) Milk from mother who is diet is sufficient and properly balanced will supply the necessary nutrients except (perhaps ) flouride and vitamin K and after several months vitamin D

Problems associated with breast milk feeding :

1- low vitamin K content of human milk may contribute to hemorrhagic disease of the newborn.

2- unconjucated hyperbilirubinemia due to breast milk .

3- trasmission of infections like H.I.V. , C.M.V. , rubella , H.B., and herpes simplex virus .

   In developed countries if the mother infected with H.I.V. so breast milk is contraindicated , but in developing countries it is not contraindicated because breast milk may be crucial to infant survival , thus the risk of H.I.V. transmission may be accepted .

4- problems related to the mother like psychological upset or disorder in the mother , poor experience of the mother , retracted nipples or fissuring or cracking .

5- problems related to infants like prematurity , poor sucking , lethargy , cleft lip and cleft palate .

Contraindications of Breast Feeding:

1)      Contraindications related to mother like septicemia , nephritis , eclampsia , profuse hemorrhage , active tuberculosis , typhoid fever , breast cancer and malaria

2)      Contraindications related to infant like galactosemia .

Determination of adequacy of milk supply:

The following signs indicate adequate breast milk feeding:-

1)      Infant sleep 2-4 hr after nursing.

2)      Infant gaining weight.

3)      Good urine output.

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