Lesson 5 reupload

• Nutrition in pregnancy and lactation

  Ensures optimum nutrition before, during and after pregnancy and during lactation
• Characteristics of pregnancy

  • Fertilized ovum implants itself to the uterus
  • Human pregnancy lasts for 266 to 280 days (37-40 weeks)
  • Consists of three trimesters
  • Has three main phases: implantation, organogenesis, growth
• Nutrition in pregnancy

  1. Always start with diet history

  2. Identify PICA (persistent ingestion of inedible substances)

  3. Ensure adequate intake of calories, protein, carbohydrates, fiber, fats, iron, calcium, sodium, folic acid, iodine, vitamins
• Calorie allowances in pregnancy

  Non-pregnant requirements: 1,800 to 2,200 Kcal/day<|>Additional caloric requirement per day: 300 Kcal/day<|>Usual daily caloric need in pregnancy: 2,100 to 2,500; never less than 1,800 Kcal/day
• Maternal weight gain

  24 to 35 lbs (11.2 - 16 kg)<|>1 lb per month during the FIRST trimester<|>1 lb per week during the 2ND and 3RD trimester<|>3 - 12 - 12
• Maternal underweight


  High risk of low birthweight, preterm and infant deaths
• Maternal overweight


  High risk of complications in labor and delivery, hypertension, gestational DM, and postpartum infections
• Protein allowances


  Additional 30 g/day to ensure 74 to 76 g/day<|>Rich food sources include milk, meat, fish, poultry and eggs<|>Provides for the storage of nitrogen, protects the mother, growth for maternal uterus/mammary tissues/placenta, fetal growth and repair, hormonal preparation for lactation
• Carbohydrates


  Sufficient intake is necessary for added energy<|>Avoid "empty" calories like soft drinks
• Fiber


  Taken from fruits and vegetables to prevent constipation
• Topics

  • Supplementation
  • Dental Health
  • Early Child Development
  • Child Health Injuries
  • DIET
• Breastfeeding/breast milk

  Best to be given until 18 months to 2 years of age
• Bottle Feeding


  Artificial feeding with cow's milk, costly, associated with infantile obesity or "protein-calorie malnutrition plus"
• Mixed Feeding/Complemented


  Insufficient supply of breast milk
• Supplemented


  Mother is away from home for feeding
• TWO METHODS OF FORMULA PREPARATION

  • Aseptic Method - Equipment and ingredients are sterilized separately
  • Terminal Method - Formulas are poured into clean but unsterilized bottles and are sterilized together
• FEEDING TIME


  • A 5 to 2.7 kg baby usually feeds every 3 hours (8 feedings)
  • A 6 to 4 kg baby usually feeds every 4 hours (6 feedings)
  • 2 to 3 months old, the baby is on 4 to 5 feedings, the baby sleeps through the night after 10 pm feeding
• WEANING

  • 6 months: Breast to bottle
  • 12 months: Bottle to cup
• SUPPLEMENTARY FOODS

  • 2 months: Liquids like rice water, calamansi juice may be introduced depending upon the infant's tolerance and acceptance
  • 4 months: First solid foods (rice cereals)
  • 5-6 months: Teething foods; full diet consisting of pureed meat, egg, strained fruits and vegetables and chewy foods be given not only to soothe the sensitive gums, but also to teach the baby the art of self-feeding
  • 7-8 months: Foods are mashed or chopped finely, not strained to teach mastication, soft cooked egg with rice porridge, boiled fish, banana and camote mash and the like
  • 9-12 months: Whole tender foods or foods chopped coarsely are given, finger foods like cottage cheese, crackers, plain meats and egg yolks
• FOODS TO AVOID IN THE FIRST YEAR OF LIFE

  • Infantile Poisoning - Honey (clostridium botulinum)
  • Choking Hazards - Hotdogs, grapes, hard candies, raw carrots, popcorns, nuts, peanut butter
  • Insufficient Calories - Skim milk
  • Potential Allergen - Cow's milk, egg whites
• CUES TO READINESS TO SOLIDS

  • Sucking reflexes are intact
  • Ability to sit with support
  • Avoid feeding an infant lying supine to prevent aspiration
  • Present salivary glands and intestinal enzymes that aids in digestion
  • Fetal iron reserves in the liver are usually consumed by 4-6 months
• RULES TO FOLLOW WHEN INTRODUCING SUPPLEMENTAL FOODS

  • Introduce one food at a time
  • Show pleasure when giving new food at the same time, make gestures
  • Give a small amount (1 tsp.) at a time
  • Offer bland foods to the baby (not too salty, not too sweets)
  • Do NOT mix with formula
  • Feed when the newborn is hungry after a few sucks of milk to increase his patience for new food
  • Never start two new foods at the same time
  • Allow an interval of 4-7 days between new foods
  • Feed the baby only with freshly-cooked foods or fruits freshly-peeled. Avoid giving left-over foods to babies
  • Do not bribe, plead, threaten or force the infant
• COMMON DISORDERS

  • Diarrhea: Most frequently caused by bacteria and viruses
  • Vomiting
  • Allergy: Milk intolerance
  • Constipation
  • Colic: Most common
• HEALTH PROBLEMS WITH INFANCY

  • Galactosemia
  • Phenylketonuria (PKU)
  • Maple Syrup Urine Disease (MSUD)
  • Congenital Hypothyroidism
• FLUID NEEDS OF THE YOUNG CHILD

  • WATER is good for thirst
  • Too much FRUIT JUICE may cause diarrhea and may reduce the child's appetite for foods
  • SODAS are not suitable
  • TEAS AND COFFEE reduce iron absorption
  • A non-breastfed child (6-24 mons.) needs 2-3 cups of water on a temperate day or 4-6 cups in a hot climate
• FEEDING THE CHILD WHO IS ILL

  • Encourage the ill child to eat and drink with lots of patience
  • Feed small amounts frequently
  • Give food that the child likes
  • Give a variety of nutrient-rich foods
  • Continue to breastfeed
• NUTRITION PROGRAM

  • Common nutritional deficiencies are Vitamin A, Iron, and Iodine
  • MICRONUTRIENT SUPPLEMENTATION - Araw ng Sangkap Pinoy/Garantisadong Pambata Child Health Week: Twice a year distribution of Vitamin A capsule
  • FOOD FORTIFICATION (RA 8976) - Mandatory fortification of staples (flour, cooking oil, refined sugar, rice and processed foods) through Sangkap Pinoy Seal
• VITAMIN A


  • Infants (6-11 months): 100,000 IU, 1 dose usually given with measles at 9 months
  • Children (21-71 months): 200,000 IU, 1 capsule every 6 months
• IRON


  • Infants (6-11 months): Drops: 15 mg iron/0.6 mL, 0.6 mL once a day for 3 months
  • Children (1-5 years): Syrup: 30 mg iron/5 mL, 1 tbsp. once a day for 3 months
  • Adolescent Girls: Tablet: 30 mg iron with 400 mcg folic acid, One tablet a day
• IODINE

  • Children of School Age: Iodized oil capsule with 200 mg iodine, 1 capsule for 1 year
  • Adult: Iodized oil capsule with 200 mg iodine, 1 capsule for 1 year
• Gluconeogenesis


  Converting protein (glucogenic amino acids) to carbohydrates releases cortisol, the so-called "stress" hormone
• Glycogenesis

  Formation of glycogen to glucose
• Glycogenolysis


  Breakdown of glycogen to glucose; the process is caused by the hormones glucagon and epinephrine which stimulate glycogenolysis and which are produced in response to low blood glucose levels. It takes place in the muscle and liver tissue which is where glycogen is stored
• TOTAL ENERGY REQUIREMENT

  • CARBOHYDRATES (CHO): 50 to 70%
  • PROTEIN (CHON): 10 to 15%
  • FATS (CHO with Glycerol base): 20 to 30%
• NUTRITION IN TODDLER

  Period of life from 1-3 years old
• DAILY CALORIC REQUIREMENT

  1,300 to 1,400 kcal/day or 100 cal/kg/day
• Physiologic anorexia


  Decrease in appetite because the toddler is busy at play
• Weight quadruples at 2 years old
• TODDS NEEDS A PRAISE

  • Temper tantrums
  • Offer choices
  • Diet preference is unpredictable, able to feed self
  • Dental examination at 2-3 years (2y/o: 16, 3y/o: 30)
  • Safety is a priority
  • No-no-no Attitude
  • Ensure increase of Ca, P and Fe
  • Elimination training (bladder training and bowel training)
  • Drinks 16-24 oz of milk/day
  • Separation Anxiety
  • Autonomy vs. Shame and Doubt
  • Parallel Play
  • Rituals, routines and dawdling
  • Accident-prone
  • Involve the parents in child care
  • Sibling Rivalry
  • Explain procedures
• NUTRITION IN PRE-SCHOOLER

  Age of 3-6 years old