We Are What We Eat

Durgapur

Jump to a Healthy Start

Before this year is over, 10.9 million of the worlds children < 5 years of age will die of conditions that would be largely prevented by Optimal Infant and Young Child Feeding .

Before this day is over 3,500 children will be lost from such causes.

Malnutrition in the Developing World

Malnutrition in the Developing World

Malnutrition in the Developing World Factors that contribute to hunger and malnutrition
Political disruptions and natural disasters War Refugees Sanctions Floods, droughts, mudslides, hurricanes Inequitable food distribution

MOTHER AND CHILD SURVIVAL

MMR 301/100,000 live births IMR* 58/1000 live births Child Mortality 85/1000 Children Rate(Under 5 years)
A whopping 45.9 per cent of India's under-three kids are underweight, 39 per cent are stunted, 20 per cent severely malnourished, 80 per cent anaemic while infant mortality hovers at 67 per 1,000. More than 6,000 Indian children below five years die everyday due to malnourishment or lack of basic micronutrients like Vitamin A, iron, iodine, zinc or folic acid. Overall, India hosts 57 million or more than a third - of the world's 146 million undernourished children.

Vijayaraghavan

NUTRITION PROBLEMS IN INDIA

WHO IS AT RISK?? PREGNANT WOMEN LACTATING WOMEN INFANTS . PRESCHOOL CHILDREN ADOLESCENT GIRLS ELDERLY SOCIALLY DEPRIVED (SC & ST Communities)

Vijayaraghavan

NUTRITION PROBLEMS IN INDIA

WHAT ARE THE COMMON PROBLEMS?
POOR WT. GAIN DURING PREGNANCY CED MICRONUTRIENT DEFICIENCIES

WOMEN

LOW BIRTH WEIGHT GROWTH FALTERING PEM MICRONUTRIENT DEFICIENCIES

CHILDREN

FLUOROSIS, LATHYRISM

DIET RELATED CHRONIC DISEASES OBESITY, CARDIOVASCULAR DISEASES, DIABETES

Vijayaraghavan

Nutrition in the Life Cycle

Achieving Optimal Infant and Young Child Feeding: A Global Responsibility

Is it really possible to promote Optimal Infant and Young Child Feeding in the 21st Century?

Yes!!!

Optimal Infant and Young Child Feeding e n e r g mixe y Matern exclusive d

al Nutriti Gestation on and Health B B
Breastfeeding

Infant and Young Child NutritionFamily foods Special Transition al foods

feed ing Complementary (weaning)

feeding

? ?

childs age

? ?
Adapted by Wellstart from
WHO, 1998

Optimal Infant and Young Child Feeding e n e r g mixe y Matern exclusive d

al Nutriti Gestation on and Health B B
Breastfeeding

Infant and Young Child NutritionFamily foods Special Transition al foods

feed ing Complementary (weaning)

feeding

6?mo

childs age

? ?
Adapted by Wellstart from
WHO, 1998

Optimal Infant and Young Child Feeding e n e r g mixe y Matern exclusive d

al Nutriti Gestation on and Health B B
Breastfeeding

Infant and Young Child NutritionFamily foods Special Transition al foods

feed ing Complementary (weaning)

feeding

6?mo

childs age

2-7? you
Adapted by Wellstart from
WHO, 1998

Characteristics of Infants

Digestion, absorption & metabolism is similar to older children except:

Pancreatic amylase deficient until around 4th

month Fat absorption is inadequate Stomach acidity is low

Calories

Milk : sole source 110-120 Kcal/kg/day = 0-2 mos. 8.5 Kcal/kg = 2-6 mos. 105 Kcal/kg BW = 6-12 mos. Cows/Human milk = 67 kcal/100ml Infant formula = 64-72 kcal/100 ml

Calories
Reasons for increased need: Rapid growth rate Great heat loss due to large body surface area Activity of the infant

Protein

RDA: 6 mos = 2.2 g/kg

12 mos = 2.0 g/kg Human milk = 1.2 gms/100 ml Cows milk = 3x more CHON Disadvantage:
increase blood urea high renal solute load AA pattern different from human milk

Protein
Deficiency: Marasmus Mental retardation
irreversible Poor reading/writing skills Less able to grasp knowledge

Carbohydrate

Prevent hypoglycemia & ketosis Lactose: sole source Improves CHON, Ca 2+ & Mg 2+ absorption Provides galactosides: brain & nerve cell formation Laxative Human milk = 42% of total caloric value Cows milk = 20%

Fat

Must constitute 35-55% of TER Essential fatty acids: linoleic & alphalinolenic acid (omega 3 series) EFA: retina & brain Ratio of lenoleic to alpha-linolenic : 5-15 Breastmilk = 30-40 mg/ml Cows milk = 10-15 mg/ml

Vitamins

Vit.A
RDA is 325 g retinol equivalents Adequate: 850 ml BM w/ 170 IU/100ml Formulas: 750 IU/100 kcal

Vit.C
Gen low content in both CM & BM BM: 5 mg/ml Vit. C rich beverages @ 6 mos to get at least

30 mcg daily

Vitamins

Vit. D
Sunlight exposure

Thiamine
RDA: 0.4 mg/day

Riboflavin
Same as thiamine

Niacin
0.25/100 kcal

Vitamins

Vit B12
0.5 mcg during 1st 5 mos. Of life

Vit. E
1/3 of adult RDA 0.7 IU/100kcal for artificially-fed infants

Vit. K
All infants: single IM/oral dose ASAP post-

partum

Minerals

Iron
0.15-0.2 mg/100 ml
4th month: RDA 15 mg/day Iron fortification of milk formula after 4-6 mos.

Calcium
BM = 33mg/100ml; Ca:P ratio is 2.3 Milk formula = 1.2 only

Phosphorus
Intake of infants is quite low

Water & Electrolytes

70-75% of BW Mostly extracellular: prone to dehydration Special attention: fever, polyuria, diarrhea & during hot weather Na+ : K+ not 1.0 Na+ : K+ = at least 1.5 Cl-

Factors Affecting Nutritional Status

Mothers attributes State of nutrition during pregnancy Feeding pattern Weaning & supplementation Illness BM: rich in long-chain polyunsaturated fatty acids LCPUFA component of structural lipids in membranes of all organs

Indications of Good Nutrition

Body weight gain BMI:

wt. in kg/ height in m2

MUAC(mid upper arm circumference) Behavioral development Bowel movements Sleeping habits

Indications of Good Nutrition

Developed motor coordination Well-formed muscles Graves study

Vigor in any activity Establishes interaction w/ mother at a distance Less irritable

RDA @ 1 year

Green leafy = 2 & cups; yellow = 2 tbsp Vit C-rich foods = 2 tbsp Other fruits & vege = 2 tbsp each for both Fat = 2 tsp Meat, fish, poultry = 1 matchbox size Milk = 2 cups

RDA @ 1 year

Eggs = Dried beans = cup Nuts = 2 tbsp Rice (lugaw) = 2 cups Rootcrops (mashed) = 2 tbsp Sugar = 6 tsp *RDA : pls refer to handouts

NUTRITION IN PRESCHOOL AGE

Early preschool age

Toddler
1-3 years old

Late preschool age

4-6 years old

RDA by FNRI

Age
13 years 46 years

Body Wt. Kg.

13 18

Protein

Calcium

Cal
1310 1640

grams
26 32

grams
0.5 0.5

Iron mg.
6 8

Retinol Equivalent Act. 250 325

Vit. A I.U.
1800 2300

B1 mg.
0.7 0.8

B2 g.
0.7 0.8

Niacin mg. Equiv.

9 11

Vit. C mg.
35 45

ENERGY

55% - metabolic activities 25% - physical activities 12% - growth needs 9% - fecal loss (90- 100Kcal/kg) FNRI estimate 1350 Kcal/day 1-3 yr old children 250 Kcal/day 4-6 yr old children

Protein Energy Malnutrition

(PEM)

Marasmus Kwashiorkor

Protein

FAO recommendation - 1.5- 2g/kg body wt.

Deficiency symptoms Retarded growth Anemia Pigmentary changes of hair and skin Edema (kwashiorkor)

Vitamins

vitamin A vitamin C vitamin B1 vitamin B2

Minerals

Calcium and iron Trace elements - iodine - fluoride -zinc

Zinc deficiency Dwarfism Retarded sexual development

TYPES OF AT- RISK FACTOR

BIOLOGICAL Mother Young child ENVIRONMENTAL Cultural Socio- economic Geographic- climactic Miscellaneous EARLY WARNING SIGNALS Community Individual

Reasons for nutritional vulnerability

His mother may have another baby to whom she lavishes more attention He gets a small share of whatever food is on the table in proportion to his size He may choose from a common dish at the table foods that are not Nutritionally protective The previous major source of his protein intake in which is breast milk maybe suddenly withdrawn from him because mother is pregnant Mother may go back to work and he is left in the care of others

Food Groups
1. 2. 3. 4. 5. 6.
Vegetables

Food Recommended
Amount
2 servings, one should be leafy or yellow 2 servings, one should be Vit. C-rich

Allowed Foods

All except strongly flavored for the younger children; chopped or cut in pieces All; skin, seeds and long fibers, and if any removed All except for whole kernel corn and malagkit

Fruits

Rice or substitute

1 to 2 cups cooked

Milk Meat or substitute Fat

At least 2 cups 3-5 servings more if milk is refused; liver twice a week As needed

Chopped or ground lean meat liver, chicken; flaked fish; eggs; mashed beans; mild cheese

Cream, butter or margarine Sucrose, syrup, jams or jellies Plain pudding, gelatin, ice cream, cakes and cookies

7.
8.

Sugar
Desserts

1 tablespoon
As needed or made from food allowance

SCHOOLCHILD

CHARACTERISTICS

Between 7 and 12 years Slow steady growth Increase body proportions Enhanced mental capabilities More motor coordination Body reserves are being laid down in preparation for the increased needs during the adolescent stage Growth rates vary within this period

NUTRIENT ALLOWANCES

His nutritional needs differ from that of an adult on the ff. points He is actively growing (girls at prepuberty stage experiences Spurts of growth) He is constantly active He is changeable in his attitudes towards food He cannot afford to eat foods poor in essential nutrients

RDA classification of Filipino school children

7 9 years old 10 12 years old / pre-

adolescence

Age 7 -9 10 -12

Energy 80 90 Kcal/kg 70 80 Kcal/kg

Protein 8% 35 gm 45 49 gm

Vitamins and minerals Vitamin C 55mg 600 700 mg 65-70 mg 70 80 mcg Calcium Iodine

FEEDING THE SCHOOL CHILD

1.

Psychological factors

Let him feel responsible for his own well-being Make him accountable for his diet Parents should take time out and spend time with the children

A HAPPY CHILD IS A HEALTHY CHILD

2. School environment
Goals of School feeding programs
To improve the nutrition of school children by furnishing

them wholesome food at the lowest possible cost To aid in strengthening the nutrition and health education program of the public schools To foster proper eating habits

3. Food Preference

FEEDING PROBLEMS
1.
2. 3. 4.

Inadequate meals Poor appetite Sweet tooth Fast foods

INDICATIONS OF GOOD NUTRITION

1.

Clinical examination

EENT test SE UA PE

2.

Dietary analysis
Diet history/food

3. Anthropometric examination Weight-for-age Height-for-age Weight-for-height

record General Eating habits Nutrient intake

FOODS TO BE INCLUDED DAILY

Food item
Milk, whole Meat, fish, poultry Dried beans and nuts Enriched rice and other cereals Rootcrops Fat- butter, margarine, oil Green and leafy vegetables Vitamin C-rich foods Other fruits and vegetables Eggs Sweets

Serving
One or more cups 3 or more servings 1/3 cup or more, cooked 4 or more cups, cooked 1 or more medium pieces 6 teaspoon cup or more One or more 2 medium fruits or 8 or more tbsp vegetables 2-3 a week 6 teaspoons

Food Allergies
Result in immunologic reactions Caused by common foods
eggs, milk, peanut, soy, wheat, fish, tree nuts, shellfish

Lead to
diarrhea, vomiting, wheezing, anaphylactic shock, abdominal pain, gas, hives, skin rashes

Can be avoided (at least in part)

slowly introduce new foods delay introduction of common food allergens until at least 1 year of age, longer depending on allergen

Fruit Juice
Too much of a good thing?
Nutrient density and displacement of nutrients Diarrhea Dental cavities

Know the limits

8 oz diluted 100% fruit juice (4 oz fruit juice and 4 oz water)

Feeding Infants Cow Milk

Not recommended during the first year. Fluid cow milk consumption can lead to:
GI bleeding Iron deficiency Displacement of nutrients

Other dairy products at 8 months

Yogurt and cheese

Benefits of Healthy Gut Flora

Infants with a healthy gut flora (i.e. one dominated by beneficial bacteria, such as Bifidobacterium and/or Lactobaccillus) have reduced risk of infection, disease and later development of food allergy.
Decreased prevalence of eczema in high risk infants given probiotics/lactobacillus.

Certain species of gut bacteria down regulate inflammation

Diarrhea/gastoenteritis Serious Respiratory Infections Recurrent Ear Infections Obesity Type I Diabetes Allergic disorders

Conditions for which nonoptimally fed infants and young children are likely be at an increased risk:

Childhood Leukemia and lymphoma SIDS NEC Lowered IQ Chronic GI Tract disorders Mortality between 28 days and 1 year of age

Influences on Food Choices

Cognitive Habits Comfort foods Cravings Advertising Social factors Nutritional value Health beliefs

Influences on Food Choices

Culture

Beliefs and traditions Religion Indian diet

Getting off to the right start: infants

Calorie needs are highest in infancy; met w/milk Respect hunger and satiety cues Delay introduction of complimentary foods (juice, cereal) till 6 months Juice4 oz/day of 100% juice; work towards mashed whole fruit after 6-9 months; juice in a cup, not in bottle Cereal: 1 T/2 oz breastmilk or formula; 1-2 times a day; not in bottle Milk: whole for 1st 2 years; 24 oz a day by 12 months

Baby and table foods:

Evaluate infants readiness for solids Begin with vegetables, then fruits, then meats No more than 1 new food every 3-5 days 1 tsp at first, then move up to 2 and beyond; maximum of 5 T. of any one item after age of 12 months, 1 tablespoon/year of age of any one food is a serving --ex. 1.5 tablespoon carrots, 1.5 T chicken, 1.5 T green beans for 18 mon old

Table foods:

Mashed up and appropriate consistency for babys age, abilities and #teeth Sit at family table, no TV Respect satiety cues Know parents and childs jobs (Satter): It is the parents responsibility to provide a variety of healthy foods. It is the childs responsibility to decide whether they are going to eat and how much to eat.

Model the right plate:

Make it colorfuleat the rainbow www.5aday.com 2/3 vegetables, fruit, whole grains, beans 1/3 protein source

Eating out:

Eat at home as often as possible Teach children about correct portion sizes, Mighty Kids meals too big for anyone! Avoid supersizing yourselfmodel Avoid all you can eat buffets

Eating and behavior:

Being a good role model is #1 Do not use food as a reward or withhold treats as a punishmentthese elevate the position of food in the childs mind Instead, reward with time spent with caregiver Do not refer to certain foods as good or bad Do not over-regulate childs eating

Childs self-regulation:
Park et al, 1994

Caregivers as providers of opportunities

Caregivers as direct instructors

Caregivers as interactive partners

Caregivers as interactive partners:

Caregivers transmit messages and values about eating and food by their interaction with their children By your words and actions, children will learn what foods are healthy Junk foodsmixed message if you say theyre junk food but then eat them Caregivers attempts to lose weight, preoccupation with food or body may lead to same in child (Thelen, Stice et al, Francis et al)

Caregivers as direct instructors:

Show children how to choose healthy foods in grocery store, at restaurant Reinforce children for making healthy choices If you overeat or exhibit out of control eating, they may, too (Cutting et al)

Caregivers as providers of opportunities:

Limiting intake of and/or access to foods of lower nutritional value Providing healthy food choices Children have natural preference for sugar, salt and fat Caregivers may respond with controlling feeding strategieseither to restrict or to pressure child to eat

Parents as direct instructors, cont:

This promotes further problems Disordered eating Enticement of the forbidden Overweight in child may result, esp. girls Too much food presented decreases childs ability to self-regulate, encourages overeating (Birch, Rolls et al) Appropriate portion size is important

Picky eaters:

Research demonstrates that it takes 10-15 times of offering a new food before an infant or toddler makes a decision Try, try and try again Make new food the 1st food toddler tries Eat it yourself, talk positively about it Allow preschoolers to help choose and prepare new foods

Toddler and preschooler eating habits:

Growth rate slows after 12 months, so they do not need as many calories to grow 100-120 cals/kg of body weight in 1st year ~100 cals/kg of body weight from 2-3 yrs 90 cals/kg of body weight from 4-6 years They dont need as many calories as they did when they were infants Make the calories they do need healthy

Toddler/preschooler diet:

One tablespoon/year of age is a serving of any one food item Switch to lowfat or skim milk at age 2 3 meals and 2 snacks a day Same diet as is recommended for adults is recommended for kids 2 and older (<30% of calories from fat, <10% from sat. fat)

Eating habits of young children: What do we know?

J Amer Diet Assn 1/04; Vol. 104 Number 1

Gerber-sponsored Feeding Infants and Toddlers Study or FITS 30% of infants have solid food introduced before the recommended 4-6 months of age 31% of toddlers ages 12-24 months have a mean energy intake exceeding their estimated mean energy requirement Intake of adult high energy density/low nutritional value foods is prevalent among toddlers

FITS Highlights, cont:

18-33% of 7-24 month olds consume no servings of vegetables, and 23-33% consume no fruits French fries are the most commonly consumed vegetable beginning at 15 months of age

FITS Highlights, cont:

~50% of 7-8 month olds consume some type of dessert, sweet or sweetened beverage Infants and toddlers in WIC are more likely to consume 100% fruit juice (vs. whole fruit), desserts, sweets and fruit drinks than their non-WIC peers

Eating habits of young children: Why do we care?

Rapid infant weight gain is associated with increased risk of being overweight at age 4 (Guo) Mothers of overweight young children are unlikely to view their child as such (Baughcum et al) Restrictive parental feeding practices are associated with increased child eating and weight status (Birch, Fisher)

Most children do not outgrow extra weight:

Children who are at-risk for overweight or overweight at any time during the preschool years are more than 5 times more likely than their peers to be overweight 12 year olds (Nader et al) >75% of overweight and obese 10-15 year olds will become obese adults (Whitaker et al)

Childhood obesity affects more than looks:

Many medical complications --cardiovascular --endocrine --pulmonary --orthopedic --liver

Childhood obesity complications, cont:

Psychosocial complications most common --poor self-esteem --decreased quality of life --depression --teasing and bullying Children prefer normal weight peers to be their friends more often, even at age 5

Role of early child care professionals:

Child Care Champions Best Practices CO Physical Activity and Nutrition/ CO Dept. of Health document 7 Best Practices for prevention of childhood overweight Goals which are attainable, realistic and proven to be effective

#1: Model healthy eating behaviors

When you eat the same foods as the children you serve, you are saying, Do as I do rather than Do as I say Sit with children at meals, eat same food Try new foods with children Start with adventurous eaters to model trying new foods to picky peers Avoid negative facial expressions, body language or words re: food served

#2: Integrate nutrition/PA into curricula

Provides repeated exposures to topics Normalizes healthy eating and PA Emphasizes their importance daily New PAT curriculum, High Five, Low Fat, preK school wellness resource guide, Movement Exploration Other ideas listed in CC Champions

#3: Practice division of responsibility (Satter)

Caregivers job=what to offer child to eat Childs job=how much, what and whether to eat Caregiver provides regularly scheduled meals and snacks at appropriate intervals Allow children to help in preparation, table setting, serving and clean up if possible Offer a variety of healthy foods repeatedly Avoid verbal or nonverbal prompts to eat

#4: Provide the best start for infant feeding:

Breastfeeding, developmentally appropriate 1st foods offered at the right time, recognition of hunger and satiety Promote breastfeeding to all parents

How can you help?

Be welcoming to breastfeeding moms For 1st 6 months, offer only breastmilk to breastfed infants unless mom wishes otherwise Provide private place to nurse for moms before they leave their infant and when they return Provide adequate and safe storage space for breastmilk (COPAN resource kit)

Appropriate 1st foods:

In addition to delaying solids till 6 months Avoid added sugars (desserts, cookies, cakes, fruit drinks, pop) and do not add sugar, molasses, honey, syrup to baby food, cereal, milk or water Do not allow grazing from plate, cup or bottle

#5: Become partners in prevention

Partner with the parent to avoid giving children mixed messages about eating and physical activity Communicate feeding policies to parent Alert parent to feeding problems quickly and enlist their ideas Use resources/newsletter to educate parents on common feeding issues

#6: Promote physical activity and free play

Young childhood is key time when PA behaviors, preferences are being set Infants should play interactive games and safely explore their environment Toddlers need safe opportunities to learn running, jumping, throwing, kicking; refine skills as preschoolers Toddlers need 30 min of structured PA and 60 min of free play Preschoolers need 60 min structured PA and 60 min of free play

Physical activity, cont:

No TV/screens for children 2 years old 1-2 hours/day of educational programs for those >2, preferably movement-promoting Dance or move to music instead of TV Use Hip Hop to Health, Jr, Movement Exploration, other resources

Examples in Child Care Champions:

How to provide activity opportunities for infants What counts as structured physical activity? What counts as free play? How to ensure play spaces are safe How to create an indoor activity space

#7: Plan meals w/childrens nutrition needs in mind

It takes time and planning Use guidance learned during conference Use Child and Adult Care Food Program Guidelines and 2005 Dietary Guidelines Provide written menus to parents Educate parents on balanced meals if they send food Establish positive eating environment

Positive eating environment:

Children should help with food prep and cleanup as developmentally able Children should sit with caregiver and each other Chairs, table, utensils suitable for children Pleasant social and learning experience with no conflict Food not a reward or punishment Allow sufficient time to eat (>20 min)

Common Disorders

Diarrhea Vomiting Constipation Colic Measures:

Determine underlying cause
Maintain water & electrolyte balance Modify milk formula

Summary:

Young children are establishing eating and activity patterns for life You have an important role to play in promoting breastfeeding as best 1st feeding, promoting and providing opportunities for healthy eating and activity for young children, families

There is always more to come!

Thank you

OK135S053

OK135S057

And we know what to do

Optimal Infant Feeding and Maternal Health