APPLIED NUTRITION POSTNATAL

LECTURE 3: INFANT NUTRITION During postnatal life, the infant receives nutrition from:
Breastfeeding,

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INFANT NUTRITION Artificial feeding,
Infant nutrition has become increasingly important through the Non-milk preparations and
3
years with the realization that there are certain peculiarities of Supplementary diet. saxwith u0 6
nutrition in early life. saxwttny
These are: CALORIES saxwt 787 12
1. Growth is extremely rapid and as a result nutritional This is based on Estimated Energy Requirements:
requirements are higher than the adult relative to
89 kcal x weight of infant (kg) + 75 0-3 months

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body size.
4-6 months saxwteny
nation 2. His surface area is relatively larger; therefore, heat 89 kcal x weight of infant (kg) + 44
water in
loss and water loss via the skin is greater. 89 kcal x weight on infant (kg) -78 7-12 months
3. He has hardly any teeth, thus, his sources of nutrition
are limited. The infant's high caloric needs are primarily driven by rapid
growth and high metabolic rate.
OTHER IMPORTANT FACTS RELATED TO INFANT NUTRITION WHICH The high metabolic rate is caused in part by the ratio of the
HAVE SURFACED ARE: infant's body surface to its weight.
1. Infants from developing and developed countries grew at the More body surface allows more heat loss from the skin; the
same rate until six months of age when there is a flattening of body must use extra calories to replace that heat.
the growth curve of infants from developing countries.
2. Infant mortality is highest in developing countries and the CARBOHYDRATE
Philippines is no exception. The causes of infant mortality in this Needs in infancy are:
bogday 06months
country are related in one way or another to malnutrition.
I 60 g per day at 0 to 6 months and
months
gigday a 12
Studies show that malnutrition has a synergistic effect on 95 g per day at 7-12 months.
infection and vice versa. A
3. Normal brain growth and development is associated with good These needs are based on the typical intakes of human milk for
nutrition from the last trimester of gestational age to six breastfed infants and their eventual use of solid foods.
months from term.
PROTEIN
During infancy, attitudes toward foods and the whole eating process Needs in infancy are about:
begin to take shape. If parents and caregivers practice good nutrition
9 g per day for younger infants and about
and are flexible, they can lead an infant into lifelong healthful food
14 g per day for older infants.
habits.

BASIC CONCEPTS ON INFANT NUTRITION About half of total protein intake should come from essential
The infant requires food for: amino acids.
1. Total energy expenditure: As with carbohydrate, protein needs are easily satisfied by
50% for Basal Metabolism, either human milk or infant formula.

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Protein intake should not greatly exceed the standard because
25% for Random Activity,
excess nitrogen and minerals from high-protein diets would
12% for Growth,
likewise exceed the ability of the infant's kidneys to eliminate
3% for Specific Dynamic Action Of Food,
the waste products of protein metabolism.
10% Lost in Feces And Urine.
The sources of calories are:

000
FAT
o Fats, Proteins and Carbohydrates.
Infants need about:
2. Maintenance of internal environment.
30 g of fat per day.
3. Cell growth and repair allchildreninfant
30gdayfor
INFANT NUTRITIONAL NEEDS Essential fatty acids should make up about: 15% day of total
Infants' nutritional needs vary as they grow, and those differ fat intake (about 5 g per day)
from adult needs in both amount and proportion. Fats are important part of the infant's diet because they are
Initially, human milk or infant formula (generally using heat vital in the development of the nervous system.
treated cow's milk as a base) supplies needed nutrients. As a concentrated source of calories, fat also helps resolve the
Solid foods are not needed until arounda6 months.a potential problem of the infant's high calorie needs and small
Even after solid foods are added, the basis of an infant's diet is stomach capacity
still human milk or infant formula. ARACHIDONIC ACID (AA) AND DOCOSAHEXAENOIC ACID
(DHA) are two long-chain fatty acids that have very important
PRENATAL roles in infant development
During the last two months of intrauterine life, the fetus CHA BLAND
receives most of its birth stores of: VITAMINS OF SPECIAL INTEREST veryimportant
Vitamins A and D, Iron, Iodine, B12 and Folic Acid. Vitamin K is routinely given by injection to all infants at birth.
Significant amounts of Calcium are also deposited. Formula-fed infants receive the rest of the vitamins they need
Stores of iron in the full-term infant are usually sufficient until from the formula.

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the third and fifth month of life and iron-containing foods are
given at about that time to replenish his stores.
Breastfed infants are to be given vitamin D supplement (200 IU
per day) until they are weaned.

56 doubles
1year triples
 Infants whose mothers are total vegetarians should receive 5. Non-milk preparations: soy-based or meat-based for
vitamin B12 in supplement form. babies who are allergic to milk proteins

MINERALS OF SPECIAL INTEREST Although sweetened condensed milk is popular with the low-
Infants are born with some stores of iron. income group because it is cheaper and it keeps better without
By the time birth weight doubles (4-6 months of age), iron refrigeration, most of the calories come from carbohydrates.
stores are generally depleted if not otherwise part of the diet. The child is jeopardized further if the mother dilutes it to
Formula-fed infants should be given iron-fortified formula from neutralize the sweetness.
birth. Condensed milk is not recommended for infant feeding due to
Breastfed infants at about 6 months of age need solid foods to the inherent drawbacks just mentioned.
supply extra iron. If it has to be used, it should be used with the full awareness of
Fluoride supplements are recommended for infants after 6 its shortcomings.
months of age to aid in tooth development. Other sources of protein will have to be used in combination to
Adequate amounts of zinc and iodide are needed to support make up for its inadequacy.
growth.
Evaporated milk is a concentrated sterilized milk preparation in
WATER which the milk fat may be retained (full cream) or may be
An infant needs about: substituted with coconut oil and corn oil (filled milk).
3 cups (9700 to 800 ml) of water per day. Full cream milk is better than filed milk since milk fat has a higher
Infants typically consume enough human milk or formula percentage of essential fatty acids.
to supply this amount. Powdered milk is the other form in which milk is supplied.
In hot climates, supplemental water may be given to avoid The information on the constituents of the milk as written on the
dehydration. can should be read to know at what dilution an isocaloric formula
(67 cal/100ml) is produced.
BREASTFEEDING The non-milk preparations which are soy-based or meat-based are
The superiority of breastmilk for infant feeding is unquestioned and not routinely used except by babies who developed allergy to the
the important reasons are: proteins of both animał and human milk.
1. Human milk produces softer and smaller curds that are
better digested by the infant. FEEDING TECHNIQUE
2. The host resistance factors in colostrums protect the infant As the infant ingests either formula or human milk, he swallows
from infection in the early months of life. a lot of air so it is important to burp him after either 10
3. The lower solute load of human milk is just enough to minutes of feeding or after 1-2 ounces (30-60 ml) of milk have
meet the needs of the infant without compromising the been consumed from a bottle, and again at the end of the
excretory capability of the infant kidneys. feeding.
4. Better acceptance and tolerance. Generally, the infant's appetite is a better guide than
5. Easy accessibility. standardized recommendation concerning feeding amounts.
6. Psychological benefits for both mother and child. Once fed, placing the infant on its back is recommended.
o The reason why an infant should not be placed on its
The greater concentration of casein in whole cow's milk is stomach is because this sleeping position has been
responsible for the formation of large and poorly digested curds in linked to Sudden Infant Death Syndrome (SIDS).
the stomach.
The higher concentration of whey in human milk results in better SUPPLEMENTARY DIET
digested curds. Bakwin says that the optimum time to introduce semisolid food
to the child is when the oral musculature is ready to receive it
The higher lactose content of human milk favors infant nutrition which is generally between three and five months of age.
because: FNRI recommends that supplementary diet be started at four
months of age.
1. It increases absorption of calcium and magnesium
2. It increases absorption of protein In deprived circumstances, it is recommended that it be started
3. It favors intestinal production of riboflavin and pyridoxine later but not later than six months of age.
4. It increases nitrogen retention
5. I tdecreases intestinal pH resulting in a stool flora that is RECOGNIZING THE INFANT'S READINESS FOR SOLID FOODS
fermentative rather than putrefactive How does one know it is time to introduce solid foods?
6. It contributes to galactolipid synthesis which is important 1. Infant size can serve as a rough indicator of readiness –
for the developing central nervous system reaching a weight of at least 13 Ibs(6 kg) is a preliminary sign of
readiness for solid foods.
ARTIFICIAL FEEDING 2. Another physiological cue is frequency of feeding, such as
When breastfeeding cannot be utilized, formula feeding will have consuming more than 32 ounces (1L) of formula daily or
to be given. breastfeeding more than 8-10 times within 24 hours.
The preparations used for this purpose are the following:
1. Evaporated full cream milk
2. Evaporated filled milk
3. Powdered milk: full cream milk or non-fat milk
4. Sweetened condensed milk
Underlying these noticeable signals are several developmental REFERENCES:
factors: APPLIED NUTRITION MANUAL

1. Nutritional need
Before the infant is 6 months old, nutritional needs can
generally be met with human milk and/or formula.
After 6 months of age, many infants need the additional
calories supplied by solid foods.

2. Physiological capabilities
As the infant ages, the ability to digest and metabolize a
wider range of food components improves.
Before about 3 months of age, an infant's digestive tract
cannot readily digest starch.
Kidney function is quite limited until about 4-6 weeks of
age.

3. Physical ability
These are the three physical markers that can indicate if a
child is ready for solid foods:
1. The disappearance of extrusion reflex
2. Head and neck control
3. Ability to sit up with support
The above markers usually occur around 4-6 months of
age, but they vary with each infant.

4. Allergy and Prevention

An infant's intestinal tract is "leaky"
o Whole proteins can readily be absorbed from
birth until 4-5 months of age.
If the infant is exposed too early to some kinds of proteins
o Particularly those in cow's milk and egg whites
the infant may be predisposed to future
allergies and other health problems like
diabetes.
It is best to minimize the number of different types of
proteins in an infant's diet, especially after the first 3
months.

The ideal supplementary diet is one that will supply sufficient

calories and proteins to the infant.
The flattening of the growth curve of many Filipino infants at six
months as previously mentioned is explained on the basis of
faulty supplementary feeding.
Supplementary diets are generally of the carbohydrate variety,
i.e., lugaw, mashed potatoes or camotes, biscuits, and the like.
It is also introduced late.
The poor quality of the artificial milk substituted for breast milk
when the infant is artificially fed contributes in no small
measure to the malnourished condition.

VITAMIN AND MINERAL SUPPLEMENTATION

Theoretically, one need not give vitamin supplements to a
breastfed infant whose mother is adequately nourished.
This is also true with formula-fed infants since most of these
formulas are enriched with vitamins.
In premature infants whose birth stores are not as adequate as
that of the full-term newborns, supplementation can be started
at two weeks of age onwards.

The most common mineral supplemented in infancy is iron.

Normally, birth stores are not depleted until three months of
age. Iron supplements, 1 mg/kg, are given at this time.
These are introduced earlier in premature infants.