Pediatric Nutrition

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Pediatric Nutrition

Definition

Pediatric nutrition considers the dietary needs of infants to support growth and development, including changes in organ function and body composition.

Purpose

Decisions parents make about nutrition and feeding their infants have short- and long-term effects on the babies' subsequent growth and development. Infectious disease and chronic digestive disease can be reduced with good nutrition choices such as breastfeeding. Breastfed infants have better overall health, so choices about pediatric nutrition are important considerations.

Since the mid-1970s, the prevalence of obesity and overweight has increased signicantly in the United States. The prevalence of overweight has tripled among children and adolescents, and almost two out of three adults are either overweight or obese. Obese children are more likely to become obese adults without intervention.

Precautions

Infants consume small amounts of food at a time, but they should not be fed directly from the jar because bacteria is introduced into a jar from the babies' mouth. If uneaten food is then put into the refrigerator, bacteria will likely grow and may cause diarrhea, vomiting, or other signs of food-borne illness. In order to prevent food sensitivities, some foods such as wheat, eggs, and chocolate should be avoided until the child is one year of age.

Ensuring adequate water intake, which can be derived solely through milk, is critical to maintain electrolyte balance and therefore the overall health of infants and young children.

Description

Breastfeeding for optimum health

There are several advantages that breastfeeding provides compared to bottle-feeding. Breast milk imparts superior nutritional, immunological, and psychological benefits to infants. Breastfeeding is also much more economical, and no preparation is required. The American Dietetic Association advocates breastfeeding exclusively for four to six months, and breastfeeding with weaning foods for at least 12 months. The American Academy of Pediatrics also advocates breastfeeding, stating, "Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first six months after birth … It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired.

Breast milk's nutritional advantages are:

It provides infants with most of the nutrients they need for growth and is a readily available energy source.
It contains large amounts of vitamin E, which may help prevent anemia. Additionally, vitamin E is an important antioxidant.
It is compatible with infants' enzymes.
Unlike cow's milk, it has an optimum calcium to phosphorus ratio of 2:1.
Breastfeeding transfers antibodies from mothers to infants.
All infectious diseases occur less frequently in infants who are breastfed rather than bottle fed.
It favorably changes the pH of stools and the intestinal flora, thus protecting against bacterial diarrheas.

Formula feeding

There are a number of commercially prepared infant formulas on the market available in powder, concentrated liquid, and pre-diluted liquid forms. The American Academy of Pediatrics advises that whole cow's milk should not be given to a child during the first year of life. It also recommends iron-fortified formula for all infants on formula. Infant formula has more protein and more iron than human milk, but lacks antibodies.

Introduction of solid foods

The age to start solid foods depends on infants' needs and readiness, but they do not need solid food before six months of age, particularly breastfed infants. Tongue and mouth movement is usually adequate by four months. If infants are force-fed early, some will rebel and develop feeding problems. Weaning of a breastfed infant depends on the preferences and needs of the mother and infant. Weaning gradually over weeks or months is easiest. When the infant is about seven months old, breastfeeding once a day should be replaced by a bottle or cup of modified formula or fruit juice. By 10 months, the infant may be weaned to a cup. Thereafter, one or two feedings daily can be continued until age 18 to 24 months. A full diet of solid foods and fluids by cup should be given to infants who are nursed even longer.

To determine an infant's tolerance, solid foods should be offered by spoon and introduced one flavor at a time. Many commercial baby foods (desserts and soup mixtures, in particular) are high in starch, calories, have no or little vitamin or mineral value, and are high in cellulose, which is poorly digested by infants. Commercial baby foods with high sodium content, more than 200 mg/jar, should be avoided. The daily sodium requirement is 17.6 mg/kilogram. Pureed home foods will suffice. Meat should be preferentially introduced to high-carbohydrate foods; however, because infants often reject meat, it must be introduced patiently and carefully.

To ensure infants eat enough fat when weaning from breast milk or formula, choose whole milk up to two years of age. Two good sources of protein and fat that infants enjoy are peanut butter and cheese. If there are concerns about obesity, lean protein choices provide the fat and protein. Adequate intakes of grains, fruits, and vegetables will ensure that infants receive all the necessary vitamins and minerals.

Preparation

In order to make appropriate choices about pediatric nutrition, it is important to be aware of the nutritional needs of infants. The following are the recommended vitamin and mineral intakes for infants and young children:

Vitamin A for infants 0-6 months: 400 micrograms/day (mcg/d); 7-12 months: 500 mcg/d; children 1-3 years: 300 mcg/d.
Thiamin (vitamin B₁) for infants 0-6 months: 0.2 milligrams/day (mg/d); 7-12 months: 0.3 mg/d; children 1-3 years: 0.5 mg/d.
Riboflavin (vitamin B₂) for infants 0-6 months: 0.3 mg/d; 7-12 months: 0.4 mg/d; children 1-3 years: 0.5 mg/d.
Niacin for infants 0-6 months: 2 mg/d; 7-12 months: 4 mg/d; children 1-3 years: 6 mg/d.
Vitamin B₆ for infants 0-6 months: 0.1 mg/d; 7-12 months: 0.3 mg/d; children 1-3 years: 0.5 mg/d.
vitamin B₁₂ for infants 0-6 months: 0.4 mcg/d; 7-12 months: 0.5 mcg/d; children 1-3 years: 0.9 mcg/d.
Pantothenic acid for infants 0-6 months: 1.7 mg/d; 7-12 months: 1.8 mg/d; children 1-3 years: 2.0 mg/d.
Biotin for infants 0-6 months: 5 mcg/d; 7-12 months: 6 mcg/d; children 1-3 years: 8 mcg/d.
Folate for infants 0-6 months: 65 mcg/d; 7-12 months: 80 mcg/d; children 1-3 years: 150 mcg/d.
Vitamin C (ascorbic acid) for infants 0-6 months: 40 mg/d; 7-12 months: 50 mg/d; children 1-3 years: 15 mg/d.
Vitamin D (in the absence of adequate sunlight) for infants 0-6 months: 5 mg/d; 7-12 months: 5 mg/d; children 1-3 years: 5 mg/d.
Vitamin E for infants 0-6 months: 4 mg/d; 7-12 months: 5 mg/d; children 1-3 years: 6 mg/d.
Vitamin K for infants 0-6 months: 2.0 mcg/d; 7-12 months: 2.5 mcg/d; children 1-3 years: 30 mcg/d.
Calcium for infants 0-6 months: 210 mg/d; 7-12 months: 270 mg/d; children 1-3 years: 500 mg/d.
Phosphorus for infants 0-6 months: 100 mg/d; 7-12 months: 275 mg/d; children 1-3 years: 460 mg/d.
Magnesium for infants 0-6 months: 30 mg/d; 7-12 months: 75 mg/d; children 1-3 years: 80 mg/d.
Selenium for infants 0-6 months: 15 mcg/d; 7-12 months: 20 mcg/d; children 1-3 years: 20 mcg/d.
Zinc for infants 0-6 months: 2 mg/d; 7-12 months: 3 mg/d; children 1-3 years: 3 mg/d.
Iron for infants 0-6 months: 0.27 mg/d; 7-12 months: 11 mg/d; children 1-3 years: 7 mg/d.
Breastfed infants need 400 international units (IU) of vitamin D and 0.25 mg of fluoride daily.

The following is the Recommended Dietary Allowance (RDA), (adapted from the Dietary Reference Intakes report) for carbohydrate, protein, and fat intakes for infants and young children:

Carbohydrate for infants 0-6 months: 60 g/d; 7-12 months: 95 g/d; children 1-3 years: 130 g/d (acceptable range 45-65 g/d); children 4-8 years: 130 g/d (acceptable range 45-65 g/d)
Protein and amino acids for infants 0-6 months: 9.1 grams per day (g/d) and 7-12 months: 11 g/d based on 1.5 g/kg/day for infants; children 1-3 years: 13 g/d based on 1.1 g/kg/day for children 1-3 y (acceptable range 5-20 g/d). Children 4-13 y: 11 g/d based on 0.85 g/kg/day (acceptable range 10-30 g/d).
Fat for infants 0-6 months: 31 g/d; 7-12 months: 30 g/d; children 1-3 years: acceptable range 30-40 g/d; children 4-8 years: acceptable range 25-35 g/d

The RDAs are set to meet the needs of 97-98% of the population.

Breastfeeding does not require any preparation, but bottle feeding requires some preparation, such as ensuring the milk is the right temperature and the nipples are sterilized, if sterilized disposable nipples are not used.

Complications

Obesity may start with excessive feeding in infancy. If an infant has two obese parents, it is particularly important to monitor and control weight gain as the infant has an 80% chance of becoming obese.

Diarrhea may be caused by conditions such as celiac disease (gluten enteropathy), cystic fibrosis, and sugar (lactose) intolerance.

Results

Infants should be closely monitored for proper weight gain to ensure they are receiving adequate nutrition. Resources such as the National Center for Health Statistics growth charts can be used as a guide.

Health care team roles

Breastfeeding education efforts are important steps for health care teams. They should encourage a longer duration of breastfeeding to achieve maximum nutritional benefits for infants. A dietitian can assist in providing advice regarding pediatric nutrition feeding decisions.

KEY TERMS

Anemia— A decrease in the number of red blood cells in the bloodstream, characterized by pallor, loss of energy, and generalized weakness.

Cystic fibrosis— A hereditary genetic disorder that occurs most often in Caucasians. Thick, sticky secretions from mucus-producing glands cause blockages in the pancreatic ducts and the airways.

Dietary Reference Intakes (DRI)— This standard recommends the daily amounts of energy, protein, minerals, and fat-soluble and water-soluble vitamins needed by healthy males and females, from infancy to old age.

Electrolytes— Any of the various ions such as sodium, potassium, or chloride required by cells to regulate the electric charge and flow of water molecules across the cell membrane.

Gluten enteropathy— A hereditary malabsorption disorder caused by sensitivity to gluten, a protein found in wheat, rye, barley, and oats. Also called non-tropical sprue or celiac disease.

Recommended Dietary Allowance (RDA)— The recommended dietary allowances are the quantities of nutrients in the diet that are needed for good health.

Resources

BOOKS

Baker Jr., Robert D. Pediatric Parental Nutrition, 1st ed. Gaithersburg, MD: Aspen Publishers, Inc., 2001.

Hendricks, Kristy M., et al. Manual of Pediatric Nutrition, 3rd ed. Hamilton, Canada: B. C. Decker Inc., 2000.

Institute of Medicine, ed. Dietary Reference Intakes for Energy, Carbs, Fiber, Fat, Fatty Acids, Cholesterol, Protein, And Amino Acids. Washington: National Academies Press, 2005.

Lutz, Carroll A., and Karen Rutherford Przytulski Nutrition And Diet Therapy, 4th ed. Philadelphia, PA: F. A. Davis Company, 2006.

Samour, Patricia Q., and Kathy King. Handbook of Pediatric Nutrition, 3rd ed. Sudbury, MA: Jones and Bartlett Publishers, Inc., 2005.

Temple, Norman J., Ph.D., et al. Nutritional Health: Strategies For Disease Prevention, 2nd ed. Totowa, NJ: Humana Press, 2005.

PERIODICALS

Grummer-Strawn LM, Mei Z; Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. "Does breastfeeding protect against pediatric overweight? Analysis of longitudinal data from the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System." Pediatrics. 113 no. 2 (2004):e81-86.

Collier S, Fulhan J, Duggan C. " Nutrition for the pediatric office: update on vitamins, infant feeding and food allergies." Current Opinion in Pediatrics. 16 no. 3 (2004):314-20.

Morgan R, Paul SM, Fisher MF. "Challenges and strategies for proper pediatric nutrition and weight control." New Jersey medicine: the Journal of the Medical Society of New Jersey. 101 no. 5 (2004):33-36.

ORGANIZATIONS

American Dietetic Association. 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. (800) 877-1600. 〈http://www.eatright.org/〉.

Food and Nutrition Information Center, Agricultural Research Service, USDA. National Agricultural Library, Room 105, 10301 Baltimore Avenue, Beltsville, MD 20705-2351. (301) 504-5719. Fax: (301) 504-6409. 〈http://www.nal.usda.gov/fnic/〉. [email protected].

International Food Information Council. 1100 Connecticut Avenue, NW, Suite 430, Washington, DC 20036. (202) 296-6540. Fax (202) 296-6547, 〈http://www.ific.org/〉. Email: [email protected]

La Leche League International. 1400 N. Meacham Road, Schaumburg, IL 60168-4079. (847) 519-7730. 〈http://www.lalecheleague.org/〉.

USDA Food and Nutrition Service. 3101 Park Center Drive, Alexandria, VA 22302 〈http://www.fns.usda.gov/fns/〉.

U.S. Department of Health and Human Services. 200 Independence Avenue, S.W., Washington, D.C. 20201. (202) 619-0257 or (877) 696-6775. 〈http://www.hhs.gov/〉.

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). 1600 Clifton Rd, Atlanta, GA 30333. (800) CDC-INFO. 〈http://www.cdc.gov/〉. Email: [email protected]

U.S. Department of Health and Human Services, CDC, National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD, 20782.(866) 441-NCHS (6247). 〈http://www.cdc.gov/nchs/〉. Email: [email protected]

Women, Infants, and Children. The Food and Nutrition Service Headquarters. 3101 Park Center Drive, Alexandria, VA 22302. (703) 305-2746.