Preventive paediatric Nursing Nutrition in children

Preventive paediatric Nursing Nutrition in children

Knowledge of the nutrition in children is important for the following:

1.     It helps to provide best possible nutrition to infants and children for their growth and development.

2.     The diet should be sufficient in calories, fluids, proteins, vitamins, and roughage. The food should be tasty and attractive.

3.     The feeding schedule should be practiced to satisfy the children's appetite, digestibility, and requirement.

4.     Nutritional requirements of children depend on the rate of growth of different body tissues and children's sex, age and health status.

Assessment of nutritional status of children is important in total health assessment.

Healthy children are full of energy and are active. Their growth and development are according to the expected norms and show no nutritional deficiency. Adequate nutrition is essential to maintain optimum health.

Assessment of height and weight:

Weight for age has been used as an index of malnutrition. Extent of height deficit, in relation to age, indicates the duration of malnutrition. Weight for height is the index regarded as an index of current nutritional status. The following factors should be considered while assessing the nutritional status:

1.     Influence of environmental conditions

2.     Culture and habits

3.     Food products available

4.     Socioeconomic condition

5.     Health and educational status of parents

The child with adequate nutrition is characterised by an erect posture, firm muscles, straight legs and spine, well-formed teeth, bright eyes, and optimum height and weight for the child's age. Poor nutritional status is characterised by sagging posture, round narrow shoulders, flat chest, abdominal protuberance, curved spine, poor muscle tone, dull hair, dull eyes, knock knees, and under weight for the child's age.

Importance of nutrition in sick children:

Sick children need food so that they can fight infection without using all the nutrients reserved in the body. Sick children may not feel hungry. If they consume adequate diet, their symptoms are usually less severe than those of undernourished children.

For the sick children, small frequent feeding should contain nonirritating, easily digestible, adequate in quantity, and adequate in quality. For example, cereal gruels, milk, tender fish, soft cooked egg, and non-fibrous fruits, such as banana may be given to the sick children.

During the recovery, children should be given additional calories and proteins to make up for the deficiency that occurred during the illness.

Nutrition and Feeding - Infant nutritional requirement:

The neonate's immature organ system and the unparalleled growth of the early period, of life impose special requirements for nutrients and fluids. These factors also limit the types and amounts of foods a neonate; can ingest and digest. Neonates diet must contain sufficient amount of carbohydrates, proteins, fats, vitamins, minerals and fluids.

Feeding of energy giving food:

Three basic nutrients, namely carbohydrates, proteins, and fats supply the body's caloric needs. Proteins promote cellular growth and maintenance, aid a metabolism, and contribute to many protective substances. Fats provide concentrated energy storage,  transport essential nutrients (such as fatty acids needed for neurological growth and development), and insulate vital organs.

Carbohydrate, which contain four calories per gram, should provide 35% to 55% of the neonate's total calories; fats that contain nine calories per gram 30% to 55%; and proteins, which contain four calories per gram, the remaining calories.

Vitamins and minerals:

Vitamins regulate metabolic processes and promote growth and maintenance of body tissues.

Fat soluble vitamins (A, D, E, and K) in excess can be stored in the body to some extent and normally are not excreted; therefore reserve, may accumulate.

Water-soluble vitamins (C, B_l, B₂, B₆, B₁₂, niacin, folic acid, pantothenic acid, and biotin) are stored only in small amounts. Consequently if these vitamins are not ingested regularly, deficiencies may develop relatively quickly.

All major minerals and trace minerals are essential for a wide range of body functions, including regulation of enzyme metabolism, acid-base balance, and nerve and muscle integrity. Calcium and iron arc particularly important for growth -calcium for the rapid bone mineralisation of the first year and for haemoglobin synthesis.

Fluid:

The neonate's difficulty in concentrating urine plus, a high extra-cellular water content result in a much greater need for fluid (150 milliliters / kg / day) compared to the adult (20 to 30 milliliters / kg / day).

The neonate has limited gastric capacity. Also, fat absorption does not reach adult level until ages six to nine months. For the first month limited splitting of the starch salivary enzyme ptyalin and absence of pancreatic amylase restrict digestion of complex starches found in solid foods.

Although the basic components of the neurological system are present at birth, myelination is incomplete. Only breast milk, infant formula and whole milk contain enough linoleic acid to facilitate myelination. Therefore, the milk that contains less than 2% milk fat is not recommended before age of one year.

Breast Feeding:

Human milk is considered ideal for a neonate. Breast milk is natural ready made food most suitable feed for the neonate.

Advantages of the breast feeding

1.     The breast feeding provides close physical contact between the neonate and the mother which provides satisfaction. It provides an opportunity for infant-mother attachment.

2.     Human milk is available at the required temperature in required strength and is fresh and free from contamination as it directly comes in the baby's mouth.

3.     Human milk contains more lacto albumin, a more complete protein than casein because of its high percentage amino acids. It is more easily digested because of soft curds. Therefore, stomach emptying is rapid and thus requires frequent feeding.

4.     Extra lactose helps in synthesis of certain vitamins. It also contains a high amount of crystine, an amino acid that may be essential during the neonatal period.

5.     Human milk contains higher amount of lactose, a disaccharide, which is converted into monosaccharide glucose and galactose. Galactose is essential for the growth of the central nervous system. Unsaturated fatty acids in the human milk help absorption of fat and calcium in the neonate. Iron in human milk is absorbed better in the neonate.

6.     The human milk contains increased amount of antibodies, immunoglobulin A (IgA), which gives immunity to the neonate against certain diseases. These antibodies are present in a high amount in the colostrum than in mature milk. In the intestines, it acts against bacteria and viruses. Lactoferin also inhibits the growth of bacteria.

7.     It contains lacto albumin bifidus, which help in suppressing E-coli. Lactobacillus bifidus help to produce lactic acid, to prevent bacterial growth and make the stools acidic.

Early breast-feeding helps the mother in rapid involution of the uterus and lesser chance of breast cancer.