paediatric Nursing Nutrition in children
Knowledge of the nutrition in
children is important for the following:
It helps to provide best possible
nutrition to infants and children for their growth and development.
The diet should be sufficient in
calories, fluids, proteins, vitamins, and roughage. The food should be tasty
The feeding schedule should be
practiced to satisfy the children's appetite, digestibility, and requirement.
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:
Influence of environmental
Culture and habits
Food products available
Health and educational status of
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
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
Nutrition and Feeding - Infant
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
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, Bl,
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
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.
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.
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
The breast feeding provides close
physical contact between the neonate and the mother which provides
satisfaction. It provides an opportunity for infant-mother attachment.
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.
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.
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.
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.
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.
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.