Maternal Nutrition &

Infant / Childhood Nutrition

Zia Imran

What is a successful Pregnancy?

• Gestational period longer than 37 weeks.

• Birth weight greater than 2.5kg

• Sound nutritional status of mother at end of pregnancy i.e;non-depleted and with adequate stores for successful lactation.

WHY IS PRECONCEPTUAL NUTRITION SO IMPORTANT IN PROVIDING A NUTRITIONAL BASELINE FOR BOTH THE MOTHER AND THE DEVELOPING FETUS?

• An optimal level of nutrition during preconception period ensures that a women begins pregnancy with all necessary nutritional stores to produce substances required to maintain healthy pregnancy and support the developing fetus/embryo.

• Women who enter pregnancy in optimal nutrition state are more likely to have an uneventful pregnancy & deliver a healthy infant.

• Iron

The need for iron increases because of increased blood volume in pregnancy. In addition the fetus increases its hemoglobin level also.

The infants hemoglobin level is reduced to normal shortly after birth. The resulting iron is stored in the liver and is available when needed during the infants first few months of life, when the diet is

essentially the breast milk or formula.

Iron requirement for non pregnant 25 years + 15mg/day

Iron requirement for pregnant 30mg/day

Iron requirement for lactating 15 mg/day

• Nutritional Risk Factors At Onset Of Pregnancy:

1. -Adolescence

2. 3 or more pregnancies within 2 years

3. Poor reproductive performance

4. Poverty

5. Food faddists

6. Substance abuse:

I. Caffeine

II. Smoking

III. Alcohol

7) Chronic Systemic Disease (gestational diabetes)

8) Pre-pregnant weight

9) Anemia

Factors Affecting Dietary Practices Among (Adolescent) Pregnant Women.

Low income

Illiteracy

Low weight gain

Lack of knowledge regarding nutrition

Low dietary intake

Poor hygiene

Lack of water

Food faddism

Early marriage

Multiple pregnancies

FOOD FADDISTS

COMMOM MYTHS ABOUT NUTRITION DURING PREGNANCY.

• You can eat anything you want because you are eating for two.

• You can eat double portions because you are eating for two.

• You should eat whatever you are craving because your body needs it.

• You must take vitamins if you need healthy baby.

• If you crave sweet, the baby is going to be a girl. if you crave pickle, the baby will be a boy.

• Drink lots of coconut water if you want fair baby.

SUBSTANCE ABUSE

CHRONIC SYSTEMIC DISEASE

RECOMMENDED WEIGHT GAIN DURING PREGNANCY

Desired weight gain is based upon pre-pregnancy wt gain using Body Mass Index criteria and the pre-conceptual nutritional status of woman.

Under weight client(BMI < 19.8) should gain 28-40

lbs.

Normal weight clients(BMI 19.8-25)should gain 25-35lbs.

Over weight (BMI 26-29)should gain 15-25lbs.

Obese client (BMI > 29) should gain < 15 lbs. Average weight gain in pregnancy is 25-35 lbs.

• Average weight gain in pregnancy is 25-35 lbs.

1st trimester-------------------------2-4 lbs

2nd and 3rd trimester--------------1 lb/ week

2nd trimester---increase in maternal tissues

3rd trimester--- the growth of a fetus

Women falling outside the recommendations for ideal body weight at the start of a pregnancy are advised to adjust their weight gain during pregnancy accordingly.

• Under weight women are advised to gain more weight during pregnancy

• Overweight women are advised to limit weight gain during pregnancy;however,they are cautioned that pregnancy should not be used as a time for weight loss.

Causes of Iron Deficiency Anemia IRON DEFICIENCY ANEMIA

Low dietary iron intake Low iron bioavailability; •Non heme iron •Iron inhibitors

6/15/2015 Zia Imran

Some common causes in Pakistan: oPica oTea consumption oLow intake of eggs and red meat oLack of knowledge

PRUNES

• LACTATION::the process of milk production.

The chief function of lactation is to provide nutrition to the young after birth.

Breast feeding provides significant nutritional, health and psychological benefits to both mother and infant.

• Maternal requirements:

• Nutritional requirements for lactation are higher than at any other time in life; increase in calories,proteins,fluids,vitamins,and minerals are required to prevent loss of maternal stores during milk production.

Breast Feeding: Initiation of breast feeding within the first hour

reduced neonatal mortality rate. Therefore it needs to start in the first hour.

Breast feeding promotes the overall health of the

child and results in decreased childhood morbidity and mortality.

Early initiation of breast feeding colostrums

which contains antibodies and good bacteria to protect your baby from illness.

INFANT NUTRITION(0-12 MONTHS)

• Prelacteal feeds: • Any food except mothers milk provided to a newborn before

initiating breast feeding.

• Pre lacteal feed is a major barrier to exclusive breastfeeding.

• It is a prevalent practice in Pakistan.

Some common reasons for PLF

Perceived breast milk in sufficiency

Preventing dehydration,hypoglycemia,neonatal jaundice.

Cleansing and preparing the baby's gastrointestinal tract for digestion.

To flush the bladder

Rest the mother

Provide variety in baby's diet and because colostrum is thought to be too strong for the baby.

Prelacteal Feeds:

Mixture of honey,butter,liquid honey water

Glucose water

Ghee Animal milk

METHODS OF GIVING PRELACTEAL FEEDS

LICKS FROM FINGERS

COTTON WICKS

SPOON BOTTLES

Disadvantages of prelacteal feeds

Delays initiation of Breast feeding

Expose infant to infection

When fed by bottle infant less inclined to

suck at breast

Starting Solid Foods(Weaning)

• Do not introduce solids until 4-6 months of age, introduction before this time is inappropriate because of immature GI system.

• Early feeding exposes infant to food allergens; this may result in development of food allergies.

• Limited motor development makes feeding solids difficult.

Sequencing Of Food

• Infants cereals(rice)often are the first solid of choice because of increased iron and energy provided; single grain,precooked,partially hydrolyzed cereal is well tolerated by infant.

• Sequencing then leads to fruits or vegetables with meats being added last.

Rice cereal

Pureed vegetables

Mashed banana

Pureed meat

Introduction Of New Food

• Introduce new foods one at a time

• Offer a new food for 4-7 days before trying another.

• May be home made or commercially prepared.

• Offer 1-2 teaspoon of solids initially, increase amount over time.

• As amount of solid food increases, decrease the amount of formula.

Safety Aspects • At ages less than 4 yrs ,there is increased risk of choking.

• Preventive measures include; 1. Cook foods well; cut into small pieces

2. Never leave infant unsupervised when eating

3. Avoid hard round foods not easily dissolved in saliva such as grapes, raw vegetables, popcorns.

4. Do not permit infant to eat or drink when lying down.

5. Do not add cereal to bottle or increase the bottle nipple size—this can increase risk of aspiration.

• Avoid use of canned fruits or vegetables because of high sugar content)

• Refrain from using honey in foods or fluids due to risk of infant botulism.

Nutritional problems of infancy and

childhood

Malnutrition

Low birth weight

Iron deficiency anemia

Diarrhea

Colic

Allergies

Galactosemia

Allergies : One common is COWS MILK .Special formulas without cows milk

protein are available.

Food allergies can cause wheezing and difficulty in breathing, itchy skin rashes, vomiting nausea,diarrhea,abdominal pain.

Common cause is food intolerance of especially peanuts,fish,shellfish,egg(egg white),milk,soy wheat.

Many children outgrow these food sensitivities by the age of 1 or 2.It is important not to permanently exclude foods from the diet based on the first year experience.

Colic :common to some children.

• Children with colic pain cry regularly because of abdominal pain, which usually trouble children for the first few months. Children draw up their legs and cry in pain.

Causes :many contributing factors

• New born have immature digestive system, muscles that support digestion have not developed the proper rhythm for moving food efficiently.

• Certain foods eaten by lactating mother e.g;eating of cruciferous vegetables cauliflower), and gas producing foods.

• Infants often swallow air while feeding or strenuous crying which increases gas and bloating, further adding to their discomfort.

• By giving pain relieving drugs colic can be controlled.

• Swallowing of air can be controlled by making the child to eat slowly. After each feed the child must be burped to release the air sucked in while feeding.

Galactosemia :an enzyme required to convert galactose into

glucose is missing, if untreated infant will die.(galactose is a

simple sugar resulting from the digestion of lactose, the sugar found in milk. When the enzyme transferase is missing, and the infant ingests anything containing galactose, the amount of galactose in blood becomes excessive that is toxic.)

Clinical manifestations are diarrhea,jaundice,lethargy,vomitting,weight loss.

Is treated by eliminating all milk and lactose containing foods.

Feeding behaviors to avoid:

1. Giving cows milk during the first year.

• Whole milk, goats milk,1-2%fat milk, evaporated milk are

not advised during the first year of life.

• Ingestion of whole milk before 1 yr age has been associated with iron deficiency anemia due to low concentration and poor bioavailability of iron in cows milk; some studies have implicated that GI blood loss occurs with milk ingestion.

• Increased protein,sodium,potassium and chloride levels in cows milk increases renal solute load for immature infant kidneys: may cause dehydration.

2- Adding Cereal to the Bottle:

• Do not add dry cereal to the bottle s of formula as it can increase the aspiration potential due to increased swallowing pressure exerted by the infant to swallow the solution.

• Increasing the nipple size of the bottle can lead to further risk of aspiration

• Mix cereal with formula then introduce with a spoon; this facilitates development of chewing muscles and coordination.

3-Nursing Bottle Syndrome: • Nursing bottle syndrome or nursing bottle caries are

caused by ingestion of milk,juice,or other sweetened beverages by bottle at night or during naps.

• Dental caries,dental decay and erosion are due to bacterial action resulting from food substances remaining on dental enamel.

• To prevent nursing bottle syndrome: exclude nighttime bottle, replace sweet substance with water, avoid using bottles as pacifiers, and avoid adding sweet coatings to pacifiers.

Infantile obesity

SPECIAL NUTRITIONAL CONCERNS

Infantile Obesity: Treatment of obese infant should focus on weight

control rather than weight loss.

Calories offered should match the requirements of the normal weight infants, approximately:

40-60 kcal/lb for the first 6 months of life

35-55 kcal/lb for 6 months to 12 months

Foods of high density should be avoided

Never force feed to the infant

Overweight children are more likely to become obese adults than are children of normal weight.

Thank you