Nutritional & Food Requirements for infants
Body composition: At the time of birth the child has 75% water and 12-15% fat. By the end of 1 year the water content decreases to 60% and fat increases to 24%. Muscles also start developing.
Changes in the body:
(a) Rapid heart rate of about 120-140 beats / min.
(b) Hemoglobin level in well nourished infants is about 17-20 gm / 100 ml
(c) Almost completely developed digestive system and so they are able to digest protein, emulsified fats and simple carbohydrates like lactose.
(d) Salivary secretion and gastric acidity are low till about 3 months.
(e) Salivary amylase secreted after 6 months and so rice and other starchy foods should be given after this period.
(f) Kidneys reach their full functional capacity but glomerular filtration rate is initially lower.
(g) The increase in the number of brain cells is most rapid during foetal life and in the first 5-6 months after birth.
Nutritional Requirements:
During infancy the fantastic rate of growth requires proper nutritional support. Since an infant mainly thrives on breast milk so his nutritional demands are mainly met by this. The RDA proposed by ICMR for infants is as follows
Energy: (a) Infant requires 108 kcal/kg body weight as compared to only 40 kcal/kg body.
(b) For a one month infant, 50% of the energy is used for basal energy, 25% for activity and 25% for growth.
(c) About 70 of calories can be obtained from milk alone and the rest have to be supplied by supplementary foods after 6 months.
(d) Excess calorie intake for a prolonged time period may lead to obesity whereas a low intake may lead to PEM, both considered as malnutrition.
Protein: (a) Infants require a large intake of protein for skeletal and muscle growth, cell division and activities.
(b) The general protein intake is about 2 gm / kg body weight.
(c) Breast milk supplies all the essential and non-essential amino acids that are needed for the infant.
(d) Human milk protein is 100% utilized. Its protein content is 1.1 gm / 100 ml or 6% of total energy.
(e) Excess protein intake leads to unnecessary burden on the kidney, ultimately resulting in kidney damage.
(e) If protein requirement is not met, the infant may suffer from kwashiorkor or marasmus, both clinical manifestations of PEM.
Fat: (a) Linoleic acid is the most important essential fatty acid for an infant.
(b) Essential fatty acids (EFA) should contribute about 3% of the total energy (3.en %) which can be satisfied by an intake of about 10 gm / day visible fat.
(c) Fat requirement can be met by consumption of human and cow milk.
(d) Although fats improve palatability, contribute fat-soluble vitamins and perform various other important functions, a high intake of fat may lead to accumulation of adipose tissue due to their high calorie density.
Minerals:
Calcium and phosphorus: (a) Macro-minerals like calcium and phosphorus are needed b by the Infant in large amounts due to mainly for the Rapid skeletal and Dental growth and other body processes.
(b) Rapid calcification of bones occur after birth, for which a steady supply of these two minerals is necessary, or else bone disorders like rickets may result and delayed motor development.
(c) Breast milk has a Ca: P ratio of 2: 1 which is desirable for maximum absorption.
Iron: (a) The RDA of iron for an infant is 1 mg/kg body weight starting from 3 months.
(b) At birth, the body of an infant contains about 75 mg/kg of iron.
(c) During the first 4 months, the baby's blood volume doubles and concentration of iron in hemoglobin falls to about half that present at birth, So, iron intake is also needed along with the iron stores to meet the high demand.
(d) Low birth infant requires iron much earlier in life compared to normal infants.
Zine: (a) Zinc is an essential element for several enzymes and thus it is needed in correct proportions. It acts as a cofactor for move than 2000 different enzymes in the body.
(b) It is necessary for brain development also.
(c) It is present in colostrum of breast milk and so infants fed on breast milk do not usually need any supplementation.
Sodium and Potassium: (a) The balance between these two electrolytes is one of the most important factors that regulate body metabolism.
(b) Sodium is a micromineral needed for a number of metabolic processes. The sodium present in breast milk is adequate for the infant. Excess sodium is detrimental to health.
(c) Intracellular and extra-cellular levels of these two minerals need to be maintained
Iodine: (a) Correct iodine level, in mothers, is an important factor for proper pregnancy and its desirable outcome.
(b) Iodine is associated with proper physical and mental growth and development. Iodine deficiency can lead to Iodine Deficiency Disorders (IDD) which include cretinism, deaf mutism, mental retardation, etc.
Vitamins:
Fat-soluble Vitamins:
Vitamin A: Usually the vitamin A content of breast milk is sufficient if the mother's diet is adequate. A healthy infant has sufficient store of vitamin A in the liver which may last for about 6 months. Excess vitamin A can lead to anorexia, hyper-irritability and desquamation of skin. Egg yolk is a good weaning food as it is rich in vitamin. A. The RDA of vitamin A is 350ug which can be fully supplied by breast milk if the mother's diet is adequate.
Vitamin D: This vitamin is needed for utilization and retention of calcium and phosphorus. Milk is not a good source of this vitamin. Exposure to sunlight helps in the vitamin D synthesis, especially in the tropical countries. About 200-400 IU of vitamin D is needed by the infant.
Vitamin E: Infants need about 5 IU of vitamin E in the first year of life. Milk is a poor source of vitamin E.
Vitamin K: New born babies are susceptible to hemorrhage caused by vitamin K deficiency. If necessary, a single dose of I mg of water miscible form of vitamin K may have to be administered.
Water - soluble Vitamins:
Vitamin B complex: Vitamins B1, B2 and niacin are the "calorigenic vitamin" since they are needed for production of energy from nutrients by acting as cofactors in the metabolic reactions. Vitamin B6 or pyridoxine is necessary for proper protein metabolism. Folic acid and vitamin B12 are the "blood forming" vitamins. All these are needed for the infant for proper growth and development.
Vitamin C: Vitamin C is a potent antioxidant vitamin. It is present in breast milk in low amounts. But since breast milk does not have to be heated, therefore the total vitamin Cis available Deficiency of vitamin C can lead to scurvy. Fruit juices can be supplemented in the infants diet during weaning.
ICMR recommended dietary allowances for infants:
|
Nutrients |
|
Months |
|
|
0-6 |
6-12 |
|
Body
weight(kg) |
5.4 |
8.6 |
|
Energy(kcal/kg) |
108 |
98 |
|
Protein(g/kg) |
2.05 |
1.65 |
|
Calcium
mg |
500 |
500 |
|
Vitamin A
(ug) |
350 |
350 |
|
Β carotene (ug) |
1400 |
1400 |
|
Thiamin (ug) |
55 |
50 |
|
Riboflavin
(ug) |
65 |
60 |
|
Niacin (ug) |
710 |
650 |
|
Pyridoxine
(ug) |
0.1 |
0.4 |
|
Vitamin C
(ug) |
25 |
25 |
|
Folic
acid (ug) |
25 |
25 |
|
Vitamin
B12 (ug) |
0.2 |
0.2 |
Problems of Infancy: Infancy is a phase of life which is marked by tremendous changes. The problems of infancy can be categorized as follows:
(A) Nutritional Problems: These problems are precipitated due to nutritional deficiencies.
1. PEM: Protein energy malnutrition or protein calorie malnutrition is a common feature in infancy in any developing country. PEM is a spectrum of diseases with varied clinical signs. The five distinct clinical types of PEM are-
Kwashiorkor: Edema is the main feature due to protein deficiency. The child look healthy generally.
Marasmus: Calorie deficiency is mainly followed by protein deficiency. The child is severely emaciated with very less body weight.
Nutritional dwarfing: There is generalized stunting of growth and the total height is much reduced.
Marasmic kwashiorkor: Both the symptoms of kwashiorkor and marasmus are present. This is the most common type of PEM seen is India.
Under weight: This is another very common condition seen in PEM. The weight generally is lower due to a total deficient intake of food.
2. Anemia: Iron deficiency anemia is the most common childhood nutritional deficiency worldwide, especially in developing countries. The consequences include delayed motor and cognitive development caused by irreversible brain injury.
Although the infant is born with proper iron stores in the liver, this is used up in the first few months. So, iron has to be supplemented as soon as possible. Moreover, anemia may also be due to folic açid and vitamin B12 deficiency.
Rickets and other bone diseases: Since infancy is the time period where rapid growth of bones take place, dentition is developed, and metabolism is continuous, the need for calcium and phosphorus along with vitamin D and other factors are more pronounced. Deficiency can lead to rickets and other bone disorders, which are usually visible when the infants starts to walk and the body weight falls on the weight-bearing bones.
(B) Feeding problems: There are several feeding problems seen in infancy since this is the time and the infant is learning to eat. The common problems include-
1. Tooth decay due to bottle feeding
2. Colic (severe crying in infants due to some unknown causes, usually abdominal distress)
3. Wind
4. Vomiting / Posseting
5. Cleft palate, hare lip and other structural abnormalities.
6. Over and under feeding.
(C) Other Problems:
1. Low birth weight: Low birth weight is defined as the birth weight less than 2-5 kg (in developing countries). Low birth weight infants may be of 2 types-
(a) Preterm: Preterm babies are those who are born before 37 weeks of gestation and are under weight due to shorter duration of gestation, than full term
(b) Small-for-gestational age ( SGA) / Small-for-date (SFD): These babies are born at term but their growth is much less than the other infants born at term. Their weight is much reduced due to intrauterine growth retardation (IUGR) or any other causes. This is more serious than preterm condition.
2. Diarrhea and dysentery: Since infants have an immature digestive system, they are often prone to diarrhea and dysentery. These conditions are usually not severe but may be so if dehydration sets in. It can be treated with oral rehydration solution (ORS) and breast milk can be continued.
3. Constipation: This is more common in artificially fed infants due to large protein intake of less fluid intake.
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