Nutritional Consideration in infancy and

preschool years
 Objectives

• Identify the best feeding options for infants in

different circumstances in Pakistan.
• Identify the major nutritional risk factors and
strategies to prevent or manage them in the first
years of life and during the pre-school years.
• Weaning, Pre lacteal feeds, food introduce with
quantity and type.
• Counsel mothers regarding nutritional care of
the children.
 Best Feeding option
• Breast milk is best for the baby and should be the
first choice.
• Formula feeding is also an option if there are
social, medical or other constraints.
• Mothers should try to breast feed at least in the
initial 3-4 weeks, as most healthy antibodies are
transferred in the initial days.
 Cont….
• If formula feeding is to be done, combining it
with breast feeding should be considered.
• Breast feeding should be done first, followed
by formula feeding in this case.  
• If you plan to use formula for occasional
feedings, limit bottles to one per 24 hours to
avoid slowing your milk production.
• Cow or Buffalo milk should not be introduced
to the baby before at least one year of age.
 ABOUT EARLY CHILDHOOD CARE

• Healthy habits are taught to the child right from

birth. In fact, health of the baby is decided even
before his birth - Healthy child is born to the mother
who kept to healthy food habits during her
pregnancy.
• Children often take the attitudes and habits formed
during their initial years, into adulthood. Learning
healthy eating behavior at an early age is very
important to lay a good foundation for the future
health of the child.
 BREAST FEEDING
• Exclusive till 6 months of age
• Species specific - suitable, natural, warm, free of bacteria
and readily available.
• Colostrum - rich in antibodies. Baby develops immunity.
• Contains easily digestible proteins, CHO and fats.
• Very rich in vitamins compared to cow’s milk
• Stimulates development of personality and behavior
( brain dev./ cognitive dev.)
Composition of milk (per 100 ml)
Nutrients Human Cow Buffalo
(gm)
CHO 6.8 5.0 4.5

Protein 1.5 3.5 4.3

Fat 4.0 3.5 7.5

Energy 68 66 103
 WEANING
• The process of introducing semi-liquid to semi-
solid foods other than breast milk.
• Consistency, frequency of food, calorie density
and nutrient density need to be monitored
closely.
• Hygiene
 When to start weaning

• At 6 months of age (WHO recommends)

Complementary feeding initiated and Supplementary to
breast milk started.
• Less milk output (malnourished mother)-----
underweight child------ initiate weaning early (at 5
or 6 months of age).
• Continue breast feeding (frequency and amount
reduced)
 Reasons for Starting Weaning at 6 Months

1. Breast-feeding becomes inadequate to meet the child

nutritional needs particularly in relation to iron and vit.C.
2. Enzymes necessary to digest the complex structure of
solid food are developed.
3. Biting is an accomplishment that becomes possible at
about 6 months of age.
4. It is a good chance for child to learn independency by
using cup and spoon to feed himself.
5. To accustom the infant to chew and swallow solid food.
 Critical/ crucial period
- each month is different till one year of age.
•Weaning at proper time
•Transition from liquid to solids -- gradual
•Frequency from 10 feeds per day (breast feeding)
to 6-7 feeds per day -- gradual
•Small amount but frequently.
•Once the critical stage of learning a particular
behavior is over, it is difficult to teach that behavior
at a later stage.
 Principles of Weaning
1. Start weaning when the child is free from any disease
particularly from any G.I.T. troubles.
2. Don’t start in summer because of the high susceptibility
to gastro-enteritis.
3. One-food item is introduced at intervals of 4-7 days to
allow for identification of food allergies and to allow the
child to get used to it.
4. New foods are fed in small amounts, from one teaspoon
to a few tablespoons, put the spoon midway back on
tongue to facilitate swallowing of semi-solid food.
 How to initiate weaning and progress
• Consistency: Introduction of right consistency of food
at the right age is important to develop good food
behaviors.
Essentially follow the sequence :
• Breast feeds (0-6 months)
• Semi-liquid (after 5-6 months) Easy to digest, smooth
and gentle on baby’s stomach.
• Semi-solid (after 8-9 months) Baby now needs food with
taste and texture.
• Semi solid (after 10 months) Baby now needs food that
satisfy his urge to chew-complex taste and texture
• Solid diet including variety of food items (1--1.2 years).
 How to initiate weaning and progress

Frequency:
• Energy requirement on a per kg basis, is 3 times more
than the adults in infants and 2 times more than the
adults in case of children till 2 years of age.
• Children have to be fed frequently since they can eat
small amount at a time due to their little capacity.
Till 5-6 months - child is given breast feeds on demand i.e.
9-10 times over 24 hours.
From 6- 8 months - As the child grows, his requirements
increase and he starts to accept larger volume and
thicker consistency at a time - feed him 7-8 times/d
 Cont…..
From 9- 12 months - child normally eats 6-7 times per day.
By 12 - 15 months - child eats at least 6 times per day.
By 18 months - child’s eating schedule of 5-6 times /day
gets fixed
3 regular meals – Breakfast, Lunch and dinner and
3 in-between healthy snacks – midmorning (recess time),
evening &
bedtime
 What to feed?

• Liquid supplements - Supplement breast

milk with undiluted cow’s milk, buffalo’s
milk, or whichever is easily available.
• Semi liquid to semisolid supplements -
Powdered rice, mashed banana, boiled &
mashed potato, suji, daliya, sabutdana,
boiled & mashed vegetables, washed dals,
khichri etc.
 Things to remember
Nutrition Plan
• Develop the baby’s taste buds gradually.
• Easy to digest -- consistency
• Well-balanced diet
• Convenient: Easy to prepare & affordable
• Hygienic
• Patience to feed
• Availability of food items
 Things to remember
Nutrition Plan
• Likes and dislikes of the child - nothing is a must.
Allow your child to dislike certain foods.
• Introduce one food at a time
• Food fads - hot and cold foods/ light and heavy foods
• Food fads - fats and sweets - not to be restricted
• Artificial milk formulas/ commercial formulas are
not recommended
 Faulty feeding and malnutrition
• Feeding on artificial milk formulas -
reconstituting wrongly.
• Feeding on diluted fresh milk
• Breast feeding for a long time
• Delayed weaning
• Feeding via dirty feeding bottles
• working mothers VS non-working mothers
Preparation of feed

• Wash hands before preparing

baby’s feed.

• Boil drinking water for 5

minutes or milk. Leave it till
it’s lukewarm.
 Preparation of feed
Important Precautions:
• Use only clean utensils
• Use prepared feed within an hour
• Discard unused feed

After the initial phase of hard work by the mother, there

will be no need of forcing, coaxing, fussing or running
after the child to eat food. It will be very natural for him to
eat at all meal times and adequately.
 Counseling

• Health education campaign stresses many

advantages of breast feeding.
• Promote breast feeding as it is effective in nutrition
and prevention of diseases.
• Mothers should be encouraged to continue breast
feeding for as long as possible.
• Mothers need to be educated that the child does
not require anything during exclusive breast
feeding of first 5—6 months—even no water as it is
enough in the milk.
Essential Nutrition Actions(ENA)
Toddler and Preschooler
Nutrition
25
 Normal Growth & Development
• Infants triple birth weight
in first 12 months, but
growth slows after that
• Toddlers gain 0.5 lbs and
0.4” per month
• Preschoolers gain 4.4 lbs
and 2.75” per year
• Decrease in growth rate
accompanied by decrease
in appetite and food intake 27
 Factors Affecting Growth
• Growth is one of the best indicators of good
health and nutrition in children.
⮚ Family History
⮚ Gender
⮚ Nutrition
⮚ Sleep
⮚ Health Status
 Planning diet
• Choosing a variety of foods
• Serve small portions
• Choose healthy snacks
• Choose healthy diet
• Children need to be offered food at intervals
not less than 2 hours, and not more than 3
hours apart (unless the child is asleep).
 Caloric Needs of Children
Food 02 year old 05 year old 10 year old
Groups:
Energy 1000 1400 1800
(Calories/d)
Fruits 1 cup 1.5 cups 1.5 cups
Vegetables 1 cup 1.5 cups 2.5 cups
Grains 3 OZ 5 OZ 6 OZ
Meat 2 OZ 4 OZ 5 OZ
Milk 2 cups 2 cups 3 cups
Oil 3 tsp 4 tsp 5 tsp

Texas Education Agency, 2012.

 Child Malnutrition
Can Cause:
•Seizures
•Bone disease
•Reproductive problems
•Depression
•Poor self esteem
•Death
 Food Preferences
• Their own food habits and food preferences are
established at this time.
– Influenced by parents, caretakers, peers, siblings, TV
– Spending more time away from home (day care,
preschool)
• At this age, children generally do not like:
– strongly flavored vegetables
– Spicy, sour, or bitter food
• Children naturally prefer sweet and slightly salty tastes
• Coercing or forcing children to eat foods can have a
long-term negative impact on their preference for
these foods.
 Tips for Parents
• Avoid distractions (ie: TV) during mealtimes.
• Allow their toddlers to practice self-feeding
skills and to experience new foods and
textures (no matter how messy!)
• Risk of choking high at this age
– Toddlers should always be seated during
meals and snacks
– Foods that may cause choking: hard
candy, popcorn, nuts, whole grapes.
Things to Remember for Young Children

1. Serve in very small amounts, encourage to ask for

second helping.
2. Serve attractively.
3. Give older child some freedom to choose food and
to eat in his own way.
4. Don’t allow drinking all milk first.
5. Don’t with hold food for punishment.
6. Don’t hurry child.
7. Don’t insist that a child “eat all this “ before he can
have any of that.
8. Spices have no nutritional value and shouldn’t be
added to children’s food.
9. By 8-12 months, the baby should be trained to drink
from cup.
10. By 12-14 months, the child may be taught to use
spoon. Spilling will occur at first but will gradually
decrease with practices. By 2 years, child can be
taught to spoon-feed himself.
11. The use of fork is not recommended before the age of
3 years.
 Things to be Avoided
1. Food that cause chocking as nuts, fruits with seeds,
potato chips, etc…
2. Food that produce allergy as fresh milk, fish, tomato,
etc….
3. Artificial colors and flavors foods.
4. Salted food might cause hypertension.
5. Junk food as sweets, candies that deprive the child
from taking more nutritious food and encourage the
desire for sweets.
6. Highly spiced and fatty food.
 Nutritional Risks
• Malnutrition is one of the great
• iniquities and social injustices
• of our age. Every minute of
• every day, four children die because
• of malnutrition
• .1 Of those children that
• survive, one in four are stunted, their physical and
• mental growth permanently damaged by the lack of
• nutritious food.
• Adequate nutrition is as critical as clean water
and as indispensable as education to human
development.
• Nutritious food is essential for every child’s
physical and intellectual development.
• First 1,000 days
• The most critical time in a child’s development
• is the first 1,000 days from conception to their
• second birthday. These first days are the window of
• opportunity to ensure that children survive, flourish
• and fulfil their potential.
• Preventing malnutrition in a child begins with the
• mother. The health of the mother is critical to the
• future health of her child. A child’s development
• inside the womb is affected if their mother is
• malnourished. During pregnancy, a woman needs
• nutrients like iron, iodine and calcium for the healthy
• development of her child. After birth, exclusive
• breastfeeding for the first six months of a child’s
• life is the best nutrition for a baby. Increasing rates
• of breastfeeding can dramatically reduce deaths
• of babies. Babies who do not breastfeed are more
• than 14 times more likely to die from diarrhoea
• or respiratory infections than babies who are
• exclusively breastfed for the first six months
•
• Mothers and children both need sufficient
nourishing
• food. The education, empowerment and
involvement
• of women is essential if we are to enable
every child
• to have the opportunity to survive and
flourish.