Pediatric Nutrition

“Normal” Nutritional Requirements…

• Differ based on age, developmental stage, weight, and activity level.

  • Infants (0 to 12 months)

  • Toddlers (1 to 3 years)

  • Preschoolers (3 to 6 years)

  • School-Age Children (6 to 12 years)

  • Adolescents (11 to 20 years)

• Adequate nutrition is essential for growth and development.

Infant Nutrition

• Encourage breastfeeding until 6 months of age.

• Formula Feeding:

  • Most formulas are 20 kcal/oz but can go up to 30 kcal/oz.

• Types of Formula:

  • Standard Cow Milk Formula

  • Partially Hydrolyzed

  • Fully Hydrolyzed

  • Amino Acid-Based

  • Soy (also Lactose-Free)

• Introduction of Solid Foods:

  • At 6 months of age, assess readiness for solid foods.

  • After 6 months, finger foods can be introduced.

  • New foods should be introduced every 4 to 7 days to monitor for allergies.

  • Foods should be introduced in this order: fruits → vegetables → meat → eggs → citrus.

  • Rice cereal, baby foods, and finger foods can be introduced at this time.

• Transition to Whole Milk & Cup:

  • At 1 year of age, whole milk can be introduced.

  • Introduce a sippy cup at age 1 and phase it out by 18 months.

Nutrition: Breastfeeding

• Breastfeeding or feeding of expressed human milk is recommended for all infants, including sick or premature infants.

• Breastfeeding Statistics (2019):

  • 83.2% of infants started out receiving some breast milk.

  • 78.6% were receiving breast milk at 1 month.

  • At 6 months, 55% of infants received any breast milk, and 24.9% received breast milk exclusively.

• Composition of Breast Milk:

  • Includes lactose, lipids, polyunsaturated fatty acids, and amino acids.

  • The concentration of iron in breast milk is lower than that of formula but has increased bioavailability, usually meeting the infant’s needs for the first 4 to 6 months.

• Monitoring Input & Output:

  • Input is estimated based on feeding time, weight, and wet diapers.

  • Adequate output is approximately 1 mL/kg.

Toddler Nutrition

• Establish healthy eating habits early.

• Weaning from breastfeeding is an individualized decision.

• Wean from the bottle around 12 to 15 months while ensuring adequate calcium intake.

• Toddlers are picky eaters—avoid substituting unhealthy foods just to get them to eat.

• Serve foods at room temperature in bite-sized pieces.

• Encourage self-feeding and promote water intake.

• Transition from whole milk to 2% if the child is tracking appropriately on the growth curve.

Preschooler Nutrition

• Quality of food consumed is more important than quantity—primary teeth are present at this stage.

• Continue to build and reinforce healthy eating habits.

• Parents should maintain positivity, patience, and offer choices to encourage healthy eating.

• Avoid substituting unhealthy foods if the child is not eating as much as expected.

• Obesity is a concern in this age group—according to the National Health and Nutrition Examination Survey, 13.9% of 2- to 5-year-olds are obese.

School-Aged Child Nutrition

• Children should consume fewer calories as their growth rate slows.

• Common influences on eating habits include family, friends, and media.

• Obesity is more prevalent in this age group.

• Limit fat and processed sugar intake.

• Avoid using food as a reward.

• Encourage children to be involved in making healthy food choices.

Adolescent Nutrition

• Desire for independence influences food choices.

• Educational support on nutrition is essential.

• Increased need for zinc, calcium, and iron.

• Higher calorie intake is required for growth and sexual maturation.

• Nutritional support is important for managing disorders at this age.

Eating Disorders

• Anorexia Nervosa: Body image disturbance leading to extreme weight loss.

• Bulimia Nervosa: Cycle of normal food intake followed by purging.

Complications:

• Fluid and electrolyte imbalance

• Decreased blood volume

• Cardiac arrhythmia

• Esophagitis

• Rupture of the esophagus or stomach

• Tooth loss

• Menstrual problems

Nursing Considerations:

• Restoration of fluid and electrolyte balance

• Encourage family involvement

• Prevent complications

• Provide referrals to resources and support

Failure to Thrive

Inadequate growth resulting from the inability to obtain and/or use calories for growth.

• Can be organic (e.g., GERD, malabsorption, cardiac conditions, increased metabolic needs) or inorganic (e.g., lack of education or resources).

• Little to no weight gain.

• Weight/age falls below the 5th percentile.

Nursing Management:

• Provide education to caregivers.

• Conduct a thorough assessment of nutritional intake and growth patterns.

• Serve as a role model for healthy feeding practices.

• Increase caloric intake for catch-up growth.

• Implement multidisciplinary care (e.g., nutritionists, social workers, therapists).

• Document progression and response to interventions.

Note: The patient may or may not appear malnourished.

Common Food Allergies

• Cow’s Milk

• Peanuts

• Wheat

• Eggs

• Fish

• Shellfish

Obesity in Children and Adolescents

For children and adolescents aged 2-19 years in 2017-2020, the prevalence of obesity was 19.7%, affecting about 14.7 million individuals (CDC, 2024).

• Overweight: BMI at or above the 85th percentile

• Obese: BMI at or above the 95th percentile

Two-part issue:

• Diet

• Exercise

Providing Nutritional Support: Enteral Nutrition

• Routes: NG, NJ, OG, G-Tube

• Functioning GI tract but cannot ingest nutrients orally.

• Cost-effective, safer than parenteral nutrition.

• Bolus or continuous feeds.

Special Considerations:

• Correct measurement

• Placement verification

Providing Nutritional Support: Parenteral Nutrition

• TPN (Total Parenteral Nutrition)

• Highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals.

• TPN is given centrally, not peripherally.

• Long-term use is not typical.

• Complications include:

  • Air embolism

  • Electrolyte imbalance

  • Infection