NUTRITION WEEK 5

nutrition in pregnancy

Always start with the diet history when it comes to giving nutritional instructions to the mother

PICA

persistent ingestion of inedible substances of little nutritional value

vegetarians

lack essential protein and minerals, need Vitamin B12 supplement

1,800 to 2,200 Kcal/day

non-pregnant requirements for calorie allowances

300Kcal/day

additional caloric requirement per day

2,100 to 2,500; never less than 1,800 Kcal/day

usual daily caloric need in pregnancy

25 to 35 lbs

maternal weight

maternal underweight

this is caued by having high risk of low birth weight, preterm and infant deaths

maternal overweight

this is caused by having risk of complications in labor and delivery, hypertension, gestational DM, post partum infections

additional 30 g/day to ensure 74 to 76 g/day

protein allowances for body-building food

milk, meat, fish, poultry and eggs

protein allowances, rich food sources include:

- provide for the storage of nitrogen

- Protect the mother from any complications

- growth for the maternal uterus, mammary tissues, and placenta

- needs for fetal growth and repair

- hormonal preparation for lactation

why protein allowances important as body-building food

carbohydrates

sufficient intake of this is necessary for added energy

“empty” calories like soft drinks

what do we avoid under carbohydrates?

fats

high energy foods for absorption of vitamins ADEK

too much fats to prevent vomiting and heartburn

what to avoid under fats

iron

most important mineral that must be taken in supplementary amount

30-60mg per day

how many iron supplements should a woman in pregnancy take

iron

needed to increase maternal RBC and for fetal liver storage in the third trimester

calcium

needed for maternal calcium and phosphorous metabolism and fetal bone and skeletal growth

1,200 mg/day, equivalent to 1 quart of milk a day (4 glasses)

how much calcium should a pregnant woman take?

sodium

• most abundant cation in extracellular fluid

• needed for tissue growth and development

• should not be restricted without serious indications

iodine

needs for fetal development and avoid cretinism

vitamins

water and fat soluble vitamins

11.2-16 kg (25 - 35lb)

Average weight gain in pregnancy

month

1lb per __ weight gain during first trimester

week

1lb per __ weight during 2nd and 3rd trimester

2,500

calorie needs

2,200

for woman in childbearing age (calorie needs)

300

for women in pregnancy (calorie needs)

1,500

Even an OBESE pregnant should never consume LESS than how calories per day

weight

the most accurate indicator if the woman has adequate caloric intake

44g - 46g

women in childbearing age (protein needs)

60g

for pregnancy (protein needs)

nausea and vomiting

- Eat dry crackers before rising in bed

- High CHO, Low FAT diet

- Small, frequent feedings

- NEVER self-medicate, esp. antacids

vitamin A for pregnant women

preparation: 10,000 IU

dose: 1 capsule (10,000 IU) TWICE a week

duration: Start from 4th month of pregnancy until delivery

remarks: NOT give if woman is taking micronutrient supplements with Vitamin A

vitamin A for post-partum women

preparation: 200,000 IU

dose: 1 capsule 200,000 IU

duration: 1 dose within 4 weeks after delivery

remarks: NOT given to PREGNANT women

vitamin A for pregnant women with night blindness

preparation: 10,000 IU

dose: 1 capsule once a day

duration: 4 weeks upon diagnosis

remarks: Can be GIVEN regardless of AOG if the woman has night blindness

vitamin b9 for pregnant women

preparation: 60mg iron/ 400mcg folic acid

dose: 1 tablet Once a day

duration: for 6 months or 180 days during the pregnancy period

remarks: A dose of 800 mcg folic acid is still SAFE for a pregnant woman

vitamin b9 for lactating women

preparation: 60mg iron/ 400mcg folic acid

dose: 1 tablet Once a day

duration: for 3 months or 90 days

1,200 - 1,500 mg

calcium for mineral needs

eat high CHON

phosphorus for calcium needs

For fetal skeleton and teeth formation

purpose of calcium and phosphorus

iodine

175 ug daily during pregnancy, Iodized salt

Serving of seafood at least once a week

iodine

Essential for formation of thyroxine

30mg - OB (piliteri)
60 mg - CHN (DOH)

mineral needs for iron

iron

Prevents IDA in pregnancy

zinc

Necessary for the synthesis of DNA and RNA

15mg

mineral needs for zinc

heartburn (pyrosis)

- Small frequent meals

- Don’t lie down immediately after eating

- Amphojel (Aluminum hydroxide) or Maalox may be prescribed

Maalox = Aluminum hydroxide + Magnesium hydroxide

formula for maalox

mother’s milk

best food for the baby

vaginal delivery

breastfeeding may done as early as 30 minutes after birth

CS delivery

breastfeeding 4 hours after delivery

demand feeding

best rule to observe when feeding the baby

letdown reflex

Provide a relaxed, warm and supportive environment as the ___ is affected by negative emotions of the mother

CHO, fat, lactose and water content

breast milk is higher in? (than in cow’s milk)

protein, vitamins, and minerals

breast milk is lower in? (than in cow’s milk)

lactalbumin

breast milk has human milk protein, also known as?

caesin

cow’s milk protein is called?

factors affecting milk secretion

•Diet

•Nutritional State of mothers

•Emotional and Physical State

•Suckling

•Use of contraceptives and drugs

infant and young child feeding

• Newborn Screening

• EPI

• IMCI

micronutrient supplementation

• Dental Health

• Early Child Development

• Child Health Injuries

1 hour

initiate breastfeeding within how many hours after birth

6 months

exclusive breastfeeding for how many months?

age 6 months up to 2 years or beyond

complementary feeding for how many months - years?

breastfeeding / breast milk is best be given until 18 months to 2 years of age

diet for newborns

bottle feeding

artificial feeding with cow’s milk, costly, associated with infantile obesity or “protein-calorie malnutrition plus

complemented mixed feeling

insufficient supply of breast milk

mother is away from home for feeding

supplemented mixed feeding

aseptic method

equipments and ingredient are sterilized separately

terminal method

formulas are poured into clean but unsterilized bottles and are sterilized together Weaning: 6 months: breast to bottle 12 months: bottle to cup

3 hours

2.5 to 2.7 kg baby usually feeds every? (8 feedings)

4 hours

3.6 to 4 kg baby usually feeds every? (6 feedings)

4 to 5 feedings, the baby sleeps through the night after 10 pm feeding

2 to 3 months old, the baby is on?

2 months old for supplementary foods

liquids like rice water, calamansi juice may be introduced depending upon infant’s tolerance and acceptance

4 months old for supplementary foods

first solid foods (rice cereals)

5-6 months old for supplementary foods

teething foods; full diet consisting of pureed meat, egg, strained fruits and vegetables and chewy foods be given not only to soothe the sensitive gums but also to teach the baby the art of self-feeding

7-8 months for supplementary foods

foods are mashed or chopped finely, not strained to teach mastication, soft cooked egg with rice porridge, boiled fish, banana and camote mash and the like

9-12 months for supplementary foods

whole tender foods or foods chopped coarsely are given, finger foods like cottage cheese, crackers, plain meats and egg yolks

cereal, fruit, vegetable, meat, fish

sequence of introducing solids

honey (clostridium botulinum)

foods to avoid in the first year of life for infantile poisoning

hotdogs, grapes, hard candies, raw carrots, pop corns, nuts, peanut butter

foods to avoid in the first year of life for choking hazards

skim milk

foods to avoid in the first year of life for insufficient calories

cow’s milk, egg whites

foods to avoid in the first year of life for potential allergen

cues to readiness to solids

•Sucking reflexes is intact

•Ability to sit with support

•Avoid feeding an infant lying supine to prevent aspiration

•Present salivary glands and intestinal enzymes that aids in digestion

•Fetal iron reserve in the liver usually consumed by 4-6 months

rules to follow when introducing supplemental foods

•Introduce one food at a time

•Show pleasure when giving new food at the same time, make gesture.

•Give a small amount (1 tsp) at a time

•Offer bland foods to the baby (not too salty, not too sweets)

•Do not mix with formula

•Feed when newborn is hungry after a few sucks of milk to increase his patience for a new food

•Never start two new foods at the same time

•Allow an interval of 4-7 days between new foods

•Feed baby only with freshly-cooked foods or fruits freshly peeled. Avoid giving left-over foods to babies.

•Do not bribe, plead, threaten or force the infant

colic

most common disorder for babies

diarrhea

common disorder most frequently caused by bacteria and viruses

health problems with infancy

•Galactosemia

•Phenylketonuria (PKU)

•Maple Syrup Urine Disease (MSUD)

water

this is good for thirst

fruit juice

too much of this may cause diarrhea and may reduce child’s appetite for foods

sodas

these are not suitable for infants

teas and coffee

these reduce infant’s iron absorption

a small drink

this will satisfy a child’s thirst during meals

2-3

a non breastfed child needs how many cups of water in a temperate day

4-6

a non breastfed child needs how many cups of water in a hot climate

feeding the child who is ill

•Encourage to eat and drink with lots of patience

•Feed small amounts frequently

•Give food that the child likes

•Give a variety of nutrient rich foods

•Continue to breastfeed

vitamin A, iron, iodine

common nutritional deficiencies

twice a year distribution of Vitamin A capsule

micronutrient supplementation of Araw ng Sangkap Pinoy / Garantisadong Pambata / Child Health Week