Infancy to Childhood Nutrition & Development – Comprehensive Study Notes

Infancy (0–12 months)

Definition & Normal Anthropometrics

"Infant" = child ≤ 12 months old.
Term infant (at birth):
- Weight: $2.7\text{–}3.2\,\text{kg} \;(6\text{–}7\,\text{lb})$
- Length: $48\text{–}50\,\text{cm} \;(19\text{–}20\,\text{in})$
- Head circumference: $\approx35\,\text{cm}\;(14\,\text{in})$
- Skin: moist, elastic, non-wrinkled.

Core Nutritional Objectives (first year)

Supply nutrients for rapid growth & development.
Establish lifelong positive food habits & attitudes.

Energy (Calorie) Requirements

High because of proportionally large skin surface (↑ heat loss) + rapid growth + high activity (≈ >½ adult level).
Guideline progression:
- Birth: 350\text{–}500\,\text{kcal·day}^{-1}
- 2^{\text{nd}}\text{–}7^{\text{th}}\,\text{month}:\;110\,\text{kcal·kg}^{-1}\text{·day}^{-1}
- 7^{\text{th}}\text{–}12^{\text{th}}\,\text{month}:\;100\,\text{kcal·kg}^{-1}\text{·day}^{-1}
Average rule of thumb: 50\,\text{kcal·lb}^{-1}\text{·day}^{-1} based on expected weight; energy usually split ➜ ⅓ milk, ⅓ added CHO, remainder fat/protein.

Protein Needs

FAO/WHO recommendations:
- 0–6 mo: 1.5\text{–}2.5\,\text{g·kg}^{-1}\text{·day}^{-1}
- 6–12 mo: 1.5\text{–}2.0\,\text{g·kg}^{-1}\text{·day}^{-1}
Practical rule: 1.5\,\text{oz cow's milk·lb}^{-1} \Rightarrow 1.5\,\text{g protein·lb}^{-1} \approx10\% of body weight; excess well tolerated.

Fat & Essential Fatty Acids (EFA)

Whole cow’s milk supplies adequate linoleic & arachidonic acids.
Short-term low-fat milk → usually safe due to infant EFA stores.
Long-term low-fat intake/bovine allergy ➜ add EFA-rich vegetable oils (corn, soybean, cottonseed).

Carbohydrates

Allowance: $\tfrac{1}{10}\text{ of body weight}$ ≈ 1\,\text{oz CHO·lb}^{-1} (or per $10\,\text{oz}$ milk).
Distribution: ⅓ intrinsic milk lactose; ⅔ added starch/sugar (later given as cereal starches).

Minerals

Requirements proportionally > adult.
Iron: hepatic stores + high Hb at birth adequate ≈ 4 mo; beyond this, iron-rich foods essential to prevent anemia.

Vitamins

Adequately nourished lactating mother → breast-milk provides almost all vitamins except:
- Vitamin D (routine supplementation/exposure required).
- Ascorbic acid (often marginal); start early tomato or orange juice regardless of feeding method.

Water & Fluids

Requirement: $10\text{–}15\%$ body weight = 1.5\text{–}2.5\,\text{oz·lb}^{-1}\text{·day}^{-1}.
Satisfied partly by formula dilution; offer plain water/juices between feeds on demand.

Feeding Modalities

Breast-Feeding

Provides complete nutrition for ≈ first 4–6 months.
Added values: immunoglobulins, anti-infective factors, psychologic bonding, maternal uterine involution.

Bottle/Formula Feeding

Formula designed to mimic breast-milk macronutrient ratio: ↓ protein & minerals (dilution) + added CHO (↑ energy).
Essential to prepare under aseptic conditions; sterilize to avoid contamination.

Formula Sterilization Methods

Aseptic – sterilize equipment & ingredients separately (steam/boil ≥ 25 min); transfer sterile formula into sterile bottles, add sterile nipples → cap.
Terminal – fill clean (unsterilized) bottles, then sterilize bottles + contents together.

Typical Feeding Schedules

Weight 2.5–2.7 kg ➜ every 3 h.
Weight 3.6–4 kg ➜ every 4 h.
~2 mo: sleeps through night after 22:00 feed.
2–3 mo: transitions to 4–5 feeds per day.

Mixed Feeding

Combination breast + bottle.
- Complemented – bottle tops off a single breastfeeding when supply low.
- Supplemental – bottle replaces ≥ 1 feed (e.g., mother away > feeding interval).

Introduction of Complementary Foods (0–12 mo)

Guiding principle: add one new food at a time; start with ½ tsp × 1 day, increase gradually; allow 2–3 d before next new food.
Encourage positive facial cues & pleasure; teach cup drinking by ~7 mo to reduce bottle-related infections.

Age	Suggested Additions
2 mo	Rice water, vegetable water, or dilute calamansi juice (as tolerated).
4 mo	Scraped banana/papaya; thin lugaw; commercial cereal (Cerelac, Ceresoy).
5–6 mo	Puréed meats, egg, fruits, vegetables, cereals – full diet purée.
7–8 mo	Finely chopped (not strained) foods to teach mastication.
9–12 mo	Coarsely chopped / tender pieces (“table” foods).

Supportive practices:

Drain canned-fruit syrup (excess sugar).
Limit egg-yolk to ≤ 3–4 wk.
If approved by physician, shift to $2\%$ low-fat milk instead of whole.
Offer bland, non-spicy, nutritionally dense foods (lugaw, root crops, beans, fresh fruits).

Common Infant Feeding Problems & Management

Diarrhea: often bacterial/viral; also over- or under-feeding, cow-milk allergy.
- Actions: identify cause; maintain water & electrolyte balance; adjust formula.
Vomiting: frequent initial days.
- Reduce feed volume, ensure burping, possibly acidify milk; stress fluid replacement.
Allergy / Lactose Intolerance:
- Eczema common < 9 mo; milk protein allergy → switch formula.
- Lactase deficiency → undigested lactose ⇒ ↑ gut fluid & fermentation.
Constipation: may need formula dilution changes, ↑ fluid, or fiber from puréed fruits.
Colic: paroxysmal pain/crying ≤ 3 mo.
- Causes: psychosocial tension, GI hypermotility, CNS immaturity.
- Interventions: warmth, prone lying on hot-water bottle, warm water; formula change seldom decisive.

Indicators of Adequate Infant Nutrition & Development

Weight: ↑ 150\text{–}240\,\text{g·week}^{-1} early, slowing to \approx120\,\text{g·week}^{-1} by 1 yr; weight × 2 by 5 mo, × 3 by 12 mo.
Length: + $25.4\,\text{cm}$ (~50 %) in first year.
Behavioral Milestones
- 0–1 mo: suckles, smiles.
- 2–3 mo: vocalizes, head control.
- 4–5 mo: hand control, rolls.
- 6–7 mo: sits briefly, crawls.
- 8–9 mo: grasps, pulls to stand.
- 10–11 mo: cruises, stands alone.
- 12 mo: walks alone.
Other signs: normal-colored stool (no green/red streaks); regular sleep; timely tooth eruption; developing motor coordination; firm musculature with moderate SC fat.

Childhood Nutrition

Pre-School Children (2–6 yrs)

Growth slows physically but emotional, social, intellectual development accelerates; period ideal for shaping food habits.

Distinctive Features of Needs vs. Adults

Higher per-kg demands for protein, vitamins, minerals to support growth.
Activity level per kg > adult ➜ ↑ calorie allowance.
Food choice modifications: textures, sizes, flavors to suit young child.
Attitude formation toward food most malleable.

Functions of Diet

Fuel muscular activity.
Supply building/repair materials.
Provide pleasure & satisfaction.

Energy Distribution (Typical)

Of total needs: $55\%$ basal metabolism, $25\%$ physical activity, $12\%$ growth, $8\%$ fecal losses.
Calorie deficit → protein diverted for energy → protein-calorie malnutrition (PCM); combined protein-energy lack → marasmus.

Specific Allowances

Calories: individualized via age + activity.
Protein: 1.5\text{–}2.0\,\text{g·kg}^{-1}\text{·day}^{-1}; RENI shows gradual per-kg decline with age.
Vitamins/Minerals: essential for tissue synthesis & immunity.
Fluids: $1{,}000\text{–}1{,}500\,\text{mL}$ (≈ 4–8 glasses) day.

Alternative Milks

Evaporated filled milk = skim-milk powder + vegetable oil + H₂O.
Skim milk = fat-removed cow’s milk.
Sweetened condensed = evaporated + large sucrose addition.

School-Age Children (7–12 yrs)

Slow, steady somatic growth; laying nutrient reserves for adolescence.
Girls 10–12 yrs typically weigh ≈ 3 kg > boys.
Avg annual weight gain: $1.8\text{–}3.1\,\text{kg}$ .

Nutrient Allowances (Philippine RENI)

Calories
- 7–9 yrs: 80\text{–}90\,\text{kcal·kg}^{-1}\text{·day}^{-1}
- 10–12 yrs: 70\text{–}80\,\text{kcal·kg}^{-1}\text{·day}^{-1}
Protein
- 7–9 yrs: \approx37\,\text{g·day}^{-1}
- 10–12 yrs: 43\text{–}48\,\text{g·day}^{-1}
Vitamins/Minerals
- Iron: add 1.4\,\text{mg·day}^{-1} for menstruating girls.
- Ascorbic acid: 35\,\text{mg·day}^{-1} (7–9 yrs); 45\,\text{mg·day}^{-1} (10–12 yrs).

Meal-Planning Guidelines (7–9 yrs sample)

Breakfast is critical; hunger ↓ alertness.
Daily "must-have": green leafy + yellow vegetables and fruits; vary color, shape, size.
Pack lunch to meet ≥ ½ daily requirements.
Avoid over-spiced, highly seasoned dishes that blunt appetite for nutritious staples.
Snack smart: root crops, beans, fresh fruits—NOT candies/soft drinks.

Practical Feeding & Health Tips Across Childhood

Introduce foods one by one; monitor tolerance.
Offer water between feeds; teach cup drinking by ≥ 7 mo.
Encourage self-feeding developmentally (finger foods, small utensils).
Monitor weight/length against growth charts; investigate plateaus or drops.
Address common GI upsets promptly—adjust diet, hydrate, seek medical care.
Foster pleasant mealtime environment; parental enthusiasm shapes acceptance.