Nutritional education and health education in Pediatric

SHIMLA NURSING COLLEGE, ANNANDALE
PRESENTATION
ON
NUTRITIONAL EDUCATION AND
HEALTH EDUCATION IN PEDIATRIC
SUBJECT: CHILD HEALTH NURSING
SUBMITTED TO: SUBMITTED BY:
DR. DEEPKANT CHATURVEDI MS. PRIYA GILL
ASSOCIATE PROFESSOR M.Sc. (N) 1ST YEAR
SHIMLA NURSING COLLEGE SHIMLA NURSING COLLEGE

INDEX
S.NO. CONTENT
1. Child Nutrition:
• Nutrient required for child
• Breast feeding
• Complementary feeding
• Artificial feeding
2. Health education for children
3. Conclusion
4. Summarization
5. References

NUTRITIONAL EDUCATION
AND
HEALTH EDUCATION
IN PEDIATRIC

CHILD
NUTRITION
HEALTHY KID’S;
WEALTHYFUTURE

DEFINATIONOFCHILD :
• Biologically, a child ( plural: children )
is generally a human between the
stages of birth and puberty.
• A person between birth and puberty.
• A person who has not attained
maturity or the age of legal majority.

DIFFERENT AGE OF CHILDHOOD:
• 1ST day – Neonatal
• 2nd to 30 days – Newborn
• 2 month to 2 years – Infant
• 2-6 years – Early Childhood
• 6-13 years – Childhood / Pre-Adolescent
• 13-18 years - Adolescents

INTRODUCTION:
• Balanced and sufficient nutritional intake
is most essential for children to promote
optimal development, to protect and
maintain health, to prevent nutritional
deficiency conditions and various illness
and to reserve for starvation and dietary
stress.

Cont….
• Foods can be classified by chemical composition as
proteins, fats, carbohydrates, vitamins and minerals.
• On the basis of nutritive value, foods broadly classified
as cereals and millets, pulses, nuts and oilseeds,
vegetables, fruits, milk and milk products, animal or
flesh foods, fats and oils, sugar and jaggery, condiments
and spices and miscellaneous foods.

Cont….
Nutrients can be groups as macronutrients
and micronutrients.
Macronutrients
Micronutrients
 Vitamins and
minerals
 Proteins, fats and
carbohydrates

BENEFITS OF CHILD NUTRITION:
• Proper weight for age/height.
• Development of internal and
external organ.
• Overall maturation of digestive
system.
• Normal physical and neuropsychic
development of the child.
• Strong immunity power.

Nutritional requirements in children
• To fulfil the nutritional
requirements, child’s diet should be
planned by the parents and family
members with different types of
food items to provide balanced and
nutritious diet.

WATER:
• Water is most important for maintenance of life.
• It constitutes about 70% of body weight in children.
• Total water content of the body is comparatively in
infants than in adults.
• Water is required for digestion, metabolism, renal
excretion, temperature regulation, transportation of
cellular substances, maintenance of fluid volume and
growth of children.

Cont….
• The daily requirements of water is fulfilled by fluid intake,
food and oxidation processes in the body.
• Water is absorbed throughout the intestinal tract.
• Evaporation from the lungs and skin accounts for 40-50%
water loss and 3-4%by fecal loss.
• Excess loss of water can cause dehydration whereas an
excess intake can result in water intoxication.

CALORIES:
• Children required more calories per kg of body
weight than adults.
• Calorie requirements gradually decrease from infancy
and adulthood.
• The average energy expenditure is 50% in basal
metabolism, 12% in growth, 25%for physical activity,
8%percent in fecal loss and 5% for specific dynamic
action.

Cont …
• The calorie requirements of children depend upon
body size and surface area, rate of growth, level of
physical activity, food habits and climate.
• In balanced diet, 50% of calories is provided by
carbohydrates, 15% by proteins and 35% by fat.

Cont…
• Deficiency of calorie intake leads to loss of
weight, growth failure and protein-energy
malnutrition.
• An excess intake of calorie results in increased
weight gain and obesity.

DAILY REQUIREMENTS OF
WATER AND CALORIES:
Age range Water (ml/kg) Calorie (cal/kg)
First 3 days 80-100 120
3-10 days 125-150 120
15days -3 months 140-160 120
3-12 months 150 105-115(110)
1-3 years 125 100

Cont….
Age range Water (ml/kg) Calorie (cal/kg)
4-6 years 100 90
7-9 years 75 80
10-12 years 50 70
13-15 years 50 60
16- 19 years 50 50
Adult 50 40

PROTEIN
• Proteins are essential for synthesis of body tissues in
growth, and during maintenance and repair.
• They helps in the formation of digestive juices,
hormones, plasma proteins, enzymes, hemoglobin and
immunoglobulins.

Cont…
• Proteins are obtained from two main dietary sources,
i.e. animal origin and vegetable origin.
• Protein requirements depends upon the age, sex,
physical and physiological factors.
• It is maximum in neonates and early infancy but
gradually decreases as age increases.

Cont…
• Deficiency of protein intake result in growth failure
and protein- energy malnutrition.

RECOMMENDED PROTEIN
ALLOWANCES:
Group Age Protein (g/kg/day) g/day
INFANTS
0-3 months 2.3(milk protein) -
3-6 months 1.8(milk protein) -
6-9 months 1.65(mixed protein) -
9-12 months 1.5(mixed protein) -

Cont….
Group Age Protein(g/kg/day) g/day
CHILDREN
1-3 years 1.83 22.0
4-6 years 1.52 30.0
7-9 years 1.48 41.0

Cont ….
Group Age Protein(g/kg/day) g/day
ADOLESCENTS
Male
10-12years 1.46 54.0
13-15years 1.40 70.0
16-18years 1.31 78.0
Female
10-12years 1.45 57.0
13-15years 1.33 65.0
16-18years 1.21 63.0

CARBOHYDRATES:
• Carbohydrates are main source of energy and supply
bulk in the diet.
• They contribute taste and texture of foods.
• They are essential for digestion and absorption of
other foods.
• Adequate intake in diet allow the use of protein for
tissue synthesis.

Cont….
• It play an important part in infant nutrition as they
spare proteins to be fully utilized for growth and
various repair processes.
• The sources of carbohydrate of infant’s diet is in the
form of lactose found in human and cow’s milk
should be provided up to 6months.

Cont….
• Afterwards cereals, legumes, fruits, pulses and
vegetables are the main sources.
• Inadequate carbohydrate may introduce symptoms of
starvation, undernutrition, constipation, depression
etc.
• Excess carbohydrate in diet lead to obesity, IHD,
cataract etc.

FATS:
• Fat supplies 40-50% energy needed for infant.
• It provides protection and support for organs and
insulation of the body as adipose tissue.
• More fat intake in diet may results in indigestion as it
remains longer in the stomach.
• Excess fat intake leads to obesity, cancer,
artherosclerosis and HTN.

Cont…
• Deficiency of all essential fatty acids may result in
growth retardation, skin disorders, neurological and
visual problems etc.
• The ICMR has recommended a daily fat intake of
25g/day in young children and 22 g/day in older
children.

VITAMINS:
• Vitamins are organic substances and essential
micronutrients for maintenance of normal health.
• Balanced diet supplies all the vitamins needed for a
healthy individual.
• Excess intake of vitamins may produce toxic effects.

Cont .…
• Poor dietary intake may leads to faulty absorption,
increased loss in chronic diarrhea and poor utilization
in chronic liver diseases.
• Vitamin requirements is more in preterm babies.
• Infants get adequate vitamins from mother lactation.

Cont…
• Dietary intake of vitamins may be low or marginal
during infancy and childhood.

MINERALS:
• Minerals are inorganic elements, required by human
body for growth, repair and regulations of vital body
functions.
• A well-balanced diet supplies a sufficient quantities of
minerals.
• Minerals are classified as macro-minerals when the
daily requirement is 100mg or more and as micro-
minerals when less than 100 mg is required daily.

Cont….
• The adequate knowledge, attitude and practice of
application of nutritional requirement must be basis
of infant feeding.
• The health and nutrition status of an infant and
subsequent growth and development through
childhood depend upon successful feeding practices.

DAILY REQUIREMENTS OF
MINERALS :
Mineral Age – group Requirement
IRON
Infant 1mg/kg
1-3 years 12mg
4-6 years 18mg
7-9 years 26mg
10-12 years Boys–34 mg/Girls–19 mg
13-15 years Boys–41mg/Girls–28mg
16-18 years Boys–50mgGirls – 30mg

Cont…
Calcium
Infant 500mg
1-9 years 400mg
10-15 years 600mg
16-18 years 500mg
Iodine - 0.2mg

Cont….
Sodium - 2mEq/kg
Potassium - 1.5mEq/kg
Zinc - 0.3mg/kg
Copper - 0.05 -1 mg/kg
Fluorine - 0.5-1mg

NECCESSITY OF CHILD
NUTRITION:
• Did you know that child nutrition, at the
right time of your baby's life, could make
the difference between mental and
physical retardation robust mental and
physical health.

Cont…..
• Child nutrition can produce such a crucial
difference, but, only, at the right time.
• The time for maximal child nutrition
influence is prior to your baby's birth.

CONT….
• It is self-evident that child
nutrition is an important factor in
determining a kid's health.
• Child nutrition becomes the single most
dominant factor determining your child's
health and, therefore, his or her future
success.

CONT…
• Imprinting means that there exists a
certain time in the development of the
unborn baby where affects of hormones,
vitamins and other internal child nutrition
factors within the womb, will have a
maximal influence on, not only the unborn
baby's health, but on its later health during
its entire human life cycle.

BREAST FEEDING :
• Breastfeeding is the optimal source of
nutrition.
• The Human Milk is specie specific and
it provides all the essential nutrients
necessary for the growth and
development of the newborn infant.

Definition :
• Breastfeeding is the feeding of an
infant or young child with breast
milk directly from female human
breasts (i.e., via lactation) not
from a baby bottle or other
container.

Advantages of breastfeeding:
Nutritive value
Digestibility
Protective value
Psychological benefits
Maternal benefits
Family and community benefits

PROLACTIN
REFLEX:
Secretion continues
AFTER feed to
produce NEXT
feed.

Infant suckles at the
breast.
nerve endings
in mother’s
nipple/areola sends
signal to mother’s
hypothalamus/
pituitary.
Pituitary releases prolactin and
oxytocin.
Hormones travel via bloodstream
to mammary gland to
stimulate milk production
and milk ejection reflex
(let-down).
Stimulation of

Oxytocin
Reflex
 For milk
ejection

Helping and hindering the Oxytocin
Reflex

Indicators of breastfeeding:
• Audible swallowing sound during the feed.
• Let down sensation in mother’s breast.
• Breast is full before feed and softer
afterward.
• Wet nappies 6 or more in 24 hours.

Cont…
• Frequent soft bowel movements, 3 to 8 times
in 24 hours.
• Average weight gain of 18 to 30 g/day.
• Baby sleeps well and doesn’t cry frequently.
• Baby has good muscle tone and healthy skin.

Different composition of breast
milk:
Colostrum
• Secreted during first 3 days
after delivery.
• It is thick, yellow and small
in quantities.
• Contains antibodies, fat
soluble vitamin (A,D,E,K).
• Protective from the babies.
Transitional milk
• Follows the colostrum .
• Secretes during first 2
weeks of postnatal period.
• Increased in fat and sugar
content.
• Decreased in protein and
immunoglobulin.

Cont….
Mature milk
• Secreted usually from 10
to 12 days after delivery.
• Has water but contains all
nutrients for optimal
growth of the baby.
Preterm milk
• It contains more
proteins, sodium, iron,
immunoglobulins and
calories appropriate for
preterm neonates.

Cont…
Fore milk
• Secreted at the starting of the
regular breastfeeding .
• It is more watery to satisfy the
baby’s thirst and contains
more proteins, sugar, vitamins
and minerals.
Hind milk
• Secreted towards the
end of regular
breastfeeding and
contains more fat and
energy.

Technique of breastfeeding:
• The baby should be properly positioned to achieve
effective latching.
• The mother should wear comfortable apparel, with the
breast well exposed for the infant to be able to latch.
• The infant’s mouth, chin and umbilicus should be
lined up with the head in a neutral position.

Cont….
• The infant is brought to the breast, with the nose
touching or close to the breast.
• The gum line should overlap the areola, and the nipple
straight back into the mouth.
• The tongue moves forward beyond the lower gum,
cupped and forming a reservoir.

Cont…
• Milk is removed for the lactiferous sinuses, the jaw
moves down creating a negative pressure gradient
that helped transfer milk to the pharynx.

Attachment :
a)Good attachment b)Poor attachment

Attachment, Outside Appearance:
a) b)

Feeding
Reflexes
Rooting reflex
When something
touches lips,
baby opens mouth
puts tongue
down and
forward
Sucking reflex
When something touches
palate baby sucks
Swallowing reflex
When mouth fills with
milk,
baby swallows
Skill
Mother learns to position
baby Baby learns to take
breast

BENEFITS OF BREASTFEEDING
TO MOTHER
1. This promotes mother and child bonding.
2. It prevents uterine bleeding in the mother after
delivery.
3. This is a natural form of Family Planning.
4. This reduces the risks of breast and ovarian cancer in
the mother.
5. This saves time and precious expenses need not be
used for buying milk powder and health care.

BENEFITS BREASTFEEDING
FOR BABY
1. This provides the best possible nutrition to the young child.
2. It reduces the incidence of coughs and colds, ear infections,
bronchitis, pneumonia, meningitis and diarrhea through its
protective factors.
3. It protects the child from colic, asthma, eczema, nose and food
allergies.
4. It is essential for the optimal physical, emotional and mental
development of the child. Breastfed child are also smarter.

HOW LONG TO BREASTFEED
• Newborns can nurse for 5 to 10 minute
per breast; every 2 to 3 hours. This comes
to about 10 to 12 feedings per day. In the
beginning, there is only colostrum, and
there’s not very much of it, so be ready to
feed often but for short durations.

Cont…
• One month or more: as baby gets older, his stomach will
get larger. He will nurse less frequently but for a longer
duration at each feeding session. For example, he may
nurse 20 to 40 minute per breast every 3 to 4 hours.
• By 6 months, Baby may breastfeed for 20 to 40 minutes
per breast; 3 to 5 times per day.

CONTRAINDICATION TO
BREASTFEEDING
 Active /untreated TB
 Mom takes radioactive
compound(cancer for chemo)
 Mom take illegal drug
 HIV infection

BREAST FEEDING POSITIONS:
Cradle hold position
 This is the most common
position used by mothers.
 Infant’s head is supported
in the elbow, the back and
buttock is supported by
the arm and lifted to the
breast.

Cont…
Side lying position
 The mother lies on her side
propping up her head and shoulder
with pillows.
 The infant is also lying down facing
the mother.
 Good position after Caesarean
section.
 Allows the new mother some rest
 Most mothers are scared of
crushing the baby.

Cont…
Cross cradle hold position
 Ideal for early breastfeeding.
 Mother holds the baby crosswise in the
crook of the arm opposite the breast the
infant is to be fed.
 The baby's trunk and head are supported
with the forearm and palm.
 The other hand is placed beneath the
breast in a U-shaped to guide the baby's
mouth to your breast.

Cont…
Saddle Hold:
 Also called Australia hold
position.
 Usually used for older infants.
 Not commonly used by mothers.
 Best used in older infants with
runny nose, ear infection.

Cont…
Football hold position
 The infant’s is placed under the
arm, like holding a football.
 Baby’s body is supported with
forearm ad head is supported with
the hand.
 Many mothers are not
comfortable with this position.
 Good position after operative
procedures.

Complication :
 Baby who doesn’t suckle
 Baby who refused on breast
 Inverted nipples
 Sore nipple
 Breast engorgement
 Breast abscess
 Working mother

INTRODUCTION :
• Breast feeding alone is adequate to maintain growth
and development up to 6 months. And complementary
feeding should be given to maintain their growth and
development according to age. So it is necessary to
introduce more concentrated energy riched nutritional
supplements by this age. Infant also need iron
containing food supplements to prevent iron deficiency
anaemia.

DEFINITION :
• Complementary feeding or weaning is the process
of giving an infant other foods and liquids along
with breast milk after the age of 6 months as breast
milk alone is no longer sufficient to meet the
nutritional requirements of growing baby. It is the
process by which the infant gradually..

Why start at six months:
Infant’s intestinal tract develops
immunologically with defense mechanisms to
protect the infant from foreign proteins.
The infant’s ability to digest and absorb proteins,
fats, and carbohydrates, other than those in breast
milk increases rapidly.

Cont….
The infant’s kidneys develop the ability to excrete the
waste products.
The infant develops the neuromuscular mechanisms
needed for recognizing and accepting variation n
the taste and color of foods.

What are the signs that baby is ready for
complementary feeding:
 Hold his/her head straight when sitting
down.
 Opens his/her mouth when others eat
 Is interested in foods when others eat.
 Receives frequent breast feed but appear
hungry soon after.
 Is not gaining weight adequately.

Principles:
Practice exclusive breast feeding from birth up to 6
months and introduce complementary feeding after
6 months of age.
Continue frequent on demand breast feeding until 2
years of age.

Cont….
 Feed infant slowly and patiently and encourage
them to eat but do not force them.
 Practice good hygiene and proper food handling to
reduce the risk of diarrhoea.
 Start with small amounts of food and increase the
quantity as child gets older.

Cont….
Gradually increase food consistency and variety
as the child grows older.
Increase the number of times the child is fed
complementary food, as the child gets older.
Feed a variety of nutrient rich foods to ensure
that all need are met.

Cont….
 Give micronutrient rich complementary foods or
vitamin and mineral supplements to the infant as
needed.
 It is advisable to start one or two teaspoons of new
food at first which should be given when baby is
hungry, just before regular feeding, during the day
time.

Preparation for weaning food:
 Wash hands.
 Keep food in clean utensils.
 Separate raw and cooked food.
 Cook food thoroughly.
 Keep food at safe temperatures.
 Use safe water and raw material.
 Give freshly prepared food.
 Keep the cooked food covered.

Qualities of complementary feed:
 Weaning food should be liquid at first,
then semi solid and solid food to be
introduced gradually.
 Clean, fresh and hygienic, so that no
infection can occurs.
 Easy to prepare at home with the
available food items and not costly.

Cont….
 Easily digestible, easily acceptable and palatable
for infants.
 High in energy density and low in bulk viscosity
and contains all nutrients necessary for the baby.
 Based on cultural practice and traditional beliefs.
 Well – balanced, nourishing and suitable for the
infant

Quantity and frequency:
Age Energy
needed in
addition to
milk
Consistency Frequency Amount at
each meal
6-8
month
200 Kcal/day Start with
liquid and
proceed
foods
2-3 times per
day
Start with 2-3
table spoons
per feed and
increase to
about 125 ml

Cont…
Age Energy
needed in
Addition to
milk
Consistency Frequency Amount at
each meal
9-11
months
300Kcal/day Finely chopped
or mashed
foods.
3-4 times a
day
Half cup of
250 ml cup
12-23
months
550Kcal/day Solid family
foods, chopped
or mashed
3-4 times a
day
1/4th to full
250 ml cup

COMPLEMENTARY FEEDING AT
DIFFERENT AGE:

4 to 6 months –
Weaning to be initiated with fruit juice.
Within one to two weeks new food to be introduced
with suji, biscuit socked with milk, vegetable soup,
mashed banana, mashed vegetable.
 Each food should be given with one or two teaspoon at
first for 3 to 6 times per day.
Within 3 to 4 weeks amount to be increased to half a cup.

6 to 9 months –
• Food item to be given at this period include soft
mixture of rice and dal, khichri, pulses, mashed and
boiled potato, bread or roti soaked with milk or dal,
mashed fruits, egg yolk, curd.
• Amount of food should increase gradually.

Cont…
• Egg yolk can be given from 6-7
months onwards.
• Curd and kheer from 7-8 months
onwards.
• 6-9 months the infant enjoy to bite
biscuits, piece of carrot and cucumber.

9 to 12 months –
• More variety of household food
can be added.
• Fish, meat, chicken can be
introduced. Food need not to be
mashed but should be soft.be
soft and well cooked.

12 to 18 months –
• The child can take all kind of cooked
food. The amount and frequency
should increase gradually.
• Number of feeds can be 4 to 5 times
or according to child’s need.

Problem during weaning:
 If on starting weaning, breast feeding is
stopped suddenly, it can have adverse
psychological effect on the child.
 Weaning food, if prepared unhygienically
or not digested properly can cause
diarrhoea.

Cont…
 If weaning food are not nutrient
rich, the child can develop
malnutrition.
 Children may develop
indigestion, abdominal pain,
diarrhoea or rashes if they are
allergic to certain foods.

ADVANTAGES:-
 It prevents malnutrition.
 It prevents deficiency diseases, e.g. anemia.
 Promotes growth.

DISADVANTAGES:-
 It may lead to diarrhea, if the
food is preparing an unhygienic
way.
 Negligence in choosing nutritious
weaning food can lead to either
calorie, protein, vitamin or mineral
deficiencies

Formula feeding :
• It is a manufactured food designed and
marked for feeding to babies and infants
under 12 months of age, usually prepared
for bottle- feeding or cup- feeding from
powder(mixed with water) or liquid (with
or without additional water).

Infant feeding & standard & specialized
formulas:
Formula
category
Example
formulas
Features and typical uses
Human Milk -Gold standard
-Expressed milk can be delivered by
gavage or nasogastric tube
Cow’s Milk-based
(With Lactose)
-Enfamil
-Similac
Standard substitute for breast milk
Cow’s Milk – Based
(without lactose)
-Lactofiree
-Similac lactose free
Useful for transient lactose
deficiency or lactose intolerance

Cont…
Formula category Example formulas Features and typical
uses
Soy protein – based/
Lactose - free
-Iscemil -Alternative to milk-
protein based formulas
-Not recommended for
premature infants
Premature formula; -
cow’s milk (reduced
lactose)
-Similac special care
-Enfamil premature
-Indicated for premature
and LBW infants
-Fat is 50%MCT, higher
in many micronutrients

Introduction :
• Artificial feeding should be started
only if mother is unable to
breastfeed the baby.
• Mothers who are not motivated for
breastfeeding may use this as an
excuse for top feeding their babies.

Meaning:
• Artificial feeding means- to feed the
child other than breast milk.
• It involves the use of breast milk
substitutes in the form of liquid milk,
i.e. fresh cows or buffalo’s milk or
commercially available dried whole
milk.

Aims of artificial feeding:
• To provide adequate nutrition to the infant.
• To substitute breast milk and provide nutrients
approx. as same as breastmilk.
• To fulfill the needs of the child for proper
growth and development.

Indications for artificial
feeding:
• Death or absence of mother.
• Prolonged material illness.
• Complete failure of breast milk production.
• Absolute contraindication of breast feeding.
• Expressed breast milk is not available.

Factors contributing to rising incidence
of artificial feeding:
• Lack of interest in breast feeding.
• Wrong beliefs and ignorance related to
breastfeeding.
• Increasing numbers of working mothers.
• Aping the western countries.
• Changing lifestyle.

Cont….
• Availability of alternatives of
mother’s milk.
• Publicity and appealing
advertisements.

Principles of artificial feeding:
 The decision of giving artificial feeding must be
taken failure of all efforts to breastfeed the baby.
 Feeding should be given by spoon and bowel or
cup or glass.
 In sick or preterm infant, the feeding can be given
with dropper.

Cont…
 Bottle feeding must be avoided and mothers need
explanation or information about the hazards of
bottle feeding.
 Strict cleanliness in the preparation and feeding
procedure should be practiced.
 Milk left over from previous feed should not be used
again.

Cont…
 Feeding must be given with the calculated amount
of fluids and calories according to the baby’s
expected weight.
 Correct technique of feeding to be followed
 The milk should be warm, not too hot or cold.

Cont….
 An average 15 to 20 minutes may be needed to
feed the total quantity, as required.
 Number of feed can be 6 to 8 times in infant
and 3 to 5 times in older babies.
 Hygienic measures are very important.

Cont…
 If dried milk is used, it should be reconstituted as
per direction given by the manufacturer.
 Burping may be needed to allow to push out the
swallowed air and to prevent vomiting, abdominal
discomfort
 Supplementation of vitamins and minerals may
be needed for babies to prevent deficiency
condition.

Cow’s milk vs human milk:
Cow’s milk
• Has more protein as
calves need more to
enable them to grow
quickly.
Human milk
• Need less protein and
more fat as required in
development of brain,
spinal cord and nerves.
Protein

Cont….
• Protein divided into CASEIN : WHEY PROTEIN
• Normal ratio in cow milk is 80:20.
• Normal ratio in human milk is 40:60.
• CASEIN is difficult to digest and linked to various
disease, allergies and diabetes in children.

Cont…
Cow’s milk
• Cow milk contain 3.9 g
• Contain more of
saturated fat.
Human milk
• Human milk contain
4.1g
• Contain more of
unsaturated fat.
Fat

Cont…
Cow’s milk
• Cow milk contain
120mg/100ml.
• Large quantity difficult
for digestion for a
newborn baby.
Human milk
• Human milk contain
34mg/100ml.
• Easily absorbed.
Calcium

Cont….
Cow’s milk
• Cow milk contain very
little iron, vitamin A, C
and D.
Human milk
• Human milk has high
protein, sodium,
potassium, phorphorus,
chloride which increase
renal load.
Vitamin

Important points:
• Use katori spoon or cup for feeding.
• Avoid using bottle for feeding which is a source
of infection.
• If used, prefer glass bottles instead of plastic or
metal bottles.
• Clean feeding vessels and rubber Nipples using
bottle brush and fresh clean water after each feed.

Cont….
• Bottle and nipple need to be sterilized by
boiling before each feed.
• Boil rubber nipple for 1 or 2 minutes only and
bottle for at least 10 minutes.
• Keep bottles and nipples in covered container,
till these are used.

Preparation of milk:
• If cow or buffalo milk, boil properly, boiling
makes casein curds finer and easily digestible.
• Commercially available dried powdered milk
are reconstituted by mixing-
one level measure of milk powder
+
30 ML of water

Feed requirement:
Age No. of feed in
24 hours
Amount(approx.)
At birth At least 6-10 Birth to day 3-baby will
need:- Frequent feeding
½ -2 ml at each feeding
2 weeks – 1months At least 6-10 60-120ml
1-2 months 6-8 60-120ml

Cont…
Age No. of feed in
24 hrs.
Amount
(approx.)
3-5 months 5-7 150-180ml
6-8 months 4-5 180-240ml
9-11 months 3-4 180-240ml
12 months 0-3 180ml

Hazardous factors related to artificial
feeding:
Danger of
contamination
Gastro-enteritis
Multiple nutritional
deficiencies

Long term sequeal of exclusive artificial
feeding leads to :
Lactose intolerance
Obesity
Atherosclerosis
Poor learning abilities

Cont…
Poor parent child relationship
Frequent pregnancy
Family disruption

PACIFIER TECHNIQUES:
• A pacifier is an artificial nipple designed for babies to
suck on for comfort.
• Pacifiers should only be used to satisfy the need to
suck. They should never be used to delay or replace
nurturing or feeding.
• As a child grows, a pacifier can be taken away,
whereas it may be harder to discourage thumb
sucking.

USES OF PACIFIER:
 To sooth a baby to sleep
 To help a baby to stay asleep when disturbed
 To calm a frightened baby
 To keep the baby quiet

TYPES OF PACIFIER:
• Pacifiers consists of a latex or silicone nipple with a
firm plastic shield and handle.
• Softer or more flexible but
wear out faster than silicone.
Latex
Pacifiers
• Firmer, hold their shapes
longer, and are easier to clean
Silicone
Pacifiers

DISADVANTAGES RECOMMENDED
BY WORLD HEALTH ORGANIZATION:
1. They may get dirty and thus contribute to poor hygiene.
2. If lost during sleep, the pacifier’s absence may cause the
baby to wake and cry.
3. The pacifier may prevent babies from using their
mouths to learn about toys and other objects.

Cont…
4. The pacifier may signal to a baby that crying is unacceptable
even though crying is one of a baby’s few means of
communication.
5. The pacifier is an easy fix that may cause parents not to seek
to understand what is bothering the baby.

Cont…
6. Pacifier may prevent children from learning how to
comfort themselves.
7. Older siblings may give the baby a pacifier to quiet
a baby in situations where the parents would not use it.
8.Many adults dislike the sight of babies with pacifiers.

PACIFIER CARE:
• Infant pacifiers should be cleaned daily by boiling or
washing in a dishwasher.
• Once a child is six months old, the pacifier can be
washed daily with warm soapy water and rinsed
with clean water.
• Children may be taught to wash their own pacifiers.
• Pacifiers should never be shared with playmates.

Cont…
• They should never be stored in plastic bags where
dampness can encourage fungal growth.
• Pacifier nipples should be examined regularly for
deterioration, including tears, frayed edges, holes, or a
change in color.
• Emerging teeth can tear pacifiers. A worn or damaged
pacifier should be replaced immediately. Since pacifiers
are lost frequently, several should be kept on hand.

TERMINATING PACIFIER USE:
• Babies need their mouths for play and exploration.
• By the time a child is crawling and learning to walk,
pacifiers are both unhygienic and limiting.
• Many experts still recommend weaning a child from
pacifier use at about age two, others suggest that six
to ten months is the best time to end pacifier use.

Cont…
• Before the age of two, children have short memories
and may easily forget about a pacifier that has been
lost for a few days.
• Pacifier use should not be terminated too soon or
too abruptly since a baby may substitute thumb
sucking or some other behavior such as hair pulling.
• A two-year-old is much less likely to revert to
thumb sucking.

For infants :
First 6 months of infancy depends upon breastfeeding
Second half of infancy become accustomed with family
diet.
-Mother educated for breastfeeding.
-Family members should be explained about the
continuous support to promote exclusive breastfeeding.
-Weaning foods to be selected with high nutrients
content and cultural preferences.

For Toddler :
• In this period, the child may be decreased appetite due to
slower growth rate and may be ritualistic in food preferences
• One-half of the amount of foods that an adult consumes, the
child should have breastfeeding especially up to 2 years of age
and at night time.
• Encourage independence of the child during feeding.
• Maintain regular mealtime schedule, attractive mealtime
equipment and a choice able foods.

For Pre Schooler:
• Complete independence at mealtime with
increased imitation.
• The child needs all food items as taken by adults
but in smaller quantities with all nutritive values
as required for the balanced diet.
• To provide balanced diet to their child.

For School Age Child:
• To help them to select food items wisely and to begin
to plan and prepare for meals.
• Food requirements per kg of body weight due to
slower growth rate.
• The child becomes dependent on peer approval for
the choice of foods and like to eat away from home to
experience more independence and increased
socialization.

For Adolescent:
• To the growth ,selection of iron- riched
food items and preparing favorite
adolescent foods for physical fitness.
• Calcium and vitamin ‘D’ requirement
should be fulfilled to promote bony
growth.

CONCLUSION:
• Good nutrition during the first 2 years of life is vital
for healthy growth and development. Starting
good nutrition practices early can help children
develop healthy dietary patterns.
• Healthy eating in childhood and adolescence is
important for proper growth and development and to
prevent various health conditions.

REFERENCES:
Book references:
• Wilson David, ‘Essentials Of Pediatric Nursing’, 8rd Edition,
Published by Elsevier.
• Datta Parul ;Paediatric Nursing, Third Edition ;Jaypee brothers
Medical Publisher (P) LTD.
Net references:
• http://en.wikipedia.org/wiki/nursing_in_India//mw-head
• http://www.ncbi.nlm.nlm.gov/pubmed/19305227
• http://www.slideshare.com followed on 15/4/2020

Nutritional education and health education in Pediatric

Nutritional education and health education in Pediatric

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