Childhood
Nutrition
Nutritional requirements
? To live,to grow and thrive,humans must take
in nutrients from their environment,Before
birth there are supplied by the mother,but
thereafter they must be ingested,
? If too little is provided,the infant will not
grow and may become ill,and too much may
lead to toxicity or obesity.
Classification of nutrients
(2000 Chinese DRIs)
?Energy
?Macronutrients
protein,fat,carbohydrates
?Micronutrients,Minerals,Vitamins
?Other diet’s components
Dietary fiber,water,and others.
Function Food sources Requirement
E
n
e
r
g
y
Five broad uses to which energy
intake is put,
?Basal metabolism,50-60%
?Requirement for growth:20-30%
?Specific dynamic action,7-8%
?Requirement for physical
activity,15-20Kcal/kg/d
?Energy lost in excreta,10%
?Protein 9~15%
?Carbohydrate
45~55%
?Fat 35~45%
1g protein = 4 Kcal
1g carbohydrate = 4
kcal
1g fat = 9 kcal
?<1y,110kcal/kg/d
?Reduce 10 cal/kg/d
when raise every 3
year
一,Energy
Notes,If calories are being obtained from a variety of foods,an
adequate intake of calories will usually ensure an adequate intake of
essential nutrients,Therefore calories should be the first item to be
evaluated in assessing a dietary history.
二,Macronutrients
Function Food sources Requirement
Protein
?Protein is a constituent of
all body tissues,There is a
requirement for growth and
for maintenance.
?In infant and children,
optimal growth depends on
an adequate dietary protein
supply
Milk production,
egg,fish,meat,
bean etc.
Animal protein
is better than
plant protein
?Breast feeding
2g/kg/d
?cow milk
feeding 3.5g/kg/d
?Plant protein
Feeding 4g/kg/d
Nine essential amino acids,histidine,isoleucine,leucine,lysine,
methionine,phenylalanine,threonine,tryptophan,and valine
Conditional essential amino acids,cystine,taurine,arginine
Function Food sources Requirement
Fat
Energy storage and
insulation against cold,a
cushion for internal organs.
Fats are required for the
absorption of fat-soluble
vitamins and for myelination
of the CNS
Animal fat,meat,
milk production,
plant oil,plant
<6y,3-6g/kg/d
>6y,2.5g/kg/d
Fatty acid
saturated fat,fats of animal origin (except human milk)
polyunsaturated fat,fats of vegetable origin
Function Food sources Requirement
Carbohydrate To supply energy cereal,fruit,legume,vegetable Infant 10-12g/kg/dChildren 12-15g/kg/d
three groups,Mono-saccharides,disaccharides,polysaccharides
三,Micronutrients
Function Food sources Requirement
mineral
Essential
components of body
tissue.
Animal and plant
food
Vitamins
Vitamins are
necessary for
proper tissue
function and for
growth.
Meat,liver,
vegetables,fruits
?Most vitamins cannot be synthesized in the body and
must be supplied in the diet
?Certain foods are fortified with vitamins,Addition of
vitamin D to milk is mandated by law.
?With the exceptions of iron and fluoride,a well-balanced
diet will provide a satisfactory intake of minerals.
?Iron deficiency is now the common nutritional deficiency
in the world.
Function Food sources Requirement
Water
?All tissues contain
water and it is the
principal constituent for
most tissue.
?Most chemical
reactions take place
only in an aqueous
medium.
Milk,soup,
water
<1y 150ml/kg/d
1-3y 100ml/kg/d
4-6y 80ml/kg/d
Reduce
10ml/kg/per 3
years
四,Other diet components
Loss of water:
?Loss in urine
?Loss in fecal
?Loss from lungs and skin (insensible water loss)
Function Food sources Requirement
Dietary
fiber
Soluble fiber
?delay GI transit
?delay glucose absorption
?lower blood cholesterol
Insoluble fiber
?accerate GI transit
?increase fecal weight
?slow starch hydrolysis
?delay glucose absorption.
Fruits( apple,
citrus),oats,
barley,legumes
Wheat bran,
whole-grain
breads,cereals,
vegetables
Points on childhood nutrition
? Calories should be the first item to be
evaluated in assessing a dietary history
? A well-balance diet
? Interaction of carbohydrate,fat and
protein
? Energy-protein malnutrition
Evaluation of Nutrition status
? Clinical examination
Birth history; feeding history; Clinic symptom & sign
? Dietary intake investigation
Inquiring method
? Anthropometric assessment
W/A,H/A,W/H,Growth curve
? Laboratory assessment
Blood sample,urine sample
Infant
feeding
Digestive system
anatomic physiological characteristic
? Mouth
? Cheek fatty mat
? Hypogenesis of neonatal saliva gland
? Amylase deficiency
? Oesophagus
? Hypogenesis of oesophageal wall muscle and bounce fiber
?Stomach
? Position
? Cardia constrictor & pylori constrictor
? Stomach capacity
Digestive system
anatomic physiological characteristic
? Intestines
the length is 6 times of body’s length (adult’s intestine is 4.5 times )
? Pancreas
<3 month infant,the activity of amylase is lower
? Liver
quite larger,the volume is 4% body’s volume,(adult 2%),soft
? Intestinal bacterium group
? Breast feeding,the major is lactobacillus
? Artificial feeding,the major is Escherichia Coli,
Normal stool
Fetal stool Breast feeding Cattle & sheep milk
Color Dark green Golden Straw yellow
Character Slimy Slimy & soft with grain Hard,easy shack off
Odor No odour Acid odour Protein decomposed odour
Times No surely >=4-5,or constipation 1-2
Infant feeding
?Breast feeding
?Artificial feeding
?Mixed feeding
Breast feeding
Breast is best
Human milk is for humans
Cow milk is for cows
Composition of breast milk
Colostrums Transitional breast milk Mature milk Terminal stage milk
Period 1 week 2 wks -1 mo 2-9months >10 months
character
?Dense,yellow
?Few fat
?High globin
?Highest fat
?Drop of
protein and
mineral
?Protein 1.2g%
?Fat 3.5g%
?Lactose 7.5g%
Decline of
amount and
nutrients
Advantage of breast feeding
? Better nutritional qualities:
?Easily digested
? Protein,whey proteins (lactalbumin and lactoglobulins) account
for 2/3
? Fat,unsaturated fatty acids,linoleic acid,rich in lipase
? Lactose,higher concentrations
?Low renal solute load,ash content of human milk (0.2%) is less
than one-third that of cow milk (0.7%)
?Favorable calcium to phosphate ratio,ensure calcium
absorption
?Better iron,zinc
Advantage of breast feeding
? Anti-infective properties
? Secretory Ig A
?Lysozyme (溶菌酶 ）
?Phagocytic cells （ 吞噬细胞 ）
?Iron-binding protein Lactoferrin （ 乳铁蛋白 ）
?Low-polysaccharid
?Zinc
?Vitamin B12
?Bifidus factor （ 双歧因子 ）
Advantage of breast feeding
? Psychologic benefit
?Promotes maternal-infant bonding
?Gain a sense of security
?Constitute the foundation for the development of all
human social relationships and communications
? others
?Economy,convenience
?Lack of contamination
Advantage of breast feeding
? Benefit for the mother
? Stimulation,by sucking,of oxytocin secretions,
which fosters uterine contractions and hastens
postpartum uterine involution
? Possible decreased risk of postpartum
thromboembolism and breast cancer
? Emotional satisfaction and sense of fulfillment
Artificial Feeding
?Milk production in common use,
fresh cow’s milk,sheep’s milk,infant formula,
yoghourt,exhalation milk
? Soya formula,Soya milk,rice flour
? Feeding schedule,avoid overfeeding
Mixed Feeding
? supple the inadequate
of breast feeding
? substitute of breast
feeding
Composition of different milk (per 100 ml )
Composition Breast milk Cow’s milk Sheep’s milk
Energy (kcal) 66 66 69
Protein (g) 1.2（ lactalbumin account for 2/3） 3.5（ casein account for 4/5） 3.3
Fat (g) 3.5（ the major is liquid fat） 3.5（ the major is volatility fatty cid） 4.1
Lactose (g) 7.5 4.8 4.7
Mineral (g) 0.2 0.7 0.77
Calcium (g) 0.033 0.125 0.061
Phosphorous (g) 0.015 0.099 0.055
Iron (g) 0.00021 0.00015 0.001
Sodium (g) 0.015 0.058 0.018
Potassium (g) 0.055 0.138 0.046
Vitamin D (IU) 0.4－ 10.0 IU 0.3－ 0.4 IU
Lipase More Less
Water (g) 87.5 87.5 86.7
α-lactalbumin
Other whey
proteins
Casein
α-lactalbumin
?-lactoglobulin
Other
whey
proteins
Casein
Bovine MilkHuman Milk
Milk Protein Composition
CaseinOther
whey
proteins
Nutrients and energy daily requirement for infants
Energy
(kcal)
Water
(ml/kg)
Protein
(g/kg)
fat
(g/k
g)
Carbohy
drate
(g/kg)
Calciu
m
(mg)
Iron
(mg)
Zinc
(mg)
Vitamin
A
IU
B1
mg
B2
mg
C
mg
D
IU
E
mg
110 150 1.7-4.0 4-6 10-12 500 15 5 1000 0.5 0.5 50 500 5
以后
每年
减 25
％
15% 35％ 50％
Energy:
100ml fresh milk include 66 kcal
5% sugary milk 86 kcal
8% sugary milk 98 kcal
Example,6 months infant,WT 7kg
?Energy daily requirement,110?7＝ 770kcal,be
equal to 770ml ml
?Liquid daily quirement:150ml?7=1050ml,still
need to supply water 280ml.
The introduction of supplementary food
The purpose of supplementary food
?To supply nutrient deficiency of breast milk
?To supply the inadequate of breast milk
?To prepare for weaning
?To train the oral motor function
The rules of supplementary food
? From small to large 从少到多
? From watery to dense 从稀到稠（从流质到半流质到固体）
? From thin to thick 从细到粗
? From one food to multi-foods 从一种到多种
Schedule of solid foods
Age Feeding foods
3-4 months Cereals,e.g,baby rice
4-5 months Pureed fruit and vegetables,meat (e.g,chicken)
6-7 months
Able to chew,e.g,rusks
Introduce lumpy foods and variety of
tastes and textures,egg yolk
8-9 months Bread and butter,fruit,egg white
12 months ‘real’ food in small bits
Toddle Feeding
?the child’s rate of growth slows
considerably after the first year of life,
and caloric needs pound decrease
?the function of digest has improved
Toddle Feeding
?Providing an adequate diet
?The development of feeding skills,
food habits,and nutrition knowledge
Nutrition
Nutritional requirements
? To live,to grow and thrive,humans must take
in nutrients from their environment,Before
birth there are supplied by the mother,but
thereafter they must be ingested,
? If too little is provided,the infant will not
grow and may become ill,and too much may
lead to toxicity or obesity.
Classification of nutrients
(2000 Chinese DRIs)
?Energy
?Macronutrients
protein,fat,carbohydrates
?Micronutrients,Minerals,Vitamins
?Other diet’s components
Dietary fiber,water,and others.
Function Food sources Requirement
E
n
e
r
g
y
Five broad uses to which energy
intake is put,
?Basal metabolism,50-60%
?Requirement for growth:20-30%
?Specific dynamic action,7-8%
?Requirement for physical
activity,15-20Kcal/kg/d
?Energy lost in excreta,10%
?Protein 9~15%
?Carbohydrate
45~55%
?Fat 35~45%
1g protein = 4 Kcal
1g carbohydrate = 4
kcal
1g fat = 9 kcal
?<1y,110kcal/kg/d
?Reduce 10 cal/kg/d
when raise every 3
year
一,Energy
Notes,If calories are being obtained from a variety of foods,an
adequate intake of calories will usually ensure an adequate intake of
essential nutrients,Therefore calories should be the first item to be
evaluated in assessing a dietary history.
二,Macronutrients
Function Food sources Requirement
Protein
?Protein is a constituent of
all body tissues,There is a
requirement for growth and
for maintenance.
?In infant and children,
optimal growth depends on
an adequate dietary protein
supply
Milk production,
egg,fish,meat,
bean etc.
Animal protein
is better than
plant protein
?Breast feeding
2g/kg/d
?cow milk
feeding 3.5g/kg/d
?Plant protein
Feeding 4g/kg/d
Nine essential amino acids,histidine,isoleucine,leucine,lysine,
methionine,phenylalanine,threonine,tryptophan,and valine
Conditional essential amino acids,cystine,taurine,arginine
Function Food sources Requirement
Fat
Energy storage and
insulation against cold,a
cushion for internal organs.
Fats are required for the
absorption of fat-soluble
vitamins and for myelination
of the CNS
Animal fat,meat,
milk production,
plant oil,plant
<6y,3-6g/kg/d
>6y,2.5g/kg/d
Fatty acid
saturated fat,fats of animal origin (except human milk)
polyunsaturated fat,fats of vegetable origin
Function Food sources Requirement
Carbohydrate To supply energy cereal,fruit,legume,vegetable Infant 10-12g/kg/dChildren 12-15g/kg/d
three groups,Mono-saccharides,disaccharides,polysaccharides
三,Micronutrients
Function Food sources Requirement
mineral
Essential
components of body
tissue.
Animal and plant
food
Vitamins
Vitamins are
necessary for
proper tissue
function and for
growth.
Meat,liver,
vegetables,fruits
?Most vitamins cannot be synthesized in the body and
must be supplied in the diet
?Certain foods are fortified with vitamins,Addition of
vitamin D to milk is mandated by law.
?With the exceptions of iron and fluoride,a well-balanced
diet will provide a satisfactory intake of minerals.
?Iron deficiency is now the common nutritional deficiency
in the world.
Function Food sources Requirement
Water
?All tissues contain
water and it is the
principal constituent for
most tissue.
?Most chemical
reactions take place
only in an aqueous
medium.
Milk,soup,
water
<1y 150ml/kg/d
1-3y 100ml/kg/d
4-6y 80ml/kg/d
Reduce
10ml/kg/per 3
years
四,Other diet components
Loss of water:
?Loss in urine
?Loss in fecal
?Loss from lungs and skin (insensible water loss)
Function Food sources Requirement
Dietary
fiber
Soluble fiber
?delay GI transit
?delay glucose absorption
?lower blood cholesterol
Insoluble fiber
?accerate GI transit
?increase fecal weight
?slow starch hydrolysis
?delay glucose absorption.
Fruits( apple,
citrus),oats,
barley,legumes
Wheat bran,
whole-grain
breads,cereals,
vegetables
Points on childhood nutrition
? Calories should be the first item to be
evaluated in assessing a dietary history
? A well-balance diet
? Interaction of carbohydrate,fat and
protein
? Energy-protein malnutrition
Evaluation of Nutrition status
? Clinical examination
Birth history; feeding history; Clinic symptom & sign
? Dietary intake investigation
Inquiring method
? Anthropometric assessment
W/A,H/A,W/H,Growth curve
? Laboratory assessment
Blood sample,urine sample
Infant
feeding
Digestive system
anatomic physiological characteristic
? Mouth
? Cheek fatty mat
? Hypogenesis of neonatal saliva gland
? Amylase deficiency
? Oesophagus
? Hypogenesis of oesophageal wall muscle and bounce fiber
?Stomach
? Position
? Cardia constrictor & pylori constrictor
? Stomach capacity
Digestive system
anatomic physiological characteristic
? Intestines
the length is 6 times of body’s length (adult’s intestine is 4.5 times )
? Pancreas
<3 month infant,the activity of amylase is lower
? Liver
quite larger,the volume is 4% body’s volume,(adult 2%),soft
? Intestinal bacterium group
? Breast feeding,the major is lactobacillus
? Artificial feeding,the major is Escherichia Coli,
Normal stool
Fetal stool Breast feeding Cattle & sheep milk
Color Dark green Golden Straw yellow
Character Slimy Slimy & soft with grain Hard,easy shack off
Odor No odour Acid odour Protein decomposed odour
Times No surely >=4-5,or constipation 1-2
Infant feeding
?Breast feeding
?Artificial feeding
?Mixed feeding
Breast feeding
Breast is best
Human milk is for humans
Cow milk is for cows
Composition of breast milk
Colostrums Transitional breast milk Mature milk Terminal stage milk
Period 1 week 2 wks -1 mo 2-9months >10 months
character
?Dense,yellow
?Few fat
?High globin
?Highest fat
?Drop of
protein and
mineral
?Protein 1.2g%
?Fat 3.5g%
?Lactose 7.5g%
Decline of
amount and
nutrients
Advantage of breast feeding
? Better nutritional qualities:
?Easily digested
? Protein,whey proteins (lactalbumin and lactoglobulins) account
for 2/3
? Fat,unsaturated fatty acids,linoleic acid,rich in lipase
? Lactose,higher concentrations
?Low renal solute load,ash content of human milk (0.2%) is less
than one-third that of cow milk (0.7%)
?Favorable calcium to phosphate ratio,ensure calcium
absorption
?Better iron,zinc
Advantage of breast feeding
? Anti-infective properties
? Secretory Ig A
?Lysozyme (溶菌酶 ）
?Phagocytic cells （ 吞噬细胞 ）
?Iron-binding protein Lactoferrin （ 乳铁蛋白 ）
?Low-polysaccharid
?Zinc
?Vitamin B12
?Bifidus factor （ 双歧因子 ）
Advantage of breast feeding
? Psychologic benefit
?Promotes maternal-infant bonding
?Gain a sense of security
?Constitute the foundation for the development of all
human social relationships and communications
? others
?Economy,convenience
?Lack of contamination
Advantage of breast feeding
? Benefit for the mother
? Stimulation,by sucking,of oxytocin secretions,
which fosters uterine contractions and hastens
postpartum uterine involution
? Possible decreased risk of postpartum
thromboembolism and breast cancer
? Emotional satisfaction and sense of fulfillment
Artificial Feeding
?Milk production in common use,
fresh cow’s milk,sheep’s milk,infant formula,
yoghourt,exhalation milk
? Soya formula,Soya milk,rice flour
? Feeding schedule,avoid overfeeding
Mixed Feeding
? supple the inadequate
of breast feeding
? substitute of breast
feeding
Composition of different milk (per 100 ml )
Composition Breast milk Cow’s milk Sheep’s milk
Energy (kcal) 66 66 69
Protein (g) 1.2（ lactalbumin account for 2/3） 3.5（ casein account for 4/5） 3.3
Fat (g) 3.5（ the major is liquid fat） 3.5（ the major is volatility fatty cid） 4.1
Lactose (g) 7.5 4.8 4.7
Mineral (g) 0.2 0.7 0.77
Calcium (g) 0.033 0.125 0.061
Phosphorous (g) 0.015 0.099 0.055
Iron (g) 0.00021 0.00015 0.001
Sodium (g) 0.015 0.058 0.018
Potassium (g) 0.055 0.138 0.046
Vitamin D (IU) 0.4－ 10.0 IU 0.3－ 0.4 IU
Lipase More Less
Water (g) 87.5 87.5 86.7
α-lactalbumin
Other whey
proteins
Casein
α-lactalbumin
?-lactoglobulin
Other
whey
proteins
Casein
Bovine MilkHuman Milk
Milk Protein Composition
CaseinOther
whey
proteins
Nutrients and energy daily requirement for infants
Energy
(kcal)
Water
(ml/kg)
Protein
(g/kg)
fat
(g/k
g)
Carbohy
drate
(g/kg)
Calciu
m
(mg)
Iron
(mg)
Zinc
(mg)
Vitamin
A
IU
B1
mg
B2
mg
C
mg
D
IU
E
mg
110 150 1.7-4.0 4-6 10-12 500 15 5 1000 0.5 0.5 50 500 5
以后
每年
减 25
％
15% 35％ 50％
Energy:
100ml fresh milk include 66 kcal
5% sugary milk 86 kcal
8% sugary milk 98 kcal
Example,6 months infant,WT 7kg
?Energy daily requirement,110?7＝ 770kcal,be
equal to 770ml ml
?Liquid daily quirement:150ml?7=1050ml,still
need to supply water 280ml.
The introduction of supplementary food
The purpose of supplementary food
?To supply nutrient deficiency of breast milk
?To supply the inadequate of breast milk
?To prepare for weaning
?To train the oral motor function
The rules of supplementary food
? From small to large 从少到多
? From watery to dense 从稀到稠（从流质到半流质到固体）
? From thin to thick 从细到粗
? From one food to multi-foods 从一种到多种
Schedule of solid foods
Age Feeding foods
3-4 months Cereals,e.g,baby rice
4-5 months Pureed fruit and vegetables,meat (e.g,chicken)
6-7 months
Able to chew,e.g,rusks
Introduce lumpy foods and variety of
tastes and textures,egg yolk
8-9 months Bread and butter,fruit,egg white
12 months ‘real’ food in small bits
Toddle Feeding
?the child’s rate of growth slows
considerably after the first year of life,
and caloric needs pound decrease
?the function of digest has improved
Toddle Feeding
?Providing an adequate diet
?The development of feeding skills,
food habits,and nutrition knowledge
