ON

PREVENTIV
PEDIATRICS- 2

SUMMITTED TO-

SUBMITTED BY-
Aim-

At the end of this seminar student will be able to understand the preventive pediatrics and role of pediatric nursing
in preventive pediatrics.

Objectives-

At the end of this seminar student will be able to-

1. Enlist the different types of nutrients

2. Describe the nutritional requirements of the children.
3. Discuss the patterns of feeding
4. Explain breast feeding
5. Enlist artificial feeding
6. Discuss BFHI
7. Explain Nutritional programs
8. Describe welfare services of children
9. Discuss about various organizations related to children
10. Give Health education and nutrition

1. NUTRIENTS AND NUTRITIONAL REQUIREMENTS OF CHILDREN

INTRODUCTION
•Nutrition is the science that interprets the interaction of nutrients and other substances in food in relation to
maintenance , growth , reproduction , health and illness of an organism .A poor diet may have an injurious impact
on health causing deficiency diseases

DEFINITION
•Nutrition is defined as the process of providing or obtaining the food necessary for health and growth
_ OXFORD DICTIONARY

NUTRIENTS
Nutrients are of two types :
• MACRONUTRIENTS , which are needed in larger amounts ( CHO , Fats , protein and water).
• MICRONUTRIENTS , which are needed in smaller amounts ( minerals and vitamins )

NUTRIENTS PRIMARY FUNCTION

WATER Dissolves and carry nutrients , removes waste and regulates body temperature
PROTEIN Builds new tissue , antibodies , enzymes hormones and other compounds
CHO Provides energy
FAT Provides long term energy insulation and protection
VITAMINS Facilitate use of other nutrients involved in regulating growth and manufacturing hormones
MINERALS Helps in growth of bones and teeth , aid in muscle function and nervous system activity

NUTRITIONAL REQUIREMENTS IN CHILDREN

PROTEINS
CARBOHYDRATES
• CHO are main source of energy and supply bulk in the diet. • They contribute taste and are essential for digestion
and absorption of other foods. • Carbohydrates play an important part , in infant nutrition as they spare proteins to
be fully utilized for growth and various repair process. • All CHO are ultimately oxidized and converts to glucose.
• Glucose is used as fuel by brain and muscle or converted to glycogen and stored in liver and muscle. • Sources of
carbohydrate in infants diet is found in the form of lactose in both human and cows milk that should be provided up
to 6 months. • Lack of adequate CHO may produces symptoms of starvation , undernutrition ,constipation , loss of
body protein

FATS
•Fat supplies 40 - 50% energy needed for the infant. •It provides protection and support for organs and insulation of
the body as adipose tissue. •It as carrier of fat soluble vitamins. •Fats and oils are concentrated sources of energy
and make the foods palatable. •Fats and oils are termed as lipids.

• SATURATED FATS :animal sources such as meat ,eggs, milk and dairy products.
• UNSATURATED FATS : commonly found in plant and fish(poly unsaturated), peas ,beans , whole cereals , nuts ,
cooking oil. • More fat intake in diet can cause indigestion as it remains longer in the stomach. • Deficiency of all
fatty acids may result in growth retardation , skin disorders, susceptibility to infections ,neurological and visual
problems. • ICMR has recommended a daily fat intake of 25 gm/ day in young children and 22 gm/day in older
children.

VITAMINS
• Vitamins are organic substances and essential micro nutrients for maintenance of normal health. • Vitamins
enables the body to use other nutrients and help in maintenance and protection of good health. • Vitamins are
classified into two groups :
1) FAT SOLUBLE VITAMINS
2) 2) WATER SOLUBLE VITAMINS • Vitamin requirement of individual child may vary with activity , age ,body
weight. • Vitamin requirement is more in preterm babies , infant get adequate vitamins from mother during lactation.

MINERALS
Minerals are inorganic element a, required by human body for growth , repair and regulations of vital body
functions. A well balanced diet is a sufficient quality of minerals. Minerals are required for maintenance of
osmotic pressure , supply of necessary electrolytes. Minerals are classified into macrominerals when the daily
requirement is 100mg or and micro minerals when the daily requirement is less than 100mg.
.
IMPORTANCE OF NUTRITION

GUIDELINES FOR PAEDIATRIC NUTRITION

Infant should be exclusively breastfed for first 6 months. After 6 months provide nutrients which are easily
digestible. Contains various antibodies which help to build immune systems. Never overfeed or force the child
to eat. Introduce new foods at regular intervals to increase acceptance of few foods. Provide small frequent
meals.
Provide food in colourful and appealing way. Balance food with physical activity. Provide plenty of grains ,
fruits and vegetables , low fat dairy products Never stop breakfast. Involve the child in making food choices.

NUTRITIONAL COUNSELLING FOR CHILDREN

The important responsibility of the pediatric nurse is to provide nutritional counselling and guidance to the parents
and also to the children, with the goal of achieving optimum nutrition through out the year of growth and
development.
 AT 6 MONTHS : complementary feeding to be initiated with fruit juices and then new foods to be introduced with
vegetable soup, mashed banana, mashed and boiled potato ect. Each food should be given with one or two
teaspoons at first for 3 to 6 times per day.

• 6 TO 9 MONTHS : Food items given in this period include soft mixture of rice and dal , khichadi, pulses, mashed
and boiled potato, bread or roti soaked in milk or dal, mashed fruits like banana ,mango, papaya, stewed apple etc.
Egg yolk can be given from 6 to 7 months onwards Curd or khir can be introduced from 7 to 8 months onwards .
• 9 TO 12 MONTHS :New food items like fish, meat , chicken can be introduced during this period. Feeds should
be soft and well cooked Spices and condiments to be avoided Breastfeeding to be continued

• 12 TO 18 MONTHS :The child can take all food cooked in family and needs half amount of mothers diet. Number
of feeds can be 4 to 5 times or according to the childs need. Breastfeeding to be continued , especially at night.

CONCLUSION • Adequate knowledge , attitude and practices of application of nutritional requirements must be
the basis of infant feeding. The health and nutritional status of an infant and subsequent growth and development
through childhood depends upon successful feeding practices. Nutritional counselling is the important responsibility
of the nurse to promote the nutritional status of the children and to prevent nutritional deficiency diseases

Fluids and Electrolytes in Infants and Children

Fluid and Electrolytes Infants and children-

Alteration in Fluid and Electrolyte Status

Lungs Ball & Bender Urine & faeces Skin Normal routes of fluid excretion in infants and children.
Developmental and Biological Variances Infants younger than 6 weeks do not produce tears. In an infant a sunken
fontanel may indicate dehydration. Infants are dependant on others to meet their fluid needs. Infants have limited
ability to dilute and concentrate urine.
Developmental and Biological Smaller the child, greater proportion of body water to weight and proportion of
extracellular fluid to intracellular fluid. Infants larger proportional surface area of GI tract than adults. Infants
greater body surface area and higher metabolic rate than adults.
Water Balance Regulated by Anti-diuretic Hormone ADH. Acts on kidney tubules to reabsorb water. The young
infant is highly susceptible to dehydration

Increased Water Needs -

Fever / sepsis Vomiting and Diarrhoea High-output in renal failure Diabetes insipidus Burns Shock Tachypnea

Decreased Water Needs -

Congestive Heart Failure Mechanical Ventilation Renal failure Head trauma / meningitis
General Appearance How does the child look?
Skin:
• Temperature
• Dry skin and mucous membranes
• Poor turgor, tenting, dough-like feel
• Sunken eyeballs; no tears
• Pale, ashen, cyanotic nail beds or mucous membranes.
• Delayed capillary refill > 3 seconds
Loss of Skin Elasticity Loss of skin elasticity Due to dehydration.
Whaley & Wong Text-
Cardiovascular-
Pulse rate change: Note rate and quality Rapid, weak, or thready - inappropriate Bounding or arrhythmias Blood
Pressure (poor indicator) Note increase or decrease
Respiratory
Change in rate or quality Dehydration of hypovolemia Tachypnea Apnea Deep shallow respirations Fluid overload
Moist breath sounds Cough
Diagnostic Tests Make sure free flowing specimen is obtained, a hemolysed or clotted blood specimen may give
false values.
Hemoglobin and Hematocrit
Measures hemoglobin, main component of erythrocytes, vehicle for transporting oxygen. Hb and hct will be
increased in extracellular fluid volume loss. Hb and hct will be decreased in extracellular fluid volume excess.
Electrolytes Electrolytes account for approximately 95% solute molecules in body water. Sodium Na+ predominant
extracellular cation. Potassium K+ is the predominant intracellular cation.
Potassium High or low values can lead to cardiac arrest. With adequate kidney function excess potassium is
excreted in the kidneys. If kidneys are not functioning, the potassium will accumulate in the intravascular fluid
Potassium Adults: 3.5 to 5.3 mEq /L Child: 3.5 to 5.5 mEq / L Infant: 3.6 to 5.8 mEq / L Panic Values: < 2.5 mEq
/L or > 7.0 mEq / L
Hyperkalemia
Potassium level above 5.0 mEq / L Significant dysrhythmias and cardiac arrest may result when potassium levels
arise above 6.0 mEq/L Adequate intake of fluids to insure excretion of potassium through the kidneys.
CM: Hyperkalemia Nausea Irregular heart rate Pulse slow / irregular
Causes of Hyperkalemia Acute renal failure Chronic renal failure Glomerulonephritis
Diagnostic tests: Serum potassium ECG Bradycardia Heart block Ventricular fibrillation
Hypokalemia
Potassium level below 3.5 mEq / L Before administering make sure child is producing urine. A child on potassium
wasting diuretics is at risk – Lasix
CM: Hypokalemia
Neuromuscular manifestations are: neck flop, diminished bowel sounds, truncal weakness, limb weakness, lethargy,
and abdominal distention.
Causes of Hypokalemia
Vomiting / diarrhea Malnutrition / starvation Stress due to trauma from injury or surgery. Gastric suction /
intestinal fistula Potassium wasting diuretics Ingestion of large amounts of ASA
Foods high in potassium Apricots, bananas, oranges, pomegranates, prunes Baked potato with skin, spinach, tomato,
lima beans, squash Milk and yogurt Pork, veal and fish
Monitor Potassium Levels A child with a nasogastric tube in place that is set to suction, needs to have potassium
levels monitored.
Sodium Sodium is the most abundant cation and chief base of the blood. The primary function is to chemically
maintain osmotic pressure and acid-base balance and to transmit nerve impulses. Normal values: 135 to 148 mEq /
L
Treatment Modalities
Peripheral IV
IV Therapy Ball & Bender
Intraosseous Therapy Intraosseous needle in place for emergency vascular access.
Central Venous Catheter
Total Parental Nutrition A tunneled catheter should have Whaley & Wong An occlusive dressing in place.
TPN Therapy
TPN provides complete nutrition for children who cannot consume sufficient nutrients through gastrointestinal tract
to meet and sustain metabolic requirements. TPN solutions provide protein, carbohydrates, electrolytes, vitamins,
minerals, trace elements and fats.
Complications of TPN Sepsis: infection Liver dysfunction Respiratory distress from too –rapid infusion of fluids
TPN: care reminder The TPN infusion rate should remain fairly constant to avoid glucose overload. The infusion
rate should never be abruptly increased or decreased.

Dehydration-
Skin Turgor In moderate dehydration the skin may have a doughy texture and appearance. In severe dehydration the
more typical “tenting” of skin is observed.
Skin Turgor

Treatment of Mild to Moderate ORT

– oral re-hydration therapy 50 ml / kg every 4 hours Increase to 100 ml / kg every 4 hours Non carbonated soda,
jelly, fruit juices Commercially prepared solutions are the best.
Re-hydration Therapy Increase po fluids if diarrhea increases. Give po fluids slowly if vomiting. Stop ORT when
hydration status is normal Start on BRAT diet Bananas Rice Applesauce Toast
Teaching / Parent Instruction Call H/S If diarrhea or vomiting increases No improvement seen in child’s
hydration status. Child appears worse. Child will not take fluids.
NO URINE OUTPUT
Moderate to Severe Dehydration IV Therapy needed
Fluid replacement Isotonic fluids initially: Normal Saline 0.9% Potassium is added only after child has voided.
 Nursing Interventions Assess child’s hydration status Accurate intake and output Daily weights most accurate
way to monitor fluid levels Hourly monitoring of IV rate and site of infusion. Increase fluids if increase in vomiting
or diarrhea. Decrease fluids when taking po fluids or signs of odema.
Care Reminder A child with severe dehydration will need more than maintenance to replace lost fluids. 1 ½ to 2
times maintenance. Adding potassium to IV solution. Never add in cases of oliguria / anuria • Urine output less than
0.5 mg/kg/hour Never give IV push Double check dosage
Over hydration
Occurs when child receives more IV fluids that needed for maintenance. In pre-existing conditions such as
meningitis, head trauma, kidney shutdown, nephrotic syndrome, congestive heart failure, or pulmonary congestion.
Signs and Symptoms
Tachypnea Dyspnea Cough Moist breath sounds Weight gain from edema Jugular vein distention
Congestive Heart Failure Ball & Bender
Safety Precautions
Use buretrol to control fluid volume. Check IV solution infusion against physician orders. Always use infusion
pump so that the rate can be programmed and monitored. Even mechanical pumps can fail, so check the intravenous
bag and rate frequently. Record IV rate hourly
Acid – Base Imbalances Acidosis:
Alkalosis. Respiratory acidosis Respiratory alkalosis is too much carbonic is too little carbonic acid in body. acid.
Metabolic Acidosis is Metabolic alkalosis is too much metabolic too little metabolic acid. acid.
Respiratory Acidosis Caused by the accumulation of carbon dioxide in the blood. Acute respiratory acidosis can
lead to tachycardia and cardiac arrhythmias.
Causes of Respiratory Acidosis Any factor that interferes with the ability of the lungs to excrete carbon dioxide can
cause respiratory acidosis. Aspiration, spasm of airway, laryngeal odema, epiglottitis, croup, pulmonary odema,
cystic fibrosis, and Bronchopulmonary dysplasia. Sedation overdose, head injury, or sleep apnoea.
Medical Management Correction of underlying cause
. Bronchodilators: asthma Antibiotics: infection Mechanical ventilation Decreasing sedative use.
Ventilation Assist Ball & Bender
Respiratory Alkalosis Occurs when the blood contains too little carbon dioxide. Excess carbon dioxide loss is
caused by hyperventilation.
Causes of hyperventilation Hypoxemia Anxiety Pain Fever Salicylate poisoning: ASA Meningitis Over-
ventilation
Management Stress management if caused by hyperventilation. Pain control. Adjust ventilation rate. Treat
underlying disease process.
Metabolic Acidosis Caused by an imbalance in production and excretion of acid or by excess loss of bicarbonate.
Causes: Gain in acid: ingestion of acids, oliguria, starvation (anorexia), DKA or diabetic ketoacidosis, tissue
hypoxia. Loss of bicarbonate: diarrhea, intestinal or pancreatic fistula, or renal anomaly.
. Ingestion of large doses of Aspirin
. Management Treat and identify underlying cause. IV sodium bicarbonate in severe cases. Assess rate and depth
of respirations and level of consciousness.
Metabolic Alkalosis A gain in bicarbonate or a loss of metabolic acid can cause metabolic alkalosis.
Causes: Gain in bicarbonate: Ingestion of baking soda or antacids. Loss of acid: Vomiting, nasogastric suctioning,
diuretics massive blood transfusion
Clinical Manifestations Hypertonicity or tetany Management: Correct the underlying condition

Feeding of Infants- types

FEEDING THE PREMATURE AND LOW BIRTH WEIGHT INFANTS
Full term infant -
Baby born with the ability to efficiently extract milk from the breast or bottle. Physical and neurological
development allows the full-term infant to maintain efficient posture for feeding, generate appropriate oral pressure
for milk extraction, coordinate suck-swallow-breathing and regulate sleep-wake cycles in a manner that facilitates
demand feeding.
Premature infant-
 Infant born prematurely has low tone, decreased muscle and fat mass, does not effectively coordinate suck-
swallow-breathing, and does not sustain prolonged wake states. This places the infant at a disadvantage for being
an efficient feeder. Globally, about 18 million infants are born with a birth weight of < 2500g every year.
Low birth weight infants constitute only about 14% of the total live births, they account for 60-80% of total
neonatal deaths
Nutritional management influences immediate survival as well as subsequent growth and development of LBW
infants.
Limitations: Pre-term infants born with inadequate feeding skills. They might not be able to breastfeed and
would require other methods of feeding such as spoon or gastric tube feeding. These infants are prone to have
significant illnesses in the first few weeks of life Preterm very low birth infants (VLBW) infants have higher
fluid requirements in the first few days of life due to excessive insensible water loss.
Very low birth weight infants have low body stores at birth. Hence they require supplementation of various
nutrients. Because of the gut immaturity, they are more likely to experience feed intolerance necessitating
adequate monitoring and treatment.
The LBW infants categorized into two types :
1. Sick infants `
2. Healthy infants.
3. Sick infants:
This group constitutes infants with significant problems. These infants are usually started on intravenous (IV)
fluids. Enteral feeds should be initiated based on the infants’ gestation and clinical condition.
Healthy infants: Enteral feeding should be initiated immediately after birth in healthy LBW infants.
Appropriate feeding method determined by their gestation and oral feeding skills.
Choice of initial feeding method in LBW infants
How to decide the initial feeding method ?
Traditionally, the initial feeding method in a LBW infant was decided based on her birth weight. This is not an
ideal way because the feeding ability depends largely on gestation rather than the birth weight. It is important to
remember that not all infants born at a particular gestation would have same feeding skills.

“NON- NUTRITIVE SUCKING” All stable LBW infants, irrespective of their initial feeding method should
be put on their mothers’ breast. The immature sucking observed in preterm infants born before 34 weeks might
not meet their daily fluid and nutritional requirements but helps in rapid maturation of their feeding skills and also
improves the milk secretion in their mothers.
Spoon / Paladai feeding:
In LBW infants who are not able to feed directly from the breast this type of feeding is used.
Intra- gastric tube feeding: The disadvantages are In Naso- gastric feeding the tube increases the airway
impedance and the work of breathing in very preterm infants. Hence, oro-gastric tube feeding might be preferable in
pre-term infants
Paladai feeding
In continuous intra- gastric feeding the major problem is that the lipids in the milk tend to separate and stick to
the syringe and tubes during continuous infusion resulting in significant loss of energy and fat content.
All LBW infants, irrespective of their gestation and birth weight, should ultimately be able to feed directly from the
mothers’ breast. For preterm LBW
infants started on IV fluids/OG tube/ spoon feeding, the steps of progression are

CHOICE OF MILK FOR LBW INFANTS:

All LBW infants, irrespective of their initial feeding method should receive ONLY breast milk.
Expressed breast milk (EBM): All preterm infants mothers should feed their own milk to their infants.
Expression should ideally be initiated within hours of delivery so that the infant gets the benefits of feeding
colostrum. Expressed breast milk can be stored for about 6 hours at room temperature and for 24 hours in
refrigerator.
Donor human milk: Donor human milk can be used for feeding a LBW infant. At present, only a few centers in
India have standardized human milk banking facilities. Hence, it is not a practical option in most of the settings
across India. In Special situations the Sick mothers / contradiction to breast feeding have the options:
1. Formula feeds: a. Preterm formula – in VLBW infants and b. Term formula – in infants weighing >1500g at
birth.
2. Animal milk: E.g. undiluted cow’s milk. Once the mother’s condition becomes stable (or the contra-indication to
breastfeeding no longer exists), these infants should be started on exclusive breastfeeding.
Fluid requirement: The daily fluid requirement is determined based on the estimated insensible water loss,
other losses, and urine output. Extreme preterm infants need more fluids in the initial weeks of life because of
the high insensible water loss. We usually start fluids at 80 mL and 60 mL/kg/day for infants birth weights of
<1500g and 1500-2500g respectively. The usual daily increment would be about 15-20 mL/kg/day so that by the
end of first week 150 mL/kg/day is reached in both the categories. We usually reach a maximum of 180mL/kg/day
by day 14.
Supplementation of infants of weight 1500-2500g: • These infants are more likely to be born at term or near term
gestation (>34 weeks). Hence, they do not require multi nutrient supplementation or fortification of breast milk. •
Vitamin D and iron might still have to be supplemented in them. • AAP recommends vitamin D (200 IU) is started
at 2 weeks and iron (2 mg/kg/day) at 2 months of life; both are continued till 1 year of age.
Supplementation of VLBW infants: • These infants who are usually born before 32-34 weeks gestation have
inadequate body stores of most of the nutrients. • Expressed breast milk has inadequate amounts of protein, energy,
calcium, phosphorus, trace elements (iron, zinc) and vitamins (D, E & K) that are unable to meet their daily
recommended intakes. • Hence VLBW infants need to supplement till they reach normal term gestation (40 weeks)
Multi-nutrient supplementation can be ensured by one of the following methods: 1. Supplementing individual
nutrients – E.g., calcium, phosphorus, vitamins, etc. 2. By fortification of expressed breast milk: a. Fortification
with human milk fortifiers (HMF) b. Fortification with preterm formula
Growth monitoring of LBW infants:
• Regular growth monitoring helps in assessing the nutritional status and adequacy of feeding, it also identifies
LBW infants with inadequate weight gain.
• All LBW infants should be weighed daily till the time of discharge from the hospital. Other anthropometric
parameters such as length and head circumference should be recorded weekly.
LBW infants should be discharged after:
• They reach 34 weeks gestation and or above 1400g .
• They show consistent weight gain for at least 3 consecutive days.

Use of Growth charts: It is a simple but effective way to monitor the growth. The plotting of measurements in GC
helps to compare the individual infants growth with reference standards. It helps in early identification of growth
faltering in the infants.

Two types of growth charts:

1. Intrauterine
2. Postnatal.
Most commonly used for growth monitoring of preterm VLBW infants are: Wright’s and Ehrenkranz’ charts.
The postnatal growth chart is preferred because it is a more realistic representation of the true postnatal growth
(than an intrauterine growth chart) and also shows the initial weight loss that occurs in the first two weeks of life.
Once the preterm LBW infants reach 40 weeks PMA, WHO growth charts should be used for growth monitoring.
Causes of inadequate weight gain: 1.Inadequate intake Breastfed infants: Incorrect feeding method (improper
positioning/attachment)
Less frequent breastfeeding, not feeding in the night hours Prematurely removing the baby from the breast
(before the infant completes feeds) Infants on spoon feeds: Incorrect method of feeding (e.g. excess spilling)
Incorrect measurement/calculation Infrequent feeding Not fortifying the milk in VLBW infants Energy
expenditure in infants who have difficulty in accepting spoon feeds
Increased demands Illnesses such as hypothermia/cold stress*, bronchopulmonary dysplasia Medications such
as corticosteroids 3. Underlying disease / pathological conditions Anemia, hyponatremia, late metabolic acidosis
Late onset sepsis Feed intolerance.

Conclusion: Optimal feeding of LBW infants is important for the immediate survival as well as for subsequent
growth. Compared to the normal birth weight infants, pre-term birth infants have vastly different feeding
abilities and nutritional requirements. They are also prone to develop feed intolerance in the immediate postnatal
period. It is important for all health care providers caring for such infants to be well versant with the necessary
skills required for feeding them.

Breastfeeding
BREASTFEEDING BY: ULFAT AMIN MSC CHILD HEALTH NURSING

Introduction
 Breastfeeding is the feeding a neonate/infant with breast milk directly from female human breasts (i.e., via lactation)
not from a baby bottle or other container.

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. 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.
Types and Composition of Human Breast Milk

COLOSTRUM or Early Milk is produced in the late stage of pregnancy till 4 days after delivery; and is rich in
antibodies.
TRANSITIONAL Milk produced from day 4 – 10 is lower in protein in comparison to Colostrum.
MATURE milk is produced from approximately ten days after delivery up until the termination of the
breastfeeding.

Benefits of Breastfeeding to Infants

1. Helps in Gastrointestinal development and function
2.Helps in development of the immune system
3. Helps in cognitive development of the infant
Infants who are breastfed have reduced risk of infection compared to formula fed infants.
4. Breastfed infants have reduced risk of obesity later in life compared to formula fed infants.
5. Reduced risk of sudden infant death syndrome, Hodgkin's lymphoma, Leukemia and Type 1 Diabetes. Lower
risk of infections e.g. Otitis media, Lower respiratory tract infection, Diarrheal diseases, Allergies , eczema,
Meningitis and inflammatory bowel diseases.
6.Benefits of Breastfeeding to Mothers
7. Enhance early maternal – infant bond.
8. Aids involution of the uterus.
9. Long term breastfeeding helps in loss of the excess weight acquired during pregnancy.
10. Documented long term effect of breastfeeding include reduced risk of breast, ovarian and endometrial cancers.

SOCIO-ECONOMIC BENEFITS OF BREASTFEEDING

1. Income savings
2.Reduced risk of infections and diseases hence reduced hospital visits and attendant medical cost.
3. Mothers are more economically productive since they will spend less time caring for a sick child.

. Mother -
. Reduces post delivery bleeding and anemia
. Delays next pregnancy
. Protects breast and ovarian cancer
. Protects obesity and shapes body
. Convenient Society
. Eco-friendly
. Human resource development
. Economy development Family
. Low cost involved
. Less illnesses
. Family bonding

What Differences Do You See? ATTACHMENT, OUTSIDE APPEARENCE

Nutrients in Human & Animal Milk 1/4 What are the differences between these milks?
. Differences in the Quality of the Proteins in Different Milks 1/5
. Differences in the Fats of Different Milks
HUMAN COW`S Contains Essential Fatty Acids, Enzyme Lipase Contains No Essential Fatty Acids No Enzyme
Lipase
. Vitamins in Different Milks 1/7
. Iron in Milk 1/8
Storage of Breast Milk
. Place of storage Temperature Maximum storage time In a room 25°C 77°F Six to eight hours Insulated
thermal bag with ice packs Up to 24 hours In a refrigerator 4°C 39°F Up to five days Freezer compartment
inside a refrigerator -15°C 5°F Two weeks A combined refrigerator and freezer with separate doors -18°C 0°F
Three to six months Chest or upright manual defrost deep freezer -20°C -4°F Six to twelve months

Breastfeeding Positions
1. Cradle Hold
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.
2. Football Hold Position
The infant’s is placed under the arm, like holding a football Baby’s body is supported with the forearm and the
head is supported with the hand. Good position after operative procedures Breastfeeding Positions
3. 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. Breastfeeding Positions
4. Cross Cradle Hold Position
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. Breastfeeding Positions
5. Twin Football Hold
6. Australian Hold Position
This is also called the saddle hold Usually used for older infants Not commonly used by mothers. Best
used in older infants with runny nose, ear infection. Breastfeeding Positions

Barriers To Effective Breastfeeding

Lack of confidence in mother
Belief that breast milk is not sufficient
Lack of adequate support system
History of previous breast surgery
Breast engorgement, cracked and sore nipples
Retractile nipples
Embarrassment by mother
Jealousy by siblings
Chronic illness in mother; psychosis, Cancer.

Contraindication to Breastfeeding
HIV , HLTV 1 & 11 infections. (Adult T-cell lymphoma virus) Active Tuberculosis.
Herpes lesions on mother’s breast.
Infant with Inborn error of metabolism; galactosemia, phenylketonuria. Mothers on certain medications ;
anticancer therapy, radioactive isotope etc.
Barriers to Bonding * A Bottle places a physical barrier between mom and baby *Less skin to skin contact *Less
eye contact * The hormonal connection between the breastfeeding mother and baby cannot be experienced by the
bottle feeding mothe
Other Options If Breastfeeding is Not Possible Mom can still use her milk, even if she decides not to
breastfeed:
Use a breast pump (electric/manual) Cup or bowl feeding Spoon feeding Eyedropper or feeding syringe
Nursing supplementer Get milk from donation bank

BFHI-
Baby-Friendly Hospital Initiative -
Introductio

• Baby friendly Hospital Initiative was launched in 1992 in INDIA.

• The history Innocenti declaration on the promoting, protection and support of breastfeeding was produced and
adapted by participants at the WHO/ UNICEF policy maker’s meeting on breast feeding in 1990s.
• The GLOBAL initiative was co- sponsored by the USAID and SIDA.
• The baby friendly hospital camping was launched by the WHO/ UNICEF in mid 1991 in Ankara to boost the
breastfeeding practices and to counter the trends of bottle feeding
• Since its launching BFHI has grown, with more than 152 countries around the world implementing the
initiative.
• The initiative has measurable and proven impact, increasing the likelihood of babies being exclusively
breastfed for the first six months.
• The programme, launched in Kerala in March 1993, is hospital .
• Manoncourt said of the 1,372 baby friendly hospitals in India 65 per cent are in Tamil Nadu and Kerala. • Dr
Elsie Philip, state co-ordinator of BFHI, said the rates of breast-feeding initiation within a day is 92 per cent in
Kerala (compared to 78.7 percent in Tamil Nadu and the national average of 37.1 per cent)
• Baby friendly hospital are required to adopted breast feeding policy and follow the “ ten step of Successful
breastfeeding” as recommended by code of practice of WHO/ UNICEF
. HIF Policies -

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding within one half-hour of birth.

5. Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
7. Practice rooming in - that is, allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial nipples or pacifiers (soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the
hospital or clinic.

Ten steps to successful breastfeeding (revised 2018)- WHO

• Critical management procedures

–1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health
Assembly resolutions.

– 1b. Have a written infant feeding policy that is routinely communicated to staff and parents.

– 1c. Establish ongoing monitoring and data-management systems.

– 2. Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding.

– 3. Discuss the importance and management of breastfeeding with pregnant women and their families.
– 4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as
soon as possible after birth.
– 5. Support mothers to initiate and maintain breastfeeding and manage common difficulties.
– 6. Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated.

Ten steps to successful breastfeeding (revised 2018)- WHO • Key clinical practices
– 7. Enable mothers and their infants to remain together and to practise rooming-in 24 hours a day.
– 8. Support mothers to recognize and respond to their infants’cues for feeding
– 9. Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.
. – 10. Coordinate discharge so that parents and their infants have timely access to ongoing support and care.
.
• Indian hospital are till in early stages of joining this movement. The National BFHI task force was formed, in
1992, towards the efforts to improve the breastfeeding practices.
• The task force comprising of Govt. of INDIA, UNICEF, WHO and Professional Organization ( TNAI, BPNI,
NNF, IMA, FOGSI, IAP, CMAI, CHAI, IBFAN, ACASH) is working for evaluation of breastfeeding practices in
the hospitals and appropriate certification as “ Baby Friendly Hospital” .
• The certificate needs re-recognition on every two years to ensure the standard and quality for successful
breastfeeding.
• Beside promotion of breastfeeding, BFHI in INDIA also proposed to provide:-
– Improved antenatal care
– Mother friendly delivery services
. – Diarrhea management
– Standardize institution support of immunization
– Promotion of healthy growth and good nutrition
– Widespread availability and adoption of family planning
• Govt. of India has made significantly efforts to promote and protect breastfeeding by enacting a law “The
Infant Milk Substitutes, Feeding Bottles and Infant Food Act,1992”.

• The act prohibits advertizing of infant milk substitutes (IMS) and feeding bottles to public, free sampling,
hospital promotion and gifts of samples of IMS to health workers. Complementary feeding ppt
1. 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.
2. 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 becomes accustomed to adult diet.
3. 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.
4. 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.
5. 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.
6. Practice exclusive breast feeding from birth up to 6months and introduce complementary feeding after 6
months of age. Continue frequent on demand breast feeding until 2 years of age.
7. 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.
8. 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
needsare met.
9. 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.
10. 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.
11. 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.
12. 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
13. AGE ENERGY NEEDED IN ADDITION TO MILK CONSISTENC Y FREQUENC Y AMOUNT AT EACH
MEAL
6 – 8 Month 200 Kcal/day Start with liquid andproceed foods 2 – 3 times per day Start with 2 - 3 table spoons per
feed and increase to about 125 ml
14. AGE ENERGY NEEDED IN ADDITION TO MILK CONSISTENC Y FREQUENC Y AMOUNT AT EACH
MEAL
9 – 11 months-
300 Kcal/day Finely chopped or mashed foods. 3 – 4 times a day Half cup of 250 ml cup. 12 – 23 months 550
Kcal/day Solid family foods, chopped or mashed. 3 – 4 times a day 1/4 th to full 250ml cup
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.
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.
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 and well cooked.
12 to 18 months –
The child can take all kind of cooked food. The amount and frequency should increase gradually.
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.
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.

NUTRITIONAL PROGRAMMES:

(1) MID-DAY MEAL PROGRAMME (MDM):

Introduction

This is also called ‘Noon Meal Programme’ which means meals are served around mid-day or noon. The target
group is 6-11 years of children who are attending the school. This was also launched in 1962 and aimed at
increasing the school attendance in addition to taking care of their health. Mid-day meal programme was launched
mainly in primary schools

This programme covers 21.1 million children of class 1 to V standard. Food grains are provided at the rate of 3 kg
per month. Provision is made for 300 calorie and 8-12 gm of protein/day to beneficiary. This is provided for 200
days in each year. Central government supplies all requirement of cost for its implementation in rural areas.
Panchayats and Nagarpalika are involved for setting up necessary infrastructure for preparing cooked food. NGO,
women’s group and parent teacher councils can be also utilized. In several areas supplementary feeding programme
are assisted by Cooperative American Relief Everywhere (CARE) and world food programme.

Objectives:

The objectives of the mid day meal scheme are:

 Improving the nutritional status of children in classes I-V in Government, Local Body and Government aided
schools, and EGS and AIE centres.
 Encouraging poor children, belonging to disadvantaged sections, to attend school more regularly and help them
concentrate on classroom activities.
 Providing nutritional support to children of primary stage in drought affected areas during summer vacation.

Utilisation of Central Assistance:

(a) Cooking Costs:

During 2007-08, Government of India have sanctioned an amount of Rs. 2372.31 lakhs as Central assistance for
cooking cost out of which Rs. 1186.155 lakhs has been released as the 1st instalment to the Districts. Necessary
action has been taken to release the remaining amount of Rs.1186.155 lakhs to the Districts within the 31st
March 2008. Steps have been taken to release the amount of Rs.95.88 lakhs for conversion cost to the UP
Schools in 9 Educational Backward Blocks. As and when foodgrains is delivered to the schools, School
Managing Committees have been advised to make use of their own resources which would be reimbursed as
soon as Finance Department releases the fund for cooking cost.

(b) Kitchen Sheds construction :

Sanction for construction of Kitchen Sheds was received towards the fag-end of 2006-07 financial year for an
amount of Rs. 1523.40 lakhs. The amount has already been released to 2539 Government LP Schools and the
Construction work is in progress. Fund for construction of kitchen sheds to 468 U.P. Schools in Educationally
Backward Blocks amounting to Rs.2,80,80,000.00 has just been received and the same has been released by State
Finance Department on the 31st March 2008.

(C) Procurement of Kitchen Devices:

The Government of India have sanctioned an amount of Rs. 72.48 lakhs for 2006-07 as central assistance for
provision/ replacement of cooking equipments/ devices in 1450 schools @ Rs. 5000/- per school. The amount
sanction has fully been utilized. Kitchen Devices to 468 UPS in EBBs amounting to Rs.23,40,000.00 has just been
received and the same has just been released by the State Finance Department on the 31st March 2008.

(d) Management, Monitoring and Evaluation:

The State has an amount of Rs.34.46 Lakhs as Opening Balance as on 1-4-2007 under the Head “Management,
Monitoring and Evaluation”. The amount was spent on School Level expenses, management/supervision, training,
internal/external evaluation and external monitoring evaluation. The Government of India has sanction a sum of
Rs.23.65 lakhs (including Rs.2.00 lakhs for EBBs) for 2007-08 which the same has just been released by the State
Finance Department on the 31st March 2008.

(e) Transport Subsidy:

Till recently the Transport subsidy to the wholesalers is paid by the District Rural Development Agencies on
production of the bills by the respective wholesalers. But for the last three years, viz. 2004-05, 2005-06, 2006-07,
many Districts have not received transport subsidy. In the previous years the DRDAs used to send their requirement
directly to the Government of India. Presently, the Directorate of Elementary and Mass Education as the State
Transport Nodal Agency of Mid Day Meal Scheme have taken up the responsibility of compiling the requirements
of transportation charges for lifting of foodgrains of all the Districts and forwarding the same to the Government of
India for sanction.
 PROGRAMME INTERVENTION AND COVERAGE

To achieve the above objectives a cooked mid day meal with nutritional content as shown in column 3 of the table
below will be provided to all children studying in classes I-V:

Norm as per NP-

Nutritional Content Revised Norm as per NP-NSPE, 2006
NSPE, 2004

Calories 300 450

Protein 8-12 12

Micronutrients quantities of micronutrients like iron, folic

Not Prescribed
Adequate acid, vitamin-A etc.

Components of the revised scheme:

The revised scheme provides for the following components:

 Supply of free food grains (wheat/rice) @ 100 grams per child per School Day from the nearest FCI godown
 Reimbursement of the actual cost incurred in transportation of food grains from nearest FCI godown to the
Primary School subject to the following ceiling :
o Rs.100 per quintal for 11 special category States viz. Arunachal Pradesh, Assam, Meghalaya, Mizoram,
Manipur, Nagaland, Tripura, Sikkim, J&K, Himachal Pradesh and Uttarakhand, and
o Rs.75 per quintal for all other States and UTs
 Provision of assistance for cooking cost at the following rates :
o States in North-Eastern Region: @ Rs.1.80per child per school day provided the State Govt. contributes a
minimum of 20 paise.
o For other States & UTs : @ Rs.1.50 per child per school day provided the State Govt./UT administration
contributes a minimum of 50- paise.

State Governments/UT administrations are required to provide the above minimum contribution in order to be
eligible for the enhanced rate of Central assistance mentioned above.

 Provision of assistance for cooked Mid-Day Meal during summer vacations to school children in areas declared
by State Governments as "drought-affected".
 Provision of assistance to construct kitchen-cum-store in a phased manner up to a maximum of Rs.60,000 per
unit. However, as allocations under MDMS for construction of kitchen-cum-store for all schools in next 2-3
years may not be adequate states would be expected to proactively pursue convergence with other development
programmes for this purpose. (Also please see para 2.5 in this regard).
 Provision of assistance in a phased manner for replacement of kitchen devices at an average cost of Rs.5,000
per school. The States/UT administration will have the flexibility to incur expenditure on the items listed below
on the basis of the actual requirements of the school (provided that the overall average for the State/UT
administration remains Rs.5000 per school).
o Cooking devices (Stove, Chulha, etc.)
o Containers for storage of food grains and other ingredients.
o Utensils for cooking and serving.
 Provision of assistance to States/UTs for Management, Monitoring & Evaluation (MME) at the rate of 1.8% of
total assistance on
o Free food grains,
o Transport cost and
o Cooking cost. Another 0.2% of the above amount will be utilized at the Central Government for management,
monitoring and evaluation.

Monitoring Mechanism:
The Department of School Education and Literacy, Ministry of Human Resource Development has prescribed a
comprehensive and elaborate mechanism for monitoring and supervision of the Mid Day Meal Scheme. The
monitoring mechanism includes the following:

 Arrangements for local level monitoring

Representatives of Gram Panchayats/Gram Sabhas, members of VECs, PTAs, SDMCs as well as Mothers'
Committees are required to monitor the (i) regularity and wholesomeness of the mid day meal served to children, (ii)
cleanliness in cooking and serving of the mid day meal, (iii) timeliness in procurement of good quality ingredients,
fuel, etc. (iv) implementation of varied menu, (v) social and gender equity. This is required to be done on a daily
basis.

 Display of Information under Right to Information Act

In order to ensure that there is transparency and accountability, all schools and centres where the programme is
being implemented are required to display information suo-moto. This includes information on:

o Quality of food grains received, date of receipt.

o Quantity of food grains utilized.
o Other ingredients purchased, utilized
o Number of children given mid day meal.
o Daily Menu
o Roster of Community Members involved in the programme.

 Inspections by State Government Officers

Officers of the State Government/UTs belonging to the Departments of Revenue, Rural Development, Education
and other related sectors, such as Women and Child Development, Food, Health are also required to inspect schools
and centres where the programme is being implemented. It has been recommended that 25% of primary
schools/EGS & AIE centres are visited every quarter.

 Responsibility of Food Corporation of India (FCI)

The FCI is responsible for the continuous availability of adequate food grains in its Depots (and in Principal
Distribution Centres in the case of North East Region). It allows lifting of food grains for any month/quarter
upto one month in advance so that supply chain of food grains remains uninterrupted.

For the NP-NSPE, 2006, the FCI is mandated to issue food grains of best available quality, which will in any
case be at least of Fair Average Quality (FAQ). The FCI appoints a Nodal Officer for each State to take care of
various problems in supply of food grains under the MDM Programme.
The District Collector/CEO of Zila Panchayat ensures that food grains of at least FAQ are issued by FCI after
joint inspection by a team consisting of FCI and the nominee of the Collector and/or Chief Executive Officer,
District Panchayat, and confirmation by them that the grain conforms to at least FAQ norms.

 Periodic Returns

The State Government/UT is also required to submit periodic returns to the Department of School Education and
Literacy, Government of India to provide information on: (i) coverage of children and institutions, (ii) Progress in
utilisation of Central assistance, including cooking costs, transportation, construction of kitchen sheds and
procurement of kitchen devices.

 Monitoring by Institutions of Social Science Research

Forty One Institutions of Social Science Research, identified for monitoring the Sarva Shiksha Abhiyan, are also
entrusted with the task of monitoring the Mid Day Scheme.

 Grievance Redressal
States and Union Territories are required to develop a dedicated mechanism for public grievance redressal, which
should be widely publicized and made easily accessible.

EXTENSION TO UPPER PRIMARY STAGE

The Finance Minister has announced in the Union Budget 2007-08 that the Mid-Day Meal Scheme will be extended
to cover children in Upper Primary Classes in 3427 Educationally Backwards Blocks (EBBs) in 2007-08. A Budget
provision of Rs.7324 crores has been made for this purpose, representing 37% increase over the budget for 2006-07

(2) SPECIAL NUTRITION PROGRAMME (SNP):

The programme was initiated in 1970 to provide supplementary nutrition to below 6 years age group and to
pregnant and lactating mothers. Provision was made for supply of Vitamin A to children and Iron (IFA) tablets
to pregnant ladies. Supplements were provided for 300 days a year. The beneficiaries of this programme are
gradually transferred to the ICDS programme which will be discussed later on. Indeed, the beneficiaries of both
the programmes are of similar type.
The programme is confined to tribal areas and slums. Main activity under this programme is to provide
supplementary feeding to the beneficiaries for 300 days in a year, although some individual initiatives were
made in some States to link some other services with supplementary feeding. For example, in early seventies in
the small State of Tripura in North Eastern India, a school drop out tribal girl was selected for running the
feeding centre, provided with some motivational training and then encouraged to impart pre- school education
to the children, teach them simple personal hygiene etc.
Tribal communities were exhorted, and they invariably did so, to construct a small hall where the pre-school
activities could take place. Under this programme, every child is to receive 300 calories and 8 to 15 gms of
protein and every expectant and nursing mother 500 calories and 20 to 25 gms of protein per day. As and when
ICDS projects coyer 'tine areas having the SNP, the programme is merged with ICDS.

BALWADI NUTRITION PROGRAMME (BNP):

INTRODUCTION:

 Bal (children) wadi (home or centre) Nutrition Programme is a contemporary of SNP and is being implemented
since 1970-71 by the Central Social Welfare Board and national level nongovernmental voluntary organisations,
namely, Indian Council for Child Welfare, Harijan (Scheduled Castes) Sevak (Service) Sangh (Board), Bhartiya
(Indian) Adimjati (Scheduled Tribe) Sevak Sangh and Kasturba (wife of Mahatma Gandhi) National Memorial
Trust.

 This is being implemented through voluntary agencies like the Central Social Welfare Board (CSWB), Indian
Council of Child Welfare (ICCW), Harijan Sevak Sangh, Adimjati Sevak Sangh, Kasturba Gandhi National
Memorial Trust, etc. The target group are preschool children of 3 years to 5 years. The provision for diet
supplementation is for 270 days a year. The diet contains 300 calorie and 10 gm protein/day. The children are
also given preschool education. Provision is made to take care of emotional and social development of children.

 The nutrition programme was started to provide healthier low cost snacks to children in the balwadi.The
women’s group was approached by Save The Children India for preparing healthy snacks in a hygienic
environment and maintaining the food quality. The samples were tested by the Programme Staff and a weekly
menu was made.

THE BENEFICIARIES
 The beneficiaries of SNP are basically from the disadvantaged section of the society like tribal/scheduled
caste people, urban slum dwellers and also migrant labourers.

BALWADI CENTRE :

The in-charge of the Balwadi Centre is an honorary worker, like Anganwadi worker of ICDS, and is paid an
honorarium which is Rs. 200 per month for trained and Rs. 150 for untrained. She is assisted by a helper who is also
an honorary worker. The Balwadis not only provide supplemental nutrition but also look after the social and
emotional development of children attending these Balwadis.

A total number of 5641 Balwadi centres are presently being run by the five organisations. About 229 thousand
children in the age group 3-5 years are covered under the programme. The budget for the SNP during 1993-94 stood
at Rs. 100 million.

APPLIED NUTRITION PROGRAMME:

 The Applied Nutrition Programme (ANP) was introduced as a pilot scheme in Orissa in 1963 which later on
extended to Tamil Nadu and Uttar Pradesh with the objectives of : a) promoting production of protective food
such as vegetables and fruits and b) ensure their consumption by pregnant and nursing mothers and children,
During 1973, it was extended to all the states of the country.

 The Nutritional Education was the main focus and efforts were directed to teach rural communities through
demonstration how to produce food for their consumption through their own efforts.

 The beneficiaries are children between 2-6 years and pregnant and lactating mothers. Nutrition worth of 25
paise per child per day and 50 paise per woman per day are provided for 52 days in a year. But this programme
did not produce any impact. The community kitchens and school gardens could not function properly due to
lack of suitable land, irrigation facilities and low financial investment.

NATIONAL NUTRITIONAL ANAEMIA PROPHYLAXIS PROGRAMME:

Available studies on prevalence of nutritional anemia in India show that 65% infant and toddlers, 60% 1-6 years of
age, 88% adolescent girls (3.3% has hemoglobin <7 gm/dl; severe anemia) and 85% pregnant women (9.9% having
severe anemia). The prevalence of anemia was marginally higher in lactating women as compared to pregnancy.
The commonest is iron deficiency anemia.
 The programme was launched in 1970 to prevent nutritional anemia in mothers and children. Under this programme,
the expected and nursing mothers as well as acceptors of family planning are given one tablet of iron and folic acid
containing 60 mg elemental iron which was raised to 100 mg elemental iron, however folic acid content remained
same (0.5 mg of folic acid) and child in the age group of 1-5 years are given one tablet of iron containing 20 mg
elemental iron (60 mg of ferrous sulphate and 0.1 mg of folic acid) daily for a period of 100 days. This programme
is being taken up by Maternal and Child Health (MCH) Division of Ministry of Health and Family Welfare. Now it
is the part of RCH programme.

NATIONAL IODINE DEFICIENCY DISORDER CONTROL PROGRAMME:

INTRODUCTION:

Iodine is an essential micronutrient with an average daily at 100-150 micrograms for normal human growth and
development. Deficiency of Iodine can cause physical and mental retardation, cretinism, abortions, stillbirth, deaf
mutism, squint & various types of goitre. Results of sample surveys conducted in 325 districts covering all the
States/Union Territories have revealed that 263 districts are endemic where the prevalence of Iodine Deficiency
Disorders is more than 10%. It is estimated that more than 71 million persons are suffering from goitre and other
Iodine Deficiency Disorders.

The Government is implementing the National Iodine Deficiency Disorders Control Programme (NIDDCP)
formerly known as National Goiter Control Programme (NGCP) since 1962 a 100% centrally assisted programme
with a focus on the provision of Iodated salt, IDD survey/ resurvey, laboratory monitoring of Iodated salt and
Urinary Iodine excretion, health education and publicity. The annual production of Iodated salt is about 52.00 lakh
M.T. Government of India has banned the sale of non iodated salt in the entire country for direct human
consumption under Prevention of Food Adulteration Act, 1954 with effect from 17th May, 2006.

For effective implementation of the Programme at the State level, the Ministry of Health is providing financial
assistance to all the States/UTs for establishment of an IDD Control Cell, and IDD Monitoring Laboratory in
addition to assistance for conducting surveys and Health Education & Publicity for consumption of iodated salt by
the population.The Ministry of Health is also conducting information, education and communication.

The programme is monitored by the Deputy Director Health Services situated in the Directorate of Health Services,
Mumbai.

OBJECTIVES

i. Surveillance of Goiter cases

ii. Supply of iodized salt in place of common salt.
iii. Monitoring through analysis of salt and urine samples.
iv. Assessment of impact of control measures over a period of time.

Iodine deficiency results in

1. Goiter
2. Physical and mental retardation
3. Dwarfism
4. Cretenism
5. Deafmutism
6. Frequent abortions, still births in pregnant mothers

At present 17 districts have been declared endemic and supply of iodized salt is made compulsory in these districts.
Four survey teams have been sanctioned for conducting sample surveys in various districts. The initial surveys have
shown more than 20% prevalence in 9 districts and more than 10% prevalence in 19 districts.

Quality of iodized salt is monitored at regular intervals. To monitor regular intake of iodized salt by people in ITDP
blocks, estimation of urinary iodine levels has been initiated at the State Public Health Laboratory, Pune since the
year 1996-97.

CURRENT STATUS

The State Govt. appointed a high level committee and as per recommendations, the consumption of common salt
was banned from 1st May 1998. However the order was stayed by the Nagpur High Court on 17th September 1998
and final orders are awaited.

PROGRESS OF IODISED SALT PRODUCTION IN INDIA:

 Available data on iodized salt transport showed that most of the manufacturers transported salt both by rail and
road; 24.7% of the manufacturers dispatched salt exclusively by rail and 22% exclusively by road.

 Salt transported by road, especially if it is transported for short distances (<250 kms) was not tested for
iodization. This is one of the major factors responsible for the relatively poor household availability of iodized
salt in coastal salt producing states.

 Wholesalers received iodized salt directly from manufacturers both by road (43%) and rail (50%). They had
adequate storage space; majority stored iodized salt in covered godown.Most of the wholesalers (69%) did not
repack the iodized salt while distributing it in retail).

 Transport of salt Concerned with the low use of iodized salt at household level, Government of India in 1997
imposed ban on the stor-age and sale of the non-iodized salt. By 2000 all the UTs and states except Kerala had
banned the storage and sale of non-iodized salt; in Andhra Pradesh and Maharashtra, the ban was partial

DISTRIBUTION OF SALT:
 Medical professionals from non-endemic states, especially, from Kerala protested against the ban because they
felt that there could be potential adverse effects of use of iodized salt. Between April 1999 and mid 2000
several consultations were held to discuss the scientific and epidemiological evidence on benefits and safety of
iodized salt for prevention and control of IDD; the consensus statement from the consultations was that under
the existing conditions in India universal iodization of salt for human consumption was safe and was needed to
combat IDD. Inspite of unanimous technical advice that the ban on non-iodized salt should not be removed, the
central government lifted the ban on sale of non-iodized salt for human consumption in October 2000 because
"matters of public health should be left to informed choice and not enforced". However, the state level ban was
lifted only by Gujarat and Arunachal Pradesh; Orissa lifted the ban initially but reimposed it later.

 Reports in the first two years of the present decade from several states suggested that though the state level ban
remained, it was not effectively implemented. Non-iodized salt was freely available in Gujarat. Increase in rail
tariff for transporting salt from 2002 led to increased movement of salt by road especially from Rajasthan; there
was no mechanism in place to monitor the quality of iodized salt transported by road.

 States reported that there was some decline in the consumption of iodized salt after the lifting of the national
ban on use of non-iodized salt. With the disappearance of severe forms of goiter many people even in the goiter
belt became complacent and did not ensure that they continue to consume only iodized salt. The people in the
coastal non-endemic regions were not aware of the adverse effects of IDD and tended to use cheaper non-
iodized salt.

PROGRESS IN AVAILABILITY AND CONSUMPTION OF IODIZED SALT AT HOUSEHOLD LEVEL:

Data from various surveys indicated that there was substantial improvement in household availability of salt
in the erstwhile “goiter belt” However the National Family Health Survey 2 (NFHS 2) showed that only about half
the households use adequately iodized salt; one fourth used salt with inadequate iodine content and one fourth used
non-iodized salt.

VITAMIN A PROGRAMME IN INDIA

Introduction:

A Vitamin A supplementation programme has been in operation in India since 1970. Under this programme, which
is sponsored by the Ministry of Health and Family Welfare (GOI), children between nine months to three years are
given six monthly doses of vitamin A. The administration of the first two doses is linked with routine immunisation.
Although the supplementation programme was started as a short-term measure to prevent blindness in children, it
has been going on for the last three decades and its continuation has become a subject of national debate.

The recent reports of child deaths after the administration of vitamin A during a mass campaign in Assam triggered
a fresh controversy over the programme (1-3). The controversy is not confined to the campaign-type approach to
vitamin A distribution. Also in question is the very existence of vitamin A deficiency (VAD) as a public health
problem in India and the need for supplementation (4). Such debates often confuse the policymakers and cause
setbacks to the ongoing programme, the implementation of which is already behind schedule. This paper is an
attempt to review the available data and answer some of the questions raised by the critics.

IS VITAMIN A DEFICIENCY A PUBLIC HEALTH PROBLEM IN INDIA?

 Clinical deficiency:

Severe deficiency of vitamin A is known to produce corneal xerophthalmia /keratomalacia and blindness in children.
Such cases are rarely seen in a community survey and require a large sample size for accurate estimates of
prevalence. Hospital records show a significant decline in keratomalacia cases in the last two decades and clinicians
vouch for its rarity. However, clinical signs of mild xeropthalmia like Bitot’s spots and night blindness are still seen
among children in poorer communities.

Xerophthalmia/ keratomalacia

The first repeat survey of the National Nutrition Monitoring Bureau (NNMB), conducted during 1988-90 in the
same villages that were surveyed earlier during 1975-79 showed that the prevalence of Bitot’s spots has declined
from 1.8 percent to 0.7 percent. However, the second repeat survey conducted in 1996-97 showed no further
improvement and the prevalence is still above 0.5 percent, which is the WHO cut off level for a public health
problem.

The national averages do not give a full picture because the prevalence rates vary widely, not only between the
states but also within a state. Nevertheless, they provide useful information on time trends.

The India Nutrition Profile (1999) is often quoted to show low prevalence of clinical deficiency in the population,
but the prevalence rates of Bitot’s spots published in this report cannot be used since they are based on pooled data
of all age groups. In a few states like Haryana, Assam and Orissa, for which the data on preschool children are
given separately, the prevalence is relatively higher.

Bitot’s spot

A survey in five northeastern states (Assam, Bihar, Orissa, West Bengal and Tripura) showed the prevalence of
Bitot’s spots to be 0.7-2.2 percent and of night blindness to be 1.2-4.0 percent, indicating a public health problem in
all five states. The survey also showed high prevalence of night blindness among pregnant women (3.2-16 percent).
The district-wise data collected in the state of Uttar Pradesh showed Bitot’s spots in 5.6 percent of children. There
was a wide variation in the prevalence between the districts, and even within a district from cluster to cluster,
ranging from 0.2 percent to 13.7 percent.

A recent survey of the Indian Council of Medical Research (ICMR 1998) covering sixteen districts, mostly in
northern and eastern regions, showed that the prevalence of Bitot’s spots ranged from 0-4.7 percent and of night
blindness from 0.4-4.8 percent.

The low prevalence of Bitot’s spots observed in a number of districts surveyed is used as an argument that VAD is
no longer a public health problem. Yet, the prevalence of night blindness, though a subjective sign, cannot be
ignored. If both indicators are used, VAD is a significant problem in seven districts. If the prevalence of corneal
scars (>0.05 percent) is also considered, eleven out of sixteen districts have a significant problem. All available
clinical and biochemical indicators are subject to limitations; therefore, WHO has recommended that at least two
indicators be used for assessing the vitamin A status of a population.

Sub-clinical deficiency:

Xeropthalmia is well-recognised as an advanced state of deficiency. In communities where clinical signs of VAD
are seen, sub-clinical deficiency can be expected to be more common. Large-scale data on serum retinol levels are
not available to assess the extent of biochemical deficiency, but the community studies carried out in Andhra
Pradesh, Tamilnadu and Uttar Pradesh indicate that 30-50 percent of children have retinol levels below 20mg/dl,
which is the WHO threshold and which indicates there is a public health problem. These observations are
corroborated by dietary data. Green leafy vegetables, milk and milk products are the major sources of vitamin A in
Indian diets.
Surveys carried out in different parts of the country show low consumption of these foods. The average intake of
vitamin A is around 300 mg in women and 120 mg in children, and more than 80 percent have intakes less than 50
percent of the recommended dietary allowance (RDA).

The available data show that although the severe forms of blinding malnutrition have declined in the last two
decades, milder grades of VAD still exist in many parts of India. National surveys provide only state level
information and the limited data available from district surveys show a wide variation between districts. The
magnitude of the public health problem varies depending upon the areas surveyed and the indicators used.

Is mild VAD a public health concern?

Apart from causing ocular signs, VAD is known to produce systemic changes, of which the most significant are
alterations in epithelial integrity and immune status. Evidence for an association between VAD and infection was
documented by Scrimshaw, et al some thirty years ago. Since then, supporting data from animal experiments and
observational studies in humans have been published.

Positive association between mild xeropthalmia and the risk of respiratory infection was reported in Indian children,
while Indonesian children showed an association with both diarrhoea and respiratory infection.

Children with clinical signs of VAD were found to be at greater risk of death than those without. A subsequent
intervention trial in Indonesia showed a 34 percent reduction in mortality among children receiving six monthly
doses of 200,000 IU vitamin A.

This effect was seen even in children without clinical signs, highlighting the importance of sub-clinical deficiency.
Controlled trials in other countries also resulted in a significant reduction in mortality: 19 percent in Ghana and 30
percent in Nepal. The reduction was attributed to a fall in diarrhoea- and measles-related deaths. Trials of weekly
supplements in India and food fortification in Indonesia showed higher reduction in mortality, indicating that the
beneficial effect was due to improvement in vitamin A status by whatever means.

There are a number of potential explanations for the variability in results across trials, including the age of the
children and the dosage schedule. Smaller and more frequent doses seem to be more protective than large, periodic
doses. A high prevalence of infections resulting in vitamin losses and depletion of stores can shorten the protective
period of supplements.

Vitamin A is likely to have a greater effect in areas where VAD is highly prevalent. Such other factors as
concomitant nutritional deficiencies and access to health care can also modify the mortality effect. Thus, the impact
of vitamin A may vary depending on the environmental conditions. An average 23 percent reduction in mortality
may not be applicable to all ecological settings, but the positive impact of vitamin A in some situations cannot be
denied.

After reviewing the studies on vitamin A and mortality, a National Consultation on the Benefits and Safety of
Vitamin A administration, held in New Delhi in September 2000, concluded that the data are ‘not robust’ enough to
recommend vitamin A supplementation for the purpose of mortality reduction in children (33). In India, infant
deaths comprise up to 80 percent of under-five mortality in some states. Therefore, it is argued that an intervention
with possible effect only beyond infancy will not be of much value for reducing child mortality (34).

It is true that vitamin A is not a panacea for all the illnesses that affect children in developing countries. However,
the need for improving vitamin A status cannot be denied. The fact that a majority of the population subsists on
inadequate diets, with vitamin A intakes less than half the recommended level and a significant proportion of
children having clinical and sub-clinical deficiency is a matter of public health concern. The aim of the National
Nutrition Policy is not only to prevent blindness in children, but also to eliminate VAD as a public health problem.
In order to achieve the goal, intervention efforts should be accelerated.

What are the appropriate strategies for VAD control?

Multiple approaches, including vitamin A supplementation, food fortification, dietary diversification, and public
health measures, have been suggested for prevention and control of VAD. This has led to considerable debate as to
which of the interventions is most cost effective and sustainable. The choice is not simple; each one has its strengths
and limitations. For maximum impact and efficacy, each strategy should be considered in the context of a country’s
needs and priorities and its capacity to implement and sustain an intervention.

Vitamin A supplementation is the quickest way to improve the vitamin A status of a population and is the favoured
strategy in areas where the problem is widely prevalent. Improving the diet, even if it is difficult to achieve in the
short term, is of paramount importance since it contributes to improvement in overall nutritional status.

Food fortification with vitamin A has proved to be an effective strategy for reducing VAD in some countries. A
right mix of interventions tailored to the local circumstances is more likely to succeed in achieving the objective.

VITAMIN A PROPHYLAXIS PROGRAMME

Introduction:

In India, the National Vitamin A prophylaxis programme was started with the primary aim of reducing blindness in
children, which was a significant problem at that time. Under this programme, sponsored by the Ministry of Health
and Family Welfare, children between 1-5 years were given oral doses of 200,000 IU vitamin A every six months.
Evaluation studies in the late 1970s revealed poor implementation of the programme and inadequate coverage in
most of the states.

The programme has been reviewed several times since then and efforts were made to correct the existing
deficiencies. Currently, vitamin A is given only to children less than three years old who are at greatest risk; and the
administration of the first two doses is linked with routine immunisation to improve the coverage. A dose of
100,000 IU is given along with measles vaccine at nine months of age and 200,000 IU with DPT booster at fifteen
months.

In recent years, there has been considerable debate on the continuation of the vitamin A supplementation
programme. Since keratomalacia and resulting blindness is no longer a significant problem, opponents argue that
there is no need for supplementation and that milder forms of deficiency can be addressed through alternate
strategies aimed at dietary improvement. It is true that dietary intervention is the most logical approach. Right from
the beginning, supplementation was conceived as an interim measure to be discontinued once effective dietary
improvement is achieved. Unfortunately, the dietary situation has not changed in the last three decades.

Vitamin A intakes of children are less than half the RDA even today, with a significant proportion of them having
clinical evidence of deficiency. Under these circumstances, it is not wise or ethical to withdraw the benefits of
supplementation.

There is also a controversy about the universal approach currently adopted, because VAD is not uniform throughout
the country. The cost of vitamin A supplements is estimated to be Rs. 3.20 per child per year, which is a negligible
proportion of the total health expenditure. It requires district mapping for VAD signs all over the country. This is
possible if the states take responsibility for conducting surveys and monitoring the program. When such data are not
available, priority should be given to backward areas that are identified using ecological indicators.

Modes of delivery of vitamin A:

The mode of delivery of the vitamin has also been a subject of intense discussion. Under the national programme,
children are given vitamin A along with routine immunisation (measles, polio & DPT).

While international agencies have been vigorously promoting supplementation linked with routine, as well as
campaign-based immunisation, it is not considered a short-term measure but a low-cost, sustainable strategy to
combat VAD in developing countries.

Efforts have also been made to expand the programme to cover pregnant and lactating women and infants younger
than six months, although the studies failed to demonstrate clear benefits in these groups. These efforts have met
great resistance in the Indian context. In recent years, Pulse Polio Immunisation (PPI) has been implemented as a
national campaign, offering an opportunity to deliver vitamin A.

The Indian Academy of Paediatrics disapproved the linking of vitamin A delivery with PPI, primarily due to the
lack of sufficient evidence for the benefit of supplements in infancy, the chances of destabilisation of routine
services, and the fact that PPI is a temporary programme. Of the two states that included vitamin A in the PPI
campaigns during 1990-2000, improved coverage was achieved in Orissa but not in Uttar Pradesh due to poor
logistic support.

Considering the inconsistent results and the fact that PPI itself is coming to an end, the National Consultation on
Vitamin A also recommended that vitamin A should not be linked with PPI; instead, the ongoing programme of
supplementation linked with routine immunisation should be strengthened to achieve high coverage (>90 percent)
for at least the first two doses. There is also a need to strengthen the education component of the programme to
improve diet as a long-term goal.

Dietary management:

Dietary improvement is, undoubtedly, the most logical and sustainable strategy to prevent VAD. There is general
consensus at both the national and international levels that its contribution to the improvement of overall nutrition
justifies the continued efforts in this direction.

Green leafy vegetables (GLV) and fruits are plentiful in season and are well within the economic reach of even the
poor. Availability alone, however, does not ensure programmatic success.

A change in dietary habits and increased access to vitamin A-rich foods are required. In recent years, efforts have
been made to achieve these objectives through educational and horticultural interventions.

Bioavailability of B-carotene is lower from GLV than from other vegetables and fruits. Young children cannot
consume leafy vegetables in sufficient quantities to meet the vitamin requirements.

Based on feeding trials with selected vegetables, it has been suggested for conversion of B-carotene to vitamin A.
However, even this is debated because bioavailability of carotene varies widely, not only with the food source but
also with the way it is prepared and the level of such other dietary components as fibre and fat.

A detailed discussion on this issue is beyond the scope of this paper, but it is unlikely that promotion of GLV alone
will eliminate VAD. Dietary diversification programmes must include a variety of vegetables and fruits as well as
animal foods such as milk and eggs. We should not settle for something ‘cheap’, but make all possible efforts to
improve the quality of diets.

Prevalence of Bitot’s spot is 0.7% in children which has not gone down since 1988-90. In all age groups it is 0.21%.
Night blindness in children and women has been found maximum in Bihar, Assam, Uttarpradesh, Under the
National Programme for Prophylaxis against Blindness in Children caused due to Vitamin A deficiency, every child
has been provided Prophylaxis against Vitamin A deficiency in the form of 5 oral doses starting at 9 months along
with measles vaccime as a first does (1 lakh IU) then at 15 months a second does (2 lakh IU), then every 6 monthly
(2 lakh IU) are given till the age of 3 years. The programme has been implemented through RCH programme.

CONCLUSION:
VAD still exists as a public health problem in many parts of India and there is a need for continued efforts to
improve the vitamin A status of the population. It is unfortunate that the Assam episode led to so much controversy,
putting an end to the vitamin A campaign there and also in other states. However, this should not be viewed as a
setback, but as an opportunity to strengthen the ongoing programme of supplementation linked with routine
immunisation and to accord higher priority to dietary approaches as a long-term sustainable solution.

Wheat Based Supplementary Nutrition Programme:

The scheme was started with the twin objective of providing supplementary nutrition to children and
popularising wheat intake. Min of Food places at the disposal of the Department of Women and child Development
about 100 thousand tonnes of wheat from the central reserves annually and that Department, in turn, sub-allocates
this wheat among States which utilise the wheat mostly to producewheat based ready-to-eat nutrition supplements.

With the spread of ICDS, this wheat or its products are increasingly being utilised for distribution of
supplementary nutrition in ICDS and mid-day-meal programmes The wheat is supplied to the State Governments
by the Food Corporation of India at the same subsidised rates as for the public distribution system.

World Food Programme Project:

World Food Programme-UN provides food-stuffs so that supplementary nutrition could be provided through
the projects supported by them. WFP-India project has been extended from time to time and the present extension
would last till the end of March 1995.

WFP currently supports 12 projects in India, with a total commitment of 292 million dollars worth of food aid. "The
major part of WFP's assistance to India supports projects in forestry, irrigation and supplementary nutrition. WFP's
food assistance to India is focused on poverty alleviation, directly targeting the most vulnerable section of the
society".

The WFP provides Soya Fortified Bulger Wheat, Corn Soya

Blend and edible oil to benefit about 2.1 million pre-school children, expectant and nursing mothers. For the last
three years or so, the WFP obtains wheat or rice locally from the Food Corporation of India in exchange for the
butter oil it gets as donation from some European countries.

CARE Assisted Nutrition Programmes:

Under the Indo-CARE Agreement of 1950, CARE-India extends food aid so that supplementary nutrition can be
provided to pre-school children of age less than six years and expectant/nursing mothers.

The CARE assistance is now dovetailed with ICDS projects and some of the ICDS projects utilise this assistance
for the nutrition component of the programme. The programme covers ICDS projects in 10 States of the Indian
Union.
CARE has also monetized oil received by it as donation for generating funds worth Rs. 100 million for
implementing activities supportive of ICDS programme.

During 1993-94, CARE would provide slightly above 200 thousand tonnes of food commodities to cover around 9
million beneficiaries.

NATIONAL PROGRAMME FOR NUTRITION SUPPORT TO PRIMARY EDUCATION :

This system was called provision of ‘dry rations’. Government of India will provide grains free of cost and the
States will provide the costs of other ingredients, salaries and infrastructure On November 28, 2001 the Supreme
Court of India gave direction that made it mandatory for the state governments to provide cooked meals instead of
‘dry rations

AKSHAYA PATRA AND PRIVATE SECTOR PARTICIPATION IN MID-DAY MEALS :

Successfully involved private sector participation in the programme The programme is managed with an ultra
modern centralized kitchen that is run through a public/private partnership. Food is delivered to schools in sealed
and heat retaining containers just before the lunch break every day

EMERGENCY FEEDING PROGRAMME 2001 :

This was introduced in May, 2001 in selected states (Orissa) Emergency Feeding Programme, is a food-based
intervention targeted for old, infirm and destitute persons belonging to BPL households to provide them food
security in their distress conditions.

Cooked food containing, rice- 200gms, Dal (pulse)- 40 gms, vegetables- 30 gms is provided in the diet of each EFP
beneficiary daily by the Government.

VILLAGE GRAIN BANKS SCHEME :

Implemented by the Ministry of Tribal Affairs to provide safeguard against starvation during the period of natural
calamity or during lean season when the marginalized food insecure households do not have sufficient resources to
purchase rations.

SC/ST/OBC HOSTELS :
These are introduced in October, 1994 by Ministry of Consumer Affairs, Food & Public The residents of the hostels
having 2/3rd students belonging to SC/ST/OBC are eligible to get 15 kg food grains per resident per month.

SAMPOORNA GRAMIN ROZGAR YOJANA :

50 lakh tones of food grains is to be allotted to the States/UTs free of cost by Ministry of Rural Development

NATIONAL FOOD FOR WORK PROGRAMME :

To provide supplementary wage employment and food security Implemented in tribal belts. The scheme will
provide 100 days of employment at minimum wages for at least one able-bodied person from each household in the
country

INTEGRATED MANAGEMENT OF NEONATAL & CHILDHOOD ILLNESSES (IMNCI)

Introduction:

Over the last 3 decades the annual number of deaths among children less than 5 years old has decreased by almost a
third. However, this reduction has not been evenly distributed throughout the world. Every year more than 10
million children die in developing countries before they reach their fifth birthday

Distribution of 10.5 million deaths among children less than 5 years old in all developing countries as shown below

 Malaria 7%
 Other 28%
 Measles 8%
 HIV/AIDS 3
 Diarrhoea 15%
 Perinatal 20%
 Pneumonia 19%

The most common causes of infant and child mortality in developing countries including India are perinatal
conditions, acute respiratory infections, diarrhoea, malaria, measles and malnutrition. These are also the commonest
causes of morbidity in young children.

In India, the common illnesses in children younger than 3 years of age according to the National Family Health
Survey (II) data include fever (21% prevalence in the previous 2-week period), acute respiratory infections
(17%),diorrhoea 13% & malnutrition 43% & often a combination of these conditions.

Infant Mortality Rate (IMR) in India continues to be high at 68/1000 live births and Under Five Mortality Rate
(U5MR) at 95/1000 live births. Neonatal mortality contributes to over 64% of infant deaths and most of these
deaths occur during first week of life
 Mortality rate in the second month of life is also higher than at later ages. Any health program that aims at
reducing IMR needs to address mortality in the first two months of life, particularly in the first week of life.

Projections based on the 1996 analysis The Glohcil Burden of Disease indicate that common childhood illnesses
will continue to be major contributors to child deaths through the year 2020 unless significantly greater efforts are
made to control them. This assumption makes a strong case for introducing new strategies to significantly reduce
child mortality and improve child health and development.

Rationale for an Evidence-based Syndromic Approach to Case Management

Many well-known prevention and treatment strategics like UIP. Oral Rehydration and appropriate antibiotic
therapy for pneumonia have already proven effective for saving young lives. Even modest improvements in
breastfeeding practices have reduced childhood deaths. While each of these interventions has shown urea I
success.

Accumulating evidence suggests that a more integrated approach to managing sick children is needed to
achieve better outcomes. Child health programmes need to move beyond single diseases to addressing the
overall health and well being of the child. Because many children present with overlapping signs and symptoms
of diseases, a single diagnosis can be difficult, and may not be feasible or appropriate. This is especially true for
first-level health facilities where examinations involve few instruments, little or no laboratory tests, and no X-
ray.

During the mid-1990s, the World Health Organization (WHO), in collaboration with UNICEF and many other
agencies, institutions and individuals, responded to this challenge by developing a strategy known as the
Integrated Management of Childhood Illness (IMCI). Although the major reason for developing the IMCI
strategy stemmed from the needs of curative care, the strategy also addresses aspects of nutrition, immunization,
and other important elements of disease prevention and health promotion.

The objectives of the strategy are:

To reduce death and the frequency and severity of illness and disability, and
To contribute to improved growth and development.

Strategy:
 The strategy has been adapted for India as Integrated Management of Neonatal and Childhood Illness (IMNCI).
 The IMNCI clinical guidelines target children less than 5 years old — the age group that bears the highest
burden of deaths from common childhood diseases. The guidelines take an evidence-based, syndromic
approach to case management that supports the rational, effective and affordable use of drugs and diagnostic
tools.
 Evidence-based medicine stresses the importance of evaluation of evidence from clinical research and cautions
against the use of intuition, unsystematic clinical experience, and untested pathophysiologic reasoning for
medical decision-making.
 In situations where laboratory support and clinical resources are limited, the syndromic approach is a more
realistic and cost-effective way to manage patients. Careful and systematic assessment of common symptoms
and well-selected clinical signs provides sufficient information to guide rational and effective actions.

An evidence-based syndromic approach can be used to determine the:

• Health problem(s) the child may have;

• Seventy of the child's condition:

• Actions that can be taken to care for the child (e.g. refer the child

immediately, arrange with available-resources, or manage at home).

In addition. IMNCI promotes:

• Adjustment of interventions to the capacity and functions of the health

system: and

• Active involvement of family members and the community in the health

Care process.

Parents, it correctly informed and counseled, can play an

important role in-improving the health status of their children by following the advice given by a health care
provider, by applying appropriate feeding practices and by bringing sick children to a health facility as soon as
symptoms arise.

Components of the Integrated Approach:

The IMNCI strategy includes both preventive and curative interventions that aim to improve practices in health
facilities, the health system and at home. At the core of the strategy us integrated case management of the most
common childhood problems with a focus on the most common causes of death.

The strategy includes three main components:

 Improvements in the case-management skills of health staff through the provision of locally-adapted
guidelines on Integrated Management of Neonatal and Childhood illness and activities to promote their use; }
 Improvements in the overall health system required for effective management of childhood illness;
 Improvements in family and community health care practices.

The Principles of Integrated Care:

The IMNCI guidelines are based on the following principles:

 All sick young infants age up to 2 months must be examined for signs of "possible serious bacterial infection"
and all children 2 months to 5 years must be examined for "general danger signs" which indicate the need for
immediate referral or admission to a hospital.
 All sick children must be routinely assessed for major symptoms (for young infants up to 2 months: diarrhoea;
and for children age 2 months up to 5 years: cough or difficult breathing, diarrhoea, fever and ear problem).
They must also be routinely assessed for nutritional and immunization status, feeding problems, and other
potential problems.

 Only a limited number of carefully selected clinical signs are used, based on evidence of their sensitivity and
specificity to detect disease. These signs were selected considering the conditions and realities of first-level
health facilities.
 A combination of individual signs leads to a child's classification(s) rather than a diagnosis. Classification(s)
indicate the severity of condition(s).
 They call for specific actions based on whether the young infant or the child

(a) should be urgently referred to another level of care,

(b) requires specific treatments (such as antibiotics or anti malarial
treatment), or
(c) may be safely managed at home.

 The classifications are colour coded: "pink" suggests hospital referral or admission "yellow" indicates initiation
of treatment, and "green" calls for home treatment.
 The IMNCI guidelines address most, but not all, of the major reasons a sick child is brought to a clinic. A child
returning with chronic problems or less common illnesses may require special care. The guidelines do not
describe the care at birth and the management of trauma or other acute emergencies due to accidents or injuries.
 IMNCI management procedures use a limited number of essential drugs and encourage active participation of
caretaker* in the treatment of children.
An essential component of the 1MNCI guidelines is the counseling of

caretakers about home care, including counseling about feeding, fluids and

when to return to a health facility.

The case management process:

The case management process is presented on a series of charts, which show the sequence of steps and provide
information for performing them. The charts describe the following steps:

• Assess the young infant or child

• Classify the illness

• Identify treatment

• Treat the infant or child

• Counsel the mother

• Give follow-up care

These steps are probably similar to the way you care for sick children now, though you may have learned
different words to describe them. The step called "Assess the Young Infant or Child" means taking a history and
doing a physical examination. "Classify the Illness" means making a decision on the severity of the illness. You will
select a category, or "Classification," for each of the child's major symptoms, which corresponds to the severity of
the disease. Classifications are not specific disease diagnoses. Instead, they are categories that are used to determine
treatment.

The charts recommend appropriate treatment for each classification. When using this process, selecting a
classification on the chart is sufficient to allow you to "Identify Treatment" for a young infant or child. For example,
a young infant with the classification POSSIBLE SERIOUS BACTERIAL INFECTION could have pneumonia,
septicemia or meningitis. The treatments listed for POSSIBLE SERIOUS BACTERIAL INFECTION will be
appropriate because they have been chosen to cover the most important diseases included in this classification.

"Treat" means giving treatment in clinic, prescribing drugs or other treatments to be given at home, and also
teaching the mother how to carry out the treatments. "Counsel the mother" includes assessing how the child is fed
and telling her about the foods and fluids to give the child and when to bring the child back to the clinic.

Management of the young infant age up to 2 months is presented on two charts titled:

* Assess and classify the sick young infant age up to 2 months and

* Treat the young infant and counsel the mother.

* The case management process for sick children age 2 months up to 5 years is

some what different from young infants and is presented on three charts titled:

* Assess and classiey till-: sick child age 2 months up to 5 years treat the child

* Counsel the mother

The charts are designed to help you to manage young infants and children correctly and efficiently. This course
trains you to use the charts and gives you clinical practice managing sick young infants and children.

After the course, the charts will help you recall and apply what you have learned when you manage sick young
infants and-children at your clinic.

Purpose of the training course:

This training course is designed to teach the case management process to doctors who see sick children and
infants. It is a case management process for a first-level facility such as a clinic, a health centre or an outpatient
department of a hospital. The course uses the word "clinic" throughout to mean any such setting.

We can learn to manage sick children according to the case management charts, including:

• Assessing signs and symptoms of illness, and nutritional and immunization

status,

• Classifying the illness,

• Identifying treatments for the child's classifications and deciding if a child

 needs to be referred.

• Giving important pre-referral treatments (such as a first dose of an antibiotic,

vitamin A. quinine injection, and treatment to prevent low blood sugar) and

referring the young infant or child,

• Providing treatments in the clinic, such as first dose of antibiotic, oral

rehydration therapy, vitamin A. and immuni/.ation. wanning the young infant

by skin to skin contact.

• Teaching the mother to give specific treatment at home, such as an oral

antibiotic or antimalarial.

• Counselling the mother about feeding

• Providing treatment to sick young infants and children who have a severe

classification but referral is not possible.

• When a young infant or child comes for scheduled follow-up, reassessing the

problem and providing appropriate care.

Course methods and materials:

In addition to the case management chart booklets, you will be using a series of training modules, which explains
each step of IMNCI guidelines. These modules are titled:

• Assess and Classify the Sick Young Infant Age up to 2 Months

• Identify Treatment for the Sick Young Infant

• Treat the Young Infant and Counsel the Mother

• Assess and Classify the Sick Child Age 2 Months up to 5 Years

• Identify Treatment for the Sick Child

• Treat the Child

• Counsel the Mother

• Follow-Up

The modules also include exercises that will help you learn the steps. Most exercises provide clinical information
describing a sick young infant or child and ask questions. Some exercises use photographs or video. You will
complete a module by reading it and working through the exercises.

For approximately half of each day, you will go to nearby clinics to observe and practice managing sick young
infants and children. In these clinical sessions you will assess, classify and treat sick young infants and children,
including teaching their mothers how to care for them at home.

How to select the appropriate case management charts:

 Depending on the procedure for registering patients at your clinic, the child's name, age and other information
such as address may have been recorded already. If not, you may begin by asking the child's name and age.

Decide which age group the child is in: Age up to 2 months Ago 2 months up to 5 years.

If the child not yet 2 months of age, the child is considered a young infant. Use the chart ASSESS AND
CLASS1FY THE SICK YOUNG INFANT. "Up to 2 months" means that the child has not yet completed 2
months of age. For example, this age group includes a child who is 1 month and 29 days old but not a child who
is 2 months old. If the child is age 2 months up to 5 years, select the chart ASSESS AND CIASSIFY , THE SICK
CHILD AGE 2 MONTHS UP TO 5 YEARS. "Up to 5 years" means that the child has not yet had his fifth
birthday. For example, this age group includes a child who is 4 years and 11 months but not a child who is 5
years old.

THE INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS)

Introduction:

The I.C.D.S. Programme aims at an integrated delivery of a package of all basic essential services, viz.health,
nurtrition and education to children under six years of age, pregnant women and nursing mothers right in their
village/locality.

The Integrated Child Development Services (ICDS) Scheme is the world's

largest and most unique Integrated Programme for early childhood care and

development. The Scheme aims to improve the nutritional and health status of all children below six years of age,
lay the foundation for their proper physical, psychological and social development; reduce among young children
the incidence of mortality, morbidity and malnutrition; improve the nutritional and health status of pregnant and
nursing women and enhance the capability of the mothers to look after the normal health and nutritional needs of
the child through proper health and nutrition education.

While ICDS covers all children in the 0-6 years of age group for many of its services viz. pre-school education, it
targets the most vulnerable among them through the intervention of supplementary nutrition Programme (SNP).

These targeted children mostly belong to the poor families and those living in disadvantaged areas including
backward rural areas and tribal areas. In addition to children below six years of age, ICDS also takes care of the
essential needs of pregnant women and nursing mothers residing in socially and economically backward rural and
tribal areas.

The identification of beneficiaries is done through surveying the community and identifying the families living
below poverty line eligible for supplementary nutrition support.
The Department of Women and Child Development was set up by the government

of Orissa in the year 1995 to provide the much-needed thrust on programmes aimed at a holistic development of
women and children. This is the nodal department for formulating plans, policies and programmes for the
development of women and children in the state.

Objectives:

(1) Improve the nutritional and health status of children in the age group of 0-6 years.
(2) Lay the foundation of psychological physical and social development of the child.
(3) Reduce the incidence of morbidity, mortality, malnutrition and school drop-out,
(4) Achieve effective co-ordination of policy and implementation amongst the various departments to promote
child development.
(5) Enhance the capability of the mother to look after the normal health and nutritional needs of the child
through proper nutrition and health education.

Package of Services Provided In I.C.D.S. Project Areas:

(1) Supplement nutrition

(2) Immunization
(3) Health Checkup
(4) Nutrition & health education
(5) Referral services
(6) Non-formal education

Pattern:

The Integrated Child Development Services is a Centrally sponsored Scheme wherein the Central
Government is responsible for Programme planning and operating costs while the State Governments are
responsible for Programme implementation and providing supplementary nutrition out of States' resources.

Population norms: The guidelines of the scheme envisage one rural/urban project for one lakh population and one
tribal project for 35,000 population, with one Anganwadi Center for a population of one thousand in rural/urban
projects and seven hundred in tribal projects.

Area of Operation & Beneficiaries

Government of India started 33 ICDS projects in the country during the year 1975- 1976. Encouraged by the results
of the experiment of the pilot project, the

Government extended the ICDS Programme to all the blocks of the state in a phased manner. By the end of the
Ninth Plan period, all the 314 blocks and 12 Urban Local Bodies have been covered under ICDS Programme
making the number of projects 326. of these 326 projects, the cost of the foodstuff for the Supplementary

Nutrition Programme (SNP) was met by the State Government in 151 projects, while in 125 projects CARE
and in 32 projects WFP provides food material as aid. Services under the scheme are presently being made available
to about 30.54
lakh beneficiaries comprising of about 25.42 lakh children (6m-6 years) and 5.12 lakh
pregnant and lactating mothers through a network of 34201 Anganwadi Centers

NUTRITIONAL REQUIREMENT OF CHILDREN

INTRODUCTION:
Nutrition is critical to our health - statistics are proving that the percentage of obese children has nearly doubled in
the past 20 years, and childhood obesity may be a risk factor for heart, circulatory, and other health problems in
adulthood. Many of us are not aware of how much sugar, salt and fat are hidden in the foods we consume daily.

Compared to adults, small children need more nutrients in proportion to their body weight. As bones, muscles, teeth,
and blood volume are developing, nutrient intake needs to be adequate to support this process, and also to keep up
with the growing child's increasing activity. A challenge also arises when growth spurts alternate with periods of no
growth or slowed growth.
But before we know what is the effect of nutrition on the growth and development of child let us know what a
balanced diet is.

BALANCED DIET:
INTRODUCTION:
A balanced diet for children is required to supply the nutrients and
energy needed for the growing child. The requirement of all
nutrients is increased, but the pattern of increase varies for
different nutrients in relation to their role in growth of specific tissues.
A child of one year of age can eat most of the dishes that are
prepared for the rest of the family, but they require less spicy food. Fussy
eating starts at this time so make sure the food is interesting and
attractive. Kids need five to six meals a day because of their
smaller appetites. Healthy and balanced diet for kids such as whole wheat
bread, cereals, fruits and vegetables should make up the major part of the
diet of the children. Foods such as meat, fish, Soya products, milk, pulses and cereals provide the proteins necessary
for this age group.

DEFINITION:
A diet containing adequate energy and all of the essential nutrients that cannot be synthesized in adequate quantities
by the body, in amounts adequate for growth, energy needs, nitrogen equilibrium, repair, and maintenance of
normal health.

Basic guidelines for nutrient requirement in balanced diet for children / kids of different age groups:

Calories requirement:
The calorie requirements are increased due to the high cellular activity in children above 5 years of age. Children
under 5 year of age should not be given skimmed milk to restrict on fat and cholesterol, as they need the extra
calories, but grilled and baked foods are always preferable to fried and fatty ones. Whole grains or enriched cereals
increase the calories. Concentrated sweets and foods that are very high in fat should be avoided.

Protein requirement:
Protein has a very important role in the diet of the preschool child because there is considerable increase in
muscular development during these years. The requirements for essential amino acids are higher for children than
adults. So protein should be selected from complete protein foods such as milk, egg and meat.

Vitamin and mineral requirement:

Vitamins and minerals must be supplemented adequately. Calcium and iron requirements are relatively greater
during early childhood. Deficiency of calcium can affect the bones of growing children. Foods rich in calcium such
as milk and milk products, ragi, green leafy vegetable and fish should be included in the diet of children.
Nutrition can impact your child's learning.

Fruit Group
Fresh fruits and berries are a delight to the taste buds, and a rich source of vitamins, minerals, enzymes, fiber,
vitamin C and beta-carotene. Local, fresh fruits, seasonal are the ideal choice. Fruits, especially apples and berries,
provide the valuable, water-soluble fiber pectin and other fiber, such as cellulose, which keeps the intestines
working properly. The white, inner peels of citrus fruits contain bioflavonoids, which
help the body absorb vitamin C. Most fruits are alkaline forming, including fruits with a
sour, acidic flavor such as lemons and limes. Fruits, therefore,
form a good balance to acid-forming grains.

Freshly made fruit juice is a highly concentrated source of

nutrients, but only if it is absolutely fresh. After only a short time,
exposure to oxygen and micro-organisms begins to ferment the juice. Oxygen and
enzymes contained in the juices destroy vitamins and fruit acid. To maximize the full
benefit of fruit it is wise to invest in a good juicer and drink fresh juice daily.

Vegetable Group
Vegetables provide many of the vitamins and minerals kids need for good health. Carrots are a good source of
vitamin A, and don't forget tasty tomatoes and cauliflower for vitamin C. Because vegetables contain many
different vitamins and minerals, it is important to have a variety of them in your child's diet.

Low in fat and high in fiber, fresh, raw vegetables are teeming with thousands of nutrients called phytochemicals.
Our discovery of phytochemicals is another clue to understanding the healing
power of plants. Phytochemicals are a determining factor in the color and flavor
of vegetables. They act as the plant’s natural immune system warding off
disease and viruses. These same phytochemicals help to increase our
body’s immunity and help to support the body’s ability to remove toxins.

These protective substances found in plants have been linked to the prevention
of cancer, heart disease, diabetes and high blood pressure. They have the power
to stop the development of cancer at a cellular level by activating enzymes that
diffuse the destructive potential of carcinogens.

Vegetables, in their colorful and flavorful variety, are rich in complex

carbohydrates, a great source of food energy. Vegetables also provide enzymes,
fiber, vitamins and minerals that are essential for body functions, including
complete and proper digestion. They are the perfect complement to protein foods, helping to aid in protein digestion.
Almost all vegetables are alkaline-forming, providing a much needed balance to the acid-forming meats, dairy
products and grains in our diets.
Fresh, raw vegetable or fruit juices provide a potent concentration of enzymes and other raw food nutrients in a
water base. Since the juicing process breaks down the cell membranes and discards the pulp, the body has more
immediate access to the full power of the nutrients contained in the fruits and vegetables.

Milk, Yogurt, and Cheese Group

These foods are important source of vitamin A, vitamin D, calcium, and protein. Vitamin A is important for healthy
eyes, skin, and hair. Vitamin D helps your child's body absorb calcium and use it for healthy bones and teeth, along
with muscle and nerve functions. Organically-produced milk and milk products are the safest and healthiest sources.
Commercially produced milk products have been pasteurized, homogenized and supplemented with synthetic
vitamin D.

Natural cheeses imported from Europe, especially Switzerland, are made from raw milk from cows grazing only on
unsprayed meadows. The most ideal sources of digestible milk products are cultured or fermented, such as natural
yogurt and kefir. These products have been partly predigested by friendly bacteria, so they are well tolerated even
by people who do not have sufficient lactase in their intestines to digest milk. These foods help maintain healthy
bacterial flora in the intestines. Make sure natural yogurt still contains live culture, such as acidophilus or bifidus,
and is not thickened with additives like guar gum, locust beans, gelatin or carrageenan. Unsweetened yogurt is most
readily digested. Bacterial cultures in commercially-prepared yogurts are often destroyed to increase shelf life, so
look for the words "live culture" on the container.

Goat milk may be more suited to the human digestive system than cow’s milk since the fats in goat’s milk are
closer in composition to those of human milk. Natural, raw-milk goat cheeses are a healthier alternative because
they are not mixed with antimold chemicals or preservatives as are most conventional cheeses.

Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Group

Meat, poultry (this means beef, pork, chicken, turkey, and other birds), fish, beans, eggs,
and nuts have one thing in common: they all supply you with the super-important
nutrient protein. They also load you up with iron and zinc. Protein is the main tissue
builder of the body and is the basic substance of every cell, including muscles, bone,
blood, skin, nails, hair and internal organs. Protein is essential for enzyme production
which enables the electrical impulses to take place. It is also important for the production
of hormones that regulate and control bodily functions, including emotional stability. Protein in the body is made
from the building blocks called amino acids. Protein's main functions are to repair and maintain body tissues,
produce hemoglobin to carry oxygen to the cells, and produce antibodies and enzymes. Some of the amino acids in
protein are produced by the body; others must be obtained in the diet. Excess protein is converted to fat in the body
and stored.

Organically-raised meat from grass-fed animals is available and is the healthiest source if you choose to eat meat.
Buy chickens fed a natural diet without the use of antibiotics and growth hormones. Wild fish, especially salmon,
sardines, mackerel and albacore tuna are among the richest sources of essential fatty acid derivatives that protect
against heart disease, cancer and inflammatory diseases.

Cold water fish give us the essential Omega-3 fatty acids we need for our bodies - salmon, tuna, and halibut. Our
bodies cannot make this fatty acid on its own.

Nuts and Seeds

Nuts and seeds are tasty, versatile foods that nourish the brain, nerves and skin. Edible nuts include walnuts,
hazelnuts, almonds, pecans, pine nuts, cashews and coconuts. The seed family includes sunflower seeds, flax seeds,
sesame seeds and pumpkin seeds. Nuts and seeds have a higher content of complete protein than all other plants,
with the exception of the soy bean. Raw nuts and seeds are the best dietary sources of the essential polyunsaturated
fatty acids omega-3 alpha-linolenic acid and omega-6 linoleic acid.

When roasted, the natural fats in nuts turn into toxic molecules and become less
digestible. Nuts have a high mineral content. They are good sources of calcium,
magnesium, phosphorus and potassium. The natural sodium content of unsalted
nuts is very low. Nuts contain vitamin E and are rich in the B vitamins, especially
B3 and biotin.

Un-sprouted, raw seeds and nuts contain enzyme inhibiters and can be soaked in
water overnight to make them easier to digest. Nut "milk" can be made and used in
most recipes calling for cow’s milk. Pour two cups of filtered water into a blender; add half a cup of raw,
organically-grown sunflower seeds; blend on medium high speed for one minute or until the "milk" is a light and
frothy texture; sweeten with honey or maple syrup and add a drop of pure vanilla flavor.

Flax seeds are a great source of omega-3 oils, but they need to be ground up, crushing the outer hull, so that they
oils are available to our bodies. If taken whole, they act as fibre, without being digested at all. You can use a mortar
and pestle to crush the seeds, or dedicate a small coffee grinder just for your flax seeds. It is recommended that an
adult have 2 Tblsp. Daily.

Eggs
Eggs from free-range chickens are balanced foods which have mistakenly been considered the culprits of
excessively high cholesterol levels. They contain cholesterol, but this is emulsified by the lecithin they also contain.
Lecithin enables fats, including cholesterol, to be dispersed in water and eliminated from the body. Eggs are an
excellent source of protein, sulfur, iron and vitamin A, and provide a valuable source of vitamin B12 for people
who do not eat meat. In addition, eggs contain choline, tryptophan (which is converted into vitamin B3), biotin,
folic acid, vitamin B2, vitamin B1, vitamin B5, selenium, zinc, phosphorus, magnesium and calcium.

Eggs from free-range chickens have bright yellow-orange yolks and thick, strong shells and a better flavor than
commercial eggs produced on factory farms. In addition, caged chickens and their eggs produce much lower levels
of the beneficial omega-3 and omega-6 essential fatty acids than free-range chickens.

Legumes
Legumes are a special category of vegetables which grow in a pod. These include beans, chick peas, peas, soy beans
and lentils. They are a rich source of protein, iron, calcium, zinc, B vitamins and fiber. Legumes are extremely
versatile and can be used in hundreds of ways including baked, in soups, casseroles, stews, vegetarian patties and
burgers, and even milks, such as soy milk.

Beans and lentils are a main food staple in many parts of the world. Mexican, Chinese and
Middle Eastern cultures consume legumes on a daily basis in a variety of forms.

Soy beans and lima beans are alkaline-forming, while lentils are acid-forming. Before
cooking legumes, soak one part legumes in four parts water for twelve hours or overnight, changing the soaking
water two or three times. Throw away the final soaking water, and use fresh water to cook. This softens the skins,
begins the sprouting process, and eliminates the binding of phytic acid to minerals.

Remove and discard any foam that forms on the water while cooking. Soaking legumes makes them more easily
digested. To avoid gas formation, add a little lemon juice or apple cider vinegar to the water before serving. If beans
are being used in a salad, marinate the cooked beans in apple cider vinegar and olive oil. Vinegar breaks down
protein chains and indigestible compounds.

Eat only small amounts of legumes at first and chew well to encourage the
body’s own formation of the enzymes necessary to digest them. Gradually
introduce mashed legumes to children at around nine to twelve months of age.
Adzuki beans, lentils, mung beans and peas are easiest to digest.

Whole Grains
Whole grains have been the basis of the human diet for thousands of years. The
word "meal" literally means ground grain. Grains play a particularly important
part in a vegetarian diet. They are an excellent source of the trace minerals, fiber,
unsaturated fatty acids, lecithin, vitamin E, B-complex vitamins and complex
carbohydrates.

Whole grains contain complex carbohydrates that are broken down during digestion and converted to glucose, the
substance the body prefers to burn for energy. Complex carbohydrates are much healthier than refined sugars
(simple carbohydrates) because they are digested more slowly and provide a sustained supply of energy.

Complex carbohydrate molecules are made of glucose (sugar) in the form of straight chains. Enzymes break open
the bonds connecting the sugar chains, releasing vitamins and minerals which help the body metabolize the
carbohydrates completely. Complex carbohydrates contain fiber which promotes smooth digestion and metabolizes
slowly. In contrast to refined sugars, complex carbohydrates found in whole, unrefined grains are nutrient dense.

Grains cannot be eaten raw, and need to be soaked, sprouted or cooked to be digestible. Grains contain phytin,
which, if raw cannot be metabolized by the body. Once prepared, grains are perhaps our most nutritious food.

Most whole grains, such as brown rice, are prepared by pouring one cup of brown rice into a one or two quart pot;
add two cups of cold, filtered water. Bring to a boil and reduce the heat to the lowest temperature; cover with a
tight-fitting lid, and let steam for forty-five minutes to one hour. Serve immediately or use the cooked rice in
casseroles, soups or rice pudding.

Store grains in clean, tightly closed containers in a dry, cool place. Whole wheat kernels, spelt, kamut and
buckwheat have thick outer layers and store for many years under dry, cool conditions. Rice can be stored for about
two years. Millet has a very thin outer layer and will go rancid more quickly. A few whole bay leaves inserted into
your grain container will act as a natural deterrent to worms.

Grains can be eaten in the form of pasta, cereals or bread. Buckwheat, rice or wheat makes excellent pasta.
Commercially-prepared dried pasta is usually made from processed white flour, so be sure to buy wholegrain
varieties, or make it yourself. Often a vegetable such as spinach or carrot is mixed with the grain for added color
and flavor. Choose cereals that are rolled, milled or cracked whole grains. The healthiest breakfast cereal is muesli
made from soaked rolled oats and fresh fruit and nuts. Congee is a porridge made from grain simmered in five to six
times the amount of water. Millet and spelt can also be used to make congee.

Cook four to six hours on low heat-crockpots is ideal. Congee is very easily digested and strengthens your spleen
and pancreas. Other foods cooked with the congee are also more easily digested. Whole grain breads can be made
from a variety of grains. Avoid "fortified" white bread, which contains little nutritive value due to processing, and is
further damaged by the addition of preservatives and bleaching agents.
Fats, Oils, and Sweets
Fats and oils are essential nutrients to maintain body function but should be used
sparingly. Fats help the body absorb vitamins A, D, E, K, and beta-carotene. They help
slow sugar's release into the bloodstream and are important for the formation of cell
membranes.

Aim for fat intake of 30% or less of total daily food intake. Saturated fats (butter, beef fat) should be limited to 10%
or less of the fat total. Unsaturated fats (safflower and corn oil) and monounsaturated fats (olive and peanut oil) are
healthier choices. That means that a child who needs 2,000 calories a day can safely have about 60 grams of fat
each day in combination with a varied diet.

Fats shouldn't be restricted in children under age 2. The developing brain and other organs of the young child need a
certain amount of fat for proper development. Many people don't realize that breast milk, nature's favorite infant
formula, is 50% fat.

Sugars, which are simple carbohydrates, are easy to digest and are quickly absorbed into the bloodstream where
they provide quick energy. Sugars provide some nutritive value, but
they should be eaten sparingly because they are often
consumed as excess calories and lead to weight gain.

Butter
Natural butter added to a prepared dish just before serving adds
flavor and aroma. Butter is great for baking and sautéing.

Butter also contains a considerable amount of unsaturated fatty

acids and is one of the best sources of fat-soluble vitamins. Butter’s
saturated fat molecules are extremely short, making them easy for
the body to digest and burn as fuel. Buy
unsalted butter; it is fresher and lower in sodium. One Tablespoon of butter is 100
calories.

The human body can digest butter more easily than other saturated fats. To illustrate this
point, try holding butter in your hand. It will quickly melt. Since your body temperature
is just as warm on the inside, butter will similarly dissolve when ingested, since the
average human body temperature is 98.6°F (37°C) and is much warmer than the melting
point of butter. Try the same experiment with margarine, shortening, beef fat or other
animal fat. You will notice these fatty substances will not melt in your hand. Likewise,
they will not dissolve in your body and become very difficult to digest; clogging arteries,
causing blood platelets to stick together, and eventually causing heart problems and high
blood pressure. No study has ever established a link between butter and heart disease.

Soft tub margarines have the same calorie count as butter (100 calories per Tablespoon)
but do not have the same saturated fat content. Be sure to buy non-hydrogenated
margarine.

Fats and Oils

The nutty flavors of cold-pressed oils, like olive oil, are a delicious addition to the natural foods pantry. Choose
fresh, unrefined oils that have been pressed at a low temperature without exposure to light and oxygen. Check the
"best before" date and use within six months after opening the bottle. Be certain to keep oils refrigerated after
opening. The unhealthy sources of fats and oils which must be avoided include all hydrogenated and partially
hydrogenated oil products such as shortenings and margarines.

Water
The body is comprised of about seventy percent water. This water is involved in almost every body process,
including digestion, circulation, elimination and transportation of nutrients. At least eight glasses of water are
needed daily to ensure proper functioning of the body’s many systems. Water can also be taken in the form of
freshly-pressed fruit or vegetable juices, vegetable broths or herbal teas. The ideal source is
pure, natural spring water, but an effective water filtration system at home will help to
remove the chemicals and heavy metals that may be in the water supply. Water supplies the
trace elements we need, and helps to maintain the acid-alkaline balance in the body.

EAT A RAINBOW!
It's the colour of food that makes it extraordinary! Within each color are brightly coloured, disease-fighting
phytochemicals. Study after study proves their healing power. Evidence suggests that single plant pigments need
other phytochemicals within that plant and from others to provide all their benefits. Supplements do not offer the
same protective benefits as foods.

The Yellow-Oranges
Top choices: sweet potatoes, carrots, corn, oranges, butternut squash, pumpkin, mangoes, kale, spinach.

Secret Ingredients: beta carotene, alpha carotene

 Cancer Fighter: Carotene acts as our defense mechanism to resist carcinogens. Carotenoids in fresh food can
offset the effects of exposure to environmental toxins such as air pollution and cigarette smoke.

 Natural Sunblock: Yellow and orange foods can act as our body's own sun-protectant.

 Skin: keeps eyes and skin healthy

The Reds, Purples and Blues

Top choices: strawberries, blueberries, raspberries, saskatoon berries, cranberries, apples, cherries, pomegranates,
red grapes, beets, red cabbage, black rice
Secret Ingredients: anthocyanin, betacyanin, proanthocyanidins
 Brain Rejuvenators: Red and blue fruit such as blueberries and strawberries are packed with anthocyanin
pigments, which are very potent antioxidants and anti-inflammatories. They rid the body of free radicals and
cytokines, which have been linked with neural and cellular breakdown from aging.

 Heart Champions: The purple anthocyanin in black rice can reduce levels of LDL (bad cholesterol). It may also
prevent your arteries from clogging up. The anti-inflammatory properties may also benefit people with arthritis.

 Lower your Risk for Cancer: Anthocyanin pigments in fresh and dried berries may help help boost resistance to
breast cancer.

The Orange Reds

Top choices: tomatoes, papayas, pink grapefruit, watermelon, guava, red peppers
Secret Ingredients: lycopene, beta carotene, zeta carotene

 Cancer Fighter: This pigment will help fight prostrate cancer and will reduce the risk of ovarian cancer.

 Lung Defense: Lycopene and carotene rich foods may substantially reduce your risk of lung cancer, as well as
other cancers.

 Heat releases the beneficial tomato pigments; adding some oil will make it easier for your body to absorb
lycopene.

The Greens
Top choices: spinach, collard greens, avocados, broccoli, asparagus, watercress, cabbage, kale, brussel sprouts,
mustard greens, romaine lettuce
Secret Ingredients: lutein, beta carotene, and chlorophyll

 Visionary Vegetables: Green chlorophyll has disease-fighting, but it's the yellow under-pigment, lutein, in leafy
greens that really benefits eye health. Eyes absorb lutein which protects them from light and free radical
damage.

 Cancer Fighter: Dark leafy vegetables, like spinach and broccoli, help build resistance to colon cancer.
 FATS: THE GOOD, THE BAD, AND THE UGLY!

Smart Fats:

Conclusive research now clearly shows that the amount and type of fat consumed during
fetal development, infancy, childhood, adolescence, adulthood, old age - and indeed
every day of your life - has a profound effect on how you think and feel. There is a definite link between learning,
behavior, concentration and essential fatty acids. Your brain is 60% fat, if you take out all the water. This fatty
tissue does need replenishing, but it's critical to know which fats will feed your brain the best. Some fats are not
only positively good for you, they are absolutely vital for mental health and to maximize your intelligence.
Essential Fats: (Good Fat!)

Essential fatty acids are good for us; they are called essential because they must be provided
in the diet since the body cannot consistently make them. Omega - 3 and Omega - 6 are
essential fats that our body needs. Eat seeds (flax, sunflower, sesame, and pumpkin), fish,
legumes, nuts and beans for the most wholesome source of these fats. You may choose to
supplement with concentrated fish oils and seed oils, such as flax, evening primrose or borage oil.

Phospholipids are the "intelligent" fats in your brain. They are the insulation experts helping make up the myelin
that sheathes all nerves and so promoting a smooth run for all the signals in the brain. Not only do phospholipids
enhance your mood, mind and mental performance, they also protect against age-related memory decline and
Alzheimer's disease. Your best source for phospholipids is lecithin.

Children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and dyslexia often have lower than
normal levels of key essential fatty acids. Adding these "good" fats into the diet of these children can make a real
difference.

Unsaturated Fat:

In foods of plant origin, a large proportion of the fatty acids are monounsaturated and polyunsaturated. In some
fatty acids, a pair of hydrogen atoms in the middle of a chain is missing, creating a gap that leaves two carbon
atoms connected by a double bond rather than a single bond. Because the chain has fewer hydrogen atoms, it is said
to be "unsaturated." A fatty acid with one double bond is called "monounsaturated" because it has one gap. Fatty
acids having more than one gap are called "polyunsaturated."
These fats do not raise LDL cholesterol levels and have health benefits when eaten in moderation. Sources of
monounsaturated fats include olive and canola oils. Sources of polyunsaturated fats include soybean, corn,
sunflower oils, and foods like nuts.

Saturated Fats: (Bad Fat!)

Saturated fat raises levels of bad cholesterol (low-density lipoproteins) and prevents good cholesterol (high-density
lipoproteins) from doing its job of cleaning the circulatory system. A saturated fatty acid has the maximum possible
number of hydrogen atoms attached to every carbon atom. High amounts of saturated fat are found in foods of
animal origin, like beef, pork, chicken skin, butter, whole milk and cheese. Coconut, palm, and palm kernel oil also
contain high levels of saturated fat. It is important to choose foods with lower amounts of saturated fats.

A Quick Guide - 5% DV (Daily Value) or less is low; 20%DV or more is high.

Trans Fats: (Ugly Fat!)

Hydrogenated oils; partially hydrogenated oils; vegetable oil shortening, shortening; hydrogenated vegetable oil;
partially hydrogenated vegetable oil.

The worst fats you can eat are called "trans" fats. They are unhealthy and artificially altered by bubbling hydrogen
gas through vegetable oil at high temperatures. The process changes the molecular structure of unsaturated liquid
fats and transforms them into solid trans fatty acids, like in vegetable shortenings and some margarines. This
process helps the product have a longer shelf life - so all the "processed, packaged foods" in the center aisles of the
grocery store are the most likely to contain trans fat. Canada does not require companies to list the trans fat content
until January, 2006.

These damaged fats are found in deep-fried food and foods containing hydrogenated vegetable oils. After you eat
trans fats, they can be taken directly into the brain where they interfere with thinking processes. They also block the
conversion of essential fats into vital brain fats. Trans fat pushes up the bad cholesterol and knocks out the good
cholesterol. Medical evidence indicates that trans fats can clog arteries and lead to premature heart disease.
Most popular children's snacks contain alarming amounts of trans fatty acids.

Trans fat can even be found in baby formula, some baby foods and in breakfast cereals.
Food Products Trans Fat per Serving
1 small serving of microwave popcorn 5.7 grams

1 serving of Goldfish crackers 18 grams

chicken fingers 6 - 10 grams

french fries 4 - 7 grams

Food Products Trans Fat per Serving

Big Mac 4 grams

Cinnabon cinnamon roll 4 grams out of 18 grams fat total

1 package of Handisnack peanut butter

1.75 grams
and crackers

1 filet Blue Water frozen fish 2.59 grams

1 McCain Pizza pocket .26 grams

1 Arrowroot biscuit .32 grams

1 Kellogg's Blueberry Eggo Waffle 2.11 grams

1 doughnut 5 grams

3 cookies - cream filled 1.9 grams

1 Tblsp. stick margarine 2.8 grams

1 Tblsp. tub margarine 0.6 grams

1 Tblsp. butter 0.3 grams

Lunch Tips
 Dedicate one drawer for all lunch supplies like thermoses, containers, and reusable
plastic bags, and one part of the fridge for lunch-only items including yogurt, precut
vegetables, sandwich fixings and lunch-sized portions of leftovers.

 Get the kids involved in the process of preparing their lunches.

 Take a tip from the prepackaged foods - make it fun and bite size. Put cut-up fruits and vegetables, melba toast,
dark bread, or mini-pita, low-fat cheese, luncheon meats.

 Bake the cookies they like instead of buying packaged ones.

 Make a list of the foods your children like according to the four major food groups. Then you mix and match.

 Set limits on what foods are acceptable in your household. Explaining about media advertising can help them
understand about making healthy food choices.

 Keep everything clean when packing the lunch, keeping cold foods cold in an insulated lunch box, and hot
foods hot in an insulated bottle stored in an insulated lunch box.

 Vegetable soup to start or warmed leftovers in a thermos.

 Juice "punch" or "cocktails" are little more than glorified soda. Even drinks labeled as juice may have only a
small percentage of real fruit. Buy 100 percent fruit juice when you have the choice.

 A truly healthy bread should be more than to hold a sandwich’s contents. Buy whole grains and try a mix: look
for oat, corn, multi-seeded or even gluten-free. Tortillas and pita pockets can also be used as alternatives to
slices of bread.

 Children like fast finger foods, so cutting a salmon sandwich into finger strips is more appealing than having a
half or whole sandwich. Graham crackers or mini-rice cakes are perfect sizes for adding toppings.

 Set a good example.

 Choose lean meats - Chicken, turkey, lean ham, low-fat lunchmeats, and tuna packed in water are excellent
choices for protein-packed meals.

 Use vegetables in a creative manner-Garnish sandwiches with spinach, bean sprouts, grated carrots or tomatoes
instead of just lettuce. Pack a salad and put dressings in a separate container. Cut peppers or cucumber into bite-
sized pieces with a low fat dipping sauce.

 Go nuts! Peanuts and almonds are easy to eat on the run. They are high in fat, but some of the kind of fat they
have is actually good for you!

 Rice or pasta salads with chopped vegetables, pineapples, apples, chicken, fish, spinach, tomatoes, or
cucumbers.

 Hard-boiled eggs or egg salad sandwiches are a good source of protein. Add fresh veggies to the egg salad.

 Tortillas spread with cream cheese and filled with chicken, fish, rice, beans or cheese are good.

 Baking an extra chicken at the beginning of the week will give you healthy meat to use in lunches for the rest of
the week. This is much healthier than using processed luncheon meats.

 Organic peanut butter sandwich wedges with jelly, honey, raisins, sliced bananas, strawberries, applesauce,
grated carrots, apple, or zucchini.

 Remember that a variety of food means a variety of nutrients.

 Your child doesn’t have to finish everything — if he or she feels full and is growing properly.
Developmental Stages:
• Newborns
• Infants:1-12 months
• Toddlers: 1-3 years
• Pre – school: 3, 4 and 5 years
• School going: 6-12 years
• Adolescents: 13-20 yrs.

NEWBORNS AND NEONATES:

We consider the children from the age zero to 7 days as newborn and from 7 days to 28 days as neonate. At this age
it recommended to give the child only excusive breast feeding.

Breast feeding:
Human milk is the ideal and uniquely superior food for infants for the first year of life and as the sole source of
nutrition for the first 6 months.
Breast milk consists of a number of micronutrients that are called bio-available, meaning these nutrients are
available in quantities and qualities that make growth.

Formula feeding:
Those newborns that are not able to take feed properly due any reason are given formula feed. The reason for not
taking feed may be:
 Weak baby so not able to suck
 Poor or no milk production from mother

Nutritional Needs: Term Newborn

• Infants need minimum of 120 cal/kg/day to maintain weight and growth
• 20 cal/oz is the usual calories found in formula
• Feedings/day q3-4 hrs= 6-8 feedings/ day

Nutritional Needs: Preterm and SGA Infants

• Preterm (<37 weeks) and SGA (<2700 g) infants
• Medical problems
• Immature body systems
• High calorie/kg intake to provide energy for necessary weight gain; may
need up to 140 kcal/kg/day

Nursing strategies for Preterm and SGA infants

• Specialized feeding methods
– Parenteral nutrition
– Gavage/ tube feedings
– Transition to oral feedings
• Assist families w/ teaching feeding methods
• Assessment of growth and development
INFANTS:
INTRODUCTION:
Good nutrition is essential for the growth and development that occurs during an infant’s
first year of life. When developing infants are fed the appropriate types and amounts of
foods, their health is promoted. Positive and supportive feeding attitudes and techniques
demonstrated by the caregiver help infants develop healthy attitudes toward foods,
themselves, and others. Throughout the first year, many physiological changes occur that allow infants to consume
foods of varying composition and texture. As an infant’s mouth, tongue, and digestive tract mature, the infant shifts
from being able to only suckle, swallow, and take in liquid foods, such as breast milk or infant formula, to being
able to chew and receive a wide variety of complementary foods.

ENERGY:
Infants need energy from food for activity, growth, and normal development. Energy comes from foods containing
carbohydrate, protein, or fat. The number of kilocalories (often termed “calories”) needed per unit of a person’s
body weight expresses energy needs. A kilocalorie is a measure of how much energy a food supplies to the body
and is technically defined as the quantity of heat required to raise the temperature of 1 kilogram of water 1 degree
Celsius. An infant’s energy or caloric requirement depends on many factors, including body size and composition,
metabolic rate (the energy the body expends at rest), physical activity, size at birth, age, sex, genetic factors, energy
intake, medical conditions, ambient temperature, and growth rate.

Infants are capable of regulating their intake of food to consume the amount of kilocalories they need. Thus,
caregivers are generally advised to watch their infants’ hunger and satiety cues in making decisions about when and
how much to feed.

ENERGY INTAKE AND GROWTH RATES:

A general indicator of whether an infant is consuming an adequate number of kilocalories per day is the infant’s
growth rate in length, weight, and head circumference. However, physical growth is a complex process that can be
influenced by size and gestational age at birth, environmental and genetic factors, and medical conditions, in
addition to dietary intake. An infant’s growth rate can be assessed by periodically plotting the infant’s weight,
length, and head circumference for age and weight for length.

What are the most important nutritional considerations in the first year of life?
In the first 12 months of life a baby will triple its weight and increase its length by 50 per cent. These gains in
weight and height are the primary indices of nutritional status and their accurate measure at regular intervals are
compared with standard growth charts. These measurements are important tools for monitoring a child's progress
particularly during the first 6 to 12 months of life.

Breast-feeding on demand remains the ideal form of feeding for healthy babies who are born at term. Human milk
provides optimum nutritional needs for growth and development. The first 4-6 months are a period of very rapid
growth, particularly for the brain, and the amino acid and fatty acid composition of breast milk is ideally suited to
meet those needs. Breast milk also contains anti-bacterial and anti-infection agents, including immunoglobulins,
which have an important role to play in boosting immune function. The colostrum, which is the fluid produced by
the mammary gland during the first few days after birth, is rich in protein and has high levels of minerals and
vitamins. Colostrum also contains antibodies, anti-infection agents, anti-inflammatory factors, growth factors,
enzymes and hormones, which are beneficial for growth and development.
Breast-feeding is strongly advocated for physiological, psychological and emotional reasons. There is no reason
why breast-feeding should not continue for as long as it is nutritionally satisfactory for mother and child up to 2
years.

However, with changing lifestyles and the availability of commercially prepared formulae, prepared formulae is
generally safe provided that an approved infant formula is used under strict hygienic conditions. Formula-fed
infants also need to be demand fed and the formulae must be made up exactly according to the manufacturer's
instructions for optimal growth. Special attention has to be taken to sterilise all the feeding equipment to reduce the
potential risk of contamination, because formula-fed babies do not have the same degree of immunological
protection as breast-fed babies.
NUTRITIONAL REQIREMENT:

CARBOHYDRATES:

AI for Infants
0–6 months 60 g/day of
carbohydrate
7–12 months 95 g/day of
carbohydrate

Sources
The major type of carbohydrate
normally consumed
by young infants is
lactose, the
carbohydrate source in
breast milk and cow’s milk- based
infant formula. Lactose-free infant
formulas, such as soy-based infant
formulas, provide
carbohydrates in the form of sucrose, corn
syrup, or corn syrup solids. These infant
formulas are prescribed to infants who cannot
metabolize lactose or galactose, a component of
lactose. Some specialty infant formulas contain other
carbohydrates in the form of modified corn starch,
tapioca dextrin, or tapioca starch. In later infancy,
infants derive carbohydrates from additional sources including cereal and other grain products,
fruits, and vegetables. Infants who consume sufficient breast milk or infant formula and
appropriate complementary foods later in infancy will meet their dietary needs for
carbohydrates.

FiberDietary fiber is found in legumes, whole grain foods, fruits, and vegetables.
Breast milk contains no dietary fiber, and infants
generally consume no fiber in the first 6 months
of life. As complementary foods are
introduced to the diet, fiber intake increases;
however, no AI for fiber has been
established. It has been recommended that from
6 to 12 months whole-grain cereals, green
vegetables, and legumes be gradually introduced
to provide 5 grams of fiber per day by 1 year of age.
PROTEIN:

AI for Infants
0–6 months 9.1 g/day of protein
RDA for older infants
7–12 months 11 g/day of protein

Sources
Breast milk and infant formulas provide sufficient protein to meet a young infant’s needs if consumed in amounts
necessary to meet energy needs. In later infancy, sources of protein in addition to breast milk and infant formula
include meat, poultry, fish, egg yolks, cheese, yogurt, legumes, and cereals and other grain products. When an
infant starts receiving a substantial portion of energy from foods other than breast milk or infant formula, these
complementary foods need to provide adequate protein.
 Proteins in animal foods contain sufficient amounts of all
the essential amino acids needed to meet protein
requirements. In comparison, plant foods contain low
levels of one or more of the essential amino acids.
However, when plant foods low in one essential amino acid
are eaten on the same day with an animal food or other
plant foods that are high in that amino acid (e.g., legumes such as pureed kidney
beans [low in methionine, high in lysine] and grain products such as mashed rice
[high in methionine, low in lysine]), sufficient amounts of all the essential amino
acids are made available to the body. The protein eaten from the two foods would be
equivalent to the high-quality protein found in animal products.

LIPIDS
AI for Infants
0–6 months 31 g/day of fat
7–12 months 30 g/day of fat

Sources
Breast milk and infant formula are important sources of lipids, including essential fatty
acids, during infancy. The lipid content of breast milk varies, but after about the first 2
weeks postpartum, breast milk provides approximately 50 percent of its calories from
lipids. Infant formulas also provide approximately 50 percent of their calories as fat.
Breast milk provides approximately 5.6 g/liter of linoleic acid, while infant formulas
currently provide 3.3–8.6 g/liter. In addition, breast milk provides approximately 0.63
g/liter of n-3 polyunsaturated fatty acids (including α-linolenic acid and docosahexaenoic
acid) while infant formulas provide 0 to 0.67 g/ liter. Manufacturers of infant formulas add
blends of vegetable oils, which are high in linoleic acid, to improve essential fatty acid content. Food sources of
lipids in the older infant’s diet, other than breast milk and infant formula, include meats, cheese and other
dairy products, egg yolks, and any fats or oils added to home-prepared foods.

Cholesterol and Fatty Acids in Infant Diets

In agreement with the National Cholesterol Education Program, the American Academy of Pediatrics (AAP) states
that “no restriction of fat and cholesterol is recommended for infants <2 years when
rapid growth and development require high energy intakes.” The fast growth of
infants requires an energy-dense diet with a higher percentage of kilocalories from
fat than is needed by older children.

Cholesterol performs a variety of functions in the body but is not

an essential nutrient because it is manufactured by the liver.
Cholesterol is not added to infant formulas whereas breast milk
contains a significant amount of cholesterol. In recent years, there
has been interest in whether the cholesterol content of breast milk has a beneficial or
adverse effect on later development of atherosclerosis. A comprehensive analysis of 37
studies confirmed total cholesterol was higher in breastfed than formula-fed infants, no
different in children or adolescents who had been breast versus formula-fed, and lower in
adults who were breast versus formula-fed, reinforcing the possible protective effect of cholesterol exposure in
infancy. It has been suggested that breast milk’s high level of cholesterol stimulates the development of enzymes
necessary to prepare the infant’s body to process cholesterol more efficiently in later life, but carefully designed,
well-controlled studies need to be conducted to confirm this possibility.

Trans fats, which are believed to be similar to saturated fats in their atherosclerotic affect, are found in fat that has
been modified to a more solid form, such as polyunsaturated oils used to make
spreadable margarine. They are present in most American diets, thus may be present
in breast milk but serve no physiologic purpose. Trans fats are not routinely used in
the preparation of infant formulas. Further research is needed to determine the long-
term effects of the consumption of trans fats by infants.

VITAMIN D
AI for Infants 0–12 months 5 μg (200 IU)/day
UL for Infants 0–12 months 25 μg (1,000 IU)/day

Sources
Vitamin D is manufactured in the skin by the action of ultraviolet
light (from the sun) on chemicals naturally present in the skin. The
requirement for dietary vitamin D depends on the amount of
exposure an infant gets to sunlight. In the United States, fortified milk products, including
milk-based infant formulas, are the major dietary source of vitamin D. Fish, liver, and egg
yolk are also sources of this vitamin. Breast milk contains a small amount of vitamin D. AAP
states: Infants who are breastfed but do not receive supplemental vitamin D or adequate
sunlight exposures are at increased risk of developing vitamin D deficiency or rickets.
Human milk typically contains a vitamin D concentration of 25 IU/L or less. Thus the
recommended adequate intake of vitamin D cannot be met with human milk as the sole source of vitamin D for the
breastfeeding infant. There is evidence that limited sunlight exposure prevents rickets in many breastfed infants.
However, experts recommend limiting sunlight exposure among young infants because of recent concerns raised
about the increased risk of skin cancer which may result from early exposure to sunlight. As a result of these factors,
the AAP recommends that all healthy infants have a minimum intake of 200 IU of Vitamin D per day during the
first 2 months of life to prevent rickets and vitamin D deficiency. A supplement of 200

IU per day is recommended for the following:

 All breastfed infants unless they are weaned to at least 500 mL per day of vitamin D-fortified infant formula
and
 All non breastfed infants who are consuming less than 500 mL per day of vitamin D-fortified infant formula

VITAMIN A

AI for Infants
0–6 months 400 μg
Retinol Active

Equivalent/day of vitamin A
7–12 months 500 μg Retinol Active

Equivalen
t/day of
vitamin A
UL for Infants
0–12 months
600 μg/day of
preformed vitamin
SourceBreast milk and infant formula are major food sources of vitamin A. Additional sources of vitamin A or
carotenes for infants consuming complementary foods include: egg yolks, yellow and dark green leafy vegetables
and fruits (e.g., spinach, greens, sweet potatoes, apricots, cantaloupe, peaches), and liver. Some infants may
have allergic reactions to certain fruits or vegetables.
VITAMIN E
AI for Infants
0–6 months 4 mg/day of α-tocopherol
7–12 months 5 mg/day of α-tocopherol

Sources
Infants receive vitamin E from breast milk and infant formula. Other vitamin E sources
for older infants include green leafy vegetables; vegetable oils and their products; wheat
germ; whole-grain breads, cereals, and other fortified or enriched grain products; butter;
liver; and egg yolks. Vitamin E can be destroyed through processing and cooking.

VITAMIN K
AI for Infants
0–6 months 2.0 μg/day of vitamin K
7–12 months 2.5 μg/day of vitamin K

Sources
Sources of vitamin K include infant formula, green leafy vegetables, pork, and liver. Although this vitamin is
manufactured by bacteria normally found in the intestine, this process is not fully developed in the early stages of
an infant’s life. Since breast milk is normally low in vitamin K,
exclusively breastfed infants are at risk of developing a fatal brain
hemorrhage due to vitamin K deficiency.

Therefore, it is recommended that all infants be given an intramuscular

injection of vitamin K at birth, regardless of the mothers’ plans to
breast- or formula-feed. Infants fed an adequate amount of infant formula receive sufficient
vitamin K. No requirement for vitamin K supplementation of breastfed infants after hospital discharge has been
established, but some experts recommend that mothers be supplemented while they
are breastfeeding.

VITAMIN C
AI for Infants
0–6 months 40 mg/day vitamin C
7–12 months 50 mg/day vitamin C

Sources
Breast milk and infant formulas are major food sources of vitamin C. Additional
vitamin C sources include vegetables (e.g., tomatoes, cabbage, potatoes), fruits (e.g.,
citrus fruits, papaya, cantaloupe, and strawberries), and infant and regular fruit and vegetable juices naturally
high in or fortified with vitamin C. Cooking home-prepared vegetables (or fruits if they need
to be cooked) for the minimum time required to process them reduces the destruction of
vitamin C in the food.

VITAMIN
B12
AI for Infants
0–6 months
0.4 μg/day of
vitamin B12
7–12 months
0.5 μg/day of vitamin B12

Sources
An infant’s vitamin B12 stores at birth generally supply his or her needs for
approximately 8 months. Major food sources of vitamin B12 are breast milk and infant
formulas. Infants consuming appropriate amounts of breast
milk from mothers with adequate B12 stores or
infant formula receive adequate amounts of this
vitamin. Complementary foods such as meat,
egg yolks, and dairy products provide this vitamin later in infancy as well.

FOLATE

AI for Infants
0–6 months 65 μg/day of dietary folate equivalents
7–12 months 80 μg/day of dietary folate equivalents

Sources
Infants receive folate from breast milk; infant formula; green leafy vegetables; oranges;
cantaloupe; whole-grain breads, cereals, and fortified or enriched grain products; legumes;
lean beef; egg yolks; and liver. Folate can be lost from foods during preparation, cooking,
or storage.

VITAMIN B6 (PYRIDOXINE)
AI for Infants
0–6 months 0.1 mg/day of vitamin B6
7–12 months 0.3 mg/day of vitamin B6

Sources
Food sources of vitamin B6
include breast milk; infant
formula;
liver; meat;
whole-grain
breads,
cereals, and
other fortified or enriched grain products;
legumes; and potatoes.

THIAMIN (VITAMIN B1)

AI for Infants
0–6 months 0.2 mg/day of thiamin
7–12 months 0.3 mg/day of thiamin

Sources
Food sources of thiamin include breast milk; infant formula; whole-grain breads, cereals, and other fortified
or enriched grain products; legumes; lean pork; and potatoes.

RIBOFLAVIN (VITAMIN B2)

AI for Infants
0–6 months 0.3 mg/day of riboflavin
7–12 months 0.4 mg/day of riboflavin
Sources
Food sources of riboflavin include breast milk; infant formula; turnip organ meats; dairy products; egg yolks;
green vegetables (e.g., broccoli, asparagus, greens); and whole-grain breads, cereals, and fortified or
enriched grain products.
NIACIN

AI for Infants
0–6 months 2 mg/day of preformed niacin
7–12 months 4 mg/day of niacin equivalents

Sources
Food sources of niacin include breast milk; infant formula; egg yolks; poultry; meat;
fish; and whole-grain breads, cereals, and fortified or enriched grain products. Niacin can be formed in the
body from the tryptophan in these foods: meat, poultry, cheese, yogurt, fish, and eggs.

CALCIUM

AI for Infants
0–6 months 210 mg/day of calcium
7–12 months 270 mg/day of calcium

Sources
An infant can obtain sufficient calcium by consuming adequate amounts of
breast milk or infant formula. Older infants can obtain additional calcium
from complementary foods such as yogurt, cheese, fortified or enriched
grain products, some green leafy vegetables (such as collards and turnip
greens), and tofu (if the food label indicates it was made with calcium
sulfate). The absorption and use of calcium in the body is affected by the
presence of other nutrients, such as vitamin D which must be available in
the body for an infant to retain and use the calcium consumed. The calcium
from breast milk is more completely absorbed than the calcium from cow’s-milk-based or
soy-based infant formulas. However, higher levels are present in these infant formulas to
account for the difference in absorption.

IRON
AI for Infants
0 - 6 months 0.27 mg/day of iron RDA for Infants
7 - 12 months 11 mg/day of iron UL
0 - 12 months 40 mg/day of iron

Sources
Most full-term infants are born with adequate iron stores that are not depleted until about
4 to 6 months of age. In comparison, preterm infants and twins have lower iron stores at birth and, with their rapid
growth rate, may deplete their iron stores by 2 to 3 months of age. Sources of iron for infants include breast milk;
infant formula; meat; liver; legumes; whole-grain breads, cereals, or fortified or enriched grain products;
and dark green vegetables. The ability to absorb the iron in food depends on the infant’s iron status and the form
of iron in the food. Absorption of iron from the diet is relatively low when body iron stores are high and absorption
may increase when iron stores are low.

Iron in food occurs in two major forms:

 Heme iron – found primarily in animal tissues, including red meat, liver, poultry and fish, this form is well
absorbed into the body. Commercially prepared infant food plain meats contain more heme iron than infant
food combinations and dinners.

 Nonheme iron – found in breast milk; infant formula; iron-fortified breads,

cereals, or other grain products; legumes; fruits; and vegetables. Infants receive
most of the iron in their diets as nonheme iron. This form is not as well absorbed
into the body as heme iron and its absorption can be affected by other foods in the
same feeding or meal. Vitamin C-rich foods or meat, fish, or poultry in a meal
increase the absorption of nonheme iron. Thus, it is recommended to serve a
vitamin C source (such as breast milk, iron fortified infant formula, or vitamin C-
 rich fruit juices or foods) at the same meal as ironfortified grain products or legumes.
Dairy products reduce the absorption of iron.

Meeting Iron Requirements of Breastfed and Formula-Fed Infants

Breastfed Infants:
 Full-term, appropriate-for-gestational-age breastfed infants need a supplemental source of iron starting at 4 to 6
months of age (approximately 1 mg/kg/day) preferably from complementary foods. Iron-fortified infant cereal
and/or meats are a good source of iron for initial introduction of an iron-containing food. An average of 2
servings (½ oz or 15 g of dry cereal per serving) is needed to meet the daily iron requirement.

 If a full-term, breastfed infant is unable to consume sufficient iron from dietary sources after 6 months of age,
an oral iron supplemental should be used.

 For all infants younger than 12 months, only iron-fortified infant formula (10 to 12 mg/L) should be used for
weaning or supplementing breast milk.

Formula-Fed Infants:

 For full-term infants, only iron-fortified infant formula should be used during the first year of life regardless of
the age when infant formula is started. All soy-based formulas are iron-fortified to 12 mg/L.

 No common medical indication exists for the use of a low-iron infant formula. The AAP has recommended the
discontinuation of the manufacturing of low-iron formula and that all infant formulas contain at least 4 mg/L of
iron. Although some believe that iron-fortified infant formula increases gastrointestinal symptoms, no scientific
evidence supports this belief. Consequently, using non-iron-fortified infant formula for healthy infants is not
justified.
Other Milks
Cow’s milk, goat’s milk, and soy-based beverages (e.g., soy milk) contain relatively little
iron or the iron they contain is poorly absorbed by infants.
These milks can promote the development of iron-deficiency
anemia by causing microscopic gastrointestinal bleeding and
nutritionally significant blood loss in infants. Studies show
that blood loss induced by the consumption of cow’s milk decreases in the older
infant and disappears by 12 months of age. For this and other reasons, cow’s milk,
goat’s milk, or soybased beverages are not recommended for infants less than 12
months old.

ZINC

AI for Infants 0–6 months 2 mg/day of zinc

UL for Infants 0–6 months 4 mg/day of zinc
UL for Infants 7–12 months 5 mg/day of zinc
RDA for Infants 7–12 months 3 mg/day of zinc

Sources
Infants obtain zinc from breast milk; infant formula; meat; poultry; liver; egg yolks; cheese; yogurt; legumes;
and whole-grain breads, cereals, and other fortified or enriched grain products. Meat, liver, and egg yolks are
good sources of available zinc, whereas whole-grain products contain the
element in a less available form. Breast milk is considered to be a good
source of zinc for the first 6 months, but is inadequate for the older infant.
In addition to breast milk or infant formula, complementary food sources
of zinc, such as meats or fortified infant cereal, help meet an infant’s zinc
needs after 6 months of age.

Zinc in Vegetarian Diets

Some vegetarian diets may be deficient in zinc. Some researchers have
recommended zinc supplementation for infants on vegan diets during
weaning.

SODIUM

Sources
Healthy, full-term infants consuming primarily breast milk or infant formula of standard dilution receive a
relatively small amount of sodium but an amount adequate for growth. Estimated minimum requirements for infants
are 100 to 200 mg/day. The sodium level in cow’s milk is greater than that in breast milk and most infant formulas;
however, cow’s milk is not recommended for infants. Salt is not added to commercially prepare infant foods;
however, salt is added to “junior” or “toddler” foods designed for children from 1 to 4 years old to improve their
taste. These foods are not recommended for infants. The amount of sodium consumed by an infant on home-
prepared complementary foods reflects the cooking methods used in the home and the eating habits and cultural
food patterns of the infant’s family.
Table 27-1. Composition of Breast Milk and Infant Formulas

Breast Standard Premature Soy

Milk (per Formula (per Formula Formula Nutramigen Pregestimil
dL) dL) (per dL) (per dL) (per dL) (per dL)
Calories (kcal) 67 67 67-81 67 67 67
Protein (g) 1.1 1.5 2.0-2.4 1.7 1.9 1.9
(% calories) (6%) (9%) (12%) (10%) (11%) (11%)
Whey/casein 80/20 60/40, 18/82 60/40 Soy Casein Casein
protein ratio protein, hydrolysate hydrolysate
methionine plus L- plus L-cystine,
cystine, L- L-tyrosine,
tyrosine, and and L-
L-tryptophan tryptophan
 Fat (g) 4.0 3.6 3.4-4.4 3.6 3.3 3.8
(% calories) (55%) (50%) (45%) (48%) (45%) (48%)
MCT (%) 0 0 40-50 0 0 55
Carbohydrate 7.2 6.9-7.2 8.5-8.9 6.8 7.3 6.9
(% calories) (40%) (41%) (42%) (40%) (44%) (41%)
Source Lactose Lactose Lactose, Corn syrup, Corn syrup Corn syrup
corn syrup sucrose solids, solids,
cornstarch cornstarch,
dextrose
Minerals (per L)

Calcium (mg) 290 420-550 1115-1452 700 635 777

Phosphorus 140 280-390 561-806 500 420 500
(mg)
Sodium (mEq) 8.0 6.5-8.3 11-15 13 14 14
Vitamin D Variable 400 1000-1800 400 400 400
Osmolality 253 270 230-270 200-220 290 290
(mOsm/L)
Renal solute 75 100-126 175-213 126-150 175 125
load (mOsm/L)
Comments Reference Risk of milk Specifically Useful for Useful for Useful for
standard, protein fortified lactose and lactose and malabsorption
deficient in intolerance- with milk milk protein states, lactose
vitamin K; gastrointestinal additional protein intolerance and milk
may be bleeding, protein, intolerance; (allergy) protein
deficient in anemia, Ca2+, P, may lead to intolerance
Na+, Ca2+, wheezing, Na+, soy protein (allergy)
protein, eczema vitamin D, intolerance;
vitamin D and MCT rickets
for VLBW oil develops in
infants VLBW
infants

Self-Feeding

Self-feeding begins when an infant is able to sit up straight, grasp food with the hands or fingertips, and move the
food from the hands to the mouth. This usually develops between six to seven months of age. Suitable foods are
arrowroot biscuits, teething biscuits, and small pieces of soft fruit or soft cooked vegetables.

To prevent choking when an infant is self-feeding, an adult caretaker should always be present.

Between seven and eight months, infants are able to move their shoulders and arms while seated. A more mature
up-and-down chewing pattern is developing at this time, making it an appropriate time to begin introducing soft,
mashed table foods.

Well-cooked vegetables and meats and soft mashed fruits are usually well tolerated. Between ten and twelve
months of age infants are becoming more aware of what others are eating, and they will want to imitate other
people's eating habits.
At this age it is appropriate to offer soft, chopped table foods in a meal pattern similar to the rest of the family. The
one year old begins to clumsily self-feed with a spoon and sip from a cup. All these self-feeding skills will be
continually refined during the toddler years.
When should solid foods be introduced?

Introduction of complementary solid food is usually a gradual process over several

weeks or months, starting at about 6 months of age. The exact timing is determined by
the individual infant and mother, and reflects the fact that breast milk will suffice in
those first months but will no longer be able to provide adequate nutrition by itself as the
baby grows. The introduction of complementary foods by about 6 months is important to ensure normal chewing
and speech development

The quality, number and variety of solid feeds can be increased gradually at a pace that will be generally dictated by
the child. Cereals are generally the first foods that are introduced into the infant's diet (mixed with a little breast
milk or formula), with purées of vegetables and fruits to follow. By exclusive breast feeding up to 4 to 6 months of
age, the likelihood of allergies is lessened.

An important consideration in the first year of life is the amount of iron supplied in the diet and iron deficiency
anaemia is routinely screened for during infancy. The use of an iron-fortified formula or cereal, and the provision of
iron-rich foods can help to prevent this problem.
TODDLERS:

INTRODUCTION:
At approximately age one, children enter the latent period of growth. During this period,
until the onset of puberty, growth and development are more gradual than during the first
year. Physical growth steadies, and the body begins to look more proportioned as it prepares
for an "upright" lifestyle.

The immediate stages following infancy are toddlerhood (age’s one through three). Characterized by temper
tantrums, exploration, and endless questions, these periods can be trying for parents. Individual children experience
growth spurts and plateaus —during which growth seems to stop completely. Food intake, and a liking of certain
foods, may change constantly, causing a great deal of anxiety for parents.

Parents need to recognize that these changes are a normal part of development. Understanding the nutritional
requirements of these age groups may help parents adapt to the new challenges. In addition, parents should be
aware of the potential problems associated with feeding young children—and the ways to prevent them.

NUTRITIONAL REQUIREMENTS

Compared to adults, small children need more nutrients in proportion to their body weight. As bones, muscles, teeth,
and blood volume are developing, nutrient intake needs to be adequate to support this process, and also to keep up
with the growing child's increasing activity. A challenge also arises when growth spurts alternate with periods of no
growth or slowed growth.
Energy and Protein Needs

Basal metabolic rate, growth, and physical activity all affect a child's daily energy. Regardless of the total intake,
the composition should resemble the following: 50 to 60 percent of calories from carbohydrates, 25 to 35 percent of
calories from fat, and 10 to 15 percent of calories from protein (see accompanying table.) It should be remembered,
however, that this is simply an estimate, and intake may need to be adjusted to suit each child.

Protein is a vital dietary component for preschoolers and toddlers, as it is needed for optimal growth. Enough
protein should be consumed every day to allow for proper development. Protein deficiencies are rare in the United
States, since most U.S. children consume plenty of protein each day. When protein malnutrition does occur, it is
usually seen in those from low-income homes, those who follow a strict vegan diet excluding all animal sources,
and those with multiple food allergies.

Vitamin and mineral needs.

Iron is a vital component of hemoglobin, the carrier of oxygen in the blood. As a young child grows, blood volume
increases, and so does the need for iron.

Preschoolers and toddlers typically eat less iron-rich foods than they did in infancy. In addition, the iron that
children get is usually non-heme iron (from plant sources), which has a lower availability than heme iron (from
animal sources). As a result, children up to three years of age are at high risk for iron-deficiency anemia. The RDA
for iron for both toddlers and preschoolers is ten milligrams (mg) per day.
Calcium is needed for bone and teeth mineralization and maintenance. The amount of calcium a child needs is
determined in part by the consumption of other nutrients, such as protein, phosphorus and vitamin D, as well as the
child's rate of growth. During this period of development, children need two to four times more calcium per
kilogram of body weight as adults do. The AI for toddlers is 500 mg/day, while for preschoolers it is 800 mg/day.
Since dairy foods are the primary source of calcium, children who do not consume enough dairy or have an
aversion to dairy products may be at risk for calcium deficiency.

The body can produce vitamin D in the skin in response to sun exposure. The amount of vitamin D needed daily
thus depends mainly on how much time a child spends outside and on geographical location. The RDA for children
living in tropical areas is between zero and 2.5 micrograms (μg) per day, depending on the amount of sun exposure.
For those living in temperate zones, the RDA increases to 10 mc/day. Vitamin D–fortified milk is the best source.
Zinc is essential for proper development. It is needed for wound healing, proper sense of
taste, proper growth, and normal appetite. Preschoolers and toddlers are sometimes at
risk for marginal zinc deficiencies because the best sources are meats and seafoods,
foods they may not eat regularly. The recommended intake of zinc is 10 mg/day.

Vitamin and mineral supplements are popular with more than 50 percent of parents of
preschoolers and toddlers. Most use a multivitamin/mineral supplement with iron. Parents should be aware,
however, that such supplements do not necessarily fulfill the needs for marginal or deficient nutrients. For example,
although calcium is often a nutrient that is low in children, most multivitamin/mineral supplements do not include it,
or include it in very low doses. The American Academy of Pediatrics does not support routine supplementation for
normal, healthy kids.

Although there is no harm in giving children standard children’s supplement, megadoses should always be avoided,
and caution should be used when supplementing the fat-soluble vitamins (vitamins A, D, E, and K).

Potential Feeding Problems

As young children develop their likes and dislikes and learn to feed themselves, parents need to allow them to
become more independent. As a result of these changes, potential concerns arise. Common feeding problems among
preschoolers and toddlers are: obesity, nursing bottle mouth syndrome, food jags, and iron-deficiency anemia.

According to the national Pediatric Nutrition Surveillance System, 10.2 percent of children in the United States
under the age of five were overweight in 1998. These rates have been increasing steadily since the 1960s.
Prevention education is the key to lowering the incidence of obesity in children. Success has been shown in
programs that include family involvement, nutritional information and modification, activity planning, and behavior
therapy.

Most often seen in children under age three, nursing bottle mouth syndrome (or baby bottle tooth decay) results
from extended bottle feeding. It occurs when a child is routinely given a bottle with sweetened beverages (such as
milk or juice) at bedtime. As the child sleeps, the liquid pools around the teeth. The result is severe caries on the
incisors and cheek surfaces of molars. Parents should avoid giving a bottle at bedtime and begin serving beverages
in a cup as early as possible.

Most children undergo a normal part of development know as a food jag. Food jags occur when children either
refuse to eat a previously accepted food, or when they insist on eating one particular food all the time. A food jag is
generally a case of a child testing his or her independence. Although annoying for most parents, food jags are rarely
a reason for concern. The best strategy is to continue offering a variety of foods every day, while keeping the
favorite food available. Most children will eventually return to a normal eating pattern. Letting a food jag take its
course is the best plan of action; force will accomplish little.

Feeding Strategies for Parents

• Allow kids to eat five to six small meals per day.

• Allow them to eat when they are hungry and do not force them to eat when they are not.

• Do not use food as a reward or punishment.

• Be aware of the risk of choking in these age groups. Avoid foods that are round, hard, or do not easily dissolve in
saliva (such as hot dogs, grapes, raw vegetables, popcorn, nuts, peanut butter, and hard candy).

• Avoid feeding too many sweetened beverages (especially in the bottle); encourage them to drink plenty of water.
Despite the wide availability of iron-rich foods, iron-deficiency anemia is the most common nutrient deficiency in
the world. Reasons for this deficiency in toddlers may be the consumption of large quantities of milk, and thus
limited intake of solids and iron-fortified foods. In addition, many young children do not
like the best sources of iron, such as meats and seafoods.
Parents should pay special attention to include good dietary sources of iron in their
children's diet. When meat or seafood sources are limited, the availability of iron from
plant sources can be increased with the consumption of ascorbic acid (vitamin C).

The preschool and toddler years often create anxiety in parents as food likes, dislikes, and requirements may change
continuously. Understanding that these changes are a normal part of development, and understanding the nutritional
requirements for this age group, will help parents make educated decisions. Parents should also be aware of the
potential feeding problems of this group, and of the ways to prevent them.

What are the most important nutritional considerations for toddlers (1-3 years of age)?

During these years, a child begins to take on its own unique personality and to exert its independence by moving
around freely and choosing foods to eat. Although the child is still growing, the rate of growth is slower than in the
first 12 months of life. At the end of the third year of age, girls and boys will have achieved about 50 per cent of
their adult height.

During this period a child becomes able to drink through a straw and eat with a spoon, and frequently they become
"fussy" eaters. The provision of a variety of foods will allow the child to choose from a range of foods with
differing tastes, textures, and colours to help satisfy their small appetites. The most important factor is to meet
energy needs with a wide variety of foods.

Food intake will be influenced increasingly by family eating patterns and peers. Early food experiences may have
important effects on food likes and dislikes and eating patterns in later life. Meal times should not be rushed and a
relaxed approach to feeding will pave the way for healthy attitudes to food.

PRESCHOOLER:

INTRODUCTION:
The preschooler's growth is slower than that of an infant. An average child age 2 through 5 will grow about 2 1/2
inches and gain 4 or 5 pounds each year. Because growth rate is slower, appetites may decrease. The preschool
period is an excellent time to help your child become familiar with the idea that eating a proper diet is part of a
healthy lifestyle. Attitudes and habits formed during preschool years are likely to be carried into the future. By 15
months of age, most children have developed enough fine motor skills to feed themselves without help.
NUTRITIONAL NEEDS OF PRESCHOOLERS

Basic nutritional needs of children are similar to the nutritional needs of other family members. Amounts needed
differ because of age. Offer your child a variety of foods from the basic food groups:
 Breads, cereals, rice and pasta
 Vegetables
 Fruits
 Milk, yogurt and cheese
 Meats, poultry, fish, dry beans and peas, and eggs.

Over time, the preschooler will take in adequate nutrients when allowed to choose from a variety of healthy foods.
Protein is needed for growth. Protein in the diet is supplied by milk, meat, fish, poultry, eggs, cheese, and dry beans
and peas.

Calcium is needed for strong bones and teeth. Dietary calcium is primarily found in milk and milk products and to a
lesser extent in leafy green vegetables. Iron is an important mineral you get from meat, poultry, fish, eggs, green
leafy vegetables, and iron fortified cereals. Iron from cereal will be absorbed better when served with a food rich in
vitamin C. Citrus fruits and their juices and dark green or yellow vegetables are good sources of vitamin C and
vitamin A. Breads and cereals contribute minerals and vitamins.

Plenty of water is needed to regulate body functions in small children. As a percentage of body weight, children
have more water in their bodies than adults; therefore, their bodies can become dehydrated more quickly than adult
bodies. Offer water to your preschooler several times during the day.
Fat is a necessary nutrient in a child's diet. Fat helps provide extra calories and needed
nutrients for active and growing children. No fat restriction should be applied to children
below the age of two. For children over the age of two, fat intake should represent about 30
percent of the total caloric intake. As with the adult diet, limit foods high in saturated fats
and cholesterol for children over the age of two. Help your child develop beneficial low-fat
dietary habits such as drinking skim or low-fat milk instead of whole milk. Remember,
these recommendations for fat intake are not for children under the age of two years or those children who have
special dietary needs.

Sugary foods provide few nutrients and should be eaten on a limited basis. Chewy, sticky, sugary foods may
promote tooth decay. Teach children to properly brush their teeth daily to help diminish this effect.

How Do I Know My Child Is Growing Properly?

A growth chart is a reliable way to tell if your child's diet is meeting body needs. These charts are available from
pediatricians, public health clinics, and child health agencies. Since children grow in spurts, their needs vary.
Changes in appetite may reflect these needs. Allow preschoolers to eat until they are full, regardless of how much or
how little. To examine what you offer your child to eat, keep track of everything your child eats for two or three
days
Family Meals With the Preschooler

Make mealtimes pleasant experiences for your young child by following these tips:

 Involve your child in meal preparation. By allowing your preschooler to take part
in meal preparation, you may help increase your child's interest in a new or
unfamiliar food.

 Include at least one of your child's preferred foods. Offer a choice of foods. The meal should have at least
one food that you know the child will select and eat.

 Offer a variety of colors and textures. This will create interest and increase the number of foods your child
will accept.

 Keep portions child size. One way to consider portion sizes is to have one tablespoon of each type of food for
each year of the child's age.

 Play it safe with foods. Round cuts of hot dogs, cherries, grapes, carrot chunks, tortilla chips, peanut butter, or
nuts may cause a child to choke. Simply cut hot dogs into fourths lengthwise; cook and mash carrots; cut grapes
and cherries into fourths. Don't serve peanut butter by the spoonfuls, combine it with other food items to
improve consistency. Nuts and chips should be cut finely or crushed.

 Expect and tolerate child-like table manners. Let a child be a child. Children are always learning from your
table manners.

 The eating environment is important. Comfort is important at mealtime. Select chairs, tables, dishes and
silverware suitable in structure and size for the preschooler. Do not expect the young child to sit still at meals;
yet some reduction in activity is desirable. A child may be excused from the table if finished or disinterested in
eating.

 Serve meals and snacks on a dependable schedule. Try to schedule meals before your child becomes overly
hungry, tired or irritable. Most children require planned nutritious snacks to safeguard an adequate intake of
nutrients and calories.

 Offer a variety of healthy foods and children will eat what they need. Remain calm if your child leaves a
portion or an entire meal untouched.

 Mealtime can be a family time. Mealtime is a good time to teach nutrition by example. Good eating habits that
preschoolers learn from their parents can develop into lifelong patterns.

Food Jags and New Foods

Most preschoolers experience food jags and may for a time eat only a few self-selected foods. When a parent prods,
the child is less likely to try new foods. Finicky food habits are often temporary and will disappear if not reinforced
by emotions and unnecessary rules. Food should not become the object of bribes or punishments. If a food is
rejected, do not make an issue of the situation as this may make your child more determined to refuse the food
being offered. Try the rejected food at a different time. Allow preschoolers as well as adults to dislike foods. Watch
family behavior. Are some foods rejected by adults in the family? Serve a variety of foods even if rejected by some
adult family members.

Give special consideration to providing foods that appeal to the child's senses. Include finger foods; foods that
crunch or crackle when you eat them; foods that differ in texture; foods with different flavor. Foods that are too hot
or too cold may be refused. Children may try a new food if it is prepared to be child attractive, such as cut in animal
shapes. Present new foods at the beginning of the meal when your child is really hungry. Brightly colored
vegetables may also attract a preschooler.

Many times the true flavor of foods are overwhelmed with sauces, gravies, syrups, herbs, and spices. A favorite or
familiar food served with the new food may encourage the acceptance of different foods.
Snacks
It is hard for preschoolers to eat enough in three meals to provide the nutrients and calories
they need. Offer snacks between meals. Snack time may be a good time to introduce new
foods. Many times children will refuse food at mealtime, but accept them at snack time.
Snacks should provide more than just calories. Some good snack foods include: dry cereal
with milk; meat or peanut butter sandwiches; vegetable or fruit breads such as pumpkin or
banana; fresh, dried, or canned fruit; fruit or vegetable juices; plain yogurt or yogurt with fruit; cheese and crackers;
or oatmeal cookies and milk.
A Final Word
To promote a positive attitude towards good food habits, it is important that parents and care givers help children
understand they are "good kids." What children "do" may be unacceptable at times, but who and what they "are"
inside are normal, healthy and okay kids.

Table I. Feeding guide for the preschool child.

Food group Suggested daily servings Suggested serving sizes

Vegetables 3-5 servings  1/4 cup of cooked vegetables

 1/4 cup of chopped raw vegetables
Dark-green leafy Include all types regularly. Serve  1/2 cup of leafy raw vegetables such
Deep-yellow dark-green leafy and deep- as lettuce or spinach
Dry beans and peas yellow vegetables often. Serve
Starchy vegetables cooked dry beans and peas
Other vegetables several times a week

Fruits 2-4 servings  1/2 whole fruit such as an apple,

banana or orange; or a melon wedge
Include citrus fruits or their  1/2 cup of juice
juices regularly.  1/4 cup cooked or canned fruit
 1/4 cup of raisins

Breads, cereals, rice and 6-11 servings  1/2 slice of bread

pasta  1/2 roll, biscuit or muffin
Include several servings of  4 crackers, saltines
whole grain products daily.  1/4 cup cooked cereal, rice or pasta
 1/3 of a cup ready-to-eat dry cereal
 1/4 of a cup for hot cooked cereal

Milk, yogurt and cheese 4 servings  1/2 cup of milk or yogurt

 3/4 ounce of natural cheese
 1 ounce of processed cheese

Meats, poultry, fish, dry 3-5 servings  1 ounce of cooked lean meat,
beans and peas, eggs and  poultry or fish
nuts  1/2 egg
 1/2 cup cooked beans
 2 tablespoons peanut butter

Feeding practices to avoid are continuing to use a bottle, giving large amounts of sweet
desserts, soft drinks, fruit-flavored drinks, sugarcoated cereals, chips or candy, as they have
little nutritional value. Also avoid giving foods that your child can choke on, such as raw
carrots, peanuts, whole grapes, tough meats, popcorn, chewing gum or hard candy.

Your child's nutrition is important to her overall health. Proper nutrition can also prevent
many medical problems, including becoming overweight, developing weak bones, and developing diabetes. It will
also ensure that your child physically grows to her full potential.

The best nutrition advise to keep your child healthy includes encouraging her to:
 Eat a variety of foods
 Balance the food you eat with physical activity
 Choose a diet with plenty of grain products, vegetables and fruits
 Choose a diet low in fat, saturated fat, and cholesterol
 Choose a diet moderate in sugars and salt

Choose a diet that provides enough calcium and iron to meet their growing body's requirements.

You can also help promote good nutrition by setting a good example. Healthy eating habits and regular exercise
should be a regular part of your family's life. It is much easier if everyone in the house follows these guidelines,
than if your child has to do it alone. You should also buy low-calorie and low-fat meals, snacks and desserts, low fat
or skim milk and diet drinks. Avoid buying high calorie desserts or snacks, such as snack chips, regular soft drinks
or regular ice cream.

What counts as one serving?

To ensure good nutrition in your child and that they grow up healthy, they will need to eat a large variety of foods.
The amount of foods that they eat is much less important. Remember that your child's appetite may decrease and
become pickier over the next few years as his growth rate slows. As long as they are gaining weight and have a
normal activity level, then you have little to worry about. You can still offer them a variety of foods, but can
decrease the serving sizes if they don't eat a lot.
Grain group servings include 1 slice of bread, 1/2 cup of cooked rice or pasta, 1/2 cup of cooked cereal, and 1
ounce of ready to eat cereal. Your child should eat 6 servings from this group.

Vegetable group servings include 1/2 cup of chopped or raw vegetables, or 1 cup of raw leafy vegetables. Your
child should eat 3 servings from this group.

Fruit group servings include 1 piece of fruit or melon wedge, 3/4 cup of 100% fruit juice, 1/2 cup of canned fruit,
or 1/4 cup of dried fruit. Your child should eat 2 servings from this group.

Milk group servings include 1 cup of milk or yogurt or 2 ounces of cheese. Your child should eat 2 servings from
this group.

Meat group servings include 2 to 3 ounces of cooked lean meat, poultry or fish, 1/2 cup of cooked dry beans. You
can substitute 2 tablespoons of peanut butter or 1 egg for 1 ounce of meat. Your child should eat 2 servings from
this group.

Fats, Oils and Sweets

No more than 30% of your diet should come from fats. For a 1600 calorie diet, that would equal 53g of fat each day,
with most preschool children requiring even less. The type of fat that you eat is also important. Saturated fats in
foods such as meats, dairy products, coconut, palm and palm kernal oil, raise cholesterol more than unsaturated
fats, which are found in olive, peanut, and canola oils, or polyunsaturated fats in safflower, sunflower, corn,
soybean and cottonseed oils. Limit saturated fats to no more than 10% of daily calories.
Sugars supply a large amount of calories, with little nutritional value. They include white sugar, brown sugar, corn
syrup, honey and molasses and foods like candy, soft drinks, jams, and jellies.

Selection tips:
 use lean meats and skim or low fat dairy products

 use unsaturated vegetable oils and margarines that list a liquid vegetable oil as the first ingredient on the label

 read the nutrition label on foods to check for the amount and type of fat it includes

 limit foods that contain a large amount of saturated fats

Limit foods high in sugar and avoid adding extra sugar to your foods.

Prevention of Feeding Problems

The best way to prevent feeding problems is to teach your child to feed himself as early as possible, provide them
with healthy choices and allow experimentation. Mealtimes should be enjoyable and pleasant and not a source of
struggle. Common mistakes are allowing your child to drink too much milk or juice so that they aren't hungry for
solids, forcing your child to eat when they aren't hungry, or forcing them to eat foods
that they don't want. Also, avoid giving large amounts of sweet desserts, soft drinks,
fruit-flavored drinks, sugarcoated cereals, chips or candy, as they have little nutritional
value.

Your child may now start to refuse to eat some foods, become a very picky eater or even
go on binges where they will only want to eat a certain food. An important way that children learn to be
independent is through establishing independence about feeding. Even though your child may not be eating as well
rounded a diet as you would like, as long as your child is growing normally and has a normal energy level, there is
probably little to worry about. Remember that this is a period in his development where he is not growing very fast
and doesn't need a lot of calories.

Also, most children do not eat a balanced diet each and every day, but over the course of a week or so their diet will
usually be well balanced. You can consider giving your child a daily vitamin if you think he is not eating well,
although he probably doesn't need it.

While you should provide three well-balanced meals each day, it is important to keep in mind that most children
will only eat one or two full meals each day. If you child has had a good breakfast and lunch, then it is okay that he
doesn't want to eat much at dinner. Although your child will probably be hesitant to try new foods, you should still
offer small amounts of them once or twice a week (one tablespoon of green beans, for example). Most children will
try a new food after being offered it 10-15 times.

Other ways to prevent feeding problems are to not use food as a bribe or reward for desired behaviors, avoid
punishing your child for not eating well, limit mealtime conversation to positive and pleasant topics, avoid
discussing or commenting on your child's poor eating habits while at the table, limit eating and drinking to the table
or high chair, and limit snacks to two nutritious snacks each day. You should also not prepare more than one meal
for your child. If he doesn't want to eat what was prepared for the rest of the family, then he should not be forced to,
but you should also not give him something else to eat. He will not starve after missing a single meal, and providing
alternatives to the prepared meal will just cause more problems later.

Calcium Requirements
Calcium is a mineral that is mostly present in your child's bones. Having a diet with foods that are high in calcium
to meet daily requirements is necessary for the development of strong bones. It is also an important way to prevent
the development of osteoporosis in adults.

Preschool age children require about 500 to 800 mg of calcium each day. See the table below for the calcium
content of common foods and check the nutrition label to choose foods high in calcium when you prepare your
families diet. Also choose foods that are fortified with calcium.

Iron Requirements
Iron is another mineral that is important for your child's growth. Having a diet with foods that are high in iron to
meet daily requirements is necessary for the development of strong muscles and production of blood.

Preschool age children require about 10 mg of iron each day.

SCHOOL – GOING CHILD:

INTRODUCTION:
School-age boys and girls require about 1600 to 2400 calories each day, depending on their age and activity level.
Once they hit their growth spurt, girls require an additional 200 calories and boys 500 calories. School age children
will therefore require between the low and middle range of servings. Children who are overweight and dieting
should at least eat the lowest range of servings.

What are the most important nutritional considerations in school-aged children?

After 4 years of age, a child's energy needs per kilogram of bodyweight are decreasing but the actual amount of
energy (calories) required increases as the child gets older. From 5 years to adolescence, there is a period of slow
but steady growth. Dietary intakes of some children may be less than recommended for iron, calcium, vitamins A
and D and vitamin C, although in most cases -as long as the energy and protein intakes are
adequate and a variety of foods, including fruit and vegetables, are eaten- deficiencies are
unlikely.

Regular meals and healthy snacks that include carbohydrate-rich foods, fruits and
vegetables, dairy products, eggs, legumes and nuts should contribute to proper growth and
development without supplying excessive energy to the diet.

Children need to drink plenty of fluids, especially if it is hot or they are physically active. Water is obviously a good
source of liquid and supplies fluid without calories. Variety is important in children's diets and other sources of
fluid such as milk and milk drinks, fruit juices and soft drinks can also be chosen to provide needed fluids.

Your child's nutrition is important to her overall health. Proper nutrition can also prevent many medical problems,
including becoming overweight, developing weak bones, and developing diabetes. It will also ensure that your child
physically grows to her full potential.

The best nutrition advise to keep your adolescent healthy includes encouraging her to:
 Eat a variety of foods

 Balance the food you eat with physical activity

 Choose a diet with plenty of grain products, vegetables and fruits

 Choose a diet low in fat, saturated fat, and cholesterol

 Choose a diet moderate in sugars and salt

 Choose a diet that provides enough calcium and iron to meet their growing body's requirements.

You can also help promote good nutrition by setting a good example. Healthy eating habits and regular exercise
should be a regular part of your family's life. It is much easier if everyone in the house follows these guidelines,
than if your child has to do it alone. You should also buy low-calorie and low fat meals, snacks and desserts, low fat
or skim milk and diet drinks. Avoid buying high calorie desserts or snacks, such as snack chips, regular soft drinks
or regular ice cream.

Fats, Oils and Sweets

No more than 30% of your diet should come from fats. For a 1600 calorie diet, that would equal 53g of fat each day
and for a 2200 calorie diet, 73g of fat each day. The type of fat that you eat is also important. Saturated fats in
foods such as meats, dairy products, coconut, palm and palm kernal oil, raise cholesterol more than unsaturated
fats, which are found in olive, peanut, and canola oils, or polyunsaturated fats in safflower, sunflower, corn,
soybean and cottonseed oils.

Limit saturated fats to no more than 10% of daily calories.

Sugars supply a large amount of calories, with little nutritional value. They include white sugar, brown sugar, corn
syrup, honey and molasses and foods like candy, soft drinks, jams, and jellies.

Selection tips:
 use lean meats and skim or lowfat dairy products

 use unsaturated vegetable oils and margarines that list a liquid vegetable oil as the first ingredient on the label

 read the nutrition label on foods to check for the amount and type of fat it includes

 limit foods that contain a large amount of saturated fats

 limit foods high in sugar and avoid adding extra sugar to your foods

Milk, Yogurt and Cheese

Dairy products provide protein, vitamins and minerals and are an excellent source of
calcium. Your schoolage child should have 2 to 3 servings of milk, yogurt and cheese
each day.

Selection tips:
 Choose skim milk and nonfat yogurt

 Avoid high fat cheese and ice cream

Meat, Poultry, Fish , Dry Beans, Eggs and Nuts

Foods in this group provide protein, and vitamins and minerals, including B vitamins, iron and zinc. You should
have 2 to 3 servings of foods from this group each day, including the equivalent of 5 to 7 ounces of lean meat.

Selection tips:
 A serving from this food group can include 2-3 ounces of lean meat, poultry or fish, which may be an average
hamburger or medium chicken breast half.

 Choices with the least fat include lean meat, poultry without skin, fish, and dry beans and peas.

 Prepare meats in low fat ways, by trimming away fat, and broiling, roasting, or boiling rather than frying.

 Remember that nuts and seed are high in fat, and egg yolks are high in cholesterol, so you should eat them in
moderation.

Vegetables
Vegetables supply you with vitamins, including vitamin A and C, and folate, minerals, such as iron and magnesium,
and fiber. Plus they are low in fat. You should have 2 to 4 servings of vegetables each day.

Selection tips:
 You should eat a variety of vegetables to provide you with all of the different nutrients that they supply,
including dark green leafy vegetables, deep yellow vegetables, starchy vegetables (potatoes, corn peas),
legumes (navy, pinto and kidney beans), and other vegetables (lettuce, tomatoes, onions, green beans).

 Do not add a lot of fat to the vegetables you eat, by avoiding added toppings, such as butter, mayonnaise, and
salad dressings.
Fruits
Fruits and 100% fruit juices provide Vitamin A and C and potassium. They are also low in
fat and sodium. You should have 2-4 servings of fruit each day.

Selection tips:
 Eat fresh fruits and 100 % fruit juices and avoid canned fruit in heavy syrups and sweetened fruit juices.
According to the American Academy of Pediatrics, 100% fruit juice may substitute for half of your child's
recommended servings of fruit each day.

 Eat whole fruits.

 Eat citrus fruits, melons, and berries, which are high in Vitamin C.

Bread, Cereal, Rice and Pasta

Foods from this group provide complex carbohydrates (starches) and provide vitamins, minerals, and fiber. You
need at least 6 to 11 servings of foods from this food group each day.

Selection tips:
 Choose whole grain breads and cereals for added fiber.

 Choose foods that are low in fat and sugars.

 Avoid adding calories and fat to foods in this group by not adding spreads or toppings high in fat.

Calcium Requirements
Calcium is a mineral that is mostly present in your child's bones. Having a diet with foods that are high in calcium
to meet daily requirements is necessary for the development of strong bones. It is also an important way to prevent
the development of osteoporosis in adults.

School age children require about 800 mg of calcium each day. Once they begin puberty, their calcium
requirements will increase to about 1200 mg each day. See the table below for the calcium content of common
foods and check the nutrition label to choose foods high in calcium when you prepare your families diet. Also
choose foods that are fortified with calcium.

Iron Requirements
Iron is another mineral that is important for your child's growth. Having a diet with foods that are high in iron to
meet daily requirements is necessary for the development of strong muscles and production of blood.

School aged children require about 10 to 12 mg of iron each day.

ADOLESCENTS:

INTRODUCTION:
Your child's nutrition is important to her overall health. Proper nutrition can also prevent many medical problems,
including becoming overweight, developing weak bones, and developing diabetes. It will also ensure that your child
physically grows to her full potential.

The best nutrition advise to keep your adolescent healthy includes encouraging her to:
 Eat a variety of foods

 Balance the food you eat with physical activity

 Choose a diet with plenty of grain products, vegetables and fruits

 Choose a diet low in fat, saturated fat, and cholesterol

 Choose a diet moderate in sugars and salt

 Choose a diet that provides enough calcium and iron to meet their growing body's
requirements.

You can also help promote good nutrition by setting a good example. Healthy eating
habits and regular exercise should be a regular part of your family's life. It is much
easier if everyone in the house follows these guidelines, than if your child has to do it alone. You should also buy
low-calorie and lowfat meals, snacks and desserts, low fat or skim milk and diet drinks. Avoid buying high calorie
desserts or snacks, such as snack chips, regular soft drinks or regular ice cream.

Fats, Oils and Sweets

No more than 30% of your diet should come from fats. For a 2200 calorie diet, that would equal 73g of fat each day
and for a 2800 calorie diet, 93g of fat each day. The type of fat that you eat is also important. Saturated fats in foods
such as meats, dairy products, coconut, palm and palm kernal oil, raise cholesterol more than unsaturated fats,
which are found in olive, peanut, and canola oils, or polyunsaturated fats in safflower, sunflower, corn, soybean and
cottonseed oils. Limit saturated fats to no more than 10% of daily calories.

Sugars supply a large amount of calories, with little nutritional value. They include white sugar, brown sugar, corn
syrup, honey and molasses and foods like candy, soft drinks, jams, and jellies.

Selection tips:
 use lean meats and skim or low fat dairy products

 use unsaturated vegetable oils and margarines that list a liquid vegetable oil as the first ingredient on the label

 read the nutrition label on foods to check for the amount and type of fat it includes

 limit foods that contain a large amount of saturated fats

 limit foods high in sugar and avoid adding extra sugar to your foods

Milk, Yogurt and Cheese

Dairy products provide protein, vitamins and minerals and are an excellent source of calcium. Your adolescent
should have 2 to 3 servings of milk, yogurt and cheese each day.

Selection tips:
 Choose skim milk and nonfat yogurt

 Avoid high fat cheese and ice cream

Meat, Poultry, Fish, Dry Beans, Eggs and Nuts

Foods in this group provide protein, and vitamins and minerals, including B vitamins, iron and zinc. You should
have 2 to 3 servings of foods from this group each day, including the equivalent of 5 to 7 ounces of lean meat.

Selection tips:
 A serving from this food group can include 2-3 ounces of lean meat, poultry or fish, which may be an average
hamburger or medium chicken breast half.

 Choices with the least fat include lean meat, poultry without skin, fish, and dry beans and peas.
 Prepare meats in low fat ways, by trimming away fat, and broiling, roasting, or boiling rather than frying.

Remember that nuts and seed are high in fat, and egg yolks are high in cholesterol, so you should eat them in
moderation.

Vegetables
Vegetables supply you with vitamins, including vitamin A and C, and folate, minerals, such as iron and magnesium,
and fiber. Plus they are low in fat. You should have 2 to 4 servings of vegetables each day.

Selection tips:
 You should eat a variety of vegetables to provide you with all of the different
nutrients that they supply, including dark green leafy vegetables, deep yellow
vegetables, starchy vegetables (potatoes, corn peas), legumes (navy, pinto and
kidney beans), and other vegetables (lettuce, tomatoes, onions, green beans).

Do not add a lot of fat to the vegetables you eat, by avoiding added toppings, such as
butter, mayonnaise, and salad dressings.

Fruits
Fruits and 100% fruit juices provide Vitamin A and C and potassium. They are also low in fat and sodium.

Selection tips:

 Eat fresh fruits and 100 % fruit juices and avoid canned fruit in heavy syrups and sweetened fruit juices.

 Eat whole fruits.

 Eat citrus fruits, melons, and berries, which are high in Vitamin C.

Bread, Cereal, Rice and Pasta

Foods from this group provide complex carbohydrates (starches) and provide vitamins, minerals, and fiber. You
need at least 6 to 11 servings of foods from this food group each day.

Selection tips:
 Choose whole grain breads and cereals for added fiber.

 Choose foods that are low in fat and sugars.

 Avoid adding calories and fat to foods in this group by not adding spreads or toppings high in fat.

Calcium Requirements
Calcium is a mineral that is mostly present in your child's bones. Having a diet with foods that are high in calcium
to meet daily requirements is necessary for the development of strong bones. It is also an important way to prevent
the development of osteoporosis in adults.
Adolescents require about 1200 to 1500 mg of calcium each day.

Iron Requirements
Iron is another mineral that is important for your child's growth. Having a diet with foods that are high in iron to
meet daily requirements is necessary for the development of strong muscles and production of blood.

Adolescents require about 12 (males) to 15 (females) mg of iron each day.

Tips to develop healthy food habits in your children Diet:

 Provide your child with regular five meals a day.

 Do not feed a child forcibly as this makes the child obstinate.

 Add color to their food by introducing raw fruits and vegetables.

 Discourage the between meals nibbling habits. Allow the child to have more outdoor
games, to increase one’s appetite.
NUTRITIONAL DEFICIENCY IN CHILDREN
Nutritional deficiencies occur when a person's nutrient intake consistently falls below
the recommended requirement. If children are fussy eaters, then add vitamin
supplements to their diet. Ensure that they are fulfilling complete nutritional requirement
of their body either through real food sources or supplements. Inadequate diet and
certain medical conditions can deprive children’s body of certain vitamins that lead to
vitamin deficiency in children.

NUTRITIONAL DEFICIENCY IN INFANTS:

Infancy is a time of tremendous growth that can be best met through breastfeeding. If this is not possible,
commercial, iron-fortified infant formulas will provide adequate nutrition. Semi-solid foods are added to prepare
the infant for more mature chewing and feeding. Throughout the first year it is important for parents to learn to
recognize and accept an infant's cues regarding their feelings of hunger and fullness. Responsiveness to an infant's
appetite will prevent overfeeding. Observing an infant's readiness to chew, and providing appropriate foods, will
help them develop self-feeding skills and independent eating.

Unabsorbed carbohydrate is in these juices. Unabsorbed carbohydrate is fermented in the lower intestine causing
diarrhea, abdominal pain, or bloating. These symptoms are commonly reported in infants and toddlers who drink
excessive amounts of juice. For this and other reasons, infants up to 6 months of age should not be offered fruit
juice; infants over 6 months should be offered no more than 4 to 6 ounces daily of pasteurized, 100 percent juice
from a cup. Fermentable carbohydrates also contribute to the development of tooth decay.

In developing countries, infants who are deprived of adequate types and amounts of food for long periods of time
may develop kwashiorkor, resulting principally from a protein deficiency; marasmus, resulting from a deficiency of
kilocalories; or marasmus-kwashiorkor, resulting from a deficiency of kilocalories and protein. In the United States,
very few infants suffer from true protein deficiency and cases of kwashiorkor are rare.

A specific wasting away disease caused by protein deficiency in third world countries that lack adequate food
supplies is called kwashiorkor. It is a word which describes the condition of an infant who has to be weaned away
after a year to make room for the next baby. The weaning food, which is mainly sugar and water or a starchy gruel
lacks protein or has a poor quality of protein. The weaning diet for these young children leads to other nutrient
deficiency diseases as well. Symptoms of kwashiorkor are apathy, muscular wasting, and edema. Both the hair and
the skin lose their pigmentation. The skin becomes scaly and there is diarrhea and anemia, and permanent blindness
can result from this condition. Marasmus is another condition of a wasting away of the body tissues from the lack of
calories as well as protein in the diet. In marasmus the child is fretful rather than apathetic and is skinny rather than
swollen with edema. Aside from contrasting symptoms between the two diseases, there may be converging
symptoms which would be described as marasmic kwashiorkor.

There is a wide variation of deficiencies between energy and protein deficient diseases as in the cases described by
marasmus and kwashiorkor. The term protein-energy malnutrition (PEM) is used to describe those differences.
PEM is the result of poverty as well inadequate information on diet. In some countries there is the mis-taken belief
that the child should not be given high protein food, which is served to the father, while the child drinks the fluid
the meat was cooked in.

In cases of severe PEM it is necessary to hospitalize the child and to administer antibiotics to prevent infections
which accompany the condition. Diets rich in protein should be continued after hospitalization, using skimmed milk
powder for an energy basis. Legumes (beans) and fish meal are also good sources for protein. Social and political
problems have to be managed to allow relief workers to help and to provide an ongoing source of food preparations
that can be consumed for adequate nourishment by those in need.

Vitamin Deficiency:
Vitamin D Deficiency
An infant not receiving sufficient vitamin D through supplementation, diet, or sun exposure can develop a
deficiency. Vitamin D deficiency leads to inadequate intestinal absorption of calcium and phosphorus resulting in
improper bone formation and tooth mineralization. Rickets is a disease that can result from vitamin D deficiency
and is characterized by swollen joints, poor growth, and bowing of the legs or knocked knees. Rickets was common
in the early 1900s; in recent years it was thought that rickets had all but been eliminated. However, a significant
number of cases were reported in the 1990s, most often among African-American infants.
These infants were breastfed, did not receive supplemental vitamin D, and had limited
exposure to sunlight. This recent resurgence of rickets as well as concerns regarding early
sun exposure resulted in the recent recommendations on supplemental vitamin D.
Vitamin A Deficiency:
Vitamin A deficiency is a major nutritional problem in developing countries. This
deficiency can result from insufficient vitamin A intake, infection, or malnutrition and can
lead to damage of varying severity to the eyes, poor growth, loss of appetite, increased
susceptibility to infections, and skin changes.

Vitamin C Deficiency
Vitamin C deficiency can eventually lead to scurvy, a serious disease with the following symptoms in infants: poor
bone growth, bleeding, and anemia. Since breast milk and infant formula are both good sources of vitamin C,
infantile scurvy is rarely seen. It should be kept in mind that cow’s milk, evaporated milk, and goat’s milk contain
very little vitamin C.

Vitamin B12 Deficiency, Breastfed Infants, and Vegetarian Diets

Vitamin B12 status at birth is strongly associated with the mothers’ vitamin B12 status and the number of previous
pregnancies. After birth, the exclusively breastfed infant’s vitamin B12 intake depends on the mother’s intake and
stores. Concentrations of vitamin B12 in breast milk are adequate as long as the maternal diet is adequate.
However, infants of breastfeeding mothers who follow strict vegetarian (vegan) diets or eat very few dairy products,
meat, or eggs are at risk for developing vitamin B12 deficiency. In these infants, vitamin B12 status may be
abnormal by 4 to 6 months of age. Signs of vitamin B12 deficiency in infancy include failure to thrive, movement
disorders, delayed development, and megaloblastic anemia. The Institute of Medicine’s Food and Nutrition Board
recommends that infants of vegan mothers be supplemented from birth with vitamin B12 at the AI for age (0–6
months, 0.4 μg/day; 7–12 months, 0.5 μg/ day). Vitamin B12 is also a concern for an infant on a strict vegetarian or
vegan diet and supplementation is indicated. Advice caregivers of infants on a strict vegetarian or vegan diet to
consult their health care provider regarding B12 supplementation.

Thiamin Deficiency
Thiamin deficiency can occur in breastfed infants of thiamin-deficient mothers.

Riboflavin Deficiency Associated With Macrobiotic Diets

Riboflavin deficiency has not been reported among infants in the United States, although breastfed infants whose
mothers are on a macrobiotic diet that excludes dairy products, red meat, and poultry may be at risk. Riboflavin
deficiency can lead to growth inhibition; deficiency symptoms include skin changes and dermatitis, anemia, and
lesions in the mouth.

Mineral deficiency
Calcium Deficiency and Vegetarian Diets
Infants on certain strict vegetarian diets may be at risk for developing a calcium deficiency. Uses of soy-based
infant formulas, which are fortified with calcium, are recommended for infants whose caregivers place them on a
vegan diet, low in breast milk. Soy-based beverages (sometimes called soy drink or soy milk), available in most
retail food stores, typically do not provide sufficient calcium for infants and thus are not recommended for infants.

Calcium Deficiency and Lead Poisoning

Calcium deficiency is related to increased blood lead levels and perhaps increased vulnerability to the adverse
effects of lead in the body. Infants at risk for lead poisoning should receive the recommended amount of breast milk
or infant formula to provide adequate dietary calcium.

Iron Deficiency
The WIC Program screens for iron deficiency (deficiency in iron stores) using hematological tests, such as the
hemoglobin and hematocrit tests. Hemoglobin is the iron-containing, oxygen carrying protein in the blood.
Hematocrit refers to the packed cell volume (volume of red blood cells and other particulate elements in the blood),
that is, the percentage the red cell volume is of a total unit volume of blood.

The symptoms of iron deficiency include anemia, malabsorption of food, irritability, anorexia, pallor, and lethargy.
Studies have also shown that iron deficiency in infants and older children may be associated with irreversible
behavioral abnormalities and abnormal functioning of the brain. Elevated blood lead levels have been associated
with iron deficiency; however, the relationship is unclear.
Current recommendations from the CDC are for infants at high risk for iron-deficiency
anemia to be screened between 9 and 12 months of age regardless of blood lead levels. If
an infant has a low hematocrit or hemoglobin level based on blood testing, it is
appropriate to assess the infant’s diet and refer him or her to a health care provider for
further assessment and treatment.

Excessive Fluoride
Fluoride supplementation should not be given to infants who are consuming an adequate amount of fluoride from
either naturally occurring or community-supplemented water supplies. Some infants and children may be drinking
water that contains naturally occurring fluoride that exceeds the recommended levels for optimal dental health. To
determine whether drinking water may contain excessive levels of fluoride, testing should be done as mentioned
above. If a fluoride supplement is prescribed, it is important for the caregiver to give only the amount prescribed.

These concerns are important because fluoride (from natural sources or supplements), when consumed in excess
over time, may cause staining or “mottling” of the teeth, termed dental fluorosis. Fluorosis affects approximately 22
percent of children, almost all to a mild to moderate degree. An alternative water source is recommended when the
home water supply contains 2.0 ppm or more of fluoride. The unintentional ingestion of toothpaste can cause an
increase in daily fluoride intake. For this reason, it is not recommended that fluoridated toothpaste be used until
after 2 years of age.

Excessive Water in the Diet and Water Intoxication

Water intoxication can occur in either breastfed or formula-fed infants who are fed excessive amounts of water.
This condition can develop in infants who consume infant formula over-diluted with water, those who are force-fed
water, or those who are fed bottled water in place of breast milk or infant formula. This condition, while
preventable, can be life-threatening to an infant. Symptoms of the condition include irritability, sleepiness,
hypothermia, edema, and seizures. Also, infants fed excessive water will not receive adequate kilocalories to meet
their needs for growth and development
Dehydration
Since dehydration (excessive loss of water from the body) can lead to death in infants, caregivers need to be aware
of the signs of dehydration, which include the following:
A reduced amount of urine, which is also dark yellow in color;
Dry membranes in the mouth;
No tears when crying;
Sunken eyes; and
Restlessness, irritability, or lethargy

Refer the infant to a health care provider for immediate medical attention if the caregiver notes that the infant has
any symptoms of dehydration.

NUTRITIONAL DEFICIENCY IN TODDLERS AND PRESCHOOLER:

As young children develop their likes and dislikes and learn to feed themselves, parents need to allow them to
become more independent. As a result of these changes, potential concerns arise. Common feeding problems among
preschoolers and toddlers are: obesity, nursing bottle mouth syndrome, food jags, and iron-deficiency anemia.

According to the national Pediatric Nutrition Surveillance System, 10.2 percent of children in the United States
under the age of five were overweight in 1998. These rates have been increasing steadily since the 1960s.
Prevention education is the key to lowering the incidence of obesity in children. Success has been shown in
programs that include family involvement, nutritional information and modification, activity planning, and behavior
therapy.
Most often seen in children under age three, nursing bottle mouth syndrome (or baby bottle tooth decay) results
from extended bottle feeding. It occurs when a child is routinely given a bottle with sweetened beverages (such as
milk or juice) at bedtime. As the child sleeps, the liquid pools around the teeth. The result is severe caries on the
incisors and cheek surfaces of molars. Parents should avoid giving a bottle at bedtime and begin serving beverages
in a cup as early as possible.

Most children undergo a normal part of development know as a food jag. Food jags occur when children either
refuse to eat a previously accepted food, or when they insist on eating one particular food all the time. A food jag is
generally a case of a child testing his or her independence. Although annoying for most parents, food jags are rarely
a reason for concern. The best strategy is to continue offering a variety of foods every day, while keeping the
favorite food available. Most children will eventually return to a normal eating pattern.
Letting a food jag take its course is the best plan of action; force will accomplish little.

NUTRITIONAL DEFICIENCY IN SCHOOL GOING CHILDREN AND

ADOLSCENTS:
Children between 10–19 years of age face serious nutritional deficiencies worldwide,
according to the World Health Organization. About 1,200 million or 19 percent of
adolescents suffer from poor nutrition that hurts their development and growth.

To a variety of health problems, the most prevalent of which are anemia, beriberi, osteoporosis, pellagra, and rickets.
Anemia occurs when the body does not have enough red blood cells to transport oxygen from the lungs to the
body's cells. The most common symptom of anemia is a constant feeling of fatigue. Making sure that one's diet
contains the proper amounts of iron, folate, and vitamin B 12 can prevent anemia.

Prolonged thiamine deficiency can result in one of the more serious nutritional deficiencies, beriberi. Thiamine
plays a major role in nerve processes, and a prolonged deficiency can result in nerve damage as well as heart and
other muscle damage. Beriberi can be prevented by eating a diet containing foods rich in thiamine, such as meats,
legumes, and whole-wheat breads.

Osteoporosis is an asymptomatic condition in which the loss of minerals can cause the body's bones to become
porous and fragile. Making sure that one's diet contains the recommended amount of calcium and vitamin D can
reduce the risk of developing osteoporosis.

The niacin-deficiency disease, pellagra, can produce symptoms such as dermatitis, dementia, diarrhea, and even
death. Pellagra can be prevented through eating almost any protein-rich foods.

Rickets, or defective bone growth, is the result of an excessive vitamin D deficiency. It has been virtually wiped out
in the United States due to the vitamin D fortification of milk.

Deficiency of Vitamin A can lead to night blindness and dry eye. It also hampers proper functioning of the immune
system, resulting in high mortality rate. Suffering from Vitamin deficiency, children show signs of tiredness, hair
loss, weakened muscle, joint pain, swelling, fatigue, weight loss and memory loss.

Vitamin B deficiency can greatly influence the nervous system, affecting the nerve transmission and functions of
the brain. Children with this deficiency are at a greater risk of heart diseases. Deficiency of Vitamin B12 results in
stress, frustrations, depression and loss of memory.

There are children who are greatly affected by the symptoms of scurvy. This is because of the deficiency of Vitamin
C in their body. They most common symptoms include inflammation and bleeding of gums. Deficiency can also
lead to joint pains, dry skin and damaged hair.

Children with deficiency of Vitamin D are more prone to growth retardation and skeletal deformities. It disturbs the
process of calcium absorption in the body and eventually leads to rickets.

Deficiency of Vitamin E and K is not so common because they are synthesized by the body. Only if a child has
problem in absorbing the dietary fats, he tends to show the symptoms of Vitamin D deficiency. While, deficiency of
Vitamin K occurs when there is excessive bleeding of wounds.

CONCLUSION:
To ensure good nutrition in your child and that they grow up healthy, they will need to eat a large variety of foods.
The amount of foods that they eat is much less important. Remember that your child's appetite may decrease and
become pickier over the next few years as his growth rate slows. As long as they are gaining weight and have a
normal activity level, then you have little to worry about. You can still offer them a variety of foods, but can
decrease the serving sizes if they don't eat a lot.
The best way to prevent feeding problems is to teach your child to feed himself as early as possible, provide them
with healthy choices and allow experimentation. Mealtimes should be enjoyable and pleasant and not a source of
struggle. Common mistakes are allowing your child to drink too much milk or juice so that they aren't hungry for
solids, forcing your child to eat when they aren't hungry, or forcing them to eat foods that they don't want. Also,
avoid giving large amounts of sweet desserts, soft drinks, fruit-flavored drinks, sugarcoated cereals, chips or candy,
as they have little nutritional value.
Child may now start to refuse to eat some foods, become a very picky eater or even go on
binges where they will only want to eat a certain food. An important way that children learn
to be independent is through establishing independence about feeding. Even though your
child may not be eating as well rounded a diet as you would like, as long as your child is
growing normally and has a normal energy level, there is probably little to worry about.
Remember that this is a period in his development where he is not growing very fast and doesn't need a lot of
calories. Also, most children do not eat a balanced diet each and every day, but over the course of a week or so their
diet will usually be well balanced. You can consider giving your child a daily vitamin if you think he is not eating
well, although he probably doesn't need it.

While you should provide three well-balanced meals each day, it is important to keep in mind that most children
will only eat one or two full meals each day. If you child has had a good breakfast and lunch, then it is okay that he
doesn't want to eat much at dinner. Although your child will probably be hesitant to try new foods, you should still
offer small amounts of them once or twice a week (one tablespoon of green beans, for example). Most children will
try a new food after being offered it 10-15 times.

Other ways to prevent feeding problems are to not use food as a bribe or reward for desired behaviors, avoid
punishing your child for not eating well, limit mealtime conversation to positive and pleasant topics, avoid
discussing or commenting on your child's poor eating habits while at the table, limit eating and drinking to the table
or high chair, and limit snacks to two nutritious snacks each day. You should also not prepare more than one meal
for your child. If he doesn't want to eat what was prepared for the rest of the family, then he should not be forced to,
but you should also not give him something else to eat. He will not starve after missing a single meal, and providing
alternatives to the prepared meal will just cause more problems later.
 Growth monitoring:
 Growth monitoring is an important strategy to monitor the nutrition in India.
 Regular monthly recording weight of children and plotting it on the growth chart it which enables us to see the
changes in the weight and giving advice to mother about the growth of child is called GROWTH
MONITORING.
 Growth Monitoring should be stared,
 Right from the birth of the child Right child
 Children of zero to three Yrs. Age (Monthly)
 Children of three to six Yrs. Age (Monthly)
 Children at risk of Malnutrition Children Malnutrition
 Children who have not gained the weight for three months weight months
 In India 20% of children are considered as properly nourished and rest as suffering from various grades of
malnutrition only 10% of severely malnourished and need medical attention.
 It is necessary that from first day child is adequately nourished that is there is normal birth weight, and weight
gain continuous as per establish norm.
 Any deviation must be identified promptly and thereby preventing depute of extreme grades of mal nutrition.
Growth monitoring based on weight records can be easily achieve this aim.

 Oral Rehydration:
 Oral rehydration prevents dehydration which is immediate cause of death in diarrheal diseases.
 About 60-70% diarrheal death are due to dehydration. Simple measures using all available resources adopted
even in the poorest of homes can be useful in preventing a lot mortality and morbidity.
 Water, salt and sugar or traditional fluids like rice water and butter milk are useful in ORT.
 All diarrhoeas are not infective but complications can develop if neglected or with too obsessive a treatment
with a series of drugs.
 Which are rarely required. It is essential to keep in mind that ORT is not the only treatment of diarrhoea. It only
buys time till it is able to seek medical care.
 Breast feeding:
 Breast feeding still continuous to be the major type of infant feeding. A decline in breast feeding has been noted
in urban areas mainly among working women.
 3 important categories in preventing decline
 Community awareness
 Health personal
 Doctors.

 Female Literacy:
 Female literacy is powerful keystone for success of the MCH and RCH activities.
 Women in Kerala have set a good example in this.
 Birth control and lowering of IMR, which are the target set for A.D 2000,have already been achieved by them 5
years ago.
 Educated women are able to understand the importance of nutrition, Family welfare services and other health
needs.
 Food and family welfare have been given prime importance for over 3 decades without the expected impact in
country because of illiteracy and lack of understanding of the masses.
 Primary health care not only restricted to the administration of health close co ordination and an effective
network need to be established, with different sectors and agencies and supportive activities planned. They are,
 Community participation and involvement.
 Development of referral support.
 Health manpower development.
 Medical and health services research.
 Development of appropriate technologies.
 Inter and Intra sectoral co-ordination.

 Immunization
 Vaccination is an effective means of prevention and contributes to reducing childhood mortality, particularly
infant mortality rate due to vaccine preventable disease most of the vaccines are the discoveries of country.
 Effective immunization consists of.....
 Administration of vaccine.
 Development of individual immunity target.
 Reduction in incidence of disease.
 Control or eradication of disease.

 The Effective immunization Programme was launched globally in 1974.( that was expanded now it is converted
in national immunisation programme) The vaccine preventable disease take a heavy toll of infants . Live 5
million children die each year and equal number are permanently handicapped due to this disease . e.g.
Immunization.

 Salient Objectives are:

 Creating community awareness by spreading information about these disease and respective vaccines.
 Increasing the production of the production of the vaccine.
 Total coverage of children and pregnant women.
 Training personal for implementation.
 Monitoring.
 Research.

 Child welfare:
 Child welfare encompasses caring and attending to the physical, emotional and social need of the children
through comprehensive child welfare services. They are broadly two types:
 Service catering to the basic needs. The children where family and community participate.
 Services to cater to the needs of physically, mentally or socially handicapped children.
 Some programme runs by government e.g, ICDS, mid day meal programme, MCH, RCH Services.

 Prevention of accidents in children

 Accident are common in children .Accidents are generally related to growth and development of the children.
 In urban areas of developing countries, due to overcrowding one room used for many purpose such as cooking,
sleeping, playing etc.
 The kind of surrounding can causes accidents in children parents and care taken may not be aware of
development of child. This lack of knowledge and ignorance add to the predisposing factors where children are
exposed to the accident prone circumstances:
 Common Accidents in Dfferent Age Group:

1. Infancy
 Falls
 Foreign Body
 Burns
 Aspiration Syndrome
 Drowning
 Suffocation by the pillow.

2. Toddler and preschool

 Falls
 Cut / injury
 Burns
 Suffocation
 Ingestion of foreign body
 Drowning
 Vehicle Accidents.

3. School Age
 Falls
 Injury from the spot
 Vehicle accidents.

 Preventive Measures:
 Provide safe Environment to the child.
 Never try to remove foreign body yourself.
 Knowledge about developmental changes which leads to various types of accidents.
 Think about potential danger of accidents at every situation.
 Make parents and community aware about accidental injuries and their relation to growth and development.

 Prevention of Poisoning:
 Poisoning is a common condition due to ingestion of injuries or toxic substances.
 It is a common in toddler and preschool.
 It is an accidents due to lack of supervision and carelessness in living poisonous material with in child’s reach.
 Some of the substances such as insecticide, paint solvent, cosmetic, detergents, kerosene, nail polish, phenyl,
turpentine keep this away from child’s reach.

 Preventive measures:
 Teach parents proper storage of kerosene, turpentine, polishing agents, insecticides, cleansing agents etc. These
substances keep away from child’s reach.
 Always put proper label to the container.
 Poisonous substances should not be kept in container used for food because the child may mistakenly ingest it.
 Emphasize the need for medical advice when poisoning is suspected.

e
References:-
BOOKS
1.K.PARK. “park’s textbook of PREVENTIVE AND SOCIAL MEDICINE’’ 25th edition,m/s Banarasidas
Bhanot publications,page no.572,609
2.Dorothy R.M. “TEXT BOOK OF PEDIATRIC” 6th edition, W.B. Sounder’s
company,Philaldelphia,P.P.30-35.

3.O.P.Ghai“ESSENCIAL PEADIATRICS”4thedition ,Interprint,New Delhi 1996 ,P.P 429-

432.
4.Parul Dutta “PEADIATRIC NURSING” 1st edition , jaypee Brothers,New Delhi,2008,P.P
22-25.
5.Suraj Gupte “THE SHORT TEXT BOOK OF PEDIATRIC’ 8th edition, jaypee Brothers
Medical Publisher, Banglor,1998 P.P-60-62.
6.Whaley and Wong’s “NURSING CARE OF INFANT AND CHILDREN” Sixth
edition , C.V.Mosby Company, London, 1999, P.P-9-15.

JOURNAL
Hurtun caspares s.“Preventive Peadiatrics”,Nashville tannessee ,ANNA corecurriculum,july 1937,American
nursing association,P.P-778-782.

ONLINE REFERANCE:-
1. www.google/preventivepeadiatric.com
2. www.pubmed/preventive paediatrics.com.
3. www.gooble/conceptsofpreventivepeadiatric.com.