Transcript Folie 1

Nutritional requirements for small
Children
Matthias Brandis
Prof. of Paediatrics
Former Chairman of Paediatrics
Senator of the National Academy of Science
Department of Paediatrics and Adolescent Medicine
University Hospital
Freiburg, Germany
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Nutritional requirements
in infants and small children
• The averagre need for any child in the
world is known since 150 years and can
be expressed as
– Energy intake per day
– Divided in
• Protein
• Crabohydrates
• Fat
– Micronutrients like Ca, Fe, Znc, Vit D
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Consequences of longstanding
malnourishment
• Children suffering from chronic
malnourishment tend to adapt to the
reduced amount of food
• The consequences are lethargy, motoric
inactivity, diminshed muscular strength
• Retarded psychomotor development
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Health consequences of nutrition in
early childhood
long time, secondary sequelae
• Metabolic program
• Metabolic diseases like Obesity,
hypertension and cardiovascular diseases
are correlated to birth weight, growth and
feeding patterns
• Fat content should not exceed 25% of
energy intake
• Protein should not exceed 15%
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Health consequences of nutritioan
in early childhood
• Breastfeeding of 4-6 month exclusively leads to
ideal serum lipid profile, reduced incidence of
atopic dermatitis
• Neuro-cognitive development is correlated to
long chain polyunsaturated fatty acids content of
the diet
• Meat intake has proven to be beneficial to
psychomotoric development. In Ghana only 6%
of the children have regularly meat as part of
their diet
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Nutrition and health development in women
and children
What are the questions?
• Are the basic nutritional needs guaranteed
for pregnant mothers?
• Are the Basic principles of feeding an infant
and small child adequately known?
• Are the parents educated enough to
understand the real necessities?
• What are the reasonable measures to be
taken routinely and in emergency situations
• Emergencies are e.g. wars and droughts
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Nutritional needs for infants and children
Age
Kcal/
Kg /d
Protein
g/kg
Fe
Mg/d
J
ug/d
0-4 m
91
1,5-2,7
0,5
40
4-12m
90/
1,1-1,3
8.
80
4-7 y
82
1,0
8
100
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Breastfeeding
as basic nutrition in infants
adequate propagation
• Advantages
– Sterility
– Adequate ratio between protein, carbohydraes and fat
– Feeding by demand
– Continuation of breast milk to toddlers diet up to 30%
guarantees adequate supplement of fat and Vitamin A
– Breast feeding might contribute to birth control
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Nutritional mix
according to regional ressources
• Agricultural local products
– E.g. Maize, Millet, Sorghum, Cassava
– Nuts,peanuts, beans, Yam et al.
• Animal products
– Meat
– Milk
• F100: Substitute for micronutrients, where
necessary
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Consequences
• The first goal is:
– Feed the mother adequately
– Teach the mother by simple information about
her own demands during pregnancy and while
breastfeeding
– Teach the parents about the local availibility of
agricultural and animal products as well as
micronutrients
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Preharvest
Controlled study in school children in Benin, 2002(Mitchipkeet al. Public Health Nutr. 2009, 12, 414 )
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Postharvest
Controlled study in school children in Benin, 2002(Mitchipk et al. Public Health Nutr. 2009, 12, 414 )
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Controlled study in school children in Benin, 2002(Mitchipke et al. Public Health Nutr. 2009, 12,
414 )
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Controlled study in school children in Benin, 2002(Mitchipke et al. Public Health Nutr. 2009, 12, 414 )
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Controlled study in school children in Benin, 2002(Mitchipke t al. Public Health Nutr. 2009, 12, 414 )
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The Importance of Micronutrients
• Micronutrients are
– Iron
– Calcium
– Zinc
– Vitamins
• Any local traditional diet may be deficient
in micronutrients which lead to anemia and
rickets, which are frequent diseases in
central Africa
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Micronutrient deficiency
• Iron deficiency:
– Leads to anemia , retarded pschomotor development
and stunting
• Calcium and Vit D deficiency:
– leads to the world wide persisting prevalence of
rickets, with growth stunting
• Iodine deficiency:
– Leads to neuro- intellectual retardation
• Zinc deficiency
– Leads to stunting, diarreha, skin disease:
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Zotor,FB and Amuna,P, Proc.Nutr.Soc.,2008. 67, 98
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Zotor,FB and Amuna,P, Proc.Nutr.Soc.,2008. 67, 98
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Hypernatremia
• Hypernatremia: Na > 150 mEq/L (Serumosmolality increase by 20 mosmol/L)
– causes:
• Water loss > than salt
• Salt ingestion(very rare)
• Rehydratation slowly: Lowering of the
elevated osmolality not faster than 5
mosmol/L in 6-12 hours
• Restitution can last up to 48 hours!
• Salt ingestion has to be treated by
Finberg et al.1979
emergency PD
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Fluidexchange in an 7kg infant per day= 50 % of ECV
700 ml
Intake
1400 ml ECV
700 ml
Excretion
Fluidexchange in adult(70 kg)= 14 % of ECV
2000 ml intake
14000 ml ECV
2000 ml excretion
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• Calculation of salt and water needs for a child of
10 kg BW
– 100ml / kg BW= 1000ml
– 2 mEq/ kg Na = 20 mEq
• All commercial infusion solutions have a 2 to 3
times higher sodium concentration
• Calory intake: e.g. 50 -70 Kcal/KG
– Glucose- containing solutions have 200
Kcal/L, that is 20 Kcal/KG
– During parenteral fluid therapy for several
days additional calory intake might be
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necessary, e.g. 2o% Glucose, Amino Acids, Fat
Oral Rehydration
• Oral Salt solutions
– Na-content 60-90 mmol/L
– Glucose content 5 g%
– Tube feeding
– Up to 100 ml/kg/ day in small fractions or
continuous infusions
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Salt and Water regulation
Summary
• In General it is practical experience to start to
treat a child in an emergency situation with clear
indications of a volume deficit with the following
regime:
– 20ml /kg BW in 1 hour Isotonic solution, if not plasma
or blood substution is needed.
– In this 1 hour all necessary calculations and lab
results can be achieved and the next steps can be
taken under the safe knowledge of the diagnosis
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Conclusions
• There is an overwhelming global evidence
about the nutritional needs and demands
in pregnant and lactating women as well
as in infants and toddlers
• A high percentage up to 50% of children
are malnourished and may suffer from
stunting, anemia, rickets and retarded
neuro-intellectual development
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Conclusions
• After decades of concern by local
governments and international
organisations the situation is as prevalent
as ever or even worse.
• Severe droughts, ongoing wars with
millions of children living in refugee camps
have worsened the situation particularly
for children and are not adequately
compensated.
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Conclusions
• Which steps can be successfull and are
mandatory:
–1 Teaching the families about
the basic principles of diets
– 2 Rely on the local accessablilty of the agricultural
products
– 3 Define the potential needs for supplementation of
micronutrients(F100)
– Emergency situationas have to be undertaken in
sitiations of humanitarian need, but should always
lead to early reinstitution of the local food culture.
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Conclusions
• Education of children and
parents seems after so many
years of support programs the
prominent task for any
government, to guarantee a better
future for the society
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• Thank You for Listening
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