Transcript nutriţia copilului şi adolescentului

CHILD AND ADOLESCENT
NUTRITION
CHILD AND ADOLESCENT NUTRITION
Definition:
Nutrition = modifications of food`s components in the
body to maintain life.
The processes of growth, maintenance of organs and
systems are due to dietary nutrients, plastics, energy and
biocatalyst.
CHILD AND ADOLESCENT NUTRITION
Nutritional needs:
- quantity (energy, calorific value);
- quality.
Quantitative nutritional needs (energy)
Life processes in the body are made of energy
expenditure.
The main energy sources are carbohydrates and lipids.
Energy needs:
- maintenance needs
- needs for thermoregulation
- physical activity or muscle activity
- needs for growth
ENERGY NEEDS
1. Maintenance needs for basal metabolism = needs and
the needs of operation:
a) basal metabolism (MB) = total body energy
expenditure for breathing, heart contractions, secretions,
etc..
M.B. MB 2 x baby = adult.
M.B. lower in premature and dystrophic.
M.B. increase in feverish.
Maintenance needs
b) Operational needs = needs for food specific dynamic
action (SDA) and losses through excretion.
SDA = calories expended in food digestion and
utilization.
higher energy expenditure after ingestion of protein
and lower fat and carbohydrate intake after small
increase in weight → high protein regimens.
Maintenance needs

similar diets meals → consuming lower calorie when
the number is higher.
Losses increased excretion:
- artificial nutrition (hyperosmolar formulas)
- diarrhea.
ENERGY NEEDS
2. The needs for thermoregulation depends on:
- large body size in relation to weight;
- skin thinness;
- ambient temperature.
3. Physical activity and muscle activity requires energy
to the intensity and duration of effort.
ENERGY NEEDS
4. Growth needs vary with:
- age (the higher the more the child is less)
- child health,
- individual peculiarities.
The caloric needs are covered by the body by burning
food that provides on average:
4 kcal per 1 gram of protein;
4 kcal per 1 gram carbohydrates;
9 kcal per 1 gram fat.
Growth Needs
Child's overall energy ratio diminishes with age:
- in the first trimester of life: 110-120 kcal / kg / day;
- in the second quarter: 100-110 kcal / kg / day;
- third and fourth quarter: 90-100 kcal / kg / day;
- child 1-3 years: 90 kcal / kg / day;
- preschool: 80 kcal / kg / day;
- school: 50-60 kcal / kg / day.
Before puberty, growth is accelerating the need to
increase caloric intake.
Growth Needs
Hiperglucidic scheme and / or infant hiperlipidic
↓
stimulates lipidogenesis
↓
± hyperplasia, hypertrophy of adipose cells
↓
early obesity
Growth Needs
Hypocaloric diets:
→ malnutrition
→ depressants sympathetic nervous system → saving
operating needs and thermogenesis.
Optimal caloric intake:
carbohydrates 45% of total calories,
33-40% lipids,
12-15% protein.
QUALITATIVE NUTRITIONAL NEEDS
Plastic factors: protein and some minerals;
Factors energy: carbohydrates and lipids;
Biocatalyst factors: vitamins, minerals, water.
Protein:
- necessary for growth,
- sole source of nitrogen and indispensable amino
acids.
Carbohydrates:
- elements easily digestible energy,
- necessary for lipid metabolism.
QUALITATIVE NUTRITIONAL NEEDS
Lipids:
- important source of energy in a small footprint
- soluble vitamins and unsaturated fatty acids.
Qualitative nutritional needs of infants:
Breast feeding
Bottle feeding
Protein
2 – 2,5 g/kg/day 3 – 3,5 g/kg/ day
Lipid
4 – 6 g/kg/ day
Carbohydrate
10 – 12 g/kg/day 10 – 12 g/kg/day
4 – 6 g/kg/ day
QUALITATIVE NUTRITIONAL NEEDS
"food balance" = optimal ratio between the principles of
food:
P: L: G = 1:2:4 (newborn and infant).
P: L: G = 1:1,2:3,5 (child 1-3 years).
Proteins
not stored in the body → required daily intak
- protein diet free total → more than 48 hours in infants
and young children
-
factors that alter protein intake:
- adaptability of the body;
- carbohydrate intervention as saving factor protein;
- biological value and protein digestibility (90% for
animal and 50-80% for vegetable).
Proteins
Sources:
meat, cheese, fish, liver, eggs
pasta, vegetables, fruits (smaller amounts)
Essential amino acids (9)
phenylalanine, lysine, leucine, isoleucine, threonine,
tryptophan, methionine, valine, histidine
- body can not synthesize or manufacture them in
sufficient quantity;
- must exist in certain proportions for protein
resynthesis health state.
Proteins

essential amino acid needs in infants = 10 x adult
proper diet → at least 50% of the total protein are
animal
Amino acid semiesential: under certain conditions the
body's ability to synthesize from their precursors.
Proteins
Cystine, taurine (derived from methionine) and tyrosine
(derived from phenylalanine) should be considered
essential amino acids in the neonatal period and low
birth weight baby.
Non-essential amino acids:
alanine, arginine, glutamine, glycine, glutamic acid,
asparagine, aspartic acid, cysteine (cystine), tyrosine,
proline, serine →contribute to meeting the needs of the
body nitrogen
Proteins
In breast fed infants protein requirement is lower
than in the bottle fed (high biological value and
digestibility of human milk proteins rapidly).
For ideal maximum use of the protein → 32-35 kcal
compared to 1 g protein.
Proteins
Plastic roles:
- constitution of cells,
- composition: hormones, enzymes, factors
coagulation
- renewal of cells and tissues,
- physical strength and intellectual
- processes of the body's defenses against infection
and poisoning.
Proteins
Functional Roles:
- circulating bilirubin, metals (Fe, Cu, Zn, Co, I),
metabolites and blood gases;
- fluid exchange between capillaries and cell gap,
device is muscle contraction;
- maintenance of colloid-osmotic pressure of plasma;
- acid-base balance.
Proteins
Excess protein
- exceeds the capacity of the kidney excretory → ↑
glomerular filtration → kidney hypertrophy.
- causes hypertrophy of cell → fat storage → obesity
in adults.
- hyperammonemia → low IQ.
Proteins
Protein deficiency:
- slow growth rate;
- reduction of enzymatic synthesis, hormonal and
humoral immunologic factors;
- clinical: swelling hypoproteinemia and protein
malnutrition (kwashiorkor).
Carbohydrates
- energy substrate for all cells,
- plastic role in human body structure
serve to biosynthesis of:
-glycogen,
-galactocerebrosis brain
-glucoproteins,
-glucolipids,
-amino acids
-fatty acids.
Carbohydrates
Food carbohydrates:
- monosaccharides (glucose, fructose and galactose)
- glucose polymers
- disaccharides (lactose, sucrose and maltose)
- polysaccharides (starch and glycogen).
Carbohydrates
Glucose:
- in fruits, vegetables, honey,
- fetal transplacental transfer of glucose - dependent of
mother glycemia;
- control of glucose homeostasis is fully in 2-5 weeks
after birth, including premature;
- glucose polymers are an adequate source of
carbohydrate for premature infants and infants with
malabsorption, and is easily hydrolyzed in the gut.
Carbohydrates
Fructose:
in fruits, vegetables, honey or derived from hydrolysis
of sucrose.
Galactose:
- derived from hydrolysis of milk lactose,
- favorably influence brain development in newborn
and infant.
Carbohydrates
Lactose:
- quantities in human milk > cow's milk only,
- important role in infant brain development.
Sucrose:
- high power sweetening
- child with customary sweetness,
- promote obesity.
Carbohydrates
Maltose:
- the seeds sprouted grains
- produced by hydrolysis of starch
- slowly hydrolyzed by maltase → 2 glucose molecules
- is well tolerated.
Starch:
- cereals, tubers, roots, bananas,
- its hydrolysis is initiated by salivary and pancreatic
amylase.
Carbohydrates
Glycogen:
- storage form of carbohydrate in the liver and muscle
- starch-like structure
- hydrolyzed by the same enzymes.
Fiber:
- wall polysaccharides in plant
- resist the hydrolytic action of human digestive
enzymes,
- digestibility dependent chemical structure, how to
prepare, while standing in the intestinal flora and colon.
Carbohydrates
The main action of dietary fiber:
- increases fecal volume and accelerates intestinal
transit bowl;
- regulates appetite - effect of satiety;
- amended by binding to intestinal bacterial flora;
- increased excretion of fat, protein and calories in the
stool;
Carbohydrates
The main action of dietary fiber:
- increase the removal of cations by reducing the
absorption of Zn, Fe, Ca, Mg, Na and K;
- binds cholesterol and bile acids in the gut;
- decrease the absorption of carbohydrates through the
formation of gels and modulates tissue sensitivity to
insulin.
Sources of dietary fiber: bran cereals, fruits, vegetables.
Carbohydrates
The quantity and quality of carbohydrate intake
during the first months of life is crucial for life and any
error during the formation of brain cells is irreparable.
Carbohydrates
Carbohydrate needs:
- premature: 6 -8 g / kg / day (first week - transient
lactase deficiency), then 12 g / kg / day;
- new - born IUGR: 18-25 g / kg / day in the neonatal
period to combat hypoglycemia;
- infant and young child: 12 g / kg / day;
- preschool: 10 g / kg / day;
- school: 8 g / kg / day.
Carbohydrates
Deficiency of carbohydrate, in terms of adequate intake
of protein, determined using protein for energy purposes
by their gluconeogenesis and avoid the structural role.
Excess sugar leads to obesity and diabetes mellitus by
insulin depletion.
Excess milk lactose in some formulas produce osmotic
diarrhea.
Excess starch creates imbalance of nutritional factors
with development dystrophy by hypoproteinemia.
Lipids
 energy and nutrients with plastic role (the nervous
system myelination)
dietary fat:
- triglycerides,
- phospholipids
- cholesterol
- metabolic derivatives of fats.
Lipids
Triglycerides (TG)
- most of the food ration;
- have animal origin (milk, butter, egg yolk, meat,
offal) and vegetable (soybean oil, corn, sunflower,
olive);
- TG animal nature prevails in saturated fats such as
vegetable and in the predominant polyunsaturated
fatty acids.
Lipids
Saturated fatty acids: increased plasma cholesterol
levels and promote atherosclerosis.
Unsaturated fatty acids:
- monounsaturated: oleic acid (role in myelination)
- polyunsaturated (omega-6 series - linoleic and
gamma-linoleic acid and omega 3 series - alpha
linolenic acid).
- considered essential,
- structural components of membranes,
- precursors of prostaglandins, leukotryenes and
trombhexanilor → growth and cell function.
Lipids
Important role in:
- diencefalo-pituitary hormones, the serum lipoproteins;
- trophicity of the skin and appendages;
- structural and functional integrity of the arterial wall
and platelets.
Lipids
Linoleic acid:
- olive oil, soy, corn, sunflower, cotton,
- reduce plasma levels of LDL cholesterol.
Linolenic acid:
- fish oil, corn, soybean, sunflower,
- major component of the phospholipids of brain and
retinal cell membranes.
Lipids
Cholesterol:
- component of all cell membranes
- in myelin structure, steroid hormones, vitamin D,
- role in the formation of bile salts.
Food sources: milk, butter, cream cheese, offal, egg
yolk.
Lipids
Fiber increases intestinal elimination of cholesterol
ingested.
Cholesterol food shortage → nerve structures are not
affected (endogenous synthesis).
Fat needs:
- infant: 4-6 g /kg /day;
- child 1-3 years: 4-5 g /kg /day;
- school: 2 g /kg /day.
Lipids
Deficiency of fat:
→ reduce energy intake disrupts the growth process,
decreases absorption of fat soluble vitamins.
Linolenic acid deficiency:
- peripheral neuropathy
- reduction of visual acuity,
- trophic disorders of the skin and hair,
- adesivity platelet growth.
Lipids
Linoleic acid deficiency:
- dermatitis,
- trophic appendages disorders,
- hypertension,
- hyperlipidemia and hypercholesterolemia.
Lipids
Excess fat:
increased intake of calories obesity → often associated
with hypertension.
Establishing a fair ration of fat quantity and quality is
the most effective prevention of adult atherosclerosis.
Water and Mineral Salts Needs
The presence of water:
- most urgent need of body
- greater need as the body is younger:
newborn: 180-200 ml / kg / day
infant: 150ml/kg/day,
child 1-3 years: 100-125ml/kg/day.
Fluid balance = balance between intake and excretion of
fluids.
Water and Mineral Salts Needs
Contribution:
- fluid intake;
- water from food constitution;
- water from combustion.
Losses:
- urine;
- faeces;
- sweating;
- skin perspiration;
- breathing.
Water and Mineral Salts Needs
Distribution of body fluids in newborn and infant:
water = 75% total body weight,
→ 40% of the total water in the extracellular fluid.
Dehydration occurs due to extracellular water.
Water and Mineral Salts Needs
The need for water increases in the following
conditions:
- ambient temperature increase;
- in newborn;
- phototherapy;
- fever;
- diarrhea / vomiting;
- decrease in ambient humidity;
- feeding with formula milk high calories and
hyperosmolar type.
Mineral Salts
Roles:
structure: are used in cell cytoplasm, the skeletal
structure, Hb, endocrine glands etc.
regulator and biocatalysts:
- maintain osmotic pressure,
- maintaining acid-base balance,
- regulating the activity of the nervous system,
myocardium, muscle,
- activation of digestive enzymes .
Mineral Salts
Actions:
synergistic (Ca and P, Cu and Fe) = contribution of an
ion demand increases synergistically of another one;
antagonistic (Na, K, Ca and Mg) = an increased intake
of other ion remove it.
Nutritional sources:
- animal products
- vegetable products
- drinking water.
Mineral Salts
Food intake is necessary for the formation of new
tissues and to cover loss of skin, hair, tears, urine and
faeces.
Body needs are great:
- during periods of accelerated growth,
- during exercise,
- in fever.
Mineral Salts
Sodium
principal cation of extracellular fluid
Roles:
- osmotic pressure regulation,
- maintaining acid-base balance,
- maintain water balance in the body
- neuro-muscular excitability,
- cardiac contraction.
Sources: milk, meat, eggs, vegetables, cooking salt.
Losses: heavy sweating, severe diarrhea
Excess → fluid retention, hypervolemia, hypernatremia
and swelling in young infants.
Mineral Salts
Potassium
cation of the fundamental cell
Roles:
- muscle contraction,
- conduct of neuromuscular impulse
- cardiac rate.
K + Na + Cl contributing to the maintenance:
- acid-base balance,
- osmotic pressure
- fluid balance.
Mineral Salts
Potassium
Sources: milk, meat, fruit (peaches), vegetables
(carrots).
Deficit:
- in acidosis,
- as corticosteroids,
-clinical: nausea, vomiting, bloating, tachycardia,
neuromuscular instability.
Excess:
- in renal failure,
- drug administration,
→ atrium-ventricular block.
Mineral Salts
Chlorine
extracellular anion,
Roles:
- osmotic pressure regulation,
- acid-base balance of extracellular fluid,
- hydrochloric acid in gastric juice structure.
Sources: milk, meat, eggs and cooking salt.
Deficit in:
-vomiting,
-profuse sweating,
-prolonged treatment with ACTH.
→ hypochloraemic alkalosis.
Mineral Salts
Calcium
the main constituent of the skeleton
Roles:
-contractibility and neuromuscular excitability;
-permeability of cell membranes;
-blood clotting;
-activation of enzymes (trypsin, pancreatic lipase).
Maintaining serum calcium: The balance between
skeletal fixation and release are regulated by
parathyroid hormone in the presence of vitamin D and
tireocalcytonin (hypocalcemya hormone).
Mineral Salts
Calcium
Sources: milk and dairy products.
Deficit:
→ tetany,
→ rickets,
→ osteoporosis.
Excess dietary calcium has no effect attributes on body,
homeostasis is well regulated.
Mineral Salts
Iron
In the composition:
-hemoglobin
-myoglobin
-of many enzymes and catalysts.
Fetal iron reserves:
proportional to the duration of pregnancy:
n.b at term → 250 mg (4-6 months are exhausted)
premature n.b → 125 mg (to cover 2-3 months).
Mineral Salts
Iron
Iron needs depend on:
-stocks in the body
-form of contribution (only 5-10% is absorbed from
ingested iron).
Fe rich foods: liver, meat, eggs, fish, cereals, beans,
spinach, tomatoes, fruit.
Mineral Salts
Iron
Recommended dietary intake:
0-6 months → 6 mg / day;
6 months-10 years → 10 mg / day;
adolescents - girls → 12-24 mg / day;
- boys → 9-18 mg / day.
Iron deficiency - etyopathogenic mechanisms:
-martial deficiency intake
-martial deperdition
-martial diversion
Mineral Salts – Iron Deficiency
Low Iron Intake
Low iron reserves at birth:
- prematurity;
- W.b < 3 000g;
- twinning;
- feto-fetal transfusion enzygotic twins;
- feto-maternal transfusion;
- martial deficiency in pregnant women (multiparous);
Mineral Salts – Iron Deficiency
Low Iron Intake
Low iron reserves at birth:
- perinatal loss (placenta previa, placental detachment);
- neonatal hemorrhage (hemolytic disease of the note,
cord bleeding, early ligation of the umbilical cord);
- exanguino-transfusion.
Mineral Salts – Iron Deficiency
Low Iron Intake
Low intake:
- greater weight gain needs → ↑ Fe ↓ dissatisfied
reserves and intake (preterm infants with rapid growth
rate);
- excessive extension of the system lactate (bottlefed
infants cow milk / standard milk powder);
- other food mistakes:
- excess flour
- diversification of food without eggs, meat, vegetables
rich in iron;
Mineral Salts – Iron Deficiency
Low Iron Intake
Low intake:
- rapid growth and teen menstrual losses not covered by
food intake;
- cyanogen congenital heart disease (right-left shunt)
with hypochromic anemia and polycythemia;
- difficulties in food intake (severe encephalopathy).
Mineral Salts – Iron Deficiency
Low Iron Intake
Intestinal malabsorption of iron:
-chronic digestive disorders
-malabsorption syndromes
-prolonged diarrhea
-celiakie
-mucoviscidosis
-gastric resection.
Mineral Salts – Iron Deficiency
Iron Losses
- repeated small hemorrhages (small and repeated
melena, recurrent nosebleeds, frequent harvesting of
blood from small infants);
- gastrointestinal bleeding (cow's milk protein allergy,
parasitic infestations, digestive abnormalities).
Other causes: bleeding after surgery or trauma, renal
(hematuria, hemoglobynuria).
Mineral Salts – Iron Deficiency
Excessive Iron Utilisation
- chronic inflammation (Crohn's disease, rheumatoid
arthritis);
- infections (tuberculosis, septicemia, osteomyelitis,
urinary tract infections);
- hemosiderosis;
- malignancies.
Mineral Salts – Iron
Prevention of iron deficiency anemia
Antenatal (maternal) prophylaxis:
- mother's diet (green vegetables and fruits, eggs,
meat);
- systematic control of hemoglobin (Hb) of V-VI
months of pregnancy;
- administration of iron preparations in the last
trimester of pregnancy.
Mineral Salts – Iron
Prevention of iron deficiency anemia
After birth (infant) prophylaxis:
-late umbilical cord ligation after the cessation of its
pulsations (ensures the transfer of 40-60 mg iron);
- early and prolonged breast feeding;
- diversification of food (at 4 - 4 1 / 2 months for
infants fed standard formula or cow's milk, from 5-6
months for those breas/bottlefed) with vegetable soup,
meat, liver, egg yolk, green vegetables, cereals fortified
with Fe;
Mineral Salts – Iron
Prevention of iron deficiency anemia
After birth (infant) prophylaxis:
- additional 1-2 mg Fe + + / kg / day to 6-8 weeks to a
year to premature twins, SGA, maternal hemorrhage at
birth, digestive disorders, recurrent infections, children
with high growth;
- systematic prophylaxis with 10 to 25 mg Fe / day (or
1-2 mg / kg) for all term infants with normal weight at 6
months (for at least 3 months).
Mineral Salts
Magnesium
intracellular cation,
Roles:
- decreases the excitability of the neuro-muscular
- reduces myocardial excitability and conduction
- vascular trophic action
- the elements of the blood physiology
- to bone - favoring the action of vitamin D and bone
matrix formation, ossification stimulates collagen
- stimulates the formation of Ig, serum complement
and phagocytosis.
Mineral Salts
Magnesium
Sources: meat, milk, nuts, peas.
Deficit → hypomagnesemia:
- convulsions,
- osteoporosis
- diarrhea,
- E.K.G. changes,
- resistance to the action of vitamin D.
Excess: increased drug intake - rarely (compensatory
mechanisms occur: diarrhea and magnesiuria).
Trace - elements
Zinc
Roles:
- synthesis of amino acids, lecithin and surfactant;
- promotes membrane glucose transport, adipocytes,
and its use by the cellular response to insulin;
- prolongs the action of insulin;
- stimulates pituitary gonadotropin, GH hormone,
androgen.
Trace - elements
Zinc
Roles:
- surgical wound healing and burns stimulating
collagen synthesis and fibroblast proliferation;
- adjusting the sense of smell and taste;
- night vision (maintain plasma vit. A).
Sources: meat, liver, fish, milk, egg yolk, cereals, water.
Trace elements
Zinc
Deficit:
- hypogonadal dwarfism
- anorexia,
- hipoosmie
- alopecia, keratitis, skin ulceration
- delayed skeletal ossification
- mental slowness,
- iron deficiency anemia.
Excess:
- keeping food in galvanized vases
- drinking water consumption of zinc pots.
Trace - elements
Iodine
essential in the synthesis of thyroid hormones.
Sources: fish, vegetables, nuts, iodized salt.
The recommended intake of iodine supplementation:
- during pregnancy
- lactating women.
Trace - elements
Fluorine
Roles:
- the skeletal structure, enamel
- in preventing tooth decay.
Supplementing the diet of pregnant women in the fetus
increases its content.
Sources: foods of plant origin, animal, water.
Deficit → cavities.
Excess → fluorosis (damage to tooth enamel).
Trace - elements
Selenium
Roles:
- the structure of cell membranes, mitochondria,
microsomes and lisosomes
- stimulates growth
- promotes IgM synthesis
- absorption of vitamin E
- the Krebs cycle
- in heme catabolism.
Sources: meat, kidney, saltwater fish, milk, cereals and
mushrooms.
Trace - elements
Selenium
Deficit:
- hemolysis
- cardiomyopathy
- ↑ incidence of breast cancer and digestive tract.
Chronic excess:
- photodermatosis
- alopecia
- trophic nail disorders
- respiratory and liver chronic disorders
VITAMINS
essential cofactors in a variety of metabolic pathways
Classification:
- fat soluble
- water soluble.
Needs vary with age and / or existence of disease.
Additional Compulsory
vitamin D early in life;
vitamin K (K1) in the newborn, 1 mg IM.
VITAMINS
Dietary sources of fat-soluble vitamins:
Vit. A (retinol): fortified milk, eggs, liver, butter,
carrots, cabbage
Vit. D: fortified milk, fish, egg yolk
Vit. E: oil seeds / grains, nuts, beans, soybeans, green
leafy vegetables
Vit. K: cow's milk, green leafy vegetables, liver,
vegetable oils
VITAMINS
Food sources of water soluble vitamins:
Vit. B1 (thiamin): milk, meat, cereals, legumes
Vit. B2 (riboflavin): milk, meat, eggs, green vegetables,
cereals
Vit. B3 (niacin, nicotinamide, PP): meat, fish, milk,
green vegetables, whole grains
Vit. B5 (pantothenic acid): meat, milk, eggs,
vegetables, whole grains
VITAMINS
Food sources of water soluble vitamins:
Vit. B6 (pyridoxine): meat, liver, milk, whole grains,
soybeans
Vit. B8 (biotin): liver, egg yolk, peanuts
Vit. B9 (folic acid / folate): green leafy vegetables,
cereals, liver, nuts
Vit. B12 (cobalamin): milk, meat, eggs
Vit. C (ascorbic acid): citrus, tomatoes, cabbage
VITAMIN D
Sources:
exogenous, provided by food:
- animal (vitamin D3 - cholecalciferol)
- vegetable (vitamin D2 - ergocalciferol)
endogenous: cutaneous precursor of vitamin D (7dehydrocholesterol) + UV → cholecalciferol (vitamin
D3), metabolized in the liver.
VITAMIN D
In the first two years of life requires daily administration
of vitamin D is rickets prevention.
The main causes of increased prevalence of rickets:
- incorrect or incomplete implementation of prevention
with vitamin D;
- waiver of prophylaxis with vitamin D after age 1 year;
- sufficient sunshine;
- high degree of pollution;
- unbalanced diet, especially excess flour;
Prevention of rickets
Antenatal prophylaxis - in the last trimester of
pregnancy:
Vitamin D:
1000 - 2000 IU daily orally or
4000 - 5 000 IU per week per os or
200 000 IU orally at the beginning of the seventh
month of pregnancy.
calcium 1-2 g / day, 10 days per month, per os.
Vit D not be administered parenteral (may cause fetal
aortic stenosis).
Prevention of rickets
Postnatal prevention(fractional, physiological, modern)
from the 7th-10th day of life by 18 - 24 months
daily vitamin D, 400-800 IU / day (~ 500 IU / day) per
os.
After the age of two years - from September to late
April:
Vitamin D - 500 IU / day, daily
Vit.A + D2 - 4000 - 5 000 IU, orally, at 7-10 days.
Prevention of rickets
Only fractional administration of vitamin D is
physiological because:
- it ensures a good, especially if taken with a meal;
- transport system is not required nor the activation of
vit. D;
- target organs are not subject to adjustment jumps;
- there is no danger of intoxication.
Prevention of rickets
Higher doses of vitamin D (2000 IU / day):
- children with low birth weight / premature
- children with pigmented skin
- children receiving chronic anticonvulsant / with
corticosteroids.
There is no need to take calcium when feeding baby
milk contains less than 500 ml / day.
Prevention of rickets
Supplementation with calcium intake:
- pregnant in last trimester of pregnancy
- premature
- children receiving < 500 ml milk per day.
Dose: 50mg/kg/day elemental calcium.
Recommended dietary vitamins intake
VITAMINS
Infant
Toddler
Vitamin A
1000 UI/day
2000 UI/ day
Vitamin D
400-800 UI/ day
400-500 UI/ day
Vitamin E
3-5 mg/ day
5-10 mg/ day
Vitamin K
5 µg/ day
5-65 µg/ day
Vitamin B1
0.30-0,50 mg/
day
0,40-0,60 mg/
day
6-8 mg/ day
1-2 mg/ day
Vitamin B2
Vitamin B3
1 mg/ day
10-20 mg/ day
Recommended dietary vitamins intake
VITAMINS
Vitamin B5
Vitamin B6
Vitamin B8
Vitamin B9
Vitamin B12
Vitamin C
Infant
2-3 mg/day
0,30-0,50 mg/day
1 mg/day
20-50 µg/day
0,50-2 µg/day
30-50 mg/day
Toddler
5-7 mg/day
1-2 mg/day
2 mg/day
75-200 µg/day
2 µg/day
50-60 mg/day