1. Maternal Nutrition
&
Infant / Childhood Nutrition
Zia Imran

2. What is a successful Pregnancy?
• Gestational period longer than 37 weeks.
• Birth weight greater than 2.5kg
• Sound nutritional status of mother at end of
pregnancy i.e;non-depleted and with adequate
stores for successful lactation.

3. WHY IS PRECONCEPTUAL NUTRITION SO
IMPORTANT IN PROVIDING A NUTRITIONAL
BASELINE FOR BOTH THE MOTHER AND THE
DEVELOPING FETUS?
• An optimal level of nutrition during preconception
period ensures that a women begins pregnancy with
all necessary nutritional stores to produce
substances required to maintain healthy pregnancy
and support the developing fetus/embryo.
• Women who enter pregnancy in optimal nutrition
state are more likely to have an uneventful
pregnancy & deliver a healthy infant.

9. • Iron
The need for iron increases because of increased
blood volume in pregnancy. In addition the fetus
increases its hemoglobin level also.
The infants hemoglobin level is reduced to normal
shortly after birth. The resulting iron is stored in the
liver and is available when needed during the
infants first few months of life, when the diet is
essentially the breast milk or formula.
Iron requirement for non pregnant 25 years + 15mg/day
Iron requirement for pregnant 30mg/day
Iron requirement for lactating 15 mg/day

15. • Nutritional Risk Factors At Onset Of Pregnancy:
1. -Adolescence
2. 3 or more pregnancies within 2 years
3. Poor reproductive performance
4. Poverty
5. Food faddists
6. Substance abuse:
I. Caffeine
II. Smoking
III. Alcohol

16. 7) Chronic Systemic Disease (gestational
diabetes)
8) Pre-pregnant weight
9) Anemia

18. Factors Affecting Dietary Practices Among (Adolescent)
Pregnant Women.
Low income
Illiteracy
Low weight gain
Lack of knowledge regarding nutrition
Low dietary intake
Poor hygiene
Lack of water
Food faddism
Early marriage
Multiple pregnancies

19. FOOD FADDISTS

20. COMMOM MYTHS ABOUT NUTRITION DURING
PREGNANCY.
• You can eat anything you want because you are eating for
two.
• You can eat double portions because you are eating for two.
• You should eat whatever you are craving because your body
needs it.
• You must take vitamins if you need healthy baby.
• If you crave sweet, the baby is going to be a girl. if you crave
pickle, the baby will be a boy.
• Drink lots of coconut water if you want fair baby.

21. SUBSTANCE ABUSE

22. CHRONIC SYSTEMIC DISEASE

24. RECOMMENDED WEIGHT GAIN DURING PREGNANCY
Desired weight gain is based upon pre-pregnancy wt
gain using Body Mass Index criteria and the pre-
conceptual nutritional status of woman.
 Under weight client(BMI < 19.8) should gain 28-40
lbs.
 Normal weight clients(BMI 19.8-25)should gain 25-
35lbs.
 Over weight (BMI 26-29)should gain 15-25lbs.
 Obese client (BMI > 29) should gain < 15 lbs. Average
weight gain in pregnancy is 25-35 lbs.

25. • Average weight gain in pregnancy is 25-35
lbs.
1st trimester-------------------------2-4 lbs
2nd and 3rd trimester--------------1 lb/ week
2nd trimester---increase in maternal tissues
3rd trimester--- the growth of a fetus

26. Women falling outside the recommendations
for ideal body weight at the start of a
pregnancy are advised to adjust their weight
gain during pregnancy accordingly.
• Under weight women are advised to gain
more weight during pregnancy
• Overweight women are advised to limit
weight gain during pregnancy;however,they
are cautioned that pregnancy should not be
used as a time for weight loss.

27. Causes of Iron Deficiency Anemia
IRON DEFICIENCY ANEMIA
Low dietary iron intake
Low iron bioavailability;
•Non heme iron
•Iron inhibitors
6/15/2015 Zia Imran
Some common causes in
Pakistan:
oPica
oTea consumption
oLow intake of eggs and red
meat
oLack of knowledge

33. PRUNES

34. • LACTATION::the process of milk production.
The chief function of lactation is to provide
nutrition to the young after birth.
Breast feeding provides significant nutritional,
health and psychological benefits to both
mother and infant.

35. • Maternal requirements:
• Nutritional requirements for lactation are
higher than at any other time in life; increase
in calories,proteins,fluids,vitamins,and
minerals are required to prevent loss of
maternal stores during milk production.

36. Breast Feeding:
Initiation of breast feeding within the first hour
reduced neonatal mortality rate. Therefore it
needs to start in the first hour.
Breast feeding promotes the overall health of the
child and results in decreased childhood
morbidity and mortality.
Early initiation of breast feeding colostrums
which contains antibodies and good bacteria to
protect your baby from illness.
INFANT NUTRITION(0-12 MONTHS)

37. • Prelacteal feeds:
• Any food except mothers milk provided to a newborn before
initiating breast feeding.
• Pre lacteal feed is a major barrier to exclusive breastfeeding.
• It is a prevalent practice in Pakistan.
Some common reasons for PLF
 Perceived breast milk in sufficiency
 Preventing dehydration,hypoglycemia,neonatal jaundice.
 Cleansing and preparing the baby's gastrointestinal tract for
digestion.
 To flush the bladder
 Rest the mother
 Provide variety in baby's diet and because colostrum is
thought to be too strong for the baby.

38. Prelacteal Feeds:
Mixture of honey,butter,liquid honey
water
Glucose water
Ghee Animal milk

39. METHODS OF GIVING PRELACTEAL FEEDS
LICKS FROM
FINGERS
COTTON
WICKS
SPOON BOTTLES
Disadvantages of prelacteal feeds
Delays initiation of
Breast feeding
Expose infant to
infection
When fed by bottle
infant less inclined to
suck at breast

40. Starting Solid Foods(Weaning)
• Do not introduce solids until 4-6 months of
age, introduction before this time is
inappropriate because of immature GI
system.
• Early feeding exposes infant to food
allergens; this may result in development of
food allergies.
• Limited motor development makes feeding
solids difficult.

41. Sequencing Of Food
• Infants cereals(rice)often are the first solid of choice
because of increased iron and energy provided; single
grain,precooked,partially hydrolyzed cereal is well
tolerated by infant.
• Sequencing then leads to fruits or vegetables with meats
being added last.

42. Rice cereal
Pureed vegetables
Mashed
banana
Pureed meat

43. Introduction Of New Food
• Introduce new foods one at a time
• Offer a new food for 4-7 days before trying another.
• May be home made or commercially prepared.
• Offer 1-2 teaspoon of solids initially, increase amount over
time.
• As amount of solid food increases, decrease the amount of
formula.

44. Safety Aspects
• At ages less than 4 yrs ,there is increased risk of choking.
• Preventive measures include;
1. Cook foods well; cut into small pieces
2. Never leave infant unsupervised when eating
3. Avoid hard round foods not easily dissolved in saliva such as grapes,
raw vegetables, popcorns.
4. Do not permit infant to eat or drink when lying down.
5. Do not add cereal to bottle or increase the bottle nipple size—this can
increase risk of aspiration.
• Avoid use of canned fruits or vegetables because of high sugar
content)
• Refrain from using honey in foods or fluids due to risk of infant
botulism.

45. Nutritional problems of infancy and
childhood
Malnutrition
Low birth weight
Iron deficiency anemia
Diarrhea
Colic
Allergies
Galactosemia

46. Allergies :
One common is COWS MILK .Special formulas without cows milk
protein are available.
Food allergies can cause wheezing and difficulty in breathing, itchy
skin rashes, vomiting nausea,diarrhea,abdominal pain.
Common cause is food intolerance of especially
peanuts,fish,shellfish,egg(egg white),milk,soy wheat.
Many children outgrow these food sensitivities by the age of 1 or 2.It
is important not to permanently exclude foods from the diet based
on the first year experience.

48. Colic :common to some children.
• Children with colic pain cry regularly because of abdominal pain, which usually
trouble children for the first few months. Children draw up their legs and cry in
pain.
Causes :many contributing factors
• New born have immature digestive system, muscles that support digestion have
not developed the proper rhythm for moving food efficiently.
• Certain foods eaten by lactating mother e.g;eating of cruciferous vegetables
cauliflower), and gas producing foods.
• Infants often swallow air while feeding or strenuous crying which increases gas
and bloating, further adding to their discomfort.
• By giving pain relieving drugs colic can be controlled.
• Swallowing of air can be controlled by making the child to eat slowly. After each
feed the child must be burped to release the air sucked in while feeding.

49. Galactosemia :an enzyme required to convert galactose into
glucose is missing, if untreated infant will die.(galactose is a
simple sugar resulting from the digestion of lactose, the sugar found in
milk. When the enzyme transferase is missing, and the infant ingests
anything containing galactose, the amount of galactose in blood becomes
excessive that is toxic.)
Clinical manifestations are
diarrhea,jaundice,lethargy,vomitting,weight loss.
Is treated by eliminating all milk and lactose containing foods.

50. Feeding behaviors to avoid:
1. Giving cows milk during the first year.
• Whole milk, goats milk,1-2%fat milk, evaporated milk are
not advised during the first year of life.
• Ingestion of whole milk before 1 yr age has been
associated with iron deficiency anemia due to low
concentration and poor bioavailability of iron in cows milk;
some studies have implicated that GI blood loss occurs
with milk ingestion.
• Increased protein,sodium,potassium and chloride levels in
cows milk increases renal solute load for immature infant
kidneys: may cause dehydration.

51. 2- Adding Cereal to the Bottle:
• Do not add dry cereal to the bottle s of
formula as it can increase the aspiration
potential due to increased swallowing
pressure exerted by the infant to swallow
the solution.
• Increasing the nipple size of the bottle can
lead to further risk of aspiration
• Mix cereal with formula then introduce with
a spoon; this facilitates development of
chewing muscles and coordination.

52. 3-Nursing Bottle Syndrome:
• Nursing bottle syndrome or nursing bottle caries are
caused by ingestion of milk,juice,or other
sweetened beverages by bottle at night or during
naps.
• Dental caries,dental decay and erosion are due to
bacterial action resulting from food substances
remaining on dental enamel.
• To prevent nursing bottle syndrome: exclude
nighttime bottle, replace sweet substance with
water, avoid using bottles as pacifiers, and avoid
adding sweet coatings to pacifiers.

54. Infantile obesity
SPECIAL NUTRITIONAL CONCERNS

55. Infantile Obesity:
Treatment of obese infant should focus on weight
control rather than weight loss.
Calories offered should match the requirements of the
normal weight infants, approximately:
40-60 kcal/lb for the first 6 months of life
35-55 kcal/lb for 6 months to 12 months
Foods of high density should be avoided
Never force feed to the infant
Overweight children are more likely to become obese
adults than are children of normal weight.
Thank you