Pediatric Nutrition and Gastroenterology:
Nutritional Needs of Full-Term Infants:
● Protein
○ Human milk*
○ Formula
● Energy (high resting metabolic rate and high growth rate)
● Vitamins
● Minerals
● Water
Nutrient Requirements:
● Influenced By:
○ Growth rate
○ Body Composition
■ Brain requires 44% of total energy under basal conditions in full-
term infant
○ Composition of new growth
■ Fat accounts for 40% of weight gain between birth and 4 months
and 3% between 2-3 years
The Breastfed Infant:
● Benefits:
○ Nutritional
○ Immunologic
○ Anti-allergic (eczema, allergies, asthma)
○ Cognitive
○ Psycho-social
○ Protective against later obesity
○ Foremilk = Higher in protein content
○ Hind milk = Higher in fat content
● Difficulties:
○ Monitoring of adequate intake
● Contraindications:
○ Specific maternal infections
■ HIV
■ Active, untreated tuberculosis
○ Maternal substance abuse
○ Specific maternal medications
○ Specific infant metabolic diseases and congenital anomalies
■ Galactosemia
, ■ Pierre-Robin syndrome
● Breast Milk Jaundice
○ Manifests within the first 4-7 days of life
■ Can persist for 3-12 weeks
○ Rule out pathological causes
○ Treatment is phototherapy
Formula Feeding:
● Made to duplicate human milk
○ Never an exact match
● Forms:
○ Powder
○ Liquid concentrate
○ Ready-to-feed
● Special Formula
○ Soy
○ Hypoallergenic
○ Elemental
Feeding Techniques:
● Breast and Bottle
○ On Demand
○ Scheduled
● Breast
○ ~15 minutes per breast (varies)
● Bottle
○ 1.5-2 ounces/body weight/day
■ 7lb baby would take 10.5-14 ounces a day
■ 14lb baby would take 21-28 ounces a day
Calories:
● Most formula is 20 cal/oz
● Breast milk ~19 cal/oz
● How many calories is an infant receiving who is taking 90ml every 3 hours of
similac advance formula?
○ 80.4 kilocal/kg/day
● What if the infant has failure to thrive?
○ Increase volume of feeds
○ Increase calories by adding more powder per feed
Introducing Solids:
● Able to sit with support, reaches and grabs, and mouths hands and toys
, ● Watches you eat, follows your fork
● "Mooches" by reaching for food on your plate
● Mimics your eating behaviors (opens mouth with you)
● Offer, but do not force
● What to start with
○ Rice, oat, and barley cereals
○ Sweet potatoes
○ Carrots
○ Squash
○ Peas
○ Green beans
○ Avocado
○ Unsweetened yogurt
○ Bananas
○ Applesauce
○ Peaches
○ Pears
● What to avoid
○ Cow's milk and egg whites
○ Small and sticky foods
○ Nuts
○ Honey
○ Caffeinated products
○ Undiluted fruit juices
Do’s and Don’t of Solids:
● Make mealtime fun
○ Be prepared for mess
● One food at a time
● Meal schedules
○ Going from 1-3+ meals
● Finger foods
4-6 months 6-8 months 9-12 months
Texture and Semiliquid - semisolid Soft foods, some finger foods Finger foods and most
that dissolve easily table foods
consistency
How much Start with 1-2 tsp, gradually 3-4 Tbsp, “bites” of finger foods Small bite-size portions
increase as baby gets older
How often 1-2x/day 2-3x/day 3x/day
Nutritional Needs of Full-Term Infants:
● Protein
○ Human milk*
○ Formula
● Energy (high resting metabolic rate and high growth rate)
● Vitamins
● Minerals
● Water
Nutrient Requirements:
● Influenced By:
○ Growth rate
○ Body Composition
■ Brain requires 44% of total energy under basal conditions in full-
term infant
○ Composition of new growth
■ Fat accounts for 40% of weight gain between birth and 4 months
and 3% between 2-3 years
The Breastfed Infant:
● Benefits:
○ Nutritional
○ Immunologic
○ Anti-allergic (eczema, allergies, asthma)
○ Cognitive
○ Psycho-social
○ Protective against later obesity
○ Foremilk = Higher in protein content
○ Hind milk = Higher in fat content
● Difficulties:
○ Monitoring of adequate intake
● Contraindications:
○ Specific maternal infections
■ HIV
■ Active, untreated tuberculosis
○ Maternal substance abuse
○ Specific maternal medications
○ Specific infant metabolic diseases and congenital anomalies
■ Galactosemia
, ■ Pierre-Robin syndrome
● Breast Milk Jaundice
○ Manifests within the first 4-7 days of life
■ Can persist for 3-12 weeks
○ Rule out pathological causes
○ Treatment is phototherapy
Formula Feeding:
● Made to duplicate human milk
○ Never an exact match
● Forms:
○ Powder
○ Liquid concentrate
○ Ready-to-feed
● Special Formula
○ Soy
○ Hypoallergenic
○ Elemental
Feeding Techniques:
● Breast and Bottle
○ On Demand
○ Scheduled
● Breast
○ ~15 minutes per breast (varies)
● Bottle
○ 1.5-2 ounces/body weight/day
■ 7lb baby would take 10.5-14 ounces a day
■ 14lb baby would take 21-28 ounces a day
Calories:
● Most formula is 20 cal/oz
● Breast milk ~19 cal/oz
● How many calories is an infant receiving who is taking 90ml every 3 hours of
similac advance formula?
○ 80.4 kilocal/kg/day
● What if the infant has failure to thrive?
○ Increase volume of feeds
○ Increase calories by adding more powder per feed
Introducing Solids:
● Able to sit with support, reaches and grabs, and mouths hands and toys
, ● Watches you eat, follows your fork
● "Mooches" by reaching for food on your plate
● Mimics your eating behaviors (opens mouth with you)
● Offer, but do not force
● What to start with
○ Rice, oat, and barley cereals
○ Sweet potatoes
○ Carrots
○ Squash
○ Peas
○ Green beans
○ Avocado
○ Unsweetened yogurt
○ Bananas
○ Applesauce
○ Peaches
○ Pears
● What to avoid
○ Cow's milk and egg whites
○ Small and sticky foods
○ Nuts
○ Honey
○ Caffeinated products
○ Undiluted fruit juices
Do’s and Don’t of Solids:
● Make mealtime fun
○ Be prepared for mess
● One food at a time
● Meal schedules
○ Going from 1-3+ meals
● Finger foods
4-6 months 6-8 months 9-12 months
Texture and Semiliquid - semisolid Soft foods, some finger foods Finger foods and most
that dissolve easily table foods
consistency
How much Start with 1-2 tsp, gradually 3-4 Tbsp, “bites” of finger foods Small bite-size portions
increase as baby gets older
How often 1-2x/day 2-3x/day 3x/day
