Lesson 3 :

Life Cycle Nutrition:

Infancy, Childhood, and
Adolescence

Ria Ambarwati
 Nutrition in Infancy

• Infancy, the first year of life, is a critical period for growth and
development
• Nutrient needs of infants reflect rates of growth, energy
expended in activity, basal metabolic needs, and the
interaction of the nutrients consumed
• The only time humans grow faster than in infancy is the 40
weeks before they are born.
• An infant’s birth weight should:
■ Double by 4 to 6 months of age
■ Triple by 1 year
 Nutrition in Infancy

• A birth length of about 50,8 cm, an infant grows to about

76,2 cm by age 1 years
• During the first few days after birth, an infant loses
weight as he or she adjusts to his or her new
environment and food supply. Among his or her
adaptations is learning to feed compared with receiving a
continuous supply of nutrients in utero.
• The amount of weight lost in these first few days should
not exceed 7% of the birth weight. Usually returns to its
birth weight within 14 days
• The period most critical to brain development
extends from conception into the second
year of life.
• Brain cells increase most rapidly before birth
and during the first 5 or 6 months after birth.
• To attain maximum brain growth, the infant
needs optimal nutrition.
 Psychosocial Development of the Infant

• The psychosocial developmental task of the infant is to learn to

trust
• The parent who responds promptly and lovingly to the infant’s
cries is teaching the infant to trust.
• If the caregiver handles the infant inconsistently --- gently one time
the next the infant learns to mistrust.
• Failure to thrive (FTT) is inadequate growth or the inability to
maintain growth ---- his or her arc of growth slips by two major
percentiles on a growth chart or when weight falls below the fifth
percentile on multiple occasions.
• Etiology : inadequate caloric and can be related to problems with
feeding including poor sucking and swallowing, breastfeeding
difficulties or difficulty transitioning to solid foods, insufficient breast
milk or formula, excessive juice consumption, or caloric absorption
problems
 Erikson’s Theory
of Psychosocial Development
 Physical Development
Physical Characteristics of Infant That Affect Nutrition

SYSTEM INFANT’S ADAPTATIONS ADJUSTMENT BY 1 YEAR OF

LIMITED AND IN FEEDING AGE
CAPACITY MATURATIONS

Gastrointestinal Salivary and Has lingual lipase Delay offering

pancreatic to digest fat, an complex
amylases are enzyme carbohydrates.
inadequate to lacking in adults.
digest complex
carbohydrates for
several months.
Intestine permits Delay offering
absorption of foods likely to be
whole allergenic until 1
proteins. year old.
Stomach holds Frequent feedings Stomach holds
about 1 2 gr about 226,7 gr
SYSTEM INFANT’S LIMITED ADAPTATIONS AND
CAPACITY MATURATIONS
Nervous Suckles with up-and- Rooting reflex well
down motion of developed. When the
the tongue for 3 to 4 infant’s cheek is stroked,
months. the head turns
toward that side to nurse.
After 4 months, the infant
can suck using
orofacial muscles. The
tongue moves back
and forth instead of up and
down
At 6 months has hand-to-
eye coordination
to put food into mouth
At 7 months can chew
appropriate foods
Urinary Young infant’s kidneys By end of the second
have limited month of life, kidneys
capacity to filter solutes can excrete the waste of
semisolid foods
ADJUSTMENT IN BY 1 YEAR OF AGE
FEEDING
Feed breast milk or
infant formula.
If semisolid food is
offered at this
time, the natural
motion of the
tongue tends to spit it
out.
Semisolid food is
more likely to be
swallowed than spit
out.
Offer appropriate
finger foods.
Increase variety of
food offered
Delay semisolid Kidneys at full
foods at least functional
until 2 months of age, capacity.
preferably 4 to 6
months.
SYSTEM INFANT’S LIMITED ADAPTATIONS AND
CAPACITY MATURATIONS
Nervous Suckles with up-and- Rooting reflex well
down motion of developed. When the
the tongue for 3 to 4 infant’s cheek is stroked,
months. the head turns
toward that side to nurse.
After 4 months, the infant
can suck using
orofacial muscles. The
tongue moves back
and forth instead of up and
down
At 6 months has hand-to-
eye coordination
to put food into mouth
At 7 months can chew
appropriate foods
Urinary Young infant’s kidneys By end of the second
have limited month of life, kidneys
capacity to filter solutes can excrete the waste of
semisolid foods
ADJUSTMENT IN BY 1 YEAR OF AGE
FEEDING
Feed breast milk or
infant formula.
If semisolid food is
offered at this
time, the natural
motion of the
tongue tends to spit it
out.
Semisolid food is
more likely to be
swallowed than spit
out.
Offer appropriate
finger foods.
Increase variety of
food offered
Delay semisolid Kidneys at full
foods at least functional
until 2 months of age, capacity.
preferably 4 to 6
months.
 Nutrition in Infancy

• Energy :
- Full-term infants who are breast-fed to satiety or who
are fed a standard infant formula
- Determine the adequacy of energy is to monitor
carefully gains in weight, length, head circumference,
and weight-for length for age and plot these data on
the WHO growth charts
 Equations for Calculating Estimated Energy Requirement (EER)
for Infants

Institute of Medicine: Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol,
protein, and amino acids, Washington, DC, 2002/2005, The National Academies Press

 Permenkes RI No. 75 Tahun 2013 tentang Angka Kecukupan

Gizi (AKG) :

Age Body Height Energy (kcal)

Weight (kg) (cm)
0 - 6 month 6 61 550
7 - 11 month 9 71 725
• Protein :
- Protein is needed for tissue replacement, deposition of
lean body mass, and growth.
- Protein requirements during the rapid growth of infancy
are higher per kilogram of weight than those for older
children or adults
- Recommendations for protein intake are based on the
composition of human milk, and it is assumed that the
efficiency of human milk use is 100%
- Human milk or infant formula provides the major
portion of protein during the first year of life.
- The amount of protein in human milk is adequate for
the first 6 months of life
 Protein Dietary Reference Intakes (DRIs) for Infants

 Permenkes RI No. 75 Tahun 2013 tentang Angka Kecukupan

Gizi (AKG) :
Age Protein (gram)
0 - 6 month 2,2
7 - 11 month 2
Lipids
 The current recommendation for infants younger than 1 year of age is
to consume a minimum of 30 g of fat per day.
 Human milk contains the essential fatty acids linoleic acid and alpha-
linolenic acid, as well as the longer-chain derivatives arachidonic acid
(ARA) and docosahexaenoic acid (DHA)
 Linoleic acid, which is essential for growth and dermal integrity, should
provide 3% of the infant’s total energy intake, or 4.4 g/day for infants
younger than 6 months of age and 4.6 g/day for infants 7 months to 1
year of age.
 In human milk 5% of the kilocalories and 10% in most infant formulas
are derived from linoleic acid.
 The concentration of DHA in human milk varies, depending on the
amount of DHA in the mother’s diet.
 DHA and ARA :
- Neural tissues
- The photoreceptor membranes of the retina
- Visual acuity
- Psychomotor development
Carbohydrates
 60% to 70% of the energy intake.
 Galactose is necessary for brain cell formation
 Approximately 40% of the energy in human milk and 40% to 50% of the
energy in infant formulas is derived from lactose or other carbohydrates
 Eating the carbohydrate honey that contains the bacterial spores ----
Clostridium botulinum spores
Water
 The water requirement for infants is determined by the amount
 lost from the skin and lungs and in the feces and urine, in addition
 to a small amount needed for growth
 0.7 L/day for infants up to 6 months and 0.8 L/day for infants 6 to 12 months
of age
 Human milk and formula that is properly prepared supply adequate amounts
of water
 Water deficits result in hypernatremic dehydration --- neurologic
 Hypernatremic dehydration has been reported in breast-fed infants who lose
greater than 10% of their birth weight in the first few days of life
 Water intoxication results in hyponatremia, restlessness, nausea, vomiting,
diarrhea, and polyuria or oliguria; seizures
Maintenance Fluid Requirements of Infants and Children
Minerals

Calcium 0 to 6 months : 200 mg/day

6 to 12 months : 260 mg/day
Fluoride  Preventing dental caries
 Excessive fluoride may cause dental fluorosis, ranging
from fine white lines to entirely chalky teeth
 0 to 6 months : 0.7 mg/day
 6 to 12 months : 0.9 mg/day
 Human milk is very low in fluoride ---dietary sources
(cereals and wet pack cereals processed with fluoridated
water), fluoride supplementation > 6 months of age is
recommended only if an infant is at high risk of developing
dental caries and drinks insufficiently fluoridated water
Minerals

Iron  Intakes of iron increase according to age, growth rate, and iron
stores
 Iron in human milk is highly bioavailable; however, breast-fed
infants should receive an additional source of iron by 4 to 6
months of age
 6 months of age offering one serving of vitamin C-rich foods per
day enhances iron absorption from nonheme sources
 Iron deficiency anemia -- 6 and 24 months --because of rapid
growth --- long-lasting poor cognition, developmental deficits,
and behavioral performance
Zinc  Newborn infants are immediately dependent on a dietary source
of zinc
 Human milk and infant formulas provide adequate zinc (0.3 to
0.5 mg/100 kcal) for the first year of life
 Zinc deficient can exhibit growth retardation
 Other foods (e.g., meats, cereals) should provide most of the
zinc required during the second year
Vitamin

Vitamin  Vitamin B12 deficiency in infants breast-fed by mothers with

B12 pernicious anemia
 Symptoms of vitamin B12 deficiency : lethargy, hypotonia,
developmental regression, vomiting, and diarrhea
Vitamin D  Infants under the age of 6 months out of direct sunlight,
exclusively and partially breastfed infants are at high risk for
vitamin D deficiency
 Prevention of rickets and vitamin D deficiency --- min vitamin D
intake of 400 IU per day shortly after birth
 Supplementation up to 800 IU of vitamin D per day may be
needed for infants at higher risk, such as premature infants,
dark-skinned infants and children
 Excessive vitamin D can cause nausea and vomiting, loss of
appetite, excessive thirst, frequent urination, constipation,
abdominal pain, muscle weakness, muscle and joint aches,
confusion, fatigue, or damage to kidneys
Vitamin

Vitamin K  The vitamin K requirements of the neonate need special

attention.
 Deficiency may result in bleeding or hemorrhagic disease of the
newborn.
 This condition is more common in breast-fed infants than in other
infants because human milk contains only 2.5 mcg/l of vitamin K
 Human Milk
• Human milk is unquestionably the food of choice for the infant.
• Its composition is designed to provide the necessary energy and nutrients in
appropriate amounts.
• Contain colostrum --- contains less fat and carbohydrate, but more protein
and greater concentrations of sodium, potassium, and chloride than mature
milk
• It contains specific and nonspecific immune factors that support and
strengthen the immature immune system of the newborn and thus protect
the body against infections.
• Prevent diarrhea and otitis media.
• Allergic reactions to human milk protein are rare.
• Mother and infant during breast-feeding facilitates attachment and bonding
• Provides nutritional (optimal nourishment in an easily digestible and
bioavailable form), decreases infant morbidity, provides maternal health
benefits (lactation amenorrhea, maternal weight, loss, some cancer
protection), and has economic and environmental benefits
• Prebiotics in the form of oligosaccharides
 Antiinfective Factors

Immunoglobulin A (sIgA) Protecting immature gut from infection

The iron-binding protein Deprives bacteria of iron and thus

lactoferrin slows their growth

Destroy the cell membranes of

Lysozymes bacteria

Interferes with the growth of certain

Lactobacillus bifidus
pathogenic organisms
 Composition of Human and Cow’s Milk
• E : 20 kcal/ml
• P : 6% to 7% (human milk), 20% (cow’ milk) of the energy
• Human milk : 60% whey proteins (mainly lactalbumins) and 40%
casein
• Cow’s milk : 20% whey proteins and 80% casein
• Lipid :
- 50% of the energy
- Linoleic acid, an essential fatty acid, provides 4% of the
energy in human milk and only 1% in cow’s milk
- cholesterol : 10 to 20 mg/dl (HM), 10 to 15 mg/dl (in
whole cow’s milk)
• Vitamin :
- CM : adequate : B-complex, A but little vitamin C.
- HM : Vit A, E
 Composition of Human and Cow’s Milk
• Iron : 0,3 mg/L, 50% of the iron in human milk is absorbed, 1% of the
iron in cow’s milk is absorbed
• The bioavailability of zinc in human milk is higher than in cow’s milk.
• Cow’s milk contains three times as much calcium and six times as
much phosphorus as human milk, and its fluoride concentration is
twice that of human milk
• The much higher protein and ash content of cow’s milk results in a
higher renal solute load, or amount of nitrogenous waste and
minerals that must be excreted by the kidney.
• The sodium and potassium concentrations in human milk are about
one third those in cow’s milk, contributing to the lower renal solute load
of human milk.
• The osmolality of human milk averages 300 mOsm/kg, whereas that of
cow’s milk is 400 mOsm/kg.
Tanda-tanda bayi sudah siap MPASI :
Kontrol kepala – bayi sudah bisa menahan kepalanya
dalam posisi tegak dengan mantap.
Refleks dorong pada lidah sudah hilang – bayi yang
belum siap menerima makanan padat akan mendorong
keluar apapun yang masuk ke mulut dengan lidahnya.
Sudah bisa duduk dengan baik – untuk bisa menelan
dengan baik, bayi harus sudah bisa duduk dengan tegak.
Gerakan mengunyah – dengan gerakan mengunyah bayi
dapat belajar menelan makanan padat dengan efisien.
Berat badan yang signifikan – kebanyakan bayi siap untuk
menerima makanan padat ketika berat badan mereka telah
dua kali lipat dari berat lahirnya.
Nafsu makan tumbuh – bayi tampak lapar, bahkan setelah
menyusu 8 sampai 10 kali dalam sehari.
Rasa ingin tahu pada apa yang Anda makan – bayi akan
mulai melirik piring Anda saat Anda makan, bahkan
mencoba meraih makanan Anda dengan sungguh-sungguh.
Common Nutritional Problems in Infancy

Regurgitation of Milk

Constipation

Burns to Mouth

Nursing-Bottle Syndrome

Allergies
 DAMPAK KURANG GIZI

Gizi kurang & Gizi cukup & sehat

infeksi

Otak Kosong” bersifat permanen Anak cerdas

Tak terpulihkan dan produktif

MUTU RENDAH MUTU SDM TINGGI

BEBAN ASET
28
Sumber : FKM UI & Unicef, 2002
 Nutrition in Childhood
GROWTH AND DEVELOPMENT

Growth Patterns
 Generally steady and slow during the preschool and school age years -
-- changes in appetite and food intake
 The body composition of preschool and school age children remains
relatively constant
 Fat gradually decreases --- 4 and 6 years of age
 Experience the adiposity rebound, or increase in body fatness in
preparation for the pubertal growth spurt.
 Earlier adiposity rebound has been associated with increased adult
body mass index (BMI)
 Body composition :
- Boys have more lean body mass per centimeter of height than girls.
- Girls have a higher percentage of weight as fat than boys, even in the
preschool years
- Differences in lean body mass and fat do not become significant until
adolescence.
Assessing Growth
Nutrition assessment includes :
 Length or stature, weight, and weight-for-length or BMI,
all of which are plotted on the recommended growth charts
 Upper-arm circumference and triceps or subscapular skin
folds.
 NUTRIENT REQUIREMENTS
1. Basal metabolism
Energy 2. Rate of growth
3. Energy expenditure of activity

1. 1 – 3 years olds : CH (45% to 65%), Fat (30% to 40%), P (5% to 20%)

2. 4 – 18 year olds : CH (45% to 65%), Fat (25% to 35%), P (10% to 30%)

Protein Dietary Reference Intakes (DRIs) for Children Through

Age 13 Years

Permenkes RI No. 75 Tahun 2013 tentang Angka Kecukupan

Gizi (AKG)
 Minerals and Vitamins

Iron Children between 1 and 3 years of age are at risk for iron
deficiency anemia, which can affect development. The rapid
growth period of infancy is marked by an increase in
hemoglobin and total iron mass
Calcium  For adequate mineralization and maintenance of growing bone
in children
 The RDA for calcium :
- 1 to 3 years old is 700 mg/day
- 4 to 8 years it is 1000 mg/day
- 9 to 18 years it is 1300 mg per day
 Actual need depends on individual absorption rates and
dietary factors such as quantities of protein, vitamin D, and
phosphorus
 Sources : milk and other dairy products, calcium-fortified
foods (soy and rice milks and fruit juices)
 Minerals and Vitamins

Zinc  Essential for growth

 Deficiency results in growth failure, poor appetite,
decreased taste acuity, and poor wound healing
 Sources : meat and seafood
 Laboratory parameters : plasma, serum erythrocyte, hair,
and urine
Vitamin  Function :
D - Calcium absorption and deposition of calcium in the
bones
- Prevention of chronic diseases such as cancer,
cardiovascular disease, and diabetes
 The DRI is 600 IU (15 mcg) per day
 Source : sunlight, dietary (milk, cheese, yogurt)
 PROVIDING AND ADEQUATE DIET

Intake Patterns

 Food pattern change :

- Foods with low nutrient density (soft drinks, baked and dairy
desserts), sweeteners, and salty snacks),
- Vegetable intake decreases
- Intakes of cereals, grain products, and sweets increase
- Prefer softer protein sources
 The total fat as a percent of energy intake has decreased --- above
recommendations of 25% to 40% of total
 Factors Influencing Food Intake

Family Environment

Societal Trends

Media Messages

Peer Influence

Illness or Disease
 Feeding Preschool Children

 Usia 2 – 5 tahun
 Peningkatan kebutuhan zat gizi
 Masa pertumbuhan cepat
 Peningkatan aktivitas fisik
 Mempunyai pilihan terhadap makanan
yang disukai
 Mudah terkena infeksi dan
kecacingan
 Feeding School Age
Children
 Growth from ages 6 to 12 years is slow but
steady
 In school a greater part of the day;
participate in clubs, organized sports, and
recreational programs
 Meal Patterns and Behaviors --- cannot
consume all the needed nutrients in three
child-sized meals healthy snacks are
necessary to complement the main meals.
 Breakfast
 School lunch program or bring a lunch from
home that support healthful eating
Nutrition Problems in School Children

Underweight

Overweight and
obesity

Iron Deficiency

GAKY

Allergies
 Nutrition in Adolescence
GROWTH AND DEVELOPMENT

 12 - 20 years old
 Puberty is the period of rapid growth and
development during which a child physically
develops into an adult and becomes capable of
reproduction
 Increased production of reproductive hormones such
as estrogen, progesterone, and testosterone and is
characterized by the outward appearance of
secondary sexual characteristics, such as breast
development in females and the appearance of facial
hair in males
 Psychologic Changes : irrational behavior, social,
cognitive and emotional development, independence
and a sense of autonomy
 Sexual Maturity

Marshall WA, Tanner JM: Variations in the pattern of pubertal

changes in males, Arch Dis Child 45:13, 1970
 Linear Growth

Typical individual velocity curves for supine length or height in males and
females. Curves represent the growth velocity of the typical boy and girl
at any given age.
 Macronutrients for Adolescents
(10 to 18 years)

 Carbohydrates: 45% to 65% of

daily calories
 Protein: 10% to 30% of daily
calories
 Fat: 25% to 35% of daily calories
NUTRIENT REQUIREMENTS
 FOOD HABITS AND EATING
BEHAVIORS

Irregular Meals and Snacking

Fast Foods and Convenience Foods

Family Meals

Dieting and Body Image

Media and Advertising

Nutrition Problems in School Children

Overweight and
Obesity
Hyperlipidemia and
Hypertension

Diabetes

Pregnancy

Eating Disorders
Thank
You!