Pediatric Nurse Tips : Daily Nutritional Requirements For Child

Nutrition is concerned with determining the proper amounts of various components of food that will provide the best opportunity for the child’s growth and continued health. These components, called nutriens, include proteins, fats, carbohydrates, vitamins, minerals and water. As you will recall, water is found in all foods and comprises abaout 70% of our body weight. The “basic four” food groups are arranged  so that these nutrients could be obtained in the aveage daily diet. Figure 17—1 shows the four groups: dairy foods, meats, vegetables and fruits, and bread ad cereals.

NUTRIENTS

Each nutrients has a very special job to do for the growing child. Proteins build and repair our body tissue. Protein is the only nutrients which contains nitrogen, the element essential proteins to life and the growth of cell. Complete proteins are those which contain  all  the essential proteins to meet life needs. These are milk, meat, fish, eggs and cheese. Good proteins, although incomplete, are legumes, gelatin, nuts, and cereals. Since the child is constanly growing, he need daily protein. Most children like meats, although finances prohibit some families from purchasing as much as they should. The end product of the digestion of protein is amino acid.

Carbohydrates give us energy which is measured in calories. A calorie is the amount of heat necessary to raise the temperature of one gram ofe water one degree centigrade. One gram of carbohydrate yields four calories. At the completion of digestion, carbohydrates become glucose. The critically ill child who cannot eat may be given an intravenous injection of one to two percent glucose to restore his energy. This nutrient is the least expensive of the four basic foods groups. Our feeling of satisfaction is short-lived after a meal consisting entirely of carbohydrates. Fruits, vegetables, cereals and bread provide this nutrients. Fruits and vegetables also yiels minerals and vitamins.

Fat is used by the body to give us heat and energy. One gram of fat yields nine calories. Fat gives falvor and palatability to food. The sick child may need some fat in the form of meat fat or eggs. Fats take longer to digest than other nutrients, therefore, they give a feeling of satisfaction while being consumed.

The essential vitamins and minerals and their contributions to our health are shown in fig. 17.2. minerals are essential to the formation of bones and teeth. Vitamins are necessary for the functioning of our heart, nerves, muscles and the health of our eyes, skin and mucous membranes.

NAME	SOURCES	FUNCTIONS
Vitamin A	Green and yellow vegetables, fish liver oil, egg yolk, cream, cheese, tomatoes, yellow fruits	Essential to growth, vitality, vision, structure and function of cells of skin and mucous membrane and resistance to infection
Vitamin B1 Vitamin B2 Vitamin B6 Niacin	Organ meats, enriched cereal, bread, potatoes	Essential to general well being, good muscle tone, nerves and digestion
	Milk, organ meats, enriched cereal, eggs, leafy vegetables	Essential to growth, health of eyes, color and structure of flip tissue
	Organ meats, fish, oatmeal, potatoes, cabbage, carrots	Help to prevent muscle weakness and certain nervous disoders
	Meat, poultry, fish, peanut butter, whole grain cereal	Essential to growth, carbohydrate metabolism, function of nervous and digestive system
Vitamin C	Citrus fruits, cabbage, berries, potatoes, tomatoes	Essential to sound teeth, bones, blood vessels, gums, for repair of body tissues and resistance of infection
Vitamin D	Exposure to sunlight, irradiated milk, fish liver oils	Essential to absorption and metabolism of calcium and phosphorus to produce healthy bone, tooth structure
Vitamin K	Green leafy vegetables, soy and vegetables oils, pork liver	Essential in clothing of blood, for normal muscular contractions of the heart muscle
Calcium	Milk and milk products, green leafy vegetables	Essential in building bones and teeth for normal muscular contractions of the hearth muscle
Phosphorus	Poultry, fish, meat, cereals, nuts, legumes, milk and milk products	Essential to bone structure, maintaining acid-base balance, metabolism of proteins, fats and carbohydrates
Iron	Liver, Organ meats, egg yolks, green leafy vegetables, whole grain bread and cereal, risins and molasses	Essential part of every cell in the body, necessary for hemoglobin formation and oxygen bearing
Iodine	Ocean and sheel fish, iodized salt, vegetables grown in iodine rich soil	Normal thyroid gland function

17.2

DIET CHANGES AND GROWTH

In the case of the newborn, it is expected that the formula will provide not only the necessary nutrients, but also the callories and volume of liquid required for proper growth and development. During the last month of prenatal development, the fetus had been storing minerals such as iron, calcium and phosphorus to provide for immediate postnatal needs. To provide the necessary amounts of vitamin C, the paediatrician may start the baby on orange juice at about two weeks. To provide iron and thiamine the infant needs, the doctor may order cereals as early as the first week of life. Additional amounts of iron can be obtained from egg yolk and strained meats. The doctor will suggest the introduction of solid foods in keeping with the individual baby’s needs and development.

Finger foods, such as meat sticks, carrots, teething biscuits and fruit slices, can be introduced when the baby’s appetite is keenest. If the food is rejected the first time it is offered, no attempt should be made to force the child to accept it. Instead, the food may be offered again after several days. 

Because of this sensitivity to strong taste and temperature, the baby’s food should be warm (about 105 F) and lightly seasoned. The shild will usually be eating most o the table foods by his first birthday, the pieces will be smaller and the texture, softer. The year-old child will enjoy drinking from a cup , drinking his food in the milk and using his fingers is feeding himself. Sample menus for the 1 and 4 year old child are shown in fig 17-3.

MENU FOR 1 YEARS OLD

MENU FOR 4 YEAR OLD

6 a.m. Juice, preferably orange Breakfast Cereal with milk, dry toast or zwieback Mid Morning Snack Milk Noon Meal Soft cooked, poached or coddled eggs, chopped spinach, mashed potatoes with butter, gelatin dessert, milk Mid Afternoon Snack Milk and cheese sticks Evening Meal Junior foods, soups, applesauce, milk Evening Milk, water as desired

Breakfast Orange or orange juice, oatmeal with milk, toast with butter or margarine, glass of milk Mid Morning Snack Fruit or juice and cookies Dinner (Noon Meal) Baked potato with butter or margarine, meat ball or boneless fish, spinach or peas, carrots, fruit, jello or custard dessert, milk Mid Afternoon Snack Fruit or Milk and cookies Supper (Evening Meal) Vegetable soup or chicken soup, meat or cheese sandwich, tomato or carrot sticks, applesauce or baked apple, milk Water as desired

The needs of the toddles vary little from those of the infant. Because he does not grow as rapidly when a toddler, one might assume that child does not need as much food. However, the calories he does not consume in growth, he uses in muscular activity. The toddler requires 45 calories per pound of body weight, the 2 year old requires from 1000 to 1500 calories per day. The preschool child requires from 1400 to 1800 calories per day. The child should have 30 to 40 grams of protein per day, and it shoud be in the form of meat, fish, eggs or cheese. His daily food needs as he grows are shown in fig.17-5

Age	2-6 Mos.	7-12 Mos.	1-3 yrs.	4-6 yrs.
Weight: Kg.                Lb.	6 13	9 20	12 27	18 40
Height: Cm.               In.	60 24	70 28	87 34	109 43
Calories Protein gm. Calcium mg. Iron mg. Vitamin A I.U Thiamine mg. Riboflavin mg. Niacin mg. equiv. Ascorbic Acid mg. Vitamin D I.U.	Kg.X 120 * 600 5 1500 0.4 0.5 6 30 400	Kg.X 100 * 800 7 1500 0.5 0.8 7 30 400	1300 40 1000 7 2000 0.7 1.0 8 35 400	1700 50 1000 8 2500 0.9 1.3 11 50 400

*Allowances are not given for protein during infancy

** Includes preformed niacin and the precursor, tryptophan 

60mg. tryptophan equals 1 mg. niacin.

The hospital diet has been carefully planned for the growing child in order that he may get all the essential for this health and growth. Eating habits vary, however, from patient to patient. Children from underprivileged areas frequently eat a starchy diet because of the higher cost of protein. Other children will demand meats and fish.

The nurse may encourage the formation of good dietary habits by making an interesting game of eating all the nutrients served. The wise nurse will eliminate sweets from the diet and serve a balanced meal in small amounts. When the child becomes hungry and observes his little neighbors eating all their food, he will begin to ask for additional servings. Then sweets may complement the regular food. The nurses should record the child’s progress on his chart.

During growing child needs food from all of the four food groups. His experience under your supervision may be his firs opportunity to eat a balanced diet. He will show remarkable changes when he is obtaining adequate sources of balanced nutrients to help him grow and have energy to spare.

During the adolescent period and particulary following the menarche, the young girl should be encouraged to have a proper diet. Calories should total about 2200 to 2800 per day, and the diet should include the four basic foods groups. Calcium, iron, vitamins D and C and protein are important to the growth of body tissue and should be plentiful in the diet. Eight to ten hours of sleep are desirable, and time should be provided for relaxation or recreation. Overweight in this period is usually due to overeating and limited activity.

Because a great deal of emphasis is placed on physical characteristics at this time, the girl may attempt “crash diets” to control her weight. This may lead to nutritional deficiencies, fatigue, poor posture and dental problems. Frequently the plumpness about which she complains may be the plumpness of childhood which will disappear as the growth pattern progresses.

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