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Nutrition in different physiological stages of childhood*

Harsh V. Gangrade*** Nutrition is an input to and foundation for health and development. Interaction of infection and malnutrition is well documented. Better nutrition means stronger immune systems, less illness and better health for people of all ages. Healthy children learn better. Healthy people are stronger, are more productive and more able to create opportunities to gradually break the cycles of both poverty and hunger in a sustainable way. Better nutrition is a prime entry point to ending poverty and a milestone to achieving better quality of life. The nutrient needs to body are affected by among other things, age and gender. The requirement for energy and several essential nutrients rises during infancy and childhood, driven by periods of growth and development. Nutrition During Infancy Malnutrition is responsible directly or indirectly for about 1/3rd of deaths among children under five. Nutrition and nurturing during the first year of life are both crucial for lifelong health and well being. No gift is more precious than breast feeding in infancy. In first 12 months of life, an infant grows rapidly. He triples his weight and increases his length by 50 per cent. Breast feeding on demand remains the ideal form of feeding for babies who are born at term. First four to six months are period of rapid growth, especially for brain and amino acid and fatty acid combination of human milk is ideal for these needs. Introduction of solid food is gradual process, which could be started at about six months of age. It is important to ensure normal chewing and speech development. Cereals are generally first food introduced followed by vegetables and fruits. Foods for example egg white and fish, which may cause allergic reactions, are generally introduced after twelve month of age. The energy needs for childhood growth has two components: while some energy is required for the synthesis of growing issues, some energy also gets deposited in the developing tissues, primarily as protein and fat. The protein requirement of an infant and children can be defined as the minimum protein intake essential for the maintenance of nitrogen equilibrium, preservation of body composition, and that which meets the need for deposition of new tissues promoted by the development and growth of the body. Children have special need for vitamins and minerals also. These too are essential or growth and development. An important consideration in first year of life is the amount of iron supplied in the diet. Infants below the age of 1 year should not be fed cow milk, goat milk or soy beverage. These milks are low in iron and differ in protein composition compare to mother’s milk. They may develop an iron deficiency the iron in breast milk is highly bio available and covers the need for infant until about the age of six month. After that infants should be supplemented with solid foods rich in ion and mineral. Energy requirement of an infant at the age of one month is around 300 kcal every day which increases to 700 kcal at 12 months age. Nutrition During 1 To 3 Years Of Age During these years a child’s own unique personality develops and he/she starts to move around independently and also chooses his food to eat. At this stage, the rate of growth is slower than in first twelve months. The child could become fussy eater. The provision of variety of foods allows the child to choose from a range of foods with differing tastes, textures and colors to help satisfy the appetite. The most important factor is to meet his energy needs with a wide variety of food. Meal times should not be rushed. A relaxed approach to feeding paves the way for healthy attitude towards food. Nutrition After Four Years Of Age A child’s energy needs per kg of body weight decreases but the actual amount of energy (Calories) required increases as the child gets older. From five years’ age to adolescence, there is a period of slow but steady growth. Dietary intakes of some children may be less than recommended for iron, calcium, vitamin D, A, and C at his stage, but in most cases, deficiencies are unlikely as long as the energy and protein intake are adequate and a variety of foods, including fruits and vegetables are eaten. Carbohydrate rich food, fruits and vegetables, dairy product, lean meats, fish, poultry, eggs, legumes and nuts should constitute a child’s regular meals and snacks that would contribute to his proper growth and development. Children need to drink plenty of fluids. Water is excellent liquid and supplies fluid without calories. Variety is important and other sources like milk and fruit juices can also be chosen. Soda and cola drinks should be avoided as they dehydrate the body. Nutrition During Adolescence In this stage, nutritional assessment is influenced by spurt of growth that occurs at puberty. Peak growth is generally at eleven to fifteen years for girls and twelve to sixteen years for boys. Nutritional need of individual teenager differ greatly and food intake varies day to day. In this stage, several nutrients are at greater deficiency including iron and calcium. Iron deficiency anemia is one of the most common diet related deficiency diseases. As there is increased blood volume and muscle mass during growth and development, adolescents are more susceptible for deficiency. Iron is needed for hemoglobin i.e., the red pigment in the blood which carries oxygen and for protein myoglobin in muscles. Iron is needed more for lean muscle mass in boys and for blood in girls after menstruation starts. One of the most important considerations during adolescence is an increase in the intake of iron rich food such as lean meats and fish as well as beans, dark green vegetables, nuts, cereals and other grains. Iron from animal source (Heam iron) is much better absorbed than iron from non animal source. Adolescent taking vegetarian diets are at more risk of developing iron deficiency anemia. However, vitamin C (From Citreous fruits) and animal proteins (meat and fish) assist in absorption of non heam iron. The Bones accounts for at least 99% of body stores of calcium and the gain in skeletal weight is most rapid during adolescent growth spurt. About 45% of adult skeletal mass is formed during adolescence. All the calcium must be derived from diet. The efficiency of calcium is only around 30% so it is important that diet supplies an adequate calcium intake to help build the densest bone possible. Dairy products such as milk, yogurt and cheese are good source of calcium. Other vitamins and minerals like vitamin D and phosphorus are also needed for building up bones. Physical activity is also essential especially weight bearing exercises which provide the stimulus to build and retain bones in the body.(PIB Features) (*Based on DGHS Handbook for Physicians, Diaticians and Nurses, Authors- Dr.RK Srivastava, Dr. Yatish Agrawal, D. BK Tiwari) **Freelance Writer images63

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