Nutrition in children - Nutrition




Nutrition in children

Breastfeeding Second and third infancy
  • Feeding time
    • Nutritional aspects of breast milk
    • Immunological aspects of breast milk
    • Other aspects of breastfeeding
    • The formulated milks
  • weaning
  • Second and third childhood

Childhood is a period of rapid staturoponderal growth (that is, it concerns both the weight and the stature and size in general of the subject) and requires an adequate supply of nutrients. Nutrition in the various stages of developmental age also constitutes an important psychological and relational experience for the child, essential for the development of correct eating habits to be maintained in adulthood.

Nutrition in the early epochs of life therefore plays a fundamental role for the health and growth of the individual, for the morphological and functional maturation of organs and systems, for the development of food habits and for the prevention of chronic degenerative diseases of the 'adulthood. Adequate nutrition during childhood is essential to ensure the smooth development of the growth and maturation phenomena that characterize the childhood age. Malnutrition in childhood, understood both as hyponutrition and as hypernutrition, exposes to the risk of short-term and long-term biological, structural and / or functional damage. Nutrition in childhood is also an important experience of relationship with the mother and subsequently with the environment. The first critical period for the development of eating habits is the prenatal period. In the months of gestation, the fetus is affected by the influences exerted by the mother's state of health and her eating habits. It has been known for some time that both malnutrition in the first months of pregnancy and excessive accumulation of fat in the last months of gestation are factors favoring the subsequent development of obesity. We can divide the baby's feeding into four phases:

  • exclusive breastfeeding in the first 4-6 months of life;
  • weaning (or weaning);
  • feeding in second and third childhood;
  • nutrition in adolescence.

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Feeding time

The national and international guidelines recommend the promotion of exclusive breastfeeding, for the feeding of the term infant, in the first 6 months of life. In fact, in this period, breast milk is the ideal food both for its nutritional characteristics and for its function of modulating the immune system in the short term (passive immunity) and in the long term (reduction of the risk of allergic diseases and protection against of pathologies of later life). Breastfeeding, particularly if prolonged, is also associated with a lower risk of morbidity for obesity. Furthermore, the psychological role it plays in developing the relationship between mother and newborn cannot be forgotten. Its success depends on several factors, including the information acquired by the mother during pregnancy, the attitude of the various health workers (obstetricians, pediatricians, pediatricians) in the perinatal period, the help provided to the mother in breastfeeding the infant in the first days of life, the pediatrician's willingness to clarify doubts and maternal perplexities.

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Nutritional aspects of breast milk

Breast milk is the ideal food as it constantly adapts to the rapidly changing needs of the different moments of the infant's life; its composition varies from woman to woman, from breastfeeding to breastfeeding and also within the breastfeeding itself. Preterm milk is richer in fat and protein and has a lower carbohydrate content than that of full-term women. The composition varies in the first days of the newborn's life passing from the colostrum phase (up to the fifth day of life), to the transition milk phase (fifth-tenth day of life), to that of the definitive milk (after the tenth day) . Colostrum is a yellowish liquid, produced in relatively low quantities, rich in proteins and minerals, with a high antibody content. Mature milk, on the other hand, shows a higher lipid and carbohydrate content. The protein content, higher in the early stages of lactation and progressively reduced thereafter, is the lowest among mammals (clearly lower than cow's, goat's and donkey's milk) and is qualitatively different. The main protein constituents of breast milk are a-lactalbumin and lactoferrin, with a casein / serum protein ratio of 40/60 against 80/20 of cow's milk; other fundamental protein constituents are immunoglobulins and lysozyme, fundamental for the defensive activity against pathogens. Lipids are the component subject to a greater degree of inter- and intra-individual variability; in fact they vary between nurse and nurse but also between one feed and the other; they also vary over the same feed, being more scarce at the beginning and more abundant at the end. They are mainly represented by triglycerides, to a lesser extent by cholesterol, phospholipids and free fatty acids. As for the carbohydrate component, the main sugar of breast milk is lactose; there are also glucose, glycoproteins, glycoprotides and oligosaccharides. Other fundamental constituents are vitamins, minerals and, to a lesser extent, enzymes and hormones. The content of vitamins varies significantly according to the nutritional status of the mother: serious deficiencies can lead to significant defects in the vitamin content. In particular, vitamin D is found in variable quantities depending on the mother's inke and may be insufficient in the milk of vegetarian women, increasing the risk of rickets in the baby. Iron is contained in modest quantities, but is characterized by a high bioavailability.

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Immunological aspects of breast milk

Breast milk contains numerous anti-infective protective factors, divided into cellular protective factors, including macrophages and neutrophils and, in smaller numbers, leukocytes, and in soluble protective factors, consisting mostly of immunoglobulins, in particular secretory IgA. Soluble factors include:

  • some oligosaccharides which can also act as receptor structures for bacteria;
  • lactoferrin, able to bind iron and subtract it from those microorganisms that use it to multiply;
  • lysozyme, a specific antimicrobial factor;
  • bifidogenic factors.

The beneficial action of human milk also exerts itself against allergies. The intestinal mucosa in neonatal times is in fact permeable to the absorption of potentially allergenic food antigens. The immunoglobulins present in breast milk prevent these antigens from crossing the intestinal barrier, limiting the development of allergies.

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Other aspects of breastfeeding

Breastfeeding is the ideal time for strengthening the bond between mother and newborn baby; the infant relives, in contact with the body and maternal heat, some sensations experienced during intrauterine life. Other aspects to underline are the practicality of breast milk which does not require preparation times, does not need to be heated and is always ready, in addition to the "zero cost" compared to the milk formulated.

Breast milk is the food of choice not only for the term infant, but also for the preterm, thanks to its immunological, anti-infectious properties, as well as for its composition in nutrients.

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The formulated milks

The use of milks formulated for babies becomes indispensable:

  • when breastfeeding is contraindicated;
  • when there is not enough production of breast milk or when the growth of the newborn is not adequate with only breastfeeding;
  • when the mother decides not to breastfeed or not breastfeed exclusively.

Contraindications are limited to a few situations:

  • the presence in the mother of infections the transmission of which can take place through her own milk (active TB, lue, AIDS, malaria and so on) or serious chronic diseases that entail a serious compromise in the general state of the mother;
  • exposure to drugs or environmental agents excreted in milk and dangerous for the baby;
  • neonatal causes including congenital diseases involving intolerance of the infant to breast milk (congenital errors of metabolism such as galactosemia, tyrosinemia and so on).

Milk formulated for babies (infant formula, starting formulas) replace breast milk and are suitable up to the fourth-sixth month; they are produced from cow's milk, which is modified in a more or less relevant way in its composition to make it as similar as possible to human milk and therefore suitable for the digestive and metabolic characteristics of the infant. Without these changes, cow's milk cannot be considered a substitute for breast milk. In fact, the former has a protein concentration which corresponds to four times the latter and is therefore less digestible for the newborn, who has an immature gastrointestinal system; the higher protein content also contributes to increasing the solute load that the kidney must manage in a delicate phase for renal function such as neonatal function. The higher concentration of lactoglobulin contributes to the allergenic power of cow's milk in the early stages of life. The lipid composition, although superimposable from the quantitative point of view, clearly varies from the qualitative point of view; saturated fatty acids predominate in cow's milk while there is a relative lack of essential fatty acids. Furthermore, some fatty acids present in cow's milk are difficult to dissolve and are irritating to the digestive mucosa. The amount of carbohydrates is lower than breast milk and oligosaccharides are practically absent. The quantity of minerals contained is more than three times that of breast milk, which causes an increased renal osmotic load; Calcium and iron, finally, although present in cow's milk in greater quantities than in mother's milk, have less bioavailability. For these reasons, the use of cow's milk should be postponed to the twelfth month of life, when the infant's digestive and renal systems have reached a higher level of maturity. International bodies such as ESPGAN (European Society for Pediatric Gastroenterology and Nutrition) and the EEC Commission have clearly defined the compositional parameters necessary for the starting formulas. For the feeding of the preterm infant, which presents particular nutritional needs, specific formulas with a higher caloric density have been prepared, which differ in both qualitative and quantitative terms from those recommended for the term infant.

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