At the conclusion of this chapter, students will be able to
Breast feeding provides superior nutrition for optimum growth; adequate water for hydration and protects the child against infection and allergies. Breast feeding also promotes mother-infant bonding and development.
Breastfeeding reduces the risk of chronic disease and the prevalence of obesity in children. Breastfeeding also decreases the risk of allergic disorders such as asthma, atopic dermatitis and allergic rhinitis. Breast feeding also has benefits for the lactating mother: helps reduces risk of uterine bleeding and helps the uterus to return to its previous size ; reduces risk of breast and ovarian cancer; helps delay a new pregnancy and helps a mother return to pre-pregnancy weight.
Breast feeding is contraindicated (must be avoided) when the mother has HIV/AIDS or when the infant has lactose intolerance. When breast feeding is contraindicated, formula feeding or artificial feeding will be necessary. Formula feeding is associated with persistent diarrhea, vitamin A deficiency, increased risk of chronic diseases, overweight, and lower scores on intelligence tests. A non-lactating mother may become pregnant sooner and may have increased risks both for ovarian and breast cancer.
Nutritional requirements differ across the life span. The goal is to achieve and maintain optimal nutritional status. However, both under-nutrition and overnutrition are common in the young child.
A child’s nutritional status could be assessed using several means. Health history questions related to the child’s nutrition are important. The use of anthropometric measurements such as weight, height for age or derived weight such as body weight as percent of ideal body weight and recent weight change and body mass index (BMI) are indicators for nutritional status.
BMI is the measure of choice as a practical indicator of the severity of obesity. It can be calculated in a variety of ways:
The limitations of BMI are that BMI overestimates body fat in persons who are very muscular and can underestimate body fat in persons who have lost muscle mass (e.g., the elderly).
Also, since the presence of excess fat in the abdomen is an independent predictor of risk factors and morbidity, waist circumference should also be measured. A high waist circumference is associated with an increased risk for type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease (CVD) in patients with a BMI in a range between 25 and 34.9 kg/m2.
High-risk waist circumference in men is defined as >102 cm (>40 in.) and in women, it is >88 cm (>35 in.).
Other abnormal findings after nutritional assessment include marasmus (protein-calorie malnutrition); kwashiorkor (protein malnutrition); and marasmus/kwashiorkor mix.