AGE AND DEVELOPMENTAL INFLUENCE ON NUTRITIONAL REQUIREMENTS AND FEEDING PATTERNS |
FEEDING PATTERN AND DIET |
NURSING CONSIDERATIONS AND PARENTAL GUIDANCE |
Neonate |
Birth-4 weeks
Neonate’s rapid growth makes infant especially vulnerable to dietary inadequacies, dehydration, and iron-deficiency anemia.
Feeding process is basis for infant’s first human relationship, formation of trust. Feeding reinforces mother’s sense of “motherliness.”
Neonates require more fluid relative to their size than adults.
Sucking ability is influenced by individual neuromuscular maturity.
Infant
1-3 months
Infants consume more formula or breast milk with each feeding and sleep for longer periods.
Infants have increased interaction during feeding due to cooing and development of a social milestone.
Bowel movements become less frequent. Breast-fed infants may not have a bowel movement after each feeding.
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Breast milk or formula is generally given in 6-8 feedings per day, spaced 2-4 hours apart.
Feeding schedules should be individualized according to infant’s needs.
Breast-fed infant up to 6 months will not need supplemental vitamins or minerals.
Bottle-fed infant may benefit from supplements.
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Breast-fed infant:
Help mother assume comfortable and satisfying position for self and baby.
Help mother to determine schedule, timing, and when infant is satisfied.
Provide specific information about:
Bottle-fed infant:
Provide specific information about:
Type of formula.
Preparation of formula: measuring and sterilization.
Equipment—types of bottles and nipples.
Sterilization of equipment.
Technique of feeding: position, “bubbling.”
Help mother to determine when infant is satisfied; develop schedule for feeding.
Provide information about normal characteristics of stools, signs of dehydration, constipation, colic, milk allergy.
Discuss need for prescribed supplements and how to administer (by dropper).
Discuss need for additional fluids during periods of hot weather and with fever, diarrhea, and vomiting.
Observe for evidence of common problems and intervene accordingly:
Overfeeding.
Underfeeding.
Difficulty digesting formula because of its composition.
Improper feeding technique; holes in nipples too large or too small; formula too hot or too cold; uncomfortable feeding position; failure to “bubble”; improper sterilization; bottle propping.
Bottles should never be given to infants to take to bed.
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Infant |
3 months-1 year overview
3-6 months
6-12 months
Loses maternal iron stores at 6 months; first tooth erupts between ages 6 and 9 months; eyes and hands can work together; infant can sit without support and has developed grasp; can feed self a biscuit; bangs objects on table; able to hold own bottle between ages 9 and 12 months; can “pincer” grasp food; able to be weaned from bottle as child becomes developmentally able to take sufficient fluids from the cup.
Food provides the infant with a variety of learning experiences; motor control and coordination in self-feeding; recognition of shape, texture, color; stimulation of speech movement through use of mouth muscles.
Mealtime allows the infant to continue development of trust in a consistent, loving atmosphere. The infant is forming lifetime eating habits; it is therefore important to make mealtime a positive experience.
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Number of feedings per day decreases through the first year.
By ages 4-6 months, generally ready to begin strained foods. The usual sequence of foods is cereal followed by fruits and vegetables. Meats may be started between 8 and 9 months. Sequence may vary according to preferences of the family and health care provider.
Mashed table foods or junior foods are generally started between ages 6 and 8 months, when infant begins chewing action.
Infant begins to enjoy finger foods between ages 10 and 12 months.
The transition from iron-fortified formula or breast milk to cow’s milk is usually advised at about age 12 months.
By age 1 year, most infants are satisfied with three meals and additional fluids throughout the day.
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The person feeding should be calm, gentle, relaxed, and patient in approach.
When first offered puréed foods with a spoon, the child expects and wants to suck. The protrusion of the tongue, which is needed in sucking, makes it appear as if the child is pushing the food out of the mouth. This response should not be interpreted as dislike for the food; it is a result of immature muscle coordination and surprise at the taste and feel of the new food.
The baby foods selected should be high in nutrients without providing excessive calories. Personal and cultural preferences should be considered. Iron-fortified formulas and cereals are needed to prevent physiologic anemia.
New foods should be offered one at a time and early in the feeding while the infant is still hungry. Allow 3-5 days between new foods.
Infants should be observed for allergic reactions when new foods are added. Common allergies are to citrus juices, egg whites, cow’s milk, and peanut butter. These foods should be avoided until age 12 months. Also avoid honey until age 12 months due to the risk of infantile botulism.
Finger foods should be selected for their nutritional value. Good choices include teething biscuits, cooked vegetables, bananas, cheese sticks, and enriched cereals. Avoid nuts, raisins, and raw vegetables, which can cause choking.
Parents can be taught to prepare their own strained or junior foods using a commercial baby food grinder or blender.
Weaning is a gradual process.
Assist parents to recognize indications of readiness.
Do not expect the infant to completely drop old pattern of behavior while learning a new one; allow overlap of old and new techniques.
Evening feedings are usually the most difficult to eliminate because the infant is tired and in need of sucking comfort.
During illness or household disorganization, the infant may regress and return to sucking to relieve his or her discomfort and frustration.
 NURSING ALERT Obtain a thorough nursing history for the hospitalized infant that includes feeding pattern and schedule; types of foods that have been introduced; likes and dislikes; breast- or bottle-fed, type of bottle; temperature at which infant prefers foods and fluids.
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Toddler
1-3 years
Growth slows at the end of the first year. The slower growth rate is reflected in a decreased appetite.
The toddler has a total of 14-16 teeth, making him or her more able to chew foods.
Increased self-awareness causes the toddler to want to do more for self. Refusal of food or of assistance in feedings are common ways in which the toddler asserts him- or herself.
Because body tissues, especially muscles, continue to grow quite rapidly, protein needs are high.
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Transition from a bottle to a cup at age 1 is recommended to prevent tooth decay.
Appetite is sporadic; specific foods may be favored exclusively or refused from time to time.
Child may be ritualistic concerning food preferences, schedule, and manner of eating.
Diet should include a full range of foods: milk, meat, fruits, vegetables, breads, and cereals. Iron-fortified dry cereals (rice, barley) are an excellent source of iron during the second year of life.
Older toddler can be expected to consume about one half the amount of food than an adult consumes.
Whole milk is recommended up to age 2 years.
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Provide foods with a variety of colors, textures, and flavors. Toddlers need to experience the feel of foods.
Offer small portions. It is fun for the child to ask for more. It is more effective to give small helpings than to insist that he or she eat a specific amount.
Maintain a regular mealtime schedule.
Provide appropriate mealtime equipment:
Silverware scaled to size.
Dishes—colorful, unbreakable; shallow, round bowls are preferable to flat plates.
Plastic bibs, placemats, and floor coverings permit a relaxed attitude toward child’s self-feeding attempts.
Comfortable seating at good height and distance from table.
Adults who help toddlers at mealtime should be calm and relaxed. Avoid bribes or force-feeding because this reinforces negative behavior and may lead to a dislike for mealtime. Encourage independence, but provide assistance when necessary. Do not be concerned about table manners.
Avoid the use of soda or “sweets” as rewards or between-meal snacks. Instead, substitute fruit, juice, or cereal.
Toddlers who show little interest in eggs, meat, or vegetables should not be permitted to appease their appetite with carbohydrates or milk because this may lead to iron-deficiency anemia. Milk should be limited to approximately 16 ounces/day.
 NURSING ALERT Nursing history for the hospitalized toddler should include feeding pattern and schedule; food likes and dislikes; food allergies; special eating equipment and utensils; whether child is weaned; what child is fed when ill.
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Preschooler
3-5 years
Increased manual dexterity enables child to have complete independence at mealtime.
Psychosocially, this is a period of increased imitation and sex identification. The preschooler identifies with parents at the table and will enjoy what parents enjoy.
Additional nutritional habits are developed that become part of the child’s lifetime practices.
Slower growth rate and increased interest in exploring his or her environment may decrease the preschooler’s interest in eating.
Eating assumes increasing social significance. Mealtime promotes socialization and provides the preschooler with opportunities to learn appropriate mealtime behavior, language skills, and understanding of family rituals.
 NURSING ALERT Consider cultural differences. Allow parents to bring in favorite foods or eating utensils from home for the hospitalized preschooler. Encourage family members to be present at mealtime.
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Appetite tends to be sporadic.
Child requires the same basic four food groups as the adult, but in smaller quantities.
Generally likes to eat one food from plate at a time.
Likes vegetables that are crisp, raw, and cut into finger-sized pieces. Often dislikes strongtasting foods.
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Emphasis should be placed on the quality rather than the amount of food ingested.
Foods should be attractively served, mildly flavored, plain, as well as being separated and distinctly identifiable in flavor and appearance.
Nutritional foods (eg, crackers and cheese, yogurt, fruit) should be offered as snacks.
Desserts should be nutritious and a natural part of the meal, not used as a reward for finishing the meal or omitted as punishment.
Unless they persist, periods of overeating or not wanting to eat certain foods should not cause concern. The overall eating pattern from month to month is more pertinent to assess.
Frequent causes of insufficient eating:
Unhappy atmosphere at mealtime.
Overeating between meals.
Parental example.
Attention-seeking.
Excessive parental expectations.
Inadequate variety or quantity of foods.
Tooth decay. Physical illness.
Fatigue.
Emotional disturbance.
Measures to increase food intake:
Allow child to help with preparations, planning menu, setting table, and other simple chores.
Maintain calm environment with no distractions.
Avoid between-meal snacks.
Provide rest period before meal.
Avoid coaxing, bribing, threatening.
Place children in small groups, preferably at tables during mealtime. Use nursing history to determine likes and provide simple foods in small portions. Peanut butter and jelly sandwiches are often favorites. Allow and encourage children to feed themselves. Do not punish children who refuse to eat. Offer alternative foods.
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School-age Child
Slowed growth rate during middle childhood results in gradual decline in food requirements per unit of body weight.
The preadolescent growth spurt occurs about age 10 in girls and about age 12 in boys. At this time, energy needs increase and approach those of the adult. Intake is particularly important because reserves are laid down for the demands of adolescence.
The child becomes dependent on peers for approval and makes food choices accordingly.
The child experiences increased socialization and independence through opportunities to eat away from home (eg, at school and homes of peers).
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By this time, food practices are generally well established, a product of the eating experiences of the toddler and preschool period.
Many children are too busy with other affairs to take time out to eat. Play readily takes priority unless a firm understanding is reached and mealtime is relaxed and enjoyable.
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Nutrition education should help the child to select foods wisely and to begin to plan and prepare meals.
Parental attitudes continue to be important as the child copies parental behavior (eg, skipping breakfast, not eating certain foods, consuming fast foods frequently).
Most children require a nutritious breakfast to avoid lassitude in late morning.
Mealtime should continue to be relaxed and enjoyable. Diversions, such as television, should be avoided.
Calcium and vitamin D intake warrant special consideration. They must be adequate to support the rapid enlargement of bones.
Parents and health care professionals should be alert to signs of developing obesity. Intake should be altered accordingly.
Table manners should not be overemphasized. The young child typically stuffs mouth, spills food, and chatters incessantly while eating. Time and experience will improve habits.
Provide some companionship and conversation at the child’s level during meals. Peers should be invited occasionally for meals.
 NURSING ALERT Nursing history of the hospitalized child should include food preferences; mealtime patterns and snacks; food allergies; food preferences when ill. Provide opportunities for children to eat in small groups at tables. Consider cultural differences. Allow parents to bring in favorite foods from home. Allow child to order his or her own meal.
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Adolescent
11-17 years
Dietary requirements vary according to stage of sexual maturation, rate of physical growth, and extent of athletic and social activity.
When rapid growth of puberty appears, there is a corresponding increase in energy requirements and appetite.
Menstruating teen is particularly susceptible to iron-deficiency anemia.
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Previously learned dietary patterns are difficult to change.
Food choices and eating habits may be quite unusual and are related to the adolescent’s psychological and social milieu.
Generally, a significant percentage of the daily caloric intake of the adolescent comes from snacking.
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Continue nutrition education, with emphasis on:
Selecting nutritious foods high in iron.
Nutritional needs related to growth.
Preparing favorite “adolescent foods.”
Foods and physical fitness.
Informal sessions are generally more effective than lectures on nutrition.
Special problems requiring intervention:
Provide nutritious foods relevant to the adolescent’s lifestyle.
Discourage cigarette smoking, which may contribute to poor nutritional status by decreasing appetite and increasing the body’s metabolic rate.
 NURSING ALERT Allow hospitalized adolescent to choose own foods, especially if on a special diet. Provide a refrigerator in the recreation room for snacks or utilize a snack cart. Serve foods that appeal to adolescents. Use a nursing history similar to that for the school-age child.
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Evidence Base
Evidence Base
NURSING ALERT
Evidence Base
NURSING ALERT
Evidence Base
NURSING ALERT
Evidence Base
Evidence Base
