Essential Nutrition for growing child, How to calculate calorie need,

1. Nutrition in Toddlers
Dr. Nyi Nyi Kyaw
M.B,B.S (Ygn)
M.Sc (Nutrition & Dietetics) (Bedfordshire, UK)
Member of Nutrition Society (UK)

2. Introduction
• The toddler (ages 1 to 3) phase can often be challenging when it
comes to feeding.
• Several developmental changes occur at this time.
• Toddlers are striving for independence and control.
• Their growth rate slows down and with this comes a decrease in
appetite.

3. Calorie Needs
• Depending on their age, size, and activity level, toddlers need about
1,000–1,400 calories a day.
• Calorie Requirement (1989, RDA)
- 1-3 year - 102 kcal/kg
- 4-6 year - 90 kcal/kg
- 7-10 year - 70 kcal/kg
Example - 2 years old child with 10 kg needs 1020 kcal per day.

4. Method For Calorie Calculation
• Schofield Energy Equation formula (for BMR)
Boy
Girl
Age Equation (kcal/day) SEE
< 3 59.512 × W - 30.4 70
3–10 22.706 × W + 504.3 67
Age Equation (kcal/day) SEE
< 3 58.317 × W - 31.1 59
3–10 20.315 × W + 485.9 70

5. Activity Factors (AF, Thermogenesis)
• Bedbound, immobile + 10% of BMR
• Bedbound, mobile or sitting + 15-20% of BMR
• Mobile, on ward + 25 % of BMR

6. Stress Factors (Disease Factors)
Todorovic & Micklewright 2004
• Brain Injury 0-50% of BMR
• Cerebral Haem 30%
• CVA 5%
• COPD 15-20%
• Infection 25-45%
• IBD 0-10%
• ICU 0-60%
• Leukemia 25-34%
• Lymphoma 0-25%
• Pancreatitis 3-10%
• Sepsis / Abscess 20%
• Solid Tumors 0-20%
• Transplantation 20%
• Surgery 5-40%

7. •TEE (Total Energy Expendicture) = BMR + AF + SF

8. HOLIDAY-SEGAR METHOD
(Fluid Maintenance )
First 10kg = 100ml per kg in 24 hrs
Second 10kg = 50ml per kg in 24hrs
Other kg (or remaining kg) = 20ml per kg in 24 hrs.

10. Calorie Distribution
• Carbohydrate - 45-65 % of total calorie intake
• Protein - 10-35 % of total calorie intake
• Fat - 20-35 % of total calorie intake
To achieve the BALANCE DIET

11. Macronutrient Distribution

12. Protein Requirement for Toddler
• Protein Distribution is 10-35% of total calorie requirement
• Easy way to Calculate protein requirement
- 1-3 years - 1.05 g/kg/day
- 4-13 years – 0.95 g/kg/day (2005, RDA)
Example – 15 kg, 2 years old child needs 15.75 grams of protein per day

13. Protein source
• Whey Protein (predominant protein in Human Milk)
• Egg
• Fish
• Milk and Dairy Products
• Beef
• Chicken
• Soy
• Legumes

14. Protein Ranking
From Highest to Lowest quality of protein

15. Serving size
Animal Protein (Meat and Fish) contain 7 grams of protein in following
serving
- 1 ounce (or) 30 grams (or) 2 ticals

16. Serving Size
• Plant protein (soy bean and legumes) yield 7 grams of protein in
½ cup. (cooked)

17. Serving Size
• Milk and Dairy products provide 8 grams of protein in following
serving size.
- Milk - 240 ml (1 glass)
- Yogurt - 160 ml
- 1/3 cup shredded cheese
- 1 cup pudding made from milk
- 1 cup of soy milk

18. Essential Fatty Acid
The Essential Fats are a group of fatty acids that are essential to
human health.
• Omega-3 (ω3) – Linolenic acid
• Omega-6 (ω6) – Linoleic acid

19. Omega 3 Source
• Walnuts
• Wheat germ oil
• Flaxseed oil
• canola oil
• Fish liver oils
• Fish, eggs, Human Milk
• Seafood, Fatty fish
• Tuna
• Mackerel
• Salmon
• Sardines

20. Omega 6 Source
• Corn oil
• Peanut oil
• Cottonseed oil
• Soybean oil
• Many plant oils

21. Different Source of Omega 3 and 6

22. Serving Size for Essential Fatty Acid

23. DHA
• Docosahexaenoic acid (DHA) is an omega-3 essential fatty acid
• DHA is an important constituent of the brain cell membrane, which
have a role in neurotransmission
• Benefits in vision and brain function

25. DHA is one of the primary structural component of brain tissue and retina

26. Recommended food intake according to Age and Gender

27. Micronutrients
• Zinc
• Iron
• Calcium
• Vitamin D

28. Zinc
• Recommended Daily Allowance (RDA) - 3-5 milligrams per day
• Zinc deficiency can occur if there is not a high enough consumption
from diet
• Deficiency can lead to growth impediments and increased risk of
infection.
• During pregnancy and lactation, women may need extra zinc.

29. Benefits of Zinc
• Zinc and regulating immune function – need to activate T cell
• Zinc for treating diarrhea
• Zinc effects on learning and memory
• Zinc to treat the common cold

30. Source of Zinc
• Beans
• Beef (lean)
• Lobster, Oyster, Crab
• Pork loin (lean)
• Rice
• Peas
• Yogurt
• Pecans, Peanuts

31. Iron
• Recommended Daily Allowance (RDA) – 7-10 mg per day
• In iron deficiency - Slow weight gain.
- Pale skin.
- No appetite.
- Irritability (cranky, fussy).

32. Iron Rich Food
• Meats: Beef, lamb, pork, veal, liver, chicken, turkey.
• Fish
• Eggs
• Grains and cereals: Iron-fortified cereals, whole grain breads,
enriched bread, pasta and rice.
• Legumes: chick peas, lentils, dried peas and beans.
• Vegetables: spinach, broccoli, watergrass

33. • To help prevent iron deficiency:
• Limit your child's milk intake to about 16–24 ounces a day (2 to 3
cups).
• Serve more iron-rich foods
• When serving iron-rich meals, include foods that contain vitamin C
(like tomatoes, broccoli, oranges, and strawberries), which improve
the body's iron absorption.
• Continue serving iron-fortified rice and cereal until your child is 18–24
months old

34. Calcium
• Recommended Daily Allowance (RDA) - 700 mg per day

35. Calcium Rich Food
• Two servings of dairy will easily add up to the 500 milligram daily goal
of calcium for toddlers. Each of the following counts as one serving:
• 1 cup of milk
• 1 cup of yogurt
• 1½ ounces of natural cheese, like cheddar or Swiss
• 2 ounces of American cheese
• 1 cup of ice cream or frozen yogurt

36. Vitamin D
• Recommended Daily Requirement – 10 umg or 400 IU per day
• Food Source – egg yolk, Organ meat, Red Meat and Oily Fish, fortified
products
• Sunlight exposure – 5-10 min per day (between 10 am to 3 pm)

38. • Avoid battles over food and meals.
• Provide regular meals and snacks.
• Be flexible with food acceptance
• Be realistic about food amounts. Portion size should be about one-
fourth the size of an adult portion.
• Limit juice intake; encourage whole fruit instead.
• Dessert should not be used as a reward.

39. Make the food easy for your toddler to eat:
• Cut food into bite-size pieces.
• Make some foods soft and moist.
• Serve foods near room temperature.
• Use ground meat instead of steak or chops.
• Use a child-size spoon and fork with dull prongs.
• Seat your child at a comfortable height in a secure chair.

40. Prevent choking by:
• Slowly adding more difficult-to-chew foods.
• Avoiding foods that are hard to chew and/or swallow such as nuts, raw
carrots, gum drops, jelly beans, and peanut butter (by itself).
• Modifying high-risk foods: cut hot dogs in quarters, cut grapes in quarters,
and cook carrots until soft.
• Always supervising your child when he or she is eating.
• Keeping your child seated while eating.

41. Take Home Message
• Calorie Requirement according to age
• Protein Requirement according to age
• RDA for Zinc - 3-5 mg
• RDA for Iron - 7-10 mg
• RDA for Calcium - 700 mg
• RDA for Vitamin D - 10 umg or 400 IU
• How to prevent choking

42. Thank You