Nutritional Counseling
Nutritional Counseling

Nutritional Counseling

In pediatric consultations, we advise on the concept of healthy and healthy eating, and we accompany families in the nutritional changes that the different stages of the pediatric age entail.

Our goal is that all families have sufficient information and knowledge so that they can offer their children a varied and balanced diet that includes food from all groups.

Nutritional needs in childhood

Why is infant nutrition so important? Because nutritional needs in childhood are high and at the same time the risk of deficiencies may be greater. Because the child’s organism is not yet mature and the imbalances have a greater impact and can cause irreversible alterations. Because it determines eating habits, which will be difficult to change in the future. And finally, because healthy eating is synonymous with well-being, proper growth, and development of the child.

The feeding of the little ones is perhaps the most controlled because the knowledge about their nutritional needs is superior to those of the needs of other ages.

Growth requires important contributions of nutrients. Both excesses and deficiencies can cause problems in childhood and later ages. Different studies show that children need to consume more nutrients but with a lower amount of calories. If a child receives a food equal in quantity and quality to that of the adult, it will reach a caloric excess that can trigger an obesity process. On the other hand, if you consume the same foods but to a lesser extent, vitamin and mineral contributions will be insufficient, causing growth and development problems.

Meal Distribution

The distribution of meals or caloric intake in the children’s diet is characteristic: 5 shots are recommended for the little ones (20% at breakfast, 10-15% at mid-morning, 25-30% at lunch, 10-15 % in the afternoon snack and 25% in the dinner) and gradually going to 4 shots per day as for the rest of the population (25% at breakfast, 30% at lunch, 15% at snack and 30% in the Dinner). We must keep in mind that the digestive system of children will work best with small amounts of food distributed throughout the day. Nor should you be without eating for long periods of time, because your metabolism is not trained for fasting.

Nutrient intake

Child feeding guidelines require a varied diet. In childhood, restrictive diets should be avoided (vegetarian, dissociated, etc.). The child should eat the different types of food from each group, even in moderate portions.

Dairy products

Milk and skimmed milk products are not recommended during childhood as they can lead to deficiencies in fat-soluble vitamins or essential fatty acids and low caloric intake.

Protein

Infant feeding should be rich in protein. They will only have to be controlled if there is an associated problem: food allergies or other diseases.

Vitamins and minerals

Obesity and sedentary lifestyle in children can be related to incorrect contributions of vitamins and minerals, essential for the maintenance of growth and functional capacity.

Calcium is essential to achieve optimal bone mineralization (its contribution will also partially condition the chances of suffering osteoporosis in adulthood) and to prevent tooth decay and other periodontal problems. In the period of rapid growth (first year of life and adolescence) it requires between two and four times more calcium/kg than in the adult stage. Dairy products are responsible for providing the necessary amount of this mineral.

In areas with non-fluoridated water, a systemic fluoride supplement is considered correct before the dental eruption (never before 6 months), as a strategy to prevent the appearance of decay from an early age.

Vitamin D should be controlled in sunny places or in children who are hospitalized or at home due to health problems. The skin exposed to the sun is what allows the synthesis of this vitamin, essential for the absorption and deposition of calcium in the bones.

Iron is the mineral that allows the rapid growth of children. The introduction of meat into the diet during early childhood helps prevent anemia at later ages.

Except in the case of fluoride, nutritional supplements are only justified in children with diagnosed deficiencies of certain nutrients. In any case, if there is supplementation, the maximum limit for which safety has been demonstrated should never be reached, taking special care with fat-soluble vitamins.

Nutrition by Ages

The recommended feeding guidelines in infants from 0 to 4 months, infants from 4 to 8 months, children from 8 months to one year and from one to 3 years are set out below.

The meat is introduced from the seventh month, mixed with the vegetable (about 40-50 g)

Infant child from 0 to 4 months

At this stage of life, the child does not have teeth yet, so that food must be administered primarily in liquid form. It will be around 6 months when the first teeth will appear. In addition, the swallowing of food is also reduced, so the incorporation of solids up to 6 months is not recommended.

The baby should double his weight between the fourth and sixth month. This objective can be achieved through three types of breastfeeding: maternal, artificial and mixed.

Breastfeeding

Breast milk contains all the necessary nutrients for the growth and development of the infant. The composition of the milk varies throughout the intake. First, the milk is liquid and rich in sugars; later it is creamy, more caloric and protein; At the end of the milk, the milk contains 5 times more fat than initially. The composition of breast milk is a reference in the manufacture of artificial milks.

The duration of the shots is variable for each child, some need between 20 and 30 minutes, others instead have finished in 5. It is recommended to first give one breast until you no longer want and then pass to the other, although you will not always accept it. In the next shot, it is advisable to start with the last chest you have taken to get the correct emptying. In a few days, a balance is established between the mother’s milk production and the baby’s needs.

You can set two types of schedules. Lately, a pediatrician in Noida recommends the so-called demand method, which is that the child breastfeed whenever he asks for it, so it is the mother who adapts to the baby’s demand. The other method is to make the baby wait approximately 3 hours between each shot. If possible, this last method is very useful for the mother, as it leaves her time to recover in every way, and also prevents any crying of the baby to calm down with breastfeeding without taking into account many times that it may be due to other circumstances (cold, heat, problems falling asleep, etc.).

Breast milk can be stored, and so the baby can be fed even if the mother is not present. Milk should be extracted and stored in plastic bags designed for this use. Fresh milk lasts in the refrigerator for 3 days at 4 ° C; once thawed only 24 hours. To defrost it, place the necessary amount in the refrigerator the night before. Warm water can also be used, but never hot water (can destroy immune components of milk), or microwaves (can change the composition of milk).

Artificial lactation

Artificial milk is obtained from modifications in cow’s milk, from the breast milk model. There are two types of formula: start and continuation formulas. The initial ones are normally used in the first 6 months of life, and then go on to the continuation ones.

The bottles are prepared by mixing 30 ml of water (previously boiled for 10 minutes) by a level measure of the milk powder. Each container comes with its dosing measure. The child should always eat immediately after preparing the bottle and leftovers should be neglected. Tools used in artificial feeding will always be sterilized. It is necessary to keep the milk containers tightly covered and refrigerated; once opened they must be consumed within a month.

You cannot set an exact amount of milk to make a bottle since each child has different needs. The amount should be adapted to the needs of the baby, always trying to give the minimum amount of milk, enough to be satisfied. The amounts recommended by each manufacturer in the packaging of powdered milk can be indicative, but it would be a mistake to strive to follow them to the letter.

Some bottle-fed children, after a while, do not have enough with artificial milk, and in these cases a cereal-based supplement is necessary. The amount added must be the minimum so that the child is satisfied. Usually, one or two teaspoons of dessert will suffice. Gluten-free cereals are advised in children younger than 7 months to avoid the early onset of celiac disease.

Mixed breastfeeding

It is used in cases where breastfeeding is insufficient and a supplement in the form of artificial milk is necessary. You should always start with breastfeeding and then continue with a lower dose than recommended for the age of artificial feeding. Initially, this combination is advised only at night. Later, if the parents observe that the baby goes hungry during the day, a supplement will be given after each blowjob. As it is easier for the child to take artificial lactation, it is recommended to use a spoon with this milk so as not to have to stop breastfeeding too soon.

Infant child between 4 and 8 months

Exclusive use of breast milk is not convenient from the fifth and sixth month. The nutritional needs of the baby require the introduction of a complementary diet. In the case of children who are still breastfeeding, it is advisable to use continuation formulas from approximately 7 months, which can last up to 3 years.

As of the fifth month, the child’s energy needs tend to increase. Then you can introduce cereal flours that initially should be gluten-free and sugar-free. They usually contain corn, soy, rice, and tapioca. The porridge can be prepared with formula milk or with breast milk, thus maintaining the recommended daily supply of milk. These flours should be slowly incorporated into the child’s diet to avoid digestive problems, due to the immaturity of pancreatic amylase. The first shots can be started by adding 1-2 teaspoons / 100 ml, to gradually increase it to 5-7 teaspoons / 100 ml.

During this period, a couple of shots that were previously used by breast milk or a bottle for another type of feeding will usually be substituted (one of these two shots will always be fruit-based). Any change in food will be made progressively.

Generally, the fruit is first incorporated, and it is customary to prepare it in the middle of the afternoon. Some pediatrician doctor in Noida recommends its introduction from the fourth month, while others do so after the fifth. You can start with a few small tablespoons of orange juice, later you will prepare a porridge based on two or three fruits: initially orange, banana, apple and pear (half of each piece). A type of fruit other than orange can be added every day to see if the child tolerates each of them. Later melon, grape, apricot, and plum can be incorporated. Cherries, strawberries, and blackberries should not be incorporated until the year because they are very fibrous. The fruit should not be green but rather ripe and must be peeled before crushing. It is usually well accepted by the child although initially, the person in charge of feeding the baby will need a good dose of patience and a lot of imagination to get the child to eat it with pleasure. The fresh fruit, in addition to providing natural vitamins to the food, contains cellulose, which will be responsible for avoiding constipation problems. There are other possibilities that we can count on: cereal porridge with fruit or fruit jars (taking into account its composition).

From the sixth month, the boiled and crushed vegetables will be introduced, prepared with potatoes, carrots, green beans, onions and a few drops of raw oil. Do not add salt. Spinach, chard, cabbage, and beet should not be introduced until after the ninth month because of its high nitrate content, which can cause methemoglobinemia. Nor can children under one year be given turnips or peas because they are very flatulent. The introduction of vegetables is difficult, due to their appearance and taste. Its fiber content also favors intestinal transit. Canned vegetables, which have excess salt and vitamin deficiency, are not advised.

As of the seventh month, cereals with gluten can be introduced: wheat, oats, barley, and rye. Once gluten is incorporated into the child’s diet, you can already eat bread and cookies. For this same reason, the food can be given in the form of soup, vegetable or meat, to which semolina, cornmeal, etc. can be added. so that it is more or less thick following the child’s tastes.

The meat is introduced from the seventh month, mixed with the vegetable (about 40-50 g). Boiled or grilled meat, chicken (skinless) and beef, which are high in iron and protein, will be used.

In this period the child usually eats approximately every 4 hours but during the night he is able to spend up to 8 hours without eating.

Child between 8 months and one year

Up to 12 months of age, the infant should receive a minimum daily amount of 500 ml of milk or derivatives.

A child fed with breast milk or well-prepared powdered milk (in sufficient quantity and not very concentrated) receives a quantity of water that fully meets their needs. A water supplement will be appropriate in certain circumstances: in hot weather if the child sweats a lot, or if he has a fever, vomiting or diarrhea.

The fish begins to take around 10 months for its potential antigenic power. It is interesting that it is fresh but should be consumed quickly to avoid alterations. Frozen fish has the same properties as fresh fish but sometimes it is drier and difficult to swallow. Lean fish: hake, flounder, whiting, etc. They are indicated at this age. Blue is not recommended because it is excessively fatty for this age. Fish is a source of protein, polyunsaturated fatty acids, and fat-soluble vitamins. It is prepared combined with the vegetable and cooked.

We will wait 10-11 months to introduce the egg, with high protein content, because it is very allergic (the white is more allergenic than the yolk). It should be taken cooked or tortilla, starting with the yolk. The clear will be introduced after the year.

Yogurt can begin to be given approximately after 9 months. It is a very suitable food in those children who have lactose intolerance. It can also be useful as a tolerated food after an acute diarrheal process from this stage. Fresh or soft cheeses can also be introduced from this age.

The homogenates are industrial preparations based on vegetables, meat, eggs, fish and fruits, cooked and vacuum packed. These products must be purchased carefully, reviewing the composition based on the child’s age and attending to the expiration date and their status. Once opened, they should be consumed immediately or stored in the refrigerator for a maximum of 48 hours.

Food can begin to come with some pieces without crushing so that the child begins to get used to feeling whole pieces of food in the mouth.

During this period, the child’s diet is distributed in 4 meals, although optional administration of a bottle is frequent. At night, the child begins to get used to sleeping about 10 hours in a row without interruption.

1 to 3-year-old child

Dairy products continue to be the staple in the child’s diet between 1 and 3 years. It is recommended that they cover 30% of the total energy needs of the child, which is equivalent to consuming 500-600 ml of milk a day or, which is the same, 2-3 glasses. Nor should excessive consumption of milk, as it can cause loss of appetite and excess fat intake.

Cow’s milk can begin to be used from 12 months of age, but continuation milk powder is recommended at least up to 2 years because among other reasons it is richer in iron. If cow’s milk is used, it should be boiled at least 5 minutes before use, even if it is pasteurized or sterilized bottled milk.

From this moment on, the diet should be almost as varied as that of an older child. Some examples of foods that can be administered:

Vegetable puree (lentils, chickpeas, peas, beans). It is still necessary to administer it in the form of puree because the intestine of young children is not yet able to destroy the fibrous skin of these legumes.

Rice and all kinds of pasta: noodles, macaroni, etc. They are boiled and then you can add natural tomato sauce, grated cheese, bechamel sauce, etc. They can also be added to a chicken or meat and vegetable stock.

Cream of vegetables based on spinach, chard, peas, etc.

Croquettes of all kinds: ham, chicken, beef, fish, cod, etc.

Minced meat used in various ways: in meatballs, hamburgers, filling empanadillas, etc.

Beef steaks (veal, chicken) and diced fish. Fatty meats should be avoided.

Sausages are not advised because of their high saturated fat content. Only York ham and Serrano ham can be used once or twice a week.

The eggs will be given mainly in the form of a small tortilla, avoiding fried eggs. It is recommended to administer one to three eggs a week.

Introduce salads for their vitamins: lettuce, tomato, carrot, onion, cucumber, etc. Initially, the olives will not be introduced.

Bread must be present in the child’s daily diet.

As for dessert: the fruit of the time. We can give the fruit in different ways: grated, in juice, in the form of smoothie, compote, small pieces, etc. You should take at least two pieces of fruit a day, one of them citrus (orange, tangerine, kiwi) for the contribution of vitamin C.

It is a good time to introduce water as an indispensable drink.

Occasionally the child can take custard, custards and commercial ice cream, but taking into account that they are not a substitute for the fruit.

It is not advisable to give children under 3 years: almonds, hazelnuts, pipes, roasted corn, candies or similar because there is a risk of choking or suffocation.

Sugar should be eliminated as much as possible because it causes cavities

Foods advised against in children under 3 years: fat pastry, chocolate in large quantities, fried, sugary drinks and exciting drinks (cola, coffee, and tea).

When cooking it is recommended to use olive oil and avoid excess batters.

Children over 3 years old

According to the Guide on infant feeding of Requejo and Ortega (1993), the best way to follow a healthy diet is the variety, consuming everyday food from all groups.

The feeding of children should be varied. During the first two decades of life, restrictions should be avoided. If the child being healthy is overweight, we should recommend an increase in physical activity and not restrict the intake of calories by the system, as it could affect their growth, deteriorating their physical and intellectual performance. If for health reasons, it is necessary to solve an obesity problem, one should never act drastically but gradually and with planned measures, following the orders of the medical specialist. You should always control the consumption of salt, candy, fats, and refreshing drinks. In childhood, you should never drink alcohol.