PERMASALAHAN GIZI Budiyanti

Wiboworini
BADUTA, BALITA

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 CASE 1

Shana is 12 months old and has been growing at the 50th

percentile for weight and the 25th percentile for length
since early infancy.
She consumes formula from a botlle (24 oz per day of Enfamil
with iron), table and finger foods (e.g ., crackers, toast fingers,
cooked carrot sticks, cooked green beans,cheese
cubes,mashed potatoes,apple sauce and canned pears), and 12
to 14 oz of apple juice each day. (1 oz = 28 gram)
Shana's mother wonders if Shana is drinking enough formula
each day.

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Nutrition Diagnosis: Food and nutrition-related knowledge
deficit related to questions concerning adequacy of formula
intake as evidenced by current inake of 24 oz infant formula
each day.
1. Do you need additional information to accurately assess
Shana's nutrient intake?
2. Do you think Shana is drinking enough formula each day?
What, if any, changes would you suggest to her mother?
3. How would you evaluate the foods of fered to Shana in terms
of her motor development? Her oral health ? Her growth?
The adequacy of her nutrient intake?
4. What suggestions might you make to Shana's mother so
that she can use food to support Shana's developmental
progress?

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 CASE 2

Lela is a l2-week-old female infant who was born by cesarean

section at 42 weeks' gestation to an l8 -year-old unmarried
mother.
Her mother gained 70 lb (1 lb/ libras/ pound = 0,45 kg) during the
pregnancy.
Lela's weight-for-length is plotted at the 95 th percentile, and her
length and weight continue in the same channels as at birth.
Lela's mother chose to feed Lela infant formula rather than breast-
feed. Lela is offered Similac with iron that is prepared with I scoop
of powder mixed in 2 oz of water. Lela consumes about six 8-oz
botlles per day and is fed on demand.
She usually sleeps during the night, but if she is fussy, her mother
gives her small amounts of commercially prepared infant cereal,
vegetables, and fruit

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Nutrition Diagnosis: Excessive oral food./beverage intake
related to using foods to soothe baby as evidenced by weight for
height above 95d percentile for age.
1. What additional information is needed to get an accurate
assessment of this infant's intake?
2. When you assess Lela's growth, what are your expectations
for her growth rate? Do you have concerns about her rate of
growth?
3. What is Lela's estimated energy intake? Is this appropriate?
4. The American Academy of Pediatrics recommendations
suggest that the addition of complimentary foods be
delayed until after 4 months of age. How would you assess
Lela's readiness for semisolid foods? Which infant skills
would you assess in a feeding evaluation?

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 FOCAL POINTS

1. Infant growth, development and nourishment are integrally

related.
2. Human milk is the food of choice for infants ; commercially
prepared infant formulas, manufactured to approximate
human milk, also promote typical growth and development.
3. Nutrient needs of infants reflect rates of growth , energy
expended in activity, basal meabolic needs, and the
interaction of nutrients consumed.
4. Infants grow rapidly in the first year of life; thus the types of
infant feedings (human milk or formula), the composition of
feedings, and the addirion of solids to infans'diets have
immediate and long-term impact.

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5. The use of solid foods of appropriate type
and portion sizes support nourishment
and developmental progress and sets the
stage for lifelong food habits.
6. The use of solid foods (with thought given to
the types of foods and portion sizes
served) to support nourishment
developmental progresss sets the stage
for lifelong food habits that promote
appropriate growth and healthy food
choice
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 A NEW LOOK AT THE FOOD PRACTICES
OF INFANTS AND TODDLERS
Assuming that a variety of nutritious foods are of fered to
infants and toddlers, parents and caregivers should encourage
self-feeding without concern for compromising energy intake
and nutrient adequacy ( Carruth et al., 2004b).
Parents and caregivers should of fer a variety of fruits and
vegetables daily; sweets, desserts, sweetened beverages, and
salty snacks should be of fered only occasionally. Because
family food choices influence the foods of fered to infants ,
family -based approaches to healthy eating habits should be
encouraged (Fox et a1 .,2004).
By 24 months of age, 50% of toddlers were described as picky
eaters. When of fering a new food, caregivers need to be
willing to provide 8 to 15 repeated exposures to enhance
acceptance of that food (Carruth et al., 2004r).

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 Infants and toddlers have an innate ability to regulate energy
intake. Parents and caregivers should understand the cues of
hunger and satiety and recognize that coercive admonitions
about eating more or less food can interfere with the infant's
or toddler's innate ability to regulate energy intake (Fox et al.,
2006).
On average, infants and toddlers were fed seven times per
day, and the percentage of children reported to be eating
snacks increased with age. Snack choices for infants and
toddlers could be improved by delaying the introduction of
and limiting foods that have a low nutrient content and are
energ'y dense (Skinner et al., 2004).

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 FEEDING BEHAVIORS:
DEVELOPMENTAL AND LANDMARKS DURING THE
FIRST 2 YEARS OF LIFE
Developmental landmarks
Tongue laterally transfers food in
the mouth
Shows voluntary and
independent movements of the
tongue and lips
Sitting posture that can be
sustained
Shows beginning of chewing
movements (up and down
movements of the jaw)
Reaches for and grasps objects
with palmar grasp
Brings hand to mouth
Change indicated Examples of appropriate foods
Introduction of Tirna fish; mashed potatoes;
soft, mashed well-cooked, mashed
table food vegetables; ground meats in
gravy and sauces; soft, diced
fruit such as bananas,
peaches, and pears;
flavored yogurt
Finger feeding Oven-dried toast, teething
(large pieces biscuits; cheese sticks
of food) (Should be soluble in the
mouth to prevent choking)
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 FEEDING BEHAVIORS 2:
DEVELOPMENTAL AND LANDMARKS DURING THE
FIRST 2 YEARS OF LIFE
Developmental landmarks Change indicated
Voluntarily releases food Finger feeding (small
(refined digial [pincer] grasp) pieces
of food)
Shows rotary chewing pattern Introduction of food
of varied textures
from family menu
Approximates lips to rim of Introduction of cup
the cup for sipping liquids
Examples of appropriate foods
Bits of cottage cheese, dry
cereal, peas and other bite-
size vegetables; small pieces
of meat
Well-cooked, chopped meats
and casseroles; cooked
vegetables and canned fruit
(not mashed); toast; potatoes;
macaroni, spaghetti; peeled
ripe fruit
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