TOTAL CALORIC REQUIREMENT

RDA (Age)WtKcal/kgCHON (g/kg)

0-5 mos3-61153.5

6-11 mos7-91103

1-2 y10-121102.5

3-6 y14-1890-1002

7-9 y22-2480-901.5

10-12 y28-3270-801.5

13-15 y36-4455-651.5

16-19 y48-5545-501.2

TCR= Wt (kg) x cal (kcal/kg) Conversion factors to calories (kcal/g) CHON 4, CHO 4, Fats 9

Determine TCR in grams, then convert to calories TCR CHON= CHON (g/kg) x ABW (kg)

Subtract TCR CHON from TCT TOT then get fraction of CHON & fats (60:40) Order: ex 1100 kcal= 25 g 150g 45 g TCR CHON CHO fats

RDA ADJUSTMENT (MALNOURISHED) CATCH UP CALORIES

Adjusted RDA= RDA for age x wt at 50%-ile or IBW for ht actual weight

Adjusted TCR= adjusted RDA x actual weight

Total Caloric intake= cal x amount of intake (oz)

Gastric capacity= age (mos) + 2

Gastric emptying time= 2-3 hours

Other caloric values 1 oz= 30 cc 1 tbsp= 15 cc 1 tsp= 5 cc

Cane/ table sugar 20 kcal/ 5 cc/ 120 kcal/ozD5W 20 kcal/100 ccD10W 40 kcal/100 ccKaro 4 kcal/cc

BREASTMILK

Colostrum- 1st 2-4 days post partum High in CHON (globulin), vit, salt, Ig Low in fat and sugar

Foremilk Clear, thin, bluish, low salt, high H20

Hindmilk Thick, creamy, high fat (peaks at daytime)

Contraindication to BREASTFEEDING ABSOLUTE: galactosemia, tyrosinemia RELATIVE: psychosis, Active PTB

HUMAN MILK vs COWS MILK

HUMANCOW

Whey: casein60:4020:80

cysteinHigh

methionineLow

Fatty AcidPUFA and long chainSaturated

Linoleic AcidHIh

Lipase+-

DigestionEfficientStool losses

Lactose7% (sweetener)4.8%

Bifidus+-

Mineralsless

NATURAL MILK vs MILK SUBS

Average Human MatureCows market aveCows cvapPrep cowsSoy based

kcal/oz2220402020

CHON g/1001.13.33.82.01.7

CHO g/10074.85.47.37

Fat g/1003.83.74.03.23.7

Na meq/L6.525288.613

K meq/L14353915.018

Cl meq/L12293213.015

Ca++ mg/L3401.171.3594710

P+ mg/L1509201.1396510

Fe mg/L1.51.01.07.912

RDA vitamins and minerals

FAT SOLUBLE

Vit A (retinol)1800 IU/day

Vit D (cholecalciferol)400 IU/day

Vit E (tocopherol)4-5 IU/day

Vit K (phytoquinone)1-2 mg/day

WATER SOLUBLE

Vit B1 (thiamine) 0.5 mg/day

Vit B2 (riboflavin)0.5 mg/day

Vit B3 (niacin)6 mg/day

Vit B4 (folacin)50-100 ug

Vit B5 (biotin)

Vit B6 (pyridoxine)1-2 mg/day

Vit B12 (cyanocobalamine)0.3 ug/day

Vit C1st yr: 30 mg>1 yr: 35-75 mg

MINERALS

Calcium10 y: 0.7 g

Chloride0.5 g/day

Magnesium150-300 mg/day

PhosphorusSame as calcium

Potassium1-2 g/1.5 meq/kg (or 40 meqs/m2)

Sodium1-2 g or 2 meq/kg or 50 mg/m2

Iodine35-45 ug

IronInfant: 1 mg/kgKids: 10-18 mg

PROTEIN-CALORIE MALNUTRITION

MARASMUSKWASHIORKOR

EtiologyLow CHON and calLow CHON

Age0-2 y1-3 y

Edema-+

WastingGross loss of SC fatSometimes hidden

Growth Retardation+++/-

Mental changesApathetic, quietsIrritable, moaning

AppetiteGoodPoor

Skin ChangesSeldomDiffuse pigmentationPaint dermatosis

Hair changesseldomFlag sign

FaciesOld manMoon facies

OthersPot bellyWinged scapulaehepatomegaly

Albuminnormallow

AnemiauncommonMegaloblastic Iron deficiency

BODY WEIGHT

IBWKgLBS

At birth3 kg

3-12 mosAge 9mos) + 9/2Age (mos) + 10

1-6 yAge (y) x 2+8Age (y) 5+17

7-12 y[Age (y) x 7-5]/2Age (y) x 7 +5

IBW given BW

Age