Nutrition in Children: NORCET Revision Notes

1. Breastfeeding Highlights

• Colostrum: Secreted for first 1-3 days. Rich in Secretory IgA (mucosal immunity) and beta-carotene (yellow color).
• Foremilk vs. Hindmilk: Foremilk is watery/protein-rich (satisfies thirst). Hindmilk is fat-rich (satisfies hunger/satiety).
• Storage (Expressed Milk): Room temp: 6-8 hours. Fridge: 24-48 hours. Freezer: 3-6 months.
• Absolute Contraindication: Infant Galactosemia (requires soy formula).

2. Weaning (Complementary Feeding)

• Initiate at exactly 6 months (180 days) due to depletion of fetal iron stores.
• First Foods: Rice kanji or mashed banana (gluten-free).
• Avoid <1 Year: Cow’s milk (causes GI micro-bleeding and iron deficiency) and Honey (risk of infant botulism).

3. Protein Energy Malnutrition (PEM)

Feature	Marasmus (Energy Deficit)	Kwashiorkor (Protein Deficit)
Age Group	< 1 Year	1 – 3 Years
Edema	Absent	Present (Pitting)
Classic Signs	Monkey facies, severe wasting	Flaky paint dermatosis, Flag sign (hair)

• MUAC Assessment: < 11.5 cm indicates Severe Acute Malnutrition (SAM).
• SAM Management: F-75 diet for Stabilization. Iron is withheld during stabilization to prevent bacterial overgrowth.

4. Vitamin Deficiency Disorders

• Vitamin A: Earliest sign is Night Blindness. Classic sign: Bitot’s spots. Total prophylactic dose: 17 Lakh IU (9 doses up to 5 years).
• Vitamin D (Rickets): Earliest sign is Craniotabes (ping-pong skull). Other signs: Rachitic rosary, Harrison’s sulcus, bow legs.
• Vitamin C (Scurvy): Defective collagen. Causes bleeding gums and pseudoparalysis (frog-leg posture) due to painful subperiosteal hemorrhages.

5. Common Feeding Problems

• GERD: Physiologic in infants. Manage with frequent burping and upright positioning for 30 mins post-feed.
• Infantile Colic: Diagnosed by Wessel’s Rule of 3 (>3 hours/day, >3 days/week, >3 weeks).
• Pica: Craving non-nutritive substances. High association with Iron-deficiency anemia and risk of Lead poisoning.