Manifestations of Gastrointestinal Disease in the Child

Gastrointestinal Disease in the Child 705
4.3 Infant Feeding
Exclusive breast feeding is recommended until six months of age with
breast feeding continued at least another six to 12 months or longer. Fruit
juice should be limited so as not to interfere with the intake of breast milk
(or iron-fortified formula). Whole cow’s milk should preferably not be
introduced until 12 months of age. It is recommended that solids be started at
six months if the child is neurologically and gastrointestinally mature enough
to support their intake. Signs of readiness include: disappearance of the extrusion
reflex, hand-to-mouth movements and ability to sit with support. Iron-fortified
cereals are currently recommended as the first foods since iron stores may
be depleted by this time. At one year of age children should be eating 70%
liquids and 30% solids for their total caloric intake.
In the second year of life children should be offered small frequent nutritious
and energy-dense feedings of a variety of foods from the different food
groups. By age one to two years, the rate of weight gain slows and the toddler
often begins to appear leaner. It is important that these normal patterns of
growth are recognized so that conflicts about meals and eating and consequent
poor-eating behaviors do not develop. Parents and caregivers should be
encouraged to recognize and respond appropriately to their toddler’s individual
verbal and non-verbal hunger cues as well as to satiety cues.
4.4 Pathophysiology
Delayed or abnormal growth usually results from an imbalance between nutrient
availability and requirements. Less commonly, in some children with adequate
nutrient availability there may be impaired utilization of calories. Children with
various metabolic, endocrine and genetic conditions will have abnormal growth
because of the inability to utilize nutrients for growth at the cellular level.
4.5 Clinical Evaluation
The key to diagnosing whether a child has inadequate growth is to accurately
measure and plot weight, height and head circumference and then assess the
trend. One approach to the differential diagnosis of inadequate growth is
based on the pattern of deviance of weight, height and head circumference on
the growth charts (Table 9).
Type I
Head circumference is normal and weight is reduced disproportionately to
height. This pattern results when there is undernutrition (an imbalance
between caloric requirements and availability) (Figure 1).
Type II
Head circumference is normal or enlarged and weight is reduced in proportion