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PHYSICAL REHABILITATION II CHI449 SUMMARY OF ALL THE LECTURES PHYSICAL REHABILITATION II 2025
PHYSICAL REHABILITATION II CHI449 SUMMARY OF ALL THE LECTURES PHYSICAL REHABILITATION II 2025
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lOMoAR cPSD| 37668344PHYSICAL REHABILITATION II CHI449 SUMMARY OF ALL
THE LECTURES
PHYSICAL REHABILITATION II 2025
Lecture 1: Nutrition in Infancy and Childhood
Nutrition of the infant – Nutrients to Support Growth (first 1000 days)
- Weight doubles by 5 months. Triples by 1 year (height doubles)
- Basal Metabolic Rate is very high. Nutrients Needed:
o 420-450KJ (100 kcal)/kg
o Carbohydrates: 60% of energy intake; needed for brain
o Fat: provides most energy
o Protein: growth & development (but excess can cause kidney damage)
o Adequate vitamin A, C, D, iodine & calcium (All in breastmilk, ?D)
o Adequate water (needs higher percentage of water c.f. adults)
o Dose of vitamin K at birth
- Nutrients in Breast Milk
o Energy nutrients
■ Carbohydrates
• Lactose (Enhances calcium absorption)
■ Lipids
• Generous amount of essential fatty acids
■ Protein
• Alpha-lactalbumin
• Easily digestible
o Vitamins & Minerals
■ Vitamin D is low (but OK)
■ Calcium is well absorbed;
■ Highly absorbable iron & zinc
■ Lower in sodium (protects kidneys)
o Immunological protection:
■ Colostrum
■ Bifidus bacteria
■ Lactoferrin
■ Lactadherin
- Cells in breast milk
o Lactobacilli (bifidus)
o White cells
o Stem cells
- Have less infections and less risk of asthma and obesity
- Higher IQ
o 5-7% higher
, lOMoAR cPSD| 37668344
- Benefit to mother
o Lower rates of:
■ Ovarian cancer
■ Breast cancer
, lOMoAR cPSD| 37668344
■ Diabetes
■ Obesity
■ Depression
• 40% reduction in postnatal depression
- Barriers for breast feeding
Unicef first 1000 days
- Low-birthweight babies (< 2.5 kg) face an increased risk of dying during their early months
and years.
- Those who survive:
o Increased risk of disease, including diabetes and heart disease later in life
o Lower IQ and cognitive disabilities leading to school failure and learning difficulties
- Weight at birth is a good indicator not only of the mother’s health
and nutritional status but also of the newborn’s chances for
survival, growth, long-term health and psychosocial development
- Weight gain during pregnancy is important
o Obese mothers have higher rates of LBW (Cnattingius
2013, 1.6 million deliveries in Sweden)
o Obese mothers and high rate of weight gain during
pregnancy are associated with large infants and later obesity
o Obese mothers – higher rate of neonatal mortality
o Underweight mothers and LBW infants are associated with later health problems
(DOHAD) – heart disease, diabetes, hypertension, obesity etc
o Usual weight gain 11.5 - 16 kg:
■ 1 to 1.5 kg in the first three months then
■ 1.5 to 2 kg each month until birth
, lOMoAR cPSD| 37668344
- Specific Intrauterine Growth periods
o Neural tube defects (6-8 weeks)
o Renal tubule development (nephrons) 7-8 months. At least a 3-fold variations in the
number of nephrons
o Bones – calcium and Vit D
o Teeth – fluoride
o CNS – iodine
Infant formula
- Manufacturers aim to mimic breast milk (make its composition similar to breast milk)
- Offers no immunity (no antibodies, no white cells)
- Standards have been set
- All need to be iron fortified
- Special formulas for allergies & lactose intolerance
- Risks of over-dilution & contamination (Requires proper foodhandling techniques and access
to clean water)
- Caution against nursing bottle tooth decay: can be caused by formula, milk or juice;
prolonged exposure to formula when sleeping; upper and lower teeth may be affected by
decay
- May contain bacteria (but not healthy ones) unless probiotics are specifically added
- Breastmilk has about 1000 substances
- Babies were born to breastfeed
- Inappropriate formulas or drinks
o Soy/rice/almond/goat or cow’s milk is NOT appropriate in the first year:
o Soy beverages are nutritionally incomplete
o Goat’s milk is deficient in folate
o Cow’s milk:
■ Poor source of iron
■ Higher in calcium but lower in vitamin C (inhibits iron absorption)
■ Higher protein can stress infant’s kidneys
■ The protein casein may cause intestinal bleeding and anemia in the first year
of life
■ Introduce small amounts in cereal, yoghurt or custards from seven months
■ 1-2 years need whole milk
■ Low-fat varieties can be recommended to 2-5 years\
o High protein levels in infant formula result in rapid cell growth
o As an infant grows those cells become stuffed with fat
o (High protein products for infants result in obesity through stimulation of the IgF-1
axis. Insulin-like growth factor originating from the small intestine)
o Breastmilk has a low protein level – its very high quality protein (0.9- 1.0G/100mls)
o Have a look at levels in your local supermarket. 1.4-1.8 and some even above 2.0
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