Solomons Noel W
Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala.
Nestle Nutr Workshop Ser Pediatr Program. 2007;60:171-184. doi: 10.1159/000106368.
A normal pregnancy and adequate lactation performance should produce at 6 months of life a healthy baby, who has a weight and height within the limits of international growth norms. When that does not happen and the child is either too small (or too big), i.e. 'malnourished', strong determinants will have been maternal health, combined with environmental stress to the baby. In discussing differential strategies for weaning and complementary feeding, the distinction must first be made between true clinical malnutrition and simply deviant growth. The former needs rehabilitation therapy, which is beyond the scope of this discussion. For deviant poor growth, one must devise a regimen that removes an infant from any low-weight danger zone for increased early mortality risk. Thereafter, one can address the emerging scientific evidence that rapid accelerated catch-up growth has implications for increased metabolic derangement and chronic disease risk in childhood and beyond. Human immunodeficiency virus (HIV), infecting either mother or mother and offspring, is one of the emerging situations that will produce malnutrition before a child is due to be weaned. It will also often induce early weaning. Attention to specific micronutrient supplementation is recommended in HIV-seropositive and malarial infants.
正常妊娠和充足的哺乳应该能在婴儿6个月大时孕育出一个健康的宝宝，其体重和身高处于国际生长标准范围内。当这种情况没有发生，孩子过小（或过大），即“营养不良”时，主要的决定因素将是母亲的健康状况，以及婴儿所面临的环境压力。在讨论断奶和辅食添加的不同策略时，必须首先区分真正的临床营养不良和单纯的生长偏离。前者需要康复治疗，这超出了本讨论的范围。对于生长发育不良的情况，必须制定一套方案，使婴儿脱离任何因体重过低而导致早期死亡风险增加的危险区域。此后，人们可以关注新出现的科学证据，即快速加速追赶生长会增加儿童期及以后代谢紊乱和慢性病风险。感染母亲或母婴双方的人类免疫缺陷病毒（HIV）是在孩子断奶前就会导致营养不良的新出现的情况之一。它还常常会导致过早断奶。建议对HIV血清阳性和患有疟疾的婴儿进行特定的微量营养素补充。
