ORDIN
Nr. 707/165 din 28 septembrie 2000
privind stabilirea necesarului minim de substante nutritive pentru alimentatia
zilnica a copiilor din unitatile de asistenta sociala
ACT EMIS DE: MINISTERUL SANATATII Nr. 707 din 28 septembrie 2000
AGENTIA NATIONALA PENTRU PROTECTIA DREPTURILOR COPILULUI
Nr. 165 din 26 septembrie 2000
ACT PUBLICAT IN: MONITORUL OFICIAL NR. 516 din 20 octombrie 2000
Ministru de stat, ministrul sanatatii, si presedintele Agentiei Nationale
pentru Protectia Drepturilor Copilului,
in temeiul prevederilor art. 2 din Hotararea Guvernului nr. 642/2000
privind alocatiile de hrana pentru consumurile colective din unitatile bugetare
de asistenta sociala pentru copii, ale Hotararii Guvernului nr. 244/1997
privind organizarea si functionarea Ministerului Sanatatii, cu modificarile si
completarile ulterioare, precum si ale Hotararii Guvernului nr. 96/2000 privind
organizarea si functionarea Agentiei Nationale pentru Protectia Drepturilor
Copilului,
avand in vedere referatul de aprobare comun nr. GH/7.303 din 28 septembrie
2000 al Directiei generale de sanatate publica din cadrul Ministerului
Sanatatii si nr. 7.376 din 3 octombrie 2000 al Agentiei Nationale pentru
Protectia Drepturilor Copilului,
emit urmatorul ordin:
Art. 1
Se stabileste necesarul minim de substante nutritive pentru alimentatia
zilnica a copiilor, pe grupe de varsta si pe categorii de deficiente si
afectiuni, conform anexelor nr. 1 si 2 care fac parte integranta din prezentul
ordin.
Art. 2
Necesarul minim de substante nutritive pentru alimentatia zilnica a unui
copil se poate modifica in caz de boala acuta sau cronica, conform
recomandarilor medicului specialist pediatru/nutritionist pediatru.
Art. 3
Prezentul ordin va fi publicat in Monitorul Oficial al Romaniei, Partea I.
Ministru de stat, ministrul sanatatii,
Hajdu Gabor
Presedintele Agentiei Nationale
pentru Protectia Drepturilor Copilului,
Vlad Mihai Romano
ANEXA 1
Necesarul minim de substante nutritive si calorii pentru
alimentatia zilnica a copiilor din centrele rezidentiale, exprimat
pe grupe de varsta si pe sexe
______________________________________________________________________________
| | | |
|
| Necesarul minim | 0 - 6 luni | 6 - 12 luni |1 - 4
ani|
|_________________|______________________________|___________________|_________|
|Calorii (kcal/zi)|0 - 1 luna | 80 kcal/kgcorp/zi|100 kcal/kgcorp/zi | 1.050
|
| |___________|__________________| |
|
| |1 - 3 luni |120 kcal/kgcorp/zi| |
|
| |___________|__________________| |
|
| |3 - 6 luni |110 kcal/kgcorp/zi| |
|
|_________________|___________|__________________|___________________|_________|
| Proteine totale |alimentatie| 1,8 - 2,3 g/ | |
|
| (g) |naturala | kgcorp/zi | | |
| |___________|__________________|1,5 - 2 g/kgcorp/zi| 35 - 40
|
| |alimentatie| 3 - 3,5 g/ | |
|
| |artificiala| kgcorp/zi | |
|
|_________________|___________|__________________|___________________|_________|
| Proteine animale|Pana la diversificare |1,25 - 1 g/kgcorp/ | 25 - 29
|
| (g) |necesarul proteic este | zi |
|
| |asigurat exclusiv din lapte | |
|
| |uman/formule de lapte adaptate| |
|
|_________________|______________________________|___________________|_________|
|% din cantitatea | 50 dupa inceperea | 50 | 70
|
| proteinelor | diversificarii | |
|
| totale | | |
|
|_________________|______________________________|___________________|_________|
|Proteine vegetale| _ |1,25 - 1 g/kgcorp/ | 10 - 12
|
| (g) | | zi |
|
|_________________|______________________________|___________________|_________|
|% din cantitatea | 50 dupa inceperea | 50 | 30
|
| proteinelor | diversificarii | |
|
| totale | | | |
|_________________|______________________________|___________________|_________|
|Lipide totale (g)| 3,5 - 6 g/kgcorp/zi |3,5 - 6 g/kgcorp/zi| 39 - 48
|
|_________________|______________________________|___________________|_________|
|Lipide animale |Pana la diversificare |1,75 - 3 g/kgcorp/ | 30 - 36
|
| (g) |necesarul proteic este | zi |
|
| |asigurat exclusiv din lapte | |
|
| |uman/formule de lapte adaptate| |
|
|_________________|______________________________|___________________|_________|
|% din cantitatea | 50 dupa inceperea | 50 | 75
|
|lipidelor totale | diversificarii | |
|
|_________________|______________________________|___________________|_________|
|Lipide vegetale | _ |1,75 - 3 g/kgcorp/ | 10 - 12
|
| (g) | | zi |
|
|_________________|______________________________|___________________|_________|
|% din cantitatea | 50 dupa inceperea | 50 | 25
|
|lipidelor totale | diversificarii | |
|
|_________________|______________________________|___________________|_________|
|Glucide (g) | 12 g/kcorp/zi | 12 g/kgcorp/zi |114 -
134|
|_________________|______________________________|___________________|_________|
______________________________________________________________________________
| |
|
| | 4 - 18 luni
|
| Necesarul minim
|____________________________________________________________|
| | | | 10 - 14 ani | 14 - 18 ani
|
| |4 - 7 ani|7 - 10
ani|___________________|___________________|
| | | | Baieti | Fete | Baieti | Fete
|
|_________________|_________|__________|_________|_________|_________|_________|
|Calorii (kcal/zi)| 1.450 | 1.750 | 2.500 | 2.100 | 2.800 | 2.250
|
|_________________|_________|__________|_________|_________|_________|_________|
|Proteine totale | 48 - 56 | 65 - 75 | 85 - 97 | 71 - 81 | 96 - 110| 77 - 87
|
| (g) | | | | | |
|
|_________________|_________|__________|_________|_________|_________|_________|
|Proteine animale | 32 - 37 | 40 - 45 | 41 - 44 | 39 - 44 | 48 - 55 | 38 - 43
|
| (g) | | | | | |
|
|_________________|_________|__________|_________|_________|_________|_________|
|% din cantitatea | 65 | 60 | 55 | 55 | 50 | 50
|
| proteinelor | | | | | |
|
| totale | | | | | | |
|_________________|_________|__________|_________|_________|_________|_________|
|Proteine vegetale| 17 - 19 | 26 - 30 | 43 - 53 | 32 - 37 | 48 - 55 | 34 - 44
|
| (g) | | | | | |
|
|_________________|_________|__________|_________|_________|_________|_________|
|% din cantitatea | 35 | 40 | 45 | 45 | 50 | 50
|
| proteinelor | | | | | |
|
| totale | | | | | |
|
|_________________|_________|__________|_________|_________|_________|_________|
| Lipide totale | 46 - 54 | 52 - 62 | 66 - 80 | 56 - 67 | 75 - 90 | 60 - 72
|
| (g) | | | | | |
|
|_________________|_________|__________|_________|_________|_________|_________|
| Lipide animale | 35 - 41 | 39 - 46 | 46 - 56 | 40 - 47 | 48 - 63 | 42 - 50
|
| (g) | | | | | |
|
|_________________|_________|__________|_________|_________|_________|_________|
|% din cantitatea | 75 | 75 | 70 | 70 | 70 | 70
|
| lipidelor | | | | | |
|
| totale | | | | | |
|
|_________________|_________|__________|_________|_________|_________|_________|
| Lipide vegetale | 11 - 14 | 13 - 15 | 20 - 24 | 16 - 20 | 22 - 37 | 17 - 21
|
| (g) | | | | | |
|
|_________________|_________|__________|_________|_________|_________|_________|
|% din cantitatea | 25 | 25 | 30 | 30 | 30 | 30
|
| lipidelor | | | | | |
|
| totale | | | | | |
|
|_________________|_________|__________|_________|_________|_________|_________|
| Glucide (g) |176 - 192|257 - 281 |333 - 363|279 - 304|376 - 417|301 -
328|
|_________________|_________|__________|_________|_________|_________|_________|
ANEXA 2
A. Necesarul minim obligatoriu de substante nutritive pentru alimentatia
zilnica a copiilor din institutiile de asistenta sociala si principalele surse
ale acestora in alimentatie*)
I. PROTEINE
a) Prezenta in alimentatia zilnica a copilului: 15%
b) Surse alimentare furnizoare de proteine si numarul de calorii
continute:
(1 gram de proteine furnizeaza 4,1 calorii)
_____________________________________________________________________________
| Alimentul | Cantitatea de proteine | Echivalentul |
| | (g)/100 g aliment | caloric (cal) |
|____________________________________|________________________|_______________|
| Carne (vita, porc, pasare, peste) | 15 - 22 | 61,5 - 90,2 |
|____________________________________|________________________|_______________|
| Mezeluri (salam, carnati, sunca) | 10 - 20 | 41 - 82 |
|____________________________________|________________________|_______________|
| Branzeturi | 15 - 30 | 61,5 - 123 |
|____________________________________|________________________|_______________|
| Lapte de vaca | 3,5 | 14,35 |
|____________________________________|________________________|_______________|
| Oua de gaina | 14 | 57,4 |
|____________________________________|________________________|_______________|
| Paste, gris, orez, faina, malai | 9 - 12 | 36,9 - 49,2 |
|____________________________________|________________________|_______________|
| Legume uscate | 20 - 25 | 82 - 102,5 |
| (fasole boabe, mazare) | | |
|____________________________________|________________________|_______________|
| Soia | 30 - 33 | 123 - 135,3 |
|____________________________________|________________________|_______________|
| Nuci | 17 | 69,7 |
|____________________________________|________________________|_______________|
| Paine | 7 - 8 | 28,7 - 32,8 |
|____________________________________|________________________|_______________|
*) Pentru copilul cu varsta cuprinsa intre 0 - 1 an vezi lit. C.
II. LIPIDE
a) Prezenta in alimentatia zilnica a copilului: 35%
b) Surse alimentare furnizoare de lipide si numarul de calorii
continute:
(1 gram de lipide furnizeaza 4,1 calorii)
_____________________________________________________________________________
| Alimentul | Cantitatea de lipide | Echivalentul |
| | (g)/100 g aliment | caloric (cal) |
|______________________________________|______________________|_______________|
| Ulei, untura, unt topit | 100 | 930 |
|______________________________________|______________________|_______________|
| Unt, margarina | 65 - 82 | 604,5 - 762,6 |
|______________________________________|______________________|_______________|
| Slanina | 70 - 75 | 651 - 697,5 |
|______________________________________|______________________|_______________|
| Smantana | 20 - 35 | 186 - 325,5 |
|______________________________________|______________________|_______________|
| Branzeturi grase (telemea, burduf, | 20 - 30 | 186 - 279 |
| cascaval) | | |
|______________________________________|______________________|_______________|
| Carne de porc, de oaie, de rata, | 10 - 30 | 93 - 279 |
| de gasca | | |
|______________________________________|______________________|_______________|
| Carne de vita, de gaina, de curca | 5 - 25 | 46,5 - 232,5 |
|______________________________________|______________________|_______________|
| Peste gras | 15 - 20 | 139,5 - 186 |
|______________________________________|______________________|_______________|
| Mezeluri | 20 - 40 | 186 - 372 |
|______________________________________|______________________|_______________|
| Nuci, arahide | 40 - 55 | 372 - 511,5 |
|______________________________________|______________________|_______________|
| Ciocolata, halva, prajituri cu crema | 20 - 35 | 186 - 325,5 |
|______________________________________|______________________|_______________|
III. GLUCIDE
a) Prezenta in alimentatia zilnica a copilului: 50%
b) Surse alimentare furnizoare de glucide si numarul de calorii
continute:
(1 gram de glucide furnizeaza 4,1 calorii)
_____________________________________________________________________________
| Alimentul | Cantitatea de glucide | Echivalentul |
| | (g)/100 g aliment | caloric (cal) |
|_____________________________________|_______________________|_______________|
| Paste, faina, biscuiti, orez, malai,| 70 - 75 | 287 - 307,5 |
| arpacas | | |
|_____________________________________|_______________________|_______________|
| Paine, cornuri, chifle | 40 - 45 | 164 - 184,5 |
|_____________________________________|_______________________|_______________|
| Legume uscate | 50 - 55 | 205 - 225,5 |
|_____________________________________|_______________________|_______________|
| Cartofi | 18 - 20 | 73,8 - 82 |
|_____________________________________|_______________________|_______________|
| Struguri, prune, cirese, mere, pere | 12 - 18 | 49,2 - 73,8 |
|_____________________________________|_______________________|_______________|
| Miere de albine | 70 - 80 | 287 - 328 |
|_____________________________________|_______________________|_______________|
| Zahar | 100 | 410 |
|_____________________________________|_______________________|_______________|
| Bomboane, caramele | 80 - 90 | 328 - 369 |
|_____________________________________|_______________________|_______________|
| Dulceturi, gemuri, marmelade, | 55 - 75 | 225,5 - 307,5 |
| jeleuri | | |
|_____________________________________|_______________________|_______________|
| Prajituri | 20 - 40 | 82 - 164 |
|_____________________________________|_______________________|_______________|
| Ciocolata | 50 - 60 | 205 - 246 |
|_____________________________________|_______________________|_______________|
IV. ECHIVALENTE ALIMENTARE
______________________________________________________________________
| 100 ml lapte concentrat (condensat) | 250 ml lapte proaspat |
|_________________________________________|____________________________|
| 100 g lapte praf integral | 800 ml lapte proaspat |
|_________________________________________|____________________________|
| 100 g cascaval | 700 ml lapte proaspat |
|_________________________________________|____________________________|
| 100 g branza topita | 700 ml lapte proaspat |
|_________________________________________|____________________________|
| 100 g telemea de vaca | 550 ml lapte proaspat |
|_________________________________________|____________________________|
| 100 g telemea de oaie | 450 ml lapte proaspat |
|_________________________________________|____________________________|
| 100 g branza proaspata de vaca | 400 ml lapte proaspat |
|_________________________________________|____________________________|
| 100 g cas | 550 ml lapte proaspat |
|_________________________________________|____________________________|
| 100 g mezeluri | 125 g carne |
|_________________________________________|____________________________|
| 100 g preparate din carne (toba, | 125 g carne |
| caltabos, carne prajita) | |
|_________________________________________|____________________________|
| 100 g smantana | 40 g unt |
|_________________________________________|____________________________|
| 100 g slanina sarata, costita | 88 g untura |
|_________________________________________|____________________________|
| 100 g slanina cruda | 80 g untura |
|_________________________________________|____________________________|
| 100 g paine neagra | 71 g faina |
|_________________________________________|____________________________|
| 100 g paine intermediara | 73 g faina |
|_________________________________________|____________________________|
| 100 g paine alba | 76 g faina |
|_________________________________________|____________________________|
| 100 g paste fainoase, biscuiti | 100 g faina |
| fara crema | |
|_________________________________________|____________________________|
| 100 g compot | 15 g zahar |
|_________________________________________|____________________________|
| 100 g dulceata | 70 g zahar |
|_________________________________________|____________________________|
| 100 g gem, peltea, marmelada | 40 g zahar |
|_________________________________________|____________________________|
| 100 g nectar de fructe | 30 g zahar |
|_________________________________________|____________________________|
| 100 g sirop de fructe concentrat | 60 g zahar |
|_________________________________________|____________________________|
| 100 g bomboane | 90 g zahar |
|_________________________________________|____________________________|
| 100 g miere | 80 g zahar |
|_________________________________________|____________________________|
| 100 g halva | 45 g zahar si 30 g grasime |
| | vegetala |
|_________________________________________|____________________________|
| 100 g ciocolata | 50 g zahar si 30 g grasime |
| | vegetala |
|_________________________________________|____________________________|
| 100 g bulion sau pasta de rosii | 600 g rosii |
|_________________________________________|____________________________|
| 100 g suc de rosii | 135 g rosii |
|_________________________________________|____________________________|
| 100 g varza acra | 135 g varza cruda |
|_________________________________________|____________________________|
| 100 g muraturi | 125 g legume crude |
|_________________________________________|____________________________|
| 100 g fulgi de cartofi | 1.000 g cartofi cruzi |
|_________________________________________|____________________________|
| 100 g fructe deshidratate, afumate, | 400 g fructe crude |
| uscate | |
|_________________________________________|____________________________|
| 100 g fulgi de fasole boabe | 300 g fasole boabe uscata |
|_________________________________________|____________________________|
| 100 g morcovi deshidratati | 1.700 g morcovi cruzi |
|_________________________________________|____________________________|
| 100 g conserve de legume | 100 g legume crude |
|_________________________________________|____________________________|
| 100 g conserve din carne in suc propriu | 100 g carne cruda |
|_________________________________________|____________________________|
| 100 g conserve de peste | 100 g peste crud |
|_________________________________________|____________________________|
B. Principalele elemente minerale necesare zilnic in alimentatia copilului
_____________________________________________________________________________
| | Cantitatea necesara zilnic | |
|Element mineral|____________________________________| Surse alimentare |
| | 0 - 6 | 6 - 12 | 1 - 4 | 4 - 18 | principale |
| | luni | luni | ani | ani | |
|_______________|_______|________|_______|___________|________________________|
| Calciu (mg) | 500 | 600 | 400 |500 - 700 | - lapte de vaca |
| | | | | | - branzeturi |
|_______________|_______|________|_______|___________|________________________|
| Magneziu (mg) | 40 | 70 | 150 | 250 | - legume verzi (salata,|
| | | | | | spanac, ceapa verde);|
| | | | | | fasole, mazare |
| | | | | | - fructe |
| | | | | | - carne |
| | | | | | - paine neagra |
|_______________|_______|________|_______|___________|________________________|
| Fier (mg) | 6 | 10 | 10 | 10 - 12 | - carne, ficat, peste |
| | | | | | - galbenus de ou |
| | | | | | - legume verzi |
| | | | | | - fructe |
| | | | | | - paine neagra |
|_______________|_______|________|_______|___________|________________________|
| Fosfor (mg) | 50 | 360 | 800 |800 - 1.200| - lapte, branzeturi |
| | | | | | - carne, peste |
| | | | | | - galbenus de ou |
|_______________|_______|________|_______|___________|________________________|
| Iod | 40 | 50 | 70 | 90 - 150 | - peste |
| (micrograme) | | | | | - legume |
| | | | | | - sare iodata |
|_______________|_______|________|_______|___________|________________________|
| Seleniu | 10 | 15 | 20 | 30 - 50 | - carne, peste |
| (micrograme) | | | | | - produse lactate |
| | | | | | - oua |
| | | | | | - derivate cerealiere |
|_______________|_______|________|_______|___________|________________________|
| Zing (mg) | 5 | 5 | 10 | 10 - 15 | - carne, peste |
| | | | | | - legume |
| | | | | | - fructe |
|_______________|_______|________|_______|___________|________________________|
C. Alimentatia copilului cu varsta cuprinsa intre 0 - 1 an
Alimentatia artificiala (a sugarului cu varsta cuprinsa intre 0 - 4 luni)
- Se folosesc formule de lapte adaptate. De exemplu: Enfamil, Humana 1,
Morinaga, Nutrilon, Similac, SMA; pentru prematur: Humana 0, Preaptamil, Milupa
Prematil.
- Cantitatea de lapte necesara zilnic se calculeaza astfel:
0 - 7 zile: L = (Z - 1) x 70 sau 80;
L - cantitatea de lapte necesara/24 ore;
Z - varsta in zile;
70 pentru greutatea la nastere < 3.250 g, iar 80 pentru
greutatea la nastere > 3.250 g.
> 7 zile: L = G/10 + 200; G - greutatea actuala a sugarului.
- De la nastere pana la 3 - 4 luni laptele este singurul aliment necesar si
suficient.
- Numarul orientativ de mese/zi: 6 - 7 mese/zi in prima luna, 6 mese/zi la
2 - 3 luni, 5 mese/zi la 3 - 4 luni.
Diversificarea alimentatiei
- Pentru sugarul alimentat artificial diversificarea alimentatiei poate
incepe mai devreme, la 3 - 3,5 luni.
- Reguli:
1. Diversificarea alimentatiei va incepe cand sugarul este sanatos clinic.
2. Introducerea alimentului nou se va face progresiv, incepand cu cantitati
mici (cateva lingurite).
3. Alimentul nou-introdus se administreaza cu lingurita.
4. Nu se introduc simultan doua alimente noi.
5. Daca sugarul refuza alimentul nou, acesta se suprima aproximativ o
saptamana, dupa care se incearca reintroducerea lui.
6. In caz de intoleranta digestiva (varsaturi, diaree) la introducerea
alimentului nou, acesta se suprima 1 - 2 saptamani pana la refacerea digestiva,
dupa care se incearca reintroducerea lui.
- Diversificarea alimentatiei incepe cu legume/fructe:
Legumele (morcovi, cartofi, pastarnac, patrunjel, spanac, dovlecei, rosii,
ardei grasi, ceapa, fasole verde) se administreaza initial sub forma de supa
strecurata, apoi imbogatita cu 1 - 3% cereale si ulei (cateva picaturi), iar
ulterior, sub forma de piure, care poate fi imbogatit cu putin unt si lapte.
Varza, fasolea boabe si mazarea se introduc in alimentatie dupa varsta de 2 ani.
Fructele (mere, piersici, caise, citrice) se administreaza initial sub
forma de suc, apoi sub forma de piureuri, care pot fi imbogatite cu cereale si
cu branza de vaci, iar ulterior, sub forma de compot. Perele se introduc dupa
varsta de 6 luni, bananele dupa varsta de 8 luni, iar capsunele si zmeura dupa
varsta de 1 an.
Cerealele: pana la 8 luni se administreaza cereale fara gluten (orez,
porumb), apoi se pot introduce si cele cu gluten (grau, ovaz). Painea
intermediara si neagra se introduc dupa varsta de 5 ani.
Carnea (gaina, pui, vita) se administreaza de la varsta de 5 luni, initial
mixata, in supa/piure de legume, iar dupa 8 luni, taiata bucatele mici. De la
varsta de 6 luni se poate da ficat de pasare, iar de la varsta de 10 luni, peste
alb. Cantitate: 30 - 50 g/zi, de 3 - 4 ori/saptamana. Carnea de porc si de oaie
se va administra dupa varsta de 3 ani.
Oua: Se administreaza dupa varsta de 6 luni sub forma de galbenus de ou de
gaina fiert tare. Albusul de ou se introduce dupa varsta de 1 an.
Branza de vaci: Se introduce de la varsta de 5 luni si se poate administra
cu orez fiert pasat.
Iaurtul: Se introduce de la varsta de 5 luni.
- Alimente interzise sau de evitat la sugar si la copilul in varsta de pana
la 3 ani:
- alimente care pot provoca aspiratie/inec: nuci, alune, fructe cu seminte,
seminte, porumb fiert, floricele de porumb, cartofi prajiti, telina cruda,
morcovi cruzi, peste cu oase, carne tare, bomboane;
- dulciuri care inlocuiesc alimentele nutritive: prajituri cu crema,
cereale cu zahar, bauturi racoritoare, bauturi cu arome artificiale de fructe;
- alimente greu de digerat: carnati, mancaruri prajite/grase, condimente;
alimente alergizante: pana la varsta de 1 an albusul de ou, capsunele,
zmeura, laptele de vaca integral; pana la varsta de 3 ani cacao, ciocolata,
alune;
mierea de albine, nu trebuie folosita pana la varsta de 1 an, deoarece
poate fi contaminata cu spori de Clostridium botulinicum.