CHILDHOOD

NUTRITIONAL CONCERNS/RISK FOR PRESCHOOLERS...

Concerns include overfeeding; intake of high-calorie, high-fat, high-sodium snacks, soft drinks, and juices; and inadequate intake of fruits and vegetables. ● Be alert to the appropriate serving size of foods (1 tbsp per year of age). ● Avoid high-fat and high-sugar snacks. ● Encourage daily physical activities. ● Can switch to skim or 1% low-fat milk after 2 years of age. Iron deficiency anemia Lead poisoning is a risk for children younger than 6 years of age because they frequently place objects in their mouths that can contain lead and have a higher rate of intestinal absorption. ● Feed children at frequent intervals because more lead is absorbed on an empty stomach. ● Inadequate intake of calories, calcium, iron, zinc, and phosphorous can increase susceptibility.

NUTRITIONAL CONCERNS/RISK FOR TODDLERS...

IRON & VITAMIN D IRON ● Iron deficiency anemia is the most common nutritional deficiency disorder in children. ● Lean red meats provide sources of readily absorbable iron. ● Consuming vitamin C (orange juice, tomatoes) with plant sources of iron (beans, raisins, peanut butter, whole grains) will maximize absorption. ● Milk should be limited to the recommended quantities (24 oz) because it is a poor source of iron and can displace the intake of iron-rich foods. VITAMIN D ● Vitamin D is essential for bone development. ● Recommended vitamin D intake is the same (5 mcg/day) from birth through age 50. Children require more vitamin D because their bones are growing. ● Milk (cow, soy) and fatty fish are good sources of vitamin D. ● Sunlight exposure leads to vitamin D synthesis. Children who spend large amounts of time inside (watching TV, playing video games) are at an increased risk for vitamin D deficiency ● Vitamin D assists in the absorption of calcium into the bones.

NUTRITIONAL CONCERNS/RISKS FOR SCHOOL-AGE CHILDREN

Not eating breakfast occurs in about 10% of children. ● Optimum performance in school is dependent on a nutritious breakfast. ● Children who regularly eat breakfast tend to have an age-appropriate BMI. Overweight/obesity affects at least 20% of children. ● Greater psychosocial implications exist for children than adults. ● Overweight children tend to be obese adults. ● Prevention is essential. Encourage healthy eating habits, decrease fats and sugars (empty-calorie foods), and increase the level of physical activity. ● A weight-loss program directed by a provider is indicated for children who are overweight, or obese if they have comorbidity. Otherwise, efforts are directed at maintaining weight so the BMI will normalize as height increases. ● Praise the child's abilities and skills. ● Never use food as a reward or punishment

NURSING ASSESSMENT/DATA COLLECTION AND INTERVENTIONS

Nursing assessments should include the parent's knowledge base of the child's nutritional requirements, and nutritional concerns with regard to age. Nurses should provide education for the parent and child about nutritional recommendations.

PRESCHOOLERS: 3 - 6 YEARS

● Generally grow 2 - 3 inches in height and gain approximately 5 - 6 lb/year. ● Preschoolers need to consume 13 - 19 g/day of complete protein. ● If the preschooler consumes foods from all five food groups and height and weight are within expected reference ranges, supplemental vitamins/minerals might not be needed. ● Preschoolers tend to dislike strong-tasting vegetables (cabbage, onions), but like many raw vegetables that are eaten as finger foods. ● Food jags (ritualistic preference for one food) are common and usually short-lived. ● MyPlate guidelines are appropriate, requiring the lowest number of servings per food group. ● Food patterns and preferences are first learned from the family, and peers begin influencing preferences and habits at around 5 years of age.

SCHOOL-AGE CHILDREN: 6 - 12 YEARS

● Grow 2 - 3 inches in height and gain approximately 5 - 6 lb/year. ● Following MyPlate recommendations, the diet should provide variety, balance, and moderation. ● Young athletes need to meet energy, protein, and fluid needs. ● Educate children to make healthy food selections. ● Children enjoy learning how to safely prepare nutritious snacks. ● Children need to learn to eat snacks only when hungry, not when bored or inactive.

TODDLERS" 1 - 3 YEARS OLD

● Grow 2 - 3 inches in height and gain approximately 5 -6 lb/year. ● Limit 100% juice to 4 - 6 oz a day. ● The 1- to 2-year-old child requires whole cow's milk to provide adequate fat for the still-growing brain. ● Food serving size is 1 tbsp for each year of age. ● Exposure to a new food might be needed 15 - 20 times before the child develops an acceptance of it. ● If there is a negative family history for allergies, cow's milk, chocolate, citrus fruits, egg white, seafood, and nut butters can be gradually introduced while monitoring the child for reactions. ● Toddlers prefer finger foods because of their increasing autonomy. They prefer plain foods to mixtures, but usually like macaroni and cheese, spaghetti, and pizza. ● Regular meal times and nutritious snacks best meet nutrient needs. ● Snacks or desserts that are high in sugar, fat, or sodium should be avoided. ● Children are at an increased risk for choking until 4 years of age. ● Avoid foods that are potential choking hazards. Always provide adult supervision during snack and mealtimes. During food preparation, cut small, bite-sized pieces that are easy to swallow to prevent choking. Do not allow the child to engage in drinking or eating during play activities or while lying down.

CHILDHOOD

● Growth rate slows following infancy. ● ChooseMyPlate.gov is a food guidance system that offers an Internet-based tool to provide clients with individualized recommendations for adequate nutrition. Children require the same food groups as adults, but in smaller serving sizes. ● Energy needs and appetite vary with the child's activity level and growth rate. ● Generally, nutrient needs increase with age. ● Attitudes toward food and general food habits are established by 5 years of age. ● Increasing the variety and texture of foods helps the child develop good eating habits. ● Foods like hot dogs, popcorn, peanuts, grapes, raw carrots, celery, peanut butter, tough meat, and candy can cause choking or aspiration. ● Inclusion in family mealtime is important for social development. ● Group eating becomes a significant means of socialization for school-age children.