Nutrition in infancy, childhood, and adolescence 15
• What does AAP stand for ?
American Academy of Pediatrics
What is best indicator of nutritional health?
Growth is the best indicator of nutritional health
What are effects of over and underfeeding? What does head circumference indicate?
Over and underfeeding ▪ -Overfeeding increases number of adipose cells ▪ -Underfeeding may affect organ development ▪ -Unwise to restrict diet
Define childhood overweight and obesity in terms of BMI-for-age.
underweight (<5th percentile) Healthy weight ( 5th up to 85th percentile) overweight (85th up to 95th percentile)
What are recommendations to improve iron stores for teenagers.
○ 10% teenagers have low iron stores or iron deficiency anemia ○ Academic and physical performance suffers ○ May appear during growth spurts ○ Emphasize iron-rich foods, lean meats, whole grains, and enriched cereals Menstruating teenage girls may need multivitamin with iron
• What is the average weight of preschool children?
○ 4.5 - 6.6 lb. per year 3 - 4 inches per year
Understand what to feed and what not to feed and why
○ AAP Guidelines ▪ •Build to a variety of foods ▪ •Avoid over and underfeeding - follow infant's cues ▪ •Infants need fat ▪ •Choose fruits, vegetables, grains • -Don't overdo fiber ▪ •Sugar and sodium in moderation (avoid sugar substitutes) ▪ •Choose foods containing iron, zinc, calcium ○ Yes ▪ Iron-fortified cereals—rice cereal ▪ •Strained foods and meats ▪ •Offer breastmilk, formula, or water in a sippy cup (not a bottle) with wide base ▪ -Prevent early childhood caries ○ No ▪ Cow milk til after 1 year old ▪ Allergenic foods (prior to 6 months of age) • -Symptoms: Diarrhea, vomiting, rash, wheezing • -Common food allergies (Egg whites, peanuts, treenuts, soy, wheat, cow's milk) ▪ •Honey or corn syrup (clostridium botulinum) ▪ •Highly seasoned foods ▪ •Excessive formula or breast milk ▪ •Foods that tend to cause choking (hot dogs, whole grapes) ▪ •Cow's milk, none till 1 year, then no fat-free or 1%, beyond 2 yr, 1%, fat-free OK ▪ •Goats milk, too low in some nutrients ▪ •Excessive juice ▪ •Food safety hazards: raw milk (unpasteurized), soft cheeses, undercooked meat ▪ •Excessive nutrient supplementation
• Understand trends and risk factors of childhood overweight and obesity and how to address it
○ AAP: limit screen time to 14 hours per week ○ Limit high-calorie foods, sugared soft drinks, and whole milk ○ More nutrient dense foods and healthy snacks ○ If weight-loss diet: gradual losses of 1 to 2 lb/wk
• Should toddlers and preschoolers take a multivitamin and mineral supplement? Why or why not?
○ Academy of Nutrition and Dietetics ▪ -Supplements generally are not necessary ▪ -Better to emphasize good foods ○ Use of fortified cereals and multivitamins together may lead to UL of some nutrients (Ex: vitamin A and zinc) ○ Risk of overdose of some nutrients (ex: iron) if child consumes too many ○ Focus on whole-grain breads and cereals, fruits, vegetables, low-fat milk, milk products
What are some of the health effects of consuming alcohol during the teenage years?
○ Adolescents prone to experimentation, rebellion, risk-taking ○ YRBS results show 20% 13 yr. olds have tried alcohol ○ 70% teenagers report trying once, 22% report binge drinking ○ Exposure reduces brain mass in area where decisions are made, learning, and memory ○ Abuse in adolescence predictor of use in adulthood ○ Should not be viewed as normal part of growing up ○ Consequences durable, devastating ○ Set clear rules
• What is ADA?
○ American Dental Association
• When does the AAP recommend to introduce solid foods? Describe ways to assess an infant's readiness for solid foods.
○ Amount of solid foods little relevance for sleeping through night ○ •Before 4 to 6 mo., not physically mature for consuming much solid food ○ •AAP: recommends solid foods be introduced at 6 months of age (if also showing readiness signs) ○ •Why introduce solids? ▪ -Nutritional needs ○ •Replenish iron stores (depleted at 4-6 months) ○ •Vitamin D ▪ -Physiological capabilities ○ •More mature digestive system ○ •Increased kidney function -Allergy prevention
• What are benefits to eating breakfast and what is a good example of a healthy breakfast?
○ As many as 1/3 school children do not eat breakfast, worse into teenage years ○ Miss out on nutrients to fuel brain and body ▪ Children who eat breakfast - more likely to meet daily needs for vitamins and minerals ○ Research shows starting day with breakfast reduces obesity risk ○ Fortified breakfast cereal nutrient dense ○ Think outside the box - get creative with options ○ Satiety - combine traditional carbohydrate-rich breakfast foods with a source of protein, such as low-fat cheese, nuts, or eggs
• List three ways to reduce risk for dental caries with healthy eating habits.
○ Begin oral hygiene when teeth appear ○ Seek early dental care ○ Fluoridated water, moderate soft sugary options ○ Fluoridated toothpaste (when they can spit it out - should not be swallowed) ○ Snacks in moderation ○ Avoid sticky foods Sugarless gum
• Understand ways to promote good oral health
○ Begin oral hygiene when teeth appear ○ Seek early dental care ○ Fluoridated water, moderate soft sugary options ○ Fluoridated toothpaste (when they can spit it out - should not be swallowed) ○ Snacks in moderation ○ Avoid sticky foods ○ Sugarless gum
• List three similarities between human milk and infant formula. List three differences.
○ Brest Milk ▪ Human milk uniquely suited to meet nutritional needs of human infants (Other benefits of breastfeeding found in chapter 14) ▪ •Maternal diet and nutritional status may impact composition of breast milk ▪ •High fat and lower carbohydrate and protein compared to adults ▪ -Provides up to 55% of total calories as fat (fat is calorie dense: thus a small volume of milk can meet energy needs) ▪ -Carbohydrates provide about 35% to 40% of calories ▪ -Protein supplies less than 10% of total calories ▪ •Flavors of the mother's diet are transferred into her milk ○ Formula ▪ Cow's milk NOT tolerated : Protein too high, mineral content not suitable ▪ •Formulas ▪ -Must follow strict quality control guidelines ▪ -Fortified with vitamins and minerals (except fluoride) ▪ •Cow's milk based formula ▪ -Contains lactose/sucrose, casein, whey, and vegetable oils ▪ •Soy based formula contains soy protein and do not contain lactose ▪ •Pre-digested formula - hydrolyzed proteins for infants with allergies ▪ •Transition formulas introduced after 6 months of age if also consuming solid foods (have less fat and more iron than breastmilk and standard formulas
• Provide three or more suggestions to help a preschooler choose nutritious foods.
○ Build on what they know, pair new food with familiar food ○ Enlist child in selection, preparation ○ Serve meals on sectional plate ○ Keep it crunchy, mild flavor ○ Finger foods are fun ○ Save best for last, serve challenging food first ○ Better chance of acceptance when hungry ○ Avoid nagging, forcing, bribing, and overreacting which makes dinner table the battlefield ○ Avoid forcing child to clean plate ○ Encourage one bite (One Bite Rule) of undesired food Lead by example
• Which two minerals are most likely to be deficient in teen diets?
○ Calcium (Vit D) Iron
• Why is unaltered cow's milk NOT recommended for infant feeding?
○ Cow's milk is too high in protein and minerals - infant cannot digest its protein
What are appropriate recommendations for fat for school-age children
○ Don't overemphasize "reduced fat" diets ○ Surveys show: too much saturated fat, whole milk, fatty meats ○ Few meet recommendations for 2 servings of omega-3 fat rich fish per week Choose: low fat milk, lean meats, baked chicken (without skin) and fish
Why does an infant have such high energy requirements?
○ EER (Estimated Energy Requirement) ▪ -(89 kcal x kg) + 75 (0-3 months old) ~450 kcal/day ▪ -(89 kcal x kg) + 44 (4-6 months) ~450-700 kcal/day ▪ -(89 kcal x kg) - 78 (7-12 months) ~700-750 kcal/day ○ •~700 kcal/day for a 6 month old child (47 kcal/lb compared to ~15 kcal/lb for adult) ○ •Breast milk, formula are foundation of diet for first year (Table 15-3) ▪ -High in carbohydrates and fat ▪ -Cow's milk is too high in protein and minerals - infant cannot digest its proteins ○ •High energy needs ▪ -Rapid growth and metabolism rate -Higher body surface area (loss of heat)
How often do preschoolers need to eat throughout the day?
○ Eat every 3-4 hours ○ -Six small meals vs. three large meals
• What contributes most often to excessive intake of sodium for toddlers and preschoolers? How can preschooler reduce sodium intake practically?
○ Excessive sodium intake a concern ○ Intakes of fast foods, processed foods elevate sodium intakes ▪ About 1000 mg/day more than needed ○ Ways to limit excessive sodium intake ▪ Limit salt added at table, decrease intake of processed foods and fast foods, rinse canned vegetables ▪ Consume fruits, vegetables, whole grains instead of prepackaged snacks
What is "failure to thrive?" What are risk factors and consequences of failure to thrive?
○ Failure to thrive: inadequate growth during infancy or childhood caused by inadequate nutrition (from poor intake, poor absorption, illness, and/or excessive expenditure) ○ •About 5% to 10% infants, children do not grow as expected ○ •Can have specific medical cause, but 80% have no apparent disease ○ •Risk factors ▪ -Poverty biggest environmental risk factor for undernutrition, leading to failure to thrive ▪ -Poor parent-infant interactions (inexperience) ○ •Consequences ▪ -Impaired physical and cognitive development ▪ -Behavioral problems
What is failure to thrive? List some possible causes.
○ Failure to thrive: inadequate growth during infancy or childhood caused by inadequate nutrition (from poor intake, poor absorption, illness, and/or excessive expenditure) ○ •About 5% to 10% infants, children do not grow as expected ○ •Can have specific medical cause, but 80% have no apparent disease ○ •Risk factors ▪ -Poverty biggest environmental risk factor for undernutrition, leading to failure to thrive ▪ -Poor parent-infant interactions (inexperience) ○ •Consequences ▪ -Impaired physical and cognitive development ▪ -Behavioral problems
• How is the need for water best met for an infant? Is supplement water needed?
○ Fluid Needs ▪ ~3 cups per day ▪ Met with breastmilk or formula intake ○ •Supplemental water ▪ AAP: Not recommended during first 6 months (even in hot climates) ○ •Babies are easily dehydrated ▪ Can damage kidneys ▪ May require rehydration fluids (Pedialyte) that contain electrolytes ○ •Best to rely on breast milk or infant formula for fluid needs up to 6 months
Distinguish between a food allergy and food intolerance.
○ Food allergy ▪ reaction to food, involves an immune response; also called food hypersensitivity ○ Food intolerance ▪ reaction to food that does not involve an allergic reaction
How do health care providers assess growth?
○ Growth: best indicator of nutritional health ▪ -Weight: use to assess short term nutritional health -Height: use to assess long term nutritional health
What is single best indicator of child's nutritional status? What does weight and height indicate?
○ Growth: best indicator of nutritional health ▪ -Weight: use to assess short term nutritional health ▪ -Height: use to assess long term nutritional health
• What are effects of undernutrition on growth?
○ Inadequate nutrition (including fat) can inhibit growth -Overnutrition more prevalent in North America
Understand guidelines for introducing first food
○ Introduce one food at a time ○ -Do not introduce mixed foods ○ -Check for intolerance ○ -Wait one week before introducing a new food ○ -1 tsp serving size ○ •Iron-fortified cereals—rice cereal ○ •Strained foods and meats ○ •Offer breastmilk, formula, or water in a sippy cup (not a bottle) with wide base ○ -Prevent early childhood caries ○ •No cow's milk until age 1 ○ Self-feeding skills ○ -Allow infants to practice ○ •Use baby-sized spoon ○ •Hold infant comfortably on lap ○ •Small dab of food on spoon tip, place on tongue ○ •Convey calm approach ○ •Expect infant to only take 2 or 3 bites, first meals ○ •Only a few bites at first
Why are iron and calcium important for preschoolers and what are effects of undernutrition of these vitamins
○ Iron ▪ Iron-deficiency anemia most likely to appear in children ages 6 to 24 months ▪ Iron stores of gestation run out ▪ Decrease stamina (low oxygen supply to cells), learning ability, and immunity ▪ WIC has helped decrease anemia ▪ Sources • Consume: lean meats (heme iron), fortified cereals, vitamin C source with iron ○ Calcium ▪ Period of rapid bone growth and mineralization ▪ Vital to maximize bone mass during childhood and adolescence ▪ Diets of children usually fall short ▪ Milk as a source • Up to 2 yr. old, whole milk only for extra fat energy • After 2 yr., reduced fat, fat-free preferred • Non-dairy beverages can supply enough calcium (soymilk, almond milk, fortified orange juice)
• What are the 8 leading food allergens in the U.S.?
○ Milk ○ Eggs ○ Peanuts ○ Tree nuts ○ Fish ○ Shellfish ○ Wheat ○ Soy
Understand how to safely prepare a bottle
○ Monitor safety and cleanliness ○ Boil cold water ▪ Hot tap water not recommended due to risk of lead poisoning (from pipes) ▪ Do not microwave (risk for "hot spots") ○ Well water should be boiled ○ Watch out for nitrates in municipal water systems ○ Prepared bottles ▪ Can be stored in refrigerator for 24 hours ▪ Leftover formula from a feeding should be discarded ▪ ADA advises not to mix formula with bottled nursery water due to high fluoride content
Understand indicators of possible dehydration in an infan
○ More than 6 hours without a wet diaper ○ Dark-yellow or strong-smelling urine ○ Unusually tired and fussy ○ Dry mouth and lips ○ Absence of tears when crying ○ Eyes and soft spot on the head appear sunken ○ Cold and splotchy hands and feet
• What are appropriate recommendations for beverages for school-age children
○ Need more nutrient dense beverages rather than empty calorie beverages (ex: soft drinks, flavored fruit drinks, sports drinks) ○ Replace empty calorie beverages with water, low- or fat-free milk ○ Replace 100% juices with whole fruits
• How does nutrition support this infant growth?
○ Nutrients needed to support proper growth -Calories, protein, calcium, iron, zinc, and other nutrients
• Describe four ways to assess an infant's readiness for solid foods
○ Physical signs of readiness ▪ -Extrusion reflex disappears ▪ -Better head and neck control ▪ -Ability to sit ○ General readiness signs: ▪ -Reaching about 13 pounds ▪ -Consuming more than 32 ounces formula daily, or breastfeeding more than 8 to 10 times in 24 hours
• Know why it's important nutritionally to start solid foods at around 6 months. Also know the physical signs of readiness
○ Physical signs of readiness ○ -Extrusion reflex disappears ○ -Better head and neck control ○ -Ability to sit up ○ •Why introduce solids? ○ -Nutritional needs ○ •Replenish iron stores (depleted at 4-6 months) ○ •Vitamin D ○ -Physiological capabilities ○ •More mature digestive system ○ •Increased kidney function ○ -Allergy prevention
• Describe the rate of infant growth.
○ Rapid growth rate ○ •Weight ▪ -Doubles by 6 months ▪ -Triples by 1 year of age ○ Length -Increases 50% by end of 1st year
• What are ways to lower the risk of lead poisoning and address constipation?
○ Reduce Lead Poisoning ▪ •Caused from exposure to: • -Contaminated drinking water • -Consuming or inhaling lead dust • -Contaminated dietary supplements ▪ •Long term intellectual and behavioral impairments ▪ •Protection: • -Balanced meals with a variety of whole grains, lean meats, and low-fat dairy products • -Let cold water run 2 to 3 minutes when it has not run for long period ○ Constipation: Hard, dry stools that are difficult to pass • Frequency of bowel movements not as important as consistency ▪ Diagnosis of constipation made after 2 or more weeks of delayed or difficult bowel movements ▪ Rule out any medical causes ▪ May be sign of food allergy or intolerance (ex: cow's milk) ▪ Treatment • Enemas • Laxatives under the direction of a physician • More fiber (whole fruits and vegetables) and fluids (4 C/day for toddlers and 5 C/day for older children) • More physical activity
• Understand the effects of calorie restriction in infancy and childhood. Understand why it is not advised to restrict fat or calories during these stages
○ Restriction of calories during infancy can impact organ systems, brain, nervous system ○ 1 to 3 yr olds, fat intake range, 30% to 40%, Older children and teenagers, 25% to 35%
• What are considerations in nutrition of vegetarian preschooler?
○ Risks of Iron and B-12 deficiency ○ Adequate intake of calories? ○ Focus on protein, vitamin B-12, iron, zinc, vitamin D, and calcium rich foods Possible need for a vitamin/mineral supplement
• How often do preschoolers need to eat throughout the day? What is an ideal snack for a toddler or preschooler?
○ Six small meals vs. three large meals can help ▪ Toddlers and preschoolers need to eat every 3-4 hour ○ Nutrient dense snacks ▪ Fruits and vegetables (fresh, frozen, or canned), whole-grain breads and crackers Offer two or three choices
What are ways to improve the diet of a teen?
○ Teens don't often think about long-term health ○ Rapid growth spurts, gains in height, lean mass and fat mass ○ At risk for deficiencies in calcium, iron, zinc, fat-soluble vitamins, and folate ○ meet (or exceed) increased energy needs with empty calories ○ ¼ high-schoolers consume minimum 5 servings fruits and vegetables ○ Recommend smaller portions of high fat/sugar foods ○ Larger servings of low-fat dairy, lean meats, vegetables, fruits, and whole grains ○ Stress importance of nutrition on physical performance and fitness
• How do health professionals assess growth?
○ They use a growth chart ▪ Used for assessment of growth in healthy infants and children ▪ Height and weight correspond to a percentile • Percentile: the rank of the person among 100 peers matched for age and gender • 50th percentile is considered average ○ Head circumference ▪ -Measures brain growth and can also be an indicator of potential health concerns if abnormally small or large -Brain grows faster during first year than any other time
• Understand how to introduce foods and handle food "issues" and "picky eaters" in the preschool years
○ Toddlers and pre-schoolers eat less and less regularly than infants ▪ Drop in growth rate ▪ More interested in playing, exploring than eating ▪ Wary of new tastes, more sensitive taste buds than adults ○ Repeat exposure: may take 10 or more exposures until acceptable ○ Food preference influenced by food temperature, appearance, texture, and taste
• Do infants require any supplemental vitamins or minerals? If so, which ones? What is the rationale for their use?
○ Vitamin K ▪ -Routinely given as injection at birth ▪ -Intestinal bacteria then begin to synthesize vitamin K ○ •Vitamin D ▪ -AAP: all infants and children should consume 400 IU vitamin D ▪ -Supplement needed if breastfed or if formula less than 1 quart a day ○ •Vitamin B12 - Breastfed infants whose mothers are vegan should receive vitamin B-12 in supplement form ○ Iron stores depleted by 4-6 months ▪ -Iron-fortified formula for bottle fed infants will supply needed iron ▪ -Iron supplementation for breast fed infants in some situations (preterm, LBW, mother deficient in pregnancy) ○ •Introduction of iron-fortified solid foods (4-6 months old) (see iron -fortified rice cereal nutrition facts on next slide) ○ •Zinc and iodide ▪ -Supplied by breast milk or formula ○ •Fluoride supplement ▪ -Not before 6 months of age ▪ -Tap water contains fluoride ▪ -Doctor may recommend if needed
