Chapter 17: Nutrition in Childhood

Normal growth and development

From birth to 1 year, average infant triples his birthweight Toddlers gain 8 oz and grow 0.4 inch (1 cm) per month Preschoolers gain 4.4 lb and grow 2.75 in per year

2000 CDC growth charts

Tool for Health Care Professionals to plot and monitor -Weight for age -Length or stature for age -Head circumference for age -Weight for length/stature (<2 yrs old) -- < 5% underweight > 95% overweight -BMI for age (2 years and older) -- < 5% underweight -- > 85% overweight -- > 95% obese

common vitamin and mineral deficiencies in toddlers and preschoolers

iron, calcium, zinc

Appetite and food intake of preschoolers

-"Picky Eaters --May prefer familiar foods --Exercising a form of control -Serve child-sized portions -Make foods attractive -Strong-flavored or spicy foods may not be accepted -Control amount eaten between meals to ensure appetite for basic foods

Physiological and cognitive development: toddlers

-A time of expanding physical and developmental skills -Walking begins as a "toddle," improving in balance & agility -Progress by month 15—crawl upstairs 18—run stiffly 24—walk up stairs one foot at a time 30—alternate feet going up stairs 36—ride a a tricycle

Nitamin and Mineral supplements

-A varied diet provides all vitamins & minerals needed -AAP recommends supplements for certain groups of children: --From deprived families --With anorexia, poor appetites or poor diets, FTT, chronic disease or a dietary program for wt mgmt --Who consume only a few types of foods --Vegetarians without dairy products

Feeding behaviors of preschool age children

-Appetite related to growth o Therefore appetite is variable - Appetite increases prior to the "spurts" of growth o Weight gain the height -Include child in meal selection & preparation

Fluoride

-Can prevent dental caries -Supplementation recommended when water supply is not fluoridated -It is the only routine supplement recommended by AAP

Nutritional requirements for catch-up growth

-Catch-up Growth: A child who is recovering from an illness or undernutrition and whose growth has slowed or ceased experiences a greater than expected rate of recovery -Stunted growth—height and weight are proportionally low, chronically malnourished -Primarily wasted—weight deficit exceeds height deficit -Nutrient requirements depend on rate and stage of catch-up growth

Iron deficiency prevention

-Consume no more than 24 ounces of milk daily --Low iron content and displaces high iron foods -Test at risk children for deficiency --Low income --African Americans --Mexican Americans --Refugee Children

food preference development, appetite, and satiety, cont.

-Consumption of foods high in sugar and/or fat before meals decreases intake of basic foods -Children are influenced by food ads in TV -Offering large portions increases food intake and may promote obesity -Restriction of palatable foods increases preference for the foods -Studies show that by late pre-school years children are more influenced by environment than internal cues.

Iron deficiency treatment

-Counseling parents and caregivers on iron rich foods meat, fish, poultry and vitamin C to increase absorption -Supplementation -If iron levels do not improve explore other causes (B12 and Folate Deficiency)

Other concerns

-Cross-cultural considerations --Build on cultural practices o Reinforce positive practices o Attempt change for more benefit -Vegetarian diets --Vegan and macrobiotic diet children tend to have lower growth rates but remain within normal ranges

Constipation

-Definition: --Hard, dry stools associated with painful bowel movements -Causes: --"Stool holding" causing painful movements and fear --Diet -Prevention: --Adequate fiber whole grain breads and cereal, fruits and vegetables that are age appropriate --Fluid intake

Nutrition and prevention of cardiovascular disease cont.

-Eat fruits and vegetable -Whole grain breads and cereals -Vegetable oil and soft margarines low in sat and trans fat -Low-fat or non-fat dairy product -Reduce salt and sugar intake -Studies show no effects on growth patterns of children

Cognitive development of preschool age children

-Egocentric—cannot accept another's point of view -Learning to set limits for himself -Cooperative & organized group play -Vocabulary expands to >2000 words -Important indicator of cognitive and emotional development -Begins using complete sentences

Energy

-Energy needs are based on basal metabolism, rate of growth, and energy expenditure -Ensures growth and prevents protein being used as energy -Suggested: Carbohydrate 45% to 65% FAT 30% to 40% Protein 10% to 30% protein

Cognitive development of toddlers

-Environment: --Toddlers "orbit" around parents -Social: --Transitions from self-centered to more interactive --Development of new relationships --Imitating parents, peers, siblings and caretakers -Vocabulary expands: 10-15 words at 18 months 100 at 2 years 3-word sentences by 3 years -Temper tantrums common (the terrible two's)

Vitamin D

-Essential for bone development -Recommendation are the same birth through age 50 (5 mcg/day) -Cows milk and fatty fish are good sources -Sunlight exposure leads to vitamin D synthesis -Assist in the absorption of calcium into the bones

Allergies

-Food allergies usually manifest in infancy and childhood -Family history of allergies -Common foods- cow's milk, chocolate, citrus, egg white, seafood and nut-butters -Introduce gradually to monitor for reactions -Allergic reactions include- respiratory, GI symptoms, skin reactions fatigue and behavior changes

Childhood growth and development

-Growth rate slows dramatically at 1 year -Periods of no growth followed by growth spurts -Appetite and intake parallel growth -Catch-up growth: after illness or undernutrition

Food insecurity in the US

-In 2013, 11% of U.S. households were food insecure. -Insecurity more common in minority populations, single parent and lower-income-level houses -Food insecurity increases the risk of iron deficiency in young children. -Even marginal food insecurity is associated with poor outcomes in children. -School lunch, SNAP, and WIC provide services to only 60% of food insecure households.

Minerals and Vitamins

-Iron deficiency most likely in children ages 1 to 3 years. -Calcium is critical for growing bones and is obtained primarily through dairy products. -Zinc is essential for growth, and marginal deficiency has been reported in preschoolers. -Vitamin D is needed for calcium absorption bone growth; need depends on geographic location and skin pigmentation.

Obesity treatment

-Maintaining weight and gaining height through lifestyle changes -Prevention Plus identifies specific behaviors and assist the family in making changes -Structured Weight Management more structure and follow-up -Comprehensive Multidisciplinary -Intervention including a Registered Dietitian, exercise specialist, behavior counselor and primary caregiver

Nutrition intervention for risk reduction

-Model program Bright Futures Nutrition -Public food and nutrition programs WIC WIC's Farmers' Market Nutrition Program Head Start and Early Head Start Supplemental Nutrition Assistance Program (formerly Food Stamps)

School age and pre-adolescent

-Nutrition continues to be important to assure full potential for growth, health, development and academic performance -School age or middle childhood --Between the ages of 9-10 years -Preadolescence --Girls ages 9-11 years --Boys ages 10-12 years -Prevalence of obesity is increasing -Eating disorders can develop

Overweight and obesity

-Of children ages 2-5: -- 12.1% are obese (BMI/age ≥95%) -BMI is lowest from ages 4-6 years -Adiposity (BMI) rebound—normal increase in BMI that occurs after BMI declines and before puberty -Best treatment is allowing child to "grow into his or her height"

Dental caries

-Prevalence: 1 in 3 children ages 3 to 5 -Causes: Bedtime bottle or "No spill" training cup with juice or milk prolonged day time use or at bed time --Increased risk of adult tooth decay Carbohydrate foods, --Sticky candy or long exposure (grazing) -Prevention: Age appropriate Crunchy foods Carrots and apples Fluoride—supplemental & fluoride content of water supply

Iron-deficiency anemia

-Prevalent problem among toddlers -May cause delays in cognitive development and behavioral disturbances -Diagnosed by hematocrit and/or hemoglobin concentration

Preschool age development feeding skills

-Proficiently use fork, spoon and cup -Can cut and spread with knife -Sits at a table for meals an snacks -Choking is still a concern --Popcorn, peanuts, carrots, celery, hotdogs, grapes, peanut butter, candy and tough meats --Hot dogs, tator tots and grapes may need to cut length wise

Elevated blood lead levels

-Seen in ~0.9% of children ages 1-5 --Has been decreasing since NHANES 1999-2002 data -Potential for exposure air borne, lead water pipes, lead paint, caned goods from other countries and contaminated soil and water supply. -Low levels of lead exposure linked to lower IQ & behavioral problems -High blood lead levels may decrease growth -Reduce lead poisoning by eliminating sources of lead

appetite and food intake of toddlers

-Slowing growth results in decreased appetite -Toddler-sized portions average 1 tablespoon per year of age -Nutrient-dense snacks needed but avoid grazing on sugary foods that limit appetite for basic foods at meals -Establish regular yet flexible meal and snack times -Sensory factors (smell, texture, temperature)

Nutrition and prevention of cardiovascular disease

-The #1 cause of death begins in childhood -Limit dietary saturated fats, trans fat & cholesterol -Acceptable total fat intake ranges: -- 2 to 3 years—30 to 35% of calories -- 4 to 18 years—25 to 35% of calories -For children at high risk of CVD limit saturated fat to < 7% of calories & cholesterol to < 200 mg

definitions of the life cycle stage

-Toddlers—1-3 years o Characterized by rapid increase in gross & fine motor skills -Preschool-age children—3-5 years o Characterized by increasing autonomy, broader social circumstances, increasing language skills, & expanding self-control o Attend pre-school, spend the night with a friend

Protein

-U.S. children are at low risk for protein malnutrition -Age 1 to 3 years, (13 g/day) 1.10 g/kg/day; -4 to 13 years, (34 g/day) 0.95 g/kg/day -Children at risk of inadequate protein intake: vegan, multiple food allergies, behavior disorders

Calcium

-Vital to establish healthy dairy consumption habits -Consumption of milk has declined since the 1970s -Needed to build high peer bone mass -Prevention against osteoporosis and fractures -Fish with soft bones, Kale, and calcium fortified beverages

Food safety

-Young children especially vulnerable to food poisoning -Food safety practices by FightBAC: Clean: wash hands & surfaces often Separate: don't cross-contaminate Cook: cook to proper temperatures Chill: refrigerate promptly

Growth charts

-growth channels not well established until 2 yrs of age -WHO birth to 24 month growth charts -CDC growth charts: 2- 20 years

Fluid intake

-replace surgery drinks with healthy drinks -offer water -milk at meals

feeding behaviors of toddlers

-rituals in feeding are common -may have strong preferences or dislikes -food jags: periods when foods that were previously liked are refused, or repeated requests to eat the same food meal after meal o serve new foods with familiar foods o serve new foods when child is hungry o eat the food with the child o do not force feed - make the meal a pleasant family time

feeding patterns

-snacks are important for young children -offer 1 tablespoon of each food for every year of age and to serve more food according to child's appetite

MPlate caloric intake

1600 cals/day

Energy needs

Dietary Reference Intakes (DRIs) have been developed -13-36 mo (89 x wt/kg - 100) + 20 = -Age 3 - 5 factors of gender, age, weight, height and activity, factor into needs -The reports present a comprehensive set of reference values for nutrient intakes of healthy individuals

Dietary and Physical Activity Recommendations

Dietary guidelines -Offer a variety of foods, limiting foods high in fat & sugar -60 minutes of vigorous physical activity each day MyPlate developed by the USDA for young children

development of feeding skills of toddlers

Gross & fine motor development improved -9-10 months—weaning from bottle begins Intake of solid food increases Learns to drink from a cup 12 to 14 months—completely weaned -12-18 months Refines pincer grasp Moves tongue from side to side Learns to chew in a rotary motion -18-24 months— Able to use tongue to clean lips Introduction of meats, raw fruits and vegetables and multi-textured foods

common nutrition problems

Iron-deficiency anemia Dental caries Constipation Elevated blood lead levels Food security Food safety

Prevention of Overweight and obesity

Limit sugar-sweet beverages Encourage fruits & vegetables Limit TV Daily breakfast Limit fast foods Limit portions Calcium rich diets Diets high in fiber Follow the DRI for carbs, pro & fat Promote physical activity Limit energy-dense foods

Normal growth and development for school age and pre-adolescents

Measurement techniques -Growth velocity will slow down during the school-age years -Should continue to monitor growth periodically -Weight and height should be plotted on the appropriate growth chart --2000 CDC growth charts

food preference development, appetite, and satiety

Prefer sweet & slightly salty, reject sour & bitter foods -Eat familiar foods -May need 8-10 exposures to new foods before acceptance -Food intake related to parent's preferences -Context of offering, reward foods, restricted foods (Good Vs Bad), Forcing consumption.

recumbent length

toddlers less than 2 years