Chapter 15

One survey of U.S. schoolchildren revealed that on the day of the survey,

- 40% of the children ate no vegetables, except for potatoes or tomato sauce, - 20% ate no fruits. - Less than 20% of school-age girls consume adequate calcium.

Solid food readiness

- reaching a weight of at least 13 pounds - frequency of feeding, such as consuming more than 32 ounces (1 liter) of formula daily or breastfeeding more than 8 to 10 times within 24 hours. - Considerations: - nutritional need - physiological readiness - physical capability - allergy prevention - Waiting about 7 days between the introduction of each new food is important because it can take that long for evidence of an allergy or intolerance to materialize (diarrhea, vomiting, a rash, or wheezing) - Sample diet starting 6 mos: Week 1: Rice cereal Week 2: Add strained carrots Week 3: Add applesauce Week 4: Add oat cereal Week 5: Add cooked egg yolk Week 6: Add strained chicken Week 7: Add strained peas Week 8: Add plums

Growth charts

- represent 90-96% of children

Teen iron needs

- 10% of teenagers have low iron stores or iron-deficiency anemia - Iron-deficiency anemia sometimes appears in boys during their growth spurt, but adolescent females are at greatest risk of deficiency due to heavy menstrual flow and poor dietary intake.

Infant water needs

- 3 cups (700 to 800 milliliters) - Met by breast milk - Even in hot weather, the American Academy of Pediatrics does not recommend supplemental water or juice during the first 6 months. Excess water can cause hyponatremia in infants. It is important to remember that excessive fluid can be harmful, especially to the brain. - Dehydration s/s: 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

Infant fat needs

- 30 grams of fat per day - 15% or 5g essential fatty acids - Arachidonic acid (ARA) and docosahexaenoic acid (DHA) are two long-chain fatty acids that have important roles in infant development of nervous system, esp. brain & eyes

A healthy range of fat intake is ______ to ______ of total calories for ages 1 to 3 years and ________ to _________ of total calories for older children and teenagers.

- 30% to 40% - 25% to 35%

Infant carb needs

- 60 grams per day at 0 to 6 months - 95 grams per day at 7 to 12 months.

Infant protein needs

- 9 grams per day for younger infants - 11 grams per day for older infants - half of total should be essential amino acids

Autism Spectrum Disorder and nutrition in children

- ASD commonly has GI issues associated incl. nutrient absorption issues - popular intervention: gluten-free, casein-free (GFCF) diet, which eliminates all wheat, barley, rye, and milk products - At this time, the American Academy of Pediatrics does not endorse any specific diet as a treatment for autism. - Other popular therapies for ASD include supplementation with probiotics, vitamins B-6 and B-12, folic acid, magnesium, and omega-3 fatty acids.

Infant Formula Safety

- All containers and utensils used to prepare formula should be washed with hot, soapy water and thoroughly rinsed with clean water before use. It is not necessary to boil the containers and utensils prior to use. - Use cold water to prepare infant formula. - If well water will be used to make infant formula, it should be tested regularly for contaminants, such as naturally occurring nitrates, which can lead to a severe form of anemia (especially among babies younger than 1 year). - If microbial contamination of well water or municipal tap water is a concern, water should be brought to a rolling boil (for 1 minute) and then cooled to room temperature (for up to 30 minutes) before use in formula preparation. - Some pediatricians recommend boiling (then cooling) the water to be used in formula preparation for infants up to 6 months of age, regardless of reports about water safety. - The American Dental Association does not recommend that formula be mixed with bottled "nursery water," which can be found alongside infant formula in most supermarkets, to limit risk of tooth discoloration from high fluoride levels. - To warm a bottle of formula, run hot water over it or place it briefly in a pan of simmering water. Infant formulas should not be heated in a microwave oven because hot spots may develop, which can burn the infant's mouth and esophagus. - Refrigerating prepared formula for 1 day is safe. - However, formula left over from a feeding should be discarded because it will be contaminated by bacteria and enzymes from the infant's saliva.

failure to thrive

- BMI < 5th percentile - 5-10% of babies - 80% have no apparent reason - reasons: - improper development of the mouth or digestive tract - problems with breastfeeding - nutrient absorption issues like celiac - CV/lung issues - outcomes: poor physical growth, impaired mental development, and behavioral problems.

Suggestions for solid food

- Build to a variety of foods. - Pay attention to your infant's appetite to avoid overfeeding or underfeeding. - Infants need fat - Choose fruits, vegetables, and grains, but do not overdo high-fiber foods. - Use sugars in moderation - Skip heavily seasoned and processed foods. - Give foods with Fe, Zn, Ca

Childhood Nutrient Needs

- Carbohydrates 130 grams per day to supply energy for the central nervous system and prevent ketosis - Protein 13 to 19 grams per day (ages 1 to 3) 34 to 52 grams per day (older children) - Fat 5 grams (minimum) per day of essential fatty acids 30% to 40% of total kcal (ages 1 to 3) 25% to 35% of total kcal (older children)

Breakfast

- Eating breakfast in general is linked to better intakes of vitamin A, vitamin C, calcium, iron, and fiber. - Instead of conventional breakfast foods, parents can offer leftovers from dinner, such as pizza, spaghetti, soups, yogurt topped with trail mix, chili with beans, or sandwiches. - For lasting energy and satiety, combine traditional carbohydrate-rich breakfast foods with a source of protein, such as low-fat cheese, nuts, or eggs.

Do not feed

- Excessive infant formula or human milk after 6 mos - Foods that tend to cause choking like hot dogs, hard or gummy candies, whole nuts, grapes, coarsely cut meats, raw carrots, popcorn, and peanut butter. - Potential food allergens before 4 months of age. Cow's milk, egg whites, peanuts, tree nuts, soy, and wheat - Cow's milk, especially low-fat or fat-free cow's milk (before age 2). - Goat's milk - Excessive fruit juice - Sources of foodborne illness - Excessive supplements

Caffeine and kids

- For children, the American Academy of Pediatrics advises limiting caffeine intake to 100 milligrams per day, if used at all - concerns over neural/CV development - negative effects of caffeine at any age are gastrointestinal distress, sleep disturbances, anxiety, increased blood pressure, and irregular heartbeat

Childhood sodium needs

- High intakes of fast foods and highly processed foods elevate sodium intakes to about 1000 milligrams per day more than preschoolers need. - lower sodium intake by limiting salt added during cooking and at the table, by cutting back on use of highly processed foods, by rinsing canned beans and vegetables before cooking, and by encouraging consumption of fruits, vegetables, and whole grains in place of prepackaged snacks.

Lead poisoning

- In the US, nearly half a million children between the ages of 1 and 5 have unacceptably high blood lead levels. - Short term effects: gastrointestinal distress, lack of appetite, irritability, fatigue, and anemia. - long term effects: devastating effects include intellectual and behavioral impairments and increased risk for several chronic diseases in adulthood.

infant mineral needs

- Iron, Fluoride, Zinc, Iodine (Zn & I usually sufficient in milk/food) - Fe: iron-deficiency anemia - if food sources of iron are not part of the infant's dietary pattern, body iron stores will be depleted by about 6 months of age. - American Academy of Pediatrics recommends that exclusively breastfed infants should receive iron supplements starting at 4 months of age and continuing until dietary sources of iron are introduced. - fluoride: low first 6 mos - fluoride supplementation is not advised before 6 months of age - after 6 mos, maybe supplement if sources insufficient

Childhood Iron needs

- Iron-deficiency anemia affects 16% of toddlers and about 5% of preschoolers. - RDA for iron is 7 milligrams per day for children ages 1 to 3 and 10 milligrams per day for children ages 4 to 8

Infant vitamin needs

- K, D, B-12 particularly important - K: clotting - Newborn infants have low levels of vitamin K because (1) limited amounts of this vitamin are transferred from the mother to the fetus during gestation; (2) breast milk is not particularly high in vitamin K; and (3) newborn infants lack the intestinal bacteria that synthesize vitamin K. Infant vitamin K deficiency can lead to a rare but potentially fatal bleeding problem. To prevent hemorrhage, vitamin K is routinely given by injection to all infants at birth. - D: bone health, immune function, and chronic disease prevention - American Academy of Pediatrics recommends that all infants and children consume 400 lU vitamin D per day starting soon after birth - toxicity is possible if intake exceeds 1000 IU per day. - B-12: anemia, failure to thrive, and irreversible damage to the nervous system

Teens calcium & vit. D needs

- Less than 10% of girls and less than 25% of boys meet recommendations for calcium intake. - one in five children is deficient in vitamin D. - Calcium requirements for 14- to 18-year-old girls and boys are 1300 milligrams per day—higher than during any other time of life. - Three servings per day from the dairy group are recommended for all teenagers and young adults to meet calcium needs. (Nondairy sources of calcium include almonds, legumes, some green vegetables, and fortified foods)

Teen growth

- Most girls begin a rapid growth spurt between the ages of 10 and 13 (Early-maturing girls may begin their growth spurt as early as age 7 to 8) - most boys experience rapid growth between the ages of 12 and 15 (early-maturing boys may begin growing by age 9 to 10). - Nearly every organ and bone in the body grows during this adolescent growth spurt. - Girls gain about 10 inches (25 centimeters) in height, - boys gain about 12 inches (30 centimeters). - Girls tend to accumulate both lean and fat tissue, whereas boys tend to gain mostly lean tissue. - This growth spurt provides about 50% of ultimate adult weight and about 15% of ultimate adult height - Teenage girls need 1800 to 2400 kcal per day - teenage boys require 2200 to 3200 kcal per day

Childhood Obesity concerns

- Only about one-half of children are getting the recommended 60 minutes of exercise per day. - children now engages in 7 hours per day of screen time, on average. - American Academy of Pediatrics recommends a limit of 1 hour per day of screen time for entertainment purposes for children 2 to 5 years of age. - Moderation in calorie intake is important. High-calorie foods, such as sugar-sweetened soft drinks and whole milk, should be limited. The focus should be on more vitamin- and mineral-dense foods and healthy snacks. - If weight loss is necessary in younger children, it should be gradual, about 0.5 to 1 pound per week. - American Academy of Pediatrics now recommends universal blood lipid screening for all children around the ages of 9 to 11. - American Heart Association recently released guidelines for children to limit added sugar intake to 25 grams per day. (This is quite a reduction from the average 80 grams of added sugars consumed by children and adolescents per day)

Childhood Calcium needs

- RDA for calcium for ages 1 to 3 is 700 milligrams per day. Between the ages of 4 and 8, calcium needs increase to 1000 milligrams per day. - diets of children fall short of the RDA for this important nutrient. - Two cups per day of milk will help toddlers and preschoolers meet their requirements for bone-building nutrients. Children up to 2 years of age should drink whole milk because they need the extra fat for energy, but after 2 years of age, reduced-fat or fat-free milk is preferred.

Beverages

- The fluid needs of school-age children range from approximately 1½ to 2½ liters per day, depending on age and gender. - 135% increase in sugar-sweetened beverage consumption has paralleled the threefold rise in childhood obesity since the 1970s. - 100% fruit juices, which are perceived by many to be an important source of vitamin C and potassium for children, have been linked to obesity, fatty liver, and metabolic syndrome.

head circumference

- a means of tracking brain growth - small head circumference could also be a result of malnutrition, infection, impaired mental development, or maternal substance abuse during pregnancy. - abnormally large measurement may be a sign of a tumor or fluid on the brain.

Potential side-effects for vegetarian children

- developing iron-deficiency anemia - deficiency of vitamin B-12 - rickets from a vitamin D deficiency.

When children refuse to eat

- have them sit at the table for a while - if they still are not interested in eating, remove the food and wait until the next scheduled meal or snack. - instead of giving attention to negative behaviors, focus on positive behaviors when they occur. Praise a child for trying something new.

Effects of iron-deficiency anemia later in life

- impaired cognition - behavioral problems - impaired motor development

Feeding babies

- it is important to burp an infant during feeding (every 1 to 2 ounces) and again at the end of the feeding. Spitting up a bit of milk is normal at this time. - a formula-fed infant should consume about 2 1/2 fluid ounces (75 milliliters) of formula per pound of body weight each day, up to about 32 fluid ounces (960 milliliters) in one day. - hunger best gague - breastfeeding usually ~20 min

Caregivers need to...

- model good nutrition - be flexible - give children a stimulating environment, sense of security, and specific attention

Prevent early childhood caries

- switch from bottle to sippy cup @~6 mos

body mass index (BMI)-for-age.

- the preferred way to assess weight status for children and adolescents - reference ranges are both sex- and age-specific - Underweight: < 5th percentile - Healthy weight: 5th to 85th percentile - Overweight: 85th to 95th percentile - Obese: ≥ 95th percentile

Breast Milk

- up to 55% of total calories as fat, varying btw. feedings - Carbohydrates provide about 35% to 40% of the calories in human milk. - Protein supplies less than 10% of the total calories in human milk. - Meets most micronutrients, not vit. D -

The American Academy of Pediatrics recommends limiting total TV and video game time to _____ hrs/wk

14

Brain growth is most rapid during

1st year

Per kilogram of body weight, at 6 months of age, a child's energy needs are approximately ______ times higher than adult needs.

2-4

For a woman with a prepregnancy BMI of 22, total pregnancy weight gain should fall within the range of ______ pounds.

25-35

In the United States, approximately _____ percent of school-age children are overweight or obese.

30

Full term infants are born with some stores of iron. However, the infant's stores of iron generally are depleted by ______ months of age.

4-6

Signs of an infant's readiness for solid food include the abilities to sit with support, control the head and neck, and move foods from the front to the back of the mouth. These typically occur at _____ of age.

4-6 mos

Approximately what percentage of obese children become obese adults?

40%

Weight gain between the ages of 2 and 5 is about ______ pounds per year.

5

Between 1997 and 2011, food allergies among children increased by

50%.

food jag

A period of time (usually a few days or weeks) during which a person will eat only a limited variety of foods.

Mildred is worried about her infant becoming obese in adulthood. Which of the following would be accurate information if you were attempting to counsel her?

All of the above would be accurate information to share with the mother.

"picky eating" in toddlers

As the growth rate tapers off, energy needs decrease and eating behaviors change.

Which of the following is true about teens and vegetable consumption?

Potato chips and French fries make up more than one-third of the vegetable intake of teens.

extrusion reflex

Thrusting tongue movements that automatically push food out of the mouth

Childhood fiber needs

Young Children 1-3 years: 19 grams/day 4-8 years: 25 grams/day Boys 9-13 years: 31 grams/day 14-18 years: 38 grams/day Girls 9-13 years: 26 grams/day 14-18 years: 26 grams/day

Avoidant/Restrictive Food Intake Disorder

a child lacks interest in eating specific foods or all foods in general, which leads to weight loss or failure to grow as expected, as well as many nutrient deficiencies.

Until a child is about 5 years of age, a good starting point for portion sizes in the vegetables group, fruits group, and protein group is

about 1 tablespoon per year of life.

high-fiber diets

are not recommended for infants

Most common cause of constipation

child withholding BM

Feeding problems may develop during the preschool years partially because of

decreased appetite associated with decreased growth rate.

Iron-deficiency anemia in the latter part of infancy is associated with

diet containing few solid foods

An infant's birth weight ________ in the first 4 to 6 months and _________ within the first year.

doubles; triples

The single best indicator of a child's nutritional status is __________

growth

Due to rapid growth and a high metabolic rate, the energy requirements per pound of body weight for an infant are the __________ of any life stage

highest EER equations 0 to 3 months: (89 kcal × weight in kilograms) + 754 6 months: (89 kcal × weight in kilograms) − 447 12 months: (89 kcal × weight in kilograms) − 7813 35 months: (89 kcal × weight in kilograms) − 80

The greatest energy requirement per unit of body weight occurs during

infancy

As solid food is introduced, which of the following should be included in an infant's diet?

iron-fortified cereal

For a girl, undernutrition could be expected to have its greatest effect on height if it occurs

just before the onset of menstrual periods.

Most formula products for infants contain

lactose, heat-treated cows' milk protein, and vegetable oils.

Having an adequate iron and calcium status helps to reduce _____ absorption.

lead

Which foods would you suggest adding to the diet of a preschool child at risk for iron deficiency?

lean meats

For toddlers (ages 1 to 3 years), the American Academy of Pediatrics recommends

limiting fruit juice consumption to 4 fluid ounces per day.

For older children (ages 7 to 18), the American Academy of Pediatrics recommends

limiting fruit juice consumption to 8 fluid ounces per day.

For infants (up to 12 months of age), the American Academy of Pediatrics recommends

no fruit juice

Girls experience their peak rate of growth

right before the onset of menstrual periods.

Mild deficiencies of zinc in children in the United States have been linked to

short stature.

Undernourished children are ___________ versions of nutritionally fit children.

smaller

According to current growth charts, an infant can be expected to ______ his or her birth weight by 1 year of age.

triple

In the short-term, gains in ________ are a good indicator of nutritional status. The best indicator of long-term nutritional status in a child is gains in ________.

weight; height