Chapter 10- Toddler and Preschooler Nutrition

Feeding behaviors of preschool-age children

-Appetite is related to growth; increased appetite prior to the "spurts" -involve child in meal selection and preparation

Healthy People 2020: population of two years and older

-Increase the contribution of fruits, vegetables, dark green leafy vegetables, orange vegetables, legumes, whole grains to the diet -Increase consumption of calcium -Reduce consumption of calories from solid, added sugars, saturated fat, sodium

Prevention of overweight and obesity

-Limit sugar-sweet beverages -Encourage fruits and vegetables -Limit television and screen time -Eat a daily breakfast -Limit restaurants and fast foods -Limit portions -Promote physical activity for 60 minutes each day -Eating a diet high in fiber

Iron deficiency anemia in children

-Prevalent problem among young children -May cause delays and long term effects in cognitive development and behavioral disturbances -Diagnosed by hematocrit and/or hemoglobin concentration

Vegetarian diet guidelines for toddlers and preschoolers

-Provide three meals and two to three snacks per day -Avoid excessive bulky foods (ie: bran) -Include energy dense foods (ie: cheese, nuts, seeds) -Provide an omega-3 fatty acid source (ie: tofu) -Ensure an adequate intake of calcium, zinc, iron, and vitamins B12 and D

WIC's Farmers' Market Nutrition Program

-Seasonal program for WIC participants -Provides vouchers for the purchase of locally grown produce at farmers' markets

Recommendation for fat soluble vitamins

-adequate calcium is important for children to achieve peak bone mass -calcium sources: dairy, canned fish with soft bones, green leafy vegetables, and calcium-fortified beverages and supplementation if needed

Recommendation for fiber intake

-adequate fiber is needed to prevent constipation and may provide long-term disease prevention -sources: fruits, vegetables, whole grains

Recommendation for fluids

-adequate hydration prevents constipation -fluids: beverages, food and sips of water

Recommendation for iron intake

-adequate iron is necessary to prevent iron deficiency and iron deficiency anemia in toddlers and preschoolers -sources: meats, fortified cereal, dried beans, peas

Nutrition assessment of toddlers and preschoolers

-anthropometric measurements (weight, height, BMI %) -Biochemical measurements -clinical assessment -food-nutrition related history -medical history

Development of feeding skills of preschool-age children

-can use a fork, spoon, and cup -eating becomes less messy -spills occur less frequently -foods should be cut into bite sized pieces -adult supervision is imperative

Preschoolers: innate ability to control energy intake

-children adjust /self regulate caloric intake to meet caloric needs -avoid telling child to "clean your plate" -Healthful eating habits must be learned -Food habits and food preferences are established during this time

MyPlate

-developed by the USDA for young children -encourages food consumption of a variety of foods from five food groups -able to customize and individualize MyPlate for the patient

Common problems with measuring and plotting growth data

-error in measuring may result in errors in health status assessment

Physical activity recommendations for toddlers and preschoolers

-games in the yard or park -family walks after dinner -freestyle dance -hide and seek -tag -ring around the Rosie -Simon says

Risks of overweight and obese in pediatric population:

-high blood pressure and high cholesterol (risk factors for CVD) -respiratory problems -sleep apnea -GERD psycholgical stressors -impaired glucose tolerance

Monitoring a child's growth

-important for children to be accurately weighed and measured -important to use proper techniques

Nutrition intevention for iron deficiency

-iron supplementation -increased consumption of lean mat, fish, poultry, and the inclusion of vitamin C sources at mealtime to increase the absorption of nonheme sources of iron -counseling parents: educating parents on iron-rich foods and which foods inhibit iron absorption -repeat screening

Prevention of iron deficiency in children

-limit milk consumption to 24 ounces -infants at risk should be tested at 9-12 months, six months later, and annually from ages two to five

Cognitive development of preschool-age children

-magical thinking and egocentrism -learning to set limits for himself -beginning of cooperative and organized play -expansion of vocabulary to over 2000 words -begins using complete sentences

Appetite and food intake of preschoolers

-may prefer familiar foods: comfort or control -young children often do not like their foods to touch or to be mixed together

Overweight and obesity in toddlers and preschoolers

-multifaceted problem that is difficult to treat, making prevention the preferred approach

Children's food preferences determine what foods they consume

-naturally prefer sweet and slightly salty -have preferences for energy dense foods -influence by media -able to adjust caloric intake based on caloric need

Dental caries (tooth decay) in children

-prevalence: one in three children ages three to five -causes: bedtime bottle with juice or milk, Streptococcus mutans, and sticky carbohydrate foods -prevention: fluoride ->supplemental amounts vary by age and fluoride content of water supply

Feeding behaviors of toddlers

-rituals in feeding are common -may have strong preferences and dislikes -Food jags/ aversions common -serve new foods with familiar foods -toddlers imitate eating behaviors of others

Elevated blood lead levels in children

-seen in 1.6% of children ages one to five

Appetite and food intake of toddlers

-slowing growth results in decreased appetite -toddler-sized portions average one tablespoon per year of age -establish regular but flexible meal and snack times

Nutrition interventions for risk reduction

-test iron status by looking at biochemical nutritional parameters (hematocrit and/or hemoglobin concentration)

Cognitive development of toddlers

-toddlers often "orbit" around parents -transition from self-centered to more interactive -vocabulary expands -temper tantrums are common (terrible twos/threes)

DRI intake for protein: preschoolers

0.95 g/kg/d

Toddlers

1-3 years -rapid increase in gross and fine motor skills

DRI intake for protein: toddlers

1.1 g/kg/d

Physical and developmental skills of toddlers

15 months: crawl upstairs 18 months: run stiffly 24 months: walks up stairs one foot at a time and jumps in place 30 months: alternates feet going up stairs 36 months: rides a tricycle

Preschoolers

3-5 years -increasing autonomy, , broader social circumstances, increasing language skills, expanding behavior control, expanding friendship groups

Development of feeding skills of toddlers

9-10 months: bottle weaning 12-14 months: completely weaned 12 months: refined pincer grasp 18-24 months: able to use tongue to clean lips and has well-developed rotary chewing

BMI: for children over 2 years

BMI 85-94 = overweight BMI >95 = obese

Constipation

Hard, slow stools that are difficult to eliminate -causes: stool holding, inadequate intake of fiber and fluids -prevention: adequate fiber and fluid

Two types of iron

Heme- in read meats, fish, poultry (contain hemoglobin and myoglobin) ->Better absorbed than nonheme Nonheme- found in non-meat foods like vegetables, grains, iron fortified cereal- can improve absorption by consuming vitamin C rich foods

Toddler protein needs

RDAs are easily met with typical American diets as well as vegetarian diets

CDC growth charts

Reference for how US children are growing -GENDER specific -ages 2 through 19

WIC

Special Supplemental Nutrition Program for Women, Infants, and Children -receive nutrition assistance, education, and follow up services

Which of the following statements regarding fat in children's diet is correct? a. Dietary fat is an important source of calories in a young child's diet. b. The amount of saturated fat is not restricted in young child's diet. c. The amount of trans fatty acids is not restricted in a young child's diet. d. Restricting fat in a young child's diet has been shown to decrease growth. e. Dietary fat recommendations are the same for children regardless of cardiovascular disease risk.

a. Dietary fat is an important source of calories in a young child's diet.

Child-care nutrition standards

an estimated 23 million preschool age children attend a child care program -nutrition standards for child care services exist and specify minimum requirements -offer food at intervals not less than two hours and no more than three hours

Expected growth and development: preschoolers (3-5 years)

average gain of 4.4 lbs and 2.75 inches per year

Expected growth and development: toddlers (1-3 years)

average gain of 8 ounces and 0.4 inches per month

Expected growth and development: birth-12 months

average infants triple their birthweight

Assessment of Overweight and Obesity

body mass index-for-age percentile is the recommended screening tool

Reduce lead poisoning

by eliminating sources of lead

Which of the following growth parameters is used as a screening tool for assessing underweight and overweight or obesity in young children? a. Weight-for-age percentile b. Length- or stature-for-age percentile c. Body mass index-for-age percentile d. Actual body mass index (weight in kg/height in m^2) e. Actual weight in kg

c. Body mass index-for-age percentile

Standard procedures for measuring growth

calibrated and appropriated equipment should be used and plotting accuracy is vital

Adult supervision during feed is vital to prevent

choking

Treatment: stage three

comprehensive multidisciplinary intervention -structured program for behavior modification -food monitoring, short term diet physical activity goal setting, creating a negative energy balance -RDN, therapist, counselor, clinician are involved

Dietary Reference intake (DRIs)

comprehensive set of reference values for nutrient intakes for healthy individuals

Obesity is defined as: a. Weight-for-age percentile >85th to 94th b. Weight-for-age percentile >95th c. BMI-for-age percentile >85th to 94th d. BMI-for-age percentile >95th

d. BMI-for-age percentile >95th

Which of the following would be the best choice for a between meal snack for a preschooler? a. 100% fruit juice b. Raisins c. Fortified gummy bears d. Peanut butter crackers e. Oatmeal cookies

d. Peanut butter crackers

Which of the following strategies would be appropriate for parents to use in teaching their young child healthy eating behaviors? a. Give a dessert as a reward for eating fruits and vegetables. b. Expect the child to eat foods that parents will not eat themselves. c. Coax the child to eat, especially new foods. d. Serve child-sized portions or allow the child to self-serve portions. e. Make the child stay at the table until she has cleaned her plate.

d. Serve child-sized portions or allow the child to self-serve portions.

The slowing of growth velocity is reflected in

decreased appetite

Food security

defined as access at all times to sufficient supply of safe, nutritious food -concern for growing children since food insecurity may hinder growth and development

T/F A well planned vegaterian diet cannot meet the needs of a growing child.

false

Recommendation for fat intake

follow DRIs and MyPlate -fat is an important source of calories, essential fatty acids and fat soluble vitamins

MyPlate five food groups

fruits, vegetables, grains, proteins, dairy

During toddler and preschool years, adequate nutrition is required to achieve

full growth and development

High blood levels may decrease

growth

WHO growth standards

growth standards for children from birth to five years -based on growth data collected over time on healthy breastfed infants and young children in six different countries

Children with vegan and macrobiotic diets tend to

have lower growth rates but remain within normal ranges

Undernutrition in toddler and preschool years

impairs cognitive development and the ability to explore environment

Calcium inhibits __ absorption

iron

Some of the risk factors for elevated blood levels are also the same risk factors for

iron deficiency ie: young age, poor nutrition, and low socioeconomic status

The eating and health established at this stage of life may impact health

later in life -young children need adequate calories and nutrients

Important aspects of toddler and preschooler development

learning about and accepting new foods, developing feeding skills, establishing healthy food preferences and eating habits

Low level lead exposure is linked to

lower IQ, impaired motor, behavioral, and physical abilities -causes brain and nervous system damage

Physical activity in toddlers and preschoolers helps to

maintain energy balance while strengthening muscles

Recumbent length

measurement of length while the child (under 2 years) is lying down

Vitamins and minerals

most toddlers and children have adequate vitamin and mineral consumption except for iron, calcium, and zinc -calcium is important for bone formation

Bright Futures Nutrition

nutrition intervention for risk reduction fosters trusting relationships to promote optimal health for the child

Dietary Guidelines for Americans 2010

offer a variety of foods, limiting foods high in fat and sugar

Treatment: stage one of

prevention plus -focusing on basic healthy lifestyle and activity habits (MyPlate) -decreasing screen time

Growth during the toddler and preschool-age years is __ than in infancy

slower

Toddler energy needs reflect

slowing growth velocity of children in this age group -growth begins to slow and the energy needs match up to that slowed growth

Adequate energy to meet an individual child's needs has a protein __ effect

sparing -with adequate energy intake, protein is used for growth and tissue repair rather than energy

Treatment: stage two

structured weight management -more structured -planned diet or daily eating plan -screen time for less than 1 hour -Registered dietitian works with the patient and family

Treatment: stage four

tertiary care intervention -offered to severely obese adolescents who have failed other interventions -a minimum of 12 years -includes weight loss medications, medically supervised low calories diets, and weight surgery

The goal treatment of overweight and obesity expert committee

the goal for overweight and obesity treatment is to improve the long term physical health through permanent healthy lifestyle habits and behavior modification -the expert committee recommends a stage approach for treatment

Cross cultural considerations

the health care provider should build on cultural practices and reinforce positive practices while attempting to make beneficial changes

Preschool children learn about food and food habits by observing

their parents, caretakers, peers, siblings, and the media

T/F According to food consumption surveys, young children exceed estimated needs for calories.

true

T/F Food habits are learned behaviors.

true

T/F Surveys of food intake indicate that most children meet their nutritional needs, but that their intakes exceed recommendations for energy and saturated fat.

true

WHO growth charts

used for children aged birth to younger than 2 years (regardless of type of feeding)

Vegetarian diets for toddlers and preschoolers

young children can grow and develop normally on vegetarian and vegan diets, as long as their dietary plans are well organized, intentional, and planned

Food safety

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