FSN 310 Final notes
What are steps for managing pediatric obesity?
-begins with assessment: Remember growth charts BMI for age parameters. -Also assess behaviors, attitudes etc. (Parental behaviors and their feelings about weight; Attitudes towards change) -Same steps as treating obesity for preschoolers -Weight goals depending on severity of overweight/obesity
How should you feed preterm infants?
-breast milk (best food) -gavage feeding (extra tubes attached to nipple) -gastrostomy tube (if can't coordinate suck and swallow)
Should children be on vegetarian diets?
-can be adequate BUT Children can only eat so much and need to get adequate kcal; Children may need to eat multiple times per day; Careful planning necessary -Vegan diets ok if parent is well educated on giving child right amount of nutrients
What school aged children may have nutrient deficiencies?
-children with anorexia or decreased appetite -children with chronic diseases -children who suffer from parental neglect or abuse -children who participate in dietary program for managing obesity -Children on a vegetarian diet without dairy -children who are underweight -Children with severe food insecurity
How can screen time contribute to obesity?
-decreased energy -increased intake (snacking) -reduction in sleep (circadian rhythm affected) -increased in sweet and salty foods -increased sweetened drinks (soda) -Decreased fruits/veggies
What are feeding problems from disabilities involving neuromuscular control?
-ex: cerebral palsy -May put child at risk for choking -May see large decrease in food intakes for children having trouble chewing, swallowing, or controlling their upper bodies -Higher risk of dehydration -Comprehensive nutrition treatment needed
What are recommendations for consideration of bariatric surgery in adolescents?
-failure to obtain adequate weight loss -Stage IV or higher of physical maturity -strong indications for major cormorbities -psychological and medical counseling before -family support
What qualities are more likely for children living in poverty?
-have anxiety, do worse on math, be tardy, absent, aggression, repeat grades, and more visits to psychologist -Food intake directly correlates to how they do in school
What are energy needs for prematurity/other serious conditions of infants?
-increased calories required for infections, fever, difficulty breathing, temperature regulation, & recovery from surgery -Preterm energy needs are ~120 kcal/kg (vs. 108, significantly higher!) -Decreased calories recommended for spina bifida or Down syndrome b/c lower muscle tone, less mobile in beginning
Why is cow's milk not recommended for infants?
-increased risk of Fe deficiency -increased blood loss in infants <4 months old -Low Fe content of cow's milk -High Ca levels (Stressful on kidneys at that age) -High renal solute load -Lack of essential fatty acids (No DHA/EPA)
How do portion sizes and restrictions affect children?
-it may vary by age (see as early as age 4; More likely to eat it all if served on larger plate -If parents restrict palatable foods: Children may select them more often OR Children may feel bad about it
What is infant formula?
-liquid or reconstituted powders fed to infants and young children -labeled as "HMS" -may be only source of nutrients for infants -FDA controlled
What nutrients are adolescents low and high in?
-low in everything (Folate, many vitamins and minerals, fruit/veggies, grains, dairy) -High in saturated fat, sodium cholesterol, added sugar
What developments of feeding skills and eating behaviors occur during preadolescence?
-mastered utensils -Can help with meal related tasks -Serve food, pick recipe, cook things -Is learning about nutrition, food prep, and different foods -Biggest influence still parents and siblings (home environment = important)
What are the rates of infant growth and maturation?
-metabolic rate is highest of any period after birth -2X birth weight by 4-6 months -3X birth weight by 1 year -40-50% increase in length in 1st year
What changes occur for the preschool age?
-period of imagination and egocentrism (Hard for them to imagine beyond their own environment and understand point of view) -Control is important -Vocabulary expands!
What are feeding behaviors and appetite of toddlers?
-picky eaters -avoid "food tantrums" by giving them something else or putting them in cute shapes -mealtime is an opportunity -appetites are variable -should eat 1 tablespoon per year/meal (type of food)
What are maternal causes for failure to thrive (FTT) while breastfed?
-poor production: diet, illness, fatigue -poor let-down: psychological resistance, drugs, smoking
What is Orlistat?
-prescription and over the counter (Alii): inhibits pancreas lipase secretions, reduces fat digestion by 30% (results in fatty stools), only one FDA approved -Can be misused as a diet drug -Should take supplements in fat soluble vitamins
What is BMI rebound?
-prior to age 6, most children have low BMI (lowest BMI between 5-7) and then it jumps -Age affects child and amount of body fat gains (if occurs early, poses for higher risk of obesity later in life)
How does parental involvement influence adolescent nutrition?
-set example for kids -parent should get child involved in shopping list, cooking (vs. doing dishes?), and buying groceries -Serving fruits, veg, and dairy at home meals may lead to more frequent choices of these foods up to 5 years down the road -send them to cooking classes
How much food is enough?
-start with 1-2 teaspoons/day to learn about how to move mouth/food in mouth -increase to 2-4 tablespoons/day (considered a meal ) -Eventually may provide 3 "meals" and 2 "snacks" per day
What are fluid recommendations for school aged children?
-water -sports drinks are okay for kids sweating/exercising intensely in the heat -no soft drinks or undiluted fruit juice b/c high CHO load can cause nausea and diarrhea
What are nutritional needs for protein for infants?
0-6 months is 1.52 g/kg 6-12 months is 1.2 g/kg
What are protein recommendations for adolescence?
0.85g per kg (decreases, closer to adult range) Depend on: where they are during puberty, how active they are
What are the recommended dietary allowances for protein established?
1-3 years: 1.1 g/kg 4-8 years: 0.95 g/kg
What are the four stages for weight loss treatment for children?
1. Prevention plus (Informal information maybe once a year) 2. Structured weight management - SWM (Planned diet or eating plan; <1 hour of screen time; play time = 60 min; monitoring with RD+counselor (monthly) 3. Comprehensive multidisciplinary intervention - CMI (Weekly visits 8-12 weeks; all members of team; negative energy balance; food monitoring; parent involvement with behavior change) 4. Tertiary care intervention
What are recommendations from the American Heart Association for toddlers and preschoolers?
30-35% kcal from fat age 2-3 25-35% kcal from fat age 4 plus < 1% kcal from trans fats -Diets high in fruit/veg/fiber/whole grains -Screening for CVD in high risk children after age 2
What is the Vitamin D need for school aged children?
4-18 years old: 600IU day
How common is iron deficiency for school aged children?
4-6% (vs. toddlers at 7%) -lucky iron fish
What is the Calcium need for school aged children?
4-8 years old: 1000mg 9-13 years old: 1300mg (higher b/c more bone formation)
What is normal growth and development for preschoolers?
4.4 lbs per year 2.75 inches per year (growth slows down)
What is the recommendation for Vitamin D in children?
400 IU -should develop diets rich in CA sources
What is the average number of hours need to teach nutrition education?
50 hours -All schools who participate in National School Lunch program must adopt a "wellness policy"
What percentage of infants are taking formula?
51% at 6 months, 63% at 12 months
What is normal growth and development for toddlers?
8 ounces per month (6 lbs per year) 0.4 inches/month (4.8 inches per year)
What is stage 2 treatment of overweight and obesity for adolescents?
Similar to stage 1 but more structured May include: -Screen time limits 1 hour or less -Food diary or journal or photo diary -Meal plan nutrient dense foods vs. strict calorie limit -Non food rewards (i.e. stickers, going to the movies, physical activity, beach, new shoes/clothes, book or game)
When might breast milk be contraindicated?
food allergies -About 6-8% of children <4 yrs have food allergies; typically due to absorption of intact proteins
What would be treatment for infants with food allergies who need to take formula?
formula with hydrolyzed proteins
What is puberty indicated by?
height, weight, body mass/comp changes, bone, sexual maturation
What does "zebra" mean?
medical term for when doctor doesn't know what is wrong with someone
What are fat needs for prematurity/other serious conditions of infants?
medium chain (6-12 C's) TG's (does not need bile for absorption)
What are nutrition needs for energy for infants?
-0-6 months: 108 kcal/kg body weight -6-12 months: 98 kcal/kg body weight -factors: Weight, height, activity status, health, sleep, temp./climate
What is anorexia?
-0.2-1.0% of adolescence -Females (9/10) -In minority groups, eating disorders are increasing for males -Restricting calories, body dysmorphia, denial of appetite -10-15% die highest death rate due to infections, dehydration, heart failure
How is lead poisoning a common nutrition problem for children?
-0.9% of children age 1-5 had high blood levels of lead -Major sources are air and lead chips and dust -Similar risk factors as iron deficiency (Adequate iron intake may reduce risk)
What is childhood celiac disease?
-1 in 141 individuals aged 6 or older -May interfere with learning or growth -Treatment: Gluten free diet
What is hyperlipidemia in adolescence?
-1 in 4 adolescence has elevated cholesterol -Recommended screening in high risk youth -CHILD: Cardiovascular Health Integrated Lifestyle Diet: Low salt, low fat, low cholesterol, low processed; High fiber, more fruits/veggies; Family meals encouraged; Breakfast eating
What is bulimia?
-1-3% adolescence -Overeating and then compensating -Vomiting, laxative use, over-exercising -Normal weight, can be under or over (if purging doesn't work) -2-4% die less likely because they are getting some nutrients (however electrolyte abnormalities cause severe side effects)
What is cerebral palsy?
-1.4-2.4 per 1000 births -Brain damage and associated issues -Spastic quadriplegia (no control of limbs) presents most nutrition problems -Possible issues: lack of coordination, increased calories
What are statistics regarding health, income, and socioeconomic disparities in school aged children?
-1/3 of children lived below the poverty level in 2010 -7.3 million children without health insurance -9.3% children had not seen MD in last year (But 1/3 of children living in poverty had visited ER; Not getting screen for CVD, not going to dentist, not getting growth chart tracked) -Many living without transportation -Odds of being obese vary by race/ethnicity (hispanic, then african american)
What are the benefits of family meal times?
-12% less likely to be overweight -20% less likely to eat unhealthy foods -35% less likely to have disordered eating -24% more likely to eat healthy food -Increased intakes of B vitamins, Iron, and Ca -Increased intakes of Fruit/Veg -Decreased intakes of fried foods/soda
What are some statistics on eating behaviors and disorders in adolescence?
-13% have fasted to loose weight -5% have taken diet pills -4% have vomited or used laxatives -Excessive exercise (over 60 minutes not related to team sport) hard to evaluate -Overall estimated that 10-20% adolescence participate in disordered eating.
What nutrition problems relate to overweight and obesity in school aged children?
-18.4% of children 6-11 are obese -Hispanic and Black affected more than Caucasian -Taller, look older, look more mature, more advanced bone density -Associated with overweight/obesity: Insulin resistance, type 2 DM, Non-alcoholic fatty liver disease, High Blood pressure
What are common nutrition and dental problems for school aged children?
-50% children age 6-9 have decay in primary or permanent teeth (Lead poisoning) -Fluoride still recommended -Teeth can have Braces and Adult teeth grow in/lose baby teeth
What is common nutrition for adolescent athletes?
-54% on a sports team -Questions to ask: What sport? how long is season/practice? how intense is the practice? -Competitive athletes may need 500-1500more kcal/day -Should monitor weight during season -Protein approx. 30% diet -Pre meal and post meals needed -Calcium and hydration very important
What are the most common prevalent chronic conditions in children?
-6.5 million children between age 3-21 -ADHD and Autism Spectrum -Asthma -Speech Delays -Learning Disabilities
What is the prevalence of diet, disordered eating, and eating disorders in adolescents?
-63% female and 33% male have dieted (self-reported, prevalence is probably higher) -Higher in Hispanics, Caucasians, then African Americans (females are higher) -Dieting in adolescence may lead to eating disorders and malnutrition (overnutrition!) later in life -Body image is very important
How is diarrhea and constipation a common nutritional issue for infants?
-65% of hospitalizations due to diarrhea occur in first 12 months life -More severe b/c can lead to dehydration -Normal baby stools is softer; more than 3/day or too liquidy so it leaks out of diaper would be concerning
How are dental carries (ECC) a common nutrition problem for children?
-About 1 in 3 children suffer from tooth decay -Caused b/c preference for sweet -Fluoride important component to prevent decay (Water, Drops, Toothpaste)
What are the dietary requirements for Ca and Vit. D for adolescence?
-Adolescence can absorb more calcium -Females do not meet Ca DRI, Males do (males have about 50% more caloric intake) -get Ca from Breads and grains, vegetables, cheese, and milk -Vitamin D: Recommend supplement of 400IU for anyone not consuming adequate amount
What is the new legislation on "smart snacks"?
-All food sold during the school day must meet the smart snack criteria -This includes vending machines and snack bars -This includes food sold at fundraisers
How can there be nutrition integrity in schools?
-All foods available to children should be consistent with DRIs and Dietary Guidelines for Americans. -Student, parent and teacher involvement
What is weight loss medications for adolescence?
-Approved for use in adolescence 12 or older -Diet needed -Side effects follow low-fat diet -Orlistat or Metformin (for diabetes) typically used
What are possible feeding/eating related changes for children with special needs?
-Approx 70% children with developmental delays have feeding problems -Self feeding skills lower than child's chronological age -Feeding takes too long -Food is spilled, lost, spit up
What are indications for using infant formula?
-As a substitute for human milk in infants whose mothers choose not to breastfeed (or can't - 2% -As a substitute for human milk in infants whom breastfeeding is contraindicated -As a supplement for breastfed infants who do not gain weight adequately and usually have special needs -Food allergies (specific to mom's milk)
What are predictors of childhood obesity?
-BMI "rebound" phase very important predictor (Occurring early (<5.5 years) may put at risk for overweight later in life, late rebound is not associated) -Home environment -Parental obesity -Maternal obesity is most significant factor
How is BMI determined for children >2 years?
-BMI in 85th percentile or > but < than 95th percentile = overweight -BMI in 95th percentile or > = obese -For all children a weight for length or BMI for age <5th percentile = Underweight
What is the baby led weaning method of starting solids?
-Babies "Lead the way" -Skip purees and wait on spoons -Infant starts eating with hands with solid food -Infant eats with family (and eat the same foods) -Wide range of foods suggested as 1st foods -Milk on demand -Baby determines how much to eat vs. parent deciding -Helps baby self regulate and listen to internal cues
What is PKU?
-Body unable to break down phenylalanine -1 in 12,000 births -lifelong diet restrictions -Low protein diet with phenylalanine removed -Foods to avoid with PKU: meat, eggs, fish, dairy, nuts, legume, soy -Foods to encourage: fruit, veggies, rice, potatoes (bland diet), breads, pasta
Who populations/types of infants would be at risk for malnutrition?
-Born before 34th week (inadequate nutrient stores, cannot coordinate suck and swallow, more immature organs, erratic feeding patterns) -Food insecure households -Infants with chronic diseases (i.e. FAS) -Abnormal development in utero
How does the media influence intake for preadolescence?
-Branded preferred -Drive them to want fast food because toys and playgrounds -Children are more likely to want foods in advertisements
What is the prevalence of meal skipping for adolescence?
-Breakfast: Up to 27% skip -Lunch: Up to 25% skip -Dinner: Up to 8%
What are feeding problems for special needs toddlers/preschoolers?
-Children may use food to control their parents behavior -Feeding problems may be signs of underlying health problems -May refuse certain foods or have behavioral feeding problems -May take a long time to eat -May drink excessive liquids -May have low interest in eating -May have difficulty chewing, swallowing, or picking up foods
What are the different protein needs for special needs children?
-Children with DM stays the same -Children with CF or burns increases -Children with PKU decreases
How do infants with special healthcare needs have unique nutrition needs?
-Children with neurodevelopmental disorders or developmental delays may have difficultly with feeding, oral motor skills and swallowing. -70-90% of children with special needs were found to have nutrition related problems -Down Syndrome: lower muscle tone, leading to higher risk of weight gain and diabetes
What is dietary supplements?
-Children with special needs take them more often than other children -When diagnosis is unknown or difficult, many families turn to supplements. -No known evidence for effectiveness
What are possible concerns of the baby led weaning method?
-Choking? Need to be supervised -Mess and Waste -Time? They will drop things, miss mouth, take longer to chew -Lack of Support from family/caregivers? -Lower weight infants if not able to eat enough? -Nutrient deficiencies - Fe, Zn -If parents food unhealthy
What are typically the infant's first foods?
-Commercial baby foods are sanitary & convenient -Portions sizes are not regulated, determined by manufacturer -Homemade through grinder (good b/c can make more ethnic, cultural foods)
What is the Let's Move Campaign?
-Comprehensive initiative launched by the First Lady, Michelle Obama -Dedicated to solving problem of obesity within a generation -Importance of good nutrition & physical activity -Resources & tools -no longer active website under Trump administration
Should pre/probiotics be used to treat constipation in infants?
-Constipation is common b/c don't know how to coordination rectum muscles or may or may not be getting fiber -Should NOT give pro or pre biotics routinely (don't want to overwhelm with good bacteria) -Can give prunes (or mother eat prunes)
What are the general growth assessment for infants?
-`AGA: appropriate for gestational age (10th to 89.9th percentile) -LGA: large, >90th percentile -SGA: small, <10th percentile
What is the overall goal for managing pediatric obesity?
"for the child and family to develop healthy eating and physical activity behaviors for a lifetime"
What are key indicators of nutrition risk for adolescents?
-Consumes fewer than 2 servings fruit of fruit juice per day -Consumes fewer than 3 servings of vegetables per day -Consumes fewer than 6 servings of bread/starch per day -Consumes fewer than 3 servings of dairy per day -Consumes fewer than 2 servings of meat or meat alternative per day -Has excessive intake of dietary fat -Exhibits poor appetite -Consumes food from fast food restaurants three or more x/week -Skips meals 3 or more times per week -Consumes a vegetarian diet -Has inadequate financial resources to buy food, insufficient access to food, or lack of access to cooking facilities -Practices unhealthy eating behaviors (chronic dieting, vomiting, diuretics, laxatives...) -Is excessively concerned about body size or shape (self esteem or affecting eating habits) -Has had significant weight change in last 6 months -Is physically inactive -Engages in excessive physical activity -Has chronic diseases or conditions -Has hyperlipidemia -Has iron deficiency anemia -Has dental caries -Is pregnant, does drugs, or uses supplements.
What are amino acid based formulas?
-Designed for infants with extreme protein hypersensitivity -When symptoms persist even w/hydrolyzed formulas -Brand names = Neocate, Elecare -AKA: "super-hypoallergenic" -More costly but insurance will most likely pay because cannot tolerate breast milk
What is cognitive development of preadolescence?
-Development of self efficacy: the knowledge of what to do and the ability to do it -Children become more independent -Peer relationships very important -Influences outside the home very important
How can certain behaviors prevent childhood obesity?
-Don't take them to fast food often -Educate families -Programs like Farm to school
What are the three stages of adolescence?
-Early adolescence (11-14) -Middle adolescence (15-17) -Late adolescence (18-21)
What are the psychological and cognitive development of the stages of adolescence?
-Early: Difficult to see future consequences (in the now, world revolves around them) -Middle: Emotional and social independence from family -Late: Development of personal identity and moral beliefs (easier to rationalize, past puberty, becoming adults)
What are the preschoolers' innate ability to control intakes?
-External cues (like mom saying its breakfast time, but parents should not force) -A child has the ability to eat the "right amount" -A child does not know what foods to include to make a balanced diet -easily influenced by others or the media b/c don't know what is real, will be more likely to try foods they see cartoons have eaten -can they "loose" this ability to control their intakes if part of "Clean plate club"
What is the usual progression for introducing solids?
-Fe fortified cereals mixed with breast milk or formula & start thin (i.e. powdered rice cereal) -Veggies first - mashed or pureed -Fruits next because more sweet, so want them to eat veggies first -High protein foods
What are tips for feeding babies with the spoon?
-Feed baby when alert -Small spoon, right temperature -Let the baby open mouth and stick out tongue -Press spoon on tongue, slight pressure -Don't scrape food (let baby use own tongue/mouth to get food off spoon)
How much do females vs. males grow during adolescence?
-Females: May gain 14-18lbs per year, 44% increase in lean body mass, 120% body fat; Need about 17% BF to begin menarche (on average) and 25% to sustain it -Males: May gain 20lbs/ year
What occurs for digestive system development for the infant?
-Fetus swallows amniotic fluid which stimulates intestinal maturation & growth -At birth the healthy newborn can digest fats, protein & simple sugars. -Takes 6 months to mature -Normal poop = Liquidy mustard yellow -Common problems include gastroesophageal reflux (GER), diarrhea & constipation (all common for short period of time)
How do infants learn food preferences?
-Flavor of breast milk influenced by mother's diet -Genetic predisposition to sweet taste -Food preference from infancy sets stage for lifelong food habits -Infants learn food preferences based on experience with foods
What are complementary foods and why would we introduce them to infants?
-Foods added in addition to breast milk/formula -Breastmilk doesn't supply enough iron after 6 months -Meet all nutritional needs that aren't met through milk -Helps develop motor skills and speech
What are "follow-up" formulas?
-For older infants taking solids -Higher protein, fat & mineral content -Most common: Advance; Follow-up; Enfamil Next Step -AAP—nutritionally adequate, but no clear advantage of these over current formulas
What is stage 4 treatment of overweight and obesity for adolescents?
-For those Severe obese, obtained 95% of their growth or 4 on tanner scale (1-5 scale for sexual maturity); co-morbidity (HTN, diabetes, sleep apnea, etc.) -Occurs at a treatment center -Might include: Very stringent meals and physical activity, Meal replacements, Meds, Surgery gastric bypass, Very low kcal diet medically supervised by RD and MD
What is the Infant Formula Act of 1980?
-Formula must meet AAP recommended ranges for nutrients -Minimum levels set for 29 nutrients & maximum levels for 9 nutrients in formulas (unless an "exempt" formula...) -Also have labeling & quality assurance requirements -One of the most highly regulated "foods" in the industry
How can the community ehnace/reduce the likelihood and ease of physical activity?
-Free parks (few lighted at night), painting bike lanes and adding more -sports endorsed by AAP (don't need to be competitive, just fun)
What would be a post op diet after surgical weight loss?
-High in protein due to healing and malabsorption -Low in sugary drinks and simple carbs -Vitamin and mineral supplemented. -Shouldn't have high fiber foods, crunchy foods, or hard foods at first
What foods are inappropriate for infants?
-Honey before 1 year b/c could have Botulinum spores (life-threatening) -Wheat before ~ 8 months b/c possible allergy -Egg whites (yolks "ok") b/c reaction to more protein -Seafood b/c one of the top 8 allergens -Nuts (or nut butters), seeds b/c one of the top allergen -Choking foods like blueberries, celery, carrots (full and raw), hot dogs, crunchy foods, dry food (i.e. white bread sandwich), peanut butter, marshmallows, popcorn -Cow's milk before 1 year -Addition of salt & sugar -Juice in place of formula no b/c pure sugar
What are safety measures for artificial infant feeding?
-Ideal medium for growth of microorganisms (protein, CHO, fat) -Sanitary technique -Cleanliness of formula preparation equipment -Maintain proper refrigeration times & temperatures -Minimizing time the prepared formula is at room or feeding temperature -Complying with expiration dates
What is the nutritional issue: Failure to Thrive (FTT)?
-Inadequate weight or height gain due to an energy deficit -Due to maternal depression, mental illness, alcohol or drug abuse, feeding delegated to siblings or others unable to respond to infant & overdilution of formula -Untreated GERD, chronic illnesses & developmental disabilities
Why is it important to track infant growth?
-Infant growth is an indicator of their health and nutrition status -Tracking weight, height, and head circumference helps identify health problems early -Head circumference to identify brain is growing
What would be missing from the "best food" for preterm infants?
-Iron, protein -Breastmilk: 20 kcal/ounce, preterm infants need 24-30 kcal/ounce (supplement w/high fat and calorie formula)
What should be cautioned about snacks at soccer, baseball practice, etc.?
-Is it an acceptable snack? -Do children who only practice for an hour really need a snack? -Are healthy snacks not normally affordable -Should not be regular; for games or not every practice -50% of children ages 6-11 consume 2-3 snacks/day
What are questions to ask for children with special needs in a nutrition assessment?
-Is their food intake adequate? -Does their medical condition diagnosis affect their nutritional needs? -Is growth on track - where is it on the growth chart? -Are their feeding/eating skills appropriate for their age? -Any food allergies or restrictions? Patterns of eating? -Activity level?
What are feeding problems with drinking excessive liquids?
-Juices are sweet but not many nutrients, no fiber -Recommendations are no more than 4-6 ounces per day of juice -But having them drink it is better than nothing
What are the general weight assessments for infants?
-LBW (low birth weight): <2.5 kg or 5/5 lbs. -VLBW (very low): <1.5 kg or 3.3 lbs. -ELBW (extremely low): <1 kg or 2.2 lbs.
What is cystic fibrosis?
-Lethal genetic disease: Recessive, Significant Malabsoprtion, Thick mucosal secretions; Can clog organs, bio-ducts, etc. -2-4x protein and kcal needs -Daily vitamin supplements (fat soluble) -Possible night feeding -Large frequent meals -Enzymes at meals required -Pancreas isn't producing enough -DM possibility
What are the dietary recommendations for cardiovascular disease in obese children?
-Limited saturated fat -Limit cholesterol -Limit trans fat -Limit added sugars -Increase fruit, veggies, whole grains, and fiber
What are nutritional considerations for children with special needs?
-Low energy needs if low muscle mass -High protein intake if high protein losses -Lots of surgeries or hospitalizations -High fluid volume needs if high fluid losses -Can't always communicate that they are thirsty -High fiber if chronic constipation -Long term or multiple med use may effect nutritional status
What is the body composition of special needs children?
-Low weight or height not always reflecting nutritional intakes -Should have body fat measured if low weight -Muscle size important factor -take note on growth chart if child starts taking growth hormone
What are possible advantages to the baby led weaning method?
-Lower risk of obesity? -Favorable effects on parental feeding practices? -More highly developed motor skills? Baby is getting different textures (sensory experience) -Less expensive for parent -More consistent family meals
What are diet recommendations compared to actual intake for school aged children?
-Macronutrients are all close to meeting goals -Calcium intake low -Are not meeting fiber, sodium (1000 mg+), or caffeine
What is the supplement use among adolescents?
-May be used to build muscle, loose weight, treat deficiency etc. -Up to 28% adolescence use them -What is the most common supplement: multivitamin -Some interesting correlations with vitamin and supplement use -Good correlations: higher intakes of fruits/veggies, lower intakes saturated fats/cholesterol
Who are children with special needs?
-May have difficulty hearing, seeing, walking or reaching developmental milestones -5-13.2% of children 0-5 have a disability -90% of children with disabilities have some type of nutritional issue
What are early intervention services for children with special needs?
-May include social worker, speech therapist, MD, registered dietitian -Paid for by government (free for children) -track and interpret growth patterns -assess daily food intakes using diet analysis program -evaluate nutrition care plan at day care
What is the composition of hydrolysate formulas?
-Milk protein is primarily casein (compared to whey) -Protein is hydrolyzed into amino acids & small peptides; fortified with additional amino acids -Contain medium chain triglycerides (easier digestion/absorption) -Supplemented with some vegetable oils for EFA -Carbohydrate: Most lactose free; contain sucrose, corn starch solids, tapioca starch, or cornstarch
What are the characteristics of standard cow's milk based formula?
-Most common formula used -Protein source is whey, nonfat milk -Some contain ARA & DHA, Some lactose free -Traditional formula-of-choice if baby not breastfed -Standard formula = 20 kcal/oz
What is the composition of nutrients in cow's milk formula?
-Protein varies: 1.45 - 1.6 g/dl -Fat: 40 - 50% energy (Butterfat replaced with vegetable oils, All with essential fatty acids DHA/ARA added) -Carbohydrate: lactose primarily; oligosaccharides (prebiotics) -Iron: Fortified: 100 - 145 mg/L (non-fortified is rare)
how do the parents play a role in body image on children?
-Mother's eating habits influence daughters as early as 5 years old (restrictive practices) -Dieting in adulthood and adolescence may have its roots in early childhood -restricting palatable foods is not a good b/c promotes intakes and overeating of these foods -Early dieting may lead to obesity -Early dieting may ignore internal cues of hunger and satiety -May contribute to eating disorders
What is motor development in infants?
-Motor development: ability to control voluntary muscles -Muscle development is "top down" -Influences ability to feed self & the amount of energy expended -May be "critical learning periods" for feeding related behaviors
What are the feeding changes of preschool age children?
-Motor skills more developed (Can use spoons and forks, maybe plastic knives, drinking from cup without spills) -Appetite may be variable and follow growth spurts -Child may appear to be a "picky" eater b/c they can control what they eat -Should engage child to help with cooking, shopping, set the table, serve themselves (family style), gardening
What are signs for infants to start eating solid foods from a spoon?
-Move towards spoon (point or look at it) -Hold up head and support head (be able to sit) -typically around 4-6 months
What is stage 3 treatment of overweight and obesity for adolescents?
-Multidisciplinary team approach (Meet both together, child separately, and then parents separately) -Even more stringent guidelines -Negative calorie balance to actively loss weight -Structured physical activity -Behavioral modifications -8-12 weeks of visits
What are physiological development for preadolescence?
-Muscle strength, coordination and stamina increase -Increase in body fat starting at age 6 to prepare for puberty -BMI may change a lot due to Growth spurts
What is the National School Breakfast Program?
-Must provide 25% of DRI for child's age -Can be paid, free, or reduced
What is the relationship between parenting and feeding?
-New parents must learn: Infant's cues of hunger & satiety; Temperament of infant; How to respond to infant cues -Infants feeding patterns may be effected by mother's mood and other environmental triggers
What is binge eating?
-No studies in prevalence in adolescence -May precede dieting -May be a "response" to abuse or stress or economic hardships -Severe psychological stress -No compensation -Possible genetic predisposition (not enough Dopamine)
Should parents control or restrict what a child eats?
-No, it makes it worse -Everyone should get dessert -Parents should provide healthy foods
What are the new standards for the School Lunch Program?
-Offer both fruits and veg every day of week, increasing offerings of whole grain foods -Offering only fat free or low fat milk -Limiting kcals based on children age -Increasing the focus on restricting sat fat, trans fat and sodium -Free or reduced or paid -must meet 1/3 of DRI's for child's age
What are vitamin and mineral needs of special needs children?
-Often recommended to children with special needs -Difficulty with them -Ex.: CF: Vitamin A, D, K, E CP: Calcium and Vitamin D
What are protein hydrolysate formulas?
-Originally developed for infants who were intolerant to cow milk protein (Allergic to cow and soy formula, 30% still won't tolerate) -Proteins extensively hydrolyzed; peptides are incapable of causing immunologic response in MOST infants -MAY BE considered "hypoallergenic" but.... -Used for infants with malabsorption due to GI disease; short gut syndrome; acute/chronic diarrhea -Named Nutramigen, Alimentum, or Pregestimil
What are the types of treatment for eating disorders?
-Outpatient: going to appointments -Day stay: cooking, healthy eating, team building -Inpatient: hospital or treatment facility -Goals of therapy: To improve social and emotional well being, to normalize eating behaviors
What are inborn errors of metabolism that might require a baby to take formula?
-PKU: can't break down phenylalonine, Can get phenyl-free formula -Galactosemia: Get soy formula
What is the issue with adolescent overweight and obesity?
-Parental obesity, specifically mom, increases risk -90% of overweight adolescents can be expected to remain overweight into adulthood?
What is normal growth and development for adolescence?
-Physical changes even greater than in infancy -Emotional and physiological changes that continue to shape lifelong food habits and behaviors -puberty -As much as 50% ideal adult body weight gained in adolescence -Peak bone mass development 50% during puberty, about 90% by age 18
What are infant causes for failure to thrive (FTT) while breastfed?
-Poor intake: poor suck, infrequent feeding, structural abnormality -Low net intake: vomiting and diarrhea, malabsorption, infection
What is the relation between poverty, food insecurity and children's nutrition?
-Poverty rates for children under the age of 6 increasing -48 % of children under age 6 living in poor and near poor families -Intake effected b/c high calorie but not nutritious foods, more likely to reward with sweets b/c cheap -14.5% of households report food insecurity
What is the relation between food allergies and toddlers/preschoolers?
-Present in only 2-8% of children -True food allergies can cause anaphylaxis -common allergens: Peanuts, eggs, wheat, treenuts, soy, shellfish, fish, cow's milk
What is ADHD/ADD?
-Prevalence rates rising up to 5 % per year -Medications have nutritional side effects: Slow weight and slow growth -Non medicated children may have chaotic eating patterns -No specific foods or nutrients to treat or cure ADHD at this time proven
What are the energy and nutrient need of school aged children?
-Protein for age 4-13: 0.95 grams/kg -DRIs for vitamin and minerals available -Fiber recommendations: for ages 4-8: 25 grams; for ages 9-13: 31 grams
What is the source of macronutrients in infant formula?
-Protein source: cow milk protein based, soy protein based, other -Carbohydrate source: lactose vs. other Sugar, Corn Syrup (bad)
What are the different forms and preparation for formula?
-Ready-to-Feed (Formula comes in micro-bottles that you add nipple to) -Liquid Concentrates -Powdered (Most provide 20 Kcals/oz when mixed right) -Sterilization of bottles and nipples is recommended
What are the physical activity recommendations in school aged children?
-Recommended 60 minutes per day -Do not need to be in sport; limit screen time -however, only 7.9% of middle and junior high schools require daily PE -Healthy people 2020 objectives: increase recess time, increase trips to school by walking or riding a bike
What are nutrition issues for toddlers/preschoolers with pulmonary problems?
-Recurrent breathing problems can increase nutritional needs, lower interest in eating and slow growth -Possible issues: Asthma, Bronchopulmonary Dysplasia -Possible treatments: Small energy packed meals; Easy to eat foods; Supplementation if growth not appropriate or intakes subpar
What are examples of behavior related nutrition problems in Autism Spectrum Disorder?
-Self restricted food selection -May prefer to drink rather than eating -May refuse to eat at all if foods aren't "acceptable" -May throw tantrums -May need supplements -May need to offer foods 15-20 times
What are dietary assessment and screening should be conducted for adolescent?
-Should be done annually -BMI for age -Dietary recall of some sort with child (vs. parent) -Many many many key indicators of nutrition risk for adolescents -Pay special attention to vegan or vegetarian diets -Monitor for eating disorders. -Already screening for hypertension, high cholesterol, food insecurity, excessive intakes of fat
What body language shows that an infant is ready to start on solid foods?
-Sit up alone or with support -Use muscles in his neck to hold head straight -Mouth fingers & toys -Open mouth when he sees something coming -Turn his head to indicate hunger -Keep mouth open to show interested (want more) -Close mouth over spoon -Scrape food from spoon -Keep food in mouth rather than squeezing back out onto chin
What is the composition of soy formulas?
-Soy protein 1.9 g -2.2 g/dl -Methionine, Taurine, and Cysteine often added (Soy is not naturally high in these; sulfur containing amino acids for growth; to mimic Taurine, the most predominant AA in breast milk) -Carbohydrate: Sucrose, cornstarch hydrolysates, or mixtures; oligosaccharides (prebiotics) -Fat: Same as cow's milk protein formula (DHA, ARA) -Vitamin and mineral content greater than in cow's milk formula to compensate for lower bioavailability
What are specialty formulas for spit up?
-Spit up doesn't affect ability to grow and get enough nutrients -Add rice-starch to sit in baby's stomach thicker (vs. more liquid) and reduces ability to spit up
What is a gastrostomy tube (G tube)?
-Supplements can be provided orally or via enteral nutrition -Children with G tubes can: Play, swim, bathe, Eat meals if safe, Get meds via the tube
What is stage 1 treatment of overweight and obesity for adolescents?
-Targeted to adolescents without comorbid conditions (HTN, sleep apnea, etc.) or for those who have not gone through a growth spurt -Goal: promote health and prevent disease -Example topics: 5 a day, Physical activity, Family meals, Screen time limited to, 2 hours a day, Eating out
What are psychosocial complications of obesity?
-Teasing: Stereotype as lazy, ugly, dirt -Self esteem and depression: Small decrease in self esteem score with increasing BMI; Depression associated overweight concern -Lower academic achievement: Largely due to self esteem issues
What are practical considerations for infant feeding?
-The parent is responsible for what -The infant is responsible for how much/rate -The parent helps the infant to be calm & organized & feeds smoothly, paying attention to information coming from the baby about timing, tempo, frequency & amounts
What is nutrition assessment for disabilities involving neuromuscular control?
-This should include assessment of growth, body fat, and musculature -Will need to observe eating and assess muscle coordination needed for eating/feeding
How is iron deficiency anemia a common nutrition problem for children?
-Toddlers 9 - 18 months at highest risk due to rapid growth and low intakes -Can cause long term issues -Recommended screening: for at risk children -Reduce risk by limit cow, goat or soy milk to less than 24 ounces a day (0 iron)
What is are physical and cognitive developments for toddlers?
-Toddlers have no sense of danger - Don't know what's hot, knives are sharp, electrical plug is dangerous, can drown, etc. -Children become aware of their environment and may develop fears (Monsters, vacuum, the dark, etc.) -Child begins to learn about families customs - including those related to food and meal times -Language develops starting around 2, they can say 100+ words
How are sweetened beverages predictors of childhood obesity?
-Trends: Intake increased dramatically (also increases with age; Sugar drinks largest source of added sugar; 80% children drink daily -Evidence: Sweetened beverages have low satiety value; Increased intakes associated with higher adiposity
What is the recommendation for infants drinking liquids from a cup?
-Usually at about 8-11 months (start with water) -1 - 2 oz portion initially -no juice -Expressed breast milk or Formula -Whole milk at 1 year
What are public food and nutrition programs for children?
-WIC/WIC farmers market nutrition program -Head start and early head start -Supplemental nutrition assistance program
What are development of feeding skills in toddlers?
-Weaning (not breastfeeding anymore) -Can move food from side to side -Learn to chew food Pincher grasp developed - 12 months (Use finger foods) -Ability to handle multiple textures/move well - 18-24 months -Using spoons gets better around age 2 (forks are harder)
How many times might you have to offer a new food before it is accepted?
8-10 times
What is the school health index?
A online tool for schools to assess their nutrition status. -Free access to drinking water -Foods can't be punishments or rewards
Should school aged children be on vegetarian or vegan diets?
Acceptable B12, Zinc, Ca, Iron, K2, adequate protein
What is the recommendation vs. actual intake of added sugars for children?
Added sugar intake: <25 grams/day is recommended Children are consuming 80 grams/day
What is the average growth during the school year for preadolescence?
Average growth during school year: 7 lbs and 2.5 inches Growth spurts and growth lows
What should parents know about the eating/feeding relationship?
By late preschool children may be more responsive to external cues than their innate ability to regulate intakes -Put dessert out at same time as dinner, so it is not put on a pedestal and valued higher (or make veggies seem bad by making them finish before getting dessert) -Should give to all children and not say only you get it because you finished your food
What vitamins/minerals are most children NOT meeting recommendations for?
Ca, Zn, iron (higher needs for growth)
How is eating fast food a predictor of childhood obesity?
Children who eat fast foods have: More total kcal More total fat More total carbs More added sugars More sugary beverages Less fiber, fruits, vegetables and milk
What are the dietary recommendations for energy for adolescence?
DRI listed per age group but should really pay attention to stage of puberty DRI established to reflect light to moderate activity
How can we assess if enough food is enough?
Diapers - clear pee, normal bowel movements
What are the negative characteristics of hydrolysate formulas?
EXPENSIVE & poor taste due to sulfur containing A.A. & bitterness of peptides
What do people need to be cautious about for childhood obesity?
Eating disorders Diet is nutritionally adequate Monitor emotional state Work with families
Why would you need more iron during adolescence?
For women starting menstrual cycle (monthly loss of iron); both genders are growing at a huge rate
How do we avoid and treat the common issue of iron deficiency in infants?
Getting complementary foods after 6 months (b/c breastmilk no longer had it) -Fortified cereals, lentils, softer meats -Iron supplements (drops)
Who hits puberty first?
Girls, overweight, and Hispanic
What should be targeted for nutrition education and counseling for adolescents?
Healthy skin (no acne) and hair, athletic performance, fitting in, doing well academically -let them dictate what they want to talk about! -set 1-2 goals -consider using technology
Why wouldn't adolescents meet folate DRI?
If they tend to skip breakfast
What is the Summer Food Service Program?
In districts where 50% of more of the children are from low income homes -Children can go and get free (reduced or paid) lunch for summer Bridges gap to healthy meals
What skews the appetite and satiety for preadolescence?
Innate ability to control eating is skewed by external cues: Time of day; Presence of other people; Variety of "good foods" in vending machines, cookies, etc.
What type of foods do people often eat for snacks?
Junk food, easy to prepare, come packaged, pre-packaged -children will prepare cookies, candies, and chips
What 29 nutrients have minimum levels set for infant formula?
Linoleic acid, E, K, Thiamin, Riboflavin, B6, B12, Niacin, Folic acid, Pantothenic acid, C, Calcium, Phosphorus, Magnesium, Zinc, Maganese, Copper -Biotin, Choline, and Inositol when formula is not made from cow's milk
How do you measure growth for preschoolers?
Measure standing without shoes Weigh in light clothing
How do you measure growth for a toddler?
Measured using recumbent board w/ foot and head piece Weigh naked without a diaper
Whaat is middle childhood vs. preadolescence (school age)?
Middle childhood: 5-10 years Preadolescence: 9-11 years for girls, 10-12 for boys
What are fluid needs of special needs children?
Needs often higher Adults must monitor
What are physical activity recommendations for children?
No recommendations for age 2-5 BUT.... -Children should have active play multiple times per day (going to park, obstacle course in house, etc.) -Screen time should be limited -Parents should model with active behavior
What are nutritional needs for fat for infants?
Only AI (not RDA): 0-6 months is 31 g 6-12 months is 30 g -50% of kcal in breastmilk
Why were soy infant formulas developed?
Originally developed with soy protein & without lactose for infants who could not tolerate (cow's) milk protein or lactose -infants with true milk allergies may develop an allergic reaction to soy (soy protein looks similar, binds to antibodies and elicit immune response, forming allergy) -For families who want to follow vegetarian product
What are key factors in food choice to teens?
Preference, Accessibility, Cost, Busy schedules, Social support from family and friends
What are specialty infant formulas designed for?
Premature infants, Digestive and absorption problems, Food allergies, Renal disorders, Special metabolic needs
What 9 nutrients have maximum levels set for infant formula?
Protein, Fat, A, D, Iron, Iodine, Sodium, Potassium, Chloride
How do macronutrients compare between human milk, cow's milk based formula, and soy formula?
Protein: highest in soy because less bioavailable, least in human milk Cholesterol: highest in human milk, none in soy
What is the best way to heat formula?
Put bottle in hot water (water bath); NOT in microwave b/c does not heat up evenly and plastic bottles; do not have to eat but babies like it because it's closer to human breast milk
What are carbs recommendations for adolescence?
Recommend 45-65% per day -most meet this but not with good carbs (pasta, donuts, chips, more processed foods)
How does feeding occurs during early infancy?
Recommended: breastmilk Alternative: formula No cow's milk or other milk alternatives (rice, soy, etc.)
What is Metformin?
Reduces liver production to glucose, increases insulin sensitivity Used off-label (not FDA approved)
What is surgical weight loss for adolescent?
Roux en Y Surgery (type of gastric bypass) -Permanent surgery, pouch may stretch with time, for life need to take dietary supplements that don't require stomach acid and can absorb through small intestine -Weight loss between 15-87% (huge range because some people still cheat with sweetened beverages and bad diets or stretching stomach)
What utensils will be helpful for preschool age children to have while eating?
Rubber bib - food falls in, water proof, easy to clean, inside out folds out even more to catch more food Divided plates - rubber stick to table
Where do adolescents get meals away from home and how does the loss of family meal time affect them?
School, friend's houses, fast food, can go anywhere with transportation -Reduced academic performance, less nutritious diet
What body trends do we see with vegetarian diets in adolescence?
Shorter and leaner before puberty After puberty, they tend to even out with their peers
What are fluid recommendations for children?
Should drink 2 cups milk or milk equivalent Should not drink fruit juice (limit is 1 cup for 7-18 year olds)
What are the stages of assessment and treatment of adolescent overweight/obesity?
Stage 1: Prevention plus Stage 2: Structured weight management Stage 3: Multidisciplinary team approach/intervention Stage 4: Tertiary care
Which foods do children innately have preference for?
Sweet -prefer fruit that is sweeter than adults prefer -children like high kcal and high fat foods
What are community engagement to create supportive environments?
The Market Garden Program The Conservation Program The Cooking and Wellness program
What are the ages for toddlers and preschoolers?
Toddler: 1-3 years Preschooler: 3-5 years
How do we start infants with solids?
Use SINGLE foods and allow 3-5 days between new foods to see how they react first before adding new
What are height changes during puberty?
Varies 15-25%, girls done by 16, boys 21
What micronutrients may be low in breastfed infants?
Vitamin D, Fluoride, B12, Iron
What chronic conditions in children have lower energy needs?
down syndrome, spina bifida, nonambulatory children with diplegia, Preader-Willi syndrome, non ambulatory children with short stature
What is the age range for the adolescent age group?
age 11-21
What are other factors that effect cognition?
environment related experiences (more crawling/walking) and stimulation (baby friendly walls vs. white plain walls)
What is reflex?
automatic response triggered by specific stimuli
What is suckle reflex?
causing tongue to move forward and backward
What chronic conditions in children have higher energy needs?
cystic fibrosis, renal disease, ambulatory children with diplegia, pediatric AIDS, bronchopulmonary dysplasia
What are protein needs for prematurity/other serious conditions of infants?
higher (4.5 g/kg vs. 1.52)
What is the goal for treatment of overweight and obese children?
improve physical health through healthy lifestyle habits and behavior modification -Maintain weight or max weight loss of 1 lb./month
How are energy needs measured?
indirect calorimetry
What is root reflex?
infant turns head toward cheek that is touched
What are fiber recommendations for children?
much higher than average American intake; help prevent constipation 1-3 years: 19 g/day 4-8 years: 25 g/day Excess not recommended
Should herbal remedies be used for children?
no because not tested and safe for children -widely used (1/3 to 50% according to WIC)
What is the growth assessment for special needs children?
pay attention to: A plateau in weight Weight gain, followed by loss Wt. loss during illness Unexplained weight gain. -some have specialized growth charts b/c not always applicable to all children
What is the relation between overweight/obesity in toddlers and preschoolers?
prevalence for ages 2-5 has decreased
What are nutritional needs for CHO for infants?
primarily lactose; babies can't store glycogen yet -some fructose and sucrose in formulas
What are nutritional factors that may effect cognition?
severe acute malnutrition leading to low infant weight; chronic undernutrition; iron deficiency; iodine deficiency
How should adolescence be assessed instead of age?
sexual maturation
What are requirements for snacks under the new smart snacks legislation?
snacks need to be 200 kcal or less, 200 mg of Na or less, 35% of calories or less, 10% or less calories from saturated fats, not high amounts of added sugars, 35% or less sugar by weight
How is newborn growth assessed?
through weight, length, and head circumference
What foods are no longer considered "inappropriate" to introduce to infants?
wheat and nuts (don't wait, with earlier introduction, reduced risk)
What is the caloric density difference for premature babies?
~20 kcal/oz vs. up to 30 or more
