Download Perspectives in Nutrition, 8th Edition

Perspectives in Nutrition, 8th Edition
Chapter 17 Outline: Nutrition During the Growing Years
After studying this chapter, you will be able to:
1. Describe normal growth and development during infancy, childhood, and adolescence and the
effect of nutrition on growth and development.
2. Describe the calorie and nutrient needs of infants, children, and adolescents.
3. Compare the nutritional qualities of human milk and infant formula.
4. Explain the rationale, from the standpoints of both nutrition and physical development, for the
delay in feeding infants solid foods until 4 to 6 months of age.
5. Describe the recommended rate and sequence for introducing solid foods into an infant's diet.
6. Discuss the factors that affect the food intake of children and adolescents.
7. Plan nutritious diets for infants, children, and adolescents using MyPyramid.
8. Describe the potential nutrition-related problems that may occur during the growing years and
their impact on future health.
17.1
Growing Up
A.
General
1.
Ability to thrive (grow and develop to the fullest physical and mental genetic
potential) is dependent on
a.
Calorie and nutrient intake
b.
Adequate sleep
c.
Loving care
2.
Effects of poor diet depend on severity, timing, and duration
3.
If hormonal and other conditions have passed, good nutrition cannot make up for
lost growth
B.
Height and Weight
1.
Infancy
a.
Physical growth rate is at peak velocity
b.
Nutrient needs per unit body weight are at lifetime highest point
c.
By 4 - 6 months, birth weight doubles
d.
By 1 year, birth weight triples, length increases by 50%
2.
Childhood
a.
Slower growth rate
b.
Growth occurs in bursts
c.
Nutrient and calorie needs and appetite rise and fall in response to
normal growth fluctuations
d.
Height increases each year by a few inches
e.
Weight increases each year by 4 - 6 lb until age 8 or 9, then increases to
8 - 10 lb/year until puberty
3.
Adolescence
a.
Transition from childhood to adulthood
b.
Rapid phase of physical growth (1/3 of all lifetime growth)
c.
C.
D.
Puberty: child matures into an adult capable of reproduction; initiated by
secretion of sex hormones
i.
Girls: begins at age 10 - 13, lasts 8 - 10 years
ii.
Boys: begins at age 12 - 15 lasts 8 - 10 years
d.
Growth rate peaks about 18 months after puberty begins
i.
Girls usually have rapid height increases at age 11 and attain
adult height within 2 years after menarche; total 10”
ii.
Boys usually have rapid height increases at age 13 and attain
adult height by age 18; total 12”
Body Composition
1.
Proportion of body water declines during first 2 - 3 years of life, then reaches
levels similar to adults
2.
Proportion of lean body mass increases throughout infancy and childhood
3.
During adolescence, males secrete testosterone and gain more muscle mass than
females (2/3 as much lean body mass as males)
4.
Proportion of body fat
a.
Rises until age 1
b.
Declines between ages 1 - 7
c.
Age 7, gradually increases to prepare for puberty
d.
During adolescence
i.
Due to action of estrogen, females continue to deposit body fat,
which is essential for sexual maturation and reproduction
ii.
When body fat = 16 - 17% and body weight is ~100 lb,
menstruation begins
iii.
Body fat declines in males during adolescence
iv.
By end of adolescence, females have twice as much body fat as
males
5.
Restriction of dietary intake among infants, children, and adolescents is not
advised
a.
Most obese infants become normal-weight preschoolers without
excessive dietary restrictions
b.
Risk of stunted growth and development
Body Organs and Systems
1.
Infancy
a.
Kidneys double in size, function more efficiently
b.
Stomach increases capacity and begins secreting digestive enzymes
c.
GI tract matures to enable larger food intakes and greater variety of foods
2.
Childhood
a.
Many organs reach full adult size
b.
Brain growth is ¾ complete by age 2, finished by age 6 - 10
c.
Heart reaches adult size and respiratory system reaches adult function by
age 9
d.
3.
17.2
Digestive system matures to efficiently absorb nutrients, build nutrient
stores
Adolescence
a.
Completion of organ system maturation
b.
Development of reproductive system and secondary sexual
characteristics
Physical Growth
A.
General
1.
Growth is best indicator of nutritional status
2.
Percentile: ranks individuals in a group of others of the same age and gender
3.
Growth depends on dietary intake and genetic potential
4.
Birth to 36 months
a.
Weight-for-age
b.
Length-for-age
c.
Weight-for-length
d.
Head circumference-for-age
5.
Ages 2 - 20
a.
Weight-for-age
b.
Stature-for-age
c.
BMI-for-age
B.
Tracking Growth
1.
It takes 2 - 3 years to establish infant’s percentile, then child usually tracks along
same percentile throughout childhood and adolescence
2.
Preterm infants may move up several percentiles if they experience “catch-up”
growth
3.
Small spurts and lags are expected, but jumping up or down 2 or more percentiles
may signal growth problems caused by nutrient excesses or deficits, illness, or
psychological problems
4.
Indicators of nutritional status
a.
At risk for developmental problems
i.
0 to 2 years: head circumference-for-age <5th percentile or >95th
percentile
b.
Stunted growth
i.
0 - 2 years: length-for-age <5th percentile
ii.
2 - 20 years: stature-for-age <5th percentile
c.
Underweight
i.
0 - 2 years: weight-for-length <5th percentile
ii.
2 - 20 years: BMI-for-age <5th percentile
d.
Overweight
i.
0 - 2 years: weight-for-length >95th percentile
ii.
2 - 20 years: BMI-for-age >95th percentile
e.
Obese
C.
17.3
i.
2 - 20 years: BMI-for-age >95th percentile
ii.
BMI ≥30
Using Growth Chart Information
1.
Changes in BMI-for-age or weight-for-length reflect increases or decreases in
recent nutritional status (before height is affected)
2.
Stature-for-age is a good indicator of long-term nutritional status
3.
Failure to thrive: not growing at the expected rate for several months;
dramatically smaller or shorter than other children of same age
4.
Potential causes for failure to thrive
a.
Physical abnormalities (e.g., heart defects, cleft palate)
b.
Infections
c.
Intestinal problems
d.
Inborn errors of metabolism
e.
Nutrition or feeding problems
i.
Poverty
ii.
Lack of parental knowledge
iii.
Weak sucking ability
iv.
Poor feeding techniques
v.
Mental depression in mother
vi.
Negative socialization factors
5.
Long-term effects of failure to thrive depend on severity and timing; catch-up
growth may be possible
6.
Growth in height ceases when epiphyses (growth plates at ends of bones) fuse;
further growth is no longer possible
a.
Girls: 14 - 19 y
b.
Boys: 15- 20 y
Nutrient Needs
A.
General
1.
Growth rate has great effect on energy and nutrient needs
2.
Peak growth velocity occurs during infancy
3.
Calorie and nutrient needs per unit body weight decline from infancy to
adulthood, but overall needs increase because body weight increases
4.
During puberty, nutrient needs increase and gender differences become obvious;
time of greatest total needs for energy and nutrients (except for pregnancy and
lactation)
B.
Energy
1.
Infancy
a.
Per unit body weight, infant calorie needs are 2 - 4 times greater than that
of adults
b.
Large body surface area allows energy loss as heat
c.
Newborns require ~ 50 kcal/lb/d
d.
From 2 or 3 months through 3 years, infants/children require ~ 43
kcal/lb/d
Childhood: from age 3 - 5, children require ~32 kcal/lb/d
Adolescence: by age 15, adolescents require ~ 16 kcal/lb/d
C.
D.
E.
F.
2.
3.
Protein
1.
Infancy:
a.
1.5 g/kg/d
b.
Excess protein may overtax infants’ immature kidneys, leading to
dehydration
2.
Childhood
a.
Needs are affected by growth and maturation of organs
b.
Age 1 - 3: 1.1 g/kg/d
c.
Older children: 0.95 g/kg/d
3.
Adolescence
a.
Needs are affected by increases in lean body mass
4.
Effects of protein malnutrition during growing years
a.
Impaired physical development
b.
Childhood illness
c.
Delayed or stunted growth
d.
Death
e.
In developed countries, may be due to excessive dilution of infant
formula or severely restricted food intake
Fat
1.
Provides cholesterol, essential fatty acids, and meets high calorie demands
2.
Infant: 40 - 55% of kcal, with at least 5 g/d EFAs for eye and nervous system
development
3.
Dietary recommendations meant to reduce risk of heart disease do not apply to
children <2 y
4.
Low-fat diets in children <2 y deprive children of nutrients and calories and
impair growth
5.
Fat intake should be reduced between ages 2 - 5 to 30 - 35% of kcal; replace fat
content with nutrient-rich foods
Carbohydrate
1.
Lactose is primary carbohydrate
2.
Starch intake increases to ½ of carbohydrate intake as solid foods are introduced
3.
Simple sugar intake should be limited
4.
Fiber
a.
No recommendations for fiber intake for children <1 y
b.
After age 1, AI for giber is 14 g/1000 kcal
c.
High fiber diets may be inadequate in calories and/or bind minerals
Water
1.
Infants have highest fluid needs per unit body weight
a.
Water losses through skin are high due to high body surface area
b.
c.
d.
G.
Higher proportion of body water
Higher turnover of body water
High metabolic rate generates wastes that need to be excreted via lungs
and kidneys (kidneys are only ½ as efficient as those of adults)
2.
Needs are usually met by human milk or formula
3.
Supplemental water should be limited to 4 oz/d; more may be needed in cases of:
a.
Diarrhea
b.
Vomiting
c.
Fever
d.
Hot weather
4.
Addition of solid foods increases waste products, also increases water needs
5.
Cow’s milk is not recommended for infants <1 y
6.
Overdiluting formula or replacing human milk or formula with water can lead to
water intoxication
7.
Supplemental fluids may need to contain electrolytes
Vitamins and Minerals
1.
Iron
a.
Healthy, full-term infants are born with internal iron stores that are
depleted by about 4 - 6 months of age (maybe sooner if mother was irondeficient during pregnancy)
b.
American Academy of Pediatrics recommends iron supplementation with
human milk or iron-fortified formula for infants starting at birth
c.
Rare intestinal problems may require low-iron formulas, but their use is
generally discouraged
d.
By 6 months of age, infants need solid foods to supply extra iron
e.
Children ages 1 - 2 are vulnerable to iron deficiency anemia
i.
Milk-dominated diet is low in iron
ii.
No longer receive iron-fortified formula
iii.
Low meat intake
iv.
Intestinal parasites could contribute
f.
Ways to boost iron intake in young children
i.
Iron-fortified breakfast cereal
ii.
Serve iron-rich foods with vitamin-C rich foods
g.
Teens are also at risk for iron-deficiency anemia because needs increase
to support expanding lean body mass, blood volume, and menstruation
i.
40% increase for males
ii.
90% increase for females
h.
Incidence of iron deficiency has declined, likely due to use of fortified
breakfast cereals and iron-fortified formulas
2.
Calcium
a.
Formation of strong bones depends on optimum calcium intake and
weight-bearing exercise
b.
3.
4.
5.
6.
7.
8.
Needs sharply increase around age 9 and remain high through
adolescence
c.
Majority of bone formation occurs between 9 - 18 y of age
d.
Inadequate calcium intake poses risk for osteoporosis later in life
e.
Replacement of milk with soft drinks is a problem during teen years
Fluoride: American Dental Association and American Academy of Pediatrics
recommend fluoride supplements between 6 months and 16 years of age unless
drinking water is fluoridated
Zinc
a.
Children consume small portions of zinc-rich foods
b.
Low zinc intake may impair growth
c.
Fortified breakfast cereal provides zinc
Folate
a.
Older children and teenagers lack dietary folate due to inadequate
vegetable intake and eating meals away from home
b.
Folate deficiency may impair growth
c.
Special concern for teenage girls due to risk of neural tube defects in
offspring if pregnancy occurs
Vitamin D
a.
Required for normal bone development
b.
Deficiency leads to rickets
c.
Supplied by sun exposure or dietary sources
d.
Infant formula supplies vitamin D, but breastfed infants should receive
200 IU/d
Vitamin K
a.
Infants are born with little or no vitamin K stores and have sterile
intestines
b.
Lack of vitamin K can lead to slow blood clotting and uncontrolled
bleeding
c.
Infants routinely receive a vitamin K injection after birth
Vitamin and Mineral Supplements
a.
Routine nutrient supplementation is not needed by healthy children and
teens
b.
Cases that require supplementation
i.
Vitamin K for newborns
ii.
Iron for breastfed infants
iii.
Vitamin B-12 for breastfed infants of vegan mothers
iv.
Vitamin D for some infants
v.
Fluoride for infants, children, and teens with unfluoridated water
supply
c.
Populations that may benefit from children’s multivitamin and mineral
supplement not exceeding 100% RDA or AI
i.
Children and teens with poor diets
d.
17.4
ii.
Vegans
iii.
Pregnant teens
iv.
Calorie-restricted diets for weight control
v.
Deprived, neglected, or abused children
Supplements are no substitute for a healthy diet
Feeding Babies: Human Milk and Formula
A.
General
1.
With a few exceptions, human milk or iron-fortified infant formula combined
with internal nutrient stores meet infants nutrient needs through age 4 - 6 months
2.
Both human milk and infant formula enable babies to grow normally
B.
Nutritional Qualities of Human Milk
1.
AAP and American Dietetic Association deem human milk the most ideal and
desirable choice of nutrients for infants, including premature and sick newborns
2.
AAP and ADA recommend exclusive breastfeeding for first 6 months of life with
combination of breastfeeding and solid foods through 1 year
3.
WHO recommends breastfeeding with solid foods through 2 years
4.
Only 70% of North American mothers initiate breastfeeding and by 6 months,
only 33% continue to breastfeed
5.
Even a few weeks of breastfeeding is beneficial
6.
Nutrient composition and bioavailability of human milk is perfect for human
infants
7.
Possible supplemental nutrients
a.
Vitamin D
b.
Iron
c.
Fluoride
8.
Protein
a.
Mostly synthesized by breast tissue, although some proteins come from
mother’s bloodstream (e.g., immune factors, enzymes)
b.
Major proteins (lactalbumin and whey proteins) are easy to digest, do not
stress kidneys, and are unlikely to cause allergies and food intolerances
c.
Human milk contains 10.6 g protein/L, whereas cow’s milk contains 30.9
g/L
d.
Lactoferrin increases iron absorption to allow high absorption despite
low iron content
e.
Immune factors and bifidus factor protect against pathogens; breastfed
infants have fewer infections, fewer and less severe bouts of diarrhea,
and better survival than formula-fed infants
9.
Fat
a.
Combination of maternal dietary fats and those synthesized by breast
tissue
b.
Mother’s dietary intake of fats affects fatty acid content of breast milk
c.
C.
High in cholesterol and linoleic acid, which are required for normal brain
growth and development
d.
Omega-3 fatty acids support development of eyes and nervous system
e.
Fat content of human milk changes during feeding session to promote
efficient digestion
i.
Foremilk (first 5 - 10 minutes) contains less fat and fewer
calories
ii.
Hindmilk is rich in fat to promote satiety and supply calories for
growth (20 or more minutes)
f.
Fat content of human milk is 45.4 g/L, compared to 38 g/L in cow’s milk
10.
Carbohydrate
a.
Lactose is main carbohydrate, formed from galactose synthesized in
breast tissue and glucose from maternal bloodstream
b.
Human milk contains 71 g/L lactose, compared to 47 g/L in cow’s milk
11.
Water
a.
Human milk supplies adequate fluid
12.
Minerals
a.
Human milk contains 344 mg calcium/L, compared to 1370 mg/L in
cow’s milk
b.
Human milk contains 141 mg phosphorus/L, compared to 910 mg/L in
cow’s milk
Nutritional Qualities of Infant Formula
1.
Iron-fortified infant formulas provide safe, nutritious alternative to human milk
as long as water supply is pure
2.
Milk (e.g., cow, goat, soy), sweetened condensed milk, evaporated milk, and
homemade formulas are not appropriate for infants
a.
Do not meet infant’s nutrient needs
b.
May overburden immature kidneys
c.
May cause bleeding in stomach and intestine
d.
Proteins are difficult to digest and absorb
e.
Potential for food allergies
3.
Infant Formula Act of 1980 set standards to closely match nutrient composition
of human milk, although they cannot duplicate immunological protection
4.
Carbohydrate sources
a.
Lactose
b.
Sucrose
5.
Fat sources
a.
Vegetable oils
6.
Protein sources
a.
Modified proteins from cow’s milk, soy, or meat
7.
Variety of infant formulas are available to meet various health needs and
tolerances
Soy-based formulas for infants who can’t tolerate lactose or cow’s milk
proteins
b.
Predigested (proteins broken down into amino acids) for infants with
digestive problems
c.
Specialized formulas for preterm infants or specific medical conditions
(e.g., PKU)
8.
Choose iron-fortified formula unless physician recommends otherwise
9.
Transitional formulas are available for older infants and toddlers - lower cost and
better flavor
Comparing Human Milk and Infant Formula
1.
Nutritional content is close
2.
Factors in human milk promote maturation of immune system and GI tract
3.
Breastfed infants have reduced risk of asthma, leukemia, obesity, diabetes,
chronic intestinal diseases, misaligned teeth, ear infections, and respiratory
infections
4.
Establishes habit of eating in moderation, reducing risk of obesity in childhood
and adolescence by 20%
5.
Breastfed infants have higher visual acuity and cognitive development scores
6.
Human milk is less expensive than formula
7.
Convenience depends on circumstances and perspective
8.
Mother-child bonding depends mostly on close physical contact
9.
Reduced risk of food allergies and intolerances
10.
Contributes to normal development of jaws and teeth, leading to better speech
development
11.
Bacteriologically safe
12.
Always fresh and ready
Feeding Technique
1.
Required amounts
a.
Newborns need 2 - 3 oz every 2 - 4 hours due to limited stomach
capacity
b.
As infants mature, volume increases and frequency of feeding decreases
2.
Close monitoring over first week of life is important for breastfed infants to
ensure normal feeding and weight gain
3.
Avoid teaching infant to overeat; watch for signs of fullness
a.
Turning head away
b.
Inattentive
c.
Falling asleep
d.
Becoming playful
4.
Adequacy of breastfeeding can be confirmed by
a.
6+ wet diapers/d
b.
1 - 2 stools/d that look like lumpy mustard
c.
Softening of breast during feeding session
a.
D.
E.
5.
6.
7.
8.
17.5
Suspicion of inadequate feeding should be addressed immediately to prevent
dehydration
Burp after 10 minutes or 1 - 2 oz
Spitting up is normal
Back to Sleep Campaign
a.
Infants should be placed on their backs to sleep to reduce risk of sudden
infant death syndrome
b.
Repositioning infant’s head can help to prevent plagiocephaly
Feeding Babies: Adding Solid Foods
A.
General
1.
Solid foods: any food other than human milk or infant formula
2.
Solid foods are needed to meet nutrient needs after nutrient stores from birth
become depleted
3.
Develop willingness to taste new foods and eat a varied diet
4.
AAP guidelines for infant feeding
a.
Build to a variety of foods
b.
Pay attention to infant’s appetite to avoid overfeeding or underfeeding
c.
Infants need fat
d.
Choose fruits, vegetables, and grains, but don’t overdo high-fiber foods
e.
Infants need sugars in moderation
f.
Infants need sodium in moderation
g.
Choose foods containing iron, zinc, and calcium
B.
Deciding When to Introduce Solid Foods
1.
Nutritional need
a.
Nutrient stores are depleted by the time an infant has doubled birth
weight or weighs 13 lb
b.
Breastfed: demanding more than 8- 10 feedings/d
c.
Formula-fed: demands > 8 oz of formula every 4 hours or > 1 quart/d
d.
Usually by 4 - 6 months of age
2.
Physiological capabilities
a.
Kidney function
b.
Maturity of digestive tract: absorption of whole proteins until 4 - 5
months of age may predispose child to food allergies
3.
Physical ability
a.
Control head movements and sit along with support
b.
Disappearance of extrusion reflex (tongue thrusting)
c.
Ability to make chewing motion
4.
Early introduction of solid foods offers no benefit, can be detrimental
a.
Overburden immature organs
b.
Feeding problems and food dislikes
c.
Overconsumption of calories
d.
Reduced nutrient density
e.
f.
C.
D.
Increased choking risk
Sleeping through the night is a developmental milestone and does not
depend on amount of food consumed
Rate and Sequence for Introducing Solid Foods
1.
Between 6 - 12 months of age, human milk or formula intake decrease as solid
food gradually increases; by first birthday, half of calories should come from
human milk/formula and half from a variety of solid foods
2.
Initial introduction of solid foods: 1 - 2 t mixed with human milk or formula
3.
Add 1 food at a time and wait several days before introducing the next food to
watch for food sensitivities and allergies
4.
Typical progression of solid foods is designed to meet iron and vitamin C needs
first, then meet protein needs by 6 - 8 months of age
a.
Rice cereal
b.
Strained carrots
c.
Applesauce
d.
Oat cereal
e.
Cooked egg yolk
f.
Strained chicken
g.
Strained peas
h.
Strained plums
5.
Tips for food choices
a.
Cereals and fruit juices marketed for babies have no added salt, sugar, or
MSG; iron is in more absorbable form than adult cereals; fortified with
vitamin C to enhance iron absorption
b.
For prepared baby food, single-food items are usually more nutrientdense than mixed dinners and desserts
c.
Rice cereal is least likely to cause allergies; wheat cereal is most likely
d.
Delay introduction of commonly allergenic foods (e.g., cow’s milk,
wheat, chocolate, egg whites, fish and shellfish, nuts)
e.
After 1 year, whole milk is recommended; reduced-fat milk may not
meet infant calorie needs without exceeding protein needs and shouldn’t
be used until 2 years of age
6.
Appearance of teeth allows addition of more texture
7.
By 9 months, introduce finger foods and allow self-feeding
8.
By 1 year, well-cooked, tender table foods are usually accepted
9.
By 1 year, infant should be consuming a variety of foods from all food groups
10.
Present new foods for several consecutive days to aid acceptance
11.
Avoid honey until1 year because it may contain Clostridium botulinum spores
Weaning from the Breast or Bottle
1.
Around 6 months, introduce fruit juices in a spill-proof cup with a wide, flat
bottom
2.
Babies should be completely weaned from bottle by 18 months to avoid
overconsumption of milk or juice and prevent early childhood dental caries
E.
17.6
3.
Infants should never be put to bed with a bottle to avoid dental caries
Learning to Self-Feed
1.
Infant must be allowed to practice and experiment with a patient and supportive
adult
2.
By 1 year, many infants can finger feed and drinking from a cup without
assistance
3.
By 2 years, children can use cups and utensils; good use of fork will occur by age
3 - 4 and knife can be used by age 4 - 5
Children as Eaters
A.
General
1.
Preschool years are a good time to start healthy eating and physical activity
routines
2.
Few children and teens meet MyPyramid recommendations
3.
Greatest risk for nutrient inadequacy
a.
Poor eating habits
b.
Vegans
c.
Limited resources
4.
Nutrition assistance for those with limited resources
a.
Special Supplemental Nutrition Program for Women, Infants, and
Children
b.
School Breakfast Program
c.
National School Lunch Program
B.
Appetites
1.
Before and during rapid growth periods, appetites are good
2.
During periods of slow growth or plateaus, appetite drops significantly
3.
Low or high intakes are a concern if they occur with
a.
Fatigue
b.
Increased susceptibility to infection
c.
Underweight
d.
Failure to thrive
e.
Obesity
4.
Healthy, normal weight children self-regulate food intake to match needs
5.
Caregiver practices to avoid
a.
Bribery: decreases preference for hurdle food, increases preference for
reward, teaches use of food as reward
b.
Forcing
c.
Teasing
d.
Trickery
e.
Restriction of child’s food intake to prevent obesity
6.
Teaching a child to override hunger and satiety signals or to use food as a reward
can lead to future weight problems
7.
C.
D.
E.
Parents are responsible for providing appropriate, nutritious, appealing, regular
meals and snacks; children are responsible for deciding how much to eat
When, What, and How Much to Serve
1.
6 small meals fulfill nutrient needs and moderate blood glucose levels better than
3 large meals per day due to small stomach size
2.
Consuming breakfast improves daily intake of several vitamins and minerals,
leads to better performance in school and longer attention span
3.
Snacks provide 25% of kcal
4.
Serving sizes are ~1 T/year of age, depending on appetite
5.
MyPyramid for children (see Figure 17-6) is a useful menu-planning tool
6.
Due to reduced appetite, providing nutrient-dense foods is particularly important
7.
Over-emphasizing low-fat diets during childhood is linked to eating disorders
and “good food, bad food” attitude
8.
Children are sensitive to strong tastes and extreme temperatures
9.
Children may reject mixed foods
Food Preferences
1.
Crisp textures
2.
Mild flavors
3.
Familiar foods
4.
Food preferences begin in utero and continue to develop through adolescence
5.
Family has profound influence in early years; peers, teachers, and television
influence food choices in later childhood and adolescence
6.
Positive role models and nutrition education are important for children to develop
healthy eating habits
7.
Encourage regular family meals
8.
Encourage acceptance of new foods by making them look attractive and serving
in a social setting with calm, supportive, approving adults who are eating the
food
9.
1-bite rule
10.
Involving children in food selection and preparation aids acceptance
Mealtime Challenges
1.
Food jags: demanding same food repeatedly
a.
Only present a problem if food is high in sugar, fat, or sodium or if food
jag lasts more than a few weeks
b.
Serve the food with the knowledge that the jag will pass
2.
Refusal to eat
a.
Avoid overreacting so that child doesn’t learn to use food refusal to get
attention or manipulate a situation
b.
Child should remain at table
c.
Remove uneaten food
d.
Wait until next meal or snack to provide food; hunger is motivation to
eat
e.
Sudden loss of appetite can signal illness
3.
4.
17.7
Picky eating
a.
Usually an expression of independence
b.
Nagging, forcing, or bribing reinforces behaviors
c.
Offer a variety of healthy foods and let the child choose what and how
much to eat
Family tension at mealtime contributes to feeding problems; parents should learn
what to expect and set appropriate food-related goals
Teenage Eating Patterns
A.
General
1.
Food consumption increases with growth spurt
2.
Types and amounts of foods are same as for adults, but teenagers need more
calcium-rich foods
3.
Problem areas
a.
Inadequate fruits and vegetables
b.
Excessive cholesterol, sugar, fat, saturated fat, trans fat, protein, and
sodium
c.
Alcohol consumption
4.
Teenage boys have better nutrient intakes because they consume 700 - 1000 more
kcal/d than girls
5.
Replacing milk with soft drinks compromises bone health
6.
AI for calcium for males and females, ages 9 - 18: 1300 mg/d
7.
Eating away from home and skipping meals decrease diet quality
8.
Snacks account for 25% of total kcal; depending on food choices, snacks can
make positive or negative contribution to nutrient intake
9.
Strategies to improve teen food choices
a.
Provide nutritious foods at home
b.
Schedule family meals at least a few times per week
B.
Factors Affecting Teens’ Food Choices
1.
Emergence of independence and change in lifestyle (e.g., participation in afterschool activities) may affect nutrition
2.
Body Image
a.
Dissatisfaction with appearance is common
b.
Boys want to look stronger, more muscular
c.
Girls want to look thinner
d.
Fear of obesity may lead to fad diets, diet pills, unrealistic and unhealthy
weight goals, severe food restriction, and eating disorders
3.
Athletics and Physical Performance
a.
Teenage athletes may not consume additional calories and nutrients
needed to maintain normal growth and maturation to support physical
activity
b.
Calorie restriction or unbalanced diets may be used to meet weight limits
or achieve desired appearance for certain sports
c.
d.
e.
C.
17.8
Overuse of protein is common among football players and bodybuilders
Endurance athletes may practice carbohydrate loading
Over-restriction or overemphasis of any nutrient can be detrimental to
health
f.
Low body fat in females may lead to amenorrhea, which is detrimental to
bone health; weight gain and vitamin and mineral supplementation may
be needed
Helping Teens Eat More Nutritious Foods
1.
Focus on short-term benefits
2.
For teenage boys, stress importance of nutrition and physical activity for physical
development, fitness, vigor, and health
3.
For teenage girls, emphasize nutrient-dense foods and enjoyable physical
activities for better health and healthy weight
4.
Small portions of fatty or sweet foods can complement larger portions of
nutrient-dense foods
Medical Perspective: Potential Nutrition-Related Problems of the Growing Years
A.
Colic: sharp abdominal pain in otherwise healthy infants leading to repeated crying
episodes that sometimes last 3+ hours and don’t respond to typical remedies
1.
Affects 10 - 30% of all infants
2.
Starts at 2 - 6 weeks of age and lasts until 3 months of age
3.
Crying episodes tend to occur in late afternoon or early evening, may disrupt
nighttime sleep
4.
Cause is unknown, generally occurs in absence of physical problems
5.
Recommendations
a.
Check for fatigue, hunger, boredom
b.
Holding snugly
c.
Pacifier
d.
Rhythmic sounds or movements
e.
Continue breastfeeding, but consider decreasing maternal consumption
of milk products, caffeine, chocolate, and strongly flavored vegetables
f.
Consider changing type of formula to soy-based or predigested protein
g.
Medications for intestinal gas
h.
Parents should try to get rest and set aside time for themselves
B.
Gastroesophageal Reflux
1.
Frequent spitting up starting before 2 - 3 months of age, usually resolves by 1
year
2.
Caused by incomplete closure of lower esophageal sphincter
3.
Usually poses no serious medical concerns, but surgery may be required to
correct serious cases
C.
Milk Allergy
1.
Cow’s milk contains > 40 potentially allergenic proteins, only some of which are
inactivated by heating
2.
D.
E.
F.
G.
True milk allergies develop in 1 - 3% of formula-fed infants, leading to vomiting,
diarrhea, bloody stools, constipation, etc.
3.
May switch to soy-protein formula, but soy protein allergy may also develop
4.
Predigested protein formula may be necessary
5.
Usually resolves by 3 years of age
Constipation
1.
Common causes
a.
Inadequate fiber
b.
Inadequate fluids
c.
Excessive milk consumption
d.
Not responding promptly to urges to defecate (fear of painful bowel
movement)
2.
Recommendations
a.
Consume adequate fiber (14 g/1000 kcal)
b.
Drink plenty of water
c.
Limit milk intake to 16 -24 oz/d
d.
Stool softeners, laxatives, or enemas may use used under physician
guidance
Diarrhea
1.
Can lead to hospitalization or death from dehydration
2.
Signs of dehydration
a.
Dry mouth or tongue
b.
Few or no tears
c.
No wet diapers for 3 or more hours
d.
Irritability
e.
Listlessness
f.
Sunken eyes and cheeks
3.
Prevention of dehydration
a.
Increase fluid intake with diarrhea
b.
Use specialized electrolyte-replacements fluids (e.g., Pedialyte)
4.
Switching to soy-based, lactose-free formula for a few days will allow intestine
to resume lactase production
5.
Continue breastfeeding throughout duration of diarrhea
Ear Infections (Otitis Media)
1.
Carbohydrate-rich drinks may pool in throat and tubes leading to ears, allowing
bacterial growth
2.
May be painful or result in hearing loss
3.
Do not allow child to take a bottle to bed
Dental Caries
1.
Mouth bacteria metabolize sugars and starch to form acids that erode tooth
enamel
2.
Often caused by sleeping with bottle
3.
Prevalence has decreased due to
4.
H.
a.
Increased use of fluoride-containing toothpaste
b.
School-based dental care programs
c.
Fluoridation of water
d.
Professional fluoride treatments
e.
Tooth sealants
Prevention
a.
Brush teeth after eating sticky, high-sugar snacks
b.
Chew sugarless gum
Obesity
1.
15% of school-age children are overweight in U.S.
2.
Diagnosed when child reaches 95th percentile for BMI and physical exam
indicates overfat condition
3.
Consequences
a.
Ridicule, embarrassment, depression
b.
Short stature linked to early puberty
c.
Cardiovascular disease
d.
Type 2 DM
e.
Hypertension
4.
High likelihood that childhood obesity will progress to adulthood obesity
5.
Factors that contribute to childhood obesity
a.
Heredity
b.
Environment (e.g., television, computer, or video games should be
limited to 14 hours/week)
c.
Dietary behaviors (e.g., excessive snacking, over-reliance on fast food,
easy availability of high-fat, high-calorie foods)
d.
Physical activity behaviors - key contributor
6.
Prevention is best approach
a.
Offer nutritious diet
b.
Provide opportunities for physical activity
7.
Treatment
a.
Assess physical activity level, encourage more physical activity (60+
minutes of moderate to intense activity per day)
b.
Find new ways to relate to foods
i.
Stop mindless snacking
ii.
Limit portions
c.
Provide support, admiration, and encouragement for weight control
d.
Weight-loss diet is usually not necessary; stored energy can be used for
growth
i.
Stunted growth
ii.
Impaired brain development (children under 2 years of age)
iii.
Micronutrient deficiencies
iv.
Impaired eating behaviors
v.
Strained parent-child relationships
e.
I.
J.
K.
L.
M.
If adult height has been achieved, weight loss may be necessary
i.
Gradual rate (1 lb/week)
ii.
Medications or surgery may be indicated
iii.
Professional supervision
f.
Accept diversity in body shape
Hyperactivity: distractibility, impulsiveness, disruptive behavior, and overactivity
1.
Diet-related causes have been proposed, but scientific evidence is lacking
a.
Food allergies
b.
Additives - recent well-controlled study shows links between additives
and hyperactivity
c.
Sugar consumption
2.
Megadoses of vitamins will not cure hyperactivity and may cause liver damage
or intestinal distress
Acne
1.
Affects 80% of teens; due to oily secretions that block pores
2.
Research fails to support link between any dietary factor and acne
3.
Megadoses of vitamins or minerals do not cure acne
4.
Vitamin A analogs may be prescribed for severe cases, but close supervision is
needed to prevent toxicity
5.
Avoid pregnancy due to risk of birth defects
Teenage Pregnancy
1.
Meeting dietary requirements of adolescence and pregnancy is a challenge
2.
Pregnant teens may try to hide pregnancy
a.
Calorie restriction
b.
Lack of prenatal care
3.
Lack of education and financial resources complicate pregnancy outcomes
4.
Pregnancy within 2 years of menarche poses greatest nutritional risk
Inadequate Nutrition Knowledge
1.
Accurate nutrition information is needed to make informed food choices
2.
Health habits formed early in life persist into adulthood
3.
School-based nutrition education is needed
Modifications of Child and Teen Diets to Reduce Future Disease Risk
1.
Cardiovascular disease
a.
Early cholesterol screening in families with history of CVD or high
blood cholesterol
b.
Dietary changes: encourage moderation of milk and animal proteins;
focus on limiting saturated fat, trans fat, and cholesterol
c.
Medications
2.
Hypertension
a.
Establish habit of moderate salt intake
b.
DASH diet
c.
Medications
3.
Type 2 DM
a.
b.
c.
Screening at-risk children every 2 years starting at age 10 or onset of
puberty
Risk factors
i.
Family history
ii.
Sedentary lifestyle
iii.
Obesity
Treatment
i.
Dietary modification (e.g., low glycemic load)
ii.
Physical activity
iii.
Medications