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Day Care Nutrition In A Nutshell Training Review Module 2 Clock Hours P.O. Box 5465, Katy, TX 77491 Tel: 281.395.7000; Toll- Free: 877.395.6560 Fax: 281.0395.7002 www.childfoodprogramoftexas.org Page 1 Instructions for completing this module: Table of Contents 1. After reviewing this material with your day home representative, please read and study the material carefully. Food Choices: Why do we eat what we eat? ........................................................... Page 3 Fuel For Life: Food and energy ............................ Page 4 What Is Food? The six groups of nutrients ...................................................... Page 5 Poor Nutrition In Children. Symptoms to look for ........................................................ Page 10 How Much Is Enough? Nutritional requirement of children ........................................ Page 12 2. Complete the test for the material and return it to Child Food Program of Texas at your convenience. There is no deadline to have this test back to us, 3. When we receive your completed test, we will evaluate it and then send you a certificate for 2 clock hours for completing this material. Objectives for this module: 1. To identify why we eat and what: we eat. 2. To educate family day care providers on the six groups of nutrients. 3. To help family day care providers identify poor nutrition in children through specific signs and symptoms. 4. To identify the specific nutritional requirements of children. The goals of the Nutrition Education and Training Program are to: 1. create an awareness of the importance of nutrition and nutrition education, and 2. promote changes in eating patterns that will result in healthier children. Page 2 Food Choices: Why do we eat what we eat? You choose foods for many reasons. You eat because you’re hungry and you choose foods because they are available. Rarely is food chosen for its nutritional value. You choose food for yourself and your family because the food tastes good, because you associate it with pleasant past experiences, or because you see it as a status symbol. Good eating habits don’t just happen, they must be learned. The strongest influences on a child’s eating habits are parent attitudes and behaviors, particularly those of mothers. A child’s first teachers also affect the development of eating patterns. A teacher with a positive attitude about food may increase a child’s acceptance and enjoyment of new foods. Every year the food industry spends millions of dollars to promote foods with little or no nutritional value. A child may see as many as 300 TV commercials for food, drinks, and candy during one week, but rarely will that child see a commercial for fruits, vegetables, or whole grain breads and cereals. How can children learn to make wise food choices when so many advertisements encourage the selection of non-nutritious foods? As a consumer, you can make a difference. The food industry produces and advertises foods that sell. If you spend your food dollars on nutritious foods, you’ll make a difference in what is advertised and available at the grocery store. Children’s nutritional status depends on their acceptance of a variety of foods. During a child’s preschool years, day care workers have a chance to affect lifetime food habits. With your leadership, motivation, and encouragement, children in your care can learn about nutritious foods and develop healthy eating habits. You should present this nutrition education in an exciting and meaningful way, because not until children establish sound eating habits can nutrition education be called successful. Page 3 Fuel For Life: Food And Energy The most important reason for eating is to supply energy to the body. Just as a car needs gasoline for fuel, your body needs food. As food is burned in your body, energy is produced and heat is released. This process is metabolism. Your body uses the energy from food for physical activity and maintenance of body processes. The more energy a food provides, the more heat it releases. A calorie is the unit used to measure the energy, or heat, a food supplies. The human body is a nonstop energy consumer. You use energy when you breathe, when your heart pumps blood, and when you digest food. You use energy when you walk, run, or exercise. During times of rapid growth, or recovery from illness or injury, children need extra calories. Children may fail to grow and develop normally if they don’t get enough food and they may even lose weight. Although their bodies and appetites may be smaller, children’s energy requirements may be equal to that of mature women. Because of their small appetites, children need to eat often. This is why the Minimum Standards for Day Care Centers and Family Day Homes describe a meal pattern which includes a mid-morning and midafternoon snack for children. To maintain a healthy body weight, you must use as much energy as you take in. Unlike a car, your body has no gas tank that overflows when it gets too much fuel. The body will process as many calories as you choose to give it, and the food not used for energy will be stored as fat. If excess food is eaten every day, overweight and obesity will occur. Physical activity is one good way to avoid these problems. Page 4 What Is Food? The Six Groups Of Nutrients All foods contain one or more of the six nutrients: protein, fat, carbohydrate, vitamins, minerals, and water. All are equally important. Each is essential for life, health, and vitality, and each has a special function in the body. Protein: The body’s building blocks Every cell in the body uses protein. Bodies use protein to build and repair skin, muscles, and connective tissue, and to make body fluids such as blood. Proteins also help regulate body processes and help the body resist infection. Protein requirements increase during periods of rapid growth and recovery from illness. Complete and incomplete protein Protein is made of building blocks called amino acids. When you eat foods containing protein, two things happen: first, your body breaks the protein into amino acids, and second, the cells rearrange the amino acids to build the proteins they need for growth, maintenance of tissues, and regulation of body functions. There are eight amino acids you must get from foods. These are essential amino acids. Although your body requires other amino acids it can make these itself if you eat enough of the essential amino acids. The protein in animal foods is complete because it contains the eight essential amino acids. The protein in plant foods is incomplete because some of the essential amino acids are missing or present in small amounts. Meatless menus can supply complete protein if they are carefully planned. By combining the incomplete protein in one plant food with the incomplete protein in a different plant food you can get a complementary protein. Complementary proteins are equal in quality to the complete protein found in meat. Examples of complementary proteins using plant foods are corn tortillas with beans, peanut butter with bread, and lentils with barley soup. You can also combine an incomplete plant protein with a small amount of complete animal protein to produce a complementary protein. Examples of complementary proteins using plant with animal foods are milk with cereal, macaroni with cheese, and eggs with rice casserole. These familiar foods provide good sources of protein when eaten in the combinations described. Ask a nutritionist about other ways to combine foods for adequate protein. What are the best sources of protein? Protein is concentrated in the animal foods-meat, fish, poultry, eggs, milk, and cheese. Other less expensive protein meat alternates will supply adequate protein sources are legumes (dried peas and beans), nuts, seeds, and peanut butter. How much is enough? As previously mentioned, protein is an especially important nutrient for growing children. Two servings a day of meat or meat alternates will supply adequate protein for most healthy children. The serving size increases as a child grows. For child size portions, refer to “Meal Patterns for Children” available from the workshop leader. Although protein is essential for growth and maintenance of body processes, you can overdo a good thing. Protein-rich foods are usually the most expensive items on the grocery list. The dietary protein not used to maintain or replace the body’s protein will be burned for energy or converted to fat and stored. This is an expensive way to provide the body with energy, and you can get fat. Most animal protein foods contain a lot of saturated fat. The potential danger of too much saturated fat is described in the next section. Fats: The energy that lasts Although dietary fat is considered a weight watcher’s enemy, it’s also an essential nutrient. Besides carrying vitamins A, D, E and K, fat is digested slowly and therefore delays hunger between meals. Fat is also needed to maintain healthy skin. Page 5 Fat is a concentrated energy source and supplies a large number of calories in a small amount of food, as shown by this comparison: 1 teaspoon fat = 35 calories 1 teaspoon sugar = 15 calories Because fat is so concentrated, it’s a good way to add calories to diets of small children with limited appetites. For example, margarine can be spread on toast or muffins, added to cooked cereals, or used to season steamed vegetables. Calorie conscious dieters, however, might restrict dietary fat to reduce caloric intake. Fats have two classifications: polyunsaturated fats are usually liquid at room temperature, and include vegetable oils, mayonnaise, and margarine. Saturated fats are solid at room temperature, and include butter, lard, shortening, and fat in meat and cheese. After digestion, saturated fat may accumulate in the arteries as a hard substance called plaque. Increased amounts of plaque may clog the arteries and lead to arteriosclerosis and other forms of heart. disease. Heart disease is the leading cause of death in this country. Although other factors may cause heart disease, a diet containing more polyunsaturated fat and less saturated fat reduces the risk of heart disease. Such a diet is recommended for people of all ages, including preschool children. Foods low in saturated fats: eat these foods more often Chicken Turkey Fish Round steak / Sirloin steak (trim all outside fat) Cottage cheese Yogurt Low fat or skim milk Buttermilk Margarine: liquid vegetable oil first ingredient on label Vegetable oil Ice milk or sherbet Foods high in saturated fats: eat these foods less often Ham Bacon Ground Beef Hot dogs bologna or salami Sausage Pork chops Cheese: cheddar, Swiss, processed Cream cheese Whole milk Butter Shortening or lard Ice cream What foods contain fat? Dietary fat sources include oils and shortening, butter and margarine, whole milk and cheese, nuts, seeds, and fatty meats. More than 50 percent of the calories in ground meat, frankfurters, bologna, ham, bacon, and sausage come from fat. Protein foods from animal sources often contain “hidden” saturated fat. Try to choose those protein foods lowest in saturated fats. (See the following list.) Page 6 What about cholesterol? Cholesterol is a fatty substance found in animal foods and the human body. Eggs, butter, cheese, liver, and the shellfish contain a lot of cholesterol. Adults diagnosed as having an increased risk of heart disease should restrict their intake of these foods. They may be used in moderation in the diets of children. Carbohydrate: Foods for quick energy Carbohydrates are nutrients found primarily in plant foods. The body uses carbohydrates for energy and for processing fats and proteins. During digestion, carbohydrates are broken into units of glucose. Glucose enters the blood stream and supplies energy in the brain, organs, and muscles. A child who skips breakfast or doesn’t eat for several hours will have a lower level of glucose in the blood. This child will feel tired and have trouble concentrating. Foods rich in carbohydrate supply quick energy by raising the blood’s glucose level. About half the calories in a balanced diet should come from carbohydrate. Food sources of carbohydrate are inexpensive, add variety to the diet, provide quick energy, and may supply other essential nutrients as well. Select carefully the carbohydrate sources in your diet. Whole grain breads and cereals, legumes (beans and peas), corn, and rice are rich in carbohydrate and also supply protein, vitamins, and minerals. Fresh fruits and vegetables supply carbohydrate and are also excellent sources of vitamins. Raw fruits and vegetables, and whole grain products provide roughage. Roughage, also called fiber, stimulates the intestine walls and helps prevent constipation. After a child is old enough to chew well, raw fruits and vegetables promote healthy gums and teeth. Syrup, honey, table sugar, soda pop, and foods made with a lot of sugar provide empty calories without other nutrients. Limit consumption of these foods, especially in children’s diets where sugar may be replacing more nourishing foods. Children who frequently eat sweet foods may develop unhealthy eating habits which last a lifetime. Eating too much sugar causes tooth decay and may lead to hypoglycemia, diabetes, or obesity. The list “Nutritious snacks for the preschool child” refers to foods you should emphasize as snacks. The foods listed in “Snacks to be avoided” contain a lot of sugar and a few nutrients. Nutritious snacks for the preschool child Dry cereal (not sugarcoated) Hot cereal Crackers Raw vegetables Fresh or canned fruit Whole grain bread or toast Banana bread Oatmeal or peanut butter cookies Cheese (cube, slice, or wedge) Milk Vegetable juice Unsweetened fruit juice Peanuts and raisins Hard-cooked eggs Popcorn Snacks to be avoided Sugared cereals Candy Honey and syrup Jellies and jams Cookies with icing or filling Cakes Doughnuts Rich pastries Sweetened beverages: - carbonated beverages - sweetened fruit drinks - fruit flavored drinks - flavored milks Vitamins: There are two kinds More than a dozen vitamins have been identified as essential nutrients for the human body. Unlike protein, carbohydrate, and fat, the vitamins do not provide energy. Each vitamin has a different function in the body. Vitamin A, for example, prevents night blindness and is necessary for healthy skin; vitamin D is necessary for strong bones and teeth; vitamin C helps in healing of wounds and resisting infection; and the B vitamins (thiamine, ri- Page 7 boflavin, and niacin) help convert food into energy. There are two types of vitamins, fat soluble and water soluble. The fat soluble vitamins are carried in the fat portion of foods, and these vitamins can be stored in the body. Dangerously high levels of vitamins A and D may accumulate if you take supplements in excessive amounts for long periods. Water soluble vitamins are carried in the water portion of foods and cannot be stored in the body. They are excreted in urine if the body gets more than it needs. For this reason you should eat good vitamin B and C sources every day to be sure your body has enough. A deficiency of one or more vitamins can produce a variety of disease-like symptoms, but these are rare unless the diet is severely restricted. Many foods common to American diets are enriched or fortified with vitamins. For example, vitamin C is frequently added to fruit juice, vitamin D to milk, vitamin A to butter and margarine, and B vitamins (thiamine, niacin and riboflavin) to flour, rice, cornmeal and cereal products. Vitamin deficiencies and malnutrition occur, but they are rare in this country. Many people, however, suffer from poor nutrition because their diet supplies less than the minimum amount of food necessary for health and growth. Signs of poor nutrition in children are described in Section IV. Vitamins are found in a variety of foods. To supply the essential vitamins, plan a diet including foods from all four food groups and at least four servings of fruits and vegetables daily. Include one rich vitamin C source daily and one rich vitamin A source at least every other day. Refer to “Fruits and Vegetables” for a list of good vitamin C and vitamin A sources. Fruits and Vegetables Rich sources of vitamin C (Eat one serving daily) Oranges Grapefruit Tangerines Tomatoes Juices or any of the above Strawberries Broccoli Brussels sprouts Green peppers Kale Rich sources of vitamin A (Eat one serving at least every other day) Broccoli Carrots Mixed vegetables Peas and carrots Pumpkin Spinach and other dark green leafy vegetables Sweet potatoes Tomatoes Squash Apricots Cantaloupe Peaches Watermelon Minerals: Strength and regulation Your body needs 18 to 20 minerals in tiny amounts to regulate its processes and build its structures. Some minerals are part of the soft tissues, muscles, nerves, heart, and liver; others build and repair bones and teeth. Minerals are also found in body fluids and form essential regulatory substances. For example, iron and copper are part of the red blood cells, and zinc is part of insulin. Plan the diet carefully to include calcium and phosphorous, the minerals required in larger amounts by the body. Calcium and phosphorous work together to build and maintain strong bones, teeth, and muscles. An adequate intake of calcium and phosphorous is especially important during childhood when bones and teeth are growing rapidly. Three or more will provide adequate calcium and phosphorous. Other good calcium and phosphorous sources include leafy green vegetables, peas, beans, and sunflower and sesame seeds. Diets of preschool children frequently lack iron, and this lack can cause anemia. A child with anemia will tire easily, look pale, have frequent infections, and may be underweight. Anemia can occur when a preschool child consumes a lot of milk and few solid foods. The following list of iron rich foods will help you plan menus for preschool children. Include a good source of iron in their diet very day. Page 8 Good sources of iron Apple juice Beans, dried Beef Cereals, iron fortified Chicken Eggs Dried fruit (raisins, prunes, apricots) Lentils Nuts Peas (greens, black-eyed) Prune juice Sunflower seeds Tomato juice Whole wheat bread Water comes from the obvious sources-drinking water, coffee, tea, fruit juices, milk, and other beverages. Water is also in every food you eat. Some fruits and vegetables contain more than 80 percent water. Because water provides no calories, fruits and vegetables containing a lot of water, such as lettuce, celery, and apples, are low in calories. Preschool children should drink four to five glasses of fluid each day. Thirst is the best indicator of the need for water, but children often need to be reminded. Offer water to children several times a day. It won’t spoil their appetites and it helps them develop the habit of choosing water instead of high-calorie, low-nutrient beverages. Fruit juice and milk are the best drinks to offer children at meals and snack time because these drinks quench thirst and provide nutrients. You can easily get the other minerals your body needs if you plan a diet containing whole grain breads and cereals, milk, meat, peas, beans, and vegetables. You may be getting more sodium in your diet than you need. Most prepared foods and snack foods contain a lot of sodium in the form of salt. Too much sodium over a long period can cause high blood pressure and lead to a stroke or heart attack. Eat less salt by eliminating salty food, reducing salt added during cooking, and omitting salt at the table. Water: Essential and calorie free Although water is not usually considered a food, it’s an essential nutrient. Humans can survive longer without food than without water. Water is a part of every cell, tissue, and metabolic process. It carries nutrients to the cells and waste products from the cells. Water is the major component of blood and helps regulate body temperature. Page 9 Poor Nutrition In Children: Symptoms To Look For Symptoms of severe nutritional deficiency, or malnutrition, are rarely seen in this country, but less obvious signs of poor health caused by poor nutrition may appear. During a child’s period of rapid growth, from birth to 5 years, poor nutrition can affect physical growth and mental development. Physicians are trained to recognize malnutrition, but children are usually examined only once a year or during illness, so symptoms of poor nutrition may not be noticed. As a care giver you should be familiar with the symptoms of a poorly nourished child. A list of nutrition related symptoms is provided for your use. If you observe a child with one or more of these symptoms, talk with the child’s parents or guardians. The child may not be getting enough food, or may re- quire a physician’s attention. In infants, the signs of malnutrition may be subtle. An infant receiving enough fluid will have six or more wet diapers each day. The bowel habits of a healthy infant range from several small movements each day, to one every other day. Suspect diarrhea when the diaper is filled four or more times a day, and report your suspicions to the parents. Notify a physician if this condition persists for more than 24 hours, because dehydration can occur rapidly. A gradual weight increase is probably the best indicator of good nutrition in an infant. Most infants will double their birth weight in five months and triple their birth weight in the first year. The next page is a chart of signs of poor nutrition in a preschool child. Page 10 Signs of Poor Nutrition in the Preschool Child Symptom Possible Nutritional Relationship Underweight Inadequate food intake Feeding problems Emotional problems - refusing to eat to gain attention Poor eating habits Overweight Entire family may eat too much Lack of exercise Emotional problems - overeating as a way to deal with other problems Failure to grow Inadequate food intake No breakfast Feeding problems Lethargy or lack or attention Inadequate food intake No breakfast Iron deficiency anemia Intestinal parasites (worms) Jitters and hyperactivity Inadequate food intake No breakfast Diet containing too much sugar Diet containing too much caffeine (colas, coffee, tea, chocolate) Severe headaches or early morning headaches Inadequate food intake Diet containing too much sugar No breakfast Frequent diarrhea Too much fiber in diet Diet not balanced Food allergy Constipation Inadequate fluid intake Lack of fiber in diet Pallor (lack of color in skin) Inadequate iron or iron deficiency anemia Weakness or easy fatigue leg cramps or bowed legs Inadequate food intake Inadequate protein intake Inadequate calcium intake Too much phosphorous Page 11 How Much Is Enough? Nutritional Requirements Of Children Care givers are faced with a challenge: feeding young children who have small and erratic appetites. This problem is complicated because children require nutrients in almost the same quantities as adults, but they need fewer calories. If children are to consume adequate vitamins, minerals, and protein, their diets must be carefully planned. Offer children only the most nutritious foods at meals and snack time. Avoid food that provides calories without many nutrients. Scientists identify more than 50 nutrients that must be included in the diet, but planning a diet to include all 50 is a difficult task. To simplify menu planning, nutritionists have designated leader nutrients. Certain food groups supply certain leader nutrients. Refer to the following list of the four basic food groups and the leader nutrients supplied by each. If you plan diets to include the leader nutrients, then the other essential nutrients usually will be included. It is important to note that you can plan an adequate diet using the four basic food groups only if you include a variety of food in the menu. Food Groups and Their Leader Nutrients Servings needed daily by preschool Four basic food groups Leader nutrients Fruits and vegetables Vitamin A and C B vitamins (niacin and thiamin) Iron 4 Bread, grain and cereal Carbohydrate Protein 4 Meat and meat alternates Iron B vitamins (niacin and thiamin) Protein 2 Milk and milk products Calcium B vitamins (niacin and thiamin) 3 Page 12