Download Green Eggs and Ham

Chapter 12
Growth and Development Issues
in Promoting Good Health
Nutritional Status/Habits
of Children
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Generally macronutrient needs met as reflected in
increased height—1 inch taller in 2002 as
compared to 1971 (Komlos and Breitfelder, 2008)
Preschoolers increased intake of grains, fruits,
and vegetables from 1977 to 1998 but also
increased sugar and fruit juice intake (Kranz et al., 2004)
On average preschoolers drink less than the
recommended 16 oz milk; less than 10% over age
2 years include the recommended skim or low-fat
(1%) milk (O’Connor et al., 2006)
Significant number take vitamin supplements; risk
of excess intake occurs (Eichenberger et al., 2005)
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Bone Growth: Best
Barometer of Nutritional Status
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Bone, as healthy, living tissue, needs a
variety of nutrients for growth
It may generally be said that a child who
follows the growth curve for height is
meeting nutrient needs
Chronic inadequate protein, kilocalories,
vitamins, and minerals will stunt growth
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Development: Ability of
Body Parts to Function
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Nutritionally poor-quality diet can impair cognitive
function and neurologic development
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Milk intake associated with increased cognitions
Nerve function requires B vitamins, vitamins C, E, K, and
iodine (Bourre, 2006)
Poor nutritional intake of CHO can have
short-term deficits in cognition
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Breakfast leads to improved mental performance in
school
Children with poor school performance found less likely
to eat high-protein foods, have less vitamins and
minerals in diet, and higher sugar and fat intake (Fu et al.,
2007)
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Growth Charts
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Based on percentiles (e.g., if child is 75th
percentile for height, this means 25
children of the same age and gender are
taller and 75 are shorter)
Body mass index for children is based on
percentiles
Most important is that the child “follows the
curve”
Optimal: >10th percentile length or height;
BMI 25th to 85th percentiles
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Toddler Feeding Guides
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Young children like plain, simple foods; avoid
mixtures
Rule of thumb: 1 tbsp of each food per serving for
each year of age
Provide cups with handles; “sippy” cups avoid
spills
Promote “one-taste” rule, but avoid food battles
Provide structured choices (e.g., “Would you like
carrots on this side of the plate or the other
side?”)
Age + 5 for fiber goal
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Picky Eaters
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Tastes are learned; research shows a food has
to be tried 10 times before acceptance
Offer a new food with well-liked foods
(e.g., offer broccoli with macaroni and cheese)
Practice patience
May be related to tactile defensiveness;
speech-language pathologist may be helpful
Avoid authoritarian approach since related to
poor vegetable intake
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Preschool Age
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Encourage food diversity by involving child in food
shopping and preparation; help children identify
foods by looking at food labels
Make eating fun; read Green Eggs and Ham, sing
“Popeye the Sailor Man”
Avoid using food bribes
Food jags are common, with same foods desired
for several weeks at a time
Exposure to a variety of foods before age 4
encourages the child to continue acceptance of
these foods when older
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Early School Years
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Encourage breakfast for enhanced school
performance
Help children learn about good nutrition through
the MyPyramid Food Guidance System. Ask
“What food group is cantaloupe in?”
Promote concept of “All foods can fit”—avoid
labeling foods “bad” and “good”; use Pyramid
concept
Remember parent role, “Provide nutritious food in
a pleasant environment,” and child’s role,
“Choose what, when, and how much to eat” (per
Ellyn Satter, RD)
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Adolescent Years
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Recognize that body fat increase precedes
puberty
Remember parent role: have a variety of foods
available for choices teen can make (e.g.,
popcorn, pretzels, and fruits instead of chips and
cookies only)
Help teen pack foods for delayed meals, such as
when sports events delay dinner
Teens need high kilocalorie, protein, and calcium
and vitamin D intake for good growth
Help teens in decision making for food purchases
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Anemia and Iron-Deficiency
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Generally due to periods of rapid growth
(early childhood and adolescence)
Preference for low-iron foods contributes
Possible malabsorption due to parasites
from lack of hand-washing after outdoor
playing or due to celiac disease
Adolescent girls high-risk with menstrual
losses and rapid growth
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Promote Dental Health
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Brush or clean teeth with a wet washcloth
BEFORE eating to help remove oral bacteria;
encourage brushing and flossing after meals,
but especially before bedtime
Encourage planned snacks versus “grazing,” with
inclusion of protein and fat source along with CHO
source to help neutralize acid
Do not give sweet liquids in bottle, especially at
bedtime; promote use of cup by age 9 months for
juices
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Help Prevent Childhood Obesity
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Discourage excess television and computer use
Encourage physical activity
Promote high-fiber foods for satiety and
encouragement of bone growth from minerals,
especially magnesium
Promote appropriate milk and water intake;
discourage sweet beverages—juice diluted with
mostly seltzer is a healthy alternative to soda pop
Encourage children to eat fruit rather than drink it
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Provide Nonfood Rewards
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Praise
Hugs
Talking and telling stories
Give flowers
Give stickers
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Other Childhood Issues
Related to Poor Weight Gain
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Celiac disease: an immune-type response
among those with genetic predisposition to
gliadin protein as found in gluten portion of
certain grains: wheat, barley, and rye
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Can result in diarrhea, poor growth,
osteoporosis, iron-deficiency anemia
Cystic fibrosis: defect in sodium and
chloride transport
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Results in thick mucous secretions
Treatment: pancreatic enzymes, high-fat and
high-kilocalorie diet, fat-soluble vitamin
supplementation, EFAs, calcium
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Asthma: An
Inflammatory Condition
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Avoid food allergens as needed
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Eggs, milk, soy, peanut, wheat, fish
Refer to RD if food restrictions are followed
Provide foods high in magnesium and zinc
or supplements with 100% DRI
Consider omega-3 fats for antiinflammatory functions
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Childhood Constipation
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Generally result of inadequate fluids and
fiber
General treatment
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Increase fluids, fiber, exercise
Use caution with laxatives
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Epsom salts can provide excessive amount of
magnesium for children and have been linked
with toxicity for this population
Avoid laxative abuse, because peristalsis of GI
tract can be seriously impaired
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Attention Deficit Hyperactivity
Disorder (ADHD)
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Research does not support restrictions of
sugar or food additives
Newer research indicates magnesium
deficiency may be a cause, with good
response to supplementation noted
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Do not exceed DRI for children
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Autism: Sensory Deficits with
Reduced Social Interaction
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Child exhibits strong need to maintain routines
and avoidance of anything new
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Diagnosis made in:
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Acceptance of new foods is extremely gradual
1 in 2500 children in the 1980s
1 in 300 in the mid-1990s
Now estimated 1 in 200 children (Liptak et al., 2008)
Possible role of gliadin protein as found in gluten
and casein (milk protein)
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Any restrictive diet necessitates supervision by an RD
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New Insights into Autism
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Theory of mercury preservative in
immunizations
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Rate has not declined with elimination of
mercury from childhood vaccines (Schecter and Grether,
2008)
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Other sources of mercury may be etiology:
environmental contamination from power
plants (Palmer et al., 2008) or antibiotics containing
mercury (Adams et al., 2007)
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Preventing Eating Disorders
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Do not discuss weight around children of
any age
Promote positive self-esteem in children
Do not restrict food intake or label foods
“good” and “bad”
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“All foods can fit”
Encourage and respect children’s ability to
recognize their hunger and satiety cues and
feelings
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Recognizing Eating Disorders
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Anorexia nervosa: food restricting (may be
masked as vegetarian diet or complaints of
GI discomfort)
Bulimia: purging with vomiting and/or
laxative abuse
Bulimorexia: combination of anorexia and
bulimia
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Bulimia: Purging Behavior
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Dehydration, dry mouth caused by
vomiting and/or laxative abuse
Dental erosion from purging—dental
professionals play key role in identifying
bulimia
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