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Chapter 12
Child and Preadolescent
Nutrition
Nutrition Through the Life Cycle
Judith E. Brown
Definitions of the Life Cycle
Stage
• Middle childhood—between the ages of 5
and 10 years
• Preadolescence—ages 9 to 11 years for
girls; ages 10 to 12 years for boys
• Both may also be termed “school-age”
Tracking Child and Preadolescent
Health
• Data on U.S. children in 2006
– 8% lived in extreme poverty (< 50% of
poverty)
– 40% lived in low-income families (<200%
poverty)
– 11.7% had no health insurance
• Disparities in nutrition status exist among
different races & ethnic groups
Tracking Child and Preadolescent
Health
• Disparities in nutrition status exist among different
races & ethnic groups. Prevalence of overweight
and obesity is measured by BMI
– Hispanic Male children have significantly
higher BMIs
– Non-Hispanic black female children
significantly greater BMIs
– African-Americans have higher percentages of
total calories from dietary fat.
Healthy People 2010
• A number of objectives are specific to
children’s health and well-being
• According to the proposed framework for
healthy People 2020, many of the objectives
will be retained
• www.healthypeople.gov/hp2020
Normal Growth and
Development
• Measurement techniques
– Growth velocity will slow down during the
school-age years
– Should continue to monitor growth periodically
– Weight and height should be plotted on the
appropriate growth chart
Normal Growth and
Development
• 2000 CDC growth charts
– Tools to monitor the growth of a child for the
following parameters
• Weight-for-age
• Stature-for-age
• Body mass index (BMI)-for-age
– Can be downloaded from CDC website:
www.cdc.gov/nchs
Normal Growth and
Development
• 2000 CDC growth charts
– Based on data from cycles 2 & 3 of the
National Health & Examination Survey
(NHES) & the National Health & Nutrition
Examination Surveys (NHANES) I, II, & III
• WHO Growth References
– Available at www.who.int/childgrowth
Normal Growth and
Development
Physiological Development in
School-Age Children
• Muscular strength, motor coordination, &
stamina increase
• In early childhood, body fat reaches a
minimum then increases in preparation for
adolescent growth spurt
• Adiposity rebounds between ages 6 to 6.2
years
• Boys have more lean tissue than girls
Cognitive Development in
School-Age Children
• Self-efficacy…the knowledge of what to do
and the ability to do it
• Change from preoperational period to
concrete operations
• Develops sense of self
• More independent & learn family roles
• Peer relationships become important
Development of Feeding Skills
•  motor coordination & improved feeding
skills
• Masters use of eating utensils
• Involved in food preparation
• Complexities of skills  with age
• Learning about different foods, simple food
prep and basic nutrition facts
Eating Behaviors
• Parents & older siblings influence food choices in
early childhood with peer influences increasing in
preadolescence
• Parents should be positive role models
• Family meal-times should be encouraged
• Media has strong influence on food choices
• http://pediatrics.aappublications.org/content/early/
2011/04/27/peds.2010-1440.abstract?papetoc
Body Image and Excessive
Dieting
• The mother’s concern of her own weight
issues may increase her influence over her
daughter’s food intake
• Young girls are preoccupied with weight &
body size at an early age
Body Image and Excessive
Dieting
• The normal increase in adiposity at this age
may be interpreted as the beginning of
obesity
• Imposing controls & restriction of
”forbidden foods” may increase desire &
intake of the foods
Energy and Nutrient Needs of
School-Age Children
• Energy needs vary by activity level & body
size
• The protein DRI is 0.95 g/kg body wt
• Intakes of vitamins & minerals appear
adequate for most U.S. children
DRI for Iron, Zinc and Calcium
for School-Age Children
Common Nutrition Problems
• Iron deficiency
– Less common in children than in toddlers
• Although rates are lower, they are still above the
2010 national health objectives
– Dietary recommendations to prevent: encourage
iron-rich foods
• Meat, fish, poultry and fortified cereals
• Vitamin C rich foods to help absorption
Common Nutrition Problems
• Dental caries
– Seen in half of children aged 6 to 8
– Reduce dental caries by limiting sugary snacks
& providing fluoride
– Choose fruits, vegetables, and grains
– Regular meal and snack times
– Rinse (or better yet, brush the teeth) after eating
Prevention of Nutrition-Related
Disorders
• Prevalence of overweight among children is
increasing
• Data from NHANES I, II, & III suggest
weight gain linked to inactivity rather than
increases in energy intake
• Excessive body weight increases risk of
cardiovascular disease & type 2 diabetes
mellitus
Prevalence of Overweight and
Obesity
• Definitions:
– Overweight = BMI-for-age >95th%
– At risk for becoming overweight = BMI-forage from 85th to 95th%
• Overweight more common in MexicanAmerican males & females and AfricanAmerican females
• Heaviest children are getting heavier
Characteristics of Overweight
Children
• Compared to normal weight peers,
overweight children:
–
–
–
–
–
Are taller
Have advanced bone ages
Experience earlier sexual maturity
Look older
Are at higher risk for obesity-related chronic
diseases
Predictors of Childhood Obesity
• Age at onset of BMI rebound
– Normal increase in BMI after decline
– Early BMI rebound, higher BMIs in children
later
• Home environment
– Maternal and/or Parental obesity predictor of
childhood obesity
Effects of Television Viewing
Time
• Obesity related to hours of television
viewing
• Resting energy expenditure decreases while
viewing TV
• Healthy People 2010 objective:
– Increase proportion of children who view 2
hours or less of TV per day from 60% to 75%
Television Viewing Time
Addressing the Problem of
Pediatric Overweight and Obesity
“An ounce of prevention is worth a pound
of cure”
Prevention and Treatment of
Overweight and Obesity
• Expert’s recommend a 4-stage approach:
• The four stages:
– Stage 1: Prevention Plus
– Stage 2: Structured Weigh Management
(SWM)
– Stage 3: Comprehensive Multidisciplinary
Intervention (CMI)
– Stage 4: Tertiary Care Intervention (reserved
for severely obese adolescents)
Prevention and Treatment of
Overweight and Obesity
Prevention and Treatment of
Overweight and Obesity
• Treatment consists of a multi-component,
family-based program consisting of:
–
–
–
–
Parent training
Dietary counseling/education
Physical activity
Behavioral counseling
Nutrition and Prevention of CVD
in School-Age Children
• Acceptable range for fat is 25% to 35% of
energy for ages 4 to 18 year
• Include sources of linoleic (omega-6) and
alpha-linolenic (omega-3) fatty acids
• Limit saturated fats, cholesterol & trans fats
Nutrition and Prevention of CVD
in School-Age Children
• Increase soluble fibers, maintain weight, &
include ample physical activity
• Diet should emphasize:
–
–
–
–
Fruits and vegetables
Low-fat dairy products
Whole-grain breads and cereals
Seeds, nuts, fish, and lean meats
Dietary Supplements
• Supplements not needed for children who
eat a varied diet & get ample physical
activity
• If supplements are given, do not exceed the
Dietary Reference Intakes
Dietary Recommendations
• Iron
– Iron-rich foods: meats, fortified breakfast
cereals, dry beans, & peas
• Fiber
– Increase fresh fruits and vegetables, whole
grain breads, and cereals
• Fat
– Decrease saturated fat and trans fatty acids
Dietary Recommendations
• Calcium & Vitamin D
– Bone formation occurs during puberty
– Include dairy products and calcium-fortified
foods
– Vitamin D from exposure to sunlight and
vitamin D fortified foods
– If lactose intolerant:
• Do not completely eliminate dairy products but
decrease only to point of tolerance
Fluid and Soft Drinks
• Preadolescents sweat less during exercise
than adolescents & adults
• Provide plain water or sports drinks to
prevent dehydration
• Limit soft drinks because they provide
empty calories, displace milk consumption
& promote tooth decay
Recommended versus Actual
Food Intake
• Saturated fat—intake is 12.6% of calories
(recommend <7%)
• Total fat—intake excessive in African American
boys & girls & Mexican-American girls
• Caffeine—increasing because of soft drink
consumption
• Fast food—30.3% of children consume fast food
each day
Other Considerations
• Cross-cultural Considerations
– Healthy People 2010-a major goal-eliminate
health disparities among different segments of
the population
– Health care professionals & teachers should
learn about cultural dietary practices
Other Considerations
• Vegetarian Diets
– Suggested daily food guides for vegetarians are
available
– Vegetarian diets should be planned to provide
adequate calories, protein, calcium, zinc, iron,
omega-3 fatty acids, Vitamin B12, riboflavin
and Vitamin D
Physical Activity
Recommendations
• Recommendations:
– Children should engage in at least 60 minutes of
physical activity each day
– Parents should set a good example, encourage
physical activity, and limit media & computer use
• Actual:
– Only 7.9% of middle & junior high schools require
daily physical activity
– Only about 36% of the 5-15 y/o children walk to
school & 2% ride a bicycle to school
Determinants of Physical
Activity
• Determinants may include:
– Girls are less active than boys
– Physical activity decreases with age
– Season & climate impact level of physical
activity
– Physical education classes are decreasing
Organized Sports
• Participation in organized sports linked to
lower incidence of overweight
• AAP recommends:
– Participation in a variety of activities
– Organized sports should not take the place of
regular physical activity
– Emphasis should be on having fun and on
family participation rather than being
competitive
Organized Sports
• Participation in organized sports linked to
lower incidence of overweight
• AAP recommends:
– Use of proper equipment such as mouth guards,
pads, helmets, etc.
– Prevention of stress or overuse injuries
– Awareness of disordered eating & heat injury
Nutrition Education
• School-age: a prime time for learning about
healthy lifestyles
• Schools can provide an appropriate
environment for nutrition education &
learning healthy lifestyles
• Education may be knowledge-based
nutrition education or behavior based on
reducing disease risk
Nutrition
Education
Nutrition Integrity in Schools
• All foods available in schools should be consistent
with the U.S. Dietary Guidelines & Dietary
Reference Intakes
• Sound nutrition policies need community &
school environment support
• Community leaders should support the school’s
nutrition policy
• The School Health Index (SHI) should be
completed & implemented
School Health Index
Nutrition Intervention for Risk
Reduction
• Model programs
– The National Fruit and Vegetable Program
• Formerly “5 A Day” program
• Public-private partnership of the CDC and other
health organizations
– High 5 Alabama
• Study to evaluate the effectiveness of a school-based
dietary intervention
Public Food and Nutrition
Programs
• Child nutrition programs
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–
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Began in 1946
Provide nutritious meals to all children
Reinforce nutrition education
Require schools to develop a wellness policy
Public Food and Nutrition
Programs
• Financial assistance provided by the federal gov’t
to schools participating in the National School
Lunch Program
– Five requirements
• Lunches based on nutrition standards
• No discrimination between those who can and
cannot pay
• Operate on a non-profit basis
• Programs must be accountable
• Must participate in commodity program
School Breakfast Program
• Authorized in 1966
• States may require schools who serve needy
populations to provide school breakfast
• The NSLP rules apply to the School
Breakfast Program
• Breakfast must provide ¼ the DRI
Other Nutrition Programs
• Summer Food Service Program
– Provides summer meals to areas with >50% of
students from low-income families
• Team Nutrition
– Provides training, technical assistance,
education, or support to promote nutrition in
schools