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Chapter 12 Child and Preadolescent Nutrition 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 – may also be termed “school-age” Introduction • Focuses on growth and development of school-age and pre-adolescent children – Physical, cognitive, emotional, social growth – Growth spurts – Modeling healthy eating and physical activity behaviors Importance of Nutrition • Establishing healthy eating habits helps prevent immediate & long-term health problems • Adequate nutrition associated with improved academic performance Tracking Child and Preadolescent Health • Data on U.S. children in 2010 – Children under 18 were nearly 10% of population – 7.5 million 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. – African American, American Indian, and Hispanic children more likely to live in poverty – Odds of being obese significantly higher for non-Hispanic Black children and Mexican American children 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/growthcharts/cdc_charts.htm 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 6.3 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 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 SchoolAge 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 SchoolAge Children Common Nutrition Problems • Iron deficiency – Less common in children than in toddlers – 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 9 – 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: – Obese = BMI-for-age ≥95th% – Overweight = BMI-for-age from 85th to 95th% (Discuss meaning of “to”) • Obesity more common in Hispanic and non-Hispanic black children and adolescents • 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 most significant 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 2020 objective: – Increase proportion of children who view 2 hours or less of TV per day from 78.9% to 86.8% 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 multicomponent, family-based program consisting of: – Parent training – Dietary counseling/nutrition education – Physical activity/addressing sedentary behaviors – 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 Tolerable Upper Intake levels 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 • Provide plain water or sports drinks to prevent dehydration • Cold water is the best fluid for children • Limit soft drinks because they provide empty calories, displace milk consumption & promote tooth decay • Energy drinks should not be consumed by children Recommended versus Actual Food Intake • Saturated fat—intake is 11% of calories (recommend <7%) • Total fat—intake excessive in Black & Mexican-American girls and Black boys • Caffeine—increasing because of soft drink consumption • Calcium intake falls short of RDA • Fast food—33% of children consume fast food each day Other Considerations • Cross-cultural Considerations – Healthy People 2020-a major goaleliminate health disparities among different segments of the population – Health care professionals 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 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. – Should not include intensive, specialized training 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 Nutrition Integrity in Schools • The SHI (School Health Index) helps: – Identify strengths and weaknesses in health promotion policies and strategies – Develop an action plan – Involve stakeholders (teachers, parents, students, community) in improving school policies and programs School Health Index Public Food and Nutrition Programs • Child nutrition programs – 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 Public Food and Nutrition Programs • The National School Lunch Program (NSLP) Standards: 1. Both fruits and vegetables every day; increasing whole grains 2. Only fat-free or low fat milk 3. Limiting calories based on child’ age 4. Reduce saturated and trans fats, and sodium 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