Chapter 16 infancy, childhood, and adolescence

Vitamins, Minerals, and Water• More than double that of adults • Provided by breast milk or formula • Supplemental water needed if environmental temperature is high • Diarrhea or vomitin

Life Cycle Nutrition: Infancy, Childhood, and Adolescence

Chapter 16

Nutrition During Infancy

• Reflects nutrient intake

• Birth weight changes

• Infant’s length

• Twice that of an adult

Vitamins, Minerals, and Water

• More than double that of adults

• Provided by breast milk or formula

• Supplemental water needed if environmental temperature is high

• Diarrhea or vomiting needs treatment with electrolyte solution

Recommended Intakes for Infant Vs Adult Based on Body

Weight

Practice of Breastfeeding

• Introduction of complementary foods

• Eight to twelve feedings per day for the first few weeks

• Lactose and oligosaccharides

• Essential fatty acids

• Protein differences between breast milk and formula

Percentages of Energy-Yielding Nutrients in Two Diets

Compared

Immunological Protection

• Supplementation

• Most valuable during first year

• Colostrum

• Bifidus factors

• Other protective factors

Allergy and Disease Protection

• More large, well-controlled studies needed

Breast Milk Banks

Special Needs of Preterm Infants

• Incomplete fetal development

• Leading cause of infant deaths

• Often low birth weight infants

• Preterm breast milk differences from term breast milk

Introducing Cow’s Milk

• Gradual transition from breast milk or formula to reduced-fat cow’s milk

• Recommendations changed recently from whole milk to reduced-fat milk

Introducing Solid Foods

Infant Development and Recommended Foods

Age (months) Feeding Skill Appropriate Foods Added to the Diet

0 to 4 Turns head toward any object that brushes cheek.

Initially swallows using back of tongue: gradually begins to swallow

using front of tongue as well.

Strong reflex (extrusion) to push food out during first 2 to 3 months.

Feed breast milk or infant formula.

4 to 6 Extrusion reflex diminishes, and the ability to swallow nonliquid foods develops.

Indicates desire for food by opening mouth and leaning forward.

Indicates satiety or disinterest by turning away and leaning back.

Sits erect with support at 6 months.

Begins chewing action.

Brings hand to mouth.

Grasps objects with palm of hand.

Begin iron-fortified cereal mixed with breast milk, formula, or water.

Begin pureed meats, legumes, vegetables, and fruits.

6 to 8 Able to self-feed finger foods

Develops pincer (finger to thumb) grasp

Begins to drink from cup.

Begin textured vegetables and fruits.

Begin unsweetened, diluted fruit juices from cup.

8 to 10 Begins to hold own bottle.

Reaches for and grabs food and spoon.

Sits unsupported

Begin breads and cereals from table

Begin yogurt Begin pieces of soft, cooked vegetables and fruit from table

Gradually begin finely cut meats, fish, casseroles, cheese, eggs, and mashed legumes.

10 to 12 Begins to master spoon, but still spills some Add variety.

Gradually increase portion sizes a

a Portion sizes for infants and young children are smaller than those for an adult For example, a grain serving might be ½ slice of bread instead of 1 slice, or ¼ cup rice instead of ½ cup

SOURCE: Adapted in part from Committee on Nutrition, American Academy of Pediatrics, Pediatric Nutrition Handbook, 6th ed., ed R E Kleinman (Elk Grove Village, Ill.: American Academy of Pediatrics, 2009), pp 113–142

Choice of Infant Foods

• Breast milk or iron-fortified formula

• Iron-fortified cereals

• Meat and meat alternates

• Fruits and vegetables

• Honey and corn syrup

Vegetarian Diets

• Greater challenge to meet nutrient needs

• Vegan diets

• Well-balanced vegetarian diet

• Cow’s milk

Sample Meal Plan for a

L u n c h ½ grilled cheese sandwich: 1 slice whole-wheat bread with ½ slice cheese

½ c vegetables b (steamed carrots)

Mealtimes with Toddlers

• Discourage unacceptable behavior

• Let toddler explore and enjoy foods

• Don’t force food on children

• Provide nutritious foods

• Limit sweets

• Don’t turn dining table into battleground

Body Shape Changes

• Height and weight

Appetite and Energy Intake

• Food intakes coincide with growth patterns

• Energy needs vary widely

• Growth and physical activity

• Difficulty meeting energy needs

Fat, Fiber, and Carbohydrate Recommendations

• Recommendations the same for children and adults

• Fiber recommendations

• DRI Committee recommendation

Protein and Vitamin Recommendations

• Nitrogen balance

• Quality of protein

• Added needs of growth

• Needs increase with age

• Iron and vitamin D

• Supplements

Planning Children’s Meals

• Amounts suited to appetite and needs

• Greater variety of nutrient-dense vegetables and fruits needed

• Inadequate intakes of vitamins and minerals

• Excessive sodium

Recommended Daily Amounts from Each Food Group

Food Group 1000 kcal 1200 kcal 1400 kcal 1600 kcal 1800 kcal Fruits 1 c 1 c 1½ c 1½ c 1½ c

Vegetables 1 c 1½ c 1½ c 2 c 2½ c

Grains 3 o z 4 oz 5 oz 5 oz 6 o z

Protein foods 2 o z 3 oz 4 oz 5 oz 5 oz

Milk 2 c 2½ c 2½ c 3 c 3 c

Hunger and Malnutrition in Children

• Greater risk of hunger and malnutrition

• Benefits of breakfast consumption

• Behavior, attention span, and learning ability

• Testing for iron status

The Malnutrition-Lead Connection

• Calcium, zinc, vitamins C and D, and iron

Hyperactivity and “Hyper” Behavior

Food Allergy

• Tend to diminish with age

• Immunologic response to food

• Reaction may be immediate or delayed

• Testing for antibodies

• Treatment

Anaphylactic Shock

• Eight most common allergy-causing foods

• Possible new technological solutions

• Reactions to chemicals in foods

• Symptoms without antibody production

Trends in Childhood Obesity

BMI-for-Age Percentiles: Boys and Girls, Age 2 to 20

Obesity and Growth

• Begin puberty earlier

• Stop growing at a shorter height than peers

• Greater bone and muscle mass

• Blood lipid profile

• Type 2 diabetes and respiratory diseases

• Emotional and social problems

Prevention and Treatment of Childhood Obesity

• Improve long-term physical health through permanent healthy lifestyle habits

• Successful approaches are multi-dimensional

• Maintain weight as child grows taller

• Focus on physical activity

Recommended Behaviors to Prevent Obesity

TABLE 16-7 Recommended Eating and Physical Activity Behaviors to Prevent Obesity

The Expert Committee of the American Medical Association recommends the following healthy habits for children 2 to 18 years of age to help prevent childhood obesity:

• Limit consumption of sugar-sweetened beverages, such as soft drinks and fruit-flavored punches.

• Eat the recommended amounts of fruits and vegetables every day (2 to 4.5 cups per day based on age).

• Learn to eat age-appropriate portions of foods.

• Eat foods low in energy density such as those high in fiber and/or water and modest in fat.

• Eat a nutritious breakfast every day.

• Eat a diet rich in calcium.

• Eat a diet balanced in recommended proportions for carbohydrate, fat, and protein.

• Eat a diet high in fiber.

• Eat together as a family as often as possible.

• Limit the frequency of restaurant meals.

• Limit television watching or other screen time to no more than 2 hours per day and do not have televisions or computers in bedrooms.

• Engage in at least 60 minutes of moderate to vigorous physical activity every day.

SOURCE: S E Barlow, Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report, Pediatrics 120

(2007): S164–S192

Mealtimes at Home

• Teach consumer skills

• Make mealtimes fun

• Help plan and prepare meals

• How much and whether to eat the food

Recommended Mealtime Behaviors

• Limit access to concentrated sweets

Dental Considerations

• Behaviors to encourage

• Physical and emotional growth

Nutrition at School

• School Breakfast Program

• National School Lunch Program

• Nutritional adequacy – 1/3 of recommended intakes

• Dietary Guidelines for Americans

Competing Influences at School

• Wellness policies established locally

Nutrition During Adolescence

• Timing of males versus females

Energy and Nutrient Needs

During Adolescence

• Can vary greatly

• Factors influencing energy needs

• Differences between girls and boys

• RDAs or AIs for most vitamins increase

• Vitamin D deficiencies

Calcium and Iron Needs

• Differences between boys and girls

• Growth spurt

• Peak bone mass

• Teenage girls most vulnerable

Childhood Obesity and Early Development of Chronic

Diseases

Highlight 16

Early Development of Type 2 Diabetes

• Obese

• Sedentary

• Family history of diabetes

Physiological Changes

• Reducing amount of glucose entering cells

• Promotes early development of cardiovascular disease (CVD)

• Depends on weight management

Early Development of Heart Disease

• Disease process begins much earlier

• Progressive thickening with plaque

• Is not inevitable

The Formation of Plaques in Atherosclerosis

Blood Cholesterol

• LDL increases

• HDL decreases

• Early atherosclerotic lesions are reversible

Blood Pressure

• Age, gender, and height

Dietary Recommendations for Children

• Balance meals

• Avoid extremes

• Most adult smokers began before age 18

• Shortness of breath

• Bad breath